EFTA00224262
Dataset 9 · 177 pages · 25.8 MB · 73,971 words
This file has been modified on the DOJ website (-107,868 bytes). View all modifications
Extracted Images (177) #
Extracted Text #
2008 NOT-FOR-PROFIT CORPORATION REINSTATEMENT FILED
Nov 03, 2008
DOCUMENT# 1496000002084 Secretary of State
Entity Name: THE KONI FOUNDATION, INC.
Current Principal Place of Business: New Principal Place of Business:
1 CLEARLAKE CENTER, #1402
250 AUSTRALIAN AVENUE
WEST PALM BEACH, FL 33401
Current Mailing Address: New Mailing Address:
3265 IMLVD
OCEA , 11572
FEI Number Applied For ( ) Fe Number Not Applicable ( ) Certificate of Status Naked ( )
FEI Number: 654670182
In accordance with s. 607.193(2)(b), F.S., the corporation did not receive the prior notice.
Name and Address of Current Registered Agent: Name and Address of New Registered Agent:
agent, or both,
The above named entity submits this statement for the purpose of changing its registered office or registered
in the State of Florida.
SIGNATURE: HOWARD SIEGEL
Electronic Signature of Registered Agent Date
OFFICERS AND DIRECTORS: ADDITIONS/CHANGES TO OFFICERS AND DIRECTORS:
title: ( ) Delete ( ) Change ( )Addtlen
Name:
Address:
City-St-Zip:
Title: D ( ) Delete ( ) Change ( ) Addition
Name: KAPNER. LEWIS Name:
Address:
City-St-Zip:
Title: ( ) Change ( ) Addllon
Name: WIENER. HOWARD Name:
Address:
City-St-Zip:
I hereby certify that the information supplied with this filing does not qualify for the exemption stated isin Chapter 119,
true and accurate and that
Florida Statutes. I further certify that the information indicated on this report or supplemental reportor director
my electronic signature shall have the same legal effect as if made under oath; that I am an officer of the corporation or
the receiver or trustee empowered to execute this report as required by Chapter 617, Florida Statutes; and that my name appears
above, or on an attachment with an address, with all other like empowered.
SIGNATURE: HOWARD SIEGEL D 11/03/2008
Electronic Signature of Signing Officer or Director Date
EXHIBI'l' 83
EFTA00224262
www.sunbiz.org - Department of State Page 1 of 2
FLORIDA DEPARTMENT OF STATE
DIVISION OF CORPORATIONS
Home Contact Us E-Fillng Services Document Searches Forms Help
Previous on List NV0 OILlaist Beffirrae
gyents No Name History Entity Name Search
Detail by Entity Name
Florida Non Profit Corporation
THE KONI FOUNDATION, INC.
Filing Information
Document Number N96000002084
FEI Number 650676162
Date Filed 04/18/1996
State FL
Status ACTIVE
Effective Date 05/01/1996
Last Event CANCEL ADM DISS/REV
Event Date Filed 11/03/2008
Event Effective Date NONE
Principal Address
1 CLEARLAKE CENTER, #1402
250 AUSTRALIAN AVENUE
WEST PALM BEACH FL 33401
Changed 03/26/2002
Mailing Address
3265 BLVD
OCEANSIDE Y 11572
Changed 09/05/2006
Registered Agent Name & Address
SIEGEL, HOWARD
Name Changed: 06/03/2005
Address Changed: 06/03/2005
Officer/Director Detail
Name & Address
Title D
SIEG RD
http://www.sunbiz.org/seripts/cordetexe?action=DETFIL8cing_doc_number=N96000002084&i... 12/12/2008
EFTA00224263
Page 2 of 2
www.sunbiz.org - Department of State
Title D
KAPNER, LEWIS
250 AUSTRALIAN AVENUE
WEST PALM BEACH FL 33401
Title D
WIENER, HOWARD
777 S FLAGER DR WEST TWR STE 1601
WEST PALM BEACH FL 33401
Annual Reports
Report Year Filed Date
2006 09105/2006
2007 10/16/2007
2008 1110312008
Document Images
BENSTA:TEMENT View Image in PDF format.
11148/2098
10/16/2007 - REIN_STATEMENI View Image in PDF format
View Image in PDF format
osion000._-_ARRUAL REPORT.
View Image In PDF forMat
.0.6.10.3/2_09.5_::ANNU4 REPORT
View Image in PDF format,
OP/5/2001j - ANNUAL REPORT
View image In PDF format
05/02/2003 - ANNUAL REPORT.
View image in PDF format
03/26/2902r, ANNUM, REPORT
View image In PDF format
07/Q6/2091 -ANNUAL REPORT
View image in PDF format
0A/.22/2901,rOEBITTVIEMQ
View image in PDF format
gwo909.1 7.DEart.mcm
View image in PDF format
iv2.1/2Q0.0.7-. ANNUAL. REPORT_
997_ View image In PDF format
04/18/1998 -_DOCUMENTS_ PRIOR:lc:0
Note: This is not official record. See docum
ents if question or conflict.
Eretome_on_Liet Next on List Retsimlo_List
No Name History Entity Name Search
Events
s Forms Help
Home Contact us Document Searches E-Filing Service
Copyright and Privacy Policies
Copyright Ci 2007 State of Florida, Department of State.
ETFIL8cinq _doe_number—N96000002084&i... 12/12/2008
httpt://www.sunbiz.org/scripts/cordet.exe?action=D
EFTA00224264
TEMENT FILED
2007 NOT-FOR-PROFIT CORPORATION REINSTA Oct 16, 2007
Secretary of State
D0CUMENT# N96000002084
Entity Name: THE KONI FOUNDATION, INC.
New Principal Place of Business:
Current Principal Place of Business:
1 CLEARLAKE CENTER, #1402
MOM New Mailing Address:
FEI Number Not Applicable ( ) Certificate of Status Desired (X)
FEI Number: 654)076162 FEI Number Applied For ( ) notice.
did receive the prior
In accordance with s. 607.193(2)(bl, F.S., the corporation not
of Curre nt Regist ered Agent : Name and Address of New Registered Agent:
Name and Address
e of changing its registered office or registered agent, or both,
The above named entity submits this statement for the purpos
In the State of Florida.
SIGNATURE: HOWARD SIEGEL Date
Electronic Signature of Registered Agent
:
ADDITIONSICHANGES TO OFFICERS AND DIRECTORS
OFFICERS AND DIRECTORS:
Title: ( ) Change ( ) Addition
Title: D ( ) Delete
O D Mime:
Name: SIEGE Address:
City-St-Zip:
( ) Change ( ) Addition
Title: D ( ) Delete
Name:
KAPNER. LEWIS Address:
City-St-Zip:
Tide: ( ) Change ( ) Addition
Title: ( ) Delete
WIENER, HOWARD Name:
N31110:
Address:
Cily-SI-Lp:
r 119,
filing does not qualify for the exemption stated in Chapte
I hereby certify that the information supplied with thisindicat and accurate and that
ed on this report or supple menta l report is true
Florida Statutes. I further certify that the information as if made under oath; that I am an officer or directo r of the corporation or
my electronic signature shall have the same legal effect as required by Chapter 617, Florida Statutes; and that my name appears
the receiver or trustee empowered to execute this report other like empowered.
above, or on an attachment with an address, with all
DIR 10116!2007
SIGNATURE: STEVEN KAPLANSKY Date
Electronic Signature of Signing Officer or Director
EFTA00224265
Page 1 of 3
Comprehensive Business Report
is sometimes
le data sources used on reports have errors. Data
Important: The Public Records and commercially availabfree from defect. This system should not be relied upon as
not
entered poorly, processed Incorrectly and Is generally Secretary of
system supplies, it should be independently verified. For
definitively accurate. Before retying on any data this s only and Is not an official record. Certifie d copies may be
tion purpose
State documents, the following data Is for informa
obtained from that individual state's Department of Slate.
ment or Government Agencies
Your DPPA Permissible Use: Court, Law Enforce
GLBA Permis sible Use: Law Enforce ment Purposes
Your
Comprehensive Business Report
Date: 12/09/08
Company Information:
Name Variations:
Company Name: THE C.O.U.O. FOUNDATION, INC.
Phone Variations:
(None Found]
Parent Company:
Name: THE K FOUNDATION INC.
3723
Address: 3265Mir BLVD, OCEANSIDE NY 11572-
Comprehensive Business Report Summary: (Click on
Link to see detail)
Industry Information:
None Found
Company ID Numbers:
1 Found
Bankruptcies:
None Found
Liens and Judgments:
None Found
Corporation Filings:
1 Found
Registered Agents:
None Found
Business Registration:
None Found
UCC Filings for Business:
None Found
Associated Businesses:
1 Found
Business Contacts:
None Found
Motor Vehicles:
None Found
Properties:
None Found
FAA Aircraft:
None Found
Watercraft:
None Found
Internet Domain Names Registered to Business:
None Found
IRS 5500:
12/9/2008
https://secure.aceurint.com/app/bps/report
EFTA00224266
Page 2 of 3
Comprehensive Business Report
None Found
Executives:
None Found
Business Filings:
Industry Information:
[None Found)
Company ID Numbers:
State of Origin: FL
Charter Number: F08000003048
Bankruptcies:
(None Foundl
Liens & Judgments:
[None Found)
Corporation Filings:
Corporation Filings # 1
THE C.O.U.Q. FOUNDATION, INC. - As of: 10/1612008
Name Type: LEGAL
BEACH FL 33401-5016
Address: 250 S AUSTRALIAN AVE STE 1404, WEST PALM
Address Type: MAILIN G
Status: ACTIVE
Business Type: FOREIGN NON PROFIT
Foreign Incorporation Date: 0710912008
Registered Agent: C T CORPORATION SYSTEM
Registered Agent Address: PLANTATION, FL 33324
Place Incorporation: DELAWARE
THE C.O.U.Q. FOUNDATION, INC. - As of: 0711112008
Name Type: LEGAL
PALM BEACH FL 33401.5016
Address: 260 S AUSTRALIAN AVE STE 1404, WEST
Address Type: MAILING
Status: ACTIVE
Business Type: FOREIGN NON PROFIT
Foreign Incorporation Date: 07109/2008
Registered Agent: C T CORPORATION SYSTEM
Registered Agent Address: PLANTATION, FL 33324
Place Incorporation: DELAWARE
Officers and Directors:
THE C.O.U.Q. FOUNDATION, INC. - As of: 10/16/2008
QTRS STE B3, ST THOMAS VI 00802-1348
Officer: JEFFREY E EPSTEIN DP 6100 RED HOOK
Officer: DARRE N K INDYK E,
Officer RICHARD KAHN, DI
Registered Agents:
[None Found]
Business Registration:
[None Found]
UCC Filings for Business:
[None Found]
Associated Businesses:
Name: THE KONI FOUNDATION, INC.
PALM BCH FL 33401-5015
Address: 250 S AUSTRALIAN AVE STE 1402, WEST
Associated People:
Business Contacts:
12/9/2008
haps://secumaccurint.com/app/bps/report
EFTA00224267
Page 3 of 3
Comprehensive Business Report
[None Found]
Assets:
Motor Vehicles:
[None Found)
Properties:
[None Found]
FAA Aircraft:
[None Found)
Watercraft:
[None Found]
Internet Domain Names Registered to Business:
[None Found]
IRS 5500
[None Found]
Executives:
(None Found]
12/9/2008
https://secure.accurint.com/app/bps/report
EFTA00224268
Page 1 of 3
Comprehensive Business Report
sometimes
le data sources used on reports have errors. Data Is
Important: The Public Records and commercially availab defect. This system should not be relied upon as
not free from
entered poorly, processed Incorrectly and is generally supplie s, it should bo independently verified. For Secretary of
definitively accurate. Before relying on any data this system be
s only and is not an official record. Certified copies may
State documents, the following data is for information purpose
obtained from that individual state's Department of State.
or Government Agencies
Your DPPA Permissible Use: Court, Law Enforcement
Enforce ment Purpos es
Your GLBA Permissible Use: Law
Comprehensive Business Report
Date: 12/09/08
Company Information:
Company Name: THE C.O.U.Q. FOUNDATION, INC.
Address: 110 E 59TH ST, NEW YORK NY 10022-1304
Name Variations:
Company Name: THE C.O.U.Q. FOUNDATION. INC.
Address Variations:
Address: 110 E 59TH ST, NEW YORK NY 10022
County: NEW YORK
Msa Description: New York, NY
Phone Variations:
[None Found)
Comprehensive Business Report Summary: (Click on
Link to see detail)
Industry Information:
None Found
Company ID Numbers:
1 Found
Bankruptcies:
None Found
Liens and Judgments:
None Found
Corporation Filings:
1 Found
Registered Agents:
None Found
Business Registration:
None Found
UCC Filings for Business:
None Found
Associated Businesses:
None Found
Business Contacts:
None Found
Motor Vehicles:
None Found
Properties:
None Found
FAA Aircrafts:
None Found
Watercrafts:
None Found
Internet Domain Names Registered to Business:
None Found
IRS 5500:
None Found
Executives:
None Found
Business Filings:
12/9/2008
https://secure.accurint.conilapp/bps/report
EFTA00224269
Page 2 of 3
Comprehensive Business Report
Industry Information:
[None Found)
Company ID Numbers:
State of Origin: NY
Charter Number: 2360817
Bankruptcies:
[None Found)
Liens & Judgments:
[None Found]
Corporation Filings:
Corporation Filings fi 1
THE C.O.U.Q. FOUNDATION, INC. - As of: 1012212008
Name Type: LEGAL
Address: 110 E 59TH ST, NEW YORK NY 10022-1304
Address Type: PROCESS ADDRESS
BE DETERMINED BY PERFORMING A SEARCH IN
Status: ACTIVE - GOOD STANDING STATUS CAN ONLY CORPO RATION RECORDS AND THE DEPARTMENT OF
THE RECORDS OF BOTH THE DEPAR TMENT OF STATE
TAX AND FINANCE
Business Type: FOREIGN NOT FOR PROFIT
Filing Date: 0312611999
Date Incorporated: 03/26/1999
Foreign Incorporation Date: 03/16/1998
Term: PERPETUAL
Type: EFFECTIVE DATE
Place Incorporation: DELAWARE
THE C.O.U.Q. FOUNDATION, INC. - As of: 07/2312008
Name Type: LEGAL
Address: 110 E 59TH ST, NEW YORK NY 10022-1304
Address Type: PROCESS ADDRESS
BE DETERMINED BY PERFORMING A SEARCH IN
Status: ACTIVE - GOOD STANDING STATUS CAN ONLY RATION RECORDS AND THE DEPARTMENT OF
CORPO
THE RECORDS OF BOTH THE DEPARTMENT OF STATE
TAX AND FINANCE
Business Type: FOREIGN NOT FOR PROFIT
Filing Date: 03/26/1999
Date Incorporated: 03/26/1999
Foreign Incorporation Date: 0311611998
Term: PERPETUAL
Type: EFFECTIVE DATE
Place Incorporation: DELAWARE
THE C.O.U.Q. FOUNDATION, INC. - As of: 0412112008
Name Type: LEGAL
Address: 110 E 59TH ST, NEW YORK NY 10022.1304
Address Type: PROCESS ADDRESS
BE DETERMINED BY PERFORMING A SEARCH IN
Status: ACTIVE - GOOD STANDING STATUS CAN ONLY RATION RECORDS AND THE DEPARTMENT OF
DEPAR TMENT OF STATE CORPO
THE RECORDS OF BOTH THE
TAX AND FINANCE
Business Type: FOREIGN NOT FOR PROFIT
Filing Date: 03/26/1999
Date Incorporated: 0312611999
Foreign Incorporation Date: 0311611998
Term: PERPETUAL
Type: EFFECTIVE DATE
Annual Report Filings:
Status: MICROFILM NBR: 990326000255
Filed Date: 03126/1999
Status: MICROFILM_NBR :990326000255
Filed Date: 03/26/1999
Microfilm Number: 9903260002
Status: MICROFILM_NBR :990326000255
Filed Date: 03/2611999
12/9/2008
httos://secure.accurint.com/aon/bos/renort
EFTA00224270
Page 3 of 3
Comprehensive Business Report
Microfilm Number. 9903260002
Registered Agents:
(None Found)
Business Registration:
[None Found)
UCC Filings for Business:
[None Found)
Associated Businesses:
[None Found)
Associated People:
Business Contacts:
Nona Found)
Assets:
Motor Vehicles:
[None Found]
Properties:
[Norte Found)
FAA Aircraft:
[None Found)
Watercraft:
[None Found)
Internet Domain Names Registered to Business:
[None Found)
IRS 5500
[None Found)
Executives:
[None Found)
12/9/2008
https://secure.accurint.com/apo/bps/reoort
EFTA00224271
Page 1 of 7
Comprehensive Business Report
is sometimes
available data sources used on reports have errors. Data
Important: The Public Records and commercially from defect. This system should not be relied upon as
genera lly not free
entered poorly, processed Incorrectly and is supplies, it should be independently verified. For Secreta
ry of
definitively accurate. Before relying on any data this system s only and is not an official record. Certified copies may be
purpose
State documents, the following data Is for Information
obtained from that individual state's Department of State.
ment or Government Agencies
Your DPPA Permissible Use: Court, Law Enforce
sible Use: Law Enforce ment Purpos es
Your GLBA Permis
Comprehensive Business Report
Date: 12/09108
Company Information:
Company Nam NI FOUNDATION INC.
3723
Address: 3265E...BLVD, OCEANSIDE NY 11572-
Name Variations:
Company Name: NICOLAUS KONI FOUNDATION
Company Name: THE C.O.U.CI FOUNDATION, INC.
Company Name: THE KONI FOUNDATION, INC.
Address Variations: FL 33401
Address: 250 S AUSTRALIAN AVE, WEST PALM BEACH
County: PALM BEACH
Msa Description: West Palm Beach-Boa Raton, FL
FL 33401
Address: 250 S AUSTRALIAN AVE 1402, WEST PALM BCH
County: PALM BEACH
Msa Description: West Palm Beach-Boca Raton, FL
BCH FL 33401
Address: 250 S AUSTRALIAN AVE 1404, WEST PALM
County: PALM BEACH
Msa Description: West Palm Beach-Boca Raton, FL
Address: 3265 BLVD, OCEANSIDE NY 11572
County: NASSAU
Msa Description: Nassau-Suffolk, NY
Phone Variations:
Phone: 516-241-1521
Comprehensive Business Report Summary: (Click on
Link to see detail)
Industry Information:
None Found
Company ID Numbers:
1 Found
Bankruptcies:
None Found
Liens and Judgments:
None Found
Corporation Filings:
3 Found
Registered Agents:
1 Found
Business Registration:
1 Found
UCC Filings for Business:
None Found
Associated Businesses:
23 Found
Business Contacts:
6 Found
Motor Vehicles:
None Found
12/9/2008
https://secure.accurint.com/app/bps/report
EFTA00224272
Page 2 of 7
Comprehensive Business Report
Properties:
None Found
FAA Aircrafts:
None Found
Watercrafts:
None Found
Internet Domain Names Registered to Business:
2 Found
IRS 5500:
None Found
Executives:
4 Found
Business Filings:
Industry Information:
(None Found)
Company ID Numbers:
State of Origin: FL
Charter Number: F08000003048
State of Origin: FL
Charter Number: N96000002084
Slate of Origin: NY
Charter Number: 2821493
Bankruptcies:
(None Found)
Liens & Judgments:
(None Found]
Corporation Filings:
Corporation Filings # 1
THE KONI FOUNDATION INC. - As of: 1012212008
Name Type: L
Address: 3265 BLVD, OCEANSIDE NY 11572-3723
Address Type: PROCESS ADDRESS IN
BE DETERMINED BY PERFORMING A SEARCH
Status: ACTIVE - GOOD STANDING STATUS CAN ONLY RATION RECOR DS AND THE DEPARTMENT OF
OF STATE CORPO
THE RECORDS OF BOTH THE DEPARTMENT
TAX AND FINANCE
Business Type: FOREIGN NOT FOR PROFIT
Filing Date: 1011012002
Date Incorporated: 1011012002
Foreign Incorporation Date: 04/1811996
Term: PERPETUAL
Type: EFFECTIVE DATE
Place Incorporation: FLORIDA
THE KONI FOUNDATION INC. - As of: 0712312008
Name Type: L
Address: 32651. BLVD, OCEANSIDE NY 11572-3723
Address Type: PROCESS ADDRESS
BE DETERMINED BY PERFORMING A SEARCH IN
Status: ACTIVE -GOOD STANDING STATUS CAN ONLY TMENT OF
OF STATE CORPORATION RECORDS AND THE DEPAR
THE RECORDS OF BOTH THE DEPARTMENT
TAX AND FINANCE
Business Type: FOREIGN NOT FOR PROFIT
Filing Date: 1011012002
Date Incorporated: 1011012002
Foreign Incorporation Date: 0411811996
Term: PERPETUAL
Type: EFFECTIVE DATE
Place Incorporation: FLORIDA
THE KONI FOUNDATION INC, - As of: 0412112008
Name Type: L
Address: 3265 BLVD, OCEANSIDE NY 11572-3723
Address Type: PROCE SS ADDRESS
BE DETERMINED BY PERFORMING A SEARCH IN
Status: ACTIVE - GOOD STANDING STATUS CAN ONLY
12/9/2008
Intos://secure.accurint.com/aptilbos/renort
EFTA00224273
Comprehensive Business Report Page 3 of 7
AND THE DEPARTMENT OF
THE RECORDS OF BOTH THE DEPARTMENT OF STATE CORPORATION RECORDS
TAX AND FINANCE
Business Type: FOREIGN NOT FOR PROFIT
Filing Date: 1011012002
Date Incorporated: 1011012002
Foreign Incorporation Date: 0411811996
Term: PERPETUAL
Type: EFFECTIVE DATE
Annual Report Filings:
Status: MICROFILM NBR: 021010000338
Filed Date: 1011012002
Status: MICROFILM_NBR :021010000338
Filed Date: 10/10/2002
Microfilm Number 0210100003
Status: MICROFILM_NBR :021010000338
Filed Date: 1011012002
Microfilm Number: 0210100003
Corporation Filings N 2
THE C.O.U.Q. FOUNDATION, INC. - As of: 10/1612008
Name Type: LEGAL
Address: 250 S AUSTRALIAN AVE STE 1404, WEST PALM BEACH FL 33401.5016
Address Type: MAILING
Status: ACTIVE
Business Type: FOREIGN NON PROFIT
Foreign Incorporation Date: 07/0912008
Registered Agent: C T CORPORATION SYSTEM
Registered Agent Address: PLANTATION, FL 33324
Place Incorporation: DELAWARE
THE C.O.U.Q. FOUNDATION, INC. - As of: 07/1112008
Name Type: LEGAL
Address: 250 S AUSTRALIAN AVE STE 1404, WEST PALM BEACH FL 33401.5016
Address Type: MAILING
Status: ACTIVE
Business Type: FOREIGN NON PROFIT
Foreign Incorporation Date: 07/0912008
Registered Agent: C T CORPORATION SYSTEM
Registered Agent Address: PLANTATION, FL 33324
Place Incorporation: DELAWARE
Officers and Directors:
THE C.O.U.Q. FOUNDATION, INC. - As of: 10/16/2008
Officer: JEFFREY E EPSTEIN, DP, 6100 RED HOOK QTRS STE B3, ST THOMAS VI 00802-1348
Officer. DARREN K INDYKE, DV
Officer: RICHARD KAHN, DIREC
Corporation Filings 0 3
THE KONI FOUNDATION, INC. - As of: 10/16/2008
Name Typo: LEE
Address: 23
Address
Status: INACTIVE
Business Type: DOMESTIC NON PROFIT
Date Incorporated: 05/01/1996
Registered Agent: SIEGEL HOWARD
Registered Agent Address: WEST PALM BEACH, FL 33401
FEIN: 85-0676162
Place Incorporation: FL
THE KONI FOUNDATION, INC. - As of: 07118/2008
Name Type:
Address: 32
Address Ty
Status: ACTIVE
Business Type: DOMESTIC NON PROFIT
Date Incorporated: 05/01/1996
Registered Agent: SIEGEL HOWARD
Registered Agent Address: WEST PALM BEACH, FL 33401
FEIN: 65.0676162
httns://secure.accurint.com/aon/bns/renort 12/9/2008
EFTA00224274
Comprehensive Business Report Page 4 of 7
Place Incorporation: FL
THE KONI FOUNDATION, INC. - As of: 03131/2008
Name Typ
Address: 3
Address T
Status: ACTIVE
Business Type: DOMESTIC NON PROFIT
Date Incorporated: 0510111996
Registered Agent: SIEGEL HOWARD
Registered Agent Address: 250 S AUSTRALIAN AVE STE 1402, WEST PALM BEACH FL 33401.5015
FEIN: 65-0676162
Place Incorporation: FL
Officers and Directors:
THE KONI FOUNDATION, I 08
Officer. LEWIS KAPNER, DI
Officer. HOWARD SIEGEL,
Officer: HOWARD WIENER,
Officer: LEWIS KAPNER, DI
Officer: HOWARD SIEGEL,
Officer: HOWARD WIENER,
Officer: HOWARD WIENER,
Officer LEWIS KAPNER, D
Officer: HOWARD SIEGEL,
Officer: HOWARD WIENER,
Annual Report Filings:
Filing Year. 2007
Fled Date: 1011612007
Filing Year: 2006
Filed Date: 0910512006
Filing Year 2005
Filed Dale: 0610312005
Filing Year: 2005
Filed Date: 0610312005
Filing Year 2004
Filed Date: 0810512004
Filing Year: 2003
Filed Date: 05102/2003
Filing Year: 2002
Status: 2002
Filed Date: 0312612002
Filing Year 2001
Status: 2001 •
Filed Date: 07106/2001
Events:
Date: 0912612008
Event: ADMIN DISSOLUTION FOR ANNUAL REPORT
Dale: 10/16/2007
Event CANCEL ADM DISSIREV
Date: 0911412007
Event: ADMIN DISSOLUTION FOR ANNUAL REPORT
Date: 12/2112000
Event REINSTATEMENT
Date: 0912611997
Event: ADMIN DISSOLUTION FOR ANNUAL REPORT
Registered Agents:
Name: SIEGEL HOWARD
Address: 250 S AUSTRALIAN AVE STE 1402, WEST PALM BCH FL 33401.5015
Date Last Seen: 3131/2008
httns://secure.accurint.com/aon/bos/renort 12/9/2008
EFTA00224275
Comprehensive Business Report Page 5 of 1
Business Registration:
Name: THE KONI FO INC
Mailing Address: 3
Filing Number: 021
Corporation Code: S
Expiration Date: 10/30f2003
UCC Filings for Business:
(None Found)
Associated Businesses:
Name: ADD-O5 • : • • RTIES LLC CO
Address
Name: A
Address
ICAL ALERT CORP
ICAL ALERT CORP.
BLVD, OCEANSIDE NY 11572-3723
ICONNECT ACQUISITION CORP
BLVD, OCEANSIDE NY 11572-3723
Name: ANS CTICUT ACQUISITION CORP.
Address: 3265 BLVD, OCEANSIDE NY 11572-3723
Name: BASE PzingWIES LLC
Address: 3265 BLVD, OCEANSIDE NY 11572.3723
Name: DO IT F ISES INC
Address: 3265 BLVD, OCEANSIDE NY 11572-3723
Name: H C I A N CORP
Address: 3265 BLVD, OCEANSIDE NY 11572-3723
Name: HC IA NS CORP
Address: 3265 BLVD, OCEANSIDE NY 11572.3723
Name: HCI ACaLialalQN CORP
Address: 3265 BLVD, OCEANSIDE NY 11572.3723
Name: HEALTUaalt
Address: 3265 BLVD, OCEANSIDE NY 11572-3723
Name: HOWAIIIALUGEL
Address: 3265 BLVD, OCEANSIDE NY 11572.3723
Name: LIVE M MERICA ACQUISITION CORP.
Address: 3265 BLVD, OCEANSIDE NY 11572-3723
Name: MD ONcial UISITION CORP.
Address: 3265 BLVD, OCEANSIDE NY 11572.3723
Name: NEW FOCUS SPORTSWEAR INC, A CORPORATION
Address: OCEANSIDE, NY
Name: NM CA R, INC.
Address: 3265 BLVD, OCEANSIDE NY 11572-3723
Name: NOR ANSWERING SERVICE, INC.
Address: 3265 BLVD, OCEANSIDE NY 11572-3723
Name: SAFE
Address: 3265 BLVD, OCEANSIDE NY 11572.3723
Name: SAFECQLWir PARTNER, INC.
Address: 3265 BLVD. OCEANSIDE NY 11572-3723
littps://secure.accurint.com/app/bpskeport 12/9/2008
EFTA00224276
Page 6 of 7
Comprehensive Business Report
Name: SIEGE DM
Address: 3261 BLVD, OCEANSIDE NY 11572.3723
Name: THE KONI FOUNDATION, INC.
PALM BCH FL 33401.5015
Address: 250 S AUSTRALIAN AVE STE 1402, WEST
Name: TRIPS , INC.
Address: 326 BLVD, OCEANSIDE NY 11572-3723
Associated People:
Business Contacts:
Name: JOHNSON JAMES
Contact Tale • DOMAIN TECHNICAL CONTACT
Address: 2
Date Last Seen: 41112002
Name: ALLISON KAPNER
Contact Title -
Address: 250 S
Dale Last Seen: 611312002
Name: LEWIS KAPNER
SSN: xxx-xx-xxxx
Contact Title - DIRECTOR , DIRECTOR
Address: 250
Date Last Seega
Name: HOWARD SIEGEL
Contact Title - R , DIRECTOR PROCESS ADDRESS CONTACT
Address: 326 BLVD, OCEANSIDE NY 11572-3723
Date Last Seen: 7/1812008
Name: HOWARD WIENER
Contact Ti
Address:
Date Last en:
Name: HOWARD WIENER
Contact Title • D
Address: 1551
Date Last Seen:
Assets:
Motor Vehicles:
(None Found)
Properties:
[None Found]
FAA Aircraft:
(None Found)
Watercraft:
(None Found)
Internet Domain Names Registere d to Business:
that name)
(Click name to go to Web site associated with
KONIFOUNDATION.COM
NICHOLASKONI.COM
IRS 5500
(None Found]
•
12/9/2008
https://secure.accurint.com/app/bps/report
EFTA00224277
Page 7 of 7
Comprehensive Business Report
Executives:
Name: HOWARD SIEGEL
Contact Title - DIRECTOR , DIRECTOR
Date Last Seen: 711812008
Name: HOWARD WIENER
Contact Title - DIRECTOR , DIRECTOR
Date Last Seen: 711812008
Name: LEWIS KAPNER
Contact Title - DIRECTOR , DIRECTOR
Date Last Seen: 7/18/2008
Name: HOWARD WIENER
Contact Title - DIRECTOR
Date Last Seen: 312002
12/9/2008
https://secure.accurint.com/app/bps/report
EFTA00224278
Page 1 of 3
Comprehensive Business Report
Data is sometimes
available data sources used on reports have errors.
Important: The Public Records and commercially free from defect. This system should not be retied upon as
general ly not
entered poorly, processed incorrectly and is supplies, it should be independently verified. For
Secretary of
definitively accurate. Before relying on any data this system s only arid Is not an official record. Certified copies may be
purpose
State documents, the following data is for information
obtained from that individual state's Department of State.
or Government Agencies
Your DPPA Permissible Use: Court, Law Enforcement
Permis sible Use: Law Enforce ment Purpos es
Your GLBA
Comprehensive Business Report
Date: 12/09/08
Company Information:
Company Name: FLORIDA SCIENCE FOUNDATION
FL 33401-5018
Address: 250 S AUSTRALIAN AVE, WEST PALM BCH
Phone: 581-366.0084
Name Variations: INC.
Company Name: THE FLORIDA SCIENCE FOUNDATION,
Address Variations: BCH FL 33401
Address: 250 S AUSTRALIAN AVE, WEST PALM
County: PALM BEACH
Msa Description: West Palm Beach-Boca Raton, FL
BCH FL 33401
Address: 250 S AUSTRALIAN AVE 1400, WEST PALM
County: PALM BEACH
Msa Description: West Palm Beach-Boca Raton, FL
Phone Variations:
Phone: 561-366.0084
Comprehensive Business Report Summary: (Click
on Link to see detail)
Industry Information:
None Found
Company ID Numbers:
1Found
Bankruptcies:
None Found
Liens and Judgments:
None Found
Corporation Filings:
1Found
Registered Agents:
None Found
Business Registration:
1 Found
UCC Filings for Business:
None Found
Associated Businesses:
None Found
Business Contacts:
None Found
Motor Vehicles:
None Found
Properties:
None Found
FAA Aircrafts:
None Found
Watercrafts:
None Found
Internet Domain Names Registered to Business:
None Found
IRS 5500:
12/9/2008
https://secure.accuritmeom/app/bps/report
EFTA00224279
Comprehensive Business Report Page 2 of 3
None Found
Executives:
None Found
Business Filings:
Industry Information:
[None Found]
Company ID Numbers:
State of Origin: FL
Charter Number: N07000010684
Bankruptcies:
[None Found[
Liens & Judgments:
[None Found]
Corporation Filings:
Corporation Filings # 1
THE FLORIDA SCIENCE FOUNDATION, INC. - As of: 1011612008
Name Type: LEGAL
Address: 250 S AUSTRALIAN AVE STE 1400, WEST PALM BEACH FL 33401.5016
Address Type: MAILING
Status: ACTIVE
Business Type: DOMESTIC NON PROFIT
Date Incorporated: 1110112007
Registered Agent: C T CORPORATION SYSTEM
Registered Agent Address: PLANTATION, FL 33324
Place Incorporation: FL
THE FLORIDA SCIENCE FOUNDATION, INC. - As of: 07118/2008
Name Type: LEGAL
Address: 250 S AUSTRALIAN AVE STE 1400, WEST PALM BEACH FL 33401.5016
Address Type: MAILING
Status: ACTIVE
Business Type: DOMESTIC NON PROFIT
Date Incorporated: 1110112007
Registered Agent: C T CORPORATION SYSTEM
Registered Agent Address: PLANTATION, FL 33324
Place Incorporation: FL
THE FLORIDA SCIENCE FOUNDATION, INC. - As of: 03/3112008
Name Type: LEGAL
Address: 250 S AUSTRALIAN AVE STE 1400, WEST PALM BEACH FL 33401.5016
Address Type: MAILING
Status: ACTIVE
Business Type: DOMESTIC NON PROFIT
Date Incorporated: 1110112007
Registered Agent: C T CORPORATION SYSTEM
Registered Agent Address: 1200 S PINE ISLAND RD, PLANTATION FL 33324-4413
Place Incorporation: FL
Officers and Directors:
THE FLORIDA SCIENCE FOUNDATION, INC. -As of: 10/16/2008
Officer: DARREN K INDYKE, ASSISTANT DIRECTOR, 457 MADISON AVE, NEW YORK NY 10022.6843
Annual Report Filings:
Filing Year: 2008
Filed Date: 09/17/2008
Registered Agents:
[None Found]
Business Registration:
Name: THE FLORIDA SCIENCE FOUNDATION INC
Mailing Address: 250 S AUSTRALIAN AVE STE 1400, WEST PALM BEACH FL 33401.5016
Filing Number: N07000010684
State of Registration: FL
https://secure.accurint.com/app/bps/report 12/9/2008
EFTA00224280
Comprehensive Business Report Page 3 of 3
Status: Active
Corporation Code: SOS
Expiration Date: 5/1/2008
UCC Filings for Business:
(None Found(
Associated Businesses:
(None Found)
Associated People:
Business Contacts:
[None Found]
Assets:
Motor Vehicles:
[None Found]
Properties:
(None Found)
FAA Aircraft:
[None Found]
Watercraft:
(None Found]
Internet Domain Names Registered to Business:
(None Found]
IRS 5500
[None Found]
Executives:
[None Found]
https://secure.accurint.com/app/bps/report 12/9/2008
EFTA00224281
EXTENSION ATTACHED
.990-PF Return of Private Foundation OMB No.1540,4D51
or Section 4947(a)(1) Nonexempt Charitable Trust
Department of the Treasury Treated as a Private Foundation
Note: The otganizadon maybe able to use a copyol this return to satisfy slate ropordnq requirements.
Internal Revenue Santee
• 999
'For calendar veerl 99 or tax year he InnIn 3/01/99 1999, and ending 02/29/00
Name of organization A Employer Identification number
Use the IRS "
label. THE C .0.0.0. FOUNDATION, INC. 13-3996471
Otherwise, Number and street (or P.O. box number K mall is not delivered to street address) Room/sung B Telephone number (see page 9 of
the Inflections)
please print
or type. ASSOCIATES, 110 EAST 59TH ST.
C/O .
See Specific c If extunpOon °pi:40212m Is lir
Instructions, City or town, elate. end ZIP +4 ' Pend q, clink hum
0 1. Fotelpn orgen~2. chin* Min li.
. 2. Orpankr6enstneolng INN 2.6%12st. u.
NEW YORK, . NY 10022 2 OCk Iwo end 2220iccenputaGon r --.J
H Check type of organization: In Section 501(914 exempt private foundation ' E If prh-210 I ounds2ort tutus Iva, loninaad r - I
1 18ectbn4947(e)(1) nonexempt charitable trust Other taxable rivate foundation I I u Ow soch:n 5(020024 diedi 2.4. >i f
I Fair market value of assets et end . Accounting method:E Gash-Li Accrual LI 2 11 Oe Iwnetalion N In 2 20•nontn wmhobca
Other (specify)
of year ((min Part ll, col. (c), line
I 0 unapt uction 60100022). 002( NM il. ----.
16 II› 379, 318 (Part I, column (d) must be on cash basis.) G if edam duns/owl new • • • 6.
. (d) Disbursements
Part I Analysis of Revenue and Expenses • (c) Adjusted net for charitable
(The tole! of amounts in columns (b), (c), end (a) Revenueper
and (0) Net investment
expenses Income Income purposes
(c may not necessarily envoi the amounts In books (flash basis only)
column (a) (see page 9 of the Instrucllons).) '
575, 000 • •
2 Conuombns, 2112. rem. eke.. teemed Win) small)
2 Contributions from split-interest trusts - -.- • •
• ' • 123 123
3 Interest on StIdelh and temporary cosh investments
4 Dividends and [merest from securities
5,379 5,379
., ,
.. • :.
se' Gross rents
) • . ' '
b (Nei rental income or MS)
8 Not gels or (bss) from ewe Mulcts net on ana l0
3 - ..
• • • :A :, •: 33.21 '.. . : .',:.• ; ''''.'-':, ••••••
§ 7 Capital gain net income (from Part IV, line 2) . .. . . . ‘"
- 3,11 5 i ... • •, •
8 Net short-larm capital gain
- •
2 9 Income modifications v • • .
10a GieSs sales less returns • •
end allowances • • • . , • . •
, . . •• • .• •• l - . .•
b taw Cog °loads sold . -.
. • ' ,• .• .
c Gross profit or (loss) (attach schedule)
N.)
11 Other Income (ottoch schedule) .
. :. .
583,623 8,623
12 Total Add lines 1 unearth 11
13 Compensellon of officers. directors. Irises:, eta.
48,077 48,077
14 Other employee siades and wages
15 Pension plans, employee benefits
18a Legal fees (attach schedule) •
5,327 • • 5,327
b Accounting foes (attach schedule)
c Other prolosslonal fees (attach schedule) ,
Operatng and Administrative Expanses
17 Interest
• 3,906
18 Texas (attach schedule) or,* peso1201he vgniaxxx)
Depreciation (attach schedule) end depletion
600
19
20 Occupancy . . . . ,_,_„„„„..,...,..— • • •
• 13,180 • 13,180
21 Tr . corieneelPiEflings
22 Pr II .and-pablitraltr :. .
84,111.
84,111
23 Cm69 anses (attach &abates) .
pensas. . .
24 Tot ta? err3ff itg2dliplailtat d 150,695
Add In through23
155,201 •
3T000 - r 3,000
20 Con ribulleolDEga* ha ^
26 Tots .expenseranddis1Mnsemen dd fines
158,201 • 0 0 153,695
24 and 25
27 Subtract line 20 from lino 12: ... •
a Excess dr revenue over expanses and
• 425,422 ' . . .• • . •
disburoomonts
8 623 •
b Net investment income (if negative, enter .0-) ':•'• .\ I :, . .4 .;‘..: I 3,121
c . " •
c Adjusted not Income III negative, enter -0;). . • • ".
JSA
For Paperwork Reduction Act Notice, see the Instructions Fonx99J,1-PF (1999)
'O21110 .000
(L)
EFTA00224282
•
2
Attached sceeduks and amounts le the Eleghering of yew . End 21y~
Part II Balance Sheets description column should be for Book Os) Book Value 4 Fair Market Value
ong.a.year amounts only. (Sea Instructions.), (a) Value
13,185 32,216 32,216
1 Cash -non-Interesl-bearing
1,710 1,710
' 2 Savings and temporary cash Investments
3 Accounts receivable » .
Less: allowance for doubtful accounts »
4 Pledges receivable » •
Less: allowance for doubtful accounts la '
.
5 Grants receivable
0 Receivables due from deters, dirwtors, huskies, and other
disqualified persons (attach schedule) (see pegs 14 of vie inalsedlend) •
loans receivable (attach schedule) » • . . • . -- ...•• --.. •
7 Other notes and
.12 le
► •
d Less: allowance for doubtful accounts
.
4k9 8 Inventories for sale or use
9 Prepaid expenses und deterred charges •
(attach schedule) . : • .
10 a investments - U.S. and stole government obtgalions
(which schedule) 405,581 343,294
b Investments •• corporate stock
• • .
c Investments - corporate bonds (attach schedule)
Investments • land, botany, Do.
11 Loss:q nt: bash
L re:cumulated deprecimlon is.
(attach schedule)
12 Investments - mortgage loans
• , •
13 investments - other (attach schedule) :::.: . . • -
14 Land, bugling', end 2.•;• .:'4: .:t:
. ..:
! ::•c . .. .: .. :: .
[t / • •: •
equeernent: bests .0. ' 2:998
Lose: accumulated dconscietion go. 900 . 2,698 2,098 J 2,098
(Mach schedule) •
15 Other assets (describe » ) .
18 Total assets (to be completed by all films - see page 16 of
16 , 3.83 . 441,605 379,318
the Instructions. Also, see page 1,10)M l)
17 Accounts payable and accrued expenses •h . • 2 • • . • .•
' -Z ,
18 Grants payable
å 19 Deferred revenue '
•51: 20 Loans From DIfiterS, directors, hostess, and other disqualified peaces —
, • • u• r
3 21 Mortgages and other notes payable (attach schedule) .
22 Other liabilities (descnbe lle )
•,
93 Total Ilphiglies (add lines 17 through 221 ..
.
I
Organizations that follow SFAS 117, check hero 10-1 I . . .
and complete lines 24 through 26 and lines 30 and 31.
- • '
Net Assets or Fund Balances
24 Unrestricted
25 Temporarily restricted
28 Permanently restricted
OrganIzall0nS that do not follow SFAS 117,"
chock here and complete lines 27 through 31. le H ...
27 Capital stock, trust prindpel, or current funds , • „
20 Peld.ln or capital surplus, or land, bldg., end equipment fund
16,183 441,605 : —. .' — ' '
29 Retained earnings, accumulated Income, endanmenl. or other funds . ... .
. .• ,.
30 Total net assets or fund balances (see page 16 of the
16,183 441,605 :: -.: . - t.
Instructions)
Total liabilities and net assets/fund balances (see page 16 of . •• •
31
• 16,183 441,605 • ...: .. ; . -.• 1
I the Instructions)"
Part Ill Analysts of Changes In Net Assets or Fund Balances
I Total net assets or fund balances at beginning of year - Part II, column (a). line 30
1 16,183
(must agree with end-of-year figure reported on prior years rakart)
2 425,422 '
2 Enter amount from Part One 27a
3
3 Other Increases not Included In fine 2 (fleini.z9)› 441,605
4
4 Add lines 1, 2, and 3
5 Decreases not Included In line 2 (itemize) OP 441,605
(b), fine 30 6
Total net assets or fund balances at end of year (line 4 mkns One 6)- Part II column
Fixm090-PF (1999)'
J8A
021420 1.000
EFTA00224283
Fenn 990-PF (1 99)
Page 3
Part IV Capital Gains and Losses for Tax on Investment Income
(b) How
acquired (c) Date ——
(a) List and describe the kinds) of property saki (o.9.• real estate.
rte mete sold
acquiredYr')
Mochas° ( 1° (me., day, yr.)
2-atory brick warehouse: or common stock, 200 she. MLC Ca) - daY1
D.Donreloo
'
SH AT&T
P 6/8/99 12/15/99
1a750
b •
c
d
e
(e) CUM sales price (6 Depreciation allowed ' (9) Cost or other bests (h) Gain or (loss)
(or allowable) plus expanse of sale , (a) plus (g minus (g)
• 42,884 • 39,763 3,121
a
b
c •
d .
0
Complete only for assets showing gain In column (h) and owned by the foundation on 12/31/89 (0 Gains pot 0.0 gain minus
CHAdjusted basis 00 Mass of col. (I) • 00t. (k), but not lass than -0-) or
Ili-• ea of 12191/69 as of 12131/69 . over all, 5),If sly Losses (nom col. (h))
•
a
b
o
d
a •
{ If gain, also enter in Part I, Una 7
2 Capital gain net income or (net capital loss)• If (loss), enter 41- in Part I, line 7 )
2 3,121
3 Net short-term capitol gain or (loss) as defined In sections 1222(5) and (6):
If gale, also enter in Part I, line 8. column (c) (see pages 11 and 16 of the instructions).
. 1 3 3,121
If 000), enter-0- in Part t fine 6
Part 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 I come.)
If section 4940(d)(2) applies, leave this part blank.
Was the organization liable for the section 4942 tag on the distributable amount of any year In the base period?. . n Yes ❑ No
if "Yes,' the organization does not qualify under section 4940(e): Do not
complete this part.
Enter the appropriate amount in each column for each year; see page 16 of the instructions before making any entries.
es
(a) h3)
IN Distribution ratio
Erase period wen Calendar year Adjualpd quallying dIsylbutio8s Hal value of oonchadtablease Mob
year beginning ) (coL (bIsthicid by col all
(or tax
54,655 6,642 8.2286
1998
1997 •
•
1996
1995
1994 _ •
'
2 D. 2286
2 Total of line 1, column (d
3 Average distribution ratio for the 5-year base period-divIde the foist on km 2 by 5, or by
3 4.1143
the number of years the foundation has been in existence If less than 5 years
4 307,635
4 Enter the net value of noncharitablo-use assets for 1999 from Part X, line 5
5 1,265,703
6 Multiply line 4 by line 3
6 86
8 Enter 1% of net investment income (1% of Part I, lino 27b)
7 li265,789
7 Add linos 5 and 6
8 153,695
8 Enter qualifying distributions from Part XII, line 4
a 1% lox rale. Soo tha Pod VI InelroclIons an poop Ie.
If Ilea 8 Is equal to or gloater Plan lino 7, axed the box In Pad VI, lino lb, and COMPSMO that part using
Jan Form 990-PF (1999)
9E1430%.000
EFTA00224284
paw 4
• 10i :tear (19991 tions) •
) 4940(b), 4940(e), or 4948 - see pare 18 of the instruc
Excise Tax Based on Investment Income (Section 4940(a
4940(dX2), check here * U end enter "NIA" on line 1.
1a Exempt operating foundations described In section . • .
(attach copy of ruling letter If necessary -see Instructions)
Date of ruling letter: 1 172
ents In Parts, check
b. Domestic na nizalions that meet the section 4940(e) requirem : •
v •
here * U and enter 1% of Part I, line 27b lino 12, cot. (b) . •. . . .
.
Exempt foreign organiza tions enter 4%d Pad I,
c All other domestic organization enter 2% of line 27b. 2
and taxable foundations only. Others enter -0-)
2 Tax under section 611 (domestic section 4947(aX1) trusts 3 172
3 Add lines 1 and 2 . . 4
trusts and Usable foundations only. Others enter -0-)
4 Subtitle A (income) lex (domestic section 4947(a)(1) 172
3. If zero or less, enter -0-
Tax based on Investment Income. Subtract line 4 from the
6 CreatalPayments:
to 1999 6e
a 1999 estimated lax payments and 1998 overpayment credited
eb
b Exempt foreign organizations - taxwithhold at source 200
2788)• Bc
c Tax paid with application for °Mansion of time to file (Fain
6d
d Backup withholding erroneously withhold
7 Total credits and payments. Add lines 6a through 6d
Check here CI If Form 2220 Is attached
8 Enter any PENALTY for underpayment of estimated tax.
more than line 7, enter AMOUNT OWED ►
9 TAX DUE. if the total of lines 6 and 8 is la 10 28
of lines 5 and 8, enter the AMOUN T OVERP AID •
10 OVERPAYMENT. If line 7 is more than the total
tax * 29 I Refunded ► 11
1 Enter the amount of tine 10 to be: Credited to 2000 estimated
• Statements Regarding Activities Yes No
e any national, stele, or local legislation or did
1 a During the tax year, did the organization attempt to influenc 1n X
It participate or Intervene In any political campaign?
or indirectly) for politkal purposes (seepage
b Did it spend more than $100 during the year (either directly b
17 of the Instructions for definition)?
of the ecratilies and copies of any materials
If the answer is 'Yes' to I a or 1b, attach a detailed desert/Hien 0 •
connect ion with the activities. I .:
published or distributed by the organization In 10
c Did the organization file Form 1120•POL for We year?
(section 4965) Imposed during the year,
d Enter the amount (if any) of tax on political expenditures
(1) On the organization, le- $ (2) On organization managers. la $
imposed
organization during the year for political expenditure tax
a Enter the reimbursement any) paid by the •
on organization managers. ► $ 2 X
have not previously been reported to the IRS?
2 Has the organization engaged In any activities that •
•
•
If 'Yes," attach a detailed &sedation of the activities. _
sly reported to the IRS, in its governing instrument, articles
3 Has the organization made any changes, not previou X
tes,"allach a conformed copy of the changes
of incorporation, or bylaws, or other similar instruments? If 4a X •
ation have unrelate d busines s gross Income of 81900 or more during the year?
a
4 Did the organiz 4b N A
this year? •
b If "Yes; has it tiled a %engem on Form 99b-T for 6 X
or substantial contraction during the year?
6 Was there o liquidation, termination, dissolution,
on T.
If "Yes," attach the statement required by General instructi
508(e) (relating to sections 4841 through 4946) satisfied either:
6 Are the requirements of suction
• By language In the governing Instrument; or •'
ng instrument so that no mandatory directions
• By state legislation that effectively amends the governi 0
Instrume nt?
that conflict with the state law remain In the governing 7 X
ation have at least $5,000 in assets at any ?me during the year? If -Yea"carlpiefe Part cot. (c). Sod Peri XV.
7 Did the organiz
with which it is registered (see page 18 of the
5 a Enter the states to which the foundation reports or
Instructions) la NEW YORK '
tion furnished a copy of Form 990•PF to the Attorney
b If the answer is 'yes' to line 7, has the organiza Bb X
Instruction 0? If "No,"sitech explanation
General (or designate) of each state as required by General 49428)( 3)
operating foundation Within the moaning of section
9 Is the organization claiming status as a private
taxable year beginning in 1999 (see instructions for Pert XIV on
or 49420)(5) for calendar year 1980 or the
page 23)? if 'Yes," complete Part XIV listing their names and addresses. 10 X
contributors during the tax year/ tf "Yes," attach a schedule
10 Did any persons become substantial
tion's annual return or Its pxomptlon application (or both)?
11 a Did anyone request to see either the organiza 11b N
c m moue 1 Instructions? (See General Instruction Q.) '
la if "yes," did the orgenle Telepho ne no. 0-121 2) 909-9680
The books aro in care of
IL_ ASSOCIATES
59TH STREE T, NEW YORK, NY 71P+4 so• 10022
Located at )0. 110 EAST
fling Form 990-PF in lieu of Form 1041 • check here
13 Section 4947(a)(1) nonexempt charitable trusts Pit 13 I
accrued dudnq the year
and enter the amount of tax-exempt interest received or Form 990-PF (1999)
JSA
951140 1.000
EFTA00224285
Page 6
Form 990-PF (1999)
IWITElleIrl Statements Regarding Activities for Which Form 4720 May Be Required
Yea No
File Form 4720 If any Item is checked In the "Yes" column, unless an exception applies.
1 Self-dealing (section 4941): '
a During the year did the organization (either (Erectly or indirec0y):
' Engage In the sale or exchange, or leasing of property with a disquall0ed person? Ei Yes El No
(2) Borrow money from, lend money to, or otherwise extend credit to (or accept it from)
a disqualified person? Yes No
(3) Furnish goods, services, or facilities to (or accept thorn from) a disqualified person? Yes 7 No
(4) Pay compensation to, or pay or reimburse the expenses of. a disqualified person? Yes ir No t : .
(6) Transfer any income or assets to a disqualified person (or make any of either ava0able : .
for the benefit or use of a disqualified person)? ❑ yes El No
(8) Agree to pay money or properly to a government official? (Exception. Check "No"
If the organization agreed to make a grant to or to employ the official for a period
after termination of government service, if terminating within 90 days.) C:l Yes El No
b II any answer Is "Yes" to tail)-(6), did ANY of the acts tall to qualify under the exceptions described In
Regulations section 53.4941(d)-3 or in a current notice regarding disaster assistance (see pogo 10 of the
lb A
instructions)?
Orgunize0ons relying on a current notice regarding disaster assistance check here
• c Did the organization engage In a prior year in any of the acts described in In, other than excepted acts,
c
that wore not corrected before the first day of the tax year beginning In 1999?
2 Taxes on failure to distribute Income (section 4942) (does not apply for years the organization
was a private operating foundation defined in section 49420X3lor 49420X5)):
a At the end of tax year 1990, did the organization have any undistributed Income (lines 6d
and 6e, Pal XIII) for tax year(s) beginning before 1999? El Yes No ..•
If "Yes," list the years 19 , 19 , 19 19
b Are there any years listed in 2a for which the organization Is NOT applying the provisions of section 4942(8X2)
(relating to Incorrect valuation of assets) to the year's undistributed Income? (II applying section 4942(0X2)
21:1
to ALL yours listed, answer 'No' and attach statement - see page 18 of the Instructions.)
a If the provisions of section 4942(aX2) are being applied to ANY of the years listed In 2o, list the years here,
19 , 19 , 10 ., 19
3 Taxes on excess business holdings (section 4943):
a Dld the organization hold more than a 2% direct or indirect Interest in any business
enterprise et any time during the year? tJ Yes E No
b • If 'Yes," did it have excess business holdings in 1999 as a result of (1) any purchase by the organization
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(0(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 deli nine • •
3b A
If the organization hod excess business holdings in 1999.)
4 Taxes on investments that Jeopardize charitable purposes (section 4944):
a Did the organization Invest during the year any amount In a manner.that would Jeopardize Its charitable
purposes? 4a
b Did the organization make any Investment In a prior year (but after December 31, 1989) that could Jeopardize its CharitatAe
4b SC
purpose that had not been removed from Jeopardy before the first day of the taxyear beginning in 1999?
6 Taxes on taxable expenditures (section 4946) and political expenditures (section 4955):
a During the year did the organization pay or Incur any amount to:
(1) Carry on propaganda, Of otherwise attempt to influence legtstation (section 4945(e))? E pui
Yes No
(2) Influence the outcome of any specific public election (see section 4955); or to carryon.
directly or Indirectly, any voter registration drive? Yes X No
travel, study, or other similar purposes? Yes X No
(3) Provide a grant to an individual for
(4) Provide a grant lo en organization other than a charitable, etc., organization described
in section 609(0)(1), (2), or (3), or section 4940(d)(2)? Ei Yes FX-I No •..
(5) Provide for any purpose other than religious, charitable, scientific, literary, or
[1 Yes No
educational purposes, or for the prevention of cruelty to children or animals?
in
b If any answer Is "Yes' to 5a(1)-(5), did ANY of the transactions fat to qualify under the exceptions described
or rrent notice regarding disaster assistance (see page 19 of the instructions)? lb
Regulations section 63.4946 in a cu
le
Organizations relying on a current notice regarding disaster assistance chock hero
o If the answer Is 'Yes' to question 5a(4), does the organization claim exemption from the tax
because it maintained expenditure responsibilty for the grant? ❑ Yes No •• •
If "Yes." or iffettfhe statement required biReoulations section 53.4945-5kh.
Form 990-PF (1999)
JSA
901450 1.000
EFTA00224286
Page 6
Form 990-PF (1999)
Part VIII Information About Officers, Directors, Trustees, Foundation Managers, Highly Paid Employees,
andtontractors
instructions):
1 List au officers, Directors, trustees, 'inundation onagers ana tneir compensation (two page la or me
(b) VIM, and average la) Compensation (dl cause:Mkt* to (e) Expense account,
. 0( not paid, enter employee benehjaant
' (a) Name and address hours per week other allowances
devoted to position a) and debated compeneen
JEFFREY E. EPSTEIN PRES/DIR
, ST. THOMAS, VI ONE HOUR 0 0 0
6100 RED HOOK -QUARTERS
DARREN K. INDYKS /DIR :
NY, NY . ONE HOUR 0 0 0
457 MADISON AVENUE,
GHISLAINE MAXWELL TREAS. /DIR
0 0 0
676a ASSOC.-110 E. 59TH ST.NY, NY ONE HOUR
Instructions).
2 Compensation of five highost-pald omployoos (other than those Included on line 1 • see page 19 of the
If none, enter "NONE,"
, • (b) Tile and overage (d) ConttrAira. to (e) Expense account,
hours per week (a) Comp myttLun etpluyes Imuifil lions other allowances
(e) Name and address of each encioyoo paid mao than $50,000 and detenul coventakon
• devoted to position
NONE .
. .
1, 0
Total number of other employees paid over $50,000
Instructions). If
3 Flve hIghest-paid Independent contractors for professional services (see page 19 of the
none, enter
" E"
(b) Type of service (c) Compensation
(a) Name and address of each potion paid mom than $50.090
. -
.• -
•
le. 10
Total number of others receiving over $60,1300 for professional services
Part IX.A Summary of Direct Charitable Activities
List tho foundation's four largest *sot charitable actIbilles during the tax year. Includo relevant sisesiical Information such is the number ExPenses
produced, etc.
of organizations end other beneficiaries served, conferences convened, research papers
2
4
Form 990-PF (1999)
JSA
OE 1460 1.000
EFTA00224287
Page 7
Fonn 990•PF (1999)
20 of the instructions)
Part DC-B Summary of Program-Related Investments (see page
Amount
foundation during the tax year.
"ascribe any program-related Investments made by the
2
3
must complete this part. Foreign foundations,
Part X Minimum Investment Return (All domestic foundations
see page 20 of the Instructions.)
directly in carrying out charitable, etc.,
1 Fair market value of assets not used (or held for use)
purposes: 1a 288, 614 •
a Average monthly fair market value of securities lb 23,706
b Average of monthly cash balances lc
instructions)
c Fair market value of all other assets (see page 21 of the 1d 312,320
d Total (add lines 1a, b, and c)
d on lines 1a and
e Reduction claimed for blockage or other factors reporte
1c (attach detailed explan ation) l 1e I
2 Acquisition indebt ednes s applic able to the 1 assets •
3 312,320
3 Subtract line 2 from line ld
1 of line 3 (for greater amount, see
4 Cash deemed held for charitable activities. Enter 112% 4 4,685
page 21 of the Instructions) Partl , 6
6 Net value of noncharitable-use assets. Subtra
ct line 4 from line 3. Enter here and en
307,635
line 4 6 15,302
Minimum Investment return. Enter 5% of line 5 n 4942(j )(3) and (j)(5) v
pri ate operat ing
(Sectio
zei Distributable Amount (see page 21 of the instructions)
certain foreign organi zation s check here b. ri and do not complete this part.)
Zall foundations and 1 15,382
1 Minimum Investment return from Part X, lino 6 172
from Pert VI, line 5
2 a Tax on Investment Income for 1999
Pad VI.)
b Income tax for 1999. (This does not include the tax from 172
c Add lines 2a and 2b 15,210
line 2c from fine 1
3 Distributable amount before adjustments. Subtract 4a I
ng distribu tions
4 a Recoveries of amounts treated as qualifyi 4b
b Income distributions from section 4947(a )(2) busts
c Add lines 4a and 4b 5 15,210
5 Add linos 3 and 4c
6 Deduction from distributable amount (see page
22 of the Instructions)
15,210
line 5. Enter here and on Part XIII. line 1 .
7 Distributable amount as adjusted. Subtract line 6 from
Part XII Qualifying Distributions (see page 22
of the instructions)
1 Amounts paid (including administrative expenses)
to accomplish charitable, etc., purposes:
la 153, 695 •
from Part I, column (d), line 26
a Expenses, contributions, gift's, etc. - total lb
IX-B . . . . . . . . . . .
b Program-related investments - total of itnes 1-3 of Part charita ble,
carrying out
2 Amounts paid to acquire assets used (or held for use) directly In 2
purposes
ts that satisfy the:
3 Amounts set aside for specific charitable projec 3a
a Suitability test (prior IRS approv al require d)
ule) 3b
b Cash distribution test (attach the required sched Pett XIII, line4 4 153, 695
hire and on Pad', Ilne 8 and
4 Qualifying distributions. Add lines la through 3b. Enter
the reduce d rate of tax on net investment
5 Organizations that qualify under section 4940(e) for 5
the Instruct ions)
Income. Enter 1% of Part I, lino 27b (see page 22 of 6 153, 695
line 4
Adjusted qualifying distributions. Subtract line from auto iag wheth er the founda tion
column (b), in subsequent years when ca
. Note: Tho amount on line 6 will be used in Part those years.
qualifies for the section 494O(e) reduction of tax in 99043F (1999).
Form
JSA
SE 1470 2.00
EFTA00224288
Paw 8
Form 990-PF (1W49)
Part XIII Undistributed Income (see page 22 of the Instructions)
Pt (d)
• (a) (b)
°NOM Years.?tor to 1998 1998 1999
1 Distributable amount for 1999 horn Part XI,
•" 15,210
lino 7 r • • .
2 UndIshibutod Intone:41f any, as dem ond c41993:
• •• •
T• 0 •r%.• •
a Enter amount for 1998 only '.
. '.
6 Total for prior Aars: hi. . '
.
3 Excess distributions carryover, If any, to 1999:
••• . /. • .,
a From 1994 • .; .r. • • : -1 .) - •: :-::' ', .:..- • • • •• •
b From 1995
• ' •
C From 1996
d From 1997
54,323 .., ' "'; - • . • :: • •
o From 1998
54,323 , : •• .-- , v •• - •• • ••,{, • . - .
f Total ol linos 3a through e • ••-•
4 Qualifying distributions for 1999 from Part
XII, Mee:6r 153,695
more than line 2a • .. •.
a Applied to 1998, but not --,.
•..... : •::::. ot
b Applied to undistributed income of prier years
(Election required -see page 23 pith* kislioclIons) . -. •
0 Treated as distributions out Or corpus (Election .
• 6 - , • . ;• . t ... .:. .. . . . . .i e
required - see page 23 of the instructions) ,
15,210
d Applied to 1999 distributable amount
138,485 ;. .- t • 7 .:.. ( .• .* ; 1 •• • • ;.: , • ••• •
iy .Rempin* amount distributed out of corpus
6 Excess distributions carryover applied to 1999 0
(Ilan amount appears In column M. the some • •
amount must be shown In column (a).) • .• . • .•
—. . .. "
6 Enter the not total of each column as
Indicated below:
192 808 • : "• • • • • — •:: 0. :•,....,.. ...i. ...•. •. •
a Corpus. Add lines 3f, 4c, and 4e. Subtract line 6 " •
. , .:..• • •s,..........r.: •.... . ' " • "
b Prior years' undistributed Incase. Subtract . '. ". '‘F ‘.. -0 . :.
• ' lino 4b from line 2b ' 7s• -5 '
1...‘:,...n... • -
o Enter the amount of prior years' undistributed . ::.::.:.• yir,,:;•:,...s.,;•
Income for which a notice of deficiency has been . :. .t., ....I:41 4:v ',...n.c.
Issued, or on which the section 4942(a) tax has - •• 2!.t.• N.?. ; t . .
boon previously assessed ',It's ..i. : •:•
" :61— .• ..i:r. •• - .. .• •'.
•
d Subtract line 03c from line Ob. Taxable • • • •.:
%.
amount . see page 23 of the instructions • •" ' .• • ...
0 UnOtslilbuted Income lot 1998. Subtract line ria
horn line 20. Taxable amount • ego page 23 of Me • t • . .
Ineltuctions
„ ... ...
f Undistributed income (or 1999. Subtract tines .- - -•• • '
4d and 6 from line 1. This amount must
bo distributed in 2000
. . . .
• ....
7 Amounts treated as distributions out of corpus lo . € '
. . ; ,i .. •
satisfy requirements Imposed by section 170(b)(1XE) or
....c..: L .'s .. . ...
4942(91(3) (see pope 23 of the Instructions)
.•. .. . .
8Excess Olettleutions convener from 1994 no! applied ,7:‘, •' ":;' t'
insbudione) 0 1
•' ' ,, ••
on line 5 or line 7 (see page 23 or the
• -' ,.
9 Excess distributions carryover to 2000. . . •. • a.: ,
' 192 8b8 • • . . - .•
Subtract Met 7 and 8 from line ea ...2
10 Analysis of fine 9: : • , . . ... : ; : ;: •, r •,.. -- " .
a Excess from 1996 . . . 1 'az. "•‘&• ; • • • • • I
b Excess from 1998 . .•. ,,,- '.• • : :• .:',;:•••: • :: . • • • , —
c Excess from 1997 . . . •
•• .• " • .. • • ... ••• • • • .7
d Excess from 1998 . . . 54,323 .."• • •,'.4'. 'i: P III .: Sii. •••!:':: A.• • •!• .
• •;„ • •:.. .i.:•••,••.:.!:%.• • • • • ......t. ... .- : . • -...- fr., : • • . •
e Excess inrm 1999 . . . 138,485
999-PF (1909) •
JSA
901400 2.000
EFTA00224289
Paco 9
Form 990.PF 0091
Private Opera Ong Foundations (see Page 24 of the Instructions and Part VII-A, question 9)
1 a it the foundation has received a ruling or determination letter, that It Is a private operating
• foundation, and the ruling is effective for 1999, enter the date of the ruling
4942M(3) or I I 4942(1X5)
'b Check box to indicate whether the organization Is a private operation foundation described In section
Tax year Prior 3 veers
2a Enlist the lesser ol the (d) loos Pa Total
not Income kom
adjusted (2.1 1099 fin 199a (o)
Pad I or the minimum
Investment return from Pert
X for each year Hoed . .
b 85% d4 Ine 2e
o 00416r0 Oleelbutons Wm Pen
a I Ina 4 ea cad. yes,
d Annowls Inekdad In Me 2e not
vied cliteclly hoc wiles coquet
of gawp( ecnnees
o Ouellhinp diseleueons nude
Woolly to; ediseundudo
tempt etInthis. Sublime
We 20 lumens 20
3 Complete 3e. b.acla the
ellennothro mewl Rued ups*
a •AseNe ellomalne IMF order.
(1 ) Vilma of eS$411 . . .
(2) Vele. ol sew% que6hing
undo: eween
4042063X0X0
b 'Endeemenla &Weber. tesl•
(Mor 2(3 oh minimize
Investment itlam shownII
Pad X, We 6 for own yern
fitted
C •Suppon• pitman.* wet • eaten
(1) Teed ' ,WOW Oiler Vien
vote Unownwl Income
(henna %%Jacinth, tenN.
mown!. on toswelof
loam 0o2lon 512(1X69.
or wieney)
(2) Supped 00m V6660
public, end 5 ot mom
°tempt orgerthellons
es proMal In sock*
45420X3 (a)( 2) .
(3) te.gnt eincelnl of euppol
bon en weenie
organialett
4 Gross kl110116004i0Vn, •
Supplementary Information (Comp eta this part only If the organization had $5,000 or more in
assets at any time during the year see page 24 of the Instructions.)
1 Information Regarding Foundation Managers: received bythe foundation
a List any managers of the foundation who have contributed more Mari 2% of the total contributions
close of any tax year (but only if they have contributed more than $5,000). (See section 507(d)(2).)
before the
JEFFREY E. EPSTEIN
equally largo podlon of the ownership
b List any managers of the foundation who own 10% or more of the stock of a corporation (or an
of a partnership or other entity) of which the foundation has a 10% Or greeter Interest.
2 Information R2E,• rdIng Contribution, Grant, Gift, Loan, Scholarship, etc., Programs:
does nol accept unsactied requests for funds,
Check here 1 ILI II the organization only makes contributions to preselected charitable organizations and
li the organization makes gifts, grants. etc., (see base 24 of the Instructions) to ineraduan
or mania:ions under other condatons. complete horns 2e, b.0. end O.
addressed:
a The name, address, and telephone number of the person to whom applications should ho
should intrude:
b The form In which applications should be submitted and Information and materials they
e Any submission deadlines:
fields, kinds of institutions, or other
d Any restrictions or limitations on awards, such as by geographical arms, charitable
Wore:
JSa Form 990•PF (1999)
951490 i.o0o
EFTA00224290
Page 10
Form 090-PF (1999)
Ina Supplementary Information (continued)
the Year or Approved for Future Payment
3 Grants and Contributions Paid During
If recipient Is on IndMiluat, Forrod000n
Recipient show any reletkoship to slaws of Purpose of grant or Amount
• eny foundation mamma( contribution
or „ motions „ ono,* rectratia
Name end address (home or business)
• a Paid during the year
STATEMENT 4
•
It. 3a 3, 000
Total
b Approved for future payment
•
•
•
la• 3b o
Total Form 990-PP (1999)
!SA
9E1401 1.000
EFTA00224291
Pagel 1
Form 990-PF (1999
Part ar\ n Analysis of Income-Producing Activities (0)
Unrelated business tnoonie Excluded b) section 512, 513, or 514
Enter g oss amounts unless otherwise Indicated. (b) (c) (10
irgt clorinegTe
Of .
Business
code Amount Elbtr il Amount Rit,tn:IgS
Pro yom service revenue:
a
b
C
d
Fees and contracts horn government agencies
2 Metnberstilp dues and assessments • 14 123
3 Intoieel on savings end la-votary cash investments 5, 379
14
4 Di Bends and Interest from securities . .
. .. . . ... .. . . .
5 Net rental Income or (loss) from real estate: •
Debt-financed property .
•
• b Not debt-financed property
6 Net rental bloom. or (loss) from PersonalProPert7
7 Othor Investment income 18 . • 3, 121
8 G t or (loss) from sales of assets other then Inventory
•
9 Net Income or (loss) from special events
10 Grciss profit or (loss) from sales cf Inventory
11 Oil Ler revenue: a
b
d
. B, 623
'.: •
12 Bbldotal .Add columns (b), (d), and (e) , , evi 3
13 Total. Add line 12, columns (b), (d), and (e)
verify calculations,)
See worksheet In Una 13 Instructions on patio 25 o ses
•. . : Relationship of Activi ties to the Accomplishment of Exempt Purpo
Is reported In column (e) of Part XVI-A contributed Importantly to
Explain below how each activity for which Insane providi ng funds for such purposes). (See
Line No. the accomplishment of the organization's exempt purposes (other than by
r page 26 of the instructions.)
Form 990-PF (1999)
JSA
9E1402 1.000
EFTA00224292
Page12
Forma PF 19991
Information Regarding Transfers To and Transactions and Relationships With Noncharitable
Exempt Organizations
Yes N
1 Dld the organization directly or indirectly engage In any of the following with any other organization described in section
• 501(c) of the Code (other then section 501(0(3) organizations) or In section 527, relating to' politicd organizations?
a Transfers from the reporting organization to a nonchadtoble exempt organization of:
jri(11
(1) Cash •
11(21 x
(2) Other assets
b Other Transactions:
1601
(1) Sales of assets to a nonchanteble exempt organization
1b(21 X
(2) Purchases of assets from a noncharilade exempt organization
lb(31
(3) Rental of facilities, °yeti:Font:int , or other assets
1l)(41
(4) Reimbursement arrangements
111(61
(5) Loans or loan guarantees
1b(6)
(6) Performance of services or membership or fundraising solicitations
10
c Sharing of facilities, equipment, mailing lists, other assets, or pdd employees
fair market
d If the answer to any of the above is 'Yes, complete the following schedule. Column (0) should Sways show the
value of the goods, other.assels, or services given by the reporting organization. If the organization received less than fair
value of the goods, other °smith, or services
market value In any transaction or sharing arrangement, show In column (d) the
received.
141Ina no. fb) Amount Involved (c)Nome of nonchadtable exempt ottanlzaeon (d)0escrlellon of transfers tranyacUorm. and sharing ammeernonts
z a Is the organization directly or Indirectly affiliated vhIlt, or related to, one or more tax-exempt organizations
described In section 601(c) of the Code (other then section 501(c)(3)) or In section 527?
Ekes ONG •
•
NI N91110 ci ORIOnitalkin 04 WM/ of oreanInsive fel Deeerleaen ottoman
EPSTEIN INTERESTS PRIVATE FOUNDATION JEFFREY E. EPSTEIN IS PRESIDENT
AND A CONTRIBUTOR TO BOTH
FOUNDATIONS
Part XVIII Public Inspection (see page 26 of the Instructions and Gene al Instruction Q)
5, 2001
1 Enter the date the notice of availability of the annual return appeared Inn newspaper gs JANUARY
THE NEW YORK LAW JOURNAL
2 Enter the name of the newspaper IP-
by the Instructions on page 20.
3 Check berets' LI to Indicate that you have attached a copy of the newspaper notice required
(If the notice Is not attached, the return Will be considered inceMoletel
el my Mcmfedge end beret, a Is
Under emerge I declare that I home examined this ;elem. Including accompaming schedules end stabonents, end to the best
of (other than taxpayer of idudery) It based on 7 mi
i/d
Min ion oletdch ortolan:4 has any knowledge.
true, se intl.:omelet . Declaration preparer
I / 0/ 6 "ter, eliA, /
Signature of lent opt° r Tide
Dal Check if self- TIN
Prepare?.
0/ employed
elfindure
t ASSOCI EIN 0. 13-2842281
n.°0 Firm's name (or
110 EAST 59TH STREET
E D" yours if self-employed)
IL 30022
NEW YORK,, NY ZIP+4 ►
and address Form 990-PF (1O6)
JSA •
9514931.000
EFTA00224293
• STATE OF NEW YORK
County of New York, s:
is the PRINCIPAL
'DIE ANNUAL tusturbq OF Leslie Francis, being duly sworn, says that she
:THE u.o.u.o. FOUNDATION JOURNAL,
ura*cl ofiizst year ended Zei t ;
To
CLERIC of the Publisher of the NEW YORK LAW
o annexed has
a Daily Newspaper; that the Advertisement heret
peinelpal office Welded at ale
Daimon Associates. 110 East
,69111 Street, • New York: NY
OURN
.10022 for kn:motion during
..negular business boUt5 by any
citizen who requests it within
been published in the said NEW YORK LA
one time on the 5th day of January, 200
.160 days hereof. Principal
Manager of the P'oundition is
'3EPPIIEY.•E.EPSTEIN. • /et- t--;
TO WIT: JANUARY 5, 2001
SWORN TO BEFORE MB, this 5th
day }
Of Janu
Christine A. Allen
Notary Public , State of New York
. No. 0IALS072870 '• •
Qualified in Nassau County .
Commission Expires Feb.10, 2001 •
EFTA00224294
THE C.O.U.Q. FOUNDATION
13-3996471
Y/E 02/29/00
FORM 990PF
STATEMENT 1
PART I. LINE 1
CONTRIBUTIONS RECEIVED
Jeffrey E. Epstein
6100 Red I look Quarters #2
St. Thomas, VI 00802 . 75,000
John J. Hannan
do Apollo Management, LP
1301 Avenue of the Americas
New York, NY 10019. 166,667
William Mack
c/o Apollo Management, LP
1301 Avenue of the•Americas
New York, NY 10019 166,666
Leon Black
c/o Apollo Management, LP
1301 Avenue of the. Americas
New York, NY 10019 166,667
Total 575,000
STATEMENT.2
PART I. LINE 23
OTHER EXPENSES
Bank Charges 21
Research 75,000
619
Filing Fees
3,436
Health Insurance
25.
Miscellaneous
850
Office Expense
Payroll Expense 1,402
Telephone • 2,758
Total 84,111
EFTA00224295
THE C.O.U.Q. FOUNDATION
13-3996471
Y/E 02/29/00
FORM 990PF •
STATEMENT 3
PART IT. LINE 10(b1
INVESTMENTS. CORPORATE STOCK
Book Value Market Value
7,650 SII AT&T. 405,581 343,294
STATEMENT 4
PART XV. LINE
CONTRIBUTIONS PAW
05/03/99 World Economic Forum $3,000
EFTA00224296
Application for Extension of Time to File
•
Form 2758
(Rev. Juno 1998) . Certain Excise, Income, Information, and Other Returns OMB No. 1546.0146
Department of pie Treasury
IP File a separate application for each return.
“•temni Revenue Service ['notary Iden Mica lion number
Name
abOuor
M. Fib lbo 13-3996471
edging] end THE C.O.U.Q. FOUNDATION, INC.
not doWired to street mains)
ono copy by Number, sheet. and room or tulle no. (or P.O. box no. If numb
the due dale
for filing your
•rolum. See C/O s• ASSOCIATES, 110 EAST 59TH STREET
Instructions.
Instructions onOily, loom or post atm stele, end ZIP code For stoner eddies,, no
beck.
NEW YORK, NY 10022 s, and
to request an extension of time to file. Partnerships, REMIC
Note: Corporate Income tax return fliers must use Form 7004 or 1041.
to me Form 1065, 1088,
trust must use Form 8736 to request en extension of time , to (ileSeck only one):
ion of time until JANUA RY 15, 2001
request an extens • Form 8812
_ Form 1120-ND (sac. 4051 taxes)
Form.70643,S(D)
Form 3520-A ' — Form 8613
Form 708-GS(T) _ Form 990-Teruel other than above)
Form 1041 testate) (see instructions) Form 4720 — Form 8726
Form 990 or 990-EZ _,, Form 8804
Form 5227
Form 990431. — Form 1041-A Form 8831
Form 1042 Form 6069
Form 990-PF
Slates, check Iles box
' If the organisation does not have an office or place of business In the United and endIngo 02/28/2000
_ _ , o other tax year betInnIn g • 03/01 /99
28 For calendar year _ _
b it this tax year Is for teas than 12 months, check reason:
. 1:11nItial return 0
Fine% return Change In accounting period
Has an extension of time tette been previously granted for this taX yaw? . . .. .. .. THE . . . . ........ . . . . . ... . . 0 vas CI
No
3
MATIO N NECES SARY FOR PROPE R COMP LETIO N OF THE RETURN
INFOR
4 Stale In detail why you need the extension
IS NOT YET AVAILABLE.
-PP, 990-T,1041 (estate), 1042,1120410,4720,
50 If ibis form le for Form 70608(3), 708-08(T), 990.-7B1, 9% $ 200
5069, 8612, 8813, 8725, 8804. or 8531, enter the tentativ e tax, less any nonrefundable credits. Soo instructions
enter any refundable aodits and
If this form Is for Form 990-PF, 990-T, 1041 (estate). 1042, or 8804, S 200
avowed as a credit
estimated tax payments made. Include any prior year overpayment
5b from line 6a. Include your paymen t with this form, or deposit with FT0
Balance due. Subtract lino $ 0
coupon II required:See Instructions r Y. . .
Signature and Verification
nying schedules and statements, and to the best of my Smoniedge
Under penalties of perlurY lam that I havaexmnlnod this (um, Including accompa
and belief. a Is true, co d COM (i; sad that I am authorized to prepare this term.
oats * / 04 4/ °,
% hue It. CPA •
sisnoso return the copy.
show below whether or not your application Is approved and will
FILE ORIGINAL AND ON COPY. The IRS will
Notice Reset • To Be Completed by the IRS
this form to your rettxn.
We HAVE approved your application. Please attach the date
er, we have granted a 10-day grace period from the later of
We HAVE NOT approved your application. Howev red to be a valid
(Including any prior extensions). This grace period le conside
shown below or the due date of your return to your return.
on a timely return. Please attach this form
extension of time for elections otherwise required to bo made cann otata itffsro gsgpipROVED
considering the reasons slated in item 4, we
• Q We HAVE NOT approved your application. After
g the 10-day grace period.
an extension of lime to tile. We ere not grantin
after the duo date of the return for which an extension was
Lj We cannot consider your application becaus was tiled
e It
NOV 0 2 2000
requested.
'El Other:
By: nicHtfto CREAMER DIRE97,
Director
which the copy should be sent
address other than that shown above, please enter the address to
If you want a copy of this term to be returned to en
Name
seen ASSOCIATES
190 I Nunibo; street, end room or wile no. (or P.O. box na $mail la not delvered lo steel address)
or
'110 EAST 59TH STREET
Print Fore lorekin address, too instmdlons.
City, twin or pest olke, stele. end ZIP code.
NEW YORK, NY 10022 Form 2758 (nev.8.98)
Fettattoqiork Reduction Act Notice, see the next page JSA
EFTA00224297
29 4 9 1 oms 3 7 0 2•
7 2 0 1545 0052 No.
tion
Return of Private Foundatable
Fo.„990-PF or Section 4947(a)(1) Nonexempt Chari
Trust
ZOO
DeparlM ent ol the Treasury Treated as a Private Foundation g requfremanl&
Internal Revenue Sonia Note: The organiz ation may be able to use a copy ol this return to sells& state reportin
, 2000, and ending 02/28/01
03/01 /00
For calendar year 2000, or tax year beginning_ suares s cnange I I name mange
G ()neck all thatgply: I I Initial return I I 1- inat return I I Arnenoeo return i j
A Employer IdeneftestIon number
Numm Of organization
Vieth. IRS 13-3996471
label. THE C.O. U . Q . FOUNDATION, INC. Room/suite a Week/no number (as page 10 or
la not delivered to street address)
Otherwise. Number and street (or P.O. box number if mai the Instructkos)
print
or type. ASSOCIATES, 110 EAST 59TH ST
See Specific C/O .1t-- C uesoner ko seelosegi •
Wang. choCk hal
li'H
insuctions.
Instruct i City or town. state, and ZIP code
0 I.r em,. trearezallots. dyne IP.
2. Icalgn menIntens inset* ii•
NEW YORK, NY 10022 OS% lea disclilin and Minh O' •
foundation compulaft's
H Check type of organization: [X I Section 501(c43_1 exempt private
taxableprivate foundation
Section 4947(810) nonexempt therilable trust I I Other E g Winn 104.041001 tolui *as lonitleted
n
end J Accou nting metho d:W Cash U Accrua l van, nct.on 607MXIKA). thocl.?so . P. ❑
I Fair market value of all assets at
❑Other (specify) S i %hi 100ridall0n Is In • COmon0. mant .
of year (from Pert It cot (c), line bests.) A urine nate 50/(b OM). check he.. I. n
47,821k (Part I, column (d)mus t be on cash
f
Edi Analysis of Revenue and Expenses
MS falai notof *mounts in columns (b), (0, and
(d) may necessarily equal the amounts in
(a) Revenu
asperse
e and
s 90,
books
(b) Nel investm
income
ent ( )4cfrusted net
income
(d) Disbursements
for chadtable
purposes
(cash basis allv)
column (a) (seepage 10 of the instructions).)
1 Contrieseens. get cams. et,imbed (Ouch 'NOW.) •
2 Distributions from split-interest trusts
3 Interest on savings and temporary cash Investments 4,457
4,457
4 Dividends and interest from securities
6a Dross rents
b (Net rental Inccas or (lees) )
-147,137
6 a Nal pin oe (loss) km sib or 11$3013 Won NW to
s b Gross sales roe kr all
assets on Ono ea
LI 7 Capital gain not Income (from ad IV. line 2)
fi Net short-term capital
0 Income modil
10 a Gross se . .
and
b s: Cll. o goads sou
c rose rotifer' (10,41(• s 0
11 11 norn ach sched 0
—142,680 4,457
12 To clines I 1 V. —re-
13 Corn Iti ti .trustees etc. 10,638
S -- 10, 638
14 Othe ample nos and wages
15 Penslo sram eployee benefits
2 tea Legal fees (attach schedule)
r b Accounting fees (attach schedule)
& a Other professional fees (attach schedule). .
17 Interest 20
Taxes (attach schedule) (so. per II el th•Inevucikno)
I 16
19 Depredation (attach schedule) and depiction
600
I
1 20 Occupancy
.21 Travel. conferences, and meetings
1 22 Printing and publications 7 2,617
m 72, 617
g 23 Other expenses (attach schedule)
.—
I 24 Total operating and administrative expenses.
Add lines 13 through 23
83,875
100,000
83,255
100,000
25 Contributions, gilts, grants paid
26 Total expenses end dlebursomenur. Add lines 0 0 183,255
183,875
24 and 25
27 Subtract line 26 from line 12: __.--. i
'venow and dIsbuniime ents —326 ,555
It Exam of menu. ow I
4,457
b Net Investment Income (II negetive. enter -0-) 0
c Adlustod net incomej4 negative, enter -0.1. • Font 990-PF (2000)
tions.
D014102.000 For Paperwork Reduction Act Notice, see the Instruc
EFTA00224298
Page 2
Attached schedules end amounts m the Beginning of year End of year
Part II Balance Sheets description column should be for (a) Book Value (b) Book Value (c) Fair Market Value
end.f.yeer amounts only. (See Instivctional
32,216 2,144 2,144
1 Cash - nominterest-bearing
1,710 79 79
2 Savings and temporary cash Investments
3 Accounts receivable 19
J
Less: allowance for doubtful accounts ix'
4 Pledges receivable ilx.
Less: allowance for doubtful accounts lw
S Grants receivable
0 Receivables due from officers, directors, trustees, and other
disqualified persons (enrich achedule)pne page IS of the inoructbeh
7 Other notes and loans receivable (attach schedule) Ile
Less: allowance for doubtful accounts II'
in 8 Inventories for sale or use
to 9 Prepaid expenses and deferred charges
./ 10 a investments • U.S. end state government obligation (Death schedule) ,
405,581 111,329 44,100
b investments - corporate stock (attach schedule)
c investments - corporate bonds (attach schedule)
11 izev= en att isturietees. ot. — ..--._ ..-. .. ... .. _..._.--- _.____ —_ ____.--J
Less: scampNeed depredation Op
(attach scmdule)
12 Investments - mortge0e loans
13 Investments - other (attach schedule)
14 Lend. buildings, end la 2,998 _... - . ............-..
equipment: haste 1,498
Less: accumulated deptedsUon p. 1, 500 2,098 1,498
(attach scheauen
15 Other assets (describe ilix )
18 Total assets (to be completed by all filers - see page lEt of
441,605 115,050 47,821
the instructions. Also, see parte 1. Iteml)
17 Accounts payable and ecaued expenses
18 Grants payable
ig Deferred revenue
g 20 Leans from officers, directors, trustees. and other asnuffified persons
1 21
22
Mortgages and other notes payable (attach schedule)
Other liabilities (describe 9' )
I 23 Total liabilities (odd lines 17 Miami, 221
Organizations that follow SFAS 117, check here /to LI
and complete lines 24 through 26 and lines 30 and 31.
Net Assets or Fund Balances
24 Unresincled
25 Temporarily restricted
26 Permanently restricted
Organizations that do not follow SFAS 117,
check here and complete lines 27 through 31. pp. X
27 Capitol stock, trust principal, or current funds
28 Pald.ln or capital surpass, at lend. bldg., and eourement fund
441,605 115,050
29 Retained awnings, aommulated Income endgame% or other funds . .
30 Total net assets or fund balances (see page 17 of the
441,605 115,050
instrucDons)
31 Total llabllitleu and net essetaffund balances (see page 17 of
441,605 115,050
I the instructions)
Part Analysis of Changes in Net Assets or Fund Balances
I Total net assets or fund balances at beghning of year - Part II, column (a), line 30
1 441,605
(must agree with end-of-year figure reported on prior year's return)
2 - 326,555
2 Enter amount from Pan I, line 27a
3
3 Other Increases not Included In the 2 (itemtte)9,
4 115,050
4 Add lines 1,2, and 3
6
S Decreases not included In Ilne 2 (ftemize)I6
6 115,050
e Total net assets or fund balances al end of year (line 4 minus fine 51- Part II column (b). line 30
Form 990-PR (2000)
,sit
0E1420 2.000
EFTA00224299
Page 3
Form 990 PF 3000)
Income
Capital Gains and Losses for Tax on Investment (b) HOW i %rya.
acquires `el ''''''''d (d) Dale IOW
CS List and describe the kind(s) of ;weeny acid (e.g., real estate, Pemba.,
acquire
day, TT4 Iltoir da% Vil
2rstory brick warehouse; or common stock, 200 she. MLC Co.) °Monition OW',
P 06/08/99 06/30/00
la 700 SH AT&T P 06/08/99 07/07/00
b700 SH AT&T P 06/08/99 08/30/00
c1,650 SH AT&T .P 06/08/99 12/09/00
d2,500 SH AT&T
• (h) Gain or (loss)
(I) Depreciation allowed (g) Cost or other basis
(a) Gross sales price plus expense of sale (a) Plus (0 mint' (g)
(or allowable)
37,112 —14,741
a 22,371 -14,145
37,112
b 22,967 -36,328
87,478
c 51,150 -81,923
132,5 50
d 50,627
• to Gains (Cd. (h) gain minus
end owned by the foundation on 12/31/89
Complete only for assets showing gain In column (h) WI (k), but not less than .0.) or
0) Adjusted basis (IQ Excess of col. 0) Losses (keen col. (h))
(I) IIM. as of 12/31189 as of 12131188 Over col. Q), if any
a
b
a
d
e
( If gain, also enter in Port I, lino 7
-147, 137
2 Capkal gale net Income o (net capital loss) If (loss), enter -0• In Part I, no 7 } 2
section s 1222(5 ) and (6):
1 Net short-term capital gain or (loss) as defined In
(see pages 13 and 17 of the Instructions).
If gain, also enter in Part I, line 8, column (c) 1 3
If (losskenter -0- In Pert Likes 8 ment incom e
ed Tax on Not Invest
Part Qualification Under Section 4940(e) for Reduc income.)
t to the section 4940(a ) tax on net investm ent
(For optional use by domestic private loundations subjec
If section 4940(d)(2) applies, leave this part blank.
base period?, . . . OYes El No
4942 tax on the distributable amount of any year in the
Was the organization liable for the section not comple te this part.
4940(e). Do
If Wes.' the organization does not qualify under section
entries.
year; see page 18 of the instructions before making any
Enter the appropriate amount in each column for each
(d)
(0) lb) (0) Distribution nib
period years Calendar yes:
Base lax Net valued noaaterl tablause assets (Col. lb) @Wed be col. MI
Adjusted quatlaftig disintrufban
gm year beginning in) 307,6 35 0.499602
1999 153,6 95
6,642 8.228697
1998 54,655
1997
1998
1995
2 8.728299
2 Total of line 1, column (d
period-divide the total on line 2 by 5, or by
3 Average distribution ratio for the 5-year base 3 4 . 364150
In eAstence if less than 5 years
the number of years the foundation has been
4 208, 595
assets for 2000 from Part X. Ina 5
4 Enter the net value of noncharitablo-use
5 910, 340
5 Multiply line 4 by line 3
8 45
I, tine 27b)
8 Enter 1% of net investment income (1% of Part
7 910, 385
7 Add lines 5 and 6
8 183, 255
8 Enter qualifying distributions from Pad XII, line 4 Instructions on pipe 15.
In VI. line lb. and complete1nel part using a l% lax rate. See the Pan VI
If inane (queue or rester then One 7. chock me cos Pad Fonn 990-PF (2000)
JSA
0E14)0 2000
EFTA00224300
at/O01
pace 18 of the InstructionS)Page 4
P
nil Excise Tax Based on Investment Income (Section 4940(a), 4940(b), 4940(0), or 4948 - see
Lj and enter '71/A' on lino 1.
1a Exempt operating foundations described in section 4940(d)(2), check here le
Date of ruling letter. (attach copy of ruling letter if necessary - see instructions)
1 89
Domestic anizations that meet the section 4940(e) requirements in Pall. check
here 18 and enter I% of Pan I. line 27b
c All other domestic organizations enter 2% of line 27b. Exempt !align organizations enter 4% of Part Lane 12, col. BS
2
2 Tax under section 511 (domestic section 4947(0)(1) trusts and Inaba foundations only. Others enter -0-)
3 89
3 Add lines I and 2
Others enter -0-) 4
4 Subtitle A (income) tax (domestic section 4947(8)(1) trusts and taxable foundations only.
5 89
5 Tax based on Investment Income. Subtract line 4 ficim line 3. If zero or less, enter -0-
6 Credits/Payments:
a 2000 estimated tax payments and 1999 overpayment credited to 2000
b Exempt foreign organizations - tax withheld at source
c Tax paid with application for extension of Lima to rile (Form 6868)
ea
orb
6c
26
I
d Backup withholding erroneously withheld 6d
7 28
7 Total credits and payments. Add linos 6a through ed
if Form 2220 is attached 8
8 Enter any penalty or underpayment of estimated tax Check here 0
owed * 9 61
9 Tex due. If the total of lines 5 and 8 is more than line 7, enter amount
► 10
10 Overpayment. If lino 7 is more than the total of lines 5 and 8, enter the amount overpaid
Refunded 18 11
11 Ent r Lhe amount of line 10 to W. Credited to 2001 estimated tax *
• Statements Regarding Activities
did Yes No
1 e During the tax year, did the organization attempt to Influence any national, state, or local legislation or
1* )1
it participate or intervene In any political campaign?
b Did it spend more than $100 during the year (either directly or Indirectly) for political purposes (soo page
1b X
19 of the instructions fa definition)?
if the answer is Wes'to la or lb, attach a detailed description of the activities end copies of any materiels
published or distributed by the organization In connection with the acUvilies.
1a X
c Did the organization fee Form 1120-FOL. for this year/
d Enter the amount (if any) of tax on political expenditures (section 4955) imposed during the year:
_, (1) On the organization. 18 $ (2) On organization managers. * $
Enter the reimbursement (it any) paid by the organization during the year for poetical expenditure tax Imposed
on organization managers. le $ ••••••••••
2
2 Has the organization engaged In any activities that have not previously been reported to the IRS?
if 'Yes,' attach a detailed description of the actiwbes.
3 Has the organization made any changes, not previously reported to the IRS, in its governing instrument. articles
3
of Incorporation, or bylaws, or other similar instruments? If 'Yes,'attach a conformed copy of the changes
40 X
4 a Did the organization hove unrelated business gross income of 51,000 or more during the year?
4b N
b If 'Yes,' has It fried a tax return on Form 990.7 for nil year?
6 X
S Was there a liquidation, termination, dissolution, or substantial contraction during the year?
If Nes,' attach the statement required by General Instruction 7.
6 Are the requirements d section 508(e) (relating to sections 4941 throtigh 4945) satisfied either:
• By language in the governing instrument or
• By state legislation that effectively amends the governing instrument so that no mandatory directions
X
that conflict with the state law remain In the govamIng Initnirnent?
and Pail XV. 7 X
7 Did the organization have at lent $5,000 In assets at any time during the year? If 'Yes,' complete Part cot (c),
a Enter the states to which the foundation reports or with which it is registered (see page 19 of the
Instructions) p NEW YORK
Attorney
b If the answer is 'Yes' to line 7, has the organization furnished a copyof Penn 990-PF to the
attach explanation X
General (or designate) of each state as required by General Instruction G? If 'No,'
foundation within the meaning of sack(' 49420)(3)
9 is the organization claiming status as a private operating
for Pan XIV on
or 49420)(5) for calendar year 2000 or the taxable 'Oar beginning Ili 2000 (see instructions
9
page 25)? R 'Yes,' complete Part XAr
listing their names and addressed. 10
10 Old any persons become substantial conldbutori diiing the tax year? II 'Yes,' attache schedule
annual returns aiid appecaacn7 11 X.
11 Did the organization with th piLblica requirements for its
ASSOCIATE $ Telephone no. le (21.2) 909 —_9_6_80
12 The books are in care of _ B.
• _
Located at p.110 EAST 59TH ST NEW YORK, NY 10611
7.113+ 4 p.
Section 4947(8)(1) nonexempt charitable trusts filing Form 990-PF In lieu or form 1041-Check here
and enter the amount of tax-exempt interest received or accrued duringthe year
13 1
►I
Farm 990-PF (2000)
iSA
OE 14 40 2.000
EFTA00224301
Page
Form 990-PF (2000)
h Form 4720 May Be Required
Part VIlit Statements Regarding Activltlea for Whic
Yes No
column, unless an exception applies.
File Form 4720 if any item is checked In the "Yes"
or indirectly):
I a During the year did the organization (either directly ❑ Yes El No
ge, or leasing al property with a disqualified wean?
(7) Engage in the sale or exchan
dit to (or accept it from)
(2) Borrow money from, lend money to. or otherwise extend cre r Yes X No
a Csquatified Persen? Yes X No
from) a disqualified person?
(3) Furnish goods. sonAces, or facilities to (or accept them Yes X No
s of, a dierluailied person?
(4) Pay compensation to, or pay or reimburse the incense
person (or make any of either available
(5) Transfer any income or assets to a disqualified
for It* benefit or use of a disqualified person) ? D Yos X
) No
official? (Exception. Check "No-
(6) Agree to pay money or properly to a government
if the organization agreed to make
ent
a grant
service . If
to or
termina
to employ the official for a period
ting within 90 days.)
❑ D Yes No
after termination of governm ions _
fail to qualify under the exceptions described in Regulat
b if any answer is "Yes- to 18(1)-(6), did any of the acts 1b N A
g disaster assistance (see page 20 of the instructions)?
section 53.4941(0)-3 or In a current notice regardin le En
assistance check here
Organizations relying on a current notice regarding disaster
ads described In 1a, other than excepted acts,
c Did the organization engage in a prior year In any of the tc X
day of the tax year beginning in 20007
that were not corrected before the first
not apply for years the organization was a private
2 Taxes on failure to distribute income (section 4942) (does
4942(j)(5)):
operating foundation defined in section 494291(3) or
2000. did the organiz ation have any undistributed Immo (lines 6d
a At the end of tax year 0 Ms ID No
and Be. Part XIII) for tax year(s) beginning before 2000?
19' , 19 , 19
If "Yes,' lb* the years p•• 19
tion is not applying the provisio ns of section 4942(02)
b Are there any years listed In 2a for which the organiza
year's undistrib uted Income? (if applying section 4942(eX2)
(relating to incorrect valuation of assets) to the 2b N A
stagna nt - tee page 20 of the instructi ons.)
to all years listed. answer °No' and attach
plied to any c4 the years listed in 2a, list the years here. •
c If the provisions of section 4942(0)(2) are beirkjap
19 19 19 , 19
Indies Interest in any business
3 a Did the organization hold more than a 2% deed or ❑ Yes M No
enterprise at any ems during the year?
a Jesuit of (1) any purchase by the organization
b If 'Yes,' did it have excess business hot/rigs In 2000 as
the lapse of the 5-year period (or longer period approved
or disqualified persons after May 26, 1969: (2)
to depose of hddngs squired by gift or bequest: or (3)
by the Commissioner under section 4943(O(7)) A
padod? (Use Schedule C Form 4720, to determine
the lapse of the 10-, 15-, or 29-year first phase holding 3b
if the organization had excess business holdings In 2000.) s? 4a X
In a manner that would jeopardize its charitable purpose
4 a Did the organization invest during the year anyamount charitable
year (but after December 31, 1969) that could jeopardize its
b Did the organization make any Investment in a prior 4b
the first day of the tax year beginnin g In 20007
purpose that had not been removed from jeopardy befoie
any amount to:
5 a During the year did the organization pay or incur El Yes FTI No
otherwi se attempt to Influence legisiallat (section 4945(0)(7
(I) Carry on propaganda, or
(see section 4955); or to carry
(2) influence the outcome of any specific public election X No
Yes
on, directly or Indirect ly, any voter registrat ion drive? 1 Yes X No
or other similar purposes?
(3) Provide a grant to an individual for travel, study,
(4) Provide a grant to en organization other than a charitable, etc.,
In section 5013(a)(1), (2), or (3), or section 41340(d X2)7
organization described
n Yes El No
scientific, Merry, or
(5) Provide for any purpose other than religious, charitable.
educational purposes, or for the Preven tioriof comity to children or animals? D [F_IYoe No
transactions fail to qualify under the exceptions described in
b If any answer is 'Yes' to 5a(I)-(5), did any of the 5b N
Regulations section 53.4945 or in a current notice regarding disaster assistance (see page 20 of the Instructions)?
e
assistance chock hero
Organizations relying on a current notice regarding disaster
organization claim exemption from the
c If the answer is 'Yes' to question 50(4), does the
ed expend iture respons ibility for the grant?
ni Yes El No
tax because it maintain
section 53.4945-5(d).
II 'Yes,' attach the statement required by Regulations
6 a Did the organization, during the year, receive any
funds, directlyor indirectly, to pay
ED D Yes No
premiums on a personal benefit contract? contrac t? lib
s, directly or Indirectly, on a persona l benefit
b Did the organization, during the year. pay premium
011 answered West fo 6b. also fife Form 8870.
Form 990-PF (2000)
J5*
OE 1450 7.000
EFTA00224302
Page 6
Form 990-PF (2000)
information About Officers, Directors, Trustees, Foundation Managers,
Highly Paid Employoes,
Part VIII
and Contractors
n sews page cu in (Ins mete tu.uutke_b
1 List all onlours, (mecum's, trustees, rounoation managers ano sneir compensano
(b) 'Tide. and rootage (e) Compensagon bouvoureeneesto (e) Expense account.
(a) Nenie end address (IOW, Per weak (It not paid, enter *mews. lunge08M other allowances
devoted lo position .41.) and alined comonnon
JEFFREY EPSTEIN -PRES/DIA
VI ONE HOUR 0 0 0
6100 RED HOOK QUARTERS, ST. THOMAS,
DARREN K. ,INDYKE /DIR
0 0 0
457 MADISON AVENUE, NY,NY ONE HOUR
GHISLAINE MAXWELL TREAS/DIR
NY,NY ONE HOUR 0 0 0
C76 IOU, ASSOC.,110 E59 ST.,
line 1 - see pago 21 of the ins ructions).
2 Compensation of five highest-paid employees (other than those included on
•
f none, ntor "NONE."
(0) tilt and overage Id) Come Auto, to (e) Expanse account.
hours Per week (c) Compensation *bemuse bomb eisne other allowtinCes
(e) Name and address el each employcs Pall MOM MVO $50.000 end OffignO CempeAuGon
devoted to position
NONE
►l 0
Total number of other employees paid over 250,000
the instructions). If none, enter
3 Fivo highest-paid Independent contractors for professional services - (see pago 21 of
"NONE."
(b) Type of musics Ic) Compensation
(a) Name and address of each person paid more than $50 000
NONE
Total number of others receiving over $50,000 for professional services
Part 1X-A Summary of Direct Charitable Activities
relevant statistical IrJorrnstion such as the number
LIM the foundation's lour largest direct charitable act Mess during the lax sat Include produced, Expanse
rch papers etc.
01 organizations end other benektento sewed. conferences convened. resea
1
2
3
4
Form 990•PF (2000)
eta
NINOUN
EFTA00224303
Page 7
Form 990•PF (2000)
22 of the instructions)
Part 1X -B Summary of Program-Related Investments (see page
Amount
by the foundat ion donna the tax year 9n fines 1 and 2.
cube the two lamest program-related investments made
2
Al other program-related lavietnionti. See pap 22 ol Ne InsUuctkms.
3
must complete this part. Foreig n foundations,
Part X Minimum Investment Return (All domestic foundations
see page 22 of the instructions.)
directly in carrying out charitable, etc.,
1 Fair market value of assets not used (or held for use)
purposes: to 193,697
a Average monthly fair market value of securities 1b 18, 07 5
b Average of monthly cash balances lc
of the instructions)
c Fair market value of all other assets (see page 23 Id 211,772
d Total (add lines la, b, and c)
reported on lines la and
Reduction claimed for blockage or other factors
lc (attach detailed explana tion) I la I
2 0
2 Acquis ition indebte dness applica ble to line 1 assets
3 211, 772
3 Subtract line 2 from line ld
1 1)2% of line 3 (for greater amount, see
4 Cash deemed held for charitable activities. Enter i 4 3, 177
page 23 of the instructions) Part line 4 208, 595
line 4 from line 3. Enter here and on
5 Net value of noncharltable•use assets. Subtract 6 10,4 30
Minimum Investment return. Enter 5% of line 5
4942( j)(3) and (i)(5) p Nate operating
instructions) (Section
Distributable Amount (see page 23 of the s check here ► FI and do not compl ete this part.)
foundations and certain foreign organization 10, 4 30
1 Minimum investment return from Part X. line 6 89
VI, Me 5
2 a Tax on investment income for 2000 from Part
tax for 2000. (This does not include the tax froth Part VI.) , 89
b income
c Add lines 2a and 2b 10, 341
ct line 2c from line 1
3 Distributable amount before adjustments. Subtra
as qualify ing distribu tions
4 a Recoveries of amounts treated
b Income distributions from section 4947(a )(2) trusts
c Add lines 4a and 4b 5 10,341
5 Add lines 3 and 4c
23 of the InStructions)
6 Deduction from distributable amount (see page 10, 341
ct line 6 from line 5. Enter here and on Part XIII, line 1
7 Distributable amount as adjusted. Subtra
Part XII Qualifying Distributions (see page
24 of the instructions).
accomplish charitable, etc., purposes:
Amounts paid (including administrative expenses) to In 183, 255
Part I, column (d), Ins 26
a Expenses, contributions, gifts, etc. - total from lb
Part IX-13
b Program-related investments - total of lines 1-3 of charita ble, etc.,
directly in carrying out
2 Amounts paid to acquire assets used (or held for use) 2
purposes
satisfy the:
3 Amounts set aside for specific charitable projects that 3a
a Suitability test (prior IRS approval required) 3b
le)
b Cash distribution test (attach the required schedu 8 and Part XIII, lino 4 4 181,258
Enter here and on Pal, line
4 Qualifying distributions. Add lines la through 3b.
for the reduced rale of tax on net investment
6 Organizations that qualify under section 4940(e) 5
of the instructions)
income. Enter 1% of Peril, line 27b (see page 24 6 183,25:
5 from line 4
Adjusted qualifying distributions. Subtract line whethe r the foundat ion
(b). In subsequent years when calculating
Note: The amount on lino 6 will be used in Part column tax in those years.
qualifies for the section 4940(e ) reducti on of
Form 990-PF (2000)
OE 1410 2000
EFTA00224304
Paw 8
Form 090.PF (20001
)
Part XIII Undistributed Income (see page 24 of the instructions
(b) (c) (d)
(a)
Years prior to 1999 1999 • 2000
Distributable amount for 2000 horn Part XI,
Corpus
1 10, 341
line 7 •
el 1999.
2 Undistributed InCome. Many. Ind tee end 0
a Enter amount for 1999 0
b Total for prior )ten:
3 Excess distributions carroyer, if any, to 2000:
a From 1995
b From 1998
o From 1997
d From 1998 54, 323
138,4 85
e From 1999
192,808
1 Total of lines 3a %Arousal e
4 Qualifying distributions for 2000 from Part
183,255
XII, lino 41. 0
• Applied to 1999, but not more than line 2a
b Applied to undistributed income of prior years 0
(Election required • act one 25 at the rstructions) .
c Treated as distributions out of COMUS (Election 0
required • see page 25 of the instructions)
, 10, 341
d Applied to 2000 distributable amount
17 2, 914
o Remaining amount distributed out of corpus 0
5 Excess distributions carryover applied to 2000
(Iran amount appears in column (d). the same
amount must be shown In column fen
B Enter the not total of each column as
Indicated below:
365,722
a Corpus. Add lines 31. 4c, and 4e. Subtract line 5
b Prior years' undistributed Income. Subtract 0
line 4b from line 2b
c Enter the amount of prior years' undistributed
income for which a notice of defiCiOnty has been
Issued, or on which the section 4942(a) tax has 0
been previously assessed
d Subtract line 6c from line 6b. Taxable 0
amount - see page 25 of the Instructions
• Undistributed Income tor 1099. Subtract line 41
0
from line 21. Tenth* 'meant . NO pep 25 piths
Instruction'
f Undistributed income for 2000. Subtract lines
4,1 and 5 from line 1. This amount must 0
be distributed in 2001
I Amourils vested es rester:lotions out or corpus to
saltily requirements Imposed by
110(100 1200XIXE)Ot
0
494 2(9)(3)(see pone 26 ol the Intstrut6066)
not applied
8 Excess disidbutions mower from 1995 0
on lino 5 or line 7 (see Pearl 25 or the lastruclkes)
9 Excess distributions carryover to 2001.
365,722
Subtract lines 7 and 8 from line 6a
10 Analysis of line 9:
a Excess horn 1996 . . .
b Excess from 1997
54,323
c Excess from 1998 . . .
138,485
d Excess from 1999 . . .
1 72_, 914 '
e Excess from 200(1 - • •
Form 99 0-PF (2000)
)9A
OE 1410 11.000
EFTA00224305
Faze 9
jaa2000)
-A, on 9)
Private Operating Foundations (seepage 25 of the instructions and Part VII quest
1 a If the foundation has received a ruling or determination letter that It is a private operating
foundation, and (ho ruling Is effective for 2000, enter the date of the ruling
in 4942(0(3j or 4942(0(5)
b Chock box to indicate whether the organization is a privaie operating foundation described section I
Tax year Price 3 sears
2 a Enter the lesser of the 001997 Id Total
adjusted net Income from fa) 2000 MI 1999 is) 1908
Pert I of the minknum
Investment return from Pan
X for each year listed . .
b 85% of line 2a
C CluMfying nInbudeno cam Pon
Me 4 for oath year bolo,
ti Amounlo inderlid 0.110 2e 1101
void dmody to wino condo°
of ammo; wend
9 Overripe' dembumms moos
Oil ocUy lot icon arta 44
sump! saves Sueuect
III. 2d from1no te
3 Camelot' 30. D. or c la Ps
senates toot rogod vow:
0 'Nate tilerlSiVe lost -*Milt:
( 1 ) Y910000 anew
(2) Valve cd smote 0/WW2
tondo serlierl
4942(0085n
b 'Endowment' Memos ten -
Enloe 7/3 el minimum
Inwootrnent 1110011 00On ;it
Put A. Ins S kr tom yes
listed
11 'Support* ollomo0.• toot • only.
(1) Total support elho• Pan
0(051 Inmotmant Income
(Unwed. adds de. i$414.
payments On 1.1011100.
loom; (tic 3I2t0X111
or reMn)
(2) Supped hem own;
Ovbeo and 5 re ewe
morem ovemuolam
preydod it swan
tettLx3Xlhaw
(3) isrpeil amount el smool
From en rano;
nonlurlon
Slaws hmumeei .
or more In
Supplementary Information (Comp eta this part only If the organization had $5,000
• assets at any Ime during the year -- sae page 26 of the Instructions.)
t Information Regarding Foundation Managers:
total cone:Monona received by the foundation
a List any managers of the foundation who have contributed more than 2% of the
507(d)(2).)
before the close of any tax year (but only if thoy have contributed more than $5,000). (See section
JEFFREY E. EPSTEIN
(or an %Nally largo portion of the ownership
b List any managers of the foundation who own 10% or more of the stock of a corporation
of a partnership or other entity) of which the foundation has a 10% or greater Interest.
2 Information Contribution, Grant, Gift, Loan, Scholarship, etc., Programs:
and does not accept unsolkriod mounts lot funds.
Check here fr W If the ofesolzellon only mates COntdbullens to preselected charitable orpenitabons
of the Instructions) so Inehleuals a ohoentzations under other commons, complete Items 2e. b, c. end d.
If the 0Manbelicin mates 07. WOOL etc. (see one 29
of the person to vrhom applications should bo eddrossed:
a The name, address, and telephone number
materials they should Include:
b The form In which applications should be submitted and information and
o Any submission deadlines:
charitable fields, kinds of institutions, or other
d Any restrictions or limitations on awards, such as by geographical areas.
factors:
ISA Fern 990-PF p000i
01.1420 2 000
EFTA00224306
Page 10
Form D90-PF (2000)
Part XV Supplementary Information continued)
II recipient la an Individual. Foundatico
Recipient showsay amatmakolo own of Purposed grant or
Amount
loundalladi manner contribution
Name and address (home or business) any reclaim%
9 substantialcontributor
a Paid during the year
STATEMENT
I
lit. 3a 100, 000
Total
b Approved for future payment
lo. 3b 0
Total
Form 990-PF 12000)
.19A
abider 2.000
EFTA00224307
Page 11
Form 990-PF (2000)
P X I- Analysis of Income-Producing Activities 10)
Unrelated business income Excluded b) section 512, 613, or 514 Relined or
Enter gross amounts unless otherwise indicated.
Nil
Business
(b)
(c)
Evar
(d)
Amount
• g:tacag,
: code Amount
1 Program service revenue
a
b
c •
d
a
1
9 Foes end contracts from government agencies
2 Membership Ikea and assessments
3 Interest on seethes and temporary cosh investments 14 4,457
4 Dividends and interest from securities , , . . I
5 Net rental Income or (loss) from real estate:
a Debt-financed property
b Not debt-financed property
6 Net tent.' Income a (loss) kern personal Impala/
7 Other Investment income 18 -147,137
8 Gain or pogo from sales Name's cern( thin Inventory
9 Not Income or (loss) from special events •
10 Gross profit or (loss) from sales of in901201).
11 Other revenue: a
b
c
d
• -142,680
,
12 Subtotal Add coitmins (b), (d). and (e) , to 13 -192, 680
13 Total Add line 12, Mums (b), (d). and (e)
verify calculations )
See worksheet in line 13 Instructions on pawn o ses
: 'Relationship of Activi ties to the Accomplishment of Exempt Purpo
income is reported In column (e) of Pad XVI-A contributed Importantly to
Explain below how each activity for which ng funds for such purposes). (see
exempt purposes (other than by providi
Una Na the accomplishment of the organization's
page 27 of the Instructions.)
Form 990-PF (2000)
JSA
Of I 49a 2,000
EFTA00224308
Pepe
esiO.PF Not
To and Transactions and Relationsh
ips With Noncharitable
Information Regarding Transfers
Exempt Organizations Yes No
described in sec ion
any of the following with any other organization
Old the organization directly or indirectly engage In organizations?
organizations) a in suction 527, relating to political
601(c) of the Code (other than section 501(o)(3)
nonCharitable exempt organization of: •••m••••
Transfers from the reporting organization to a laid X
(1) Cash . lain X
(2) Other assets
b Other Traosaction 16(1) x
tion
(1) Sales of assets to a noncheritatie exempt organiza 1bW
tion
(2) Purchases of assets from a nom:heritable exempt organiza 16138
(3) Rental of facilities. equipment, or other assets 'O(\
(4) Reimbursement arrangements 16(51
(5) Loans or loan guarantees 1bfI
or fundraising solicitations
(6) Performance of services or membership 10
facilitie s, equipm ent, mailing lists, other assets, or paid employoes
a Sharing of show the fair market
e the following schedule. Column (b) should always
d If the answer to any of the above is 'Yes." complet loss than fair
by the reporting organization. I the organization received
value of the goods, other assets, or services given other assets, or services
show in column (d) the value of the goods,
market value In any transaction or sharing arrangement.
received. armaments
Jo) Name of mecheritatte exempt alanliatien (0 Description d Veneers eansactkos end sharing
Line no. fb) Amount into
tions
d with, or related to, one or more lakeismpt organiza
2 a Is the organization directly or ndlreclly affiliate
section 501(c)(3 ))or In section 5277 lj Yes D
No
described In section 501(c) of the Code (other than
b 'Y • canolete the
DI Description of estalioahlp
(a) Name et Orgentragon DI Tea Of deentution
JEFFR EY E. EPSTEIN IS
PRIVATE FOUNDATION
EPSTEIN INTERESTS IDENT AND A CONTRIBUTOR
PRIVATE FOUNDATION PRES
J. EPSTEIN VIRGIN ISLANDS
TO ALL THREE FOUNDATIONS
FOUNDATION, INC.
PRIVATE FOUNDATION GHISLAINE MAXWELL IS A TRUSTEE
MAX FOUNDATION OF BOTH FOUNDATIONS
e d bold, it is
nying schodu and statements. and to the best of my knowledg an
lare wail have examined this return. including accompa
I
Under penalties of palm fon of vihiCh wearer has any knowledg e.
other than Unrayer or (duciary)ls based on all I
true, correct, and comp a. Dec ration dampers:
I
?'• '97 • ii •
Oslo r lute . /1'
Stratum of aim or trustee 9 s SSN or PTIN
Sign Here
/001 c
e n
ptoye
hock dep. I. ii Prepare
Did7 (Sac Signature on P999 28
1g Pit:adorer's k
r /
I ,: 9 gnature
Firm's name ( yarn
I. ASSOCIATES ON lit. I IMIM
If self-employed), address, e lli lIST 59TH STREE T
10022 Phone no.
and ZIP code NEW YORK, NY
I ran 990-PF (2000)
rsn
del 493 2.000
EFTA00224309
THE C.O.U.Q. FOUNDATION
13-3996471
Y/E 02/28/01
FORM 990PF
STATEMENT 1
PART I. LINE 23
OTHER EXPENSES
Bank Charges 36
Consulting & Research 50,000
Filing Fees 180
Health Insurance 3,974
Office Expense 145
Payroll Expense 1,284
Telephone 226
Total 55,845
STATEMENT 2
PART II, LINE 10(b1
INVESTMENTS. CORPORATE STOCK
Book Value Market Value
2,100 SH AT&T 111,329 44,100
STATEMENT 3
PART XV. LINE 3
CONTRIBUTIONS PAID
07/06/00 World Economic Forum $50,000
05/04/00 Ionia, Inc. $50,000
Total $100,000
EFTA00224310
EXTENSION ATTACHEG
OMS No 1545 0052
F.990-PF Return of Private Foundation
oriiecteen4947(a)(1)tionexensptCharitableTrust
Dopanmon't olteeTreasury Treated asa Private Foundation requuemena
2001
InterneFtovitnue Samos Note The organization may be ada to use a Øyd PM retur', lo satisly state reporang
03 01 01 2001, and endel 02/28/02
'or calendar eat 2001 or tax oar be Inni
return Final return Amended return Address charge 'Nome °hange
3 Check all Chat 3 '
A E/ni:kipa Idimulketion numbor
Neme ol organa:al«
Us* tho IRS
13-3996471
lab*, THE C 0 U Q FOUNDATION, INC
(»envist% Numbor and street (or P 0 box numbor d mal ts not deiwered to street address) Roongsuito B Tol•phonn nurnber (1.0 6096 le ot
tho wittnictiore)
print
or type
1.1 ASSOCIATES, 110 EAST 59TH ST.
Ses Seedet C/010101 e il wrimptcn ►
City ot town, sta anti ZIP cafe .9Licr " .
ptindaig 6160 •
Instruction
l) %als Organ:ram cbv:/then. ►
10022 2 Fonnen eiginiteemelSig 114
NEW YORK, NY 65% lan d.a hun ene i I.
14 Check type of orgarezabon i X I Section 501(ca exempt private foundation compulaan
ri Sedlen 4941(a)(1) nomerompi chadable bust n
I Fair merket value of all assets at end
Olher taxable puvete loundation
J Accounting melhud Luc Cash LI Accrual
e 1/ pmau reenineen 6161565a. ~Mod rn
tant, na.on 50%b 16/4 cm* hala
of year (horn Part II, ad (c), kne ri OMGI' (spocify) F /11156 loondahon la in el)NnoninleonnlitCn
n iiii 12, 573, 103 (Part i. tolunn (d) mus: be on cash basis ) undili uncis 50/[b 16115 chn% lun ) 5 ri
(d) Dtsbursements
Analysis of Revenue and Expenses (a) Revenue ni (b) Net investment ( ) Adjusted net for chantalake
(17ze total of amounts n cdumns (b), (c), and
the amourds inpenses per income ineome parposes
Pemay not nocessanly aqua! booke
(e) (sea page 10 ol the instmciscns)) (cash basis °nite
column
i Coanbann n. 'scenel team artselme) 32
1156 tegneleen is 001repustel ID
Chice eriach Sch B
2 Distributions hom sølt-Internt buste
39,223 39,223
3 lille((ril on savspe end 56014104%iy t&Sh Inserere
219,790 219,790
4 Dmdends and interest from sectiMeas
5a Gross rente
b elet Neie ~me or (lote)
5a Net VM or onn) from ule ot auet, not on be 10 13, 101$51
b Gies* saknenes lor sit
'peis on Si. sa
13,101,951
7 Oppdal gem net incomo (frem Part IV, hno 2)
13 168 397
8 Net short-term captal gein
9 Income modifications • • •
10 s Gross sees bes rorums
end atkmences •
b Lest eost of potes solel
e Gross profil c< (loss) (allach schekile)
11 Othor meorno (aftach acheAde)
13, 360, 996 13, 360, 964 13,168,397
12 Total Aud lines 1 Inn:mett 11 i
13 Componeetton ot ~ro nedom trues sto
14 Olher employee selanes and ringes
15 Pension plans, employoe banefits „
1,962 1, 962
18a Legal Res (attach schodale)
4, 332 4,332
• b Accounling feos (altach schedule)
c Other esprinalfees (Lattac/
C 17 kikkes REGI:Rit
—scheduite len;; ;in/ 1% 61 253
c 18 Tonn(
Deprec t r ittet dtp on 600
O 19 *
20 ()ete -
• • • t_19-:
21 Travel, on etes, n randr uleetings,...,-
In 22 Panting and pi6D‘.6tWN, u i
c 50_, 809, 50, 809
23 Othor expenses (anedl schedule) ST 2 .
14 Total operating and admintstravo typenes*
aO Add lines 13 through 23 • , 57,956 57,J.03
845, 000 845, 000
25 Conlyebubon!, girt, grans pakt
28 iss ineeeeeteeeettenemmue Atitlinis 24 an5125 902, 956 0 0 902,103
27 Sublrael line 26 from lene 12
• UN., alrevens» ev«ripren end disbuninwel, 12, 458, El40
b Not Investment Incoma negative, enter 4-) 13, 360, 964
13,168,397
• AdJustod net interne gl negative_ enter -04_
2 Fonn 990-P F noci$
alm 1.455
56 For Paperwork Reduction Act Holke, sos the InstnictIons
EFTA00224311
a2
F rn 99¢PF2 1
Attached sanctums and amounts In the Beginning of veer End of year
Part II Balance Sheets desCriplion colonel should be for (a) Book Value (b) Book Value (c) Fair Market Value
end(ol.year amounts only (See Instructions )
2,144 14,811 14,811
1 Cush • non-interest-boanng , ,
2 Savings and temporary cash investments . . . . 79 12,307,404 12,307,404
.
3 Accounts receivable *
Less allowance for doubtful accounts *
4 Pledges recervable le
Less allowance for doubtful accounts le
5 Grants arnelVable . . .
6 Receivables due from officers, directors, trustees, and other
disqualified persons (attach schedule) (see page IS of the washeons)
7 Other notes and loans reoervable (attach schedule) O'''
Less allowance for doubtful accounts le
41 8 Inventones for sale a use , , ,
: 9 Prepaid expenses and deferred charges , . . .
se
4 10 a InvernmentS • U 3 and slats government obbgebons (attach schedule) .
b investments - corporate stook (attach schedule) . . . 111,329
c Investments - corporate bonds (attach schedule) . .
ii 177g7Zgi ,r1r".. *
Leh accumtamsd deprecation *
(attach schedule)
12 Investments • mortgage loans . , .
13 Investments • other (attach adtcdthe) , , , . .
14 Land budings, and Il. 2 L 9138
equipment basis
Less &COMO Add deposcation gii, 2 L100 1,498 888 888
(attach echedua)
) 250,000 250,000
15 Other assets (detente * Property rights
16 Total assets (to be completed by ell filers -see pegs to of
the instructions Also, see page 1, item l) • • • • - • • • 115,050 12,573,103 12,573,103
17 Accounts payable and accrued toppings . . , . , , ,
16 Grants payable . . . . . . . . . . .
-: la Deferred revenue . . . . .
... 20 Loans Imo officers (hectors. Innate, and caw OISCIVOlkaa POW'S .
Mortgages and other notes payable (attach schedule) .
1 21
22 Other habldies (descnbe lie )
23 Total Imbeciles (add Imes 17 IhroUal) 221 • • • • •
Organizations that follow SFAS 117, check hero ,.. LJ
and complete lines 24 through 26 and lines 30 and 31
E 24 u4,441444.2 . , ... . ..
5 26 Temporanly restricted . . . . . . . .
.
a 26 Permanently restricted • • • • •
vc Organizations that do not follow SFAS 117,
2
is. chock here and complete lines 27 through 31 p. x
t• 27 Capital stock, trust principal, or current funds . . . .
f
o 2$
p29
Palcbm or evaded surplus, a land. bldg end equipment fund
Retained earnings, accumulated income encloomonl. Of Olibef iAldt
115,050 12,573,103
4 30 Total net assets or fund balances (see page 17 of the
to , , , , , 115,050 12,573,103
z instructions) . . . . . , , , , , .
31 Total liabilities and net assets/fund balances (see page 17 of
the instructions) • • • • • • • • 115,050 12,573,103
Part III Analysis of Changes In Net Assets or Fund Balances
I Total net assets or fund balances at beginning of year • Part k, column (a), hne 30
, 115,050
(must agree with end-of-year figure reported on prior years rotten)
, 12,458 040
2 Enter amount from Part I, line 27a
3 13
3 Other increases not included in line 2 (Remo) le Rounding
4 12 573 103
4 Add lines 1,2, and 3
5
5 Decreases not included in MO 2 (itemize) le
6 12 573 103
Total net assets or fund balances at end of year (hne 4 minus line 5) - Pad II column (b), line 30 .
Fenn 990-PF (2001)
JSA
131420)003
EFTA00224312
Paco 3
F 12001)
Capital Gains and Losses for Tax on Investment Income
(b) How
) Date
‘c"w:. 4 -
ne... (el) Date soid
(a) List and descnbe the kind(s) of property sdd (e g. real estate, occlusal
iry" (rno . day1 yr)
ninon, ( x)
2-story brick warehouse, a cannon meek 200 shs MLC Co) D-Donabon na
• dirt
1a Statement 3
b .I
c
d
e
(e) Gross sales price (t) Depreciation allowed (g) COS) or other basis (h) Gain a foss)
(or allowable) plus expense of sale (e) plus (I) minus (g)
a
b
c
d
a
Complete only for assets showing gain in column (ll) and owned by the foundation on 12131/89 p) Gans (Cd (h) gain minus
(I)Adiusted basis (Id Excess d col (i) cot (k), but not less than -0-) or
(I) F M' as of 12/31/139 over ed 0), if any tans (from cd (h))
as of 12131169
a
b
e
d
e
If gain, also enter in Pan I, line 7
{
2 Capital gam net income o (net caplet loss) • • •
If (loSs). enter -0- in Pad I, tine 7 } 2 13, 101, 951
3 Net short-term capital gain or (loss) as defined in sectons 1222(5) and (6)
If gain, also enter in Part I, line 8, column (c) (see pages 13 and 17 of the instructions)
. , , . . . ) 3 13, 168, 397
If (loss), enter -0- in Part I, line 8 , . . .
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 Mink
. No
Was the organization liable for the section 4942 tax on the distributable amount of any yearn the base perod? Yes ❑
If Wes; the organization does not qualify under section 4940(e) Do not complete gas part
making arty entries
1 Enter the appropriate amount in each column for each year. see page 18 of the instructions before
(d)
(a) 04 (c) ChsInbuleln Aim
Base petted Alm Calendar see Net valued 00nCasntable-use Mats
A/Jollied (SIIIIITASI (Ilibibubcni (Col (b) deeded eyed fen
(or lox reef bedetrung in)
183,25`5I 208,595 0.878521
2000
1999 153,695 307, 635 0 4 99602
1998 54,655 6,642 8 228697
1997
1996
. . . , . . . . . . . . 2 9 606820
2 Total of line 1, column (d . .
3 Average distribution ratio for the 5-year base period-divide the total on lone 2 by 5, or by
than 5 years . 3 3 202273
the number of years the foundation has been in existence rf less
. , . . 4 7,498,097
4 Enter the net value of nonchantabte-use assets for 2001 from Part X, line 5 .
. . . . . . . . . . . . . . 5 24, 010, 954
$ Multiply line 4 by line 3 . .
. . . , . 6 133, 610
6 Enter 1% of net investment income (1% of Part I, line 27h)
. . . . . . . . . . . . . . 24,144, 564
7 Add lines 5 and 6
• • . • • • . • • 8 902, 103
8 Enter qualifying distributions from Part XII, line 4
Mal pan ming a l% tea Ms See the Pei VI inelyuctons co peg. IS
Ilene a Is ideal to or greater than Me 7. Meek the bac el PM VI Me lb. end coMpWe
Jae [Aim qcsfi-PF rWinti
le trine cen
EFTA00224313
Page
FOMI oliFr2001) ) 4940(p ), 4940(e ), or 4948 - see page 18 of the Instructions)
4940(a
Excise Tax Based on Investment Income (Section
(2), check hero * and enter 'NM' on line 1
1a Exempt operating foundations described in seCtIon 4940(d)
(attach copy of ruling letter if necessa ry -see Instructions)
Date of ruling letter 267,_219
ahons that meet the section 4940(e) requirements if, Pan 'check
Domestic or
• . , . • •
here Ilk Lj and enter 1% of Part I, tine 27b
I •
Exempt foreign organtia ticns enter 4% of Part I, Me IZ col (b)
c All other domestic organizations enter 2% of line 27b 2
)(1) trusts and taxable Icundab ons only Others aster -0-)
2 Tax under section 511 (domestic section 4947(a 3 267,219
3 Add lines 1 and 2 ,
-0-) 4
trusts and taxable foundations only Others enter
4 Subtitle A (Income) tax (domestic section 4947(a)(1) 6 267,219
Subtrac t Me 4 frern lino 3 II zero a less, enter -0- , • •
5 Tax based on Investment Income
6 Credits/Payments
to 2001 6a 1
a 2001 estimated tax payments end 2000 overpayment credited
bb
b Exempt foreign organizations - taxwithheed at source 89
6e
c Tax paid with application for extension of time lo file (Form 8868)
64
d Backup withholding erroneously withheld, , . . .
7 89
• •_,.. •
7 Total credits and payments Add lines 6a through 64:1
OW • • • •
8 6,609 _
here t , l if Form 2220 is attached , , ,
a Enter any penalty fa underpayment of estimated tax Check Ile 9 273,739
7, enter amount owed • , , • . .
9 Tax due If the total of lines 5 and 8 is mete than hoe . 19 10
total of lines 6 and 8, enter the amount overpai d . . . . . . , ,
10 Overpayment. If line 7 is more than the I Refund ed * 11
estimated tax *
11 Enter the amount of line 10 to be Credited to 2002
Part VII-A Statements Regarding Activities Yes No
e any national, state, a local legstaton a did
a During the tax year, did the organization attempt to influenc 1a
• • • •
it participate a intervene in any political campaign?
• • •
or indirect ly) for political purpose s (see page
b Did n spend more than $100 during the year (either directly 1b x
• • • •
19 of the Instructions for definition)?
• • •
• •
on °Oho acInntias and copies or any manna 's
If the answer /9 "Air to fa or lb, attach a debuted descnpb
tion in connect ion with the acimtres
published or distributed by the organiza x
L for this year? • • , . . .
c Did the organization tile Form 1120-PO
4955) imposed dunng the year
Enter the amount fit any) of tax on political expenditures (section
(1) On the organization * (2) On organization managers ► $
ation during the year for politcal excencliture tax imposed
• Enter the reimbursement (il any) paid by the organiz
on organization managers
not prinnously been reported to the IRS? ,
2 Has the organization engaged in any activities that have
If 'Yes,' attach a detailed descnpbon of the activitie s
sly reported to the IRS, in its governing Insliument, articles
3 Has the organization made any changes, not previou
nts? If 'Yes.' attach a conformed copy of the changes , • • . •
of incorporation, or bylaws, or other similar instalme 4a
inccrne d 51,000 or more during the year? ,
4 a Did the organization have unrelated business gross 4b N A
, , • • •
b II `Yes' has it filed a tax return on Form 990.T for this year? 6
tial contraction dunng the year?
5 Was there a liquidation, termination, dissolution, or substan
nt required by Genera l instructi on T
It Yes,' attach the stateme
s 4941 through 4945) satisfied either
6 Are the requirements of section 508(0) (relating to section
• By language in the governing instrument or
ng ent so that no mandatory directions
• By state legislation that effectively amends the governi instrum 6
governin g Instrume nt? . . • • •
that conflict with the stale law remain in the Part XV 7
Part IS, cot (c), and
time dining the year? a 'Yesi scomplote
7 Chd the or ganization have at feast 55,000 in assets at any
or with which it is registered (see page 19 of he
a Enter the stales to which the foundation reports
instructions) o. New York
tion lumishoi a copy of Form 990-PF to the Attorney
b If the answer is Yes' lo line 7. has the organiza eb
Instruction G? It 'No,' attach explanation . . . .
General (or designate) of each state as required by General
operating foundation within the meaning of section 49420)(3)
9 15 the organization claiming status as a private
beginning in 2001 (see instructions fa Part XIV on
or 49420)(5) for calendar year 2001 of the taxable year
page 2s)? complete Part XN • • • • • • •
10, x
and addresses
tax year? //Yes,•attech a schedule listing their names
10 Did any persons become substantial contributors dunng the 11
ion requirements for its annual returns and exempti on applicati on?
11 Did the organization comply with the public inspect
Web site address _
Telephone no 1._11121_909-9680
The books are in care of i.jullint_ Dotson Associates --- ---------------
21P+4 yo 10222
t, New York,. NY
Located at ► 110 East 59th Stree , • . . . •
Pang Form 990,PF in lieu of Form 1041 -Check hero
13 Section 4947(e)(1) nonexempt chantable trusts . 13 I
or acaued during the year .
and enter the amount of tax-exempt interest received Form 990-PF (2001)
sE1440 4000
EFTA00224314
Page 5
Form 990-PF (2001)
4720 May Be Required
Statements Regarding Activities for Which Form
Yes No
column, unless an exception applies
Filo Form 4/20 If any Item Is checked In the "Yee
ation (either direetty cr indirectly)
1 a During the year did the organiz Yes M No
ge, or leasing of property with a disqualified person? .
(1) Engage in the sale or exchan
extend credit lo (ot accept a from)
(2) Borrow money kern, lend money to, or otherwise Yes No
person? • . .
a disqudilled Yes x No
.
Moll= lo (or accept them from) a asquallied person?
(3 ) Furnish goods services, or . . . , Yes X No
s of, a disqualif ied person?
(4) Pay compensation to, or pay or reimburse the axpense
make any of either available
(5) Transfer any income or assets to a disqualified person (a
for the benefit or use of a disqualified person)? . . . . . • • 0 Yes 0 No
official? (Exception Check 'No'
(6) Agree to pay money or property to a government
if the organization agreed to make a grant to or to employ the official for a gonad
after termination of government service , if termina ting within 90 days ) 0 Yes Q No
fail to qualify under the exceptions describe d in Regulat ions
b II any answer is 'Yes' to 1t(1)-(6), did any of the acts . . . . Ib N A
section 53 4941(d)-3 or in a current notice regardin g disaster asststate (seepage 19 of the instructions)?
•
assistance chock here
Organizations relying on a current notice regarding disaster
acts deserted in it other than excepted acts,
e Did the organization engage in a prior year in any of the le
begnning in 20017 . • . •
that wore not corroded before the first day of the tax year
(does not apply for years the organiza tion was a private
2 Taxes on failure to distribute income (section 4942)
4942Q)(5))
operating foundation defined in section 49420)(3) or
any undistributed name (lines 6d
• At the end of lax year 2001. did the organiz ation
before
have
2(3017 . . . . .
Dyes Elc.No
and 6e. Part XIII) for tax years) beginning
If 'Yes.' list the years
2)
ban is not applying the provisions of section 4942(0X
b Aro there any years listed in 2. fa which the orgeniza (2)
uted income? (II applying section 4942(0)
(relating to incorrect valuation of assets) to the year's undistrib 2b N A
answer 'NW and attach stateme nt • see page l9 of the instructions ). . . .
to all years listed,
to any of the years listed in 2a. hal the years here
II the provisions of section 4942(8)(2) ere bang applied
or indirect interest in any business
3 a Did the organization hold more than a 2% direct ❑ Yes ri:( No
enterprise at any arse dung the year? • , „ . . . . . . .
a result of (1) any purchase by the organiza tion
b If - Yes' did it have excess business hddings in 2001 as
26, 1969, (2) the lapse of the 5-year period (or tenger period approved
or disqualified persons atter May
of holdings weaved by gift a bequest, or (3)
by the Commissioner under section 4943(c)(7)) to dispose
period? (Use Schedule C, Form 4720, to determine
the lapse of the 10-, 15-, or 20-yew first phase holding 3b N
) • • • . •
d the orgennatran had excess business hdangs in 2001 to
amount in a manner that would popard ae ys charitab le purposes? . . .
4 • Did the organization invest during the year any :pardon its chwitable
in a prior year (but after December 31, 1969) that couldpi
b Did the organization make any investment 4b
the first day of the tax year beginning in 2001?
purpose that had not been removed from Jeopardy before
5 a During the year did the organization pay a
(1) Curry on propaga nda, or otherwi se attempt
incur any
to
amount
influenc e
to
legislation (section 4945(e))? ri Yes LNo
(see section 4956), or to carry
(2) Influence the outcome of any specific public steelier) Yes No
on, directly or indirect ly, any voter registra tion drive?
Yes No
or other similar Purposes? • •
(3) Provide a grant to an individual for travel, study,
(4) Provide a grant to an organization other than a
in section 509(8)(1), (2), or (3), or suction 4940(0)
charitable, etc, organization descnbod
(2)7 • , , • • , n Yes I NI No
than religious. charitable, sooner); literary. Cf
(5) Provide ler any purpose other
educational purposes, or for the prevention of cruelty to children or animals? F-1
, Yos I N-1No
describe d in
the transactions fail to qualify under the exceptions
b If any answer is 'Yes" to 58(1)-(5), did any of 20 of the instructions)? •
Sb N
(see page
Regulations section 53 4945 or in a current notice regardin g disaster assists's
assistance check here
:a
. . .
).
Organizations relying on a current notice regarding disaster
the or ganization clam exemption from the
c If the answer is 'Yes' to question 5a(4), does Yes ❑ No
ibility for the grant? . . . . . . . . •
tax because it maintai ned expend iture respens
ions sectico 53 4945-5(d)
It 'Yes: attach the statement required by Regulat
year, receive any funds, direcUy or indirectly. topay
6 a Did the organization, during the
premiums on a personal benefit =tract? • ,
• 11 Yes Li No
SD
l benefit centred ? • • ,
s, directly or indirectly, on a persona
b Did the organization, during the year, pay premium
It you answered 'Yaffe/ 66, alsoMe Form 8870 Fenn 990-PC (2001)
45).
101450 4 000
EFTA00224315
Page 6
Form WA* (2001)
Employees,
Part VIII
Information About Officers, Directors, Trustees, Foundation Managers, Highly Paid
and Contractors
AU or me instrumiona)
I ust an OtTICIWO, directors, trustees, foundation managers ana their compensation (see page
gamin and ;versa firj Compensation awceoworwnsto (e) E won se aocouni.
hours per week (), not paid, inlay MSc" pm DPIIK4 Pi1011
calNemo and rddress 4-) end a Wars, caregensurn °:"( a'f°Wan C.2
devoted to canon
Jeffrey Epstein Pres/Dir
VI One Hour 0 0 0
6100 Red Hook Quarter, St Thomas
Darren X Indyke 1 Pres/Dir
-One Hour 0 0 0
457 Madison Avenue, New York, NY
Ghislaine Maxwell Treas/Dir
0 0 0
c/0 Deleon A38O., 110 E 59th St NY,NY One Hour
line 1 • see page 21 of the instructions)
2 Compensation of five highest-paid employees (other than those Included on
If none, enter "NONE"
(b) Tale end MIMI. icn Call..ibActos lo (a) Expense account
hours est week (c) Compensation •mplayes tined pans other allowances
(a) Name and address of each antelcre peel more than $50 000 ono Olen"! comeensem
desvted to pouraon
NONE
. . . . . . . . . 0
Total number of other employees paid over $50.000
for • see page 21 of the instructions) If none, error
3 Five highest-paid independent contractors professional services
-- "NONE."
(b) Type of se:vice (c) Compensation
(a) Marne end address of each poison paid more than $50.000
NONE
, . o
Total number of others receiving over $50,000 for professional services
Part ILA Summary of Direct Charitable Activities
relevanlatelewel Inlormabco such es the number
List the rauncier:4i s lour larsesi direct charitable ocular's: Owns the tax year imams
papers produced, arc
Expel$413
of organdie/one and other benecterres tenon. conferences convened. research
I
2
3
row, 990-PF (2001)
can
141400 a 000
EFTA00224316
Prue?
Form 990-PF (2ool)
•Related investments of instructions)
Amount
-Abe the two lamest program-retaled investments made by the loundahon dunng the tax year on toes 1 and 2
2
micas proetem•teleted uwastments ate pikio22 of irionsinceoni
3
Total Add lines 1 through 3 li-
(All domestic foundations must complete this part Foreign foundations,
Part X Minimum Investment Return
see page 22 of the instructions )
1 Fair market value of assets not used (or held for use) directly in carrying out chartable, etc .
purposes
1a 1,366,729
a Average monthly fair market value of sect/dies . .
1b 6,162 219
b Average of monthly cash balances • • .
83 333
e Fair market value of all other assets (see page 22 of Ile instructions) . . , .
. . . Id 7 612,281
d Total (add lines la, b, and c)
a Reduction claimed for blockage or other factors reported on lines la aril
lc (attach detailed explanation) 9 9 9 9 9 • •
1 10 •
Acquisition indebtedness applicable to line 1 assets 2
2 • • • • • • •
3 7, 612 281
I
3 Subtract line 2 from line 1d . • • • • • •
4 Cash deemed held for charitable activities Enter 1 1/2% of line 3 (for greater amount, see page 23
. . . . . . 4 114,184
of the instructions) .
• Net value of noneharitaide•use assets. Subtract line 4 from line 3 Enter
•
here
9
and on
1
Part
•
4 5 S. M. 7, 498, 097
- AlnImum Investment return. Enter 5% of line 5 • . • • •
6 • • 374 905
instructions) (Section 4942Q)(3) and (i)(5) p Nate operating
Distributable Amount (see page 23 of the
foundations and certain foreign organizations check here I. and do not complete this pad ) pi
. . . . . . . . 374 905
1 Minimum investment return from Part X, line 6
,
•
from Part VI, line 5 2a 267,219
2 a' Tax on investment income for 2001 . .
b Income tax for 2001 (This does not include the tax from Part VI ) 12b,
2 267, 219
c Add lines 2a and 2b . . . .
107, 686
3 Distributable amount before adjustments Subtract line 2c from line 1 • • • I
44
4 a Recoveries of amounts treated as qualifying dalnbulions
b Income distributions from section 4947(02) trusts 4b
4
Add lines 4a and 4b , . , ,
5 107,686
Add lines 3 and 40 . . . . .
6
6 Deduction from distributable amount (see page 23 of the instructions) . .
XIII, line 1 . . 107.686
7 Distributable amount as adjusted Subtract line 6 from line 5 Enter here and on Part
Part XII Qualifying Distributions (see page 23 of the instructions)
1 Amounts paid (including administrative expenses) to accomplish chartable, etc • puposes
Is 902 103
a Expenses, contributions, gifts, etc - total from Part I, column (d), line 26 • . l • • I
lb
b Program-related investments • Total from Part IX-S. • . • • • • •
etc ,
2 Amounts paid to acquire assets used (or held for use) directly in carryng out charitable,
2
purposes • • • • • • • •
•
3 Amounts set aside for specific charitable projects that satsfy the
3a
a Suilabibly test (prior IRS approval required)
3b
b Cash distribution test (attach the required schedule) • . • .
and Pan All, line 4 4 902 103
4 Qualifying distributions, Add lines fa through 30 Enter here and on Pan', line 8
Organizations that qualify under section 4940(e) for the reduced rate of tax on net investment
s
5
income Enter 1% of Part I, line 27b (see page 24 of ire instructions)
line 4 . 6 902 10 3
Adjusted qualifying distributions Subtract line 5 from
Pan f, coturm (b), in subsequent years vhen calculating Mather the foundation
Note The amount on line 6 will bo used in
qualifies for the section 4940(e) reduction of fax in those years
Form 990-PF (2001)
ISA
IEI4 TO 4 000
EFTA00224317
P.c.. 8
Fo'm 000.PF (2001)
tions)
Part XIII Undistributed Income (see page 24 of the instruc
lc) (d)
(a) (b)
Years prior to 2000 2000 2001
CcrPus
Chstnbutable amount for 2001 from Part Xt, 107 686 '
hne 7 . .
2 Undistributed income deny as Sam end of 2000
a Enter amount for 2000 only , , .
b Total for pointer s
3 Excess distributions car 4 any. to 2001
a From 1996 . . .
b From 1997 .
e From 1993 54, 323
d From 1999 138,4 85
• From 2000 . . • 172,9 14
. 365, 722
I Total of lines 3a through e
Qualifying distribu tions for 2001 tram Pot
Xli, brie 4 lie 902,1 03
a Applied to 2000. but not more than line 2a
b Applied to undistributed income of pnor years
(Election requited • see pogo 24 cA the Instrucbons)
c Treated es distributions out of corpus (Election
required - see page 24 ci the instructions) 101,686
d Applied to 2001 distributable amount, . .
7 94 4 17
• Remaining amount distnbuted out of ccrywe
I Excess distributions carryover applied to 2001
(ten amount appears in cciumn (d). Me
same amen( must be sham en sawn (a))
i Enter the net total of each column as
indicated below.
1, 160, 13 9
a Corpus Add lines 31. 4c. and 4e Subtract tine 5
b Prior years' undistributed income Subject C
line 4b from line 213 . . .
e Enter the amount of pnor rein' undistnbuted
income for which a notice of deficiency has
been issued, or on which the section 4942(e)
tax has been previously assessed .
d Subtract line 6c from line 6b TaxeUe
amount • sea page 25 of the instructions
• Undislilbuted income toi. 2000 Subireci line
4a from sins 2a Taxabk. amount • se pogo 0
25 of the instructions . .
f Undistributed income for 2001 Subtract
lines 4d and 5 from line 1 This amount must 0
be distributed in 2002 . .
7 Amounts treated as distnbutictis out of
corpus to satisfy requirements imposed by
section 170(bX1)(E) Cr 4942(9X3) (see page
25 of the instructions)
8 Excess distnbutions carryove7r Iran 1996
not applied on line 5 or hoe (see Page 25
of the instructions) . . . . . . . . .
9 Excess distributions carryov er 10 2002
. , 1,160,139
Subtract lines 7 and 6 from line Gs
10 Analysts of lino 9
a Excess from 1997
54: 323
to Excess from 1998 .
1a 485
c Excess Crum 1999
cl Excess InX112000 172, 914
• Excess from 2601 714,417
torn 990-P F 12001)
JSA
E 1450 4 000
EFTA00224318
p.m, 9
Form tao•Pe Ram
Private Operating Foundations (see page 25 of the instructions and Part MIA question 9)
that en a private operating
1a if the foundation has received a ruling or determination letter
foundation, and the ruling is effective for 2001, enter the date of the
rukng ►
Check box to indicate whether the organization is a private operating foundation described
m section 4942(p)(3)or 1 49420)(5)
4
Tax year Prier 3 yews
2a Enter Ilia *swot the
112000 kirsati 111005 (61 Total
adjusted net Pam* from (a1S901
Parl I or tip marnum
Investment return from Pad
X lot each year hated
b as% of line?. . .
C Ouraftlying Masao, from Pan
lie lon• 4 la each year NINO
d Mounts included n toe 24 not
urea ear ay lor IMP oviduct
of exempt ac/taYal
• Cumbering antaritats may
dimply 104 Ma meta of
*twat pump &Milo
line 20 Iran Si. . •
3 Coca IP 34b, a e Ice N.
anwnstive Sal naiad opal
a 'Aeos' ellamathe nor snit
(I) ay. of fal poets
(2) Volved sasMi arta";
under mac
4120X3X1:0
b 'EnOwernsnr allanwhe lam
inter 213 ol pomp,
Investment mum mum In
Po X Me 6 la each year
11.10
C 'Support' Pm Om Sal ants-
( I) fool roam ape ViM
giant Vnealananl nano
UM/MK draa•r4s iamb
poyernoti on seamen
teens (.dal 517(0XS)l
of Madan) . .
(2) supra'. IOTA genial
pubic ea 6 a non
•rompl onwombats
al Maid n pan
49426630)p)
(3) Largest root of ampere
hem en mem
crampoon •
4 amen mortmell brat.
Supplementary Information (Comp eta this part only if the organization had $5,000 or more In
assets at any time during the year - see page 26 of the instructions )
1 information Regarding Foundation Managers
than 2% of the total contnbutcns received by the foundation
a List any managers of the foundation who have contributed more
more than $5,000) (See section 507(dX2) )
before the close of any tax year (but only if they have contributed
Jeffrey E Epstein
b List any managers of the foundation who own 10% or more of the stock of a wren-aeon (or an equally large pottiest of the
ownership of a partnership or other entity) of which the foundation has a 10% or greater interest
2 Information Rem.rding Contribution, Grant, Gift, Loan, Scholarship, etc , Programs
and does not accept unsolicited requests la funds
Check here Iso I kea marthation only mikes contributions to preselectod Wnlsble aganitaions
to ramie a Ot Orgentatrall under Other COnektionS. MOOS demo Te b C and d
ti the Caen Patton makes pills grants MC (see page 26 of the insUuctqcs)
addressed
a The name, address, and telephone number of the person to whom ea:ketone should be
and matanals they should include
b The form in which applications should be submitted and information
c My submission deatAnes
areas, chaitable fields, kinds d insbtubons, a other
d My restnctuons or limitations on awards, such as by geographical
factors
JSA clellt.PF Irina%
toremonnot
EFTA00224319
Pago10
Form 990.PF (2001).
Dicta Supplementary Information continued)
rants and Contributions Paid During the Year or
Approved for Future Payment
II t•Cspient is an sldnvbsst Feu
Recipient show any relabobillup to Putpose c4 grant « Amount
status ol
any foundation manager contnbubon
iscIplant
Name and address (home or business) or substantial cannbutor
a Patel during the year
Statement 4
. . O. 3a 84 5, 000
Total . . . . .
b Approved for future payme nt
None
0
Total . .
Form 990-PF (2001)
it'
1[14,1 31300
EFTA00224320
Page 11
Form 990-PF (2001)
Analysis of Income-Producing Activities 'Ter
Unrelated business income Excluded b' section 612. 513, or 514 Related or exempt
Enter gr oss amounts unless othemnse indicated (c) (d) function income
(a) (b) (See page 26 of
Business Eschew Amount the instrucbonsy
Cede Amount code
1 Pr cram scenic, revenue
a
b
d
,._
Fein and Conleante kern government *minces
2 Me nbership duos and assessments 39,223
14
3 Inlet est on sewes am lettpearyCaah ummlmente 219,790
14
4 Oiv dends end interest from secuMies ,
S Net rental income a (loss) from real estate
a Debt•linanced property
b Not debt-financed property
6 Net rental income or (loss) from Peronnel properly •
7 0thef Investment incase , .
13,101,951
18
S Ourlot (loss) learn gas of sisals Whim WA iment0ey
9 Net income or (Ices) from special events .
10 Or iss profit or (Ices) Iran sates of inventory. .
11 0thef revenue •
b
d
13,360,964
12 Sul>total Add columns (0). (d), and (e) • , pe13 13,360,964
3 Total Add line 12, columns (b), (d), end (e) . .
verify calculations )
See worksheet in line 13 instructions on perm 20 o Purposes
Relationsh ip of Activi ties to the Accomplishment of Exempt
income is reporte d in column (e) of Pan XVI-A contributed importantly to
Explain below how each activity for which providi ng funds for such purposes) (See
t purposes (other than by
Unsieo the accomplishment of the organization's exemp
page 27 of the instructions )
Fcan 990-PF (2001)
J9.4
if IAN 4 000
EFTA00224321
pr o 12
Form S9044 200Th
Information Regarding Transfers To and Transactions and Relationships With Noncharitable
Exempt Organizations
doscnbed m socSon Tea No
I Did the organization directly or indirectly engage in any of the following with any other organizabcn
of the Code (other than section 501(cK3) organizations) a in section 527, relating to political again/ titan?
50f(c)
a Transfers horn the reporting organization to a nonchentable exempt organization of
x
(I) Cush .
1a121
(2) Other assets ,
b Other Transactions
, 11411 X
(1) Sales of assets to a nonchantable °mina organization
(2) Purchases of assets from a nonchantable exempt organaation 1,b(2), X
. b(2‘ X
(3) Rental of facilities, equipment, a other assets •
11441 X
(4) Reimbursement arrangements . . .
(5) Loans or loan guarantees • • • • •
• •
, 1b(13) X
(6) Performance of services or membership or fundraising schatations • • • •
, , . Ic X
c Sharing of facilities, equipment, mailing lists, other assets, a paid employees , . .
schedule Column (b) should always show the fast market
d If the answer to any of the above is 'Yes,• complete the following
received loss than fair
value of the goods, other assets, or services given by the reporting organization If the organization
anangement show in column (d) the value of the goads, other assets, a services
market value in any transaction or sharing
received
(el Name of nononentable exempt oresineabon tin psicnotion of hang transactions and shams arrangements
Mime no (Wampum myched
2 a Is the organization directly or ndirectly affiliated with, or related to, one a mere tax-exempt agent/San
El Teen No
descnbed in section 501(c) of the Code (other than section 5010(3Da n section 627?
ti f "Yes • tamable the folloMno schedule
(a) Name ol organism= Oils or errisnanen (e) Description of relalinsho
statements and to the best of my knoreedge and babel 0 a
Under pantiles. of perjury I declare Mat I have exernmed this return mewling accompanying schedules and
prOptgOr (other than taxpayer or f4uoarp is based on NI torrnatien of khan papa has any snoMedge
°VOL"- r Iiim
true. correct, and c to last
1 9 t h 1 3•1/43-02..—
/°. Signature of o Dale
Sign Here
Daly ° 7...... if sang 0. O
mployed
kohea Repliers SSN a PTIN
(See Signature on page 26
t° 2. Preparers W inslilittas )
ow O c signature
To •
a d,
o. •
ASSOCIATES 8N liv 13-2842281 •
,- 5 Finns nano (a yours
if sollemployed). address. OliMill
110 +
EAS' . SM
59 STREET
and ZIP code NEW YORK, NY 10022 Phan no
Ferei990-PE (2001)
JSA
IS1493 3000
EFTA00224322
THE C.O.U.Q. FOUNDATION, INC. STATEMENT 1
13-3996471
FORM 990-PF - Y/E 2/28/02
Part 1. Line 1 and Part Lino 10
Contrtbutions Recelyslf
From Leslie H Wexner, as Grantor of
The Werner Children's Trust
600,000 shares of Too, Inc common stock having a market value of
$11,205,000 at date of gift recorded on the Foundation's books at the
donor's basis
EFTA00224323
THE C.O.U.Q. FOUNDATION STATEMENT 2
13-3996471
FORM 990-PF - Y/E 2/28/02
PART L LINE 23
OTHER EXPENSES
Dank Charges 85
Consulting & Research 50,000
Filing Fees 419
Office Expense 305
Total 50,809
EFTA00224324
THE C.O.U.Q. FOUNDATION, INC. STATEMENT 3
13-3996471
FORM 990-PF - Y/E 2/28/02
PART IV. CAPITAL GAINS AND LOSSES
Date Sales Gain
Number How Date
Sold Price Cost (Loss)
of Shares Description Acquired Acquired
4/22./01 38,939 1 38,938
2,000 Too, Inc D 4/23/01
4/27/01 444,802 2 444,800
23,000 Too, Inc D 4/23/01
512101 63,901 1 63,900
3,200 Too, Inc D 4/23/01
5/8/01 932,799 3 932,796
50,000 Too, Inc D 4/23/01
5/10/01 297,830 2 297,828
15,700 Too, Inc D 4/23/01
5/10/01 353,692 3 353,689
18,800 Too, Inc D 4/23/01
5/16/01 1,333,687 3 1,333,684
70,000 Too, Inc D 4/23/01
5/17/01 365,487 2 365,485
17,300 Too, Inc I) 4/23/01
5/21/01 44,883 111,329 -66,446
2,100 AT&T P 6/8/99
5/24/01 2,433,051 5 2,433,046
100,000 Too, Inc D 4/23/01
5/31/01 3,321,141 5 3,321,136
143,600 Too, Inc I) 4/23/01
6/6/01 3,583,100 5 3,583,095
136,200 Too, Inc D 4/23/01
13,213,312 111,361 13,101,951,
EFTA00224325
STATEMENT 4
THE C.O.U.Q. FOUNDATION, INC..
13-3996471
FORM 990-PF Y/E 2128/02
PART 1, LINE 25 AND PART LINE 3
CONTRIBUTIONS PAID
UNRESTRICTED
50,000
6/11/01 University of Maryland
400,000
6/15/01 Institute of Advanced Study
50,000
6/21/01 Nelson Mandela Children's Fund
100,000
7/27/01 UNM Foundation
25,000
8124/01 Edge Foundation
10,000
10/2/01 Ackerman Institute for the Farr*
50,000
10/9/01 The Pnze for Promise
10,000
10/9/01 New York University School of Medicine
125,000
12/20/01 Harvard University
25,000
2/28/01 The Prize for Promise
845,000
EFTA00224326
SF 1c cop
Conn 8868 Application for Extension of Time To File an
(December 2000) Exempt Organization Return OMB No 1545.1709
Oeponmenl of the Treasury 0, File a separate appecatcn to each return
eternal Revenue Senna . 1 X
complete only Part I and check this box
• If you are filing for an Automatic 3-Month Extension, form)
Extension, complete only Part II (on page 2 of this
• If you are filing for an Additional (not automatic) 3-Month
granted an automatic 3-month extension on a previously filed
Note: Do not complete Part Runless you have already been
Form 8868
Time - Only submit original (no copies needed)
Part I Automatic 3-Month Extension of
ata 8-month extension - check this box and corplete Part
I only 1 D
Note: Ran 990-7corporabans requesting an autom of tine to file taco= tax
must use Form7004 to request en extension
AO other corporations (including Form 990-C filers) Form 108O 1060 or 1041
returns Partnerships, REMICs and trusts must use Form 8798 to request art extension of tine to tile
Employer identecaticti number
Type or Nano of Exempt Orgarszabai
13-3996471
print THE C.O U.0. FOUNDATION, INC. ims
instruct
Number, seem, end mom or suds no Itt a P 0 bca sea
Flaw ih• due
date nor ling ASSOCIATES, 110 EAST 59TH STREET
your return ..059 basil address, see vistmckns
in:1111CIOn3 City. town or post office, stale. and ZIP code Fore
NEW YORK, NY 10022
tion for eachreturn)
Check type of return to be flied (file a_siparate applica Form 4720
Form 990-7 (ccreora eon)
Form 990 Form 5227
Form 990-B1 Form 990-T(sec 401(s) a 400(a) trust)
S Form 6089
Farn 990-E2 Form 990-7 (trust ether than Wave)
Form 8870
Form 1041-A
I3 Fam 990-PF
ss in the United States, check this box
• I the organization does not have en office or place of busine If the is
four digit Group Exemption Number (GEN)
• If this is for a Group Return, enter thempanizabores the
for the whole group, check this box *
it it is
for part of the group, check this box P. U and attach a list with
names and EINe of all members the extension will cover . 2002
ation) extension of time until OCTOBER 15
1 I request en automatic 3•month (6-month, for 990-T corpor the Organz ationfs return for
named above The extension is for
to rib the exempt organization return for the organization
► calendar year or
, 2002
► —1 tax year beginning March 1 2001 and ending February 28
2 If this tax year is for less than 12 months, check reason
0 Initial return n Final return ❑ Change in accounting period
less any
990-T, 4720. or 6069, enter the tentative tax,
3a If this application is for Form 990-01, 990-PF, 89
nonrefundable credits See Instructions . . . . . .
nts
enter any refundable credits and estimated tax payme
b If this application is for Form 990-PF or 990.1. 0
made Include any prior year overpayment allowed as
a credt . . . . . . . . . . . . . . . . . .
your payment with this form, or, if require d, deposi t
e Balance Due. Subtract line 3b from line 3a Include
require d, by using kr- fro (Electronic Federal Tax Payment System) See
with FTC coupon or. if . . . . . . . 89
instructions , . . .
Signature end Verification
ts. end to the best of my anowledge and Sae(
Under penalties of pedury. I declare that I hew examme d this form, hicludng accompanying scheduled and statemen
it is tart coned and complete. and autism einhoneed to pftgafe this Iona
Date P' 7124-t
Signature * Fam8868 (124000) •
tion
For Paperwork Reduction Act Notice, see Instruc
is.
1r1O54 s boo
EFTA00224327
•
OMB No 1545.0052
Return of Private Foundation
Departrnon-PF
.990. i.,.... Note:
or Section 4947(8)(1) Nonexempt Charitable
Treasury
Internal Revenue Some organization may be able a this Mum to satisfy state The to use copy of
Trust Treated as a Private Foundation
reporting requirements 2002
For calendar year 2002, or tax year beginning March 1 , 2002, and ending Februa 28 , 2003
1G Check all that a Initial return Final return I Amended return I Address change ry_ Name change
A Employer Identification number
Name of organization
Use the IRS
label THE C . O.0 . Q. FOUNDATION, INC. 13-3996471
i Room/suite B Telephone nbmbor (see pegs 10 of
Otherwise, Number and Street (or P.O. box number If mall Is not delivered to street address) the instructs:as)
print
Ix M lle ASSOCIATES 11.0 EAST 59TH STR
See Specific C/O
C ii siidezuee tre e , s le.
Instructions, City or town, state, and ZIP code pen chec
0 1. Facean orpervalcm, chock here • , ___/
2. Foreign oiganimiions moons the
NEW YORK NY 10022 05% tett cheat here end teach
x Section 501(c43_) exempt private foundation compulan lo ❑
H Check type of organization
charitable trust I I Other taxableyrivate foundation
n Section 4947(a)(1) nonexempt E II penis founding:A NSA su ismssated
market value of all assets at erd J Accounting method' ijc Cash LI Accrual imam wept SOTobigA). Me* here . 0 ❑
I Fair
of year ((mm Part II, col. (c), tine 0 Other (specify) F Huns foundation is In selsrucoln thasmassn r
11,252,977 (Pad I, wham (d) must be on cash basis ) undo, when 507(0)(1/03). duds hem . 11. I ]
di
fi b
(d) Disbursements
Analysis of Revenue and Expenses (a) Revenue and ps Not investment ( ) Adjusted not for charitable
(lire total of amounts in columns (b), (a), end expenses per income income purposes
(d)may not necessarily equal the amounts in books (Cash basis only)
column (a) (see page /0 of the
I Coninbustis, pmts. etc,mama wiath KheSulo) •
if the foundation is not required to
Mack * attach Sch. B
... WC,'
2 Distributions from split-Interest trusts . , , ,
195,286 195,286
3 Inteiest on ;amps and temporary cash investments
4 Dividends and Interest From securities , . . ,
..neruggigaiiewer •
S a Gross runts
b (Nei rental income or(kiss) )
6 a Net gain or (lose) from sale of assets not on tine 10
b Gross solos price for oil
assets on one Oa
7 Capital gain not Income (from PM IV, line 2) .
6 Not short•term capital gain
9 income modlfic.aticnS
10 a Gross setae less returns
and allowances . • . . .
b less Cost of goads sold
c Gross profit or (loss) (attach schedule) . . , .
11 Other income (attach schedule)
iasqaitjtEntai t
aontt 195 L 286 195 , 286
i
13 Compensation of officers, directors, trustees. etc.
Other employee salaries and wages
Operating and Administrative Expenses
14
15 Pension plans, employee benefits
llia legal fees (attach schedule)
b Accounting fees (attach schedule)
c Other professional loos (attach schedule). .
il e
17 Interest
18 Taxes (attach schedule) (see pep 13 of vie nstruc03111)
278,515
D
19 Depreciation (attach schedule) and depletion 600 41/4/
i 3
20 Occupancy
201/1 o
21 Travel, conferences, and moobngs Cop m fi6
22 Printing and publications --....ti_k 1 7„,
915, 915
23 Other expenses (attach schedule) St.. . 3. .
24 Total operating and admkilstrative expenses.
280,030 915
Add lines 13 through 23
1,245,000 1,245,000
‘17
25 Contributions, gifts, grants paid
1,525,030 1,245,915
Tolel erwnen end Oielninemente Add tines 24 and 24,
27 Subtract line 26 from line 12.
a Wiwi of worms crew imams and 614buisomenle , -1,329,744
b Not Investment Income (If negative, enter -0-)
195,286
JSA
IC,AN4MA
a Adjusted net Income (if negative, enter -04. •
For Paperwork Reduction Act Notice, see the Instructions.
Form 990-PF (20021
2i)
EFTA00224328
Page 2
Fan, 990.PF (2002
Attached sch0dules and amount, in the Beginning of year End of year
Part II Balance Sheets descaphon column shmild Wax (0) Fair Markel Value
end-el:jeer 'mounts only (Stitettaruclasia) (a) Book Value fir) Book MMus
1 Cash - nal-Interest-bearing 14,811
' 11,252,689 11.252,689
2 Savings and temporary cash investments
3 Accounts recorvab/e III'
Less allowance for doubtful accounts Il°
4 Pledges receivable tto
Less allowance for doubtful accounts le
5 Grants receivable
6 Receivables due from officers, directors, trustees, and other
disqualified persons (mulch schedule) (see page 15 of the instructions)
7 Other notes and loans receivable (attach schedule) io
Less allowance for doubtful accounts III"
8 inventones for see or use
;21 9 Prepaid expenses and deferred charges
rrZ 10 a Investments • U S. and slate government obigabons (attach schedule) ,
b Investments • corporate stock (attach schedule)
c Investments • corporate bonds (attach schedule)
11 Investments - land, bulldngs, pi„
and equipment bans
Less accumulated deprecation le.
(attach schedule)
12 Investments • mortgage loans
13 Investments - other (attach schedule)
14 Lend, butt:legs, and IP 2 L988
equipment bests
Less. accumulated %premien p,. 2,390 888 288 288
(attach schedule)
15 Other assets (describe Ilemrekert y rights ) 250.000
16 Total assets (to be completed by all filers - see page 16 of
12,573,103 12.,252,977 1 1 t 2 52 , 97 7
the instructions Also, see page 1, nem 0
Accounts payable and accrued expenses
9,619
17
18 Grants payable
: 19 Oefened revenue
2. 20
:1 Loans from %Icon, %odors, Oaten, and other disquetilled persons ,
is Mortgages and other notes payable (attach schedule)
21
A 22 Other liabilities (describe le• -- )
9,619
23 Total liabilities (add lines 17 throuoh 22)
I
Organizations that follow SFAS 117, check here a LI
and complete lines 24 through 26 and lines 30 and 31.
Net Assets or Fund Balances
24 Unrestricted
25 Temporarily restricted
26 Permanently restricted __
Organizations that do not follow SFAS 117,
check hero and complete lines 27 through 31. a x
27 Capital stock, trust principal, or current funds
28 Patd•in or capital surplus, or land, bidg , and equipment fund
12,573,103 11,263,358
20 Retained earnings. accumulated income, endowment. or other funds . .
30 Total not assets or fund balances (see page 16 of the
12,573,103 11,243,358
Instructions)
31 Total liabilities and not assetallund balances (see page 16 of
12,573.103 11,252,977
I the Instruction)
Part Ill Analysis of Changes In Net Assets or Fund Balances
kw 30 (must agree wth
1 Total net assets or fund balances at beginning of year - Part Ii, cokmut (a),
robin) 1 12 573 103
end-of-year figure reported on prior year's
2 -1 32 744
2 Enter amount from Part I, line 27a
3 243 359
3 Other Increases not included in line 2 (Itemize) bi•
4 11 243 359
4 Add lines 1, 2, and 3 1
5
5 Decreases not included in line 2 (itemize)* Roundins
6) Part II, column (b), km 30 8 11 243 3 8
6 Total net assets or fund balances at end of year (line 4 minus kris
Fonn990-PF (2002)
JSA
ic • NIA
EFTA00224329
Page 3
Form 990.PF 204I2)
income
Capital Gains and Losses for Tax on Investment 14°• (c) ate (d) Date sold
(e.g., real estate, acq01/uire Dired
(a) List and describe the kind(s) of property add Pitedw a acqu
,yr.)
day.
ono ('A0 , day. yr f
2-story brick warehouse; a common stock. 200 she MW Co)
1a
b
c
d
e (h) Gina (loss)
(f) Depreciation allowed (g) Cost or other basis
(e) Gross sales price plus expense of sate (e) plus (I) minus (g)
(or allowable)
a
b
c
d
•
and owned by the foundation on 12/31169 (I) Gains (Cd. (h) gam minus
Complete only for assets showing gain in column (11) col. (k), but not less than -0-) or
Q) Adjusted basis (k) Excess d cd. 9)
Looses Nom cd. (h))
1
MF81 as of 12/31189 as of 12131/69 over col. Q), d any
el
b
e
d
a I, line 7
{ If gain, also enter in
2 Capital gain net Income o (net capital loss) If (loss), enter -0- in Part I, line 7 } 2
ns 1222(5) and (6).
3 Net short-term capital gain or (loss) as defined insectio
pages 12 and 17 of the instructions)
If gain, also enter in Part I, line 8, column (c) (see ) 3
If (loss), enter -0-n Part I, line 8 Incom e
ed Tax on Net Investment
Part r Qualification Under Section 4940(e) for Reduc Income.)
ent
(For optional use by domestic private founda
tions subject to the section 4940(a) tax on net investm
If section 4940(d)(2) apphes, leave this part blank.
perod7. . . . FIN°
tax on the distributable amount of any year ki the base
Was the organization liable for the section 4942 comple te this part.
section 4940(e ). Do not
If *Yes,' the organization does not qualify under
anyentries.
for each year; see page 17 of the instructions before making
1 Enter the appropriate amount in each column
Id)
4) (c) Ounneution ruse
year
(d) or nonchent abia-use ousts kb
Base period years Calendar Adjusted qualeeng drstnbulams Net value (col ref SW bred
(or lax year boalnnIng n) 0.120310
902,103 7,498,097
2001 0.878521
183,255 208,595
2000 0,499602
153,695 307,635
1999 8.228697
54.655 6,642
1998
1997
2 9.727130
2 Total of line 1, column (d
period - divide the total on line 2 by 5, or by
3 Average distribution ratio for the 5-year base 3 2.431782
existence if less than 5 years
the number of years the foundation has been in
4 12, 223.. 526
for 2002 from Part X, line 5
4 Enter the net value of noncharitabte-use assets
5 29.720 .092
5 Multiply line 4 by line 3
6 1,953
Part t line 27b)
6 Enter 1% of net Investment Income (1% of
7 29.722.045
7 Add hnes 5 and 6
• 8 1, 245, 915
line 4
8 Enter qualifying distributions from Part XII, that part usng 01% lax rale See the Port VI Instructions on page IT
If lane 8 ill equal lo or greater then lone 7. check the box in Pen VI. Ina 10, and complete Penn 990-PF (2002)
A •
JSAIAI
IC PIA
EFTA00224330
Pees 4
Form 990.PF (2002)
17 of the instructions)
is o Tax Based on Investment income (Section 4940(a), 4940(b), 4940(e), or 4948 - see page
grma l_ALic
L_J and enter "NIP on line 1
to Exempt operating foundations described In section 4940(4)(2). check here ►
Date of ruling letter. (attach copy of ruling letter If necessary - see Instructions)
the section 4940(e) requirements in Part check 3,906
Domesticlas:nations that meet
here le U and enter 1% of Pail I. line 27b
s All other domestic organizations enter 2% of line 27b. Exempt foreign organizations enter 4% of Part I, line 12, col. (b)
Others enter -0-) 2
2 Tax under section 511 (domestic section 4947(8)(1) trusts and hirable foundations only
3 3, 906
3 Add lines 1 and 2
only. Others enter -0.) 4
4 Subtitle A (Income) tax (domestic section 4947(aX1) trusts and taxable foundations
5 3, 906
5 Tax based on investment income. Subtract line 4 from tine 3 If zero a less, enter •O•
6 Credits/Payments:
6a 5, 000
a 2002 estimated tax payments and 2001 overpayment credited to 2002
b Exempt foreign organizations • tax withheld at source 6b
c Tax paid with application for extension of time to We (Form 8868) 6c
d Backup withholding erroneously withheld Ild
7 5 000
7 Total credits and payments. Add lines 5a through 6d
8
8 Enter any penalty for underpayment of estimated tax Check here ri If ram 2220 Is attached
► 9
9 Tax due. If the total of lines 5 and 8 Is more than lice 7, enter amount owed
► 10 1, 0 94
10 Overpayment. If line 7 is more than the total of lines 5 and 8, enter the amount overpaid
1,094 Relunded00 it
11 Enter the amount of line 10 to be Credited to 2003 estimated tax Ile
Part VII-A Statements Regarding Activities
did Yes No
1 a During the tax year, did the organization attempt to influence any national, state, or local legislation or
campaign' la X
It participate or Intervene in any political
(see page
b Did it spend more than $100 during the year (either directly or Indirectly) for political purposes
1b
18 of the instructions for definition)?
motenals
If the answer is •Yes•to la or lb, alfach a detailed descnflon of the SCS1,7110S and wpbs of any
published or distributed by the organization in connection with the activities
1c x
c Did the organization file Form 1120•POL for this year?
Enter the amount (If any) of tax on political expenditures (section 4955) imposed during the year
(1) On the organization lie $ (2) On organization managers. le $
a Enter the reimbursement (If any) paid by the organization during the year fee political expenditure tax Imposed
on organization managers ► $
2
2 Has the organization engaged In any activities that have not previously been reported to the IRS?
If -Yes,' attach a detailed descnption of the activates
articles
3 Has the organization made any changes, not previously reported to the IRS, in Its governing instrument,
3
of incorporation, or bylaws, or other similar instruments? If Yes," attach a conformed copy of the changes
4.
4 a Did the organization have unrelated business gross income of $1,000 or more dung the year?
4b N A
b If 'Yes; has It tiled a lax return on Form 990•T for this year?
6
5 Was there a liquidation, termination. dissolution, or substantial contraction during the yea?
'Yes," attach the statement required by General Instruction T
either:
Are the requirements of section 508(e) (relating to sections 4941 through 4945) satisfied
• By language In the governing instrument or
• By state legislation that effectively amends the governing instrument so that no mandatory directions
S x
that conflict with the slate law remain in the governing instrument?
year? lt 'Yes,' complete Pan II, col (c), and Part XV 7 X
7 Did the organization have al least $5,000 in assets at any time Curing the
Enter the states to which the foundation reports or with which ills roosters'? (see page 19 of the
8 a
instructions) is New York
Attorney
b If the answer is "Yes" loans 7, has the organization furnished a copy of Form 990'Pf to the
Instruction G? 'No,' attach explanation X
General (or designate) of each state as required by General
of section 49420)(3)
9 is the organization claiming status as a private operating foundation within the meaning
49420)(5) for calendar year 2002 or the taxable year beginning in 2002 (see instructions for Part XIV on
or
•
page 25)?1•Yes,acomphife Pert NY
the tax year? ••Yes,"attach a schedule :Wog thew names and addresses 10 X
10 Did any perions become substantial contributors dunng
for its annual returns and exemption application? 11 X
11 Did the organization comply with the public Inspection requirements
Web site address le _ _ _
The books are in care of Pal: SIM Associates ---------- Telephone no.
2117+4 es 10022
909-9680
Located at as 110 East 59th Street, New York, NY
here
13 Section 4947(a)(1) nonexempt charitable trusts Ming Form 990-PF in lieu of Form 1041- Check
of tax-exempt Interest received or accrued dunnq the year ► I 13
end enter the amount
Form 990-PF (2002)
JSA
251440 1 000
EFTA00224331
Page 5
Form 990-PF 2002)
Statements Regarding Activities for Which Form 4720 May Be Required
Yes No
File Form 4720 If any Item Is checked in the "Yes" column, unless an exception applies.
1 a During the year did the organization (either directly or Indirectly)
(1) Engage In the sale or exchange, or leasing of properly with a di-aqua/lifted person?
D Yes 0 No
(2) Borrow money from, lend money to, a otherwise extend credit to (ck accept it from) x No
Yes
a disqualified person? x No
Yes
(3) Furnish goods, services, or facilities to (a accept them Iran) a disqualified person?
Yes X No
(4) Pay compensation to, or pay or reimburse the (licenses of, a disqualified person?
(5) Transfer any Income or assets to a disqualified person (or make any of either available
El Yes 1_73 No
for the benefit or use of a disqualified person)?
(6) Agree to pay money or property to a government official? (Exception, Chock 'No"
if the organization agreed to make a grant to or to employ the official for a period
after termination of government service, if terminating within 90 days.)
El Yes No El
Regulations
b If any answer is "Yes" to 1a(1)-(6). did any of the acts fall to qualify under the exceptions deserted in
of the instructions)? b N
section 53 4941(d)-3 or in a current notice regarding disaster assistance (see page 19
Organizations relying on a current notice regarding disaster assistance check here ► 1:1
c Old the organization engage In a prior year In any of the acts described In 1a, other than excepted acts,
1c x
that were not corrected before the first day of the lax year beginning in 2002?
2 Taxes on failure to distnbute Income (section 4942) (does not apply for years the organization was a private
operating foundation defined In section 4942QX3) or 49420)(5)).
a Al the end of lax year 2002, did the organization have any undistnbuted income (linos 6d
and 6e, Parr XIII) for tax year(s) beginning before 2002?
ri Yoe El No
if "Yes," list the years
b Are there any years listed In 2a for which the organization is not applying the provisions of section 4942(a)(2)
(relating to Incorrect valuation of assets) to the years undistnbuted income? (If applying section 4942(a)(2)
2b x
to all years listed, answer "No" and attach statement - see page 19 of the instructions )
here
c if the provisions of section 4942(a)(2) are being applied to any of the years listed in 2a, list the years
►_
3 a Did the organization hold more than a 2% direct or indirect interest in any business
_
enterprise el any tkne during the year'?
[Ti Yes rol No
b If 'Yes; did it have excess business holdings in 2002 as a result of (1) any purchase by the organization
approved
or disqualified parsons alter May 26. 1969; (2) the lapse of the 5-year period (or longer period
by the Commissioner under section 4943(c)(7)) to dispose of holdings acquked by gift or bequest; or (3)
the lapse of the 10-, 15-, or 20-y ear first phase holding period? (Use Schedule C, Fenn 4720, to determine
3b N A
if the organization had excess business hddings in 2002 ) x
its charitable purposes? 4a
4 a Dld the organization invest during the year any amount In a manner that would jeopardize
Jeopardize its charitable
b Did the organization make any Investment in a prior year (but after December 31, 1969) that could 4b x
purposo that had not been removed from Jeopardy before the first day of the tax year beginning In 2002?
5 a Dunng the year did the organization pay or incur any amount to:
(1) Carry on propaganda, or otherwise attempt to influence legislation (section 4945(e))? 0 Yes ryi No
(2) Influence the outcome of any specific public election (see section 4955); or to carry
Yes Ir x No
on, directly or Indirectly, any voter registration drive?
Yes ( x No
(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., ctganizacct descnbed
in section 509(a)(t), (2), or (3), or section 4940(dX2)? n Yes No
(5) Provide for any purpose other than religious, charitable, scientific, literary, or
0 Yes El No
educational purposes, or for the prevention of cruelty to children or animals?
the exceptions described in
b If any answer is "Yes" to 5a(1)-(5), did any of the transactions fall to qualify under 6b N A
Regulations section 53 4945 or in a current notice regarding disaster assistance (see page 20 of the instructions)?
►
Organizations relying on a current notice regarding disaster assistance chock here
D
c if the answer is 'Yes" to question 6a(4), does the organization claim exemption from the
tax because it maintained expenditure responsibility for the grant?
' ❑ Yes E No
if 'Yes,' attach the statement required by Regulations sectlen 53 4945-54
6 a Did the organization, during the year. receive any funds, directlyor indirectly, to pay
premiums on a personal benefit contract? [Ti
Yoe ri No
benefit contract? b x
b Dld the organization, during the year, pay premiums, directly or Indirectly, on a personal
If you answered 'Yes'to 66, also file Form 8870
Form 990-PF (2002)
JSA
2 14 50 1 000
EFTA00224332
Page 6
Form 990-PF 2002)
Managers, Highly Paid Employees, and Contractors
information About Officers, Directors, Trustees, Foundation
ers and their compe nsation see page 20 of the instructions
1 List all officers, directors, trustees, foundation manag (c) Compensation (e) Certifications10 (a) Expense account.
(b) Title, and average employee banes pleas
hours per vwook (It not paid, enter othw allowances
(a) Name and address
devoted to position 44 and defend corneansewn
Pres/Dir.
Jeffrey E. Epstein 0 0 0
Quart ers, St. Thomaa,Vl Ono hour
6100 Rod Hook
Indyk e - I. Pres/Dir
Darren K 0 0 0
One hour
457 Madison Ave., New York, NY
Treas/Dir
Ghislaine Maxwell 0 0 0
Assoc.,110 E.59th St. NY One hour
c/o
s).
those Included on line 1 - see page 20 of the Ins ruction
2 Compensation of five highest-paid employees (other than
If none, enter "NONE." menage 011 Coning:Mr:au la (e) Evens* account.
(b) Tale and tense penvn
$50.000 hours weer* (c) Corn9ensabon ati onensa other allowances
(a) Name and address of each employee peel mom than devotedlowmWn
NONE
O. I 0
Total number of other employees paid over $50,000 of the instruc tions). If none, enter
sional services - (see page 20
3 Five highest-paid independent contractors for profes
"NONE." Ic) Compensation
(b) Type of seance
fat Name and address of each person paid more than $60,000
NONE
► 0
ional services
Total number of others receiving over $50,000 for profess
Charitable Activities
Part IX -A Summary of Direct
n Seth es the number
es during the tax year Include relevant Slabibell tronnabo
List the foundation', four largest direct charitable acne es
Exercises
nes servot conferenc convened , research papers produced. etc.
of organaations end other beneficia
1
NONE
2
3
4
Rem 990-PF (2002)
JSA
211460 1 000
EFTA00224333
Page 7
Form 990•PF 12002)
Part IX-B Summary of Program-Related Investment
s (see page 21 of the instructions Amount
foundation during the tax year on lines 1 and 2.
Describe tho two largest program•related Investments made by the
2
Al other program-related nestmenle See pep 21 of the instructions
3
►
Total. Add lines 1 through 3 this part. Foreig n foundations,
ations must comp lete
Part X Minimum Investment Return (All domestic found
see page 21 of the instructions.)
directly in carrying out chantable, etc.,
1 Fair market value of assets not used (or held for use)
purposes' 1a
a Average monthly fair market value of sausages 1b 12 282 643
b Average of monthly cash balances 1c 125 000
of ire Instructions)
c Fair market value of all other assets (see page 22 td 12 407 643
d Total (add lines la, b, and
d on hnes to arc)
e Reduction claimed for blockage or other factors reporte
. 11e I
lc (attach detailed explanation) .
2
1 assets
2 Acquisition indebtedness applicable to line 3 12 407 643
3 Subtract line 2 from line td
1 1/2% of line 3 (for greater amount, see page 22
4 Cash deemed held for charitable activities. Enter 4 186 115
of the instructions) Parts, line 4 5 12 221 528
from line 3 Enter here and on
Net value of noncharitablo-use assets. Subtract One 4 6 611 076
Minimum Investment return. Enter 5% of line 5
n 4942(j)(3) and 0)(5) private operating
Distributable Amount (see page 23 of the instructions) (Sectio and do not complete this part.)
Part XI foundations and certain foreign organizations check here ► in
611,076
6
1 Minimum investment return from Part X, line 3,906
ent income for 2002 from Part VI, line 5
2 a Tax on Investm
tax from Part VI.)
b Income tax for 2002. (TMs does not include the 2 3.906
c Add lines 2a and 2b 607,170
Subtract Me 2c from the
3 Distributable amount before adjustments.
distributions
4 a Recoveries of amounts treated as qualifying 14b
b Income distributions from section 4947(8)(2) trusts 4
c Add lines 4a and 4b 5 607,170
5 Add lines 3 and 4c
23 of the Instructions)
6 Deduction from distributable amount (see page 607,I7Q
Subtra ct line 6 from line 5. Enter here and on Part XIII, the 1 . .
7 Distributable amount as adiusted
Part XII Qualifying Distributions (see page
23 of the instructions)
lish charitable, etc., purposes:
1 Amounts paid (Including administrative expenses) to accomp la 1 245 915
Part I, column (d), line 28
a Expenses, contributions, gifts, etc. - total from 1b
IX-B
b Program-related investments - Total from Part ble, etc.,
directly In carrying out charita
2 Amounts paid to acquire assets used (or held for use) 2
. . .. . . . . . . . . . . . . . . . .
purposes . . the:
s that satisfy
3 Amounts set aside for specific charitable project 3a
a Suitability test (prior IRS approval required) 3b
sctedule)
b Cash distribution test (attach the required line 4 4 1 245 915
Qualifying distributions. Add Ones la through 3b. Enter here and on Part" line 8, and Part XIII,
4 on net investm ent
for the reduced rate of tax
Organizations that qualify under section 4940(e) 5
line 27b (see page 24 of the hstructbns)
Income. Enter 1% of Part I, 6 .245,91*
from line 4
Adjusted qualifying distributions. Subtract line 5 vbether he founda tion
I, colurm (b), In subsequent years Wien calculating
Note: The amount on line 6 will be used in Part tax in those years.
qualifies for the section 4940(e ) reduction of
Form 990-PF (2002)
JSA 1000
2E1470
EFTA00224334
Pigs B
Farm 990-PF (2002)
Part XIII Undistributed Income (see page 24 of the instructions)
(a) (b) (c) (d)
Curp.is Years prior to 2001 2001 2002
I Distributable amount for 2002 from Part Xi,
line 7 • 607,170
2 Undistnbuted income, d any, as of the end of 200t•
a Enter amount for 2001 only 0
b Total ter poor years a
3 Excess distributions carryover, If any, to 2002-
a From 1897
b From 1998 54,323
c From 1999 138,485
d From 2000 172,914
e From 2001 794,417
I Totalof tines 3a through e 1, 160, 139
4 Qualifying distributions for 2002 from Part
XII. line 4 04 5 1,245,915
0
a Applied to 2001, but not more than line 2a
b Applied to undistributed Income of prior years
0
(Election required - see page 24 of the ;minx-hone)
c Treated as distributions out of corpus (Elecbon
required - see page 24 of the Instructions) 0
607 170
d Applied to 2002 distributable amount
e Remaining amount distributed out of corpus 638,745
5 Excess distributions carryover applied to 2002 0 0
Kan amount appears In column Oa, the
same amount must be shown in column (a))
8 Enter the net total of each column as
Indicated below:
a Corpus. Add lines 31, 4e, and 4e. Subtract line 5 1,798,884
b Prior years' undistributed income. Subtract
line lib from line 2b 0
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
• 0
amount - sea page 24 of the instructions , , . ,
o Undistributed income for 2001 Subtract Inc
4a from line 25 Taxable amount- see page 0
24 of the mmfechons
f Undistributed Income for 2002. Subtract
lines 4d and 5 train line 1. This amount must
0
be distributed in 2003
7 Amounts treated as distributions out of
corpus to satisfy requirements imposed by
section 170(b)(1)(E) or 4942(gX3) (see page
24 of the instructions) 0
8 Excess distnbutions carryover from 1997
not applied on tine 6 or line 7 (see page 25 0
of the instructions)
9 Excess distributions carryover to 2003.
1..798,884
Subtract lines 7 and 8 from Nno fla
10 Analysis of line 9:
a Excess from 1998 54,323
b Excess from 1999 138,485
c Excess from 2000 . . . 172,914
d Excess horn 2001 . . . 794,417
a Excess from 2002 . • • 638,745
Form 99042F (2002)
JSA IVII1
OOOOOtit
EFTA00224335
Page 9
Form 990•PF 2002) on 9)
25 of the instructions and Part VII-A, questi
Private Opending Foundations (see page
nation letter that d is a pdvate operating
la If the foundation has rec wed a ruling or determi
of the ruling
foundation, and the rulin is effective for 2002, enter the date 49420)(3) or 49420)(5)
a private operatin g foundation described in section
b Check box to indicate w other the organization is
Tax year Prior 3 years
2a Enlor the lessor of the (a) 2000 (d) 1999 he Total
(a) 2002 Ib) 2001
adjusted not morns from
Part 1 or the minimum
investment return irons Pan
X for each year listed . .
b 85%d the 2a
C Qualifying clainbuionl from Pan
XII, lino 4 la oath yaw baled ,
d AMOunle included in Inc 2c not
used duw-er to IICINO oondud
of exempt &d»bµ
0 Qualifying OnIntvlOnt made
&Melly for ochre conduct al
exempt SCHOU Subtract
One 20 from line 2c
3 Cemplate le, b. or c !Of
altelnlitror Iµ1relied upon
a •Asiftellemiiw enter
(1) Yoke of ell aµW •
(2) vim, ci asses qualm'
under Sadao
4 9420XZXBXI
b •endewnenC Osman lost •
Enter 2/3 el rninurum
investment return &Wool m
Pen X um 6 to each year
IMO
C 'Support' aittmeinv lot • enter
ow man
) TC401 supped
Met Invaibrent iniapme
(Oren dm:tends, rents,
pa&monia ,.tense
loans Isorson 512105g
or tossers)
(2) Support fors pawn'
public and S ot more
exempt orseatuntoos
as Nereid n HOPI
4942010X9X.0
(3) Larsen anatnlof sopped
nom en IMMO
rpenurbon
4 Coos Ovrtnewil near. , more In
part only if the organization had $5,000 or
Supplementary Information (Complete this
page 25 of the instruc tions.)
assets at any time during the year • see
ation Manag ers:
1 information Regarding Found by the foundation
contributed more than 2% of the total contnbutions received
a List any managers of the foundation who have ted more than $5,000) (See section 507(dX2)
they have contribu
before the close of any lax year (but only If
Jeffrey E. Epstein large portico of the
10% or more of the stock of a corporation (or an equally
• b List any managers of the foundation who own .
the foundation has a 10% or greater Interest
ownership of a partnership or other entity) of which
Gift, Loan, Scholarship, etc., Programs:
2 Information Regarding Contribution, Grant, funds
dateable organizations and does not accept unscdoted requests for
Check here I►QX d the organization only makes conintwtions to wesetected
other condition s complete stems 2e, b, c, and d
25 ad the instruction) to indieduals or organisations under
If the organization makes gins, grants, etc (see peg. ed:
address
of the person to whom applications should be
a The name, address, and telephone number
submitt ed and information and materials they should nclude•
b The form in which applications should be
c Any submission deadlines:
kinds of institutions, or other
such as by geographical areas, chantabie fields,
d Any restrictions ur limitations on awards,
factors:
ens,. RAII.PF rennet
JSA
lc 1,10I non
EFTA00224336
Page 10
Form 99(aFF (2002)
Part XV Supplementary Information continued)
3 Grants and Contributions Paid During the Year or Approved for Future Payment
Recipient If recipient is an mciniclual, poonoopon
Mow any relationship to stow of Purpose of grant or Amount
my foundation meneew roapiont conditional
Name and address (home or business) or substantial coninbutix
a Paid during the year
Statement 2
►3a 1,245,000
Total
b Approved for future pewee(
NONE
llo.3b 0
Total
Fon990-PF (2002)
JSA
2E1411 1 000
EFTA00224337
Page 11
Form 990.PF (2002)
s
Analysis of Income-Producing Activitie Excluded by section 512, 513, or
514 fit
Related or exempt
ted Unrelated business twine function income
Enter gr Q55 amounts unless otherwise 'nota (1 (b) (4) (d) (See page 26 of
)
Business Exclusion Amount the instructions)
code Amount code
1 Pro ram salvia) revenue'
a
b
C
d
ies
Fees and contracts torn government agenc
2 Me torah, dues and assessments 14 195,286
3 Interset co savings and temporary cash
'mes ses
,
4 Di clends end interest from securities
S Net rental Income or (loss) from
real estate.
a Debt-financed property
b Not debt-financed properly
ty .
6 Net rental Income or (loss) from personal proper
7 Other Investment Income
n
80asi or (loss) from sales of assets other den wen
al events ,
9 Net Income or (loss) from speci
from sates of inven tory
10 Gross profit or (loss)
11 Other revenue. a
b
C
d
195,286
12 Su 'total. Add columns (b),
(d), end (a) , , , , 13 195,286
(0), (d), and (e)
13 Total. Add line 12, columns
lations )
ctions on page 26 o verity calcu
Sec worksheet in line 13 instru
omp lishment of Exempt Purposes
Relationship of Activities to the Acc XVI-A contributed importantly to
ity for whic h incom e is reported in column (e) of Part ) (See
Explain below how each activ by providing funds for such purposes
ion's exempt purposes (other than
Line No. the accomplishment of the organizat
V page 26 of the instructions.)
Form 990-PF (2002)
JSA
2g 14112 1 000
EFTA00224338
Pepsi 2
Form 990-PF 20021 Relationships With Noncharitable
Information Regarding Transfers To and Transactions and
Exempt Organizations No d in section Vas
of the following with any other organization describe
I Did the organization directly or Indirectly engage In any organiza tions?
ations) or in section 527, relating to political
501(c) of the Code (other than section 501(cX3) organiz
table exempt organization o(
a Transfers from the reporting organization toe nonchan UM, x
(1) Cash 11(2). x
(2) Other assets
b Other Transactions' WW1
tion
(1) Sales of assets to a nonchantable exempt organiza WM)
(2) Purchases of assets from a nonchan table exempt or ganization
11)(31
(3) Rental of facilities , equipme nt, or other assets
1b(4)
(4) Reimbursement arrangements 1bNil
(5) loann or loan guarantees TWO)
solicitations
(6) Performance of sermons or membersNp or fundraising
paid employees
c Sharing of facilities, equipment, mailing lists, other assets, or
follawing schedule. Column (b) should always show the fair market
d If the answer to any of the above is "Yes," complete the fair
reporting organization. If the organization received less that
value el the goods. other assets. or services given by the or seMces
ment, show in column (di the value of the goods, other assets,
market value in any transaction or sharing arrange
received (d) Description of transfers, Pensechons, and shanng arrangements
(a) Lino no 99 Amount involved (c) Name of noncharitoble exempt men et
or related to, one or more tax-exempt organizations
2a Is the organization directly or Indirectly affiliated with,
501(cX3)) or in section 5277
Yes ID E No
described in section 501(c) of the Code (other than section
b if "Yea complete the followin schedule (a) Desamtion of relmonsho
(a) Name of organization (b) Type of orgenizaton
...--" my knowledge end
I
that I mod tin return, including occompanrng sc odules end statements, and to the beet of kricmitde s
Under maudlin of penury 0ix man taxpayer cc bducgtry) is sod on ell informatio n of which prepay has any
belief, it le true, correct d corn ern of prepare, (other
roll
(
1 0i k -7,,,evta,f --
r Tills
Signature of awe al
Sign Here
Prepares SSW or PT1N
D t Ow signature on page 26
7151 0 4 s ell-employed P.
Paid "1 7 411 61 7
...71.„n--- --"
PreparoeS 0, MO
signature
Preparers ON 11, 13-2842281
'GEORGE . ASSO CIATE S
Firm's name tor yours If
Use Only
seMemptoymi), address, rnoEAST 59TH STREET
Phase no
L and ZIP cede NEW YOWL NY 10022
Form 990-PF (2002)
JSA
EFTA00224339
THE C.O.U.Q. FOUNDATION
13-3996471
FORM 990-PF -Y/E 02/28/03
STATEMENT 1
PART I. LINE 23
OTHER EXPENSES
60
Bank Charges
Filing Fees 855
Total 915
EFTA00224340
THE C.O.U.Q. FOUNDATION, INC.. STATEMENT 2
13-3996471
FORM 990-PF Y/E 2/28/03
PART I, LINE 25 AND PART LINE 3
CONTRIBUTIONS PAID
UNRESTRICTED -CASH
5/6/02 Stockholm School of Economics 25,000
5/6/02 Santa Fe Institute 50,000
5/14/02 Engines for Education 62,500
5/28/02 The Prize for Promise 10,000
5/30/02 Harvard University 200,000
6/20/02 Engines for Education 62,500
9/3/02 Council on Foreign Relations 25,000
9/3/02 Trilateral Commission 25,000
9/5/02 New York University 7,000
9/9/02 The Prize for Promise 71,000
9/11/02 Santa Fe Institute 100,000
9/23/02 Massachusetts Institute of Technology 100,000
10/4/02 Ballet Florida 15,000
11/11/02 The Schneider Fund 7,000
2/1/03 Neurosciences Research Foundation, Inc. 250,000
2/7/03 The Dalton School 75,000
2/19/03 Harvard University 110,000
2/25/03 Edge Foundation, Inc. 50,000
1,245,000
EFTA00224341
EXTENSION ATTACI ler)
OMB No 1545.0052
Return of Private Foundation
Form 990 . PF
Department of the Tressuiy
Internal Revenue Some.
or Section 4947(a)(1) Nonexempt Charitable Trust Treated as a Private Foundation
Note: The organization may be able to use a copy of this return to satisfy state reporting requ rements
2003
March 1 , 2003, and ending February_ 29, 2004
For calendar yoar 2003, or tax year beginning
Initial return I I Final return Amended return Address change i Name change
G Check all that apply:
Name of organlzaticn A Employer Identification number
Use the IRS
label. The C .O. U.Q • Foundation, Inc. 13-3996471
Otherwise, Number and street (or P 0 box number if media not de5vered to street address) Roomisuite a Telephone number MO pep 10 of
the instructions)
print
or type. •
i It • Associates, 110 East 59th St.
See Specific d° o examigiOn tWafaiiOn a
c Pandino.Clvxk IP
Instructions. City or town, state, and ZIP code Iwo
D 1 Fauns orosneatronnOnnk .r c P. I
2. F000n orontinon3 mooing Ina
New York, NY 10022 55% lint chock ire .w cited.
H Check type of organization 125j Section 501(c43.) exempt private foundation CompulatiOn Illa
ri Section 4942(0(1) nonexempt charitable trust I I Other texableprivate foundation E if priveie foundabOn Moue was larnin.und
Illn ❑
I Fair market value of all assets at end .1 Accounting method L7.C_I Cash U Accrual under soCi4n507(0KIKAI, chock Iwo
of year (from Pad II, COL (c), brie ❑ Other (specify) F a the foundatiOn a on ellOainth torranonon r __,
16) Po $ 20,391,162 (Part I, column (d) must be on cash basis.) undo SO:Van5071OXVIrj. check hoe . IP. I I
(d) Disbursements
Part I Analysis of Revenue and Expenses (a) Revenue and (b) Net Investment ( ) Adjusted net for charitable
(The total of amounts in columns (b), (e , and expenses per Income Income purposes
(d) may not necessarily equal the =writs in books (cash bate only)
column (a) (see page 10 of the instructions))
10,000,000
coneburionx4s. wino. et. taws yawn Khedulei .
1
if 1110 foundation is not required to
0. Cited' IIP LJ Beech Sch a
I: 2 Distnbulions from split-Interest trusts
3 Interest on sample and temporary cash investments
o 116,028 116,028
4 Dividends and interest from securities
P •
Se Gross rents
.. b (Nat rental income a 0053) I
;=
n Oa Not gain or (loss) hem sale of rissole not on line 10
ai b Gross sales price for as
fr assets on line 8a
7 Capital gain not income from Part IV, line 2)
8 Nei short-term capital gain
9 Income modifications
lea Gross sales less mime
I and sllowances • • • • •
I b Loss Cost ol goods sokl
c Gross proht or (loss) (atiach schedule) . . .
11 Other income (Oath schedule)
10,116_,028 116,028
I 12 Total. Add Imes 1 through 11
11 Compensation al dicers. directors. Melees etc
14 Other employee seisms and wages
Operating and Administrative Expenses
15 Pension plans. employee benefits
2,462 2,462
lea Legal foes (attach schedule)
b Accounting fees (attach schedule)
-n
30,000 11 30,000
c Other professional fees (attach schedule)
17 Interest
REG....
18 Teen (Nisch schedule) (see page 13d the onsunctonn
280 JAN 9 4 2nr14
19 Depredation (attach schedule) and depletion Li
29 Occupancy
21 Travel. conferences, and meetings
OGDEr -
22 Printing and publications 895
695
23 Other expenses (Mach schadule)St 1
24 Total operating and administrative expenses.
33,645 0 33,357
Add lines 13 through 23
1,008,203 1,008,203
25 Contributions, gilts, grants paid 1,041,560
1,041,848 0
26 Tole noonsa on0 01.0uneenanis Add linos 22 and 25
27 Subtract line 26 from line 12.
0 duns of revenue war3306nm and dlabOnlonont•
b Net Investment income (if negative, enter -0•)
c Adjusted not Income (if negative, enter -0-). .
9,074,180
116,028 P
Form 990-PF (2003) /)
Jan
351410 2 000
For Paperwork Reduction Act Notice, sea the Instructions.
EFTA00224342
e2
F • F
t End of year
Attached schedules and amounts In the
• Beginning of year
n scaJmn abased be for (c) Fair Market Value
Part II Balance Sheets destripliOm amounts only (Sea sistnictions I (a) Book Value (b) Book Value
enter-a
1 Cash- non•Interest-beanng 10,229,739 10,229,739
11,252,689
2 Savings and temporary cash Investments
3 Accounts receivable le
Is.
Less allowance for doubtful accounts
4 Pledges receivable la
Less allowance for doubtful accounts IP'
5 Grants receivable
6 Receivables due from officers. directors, trustees, and abet
ns)
disqualified persons (attach schedule) (see page 16 of the instructio
e) fr
7 Other notes and loans recavable (attach schedul
Less allowance for doubtful accounts fr
Inventories for sale or use
8 50,000 50,000
Assets
Prepaid expenses end deferred charges
9
e (attach adulates) ,
10 a Investments • U S end slate government %hipbon
b Investments - corporate stock (attach schedule)
o Investments - corporate bonds (attach schedule)
11 Investments - land. buddines, pp
and equipment basis
Less accumulated deprecia tor, le.
(attach seheClule)
12 investments - mortgage loans 1 0,0 00,000 10,073,623
h achcauheartnerahip
13 Investments • other (attac
14 Land, buildings, end 0,
equipment bass 288
Less accumulated eeprectabon p.
(attach schedule) 37,800 37,800
dry )
15 Other assets (describe leSun
of
16 Total assets (to be completed by all filers - see page 16 20,391,162
11,252,977 20,317,539
me Instructions AIM see one 1, item I)
9,619
17 Accounts payable and accrued expenses
18 Grants payable
g 19 0ererred revenue
20 Loans from officers, direelOra, liuStees, and Care gliseieWlea persons
:3
A 21 Mortgages and other notes payable (attach schedule)
Other liabilities (describe I. )
22
9,619
23 Total Ilebilitles (add lines 17d-dot/oh 22)
__I
Organizations that follow SFAS 117, check here
D.Lj
30 and 31.
and complete lines 24 through 26 and lines
Net Assets or Fund Balances
24 Unrestricted
25 Temporarily restricted
26 Permanently restricted
Organizations that do not follow SFAS 117,
31. Is.
check here and complete !Ines 27 through
27 Capital stock, trust pnncipal, or current funds
20 Pere-in or capital surplus, a land. bldg , and equipment hind 20,317,539
olher runes . , 11,243,358
29 Regime earnings. accianutilled income. endotonent. or
or fund balance s (see page 17 of the
30 Total net assets 20,317,539
11,243,358
instruct ions)
(see page 17 of
31 Total liabilities and net assets/fund balances
11,252,977 20,317,539
I the instructions)
or Fund Balances
Part III Analysis of Changes in Net Assets
agree with
beginning of year - Part II. column (a). line 30 (must
1 Total net assets or fund balances at 11,243,358
return)
end-of-year figure reported on prior year's 2 9,074,180
2 Enter amount from Part I, line 27a 3 1
line 2 (itemize) 9. Rounding
3 Other increases not Included in 4 20,317,539
4 Add lines 1, 2, and 3 5
e),
5 Decreases not included in line 2 (itemiz 6 20 317,539
30
net assets or fund balanc es at end of year (line 4 minus line 5)- Part II, column (b), line
6 Total Fam 990-PF (2003)
JSA
3E1420 1 000
EFTA00224343
Page 3
Form 990-PF (2003)
Capital Gains Losses for Tax on Investment Income
Of 8"
acquire] (c) Date
acquired (d) Date 6014
(a) Ust and describe the kInd(s) of property sold (e g , real estate,
r ural' s° (me edaY, W ) " cl i c"' Yr)
2•s2-story brick warehouse, or common stock, 200 shs. ACC Co.)
1a
b
c
d
a
(f) Depreciation allowed (a) Cost or other basis (h) Gan or (loss)
(a) Gross sales price plus expense of sale (e) plus (I) minus (g)
(or allowable)
a
b
c
d
a
Complete only for assets showing gain in column (h) and owned by the foundation on 12/31/89 (I) Gains (Col. (h) gain minus
0) Adjusted bass (k) Excess of col (i) ed. (k), but not less man -0-) Of
(OF MI as of 12/31/69 over cd (I), if any Losses (from od (h))
as of 12/31169
a
b
c
d
e
If gain, also enter in Part I, kne 7
{
2 Capital gain net income o (net capital loss) If (loss), enter -0- In Part Line 7 } 2
3 Net short-term capital gain or (loss) as defined in sections 1222(5) and (6)
If gain, also enter in Pan I, Ilne 8, column (e) (see pages 13 and 17 of the instructions)
If (loss) enter -0- in Part I, line 8 } 3
Part Qualification Under Section 4940(e) for Reduced Tax on Net Investment Income
investment Income )
(For optional use by domestic private foundations subject to the section 4940(a) tax on net
If section 4940(d)(2) applies, leave the part blank
Was the organization liable for the section 4942 tax on the distributable amount of any year in the
this
base period", . . . Yes n No
If "Yes,' the organization does not qualify under section 4940(e) Do not complete part.
before making any entries.
1 Enter the appropriate amount in each column for each year; see page 17 of the instructions
(s) Cc) 01)
(b) Distotbution no
Base penal years Calendar yew Adjusted queliedne disInOutions Nei value of nonchentablause easels c4 lb) desied by tol all
(or lax year booming al)
1,243,915 12,221,528 0.101944
2002
902,103 7,498,097 0.120310
2001
183,255 208,595 0.878521
2000
153,695 307,635 0.499602
1999
54,655 6,642 8.228697
1998
2 9.829074
2 Total of line 1, column (d
or by
3 Average distribution ratio for the 5-year base period - divide the total on line 2 by 5,
been in existence if less than 5 years 3 1.965814
the number of years the foundation has
4 12,227,806
4 Enter the net value of nonchantable-use assets for 2003 from Part X, line 5
5 24,037,592
5 Multiply line 4 by line 3
6 1,160
6 Enter 1% of net investment income (1% of Pad I, line 27b)
7 24,038,752
7 Add lines 5 and 6
8 1,041,560
6 Enter qualifying distributions from Part XII, line 4 CO pone 17
rite See the Part VI insuuctions
Ilene 8 is equal to or °reales than line 7, check the box in Part VI, line lb. end complete lhol pan name a 1% lax
JSA Form 990-PF (2003)
38100 1 000
EFTA00224344
•
Pane 4
Form tosio•PF (2003)
Based on Investment Income (Section 4940(a), 4940(b), 4940(0), or 4948 • sae pago 17 of the Instructions)
Part VI Excise Tax
1a Exempt operating foundations described in section 4940(d)(2), check here le u and enter "NIA" on tine 1.
Date of ruling letter (attach copy of ruling letter if necessary • see Instructions)
h Domestic organizations that meet the section 4940(e) requirements in Part gcheck 1 2 , 321
here le U and enter 1% of Part I, line 27b
(b)
• All other domestic organizations enter 2% of lino 27b, Exempt foreign organizations enter 4% of Part I, line 12, col
511 (domestic section 4947(a)(1) trusts and taxable foundations only Others enter -0-) 2
2 Tax under section
3 2, 321
3 Add Ones 1 and 2
-0-) 4
4 Subtitle A (income) tax (domestic section 4947(a)(1) trusts end taxable foundations only. Others enter
6 2, 321
5 Tax based on Investment Income. Subtract line 4 from line 3 If zero or less, enter •O•
e Credits/Payments
a 2003 estimated tax payments and 2002 overpayment credited to 2003 ea
b Exempt foreign organizations - tax withheld et source Bb
tic 5, 000
c Tax paid with application for extension of time to file (Form 8868)
d Backup withholding erroneously withheld 6d
7 5, 000
7 Total credits and payments Add lines 6a through 60
8
8 Enter any penalty for underpayment of estimated tax Check here [1 If Form 2220 is attached
► 9
9 Tax due. II the total of lines 5 and 8 is more than line 7, enter amount owed
. ► 10 2 , 679
10 Overpayment. If lino 7 is more than the total of lines 5 and 8, enter the amount overpaid
2 , 67 9 Refunded le 11
11 Enter the amount of tine 10 to be Credited to 2004 estimated tax le
P. r Vila Statements Regarding Activities
did Yes No
1 a During the tax year, did the organization attempt to influence any national, state. or local legislation or
o X
it participate or intervene in any political campaign?
b OM it spend more than $100 during the year (either directly or indirectly) for political purposes (soo page
b X
18 of the instructions for definition)?
materiels
If the answer a "Yes' to to or lb, attach a detailed description of the actIntles end apes of any
published or distributed by the orgenuatIon in connection with the activities.
1c X
c Did the organization file Form 1120•POL fa this year?
the year.
d Enter the amount (If any) of tax on political expenditures (section 4955) Imposed during
(1) On the organization ► $ (2) On organization managers ►$
during the year for political expenditure tax imposed
- Enter the reimbursement (If any) paid by the organization
on organization managers le $
IRS? 2 X
2 Has the organization engaged in any activities that have not previously been reported to the
'Yes,' attache detailed description of the activities
articles
3 Has the organization made any changes, not previously reported to the IRS, in Is governing Instrument.
changes 3 X
of incorporation, or bylaws, or other similar instruments? If 'Yes,' attach a conformed copy of the
year? 4a X
4 a Did the organization have unrelated business gross inecme of $1,000a more dunng the
4b N A
b if -Yes? has it fried a tax return on Form 990•T fa this year?
5 X
5 Was there a liquidation, termination, dissolution, or substantial contraction dunng the year?
If 'Yes,' attach the statement required by General Instruction
satisfied either
6 Are the requirements of section 508(e) (relating to sections 4941 through 4945)
• By language in the governing instrument or
no mandatory directions
• By state legislation that effectively amends the governing instrument so that
X
that conflict with the state law remain In the governing nsuument?
7 X
year? tl 'Yes,' complete Part II, col (c), and Pert KV
7 OS the organization have at least $5,000 in assets at any time during the
or with which it is registered (see page 19 of the
8 a Enter the slates to which the foundation reports
instructions) se. New York
to the Attorney
b If the answer Is 'Yes' to line 7, has the organization furnished a copy of Form 990-PF X
as required by General Instruction CI? If 'No,' attach explanation b
General (or designate) of each stale
claiming status as a private operating foundation within the meaning of section 49420)(3)
$ Is the organization
for Part XIV on
or 49420)(5) for calendar year 2003 or the taxable year beginning in 2003 (soo instructions X
9
page 25)?trYeA s complete Part XIV X
If 'Yes," attach a schedule ksting their names and addresses 10
10 Did any persons become substantial ccntributas diming the tax year? X
requirements for its annual returns and exemption application? 11
11 Did the organization comply with the public inspection
Web site address le _ _ -
Associates Telephone no. Pia Milt
The books are in care of
east 59th Steatit, New York e. NY . ZIP.4 lye 10022
Located at le 110
9.1
Section 4947(a)0) nonexempt chenteble trusts Ming Form 9904,
WI eau el Form 1041 -Check here
Do I 13 I
and enter the amount of lanexempl interest reutned or accrued dumq the year
Form 990•PF (2003)
J3A
3E1440 1000
EFTA00224345
Page 5
Form 99044f 2003)
Statements Regarding Activities for Which Form 4720 May Be Required
Yes Ne
File Form 4720 If any Item Is checked in the "Yes' column, unless an exception applies.
a During the year did the organization (either directly or indirectly)
7
(1) Engage in the sale or exchange, or leasing of property with a disqualified person?
n Yes No
(2) Borrow money from, lend money to, or otherwise extend credit to (or accept It from)
Vim No
a disqualified person?
Yos No
(3) Furnish goods, services, or facilities to (or accept them from) a disqualified person?
Yes No
(4) Pay compensation to, or pay or reimburse the expenses of. a disqualified person?
(5) Transfer any income or assets to a disqualified person (cr make any of either available
Yes L^J No
for the benefit or use of a disqualified person)?
(6) Agree to pay money or property to a government official? (Exception. Check 'No"
if the organization agreed to make a grant to or to employ the official for a period
n
Yes IX INo
after termination of government service, if terminating within 90 days )
in Regulations
b If any answer is "Yes' to 10(1)-(6), dd any of the acts fail to qualify under the exceptions described
section 53 4941(d)-3 or in a current notice regarding disaster assistance (see page 19 of the instructions)? 1b N A
Organizations relying on a current notice regarding disaster assistance check here
acts.
c Did the organization engage in a prior year In any of the eels desonbed in la, other than excepted X
c
that were not corrected before the first day of the tax year beginning n 2003?
was a prwale
2 Taxes on failure to distribute income (section 4942) (does not apply for years the organization
operating foundation defined in section 49420)(3) or 49420X5))
a At the end of tax year 20D3, did the organization have any undistributed income (lines 60
and 6e, Part XIII) for tax year(s) beginning before 20037
YesEl El No
If 'Yes," list the years ei•
b Are there any years listed in 2a for which theorganization is not applying the provisions of section 4942(8X2)
4942(8)(2)
(relating to incorrect valuation of assets) to the year's undistributed income? (if applying section X
the instructions ) 2b
to eh years listed, answer "No' and attach statement • see page 19 of
c If the provisions of section 4942(a)(2) are being appeal to any of the years listed in 2a, list the years here
3 a Did the organization hold more than a 2% direct or indirect Interest in any business
enterprise at any time dunng the year?
ri Yes R.] No
organization
b If "Yes," did it have excess business holdings in 2003 as a result of (1) any purchase by the
longer period approved
or disqualified persons after May 26, 1969. (2) the lapse of the 5-year period (or
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 D Form 4720, to
if the organization had excess business Add/flys in 2003)
determine
3b N A
its charitable purposes? 4a
4 a Did the organization Invest during the year any amount In a manner that would Jeopardize
that could jeopardize its charitable
b Did the organization make any investment in
from
a prior
jeopardy
year
before
(but
the
after
first
December
day of the tax
31, 1969)
year beginning in 2003? 4b X
purpose that had not been removed
pay or incur any amount to.
5 a During the year did the organization
(1) Carry on propaganda, or otherwise attempt to influence legislation (section 4945(e))?
Li Yes ri No
or to carry
(2) Influence the outcome of any specific public election (see section 4955),
Yes X No
on, directly or indirectly, any voter registration dnve?
similar purposes? Yes X No
(3) Provide a grant to on Individual for travel, study, or other
(4) Provide a grant to an organization other than a charitable, etc organization described
in section 509(0(1). (2), or (3), or section 4940(d)(2)? C:1Yes C:INo
(5) Provide for any purpose other than religious, chantable, scientific. Mini?, or
educational purposes, or for the prevention of cruelly to ch3dren or animals?
Ell Yes Fi
No
described in
b if any answer is Yes" to 5a(1)-(5), did any of the transactions fail to qualify under the
Regulations section 53 4945 or in a current notice regarding disaster assistance (see page 20
exceptions
of the instructions)? 5b N A
Organizations relying on a current notice regarding disaster assistance check here L _I
c if the answer is "Yes' to question 5a(4), does the organization claim exemption from the
1- 1 Yes No
tax because it maintained expenditure responsibility for the grant?
It 'Yes,' attach fhe statement required by Regulations section 53 4945•5(0)
6 a Did the organization, during the yew, receive any funds, directly or indirectly, to pay
premiums on a personal benefit contract? I-1Yes LX -,I No
6b X
directly or Indirectly, on a personal benefit contract?
b Did the organization, during the year, pay premiums,
if you answered "Yes' to 6b, also file Form 8870
Form 99044F (2003)
isA
3E1450 1 000
EFTA00224346
Page 6
Form 990.1eF (2003),
Information About Officers, Directors, Trustees, Foundation Managers, Highly Paid Employees,
Part VIII and Contractors
sisespage zu or me Instructions):
1 List all officers, directors, trustees, foundation managers ana tneir cornpensatio (9) Expense account.
(b)Tille, end average (o) Compensation el) Conlinolyans lo
(a) Name and address been per week pi not paid, enter esnineyeeeenent OW,. other allowances
devoted to potabon .04 me Moiled =igen. Won
Jeffrey K. Lipstein . Prea/Dir
St. Thosas,VI hour 0 0 0
6100 Red Hook Quatters, tie
Darren K. Indyke 1 Pres/Dir
One hour 0 0 0
457 Madison Avenue, New York, NY
Ghislaine Maxwell . . Treasurer
NY One Hour 0 0 0
o/o Assoo,110 E. 59th St,
2 Gomnansation of five hlahest-oald employees (other than those included on line 1 - see sago 20 of the instructions).
If none, enter "NONE." to (d) Contributions
(b) Tele end average employee ben* (a) Expense account,
0)Compensabon
(a) Name and address of each employee pad maga $60,000 hours per weak plane and deferred other allowances
devoted to position compensation
None .
. -
* j0
Total number of other employees paid over 550.000
services • see page 20 of the Instructions). If none, enter
3 Five highest-paid Independent contractors for professional
"NONE."
(b) Type of Write (c) Compensation
(a) Name and address 01etCh Wean past more Man $60.000
None
Total number of others receiving over $50,000 for professional services
Part IX-A Summary of Direct Charitable Activities
dumg Me lax year include relevant statistical adarnaton such es the number
list the foundation's four largest direct charitable mimeos Expenses
convened, research Smears produced, ehe
of organizations and other benercanes served, conferences
1
2
3
4
Form 990-PF (zoos)
S
1114•01000
EFTA00224347
Page 7
Form 990-PF (2603)
(see page 21 of the instructions)
Part IX43 Summary of Program-Related Investments
2 Amount
Describe the two largest program-related Investments made by the foundation dunng the tax year on lines Land
•
2
All other program-related investments See page 21 ol the mai/unions
3
►
Total. Add lines 1 through 3
LEM Minimum Investment Return (All domestic foundations must complete this part. Foreign foundations.
see page 21 of the instructions.)
1 Fair market value of assets not used (or held for use) directly in carrying out chartable, etc.,
purposes:
la
a Average monthly fair market value of securities
lb 10,741,214
b Average of monthly cash balances
lc 1,672,802
c Fair market value of all other assets (see page 22 of the instructions)
1d 12,414,016
d Total (add lines la, b, and c)
e Reduction claimed for blockage or other factors reported on lines la and
lc (attach detailed explanation) Ile
to line 1 assets 2
2 Acquisition indebtedness applicable
line ld 3 12,414,016
3 Subtract line 2 from . . . . . . . . . . . . . . . . .. . . . . ... . . . . . .
4 Cash deemed held for charitable activities. Enter 1 1/2 % of line 3 (for greater amount, see page 23
4 186,210
of the instructions)
Part, line 4 5 12,227,806
5 Net value of noncharitable-use assets. Subtract line 4 from line 3 Enter here and on
6 611,390
Minimum Investment return. Enter 5% of line 5
_ and 0)(5) private operating
— Distributable Amount (see page 23 of the instructions) (Section 49420)(3)
in foundations and certain foreign organizations check here sp. pi and do not complete this part )
611,390
I Minimum investment return from Part X, line 6
2,321
2a Tax on investment income for 2003 from Part VI, line 5
b Income tax for 2003. (This does not include the tax from Part VI ) 2
2 2,321
c Add lines 2a and 2b
2c from line 1 609,069
3 Distributable amount before adjustments. Subtract line
4a Recoveries of amounts treated as quakfying distributions 14a
b Income distributions from section 4947(a)(2) trusts
4 0
e Add lines 4a and 4b
5 609,069
5 Add lines 3 and 4c
6 Deduction from distributable amount (see page 23 of the Instructions)
1 . . 609,069
7 Distributable amount as adjusted. Subtract line 6 from line 5 Enter here and on Part XIII, kne
Part XII Qualifying Distributions (see page 23 of the instructions)
1 Amounts paid (including administrative expenses) to accomplish charitable, etc purposes:
1a 1,041 560
a Expenses, contributions, gifts, etc. - total from Part I, column (d), line 26
lb
b Program-related investments - Total from Part
2 Amounts paid to acquire assets used (or held (or use) directly in carrying out chantable, etc ,
purposes 2
3 Amounts set aside for specific charitable projects that satisfy rhe-
Suitability test (prior IRS approval required) 3a
a
(attach the required schedule) 3b
b Cash distribution test
Add lines la through 3b Enter here and on Parti, line fl, and Part XIII. line 4 4 1,041,560
4 Qualifying distributions.
5 Organizations that qualify under section 4940(e) for the reduced rate of tax on net investment
5 0
income. Enter 1% of Part I, line 27b (see page 24 of the instructions)
6 1,041,560
Adjusted qualifying distributions. Subtract line 5 from line 4
calculating whether the foundation
Note: The amount on line 6 will be used in Patti column (b), in subsequent years when
qualifies for the section 4940(e) reduction of tax in those years.
Form 990•PF (2003)
JSA
301470 1 000
EFTA00224348
Page
Form 990:PF (2003)
tions)
Part XIII Undistributed Income (see page 24 of the instruc
(b) (o) (d)
(el 2003
Corpus Years prior to 2002 2002
1 Distributable amount for 2003 from Part XI, 609,069
line 7
2 Undistributed income. ir any, as of the end ci 2002 0
a Enter amount for 2002 only 0
b roue tor pnor years
3 Excess distnbutions carryover, it any, to 2003
a From 1996 54,323
138,4 85
b From 1999
172,9 14
c From 2000
794,417
d From 2001
638,745
o From 2002
1,798,884
f Total of lines 35 through e
4 Qualifying distributions for 2003 from Part
XII. hne 4 P- 5 1 , 04 1 , 560
0
a Applied to 2002, but not more than line 2a
b Applied to undistributed income of aria years 0
(Electron required • foe page 24 of the instructcos)
e Treated as distributions out of corpus (Election 0
required - see page 24 of the Instructions) 609,069
d Applied to 2003 distributable amount
432 , 491
e Remaining amount distributed out of corpus 0
0
5 Excess distnbutions carryover applied to 2003
Wan amount appears hi column (d), the
same amount must be shown in column (a))
6 Enter the net total of each column as
Indicated below:
2,231,375
a Corpus. Add fines 3f, 4c, ender) Subtract line 5
b Prior years' undistributed Income Subtract 0
line 4b from ins 2b
c Enter the amount of prior years' undistnbuted
income for which a notice of deficiency has
been issued, or on which the section 4942(a) 0
tax has been previously assessed
if Subtract line& from line 6b. Taxable 0
amount - see page 24 of the Instructions
• UnOmInbuled income for 2002 Subtract line
4a from has 2a Tenable amount • see page 0
24 of tae mstruclio ns
f Undistributed Income for 2003 Subtract
lines 44 and 5 from line I This amount must 0
be distributed in 2004
7 Amounts treated as distributions out of
corpus to satisfy requirements imposed by
section 170(b)(1)(E) or 4942(gX3) (see page 0
25 of the instructions)
8 Excess distributions carryover from 1995
not applied on line 5 or line 7 (see page 26 54,323
of the Instructions)
9 Excess distributions carryover to 2004. 2,177,052
Subtract lines 7 and 8 from line 6a
10 Analysts of line 9
138,485
e Excess from 1999
172,914
b Excels from 2000 . .
794,417
e Excess from 2001 . . .
638,745
d Excess from 2002
2003 • • - 432 , 491
0 Excess from Form 990-PF 12003)
JSX
3E1480 1000
EFTA00224349
Page 9
Form 990.111: (2003)
PrlLate Operating Foundations (see page 25 of the instructions and Part question 9)
la If the foundation has received a ruling or determination letter that it is a private operalmg
foundation, and the ruling is effective for 2003, enter the date of the ruling lls
whether the organization is a private operating foundation described in section I 49420X3) or I j 4942(0(5)
Is Check box to indicate
Tax year Prior 3 years
2a Enlor the lesser of the (42000 (a) Total
0°2003 (b)2002 to 2001
adjusted net income tom
Part I or the mmimum
investment Mum horn Port
X for each year Hied .
b 85% of Imo Ett •
C Ovattlymp ctsinbatons Iran Pal
XII, Ione 4 toi eacri yea haled ,
d Arnounts rncioded in Imo 2c not
(nal atectly for ammo co•acci
a *tempt autores
0 autilitpng ilialiibuticeis made
directly roe peen ConduCi el
*lamp, pelmets Subtract
lime 7d fern lie 2c
3 Complete 3a, a ac la the
0Aernalive test eased upon
a 'Mass' enarnalne lost - al*
(1) VOAe elm nai,
(2) value el meals quieten
woe seeton
49425X31(5)01• • • • •
b 'Endowment' ielemaino teat •
Enter 213 a rivneinum
investment mean shown in
Past X, Mae fix Oeth year
Inted
C 'Support' owner., lest. enter
(1) iota &upped deer man
peels investment titian
(Maros& as lende ears,
Melon,* en seaman
loon. (swan 512(e)(6)A
or roWhes)
(2) Support Iron penal
public end 5a mete
exempt inanitateens
a prevail n lacteal
49420)(3Xa)(u)
(3) latent amount et support
ken en swept
otganaeme.
(4) Gross irwoorms mom .
had $5,000 or more in
Supplementary Information (Complete this part only If the organization
assets at any time during the year - see page 25 of the instructions .)
1 Information Regarding Foundation Managers:
received by the foundation
a List any managers of the foundation who havo contributed more than 2% of the total contributions
507(d)(2) )
before the dose of any lax year (but only if they have contributod more than $5,000) (See section
Jeffrey E. Epstein
an equally large portion of the
b List any managers of the foundation who own 10% cc more of the stock of a =potation (or
ownership of a partnership orother entity) of which the foundation has a 10% or greater interest
•
2 Information Regarding Contribution, Grant, Gift, Loan, Scholarship, etc., Programs:
Check hero ► {] if the organization only makes contributions to preselected chantatde aganualoons and does not accept uncoated requests
complete gems 2a,
for funds
b, e, and cl
the organization makes gifts. granliocic (seepage 25 of the instruceandioindmduals or organizeoons under other condboes,
a Tho name, address, and telephone number of the person lowhom applications should be addressed
include
b The form In which applications should be submitted and information and materials they should
c Any submission deadlines.
kinds of Institutions, or other
d My restrictions or limitations on awards, such as by geographical areas, chanted° holds,
factors:
ISA Form 990-PF (2003)
351490 1 000
EFTA00224350
Page 10
Nom 9904" (2003)•
Enal__ Supplementary Information continued)
Future Payment
3 Grants and Contributions Paid During the Year or Approved for
If reaped is an inendosi. poundaswn
Recipient show any Matronship lo mews of Purpose d oranl or Amount
any louncloon manses( conineueon
wipe&
Name and address (home or business) or substantial cattalo,
a Ped dung the year
Statement 2
la. 3a 1,008,203
Total
b Approved for future payment
None
le 3 b 0
Total
Fawn 990-PF (2003)
JSA
391491 1 000
EFTA00224351
Page 11
Form 990-PF (200S)
Part XVI-A Iysis ofIncome-Producing Activities
unrelated business income Excluded b' section 512. 513, or 514 Relaterg exempt
Enter gross amounts unless otherwise indicated function income
(a)
Business
(b) (9) (l)
Amount
(sea Vitt Unr)
_code Amount E1029cm
1 Program service revenue.
•
b
c
d
e
1
g Fees and contracts from government agencies
2 Membership dues and assess sets
3 Interest on savings and temporary cash investments 14 116,028
4 Dividends and Interest horn secunbes
5 Net rental income or (loss) from real estate
aDebt-financed property
bNot debt-financed property
6 Net rental income or (loss) from personal woody .
7 Other investment Income
8 Gain or pose) titan sells of assets other men inventory
9 Net Income or (loss) from special events . .
10 Gross profit or (loss) from sales of inventory. .
11 Other revenue a
b
c
d
0 116,028
12 Subtotal Add columns (b), (d), and (e) . . . - 13 116,028
13 Total. Add line 12. columns (b), (d), and (e)
o verify calculations I
See worksheet in line 13 instructions on page 26 ses
Relationship of Activi ties to the Accomplishment of Exempt Purpo
In column (e) of Part XVI-A contributed Importantly to
income Is reported
Explain below how each activity for which than by providi ng funds for such purposes) (See
Line No. the accomplishment of the organization's exempt purposes (other
page 26 of the Instructions )
N/A
Form 990-PF (2003)
19.4
3•l452 1 000
EFTA00224352
Patio 12
form 990•PF 2003
information Regarding Transfers To and Transactions and Relationships With Noncharitable
Exempt Organizations
described In section Yes No
1 Did the organization directly or Indirectly engage in any of the following with any other organization
or In section 527, relating to political organizations?
501(c) of the Code (other than section 501(c)(3) organizations)
a Transfers from the reporting organization to a nonchantabte exempt organization of:
1am
(1) Cash
?aj21 X
(2) Other assets
b Other transacluxis
1b(1) X
(1) Sales of assets to a nonchantable exempt organization
1b12) X
(2) Purchases of assets from a noncharitable exempt organization
Ilb(3) X
(3) Rental of facilities, equipment, or other assets
lo(e), X
(4) Reimbursement arrangements
1b(5)
(5) Loans or loan guarantees
b(6) X
(5) Performance of services or membership or fundraising solicitations
I c
c Sharing of facilities, equipment, mailing lists, other assets, or paid employees
show the fair market
d If the answer to any of the above is "Yes' complete the following schedule Column (b) should always
organization If the organization received less than fair
value of the goods, other assets, or services given by the reporting
in column (d) the value of the goods, other assets, or services
market value in any transaction or shanng arrangement, shay
received
(c) Name of nonchentable exempt organizalion (0) Description °Monsters. transactions. and shanng wrengomonts
(a) Lew no (b) Amount smoked
organizations
2 a Is the organization directly or indirectly affiliated with, or related to, one or morel x•exempt
527? ❑ Yes El No
described in section 501(0) of the Code (other then section 501(0)(3)) or In section
b If "Yes "comdele the fotlowinoschedu le
(h) Type of organization (c) Description of relationship
(a) Name of organization
Under penalties of pequry. I dodans that I have oxamvied return, including accompanying schedules end statements, and to the best of my knomaydge end
belief, al es We, Cermet, end complete fall° (other Own Impayer or aduaary) is based on all information of which means has any km:Wedge
kl krel-6 2--• 0"0`,Q.C/41-i--A--
_
r Title
. Signature of ofgoer or trustee Dale
• Date
E
„?...c.,L....\
e/ '1
....t Cheek 0
"IPI0Yed►
.7 / •4 .
4".. / /0/4).5 348-4
& C .2.• PropOrerS Os
Fo y E 8 signature
ii a 0 Associates EIN
. E g Firm's name (or yours if
IL self-employed). address, 10 East 59th Street
and ZIP code New York, NY 10022 Phone no 212 -909-9680
rem, 990-PF (2003)
JIA
3E1403 1 000
EFTA00224353
0 8 No 1645.0047
Schedule B Schedule of Contributors
(Form 990, 980-EZ,
or 990.PF) Supplementary information for
99D, 990-EZ, and 990•PF (see instructions)
2003
Department of the Treasury line 1 of Farm
Internet Revenue Sent. Employer Identification number
Name of organization
13- 3996471
The C.O.U.Q. Foundation, Inc.
Organization type (check one)
Fliers of: Section:
Form 990 or 990-EZ o 501(c)( ) (entefnumber) organization
a private foundation
4947(a)(1) nonexempt charitable trust not treated as
527 political organization
Form 990-PF CI 501(c)(3) exempt private foundation
foundation
4947(a)(1) nonexempt charitable trust treated as a private
501(c)(3) taxable private foundation
or (10)
or a Special Rule. (Note: Only a section 501(c)(7), (8),
Check If your organization is covered by the General Rule
and a Special Rule - see instructions.)
emeruza0on can check box(es) for both the General Rule
General Rule -
(in money or
)C 990-PF that received, during the year, $5,000 or more
❑ For organizations filing Form 990, 990-EZ, or
I and II.)
property) from any one contributor. (Complete Parts
Special Rules •
33 113% support test of the regulations
❑ For a section 501(c)(3)(1organiz ation filing Form 990, or Form 990-EZ, that met the
y170(b)(1XA)(vi) and received from any one contrib utor, during the year, a contribution of the
under sections 509(8)
of these forms (Complete Parts I and II )
greater of $5,000 or 2% of the amount on line 1
ono contributor,
Form 990, or Form 990-EZ, that received from any
❑ For a section 501(c)(7), (8), or (10) organization filing s, charitable,
of more than 51,000 for use exclusively for religiou
during the year, aggregate contributions or bequests (Comp lete Pans I, II, and Ill )
tion of cruelty to children or animals
scientific, literary, or educational purposes, or the preven
one contributor,
filing Form 990, or Form 990-EZ, that received from any
❑ For a section 501(c)(7), (8), or (10) organization es, but these contribu tions did
vely for religious, chantable, etc , purpos
during the year, some contributions for use exclusi utions that were receive d during
d, enter here the total contrib
not aggregate to more than $1,000. (If this box is checke the Pads uNess the Genera l Rule
e. Do not complete any of
the year for an exclusively religious, charitable, etc , purpos , contnb utions of $5,000 or more
luslvely religious, charita ble, etc
applies to this organization because it received nonexc ►$
during the year )
le B (Form 990,
General Rule and/or the Special Rules do not frle Schedu
Caution: Organizations that we not covered by the tine I of (heir Form
In the heading of their Form 990, Form 990-EZ, or on
990-EZ, or 990-PF), but they must check the box ).
requirements of Schedule B (Form 990, 990-EZ, or 990-PF
990-PF, to certify that they do not meet the filing
Schedule B (Form 990, 990.E2, or 990-PF) (2003)
For Paperwork Reduction Mt Notice, ree the Instructions
for Form 990 end Form 99041
3E+251 1 000
EFTA00224354
Mori to &rani
Schedule 0(rotm eS0..S9) EL or Ii1104,1)(2003l Employer Identification number
Name of organixation
13-3996471
The C.O.U.Q. Foundation, Inc.
tElll Contributors (See Specific Instructions.)
(c) (d)
(b) Type of contribution
(a) Aggregate contributions
No. . Name, address, and ZIP + 4
Person —
1 The Leslie H. Wexner Charitable Fund
Payroll _ ,
Assoc ,110 E. 59th St 10,000,000 Noncash
c/o
(Complete Part lid there is
a noncash contnbution )
New York, NY 10022
(c) Id)
(b)
(a) Aggregate contributions Type of contribution
No. Name, address, and ZIP +4
Person _
Payroll —
Noncash
(Complete Part II if there is
a noncash con ribution.)
(c) (d)
(a) (b) Type of contribution
Name, address, and ZIP + 4 Aggregate contributions
No.
Poson
Payroll 11-1
Noncash
(Complete Part II if there is
a noncash contribution )
(c) (d)
(a) (b) Type of contribution
Name, address, and ZIP + 4 Aggregate contributions
No.
Person _
Payrol l
Noncash
(Complete Part II if there is
a noncash contribution )
(c) (d)
(a) (b) • Type of contribution
Aggregate contributions
No. Name, address, and ZIP + 4
Person —
Payroll —
Noncash _
(Complete Part II If there is
a noncash contnbution.)
(c) (d)
(b) Type of contribution
(a) Aggregate contributions
No. Name, address, and ZIP + 4
Person —
Payroll _
Noncash _
(Complete Part II if there Is
a noncash cont ibution.)
Schedule 9 (Form Dee. 1100a or 9.04aF) t20031
JSA
3E125] ICAO
EFTA00224355
Pepe to of Pettit
Schedule (Form 900,990•EZ. Or 990$F) (2003)
Employer Identification number
Name of organization
13-3996471
The C . O. U .Q . Foundation, Inc.
Part fl Noncash Property (See Specific instructions.)
(a) No. (c)
(d)
(b) FMV (or estimate)
from Date received
Description of noncash property given (see Instructions)
Part I
(a) No. (c) (d)
(b) FMV (or estimate)
from Date received
Description of noncash property given (see Instructions)
Part I
(a) No. (c)
(b) (d)
from FMV (or estimate)
Date received
Description of noncash property given (see instructions)
Part I
(a) No. (c)
(b) (d)
from FMV (or estimate)
Date received
Description of noncash property given (see instructions)
Part I
(a) No. (c)
(d)
(b) FMV (or estimate)
from Date received
Description of noncash property given (see instructions)
Part I
(a) No. (c) (d)
(b) FMV (or estimate)
from Date received
Description of noncash property given (see instructions)
Part I
Schedule a (Form 990, 990.EZ, or 990.PF) (2003)
(So
361254 I C00
EFTA00224356
Pogo to of Panel
Schedule q (Form 99.0, 990.EZ, or 900•Pf ) (2003)
Employer Idontlfication number
Ham. of organization
13-3996471
The C.O.U.Q. Foundation, Inc.
organizations
Part Excius/vefy religious, charitable, etc., individual contributions to section 501(c)(1), (8), or (10) line entry.)
aggregating more than $1,000 for the year. (Complete columns (a) through (e) and the ollowing
For organizations completing Part III, enter the total of exclusively religious, charitable, etc ,
contributions of $1,000 or less for the year. (Enter this information once - see instructions.) p $
( (o) )
VA"
Part I
Purpose a gift Use of gift Description oldhow Otis held
(I)
Transfer of gift
Transferee's name, address, and ZIP + 4 Relationship of transferor to transferee
(a) No. (a (d)
from Purpose of gift Use ol gift Description of how gift is held
Part I
(e)
Transfer of gift Relationship of transferor to transferee
Transferee's name, address, and ZIP + 4
(el (d)
(a) No. (b) Description of how gift is held
from Purpose of gift Use of gift
Part I
(e)
Transfer of gift
Relationship of transferor to transferee
Transferee's name, address, and ZIP s 4
(b) e) (d)
(a) No. Description of how gift Is held
Purpose of gift Use of gift
from
Part I
(e)
Tran far of gift
Transferee's name, address, and ZIP + 4 Relationship of transferor to transferee
LA Schedule a (Form 990, 990•EZ, or 900•OF) (2003)
3C 1255 1 000
EFTA00224357
STATEMENT I
THE C.O.U.Q. FOUNDATION, INC.
13-3996471
FORM 990-PF - Y/E 2/29/04
Part I. Line 23
Other Expenses
$30
Fees
865
Bank charges
Total $895
EFTA00224358
THE C.O.U.Q. FOUNDATION INC. STATEMENT 2
13-3996471
FORM 990-PF Y/E 2/29/04
PART I, LINE 25 AND PART LINE 3
CONTRIBUTIONS PAID
Amount purpose
Date Name
15,000 Unrestricted
3/4/03 Ballet Florida
10,000 Scholarship
3/27/03 South University
17,000 Unrestricted
4/7/03 Interlochen Center for the Arts
25,000 Unrestricted
4/7/03 Council on Foreign Relations
5,000 Unrestricted
4/10/03 The New York Botanical Garden
6,000 Unrestricted
5/6/03 Aveda Institute
100,000 Unrestricted
5/29/03 Columbus Jewish Foundation
4,079 Scholarship
6/24/03 Don Quijote
25,000 Unrestricted
7/23/03 Ovarian Cancer Research Fund
1,798 Unrestricted
8/12/03 Rutgers University
10,000 Unrestricted
8/21/03 Julliard School of Music
110,000 Unrestricted
8/22/03 Santa Fe Institute
10,000 Unrestricted
9/2/03 DARE
10,000 Unrestricted
9/2/03 Ballet Florida
5,700 Unrestricted
9/2/03 Harvard University
7,495 Unrestricted
9/2/03 Harvard University
10,000 Unrestricted
9/15/03 The Ricardo O'Gorman Garden & Center
15,000 Unrestricted
9/17/03 Physics Dept, Case Western Reserve U
100,000 Unrestricted
9/25/03 Harvard University
10,000 Unrestricted
10/7/03 South University
25,000 Unrestricted
10/9/03 Stockholm School of University
36,000 Unrestricted
10/16/03 Town of Palm Beach
25,000 Unrestricted
10/20/03 Council on Foreign Relations
30,000 Unrestricted
10/22/03 Harvard University
50,000 Unrestricted
12/1/03 American Ballet Theatre
20,000 Scholarship
12/8/03 California School of Culinary Arts
120,000 Unrestricted
12/15/03 Harvard University
7,000 Unrestricted
12/15/03 Snyder Fund for Young Musicians
2,500 Unrestricted
1/6/04 Hunter College
11,000 Scholarship
1/6/04 New York University
15,000 Unrestricted
1/6/04 Ballet Florida
18,200 Unrestricted
1/7/04 The International Institute for Strategic
11,431 Scholarship
1/8/04 Columbia University
15,000 Scholarship
1/9/04 New School University
50,000 Unrestricted
1/21/04 Trilateral Commission
50,000 Unrestricted
1/21/04 City College
25,000 Unrestricted
1/23/04 Center for Health and Healing
1,008,203
EFTA00224359
Page 2
Form SS (12.2000)`
h Extension, complete only Pad II and check this box
a,IX
• If you are filing loran Additional (not automatic) 3-Mont ion on a previou sly filed Form 8868.
an automatic 3-month extens
Note: Only complete Part If if you have already been granted
aro filing for an Automatic 3-Mont h Extens ion, comple te only Part I (on page 1).
of Time - Must File Or glnal and One Copy.
Additional (not automatic) 3-Month Extension Employer identification number
Name of Exempt Organization
Type or 13-3996471
print THE C.0.1.1.Q. FOUNDATION, INC, : Fa IRS use only
Number, street, and room or suite no. If a P.O. box, see Instructi ons .,
Ho b,, ono .
extender) ASSOCIATES, 110 EAST 59TH ST ' e
iiiisaws,w C/O . •
code For a fasten address , see instructi ons ::'.ea%
Ill ng the DIY, town or post office, slate, and ZIP
rout', Soo
NEW YORK, NY 10022
instructions
CO
{R ack type of return to be flied (Re a separate applica
Form 990 n Form 990-EZ
tion for each return).
Form 990.1 (sec 401(a) or 408(a) trust)
Form 990-T (trust other than above)
Form 1041-A
Form 4720
R Form 5227 O Form 8870
Form 6069
Form 990431 Form 990-PF
tiled Form 8868.
granted an automatic 3-month extension on a previously
STOP: Do not complete Part II If you were not already
P- 1_1
ss in the United States, check this box
• If the organization does not have an office or place of busine If this is
• If This is for a Group Return, enter the or ainization's four digit Group Exemption Number (GEN)_,
a 1st with the
for the whole group, check this box le U if for part of the group, check this box le U and attach
names and EINs of all members the extension is for.
until January 15, 2005
4 I request an additional 3-month extension of time and ending February 29, 2004
5 For calendar year , or other tax year beginning March 1, 2003
accounting period
- Li Initial return U Final return U Change In
e If this tax year is for less then 12 months, check reason prope r comp letion of
Certain information necessary for the
7 State in detail why you need the extension
the return is not yet available.
or 6069, enter the tentative tax, less any
8a If this application Is for Form 990-BL, 990-PF, 990-T, 4720, 5, 000
nonrefundable credits See Instructions ted
4720, or 6069, enter any refundable credits and estima
b If this application is for Form 990-PF, 990-T, amoun t paid
allowed as a credit and any
tax payments made. Include any prior year overpayment $ 5 , 000
previously with Form 8868 require d, deposi t
your payment with this form, or, if
c Balance Due. Subtract line 8b from line 8a. Include
by using EMS (Electronic Federal Tax Payment System). See
with FR) coupon or, if required,
Instructions
Signature and Verification
my knowledge and belief
schedules and statements. and to the best of
commuted tha Wm, including aCcompeowng
kind penalties of W)ey. I doctors that I have
d n t ue, correct, end conrpym, and that
I am auihonlod to prepare Ohs loom OCT 2 5 2004
Srgn lum ►
Title Ilk M the IRS maim
Notice to Applicant - To Be Completed by
organization's return.
We have approved this application. Please attach this form to the or the due
r, we have granted a 10-day grace period from the later of the date shown below
We have not approved this application. Howeve artfilg teNAV INR0 VEVI ons
This grace period is considered to be
date of the organization's return (Including any prior extensions).
otherwise required to be made on a timely return. Please attach
We have not approved this application. After conside ring the
this form to the organization's return.
reasons stated In item 7, we cannot grant your rotyt r
lotririon of time
to file. are not granting a 10-day grace period.
due date of the return for which an exlensl9
We cannot consider this application because It was filed after the •
Other t
••••• .. alkaiSIONPROCtmtE kti
BY • ••••
• —.,
_• Oars
extension
the copy of this application for an additional 3-month
Director
Alternate Mailing Address Enter the address if you want
above.
returned to en address different than the one entered
Name
Associates
box number
Type or Number and street (Include suite, room, or apt. no) Or a P.O.
print 110 East 59th Street
or ZIP code)
City or town, province or state, and country (Including postal
J$A New York, NY 10022 F00118856 (12-2000)
3F 0465 1000
EFTA00224360
EXTENSION ATTACI !7:o
OMB No 1546-0052
F.900-PF Return of Private Foundation
Department ol the Treasury
Internal Revenue Senwe
or Section 4947(a)(1) Nonexempt Charitable Trust Treated as a Private Foundation
Note: The organization may be able fo use a copy of this return to satisfy state reporting requrements
2003
March 1 , 2003, and ending February 29, 2004
For calendar year 2003, or tax year beginning_
I Final return I I Amended return I I Address charge Name change
Check all that apply: I I Initial return I
Name of organization A Employer identification number
Use the IRS
label. The C . O. U . Q. Foundation, Inc.
13-3996471
Otherwise, Number and street (or P 0 box number if mail is not deirmredlostreet address) Room/suite B Tetepeone number (see page 10 of
the trisKictions)
print
or typo. _ ,O
Sou Specific Cf , • Associates, 110 East 59th St.
C ii **emotion nonthon a Illo
Instruction*.
City or town, state, and ZIP code ponOmo. chock bolo
0 I Fo, ton orgouroban. ohm" hen . I,
2. F0:44,11 °rpm...ono moan Coo
New York, NY 10022
H Check type of organization Il_C.I Section 501(cal exempt private foundation
rompuiebon
65% Matched. hero ond dit•Ch
.F1
ri Section 4947(a)(1) nonexempt charitable trust I I Other taxbbleeprivate foundation E II panto foundobon siolus mos ;rowan m---1
I Fair market value of all assets at end J Accounting method L)u Cash Accrual Li onder anion 5070XIXO). duck Moo l• l_l
of year (from Part II, col. (c), line ❑ Other (specify) F V Co loonnocm to in • 60.month lonnmolgo
20,391,162 (Part I, column (d) must be on cash basis.) untie flan, sIneXeleA chika rte.. Ill. I I
EIS
$
Id) Disbursements
Analysis of Revenue and Expenses (a) Revenue end Net Investment (b) (e) Adjusted net for charitable
(The Mal of amounts in cdumns (b), ( ), and expenses per Income income purposes
Of) may nd nocessailly equal the amounts in book (cash oasts oeM
column (a) (seepage 10 of the instruc ions))
I Conlituiscons. points. M:, mown (sled,schadulo) . 10,000,000
if the loundanoi is not roe MOO 10
• Oath fle attach Sch 8
I
2 Distributions from split-Interest trusts . . .
1
3 Interest on fl ans end temporary cash investments
116, 028 116,028
4 Dividends and interest from secuntsas
5a Gross rents
raniai income a 0055) )
Z it, " Net
PE 8 ii Not gain or (loss) horn sale of easels not on lino 10
• • Gross solos pnco for at
assets on line 6a
sA 7 Capital gain net income (from Part IV, line 2) .
: 8 Net short-term capital gain
: 9 Income modifications
: 10 a Grtoss solo, lea mavens
I and allowances • • • • •
i b Less Cool of goods sold .
c Gross profit or (loss) (attach schedule) , . . ,
11 Other Income (attach schedule)
10,116,028 116,028
i 12 Total. Add lines 1 through 11 . . . . , . . ,_
11 Compensation of ofScors. directors. trustees. etc
Other employee salaries and wages
Operating and Administrative Expenses
14
15 Pension plans, employee benefits
2,462 2,462
lee Legal fees (attach schedule)
b Accounting foes (attach schedule) .....---i
30,000 30, 000
17
c Other professional fees (attach schedule), . ,
Interest it
RECEIVE- 0 _ k.
18 Taxes (enrich schedine)Isa ono 13 of Co oulivciono)
19 Depreciation (attach schedule) and depletion
288 4 JAN 9 4 2nti
20 Occupancy
Travel, conferences, and meetings '
21
22 Printing end publications
OGDEr- 895
Other expenses (attach schedule)SP/ . 38 .
895
23
24 Total operating and administrative expense
33,645 0 33,357
Add lines 13 through 23
1,008,203 ' 1,008,203
25 Contributions, gifts, grants paid
1,041,848 0 1,041,560
26 T is ft see sod ell b onto Add fines 24 and 25
27 Subtract lino 26 from line 12.
8 nom of menus cow aroma sad allairt•MOMI
b Net Investment income (if negative, enter -0-)
. 9,074,180
116,028 P
c Adlusted net Income Of negative, enter 4)-). •
Form 990-PF pootip3
JSA For Paperwork Reduction Act Notice, see the Instructions.
3E 1410 2030
EFTA00224361
PaOa 2
Pam 990 I2F (2003 End of year
i Attached schedules end amounts in iho Beginning of yew
Part II Balance Sheets clescnott on cotumn Ovule be los (a) Book Value (b) Book Value (c) Fair Market Value
I end-ohyear amounts only (See install:eons )
Cash - non-Inlerest-boanng
1 10,229,739 10,229,739
11,252,689
Savings and temporary cash investments
2
Accounts receivable lo
3
Loss allowance for doubtful accounts fr
4 Pledges receivable lb
Leas allowance for doubtful accounts la-
5 Grants receivable
6 Receivables due from officers. directors, trustees, and other
disqualified persons (attach schedule) (see page 16 or the matwebons)
7 Other notes and loans receivable (attach schedule) OP
Less allowance for doubtful actOunal.
8 Inventories for sale or U90 50,000 50,000
Assets
9 Prepaid expenses and deferred charges
10 a investments - LI $ end elate spreinmeni obligabons (attach achedule)
b Investments - corporate stock (attach schedule)
e Investments - corporate bonds (attach schedule)
11 Investments • land, budding!, io,
end equipment basis
Lass accumulated daeractatton le-
(attach whacks)
12 Investments - mortgage bens 10,000 , 000 10,073,623
Or.tn .ets. Oh...
13 Investments - other (attach schedule)P.
14 Land, theldings . and II
equipment basis 288
Less accumulated deptemation 0.
Mach schedule) 37,800 37,800
)
15 Other Meta (describe leSurtdry
16 al
14 Total assets (to be completed by all Mere - see page 20,317,539 20,391,162
items) 11,252,977
the Instruct ions Also, see page!,
I 9,619
17 Accounts payable and accrued expenses
18 Grants payable
g 19 Deferred revenue
persons
g 20 Loans Item olficen, directors, trustees, and outer drsousded
schedul e)
21 Mortgages and other notes payable (attach
3 22 Other liabilities (describe lei
)
9,619
23 total Ilabletles (add lines 17 through 291
I
Organizations that follow SFAS 117, check here
P Li
ete lines 24 throug h 26 and lines 30 and 31.
and compl
Net Assets or Fund Balances
24 Unrestricted
25 Temporarily restricted
26 Permanently restricted
Organizations that do not follow SFAS 117,
p
check here and complete lines 27 through 31.
27 Capital stock, trust principal, or current funds
28 Paid-in or capital surplus, or land, bldg , and equipment land 20, 317, 539
11,243,358
29 Reigned earnings, accumulated income. endowment or other ands„
the
30 Total net assets or fund balances (see page 17 of 20,317,539
11,243,358
instructions)
17 of
31 Total liabilities and net assets/fund balances (see page 20,317,539
11,252,977
I the Instructions)
Balances
Part III Analysis of Changes In Net Assets or Fund
of year - Part It, column (a), line 30 (must agree with
1 Total net assets or fund balances at beginning 1 11,243,358
return)
end-of-year figure reported on prior year's 2 9,074,180
2 Enter amoun t from Part I inta 27a 1
3
(itemize) p Rounding
3 Other increases not included mine 2 4 20,317,539
4 Add lines 1, 2, and 3 5
5 Decreases not included in line 2 (itemize) Pi 8 20,317,539
(line 4 minus line 5) - Part II column (bkline 30
6 Total net assets or hind balances at end of year roim990-PF (2003)
Yea
391420 1000
EFTA00224362
page 3
Form 9a0-.Pf (2003)1
Part IV Capital Gains and Losses for Tax on Investment Income
) Hew
'(0come tied
(e) Dir
Da (d) Date sold
(a) List and describe the kIncl(s) of property sold (e g , real estate, eavrme (mo
Das Bo.ned . ) (mo. day, yr )
2-story brick warehouse, or common stock,200shs. MLC Co.) K
to
b
c
d
e
(f) Depreciation allowed (e) Cost or other basis 04 Gam or (loss)
(e) Gross safes price (e) plus (f) minus (g)
(or allowable) plus expense of sate
a
b
e
d
e
Complete only for assets showing gain in column (h) and owned by the foundation on 12131/69 (I) Gains (Col. (A) gain minus
(k) Etas d col (i) col. (k). but not less than -0-) or
U) Adjusted bass Losses (from col (h))
(I) F M 1 as of 12/31169 as of 12/31/69 over col 0), if any
a
b
c
d
e
If gain, also' enter in Part I, line 7
I
2 Capital gain net income o (net capital loss) II (loss), enter -0- In Part I, line 7 } 2
3 Net short-term capital gain or (loss) as defined in sections 1222(5) and (6)
If gain, also enter in Part I, line 8, column (c) (see pages 13 and 17 of the Instructions)
} 3
If (loss), enter -0- In Part I. line 8
Part Qualificatio n Under Section 4940(e) for Reduced Tax on Net investment Income
Income )
(For optional use by domestic private foundations subject to the section 4940(a) tax on net investment
If section 4940(dX2) applies, leave INs Part Mari(
yearn the base period', . . . 1111 Yes El No
Was the organization liable for the section 4942 tax on the distnbutable amount of any
If "Yes," the organization does not qualify under section 4940(e) Do not complete this part.
before making any entries.
1 Enter the appropriate amount in each column for each year; see page 17 of the instructions
18) (c) lson Me
(d)
CasInbu
Base period yeah Calendar year ( s° destitution,
Adjusted clueles Net value 04 nonchareable-use assets (col io) (Weed by ccit (c))
(or tax you berm° in)
1,243,915 12,221,528 0.101944
2002
902 , 103 7,498,097 0.120310
2001
183,255 208,595 0 . 878521
2000
153 , 695 307 , 635 0 . 4 99602
1999
54,655 6,642 8.228697
1998
2 9. 829074
2 Total of line 1, column (d
3 Average distribution ratio for the 5-year base period - divide the total on brie 2 by 5, or by
3 1.965814
the number of years the foundation has been In existence if less than 5 years
4 12,227,806
4 Enter the net value of noncharitabie-use assets for 2003 from Part X, line 5
5 24,037,592
5 Multiply line 4 by line 3
6 1,160
8 Enter 1% of net investment income (1% of Part One 27b)
7 24,038,752
7 Add Imes 5 and 6
8 1,041,560
8 Enter qualifying distributions from Part XII, line 4
tax into See the Part Vi instrucuons on pagan
II line a is equal le or greeter than line 7. Bieck Me box in Pad VI. knells. and complete that part owlet%
Form 990-PF (2003)
SSA
3EI130I000
EFTA00224363
Page 4
Form 990-PF ar3, Investment Income (Section 4940(a), 4940(b), 4940(e
), or 4948 - soo paqo 17 of the instructions)
Part VI Excise Tax Based on
2), check hero ► and enter "NIA" on line 1.
1a Exempt operating foundations described in section 4940(dX
Dale of ruling letter (attach copy of ruling letter If necessary - see Instructions) 2 , 321
1
h Domestic or anizations that meet the section 4940(e) requirements in Pater, check
here ► u and enter 1% of Part I, tine 27b
12, col (b)
27b. Exempt foreign organizations enter 4% of Part I, line
o All other domestic organizations enter 2% of line 2
(1) trusts and taxable foundati ons only Others enter -0-)
2 Tax under section 611 (domestic section 4947(a) 3 2,321
3 Add lines 1 and 2 4
and tenable foundations only. Others enter -0-)
4 Subtitle A (income) tax (domestic section 4947(a)(1) trusts 5 2,321
4 from line 3 If zero or less, enter -0-
5 Tax based on Investment Income. Subtract line
• CrechtsIPayments
credited to 2003 6a
a 2003 estimated tax payments and 2002 overpayment
6b
b Exempt foreign organizations - tax withheld at source 5,000
Ida (Form 8868) 6c
c Tax paid with application for extension of time to
60
d Backup withholding erroneously withheld 7 5,000
6d
7 Total credits and payments Add Ilnes 6a through 8
d lax Check here ❑ If Form 2220 is attached
8 Enter any penalty for underpayment of estimate ► 9
8 is more than line 7, enter amount owed
9 Tax due. If the total of lines 5 and 2,679
5 and 8, enter the amount overpaid
10 Overpayment. If line 7 is more than the total of lines 2, 6'79 Refunded ► 11
to be Credite d to 2004 estimat ed tax ►
11 Enter the amount of line 10
ies
P rt VII-A Statements Regarding Activit lee No
organiz ation attempt to influence any national, slate, or local legislation or did
1 a Dunne the tax year, did the 1■ X
n?
it participate or intervene in any political campaig
than $100 during the year (either directly or indirectly) for political purposes (see page
b Did it spend more lb X
t8 of the instructions for definition)?
description of the activities and ccpies of any materials
If the answer is 'Yes' fo la or lb, attach a detailed
ion mai the activities.
published or distributed by the organization in connect 10 X
this year?
c Did the organization file Form 1120-POL for
the amount (If any) of lax on political expendi tures (section 4955) Imposed during the year.
d Enter
(2) On organization managers ►$
(1) On the organization ► 5
_ organiz ation during the year for political expenditure tax imposed
Enter the reimbursement (If any) paid by the
on organization managers ► $ 2 X
that have not previously boon reported to the IRS?
2 Has the organization engaged in any activities
If 'Yes,' attach a detailed desorption of the ectnithes articles
sly reported to the IRS, in Re governing instrument,
3 Has the organization made any changes. not previou changes 3 X
nts? If 'Yes.' attach a conform ed copy of the
of incorporation, or bylaws, or other similar instrume 45 X
s gross income of $1,000 or more during the year?
4 • Did the organization have unrelated busines 4b N
990.7 for this year?
b If 'Yes; has It filed a tax return on Form 6
Was there a liquidat ion, termina tion, dissolut ion, or substantial contraction during the year?
l kistruction T
If Nasal attach the statement required by Genera
requirem ents of section 508(e) (relating to sections 4941 through 4945) satisfied either
8 Are the
nt or
• By language in the governing instrume s
By state legislati on that effectiv ely amends the governing instrument so that no mandatory direction X
• 6
g instrument?
that conflict with the state law remain In the governin 7 X
it Col (c). and Part )N
Did the organiz ation have al least $5,000 in assets at anytime during the year? If 'Yes," camPlete Part
7 of the
ion reports or with which it is registered (see page 19
8 a Enter the states to which the foundat
instructions) ► New York
tion furnished a copy of Form 990-PF to the Attorney
b if the answer Is 'Yes" to line 7, has the organiza ak X
by General instruction G7 If "No," attach exPlanahon
GenSf81 (or designate) of each state as required 49420)(3)
operating foundation within the meaning of section
9 Is the organization claiming status as a private Part XIV on
year beginning in 2003 (see instructi ons for
or 49420)(5) for calendar year 2003 or the taxable 9 X
page 25)? /1"Yesia complete Part XIV e listing their names end address es 10 X
tors dunng the lax year? If "Yes," attach a schedul
10 Did any persons become substantial contribu returns and exemption application? 11 X
public inspecti on requirem ents for its annual
11 Did the organiz ation comply with the
Web site address lo _ _ Telephone no. ►_ 909-9680
--------
Associates
The books are in care of ZIP44 ► 10022
New York c_ NY
locaied ► 110 east 59th Street 1
nonexem pt charitab le trusts Ming Form 990-PF in lieu of Form 1041 -Check here
".r Section 4947(0(1) Poi 131
received or accrued during the year
and enter the amount of tax-exempt interest Rim 990*PF (2003)
JSA
3E14401 000
EFTA00224364
Page 5
Form 990•PF 2003)
Be Required
Statem ents Regardinj Activities for Which Form 4720 May
Yes
column, unless an exception applies.
File Form 4720 If any Item Is checked In the "Yes"
1 a During the year did the organization
(either directly or indirectly)
with a disqualified person?
ri Yes ri No
(1) Engage in the sale or exchange, or leasing of property
extend credit to (or accept it from)
(2) Borrow money from, lend money to, or otherwise Yes No
a disqualified person? Yes No
them from) a disqualified person?
(3) Furnish goods, services, or facilities to (cc accept Yes No
s of, a disqualified parson?
(4) Pay compensation to, or pay or reimburse the expense
for make any of either available
(5) Transfer any income or assets to a disqualified person El Yes No
for the benefit or use of a disqualif ied person) ?
official? (Exception. Check 'No'
(6) Agree to pay money or property to a government
employ the official for a period
if the organization agreed
governm
to make
ent
a grant
service, if
to or
termina
to
ting withal 90 days )
D Yes rfl No
after termination of
fad to qualify under the exceptions descnbed in Regulations
b If any answer is "Yes" to ¶a(1)•(6), did any of the acts lb N A
assistance (see page 19 of the instructions)?
section 53 4941(d)-3 or in a current notice regarding disaster O
assistance check here
Organizations relying on a current notice regarding disaster
acts described in la. other than excepted acts,
c Did the organization engage in a prior year In any of the 1c X
beginning in 2003?
that were not corrected before the first day of the tax year
(does not apply for years the organization was a private
2 Taxes on failure to distribute income (section 4942)
a 4942(jX 5))
operating foundation defined in section 4942Q)(3)
uted income (lines 6d
a At the end of tax year 2003, did the organiz
g
ation
before
have
2003?
any undistrib
ri Yes No
and 6e, Part XIII) for tax year(s) beginnin
If "Yes," list the years le
tion is not applying the provisions of section 4942(a)(2)
b Are there any years listed in 2e for which the organiza
undisintuted income? (If applying section 4942(a)(2)
(relating to incorrect valuation of assets) to the years 2b
• see page 19 of the instructions )
to all years listed, answer "No' and attach statement
to any of the years listed in 2a, list the years here
e If the provisions of section 4942(8)(2) are being applied
le
Interest In any business
3 a Did the organization hold more than a 2% direct or indirect in Yes E, No
enterpnse at any time dunng the year?
as a result of (1) any purchase by the organization
b if 'Yes." did it have excess business holdings in 2003
lapse of the 5-year period (or longer period approved
or disqualified persons after May 26. 1969. (2) the
dispose of holdings acquired by gift or bequest, or (3)
by the Commissioner under section 4943(c)(7)) to
paned? (Use Schedule C. Form 4720, fo determine
the lapse of the 10., 15., or 20-year first phase holding 3b N A
if the organization had excess business hddlngs in 2003) X
purposes? 40
amount in a manner that would jeopardize its chantable
4 a Did the organization invest during the year any jeopardi ze its charitable
year (but after December 31, 1969) that could
b Ord the organization make any investment in a prior X
the first day of the lax year beginnin g in 2003?
purpose that had not been removed from jeopardy before
organiz ation pay or incur any amount to.
5 a Dunng the year did the [ Yes No
e legislation (section 4945(e))?
(1) Carry on propaganda, or otherwise attempt to Influenc
(see section 4955), or to carry
(2) influence the outcome of any specific public election Yes A No
on, directly or indirectly, any voter registrat ion drive?
Yes X No
other similar purposes?
(3) Provide a grant to an Indlindual for travel, study, or
le, etc, organization described
(4) Provide a grant to an organization other than a charitab Ej No
4940(d) (2)? ❑ Yes
in section 509(8)(1), (2). or (3)• or section
e, scientific, literary, or
(5) Provide for any purpose other than religious, chantad Yes a No
cruelty to children or animals? n
educational purposes, or for the prevent ion of
transactions fail to qualify under the exceptions describe d rn
b If any answer is 'Yes" to 58(1)-(5), did any of the lib N A
Regulations section 53 4945 or in a current notice regarding disaster assistance (see page 20 of the instructions)?
10E]
assistance check here
Organizations relying on a current notice regarding disaster
organization claim exemption from the
c if the answer is "Yes" to question 5a(4). does the
expendi ture respons ibility for the grant?
El Yes C3 No
tax because it maintained
sectkri 53 49454(d)
If 'Yes," attach the statement required by Regulations
6 a Did the organization, during the year,
receive any funds. directly a indirectly, to pay
❑ Yes [3 No
premiums on a personal benefit contract? contract ? bb
s, directly or Indirectly, on a personal benefit
b Did the organization, during the year, pay premium
d
If you answere "Yes' to 6b. also file Form 8870
Rem 990-PF (2003)
'SA
3E i450 1 000
EFTA00224365
page 6
Form 990•OF (2003)' Highly Paid Employees,
Information About Officers, Directors, Trustees, Foundation Managers,
Part VIII and Contractors (etelpege tu in me inatrucuune):
tion managers anu men compensation
1 List an °moors, (erectors, trustees, rounoa ensathin (e)COnInbubfela 10 (e) Espouse account,
(b) title. and average (c)Comp
(IInot paid, enter employee emelt Orr Other allowances
(e) Nome end fl ing hours per weak tion
devoted to position .04 end deterred compensa
Pres/Dir
Jeffrey E. Epergne 0 0 0
Quart ers, St. Thoma d,VIO ne hour
6100 Red Hook
Indyk e it. Pres/Dir
Darren K. 0 0 0
One hour
457 Madison Avenue, New York, NY
Treasurer
Ghislaine Maxwell 0 0 0
We Assoa,110 E. 59th St, NY One Hour
page 20 of the Ins ructions).
(other than those included on line 1 - see
2 Compensation of five highest-paid employees
If none enter "NONE." (d) Contributions to
(b) idle and average employee benefit (e) Expanse escor t
ileum per week (c) Compensation plans and deferred other allowances
(a) Name and address of each employee peel more men 350,000 compensation
(leveled to porta
None .
.
.
•
- -
te 0
Total number of other employees paid over $50,000 of If none, enter
professional services • (see page 20 the Instruc tions).
3 , Five Mghest-paid Independent contractors for
"NONE." (e) Compensation
(b) Typo of sena
(a) Hanle and seeress ce each noon pad more.then 350,000
None
. . . . . 0
Total number of others receiving over $50,00
0 for professional services
Part IX -A Summary of Direct Charitable Activities
m such es the numbor
*Ours arms se lax year Include relevant SWISUCOInformalic EJMOOSOS
List the foundation's lour largest (erect charitable Produced . etc
served. conferra ls cemented . research Parrs
of organizations and other bunenuemas
2
3
4
Form 990-PF (2005)
!IA
Se1410 1000
EFTA00224366
Page 7
Form 990-Pr (2603)
(see page 21 of the instructions)
Part IX-B Summary of Program-Related Investments
made by the foundatIcn dunng the lax year on lines 1 and 2 Amount
Describe the two largest program-related investments
2
All other 0100,601401010d onvestmenle see page 21 of the inalrutttons
3
►
Total. Add lines 1 through 3
LEM Minimum Investment Return (All domestic foundations
of the instructions. )
must complete this part. Foreign foundations,
see page 21
1 Fair market value of assets not used (or held for use) directly in carrying out chantable, etc..
purposes:
1a
a Average monthly fair market value of secuMies
lb 10,741,214
b Average of monthly cash balances
1c 1,672,802
c Fair market value of ail other assets (see page 22 of the instructions)
1d 12,414,016
d Total (add lines la, b, and c)
Reduction claimed for blockage or other factors reported on lines la and
lc (attach detailed explanation) to I I
indebtedness applicable to line 1 assets 2
2 Acquisition
3 12,414,016
3 Subtract line 2 from line td
4 Cash deemed held for charitable actmbes. Enter 11/2% of line 3 (for greater amount, see page 23
4 186,210
of the instructions)
4 from line 3 Enter here and on Pan/ line 4 5 12,227,806
5 Net value of noncharitable-use assets. Subtract line
line 5 6 611,390
Minimum Investment return. Enter 5% of
Distributable Amount (see page 23 of the instructions) (Section 49420)(3) and 6)(5) private operating
- An foundations and certain foreign organizations check here ► F-1
and do not complete this part)
1 611,390
1 Minimum investment return from Part X, line 6
from Part VI, line 5 2,321
2a Tax on Investment income for 2003
b Income tax for 2003. (This does not include the tax from Part VI ) 2
2 2,321
c Add lines 2a and 2b
609,069
3 Distributable amount before adjustments. Subtract line 2c from bite 1
14
4a Recoveries of amounts treated as qualifying distributions
b Income distnbutions from section 4947(a)(2) trusts
0
e Add lines 4a and 4b
609,069
5 Add lines 3 and 4c
6 Deduction from distributable amount (see page 23 of the instructions)
XIII. line 1 . . . . 609,069
7 Distributable amount as adjusted. Subtract line 6 from line 5 Enter here and on Part
Part XII Qualifying Distributions (see page 23 of the instructions)
1 Amounts paid (including administrative expenses) to accomplish chartable, etc , purposes:
1a 1,041 560
a Expenses, contributions, gifts, etc. - total from Part I, column (d), line 26
Part IX-B. lb
b Program-related investments - Total from . . . . . . .. . . .
2 Amounts paid to acquire assets used (or held for use) directly in carrying out chartable, etc ,
purposes 2
3 Amounts set aside for specific chantable projects that satisfy the•
3a
a Suitability test (prior IRS approval required)
3b
b Cash distribution lest (attach the required schedule)
knee, and Part XIII, erne 4 4 1,041,560
4 Qualifying distributions. Add lines Ia through 3b Enter here and on Part',
Organizations that qualify under section 4940(e) for the reduced rate of tax on net investment
5
5 0
income. Enter 1% of Part I, line 27b (see page 24 of the instructions)
5 from line 4 6 1,041,560
Adjusted qualifying distributions. Subtract line
whether the foundation
Note: The amount on line 6 will be used in Patti, column (b), in subsequent years when calculating
qualifies for The section 4940(e) reduction of fax in those years.
Form 990-PF (2003)
J$A
301410 1000
EFTA00224367
Page 8
Form 990.PF (2003)
tions)
Part XIII Undistributed Income (see page 24 of the instruc
(b) (c) (d)
(a) 2003
Corpus Years prior to 2002 2002
1 Distributable amount for 2003 from Pan XI, 609,069
line 7
2 Undistributed income, it any, as of Ihe end 012002 0
a Enter amount for 2002 only 0
b Total for poor years
3 Excess distributions canTover, if any. to 2003
a From 1995 54 , 323
138,4 85
b From 1999
172,9 14
c From 2000
794,4 17
d From 2001
638,7 45
e From 2002
a 1,798,884
f Total of lines 3a through
4 Qualifying distributions for 2003 from Part
XII, Ince P s 1,041,560
0
a Applied to 2002 but not more than line 2a ,
b Applied to undistributed income of once years 0
(Election required • see page 24 of ere instructions)
c Treated as distributions out of corpus (Election 0
required • see page 24 of the instrucbons) 609, 069
d Applied to 2003 distributable amount
432,491
e Remaining amount distributed out of corpus 0
0
5 Excess dielnbutions carryover applied to 2003
gran amount appears In column (d), the
same amount must be shown in column (a))
8 Enter the net total of each column as
Indicated below:
2,231,375
a Corpus. Add fines 3f. 4c, and 4e Subtract line 5
b Prior years' undistributed Income Subtract 0
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) 0
tax has been previously assessed
d Subtract tine 8c from line fib. Taxable 0
amount - see page 24 of the Instructions
• Undistributed income for 2002 Subtract line 0
4a horn line 2a Taxable amount • see page
24 of the instructions
IUndistributed income for 2003 Subtract
lines 4d and 5 from line I This amount must 0
be distributed in 2004
7 Amounts treated as distnbutions out of
corpus to satisfy requirements imposed by
section 170(b)(1)(E) or 4942(gX3) (see page 0
25 of the instructions)
8 Excess dtstnbutions carryover from 1998
not applied on line 5 or line 7 (see page 25 54 ,323
of the Instructions)
9 Excess distributions carryover to 2004. 2,177,052
Subtract lines 7 and 8 from line 6a
10 Analysis of line 8
138,485
a Excess from 1999
172,914
b Excess from 2000 , .
794,417
c Excess from 200t
638,745
d Excess frcm 2002
4 Excess from 2003 • • • 432,491
Form 990-PF 12003)
J59
3E14$0 1 000
EFTA00224368
Form illso-PF 1003) Ns 9
PrNate Operating Foundations (see page 25 of the instructions and Part Vila, question 9)
Ia if the foundation has received a ruling or determination letter that it s a private operating
foundation, and the ruling Is effective for 2003, enter the date of the ruling 10
whether the organization is a private operating foundation described in section I 49420X3) or l' J 40420)(5)
b Check box to indicate
Tax year Pnor 3 years
2a Enlei the leSSer Of the (d) 2000 **Total
hem (al 2003 (b) 2002 (0)2001
adjusted net income
Part I or the ininimvin
investment 'alum trOM Pert
X for each year toted . .
I2 85%of ins 2e
c 0vehlyine 041/tun:as Iron Pal
XII. lon• 4 tor oxn year inted ,
d Arno-J.1ra mclueed in kw 2c not
coal dinecny far acute conduct
0 exempt menten
0 04elifying dainty/tons mode
erectly tor awn conduct Cl
exempt admen Sonnet%
line 2,1 from Ina 2c
3 Complete 3a. b. of o la the
orneminive ten tidied upon
a 'Assets' 1.116.1111:I/Oleil . WW
(1 ) Vi0000hiallitin, .
(2) vows 01sawn quelMing
under /GOO
4 9420)(3X0Eit
b 'Endowment' eliemaine test •
Enter 213 of rmninen
investment rulum anion n
Pat X. inc 6 for tech per
hoed
C 'Support' sfeivnaine lest • enter
(1) Tote support other then
9106. IrIVOW4nlinf.alle
41111.0.01, dmdends. rents,
penimenu on wombs.
lane (.Mon 512(015))
of /game)
(2) Support hos *envoi
public end 6 se woe
exempt cepennetiens
*I {needed n sectica
45420/13E0E46
(3) Largest imam or support
kcal on exempt
ergOnted4011
(4) Own mieslment noire
Part XV Supplementary Information (Complete this part only If the organization had $5,000 or more in
assets at any time during the year - seepage 25 of the instructions.)
1 Information Regarding Foundation Managers:
trial contributions received by the foundation
a List any managers of the foundation who have contributed more than 2% of the
507(d)(2) )
before the close of any tax year (but only if they have contributed more than $5,000) (See section
Jeffrey E. Epstean
an equally large portion of the
b List any managers of the foundation who own 10% or more of the stock of a corporation (or
of which the foundation has a 10% or greater interest
ownership of a partnership or other entity)
2 Information Rilarding Contribution, Grant, Gift, Loan, Scholarship, etc., Programs:
not accept unSolicile0 requests la funds
Check here ► al of the organization only makes contributions to preselected chartable InenaelienS end does
complete dons 2a. 0,c, and d
If the organization makes gets, grantji.fitc [see plus 25 or the instiliChenelle indenduala or organaahons under Mho( conditions,
a The name, address, and telephone number of the person to whom applications should be addressed
include
b The form in which applications should be submitted and information and materials theyshould
e Any submission deadlines.
fields, kinds of Institute:es, or other
d Any restrictions or limitations on awards, such as by geogruphical areas, charitable
factors:
JSA Form 990-P F (2003)
3E1490 1000
EFTA00224369
Pogo 10
Form 000-PF (2003).
Supplementary information continued) •
rn
Future Payment
3 Grants and Contributions Paid During the Year or Approved for
Recipient it sapient is an sidwaluat. Foundalon
Purpose of grant Or
show any relabonslwi 10 status ol Amount
any tountlabOn Manager recipient Contrubullon
Name and address (home or business) or substantial contnOutor
a Paid during the year
Statement 2
ll. 3a 1,008,203
Total
b Approved for future payment
None
lio 3b 0
Total
Form 990-PF (2003)
Jan
001491 1 000
EFTA00224370
Pagett
Form 996PF (200)
•Producing Activities (o)
Unrelated bustness inccrns Excluded b) section 512, 513. or 514
Enter gross amounts unless atomise indicated
ti) (b) pa fil Mtne
ficti:
(See
liti
(b) 10)
Business Exclusion
code Amount cone Amount
1 Program stows revenue,
a
b
c
d
0
.
1
9 Fees end contracts from gownmenl agencies
2 Membership dues and assessments
3 interest on savings and 'memory cash investments
14 116,028
4 Dividends and Interest Iran secunbes
5 Net rental income or (loss) from real estate
a Debt-financed property
b Not debt-financed property
8 Net rental income or (loss) Irmo personal properly .
7 Other investment Inane
8 Gem or (loss) horn sales of assets ether then inventory
9 Net Income or (loss) from special events
10 Gross profit or (loss) from sales of inventory. .
11 Other revenue s
b
c
d
0
116,028
12 Subtotal Add columns (b), 01, and (e) . . . .
13 116,028
13 Total. Add line 12, columns (b), (d), and (e)
See worksheet in line 13 instructions on page 26 o verify calculations )
Relationship of Activities to the Accomplishment of Exempt Purposes
XVI•A contnbuted Importantly to
Explain below how each activity for which income Is reported In column (e) of Part
Line No. the accomplishm ent of the organization's exempt purposes (other than by providing funds for such purposes) (See
page 26 of the instructions )
N/A
Form 990-PF (2003)
JSA
3114921 coo
EFTA00224371
Pare 12
Form 990.PF 2003)
Transactio ns and Relationsh ips With Noncharita ble
Information Regarding Transfers To and
Exempt Organizations
in section Yes No
1 Old the organization directly or Indirectly engage in any of the following with any other organization described
in
501(c) of the Code (other than section 501(eX3) organizations) or section 527, relating to political organizations?
a Transfers from the reporting organization to a nonchantable exempt organization ol:
Taft) x
(I) Cash
1312) x
(2) Other assets
b Other transactions
;to(1)
(1) Solos of assets to a nonchantable exempt organization
assets from a noncharltable exempt organization 1b(2),
(2) Purchases of
1b(3)
(3) Rental of facilities, equipment or other assets
10(4)
(4) Reimbursement arrangements
10( 5
(5) Loans or ban guarantees
11:16)
(6) Performance of services or membership or fundraising solicitations
1c
e Sharing of facilities, equipment, mailing lists, other assets, or paid employees
(b) should always show the far market
d If the answer to any of the above is "Yes," complete the following schedule Column
received boss than fair
value of the goods, other assets, or services given by the reporting organization I the organization
market value in any transaction or sharing arrangement, show in column (d) the va ue of the goods, other assets, or seMces
received
(a) Line no (0) Amount invoked (c) Name of nonchantable exempt orgainualon (d) Desoto:don of transfers. Itansia:Idass. end sling arrangements
tax-exempt organizations
2 a Is the organization directly or indirectly affiliated with, or related to, one or more
section 501(c)43)) a in section 5277 ri Yes Q No
described in section 501(e) of the Code (other than
b If ' complete the laliwano schedule
(b) Type of ofganizabon (c) Descriplon of Waive tup
. (a) Name ol organization
I
Under gentian of penury. I declare that I have examinedr isort:leurmt.min cludasg Par
has enOyl knowledge
sf tsiSismalVoti0 t it i"
mecri
s abon
CCArluiZityVbrtecl on allauTorm
taxpayeraCH end
belief, il is Imo, coned, and complete mho
cov....L.,.. K•
Signature of officer ot bud*
I it , Loy •14.,,-..,_ e:-‘isiczkait-
Dale We
Sign Here
„a c.....L...\.. Dab/
_ Check if
i / 0/0 5 reen°r PTIN211
selhocuRloYed ".pasPrePatlireem:tuSSN
t e .6. Prepatets plo /
m E 8 signature
I • Associates EIN II.
Spa Firm's name (or yours d
a. D soft-empbyod). address, 110 East 59th Street
and ZIP cods New York, NY 10022 Phone no 2 12 -90 9-9680
I Form 990•PP (2003)
.MA
3E14931000
EFTA00224372
•
OMB No 1545.0047
Schedule B Schedule of Contributors
(Form 990, 990-EZ,
or 990-PF)
Doper[moot el the Treasury
Supplementary Information for
One 1 of Form 990, 990-EZ, and 990-PF (see instructions)
2©03
Internal Revenue Selma
Employer Identification number
Name of organization
13-3996471
The C.O.U.Q. Foundation, Inc.
Organization type (check one)
Filers of: Section:
Form 990 or 990-EZ 501(c)( ) (enter number) organization
4947(a)(1) nonexempt charitable trust not treated as a private foundation
527 political organization
Form 990-PF 501(c)(3) exempt private foundation
4947(a)(1) nonexempt charitable trust treated as a private foundation
501(c)(3) taxable private foundation
501(c)(7), (8), or (10)
Check if your organization IS covered by the General Rule or a Special Rule. (Note: Only a section
organization can check box(es) for both the General Rule and a Special Rule • see instructions.)
General Rule -
or more (in money or
El For organizations filing Form 990, 990-EZ, or 990•PF that received. during the year, 55,000
property) from any one contnbutor. (Complete Parts I and IL)
Special Rules •
33 113% support test of the regulations
EP For a section 501(c)(3) organization filing Form 990, or Form 990-EZ, that met the
under sections 509(8)(1)l170(b)(1)(A)(vI) end received from any one contributor, during the year, a contnbution of the
greater of $5,000 or 2% of the amount on line 1 of these forms (Complete Parts I and II )
E] For a section 501(c)(7). (8), or (10) organization filing Form 990, or$1,000
Form 990-EZ, that received from any one contributor,
for use exclusively for religious. charitable,
during the year, aggregate contributions or bequests of more than
I, II, and III )
scientific, literary, or educational purposes, or the prevention of cruelty to children or animals (Complete Parts
CI For a section 501(c)(7), (8), or (10) organization filing Form 990, orcharitable,
Form 990-EZ, that received from any one contributor,
etc , purposes, but these contnbutions did
during the year, some contributions for use exclusively for religious,
were received during
not aggregate to more than $1,000. (If this box is checked, enter here the total contributions that
of the Pads uNess the General Rule
the year for an exclusively religious, charitable, etc , purpose. Oo not complete any
charitable, etc , contributions of $5,000 or more
applies to this organization because it received nonexcluslvely religious,
* $
during the year )
Schedule B (Fonn 990,
Caution: Organizations that are not covered by the General Rule and/or the Special Rules do not fife
the heading of their Form 990, Form 990-EZ, or on line 1 of their Form
990-EZ, or 990-PF), but they must check the box In
the tiling requirements of Schedule B (Form 990, 990-EZ, or 990-PF).
990-PF, fo certify that they do not meet
For Paperwork Reduction Act Hence, see the Instructions Schedule B (Form 990, 990-U, or 990-0F) (2001)
for Form 990 end Form 090a.
J5A
3E1251 1 000
EFTA00224373
Pro to ottani
Schechdo 000, 99042, oceSOPF) (20031
Ertl:toyer IdOtilifiCation numhor
Name of organization
13-3996471.
The C.O.U.Q. Foundation, Inc.
Part I Contributors (See Specific Instructions.)
(c) (d)
(a) (b)
Name, address, and ZIP +4 Aggregate contributions Type of contribution
No.
1 The Latino N. Wexner Charitable Fund Person —
Payroll —
c/o Aesoc,110 E. 59th St 10,000,000 Noncash
I.
(Complete Part II d there is
New York, NY 10022 a noncash cont button )
(b) (c) (d)
(a)
Name, address, and ZIP +4 Aggregate contributions Type of contribution
No.
Person —
Payroll —
Noncash _
(Complete Part II if there is
a noncash contribution.)
(b) (c) (d)
(a)
Name, address, and ZIP +4 Aggregate contributions Type of contribution
No.
Person —
Payroll —
Noncash _
(Complete Part II d there is
. a noncash contribution )
(b) (c) (d)
(a)
No. Name, address, and ZIP +4 Aggregate contributions Type of contribution
Person
Payroll _
Noncash
(Complete Part II if there is
a noncashcont 'button)
(b) (c) (d)
(a) Type of contribution
No. Name, address, and ZIP +4 Aggregate contributions
Person —
Payroll _
Noncash
(Complete Part II if there's
a noncash con nbution.)
(b) (c) (d)
(a) Aggregate contributions Type of contribution
No. Name, address, and ZIP +4
Person —
Payroll _
Noncash
(Complete Part II if there is
a noncash contribution.)
Schedule B (Form t90, IIMEL or VOI-PF) 0003)
,ISA
341253 f 000
EFTA00224374
Page to of Port II
Schedule ft (ream 900. 990.EZ, or 090.PF) (2003)
Employer Identification number
Name of organization
13-3996471
The C . O. U . Q. Foundation, Inc.
Part 11 Noncash Property (See Specific Instructions.)
(a) No. (c) (d)
(b) FMV (or estimate)
from Date received
Description of noncash property given (see instructions)
Part I
(a) No. (c) (d)
(b) FMV (or estimate)
from Date received
Description of noncash property given (see Instructions)
Part I
(a) No. (e)
(b) (d)
from FMV (or estimate)
Date received
Description of noncash property given (see instructions)
Part I
(a) No. (c)
(b) (d)
from FMV (or estimate)
Description of noncash property given Date received
Part I (see instructions)
(a) No. (c)
(b) (d)
from FMV (or estimate)
Description of noncash property given Date received
Part I (see Instructions)
(a) No. (c)
(b) (d)
from FMV (or estimate) Date received
Description of noncash property given (see instructions)
Part i
Schedule a (Form sim. swat of 990.PF) (2003)
JSA
3e I254 1000
EFTA00224375
Pea to of Penal
Schedule Q (Poem 900. 090EE of 990-PF) (2003) Employer IdenlIfication number
Name of organization 13-3996471
The C.O.V.Q. Foundation, Inc. n 501(c) (1), (8), or (10) organizations
utions to sectio
Part ill Swarth* religious, charitable, etc., Individual contriblete colum ns (a) throug h (e) and the follow ing line entry.)
aggregating more than $1,000 for the year. (Comp
exclusively religious, charitable, etc.,
For organizations completing Part III, enter the total of
information once - see Instructions.) $
contributions of $1,000 or less for the year. (Enter this
b) Description orhow gift Is held
Vl °. ( e of gift
Purpos Useof gift
Part I
(t)
Transfer of gift
Relationship of transferor to transferee
Transferee's name, address, and ZIP * 4
()
b) (c
o.
Use of gift Description ofdhow gilt b held
(from Purpose of gift
Part 1
(e)
Transfer of gtft Relationship of transferor to transferee
Transferee's name, address, and ZIP .4
(d)
(a) No. (b) (0) Description of how gill is held
Use of gift
train Purpose of gift
Part I
(e)
Transfer of gift
Relationship of transferor to transferee
Transferee's name, address, and ZIP • 4
c)
(a) No. (b) Description ortioW gift is held
Purpose of gift Use of gift
from
Part I
(e)
Transfer of gift
Relationship of transferor to transferee
Transferee's name, address, and ZIP • 0
Schedule B (Form 990, 090(EZ, or 990(PF) (2003)
JSA
3E 12SS 1 000
EFTA00224376
STATEMENT 1
THE C.O.U.Q. FOUNDATION, INC.
13-3996471
FORM 990-PF - Y/E 2/29/04
Part I Line 23
Other Expenses
Fees $30
Bank charges 865
Total $895
EFTA00224377
THE C.O.U.Q. FOUNDATION INC. STATEMENT 2
13-3996471
FORM 990-PF Y/E 2/29/04
PART I, LINE 25 AND PART LINE 3
CONTRIBUTIONS PAID
Date Name Amount Purpose
3/4/03 Ballet Florida 15,000 Unrestricted
3/27/03 South University 10,000 Scholarship
4/7/03 Interlochen Center for the Arts 17,000 Unrestricted
4/7/03 Council on Foreign Relations 25,000 Unrestricted
4/10/03 The New York Botanical Garden 5,000 Unrestricted
5/6/03 Aveda Institute 6,000 Unrestricted
5/29/03 Columbus Jewish Foundation 100,000 Unrestricted
6/24/03 Don Quijote 4,079 Scholarship
7/23/03 Ovarian Cancer Research Fund 25,000 Unrestricted
8/12/03 Rutgers University 1,798 Unrestricted
8/21/03 Julliard School of Music 10,000 Unrestricted
8/22/03 Santa Fe Institute 110,000 Unrestricted
9/2/03 DARE 10,000 Unrestricted
9/2/03 Ballet Florida 10,000 Unrestricted
9/2/03 Harvard University 5,700 Unrestricted
9/2/03 Harvard University 7,495 Unrestricted
9/15/03 The Ricardo O'Gorman Garden & Center 10,000 Unrestricted
9/17/03 Physics Dept, Case Western Reserve U 15,000 Unrestricted
9/25/03 Harvard University 100,000 Unrestricted
10/7/03 South University 10,000 Unrestricted
10/9/03 Stockholm School of University 25,000 Unrestricted
10/16/03 Town of Palm Beach 36,000 Unrestricted
10/20/03 Council on Foreign Relations 25,000 Unrestricted
10/22/03 Harvard University 30,000 Unrestricted
12/1/03 American Ballet Theatre 50,000 Unrestricted
12/8/03 California School of Culinary Arts 20,000 Scholarship
12/15/03 Harvard University 120,000 Unrestricted
12/15/03 Snyder Fund for Young Musicians 7,000 Unrestricted
1/6/04 Hunter College 2,500 Unrestricted
1/6/04 New York University 11,000 Scholarship
1/6/04 Ballet Florida 15,000 Unrestricted
1/7/04 The International Institute for Strategic 18,200 Unrestricted
1/8/04 Columbia University 11,431 Scholarship
1/9/04 New School University 15,000 Scholarship
1/21/04 Trilateral Commission 50,000 Unrestricted
1/21/04 City College 50,000 Unrestricted
1/23/04 Center for Health and Healing 25,000 Unrestricted
1,008,203
EFTA00224378
Page 2
ram sof ('2.7000)'
p.)LI
• If you are filing for an Additional (not automatic) 3-Month Extension, complete only Part II and check this box
Note: Only complete Part liltyou have already been granted an automatic 3-month extension on a previously
filed Form 8868.
are flung ies' an Automatic 3-Month Extension, complete only Pad I (on page 1).
Additional (not automatic) 3-Month Extension of Time - Must File Original and One Copy.
Name of Exempt Organizabon Employer Identification number
Type or 13-3996471
print THE C. O. U. Q. FOUNDATION, INC.
Number, street. end morn or suite no. If a P.O. box see instructions : Fa IRS use only
FAe by the .,
nkindad C/O It • ASSOCIATES, 110 EAST 59TH ST
due dale lot • link '.
Ming the Olt lawn or post office, stale, and ZIP code For a foreign address, see Instructions
return See
mammas NEW YORK, NY 10022
:i
Check type of return to be filed (File a separate application for each return).
1
:1 Form 990 Form 990-EZ El Form 990-T (sec 401(a) or 408(e) OW) (' Form 1041-A (' Form 5227[:] Form
Form990,BL X Form990-PF Form 990-T (trust other than above) (' Form 4720 Form 6069
8870
STOP: Do not complete Part II If you were not already granted an automatic 3-mon h extension on a previously filed Form 8868.
►Lj
• If the organization does not have an office or place of business in the United States, check this box
the omadization's four digit Group Exemption Number (GEN) If this is
• if this is for a Group Return, enter
Mat with the
for the whole group, check this box . Lj If it is for part of the group, check this box . U and attach a
names and EMs of all members the extension is for.
4 I request an additional 3-month extension of time unti January 15, 2005
, or other tax year beginning March 1, 2003 and ending February 29, 2004
5 For calendar year
Change in accounting period
8 if this tax year is for less than 12 months, check reason' U Initial return Lj Final return U
n necessary for the proper completion of
7 State in detail why you need the extension Certain informatio
the return is not yet available.
If this application is for Form 990-BL, 990-PF, 990-T, 4720, or 6069, enter the tentative tax, less
any
Ba
E 5, 000
nonrefundable credits See instructions
b if this application is for Form 99043F, 990-T, 4720, or 6069, enter any refundable credits and estimated
tax payments made. Include any prior year overpayment allowed as a credit arid any amount paid
$ 5, 000
previously with Form 8868
c Balance Due. Subtract line Bb from line Ba. Include your payment with this form, or, if required, deposit
with RD coupon or, if required, by using EFIPS (Electronic Federal Tax Payment System) See
instructons
Signature and Verification ES(INIONAPPROVEli
r end belief.
dent e that I have nommen this form. including accompanying schedule, and stglOSPOli15, end to the best of my knowledge
Unde penalties of perjury, Ipry
d is I ue, correct. end comp' • and that I am aulhonte0 to prepare this lona OCT 2 5 2004
illa—•••*"
:1
1./.1 ......-------... Tide ► CPA
Sig two ►
Notice to Applicant - To Be Completed by the IRS
We have approved this application. Please attach this fon to the organtrallaYs rotum.
date shown below or the due
We have not approved this application. However, we have granted a 10-day grace period from the later of the
pROVEDions
dale of the organization's return (Including any prior extensions). This grace period is considered to be E lifitgtinntigg
otherwise required to be made on a timely return. Please attach this form to the organization's return.
titort tic gn gif ition of time
We have not approved this application. After considering the reasons stated in item 7, we cannot grant your
to hie. We are not granting a 10-day grace period.
We cannot consider this application because k was filed after the due date of the return for *Nisch an extort* wic.f giu OWOOKE
eitel
Other
j
Director
By te:”"..•ti lir
Alternate Mailing Address - Enter the address if you want the copy of this applicaloon for an additional 3-month extension
returned to an address different than the ono entered above.
Name
Associates
Typo or Number and street (include suite, room, or apt. no.) Or a P.O. box number
print
110 East 59th Street
City or town, province or state, and country (including postal or ZIP code)
inos,I Ooo New York, NY 10022 Form 8868 (12.2000)
EFTA00224379
EXTENSICI i
t
Return of Private Foundation 0018 No 1545-0052
F" 990-PF or Section 4947(a)(1) Nonexempt Charitable Trust
depenmen of the Deana*
Treated as a Private Foundation
Note: Tie orgenosson may be able to use a copy of thus return to satisfy wale reporting reduremenD
2004
knerrel Revenue Service
, 2004, and ending 28 • 20 05
For calendar year 2004, or tax year beginning March 1
Check all that apply ❑ Initial return D Final return ❑ Amended return ❑ Address change 0 Name change
Name of orpenizetnn A Employer identification number
Use the IRS
label.
Otherwise,
print
The C.O.U.Q. Foundation
"dillailli
ra,
,unbar d moil is not debased
Associates, 110 E. 59th Street
le street address) Roomistate B
13 . 3996471
Telephone
( )
,unbar (see meted the IllitrUCIIO116)
or type.
See Specific City or lown, state, and ZIP code C a aernpbon application spencling.check hew * 0
Instructions. 'New York, NY 10022 D 1. Foreign organizations. check here e •
H Check type of organization. U Section 501(c)(3) exempt private foundation 2. Foreign eigencations meeting the 85% la „
attach computation . w u
0 Section 4947(e)(1) nonexempt charitable trust 0 Other taxable private foundation check here and
a
n 50P(CoTar. csh:crhteerrenma . '1 0
I Fair market value of all assets at end J Accounting method* [ZI Cash ❑0 Accrual itprivatessO1tu
termination
of year ((mm Peel), cot (c), 0 Other (specify) F II the foundation is in a 80-month
(Part I, column (d) must be on cash basis ) under section 507(OXIMB). check Nara . * LJ
line 16) le 3
ID CtSbursentems
Part I Analysis of Revenue and Expenses (The tow of (y Revenue and
08 Net investment (c) Adjusted net for crantable
amounts in columns (b), (c), and net necessarily equal even." per
income income PurP
the amounts in column (a) (sae page of the
I1 instructions)) books (cashbeats on'y)
'' n'5 tin. 4'itoAtfAr a,sow
1 Contributions. gills, grants, etc. received (attach schedule) . •i.R l~
2 Check le 0 il the tandem is not required to attach Bch El
3 Interest on savings and temporary cash investments 1). t ti
, . 412,220 412,220
4 Dividends and Interest from secunties .;!ik4riiV75SMi
5a Gross rents
' ).1.,tVast* tiii. .MaititiX1... al 1:/2.21111M:
b Net rental income or (loss) -1 /
4
1
6a Net gain or (loss) from sale of assets not on line 10 191,906 tat. F REi ' a rtkiw.c..ie illICKiet4tW
f heiress sales price kx all assets on ins 6a -2Th1.:44;!;: agal.itij iii ..'Llit atalLo-,:eq.ihtsk *Iiiii.gx.4filit4
agirittla-ia 191,906 :litt tag: rifacAtictet":
7 Capital gain net income (from Part IV, line 2) iniiiiMIOA21
ifti ct' •
i, irsitikel. .,S
8 Net short-term capital gain .
i•t rttiNiiiie
. . . . le n: bs.tbialIa
9 Income modifications
10a 910SS sales less returns and allowances
fieetWi it le,illiNii ll'a.AS
b Less: Cost of goods sold. 4.11.141bill
'(ZIEWt.V )
c Gross profit or (loss) (attach schedule) 41COPrelfAq.
307,036 307,036
11 Other income (attach schedule). st r 1 .t
12 Total. Add lines 1 through 11 911,162 911,162 AVe. 3
"
13 Compensation of officers, directors, trustees etc
Operating and Administrative Expenses
14 Other employee salaries and wages
15 Pension plans, employee benefits ,
18a Legal fees (attach schedule) . .
b Accounting fees (attach schedule) . . 87,500
215,694 128,194
c Other professional fees (attach schedule) St. 2
. . . . 37,361 37,381
17 Interest . . .
. 5,000
18 Taxes (ad . - ! • ir i: n.,. ructions)
.2V!I
ion tcreN. 1.1
18 Depreciat Ai ItriSO deal
20 Occupa
21 Travel, c' rdligNailp 7
22 Printing : ublications. 4,938
3. 7,516
23 Other ex ch-schedule
24 Total o 1 strialtre a onses. 92,438
285,571 165,555
Add lines 13 throug 844,227
844,227 aiii.gAgnt tia; AW I
ranfila
25 Contributions, gifts, grants paid . . . 165,555 936,665
1,109,798
26 Total enerees ard tett:senses. Add lines 24 and 25 i own • , fi ,
27 Subtract line 26 from line 12: thIghttrAgia
-198,636 zi
a Excess of revenue over eqsanses and dsixasernents • sicr u ,,i
b Net investment income Of negative, enter -0-) ..... . 4Vite 745,607 ismorasre lw
c Adjusted net income hi negative, enter -0-) . _ Itgrait 314ItItION" Mdtailff.13.4
Cat No 11289X Form 990-PF (70O4)
For PrIVaoy Act and Paperwork Reduction Aot Notice, see the instructions.
co
EFTA00224380
Page 2
Form 990-PF (2004)
Beginning oi Year End of year
Mend schedules Iand emotes in the dome:in column
Part II , .0(
Balance Sheets shock, a r ei-icrytar
ni amounts Pay (Ste instiLoons ) mean yaw. 04 Book BMA BB Ft, Mackel Value
1 Cash—non-interest-bearing . . , , . .
10,229,739 6,336,208 6,336,208
2 Savings and temporary cash investments .
3 Accounts receivable ) tilthita.,..."M-ti ...
Fakistifitir ati±Inti, .'"
' ---Th .91
ktn„S17
Less: allowance for doubtful accounts li.
4 Pledges receivable P. Elititigrai40.91itIONSAftlieitkitilagaaili
Less: allowance for doubtful accounts Pi
5 Grants receivable •
6 Receivables due from officers, directors, trustees, and other
disqualified persons (attach schedule) (see page 15 of the
instructions) .
7 Other notes and loans reteriable (attach schedule) ) . lisWi tit 1 1.11Y Ovicecistfig-Arbill
$2 Less allowance for doubtful accounts 00
ri 8 Inventories for sale or use 8,000 6,000
50,000
:it 9 Prepaid expenses and deterred charges .
10e Investments-0 S and stale government obhgatienS (attach schedule)
b Investments—corporate stock (attach schedule)
c Investments—corporate bonds (attach schedule) . .
11 Investments—land, buildings, and equipment basis le wasstrim?AM/kVNike k. P
less accumulated depreciation (attach schedule) le
12 Investments—mortgage loans . . . 14,166,821
10,000,000 1.3,744,696
13 Investments—other (attach schedule) .$t . 4 • ei..
az
14 Land, buildings, and equipment basis lv
less accumulated depreciation (attach schedule) le 32,000 32,000
Sundry ) 37,800
15 Other assets (describe le
16 Total assets (to be completed by all filers—see page 16 of
. . . 20,317,539 20,118,904 20,541,029
the instructions Also, see page 1, item 0 . . •
17 Accounts payable and accrued expenses .
18 Grants payable
in . . . . . . .
a) 19 Deferred revenue. . . . vti
:a .
..,•-• 20 Loans from officers, directors, trustees, and other thsqualihed persons
16to, 21 Mortgages and other notes payable (attach schedule) .
) ea
:3 22 Other liabilities (descnbe )
23 Total liabilities (add lines 17 through 22). . .
Organizations that follow SFAS 117, check here la ID a
and complete fines 24 through 26 and lines 30 and 31. .
Net Assets or Fund Balances
24 Unrestricted o
„, ;:.
26 Temporarily restricted ,
28 Permanently restricted, . . . . . .
Organizations that do not follow SFAS 117, check here ) 0
and complete lines 27 through 31. ti:
27 Capital stock, trust principal, or current funds .
<u a+
28 Paid-in or capital surplus, or land, bldg., and equipment fund 20,118,904 r
20 317,539
29 Retained earnings, accumulated income, endowment, or other funds
30 Total net assets or fund balances (see page 17 of the 20,317,539 20,118,904
instructions) "
31 Total liabilities and net assets/fund balances (see page 17 of 20,317,539 20,118,904 !cc AX:lz
the instructions) .
Part III Analysis of Changes in Net Assets or Fund Balances
With
1 Total net assets or fund balances at beginning of year—Pan II, column (a). line 30 (must agree 1 20,317,539
end -of-year figure reported on prior year's return). . . .
2 -198 838
2 Enter amount from Part I, line 27a Rounding 3
3 Other increases not included in line 2 (itemize) Po 4 20,118 904
4 Add lines 1, 2, and 3 . . . .
. . . . ...... ..... . .............. . . 6
5 Decreases not included in line 2 (itemize) column (b), line 30 . 6 20,118,904
balances at end of year (line 4 minus line 5)—Part II,
8 Total net assets or fund
ram 990-PF (2w4)
EFTA00224381
Paps 3
Form 99MPF (20D4)
Part IV Capital Gains and Losses for Tax on Investment Income
(a) La' and descnbe 'he kraas) of property sold (0 g , rroi owe. M pil_firdti t iuse
nd KL_Dste wound (dl Oslo acid
Yon • day, r 1 encl, day. yr)
2-story brick wattaanc. or Wilma stock. 20O s'is f.(10 CO ) 0—Donslion
1a
b
e
d
a
aM4 price II) Mammal= allowed PS Cost or 0010, ban PS Gain or pots)
te Gross tor tiO0wabICI Pus expense of sea 10/ Plus (f)mnus Ig)
. 248,113
a
b
o
d
a
Complete only for assets shoving gain in column (4 and owned by the foundation on 12/31/89 Meares feet IN pen news
od - 00, but not Ins Oran +1or
e) /Ousted basis pe Excess of col 14
(0 F 4as of 12/31/69 as of 12/31/69 over col Q, if any
Losses (Porn cci 414)
a •
b
e
d
a
{ If gain, also enter in Part I, line 7
2 Capital gain net income or (net capital loss) 248,113
If (loss), enter -0- in Pert I, line 7 2
3 Net short.term capital gam or (loss) as defined in sections 1222(5) and (6).
II gain, also enter in Part I, line B, column (c) (see pages 13 and 17 of the instructions)
. . 3
.. If (loss), enter -0- in Part I, line 8
Tax on Net Investment Income
Part Qualification Under Section 4940(e) for Reduced
4940(a) tax on net investment income.)
(For optional use by domestic private foundations subject to the section
If section 4940(d)(2) applies, leave this part blank.
amount of any year In the base period', 0 Yes 0 No
Was the organization liable for the section 4942 tax on the distnbutable
II "Yes," the organization does not qualify under section 4940(e). Do not complete this part.
18 of the instructions before making any entries
1 Enter the appropriate amount in each column for each year, see page
101
(s) OS (0) Matnbution rall0
Boo and yews Achustsd qualtlyffig clowbutons Net raw of ncetchanlablfnuse assets tool OS dmdree ev col (c))
Canny year Or tax yaw beginning in)
1,041,560 12, 227, 605 0.085179
2003
1,243,915 12,221,528 0.101944
2002
902,103 7,498 097 0.120310
2001
183,255 208,595 0.878521
2000
153,695 307,635 0.499802
1999
2 1.885556
2 Total of line 1. column (cf) .
2 by 5, or by
3 Average distribution ratio for the 5-year base period—divide the total on line 0.337111
the number of years the foundation has been in existence if less than 5 years
4 20,159,108
• 4 Enter the net value of nonchantable-use assets for 2004 from Part X, Poe 5
5 6,795,856
5 Multiply line 4 by line 3 . .
6 7,45(1
8 Enter 1% of net investment income (1% of Part I, line 27b)
6,803,312
. . .
7 Add lines 5 end 6
8 939,885
Ift Fntnr ounlifmno dminhutinns from Part XII. line 4
VI, line lb, and complete that part us ng a 1% tax rate. See the
If line 8 is equal to or greater than line 7, check the box in Part
Part VI instructions on page 18.
Form 990-PF ROCK)
EFTA00224382
•
Page 4
Form 910-PT RON)
instructions)
Part VI Excise Tax Based on Investment Income (Section 4940(a), 4940(b), 4940(e), or 4948—see p e 18 of the
on line 1. '
1a Exempt operating foundations described in section 4940(d)(2), check here le. O and enter 'N/A' d
Dale of ruling letter. (attach copy of ruling letter if necessary-see instructions)
14,912
h
b Domestic organizations that meet the section 4940(e) requirements in Part /, check
a
here Iii• O and enter 1% of Part I, line 27b WI ji
e All other domestic organizations enter 2% of line 27b Exempt Arleen organizations enter 4% of Part I. hne 12 col (b)
II
2 Tax under section 511 (domestic section 4947{0(1) trusts and taxable foundations only Others enter -6) 2
3 -- 14,912
3 Add lines 1 and 2
4 Subtitle A (income) tax (domestic section 4947(8)(1) trusts and taxable foundations only Others enter -0.) . 4
5 14,912
5 Tax based on investment Income. Subtract line 4 from line 3 If zero or less, enter -0-
i I. f.i-I
6 Credits/Payments
88 2,679
a 2004 estimated tax payments and 2003 overpayment credited to 2004 1
withheld at source . 6b _A -
b Exempt foreign organizations—tax
Sc 25.000 tl ( 1 4- .
c Tax paid with application for extension of time to file Form 8868)
. . . 6d .1,r ;a.- al. C2 IS
d Backup withholding erroneously withheld. 27,679
. , . . 7
7 Total credits and payments Add lines 6a through 6d .
S
8 Enter any penalty for underpayment of estimated tax Check here O If Fo m 2220 is attached
is more than line 7, enter amount owed le. 9 •
9 Tax due. If the total of lines 5 and 8 12,767
pi. 10
10 Overpayment. II line 7 is more than the total of lines 6 and 8. enter the amount overpaid.
11 Enter the amount of line 10 to be Credited to 2005 estimated tax 1.- 12,7671 Refunded le 11
Statements R ardln Activities
legislation or did
1a During the tax year, did the organization attempt to influence any national, state, or local
it participate or intervene In any political campaign? . . . . . . . . .
the year (either directly or indirectly) for political purposes (see page
b Did it spend more than $100 during
19 of the instructions for definition)? . , . . . . . . .
of materials
If the answer is "Yes" to Is or lb, attach a detailed description of the activities and copies any
published or distributed by the organization in connection with the actrwties
c Did the organization the Form 1120-POL for this year? . . . . . . .
d Enter the amount (if any) of tax on political expenditures (section 4955) imposed dunng the year:
(1) On the organization. le $ (2) On organization managers Ile $
tax imposed
e Enter the reimbursement (if any) paid by the organization during the year for political expenditure
on organization managers le' $
the IRS?
2 Has the organization engaged in any activities that have not previously been reported to
fl 'Yes," attach a detailed description of the activities.
instrument, articles
3 Has the organization made any changes, not previously reported to the IRS, in its governing
of incorporation, or bylaws, or other similar instruments'" II "Yes," attach a conformed copy of the changes
4a Did the organization have unrelated business gross Income of $1,000 or more during the year?
b If "Yes,' has it filed a tax return on Form 990-T for this year? . . . .
the year?
5 Was there a liquidation, termination, dissolution, or substantial contraction during
11 "Yes," attach the statement required by General Instruction T
satisfied either:
6 Are the requirements of section 508(e) (relating to sections 4941 through 4945)
• By language in the governing instrument, or
mandatory directions
• By state legislation that effectively amends the governing instrument so that no
that conflict with the state law remain in the governing instrument?
Part II, col (c), and Part XV.
7 Did the organization have at least $5,000 in assets al any lime during the year" II 'Yes,' complete
8a Enter the states to which the foundation reports or with which it is registered (see page 19 of the
Instructions) Po .. .
the organization furnished a copy of Form 990•PF to the Attorney
b If the answer is "Yes" to line 7, has
attach explanation
General (or designate) of each state as required by General Instruction G? If "No,"
of section 4942(j)(3)
9 is the organization claiming status as a pnvate operating foundation within the meaning
year beginning in 2004 (see instructions for Part XN on
or 49420X5) for calendar year 2004 or the taxable
page 25)1 If "Yes," complete Part XIV . . . • • . •
a schedutehong thew names and addresses.
10 Del any persons become substantial contributors during the tax yearlif "Yes,sattech
annual returns and exemption applicakm?
11 Did the organization comply with the pubSC inspection requirements for es
Web site address Ito 211401):9100—
Associates Telephone no I.
12 The books ore in care of le 10022.
East 59th Street, New York, NY ....... . . ZIP44 ► . -
Located at lo 110
990-PF in lieu of Form 1041—Check here . .
13 Section 4947(aX1) nonexempt charitable trusts filing Form o. 13
and enter the amount of tax-exempt interest received ix accrued dunng the year .
Form 990-PF MOM
EFTA00224383
Page 5
Form 990.PF (2eal)
Part VII-B Statements Regarding Activities for Which Form 4720 May Be Required
File Form 47201f any Item is checked In the "Yes" column, unless an exception applies.
1a During the year did the organization (either directly or indirectly):
(1) Engage in the sale or exchange, or leasing of properly with a disqualified person? ❑ Yes 0 No
(2) Borrow money from, lend money to, or otherwise extend credit to (or accept it from)
a disqualified person? . . . . ❑ Yes ca No
(3) Furnish goods, services, or facilities to (or accept thorn from) a disqualified person? ❑ Yes 0 No
(4) Pay compensation to, or pay or reimburse the expenses of, a disqualified person? ❑ Yes
F2J No
(6) Transfer any income or assets to a disqualified person (or make any of either available
for the benefit or use of a disqualified person)? . . . . ❑ Yes Ca No
(6) Agree to pay money or property to a government official? (Exception. Check "No"
if the organization agreed to make a grant to or to employ the official for a period
after termination of government service, if terminating within 90 days ) . Yes 0 No
b If any answer is 'Yes" to la(1)-(6), did any of the acts fail quahfy to under the exceptions described ri Regulations
section 53 4941(d).3 or in a current notice regarding disaster assistance (see page 20 of the instructions)?
Organizations relying on a current notice regarding disaster assistance check here ►❑
c Did the organization engage In a prior year in any of the acts described in la, other than excepted acts,
that were not corrected before the first day of the tax year beginning in 2004? . . .
2 Taxes on failure to distribute income (section 4942) (does not appty for years the organization was a private
operating foundation defined in section 4942(0(3) or 4942(1)(5))•
a At the end of lax year 2004, did the organization have any undistributed income (lines 6d
and 60, Part XIII) for tax year(s) beginning before 20047 . . ❑ Yes 0 No
If "Yes' list the years ► 20 ... , 20.... , 20 . , 20
b Are there any years listed in 2a for which the organization is not applying the provisions of section 4942(a)(2)
(relating to incorrect valuation of assets) to the year's undistnbuted income? (If applying section 4942(a)(2)
to all years listed, answer "No" and attach statement—see page 20 of the instructions )
years here
c if the provisions of section 4942(a)(2) are being applied to any of the years listed in 2a, list the
► 20 .... , 20 ... , 20 . , 20
3a Did the organization hold more than a 2% direct or indirect interest in any business
enterprise at any time during the year? ❑ Yes 0 No
by the organization
b If "Yes," did it have excess business holdings In 2004 as a result of (1) any purchase
or disqualified persons after May 28, 1969, (2) the lapse of the 5-year period (or longer period approved
bequest; or (3)
by the Commissioner under section 4943(c)(7)) to dispose of holdings acquired by gift or
the lapse of the 10-, 15-, or 20-y ear first phase holding period? (Use Schedule C, Form 4720, to determine
if the organization had excess business holdings In 2004)
chantable purposes?
4a Did the organization invest during the year any amount In a manner that would reopardue its
31, 1969) that could jeopardize its charitable
b Did the organization make any investment m a prior year (but after December
purpose that had not been removed from feopardy before the first day of the tax year beginning In 2004?
5a During the year did the organization pay or incur any amount to.
0 No
(1) Carry on propaganda, or otherwise attempt to influence legislation (section 4945(a))? ❑ The
(2) Influence the outcome of any specific public election (see section 4955), or carry to
Ori, directly or indirectly, any voter registration dnve? 0 yes 0 No
(3) Provide a grant to an individual for travel, study, or other similar purposes?. ❑ Yee Pi No
(4) Provide a grant to an organization other than a charitable, etc , organization described
in section 509(a)(1). (2), or (3), or section 4940(d)(2)? . . . . ❑ Yes FL1 No
(5) Provide for any purpose other than religious, chantable, scientific, literary, or
educational purposes, or for the prevention of cruelly to children or animals? . ❑ Yes 0 No
;-4
any of the transactions fail to qualify under the exceptions described in ao a5
b If any answer is 'Yes" to 58(1)-(5), did 5b
the instructions)?
Regulations section 53 4945 or in a current notice regarding disaster assistance (see page 20 of
►❑
Organizations relying on a current notice regarding disaster assistance check here
claim exemption from the
c If the answer is "Yes" to question 5a(4), does the organization
tax because II maintained expenditure responsibility for the grant? . ❑ Yes ❑ No
If 'Yes," attach the statement required by Regulations section 53.4945-5k°. ti
-I v VII
6a Did the organization, during the year, receive any funds, directly or indirectly, to pay
premiums on a personal benefit contract? . ❑ Yes 0 No
directly or indirectly, on a personal benefit contract? 6b
b Did the organization, during the year, pay premiums,
If you answered 'Yes" to 66, also file Form 8870. Sti 'AM
Form 990-PF woo
EFTA00224384
•
RV 6
Furor 090-OF 90041
Information About Officers, Directors, Trustees, Foundation Managers, Highly Paid Employees,
Part VIII
end Contractors
(b) Title. aril average (o) Compensation (0) Conti**, OM to la) Expense account.
(a) Name and address hours per week Pt not paid, enter employee benefit plans other allowances
devoted to Nadal iiI).) and deterred compensation
•• • PresidenUDir. 0 0 0
. Jeffrey E. Epstein
6100 Red Hook QTRS St. Thomas, Vi nn. Nam.
Darren K. Indyke Vice 0 0 0
457 Madison Avenue. New York, NY Prinad•ntint.
Ghlslalne Maxwell Treasurer 0 0 0
clo Associates, 110 E. 59th St., NY, NY on. Straw
21 of the instructions).
2 Compensation of five hIghest-pald employees (other than those included on line 1—see page
If none, enter "NONE."
(d) Contributions to
le and swage
Ibehr ua w e anpeneabon employee boned (e) Expense account,
(a) Name and address of each employee paid more than $50000 per week plans and delerred other allowances
demoted to position compensation
None. •
•
Total number of other employees paid over $50,000 • . . •
highest-paid Independent contractors for professional services—(se e page 21 of the Instructions). if none, enter
3 Five
"NONE."
Da) Type of aria K4 ComPensation
(a) Name and &Wen of east pawn mid more VS $50.003
Marvin Minsky. Consulting • 75,000
111 ivy Street, Brookline, MA 02446
Kyle Godfrey Consulting 12,500
200 W. 54th Street, New York, NY 10019
•
Total number of others receiving over $50,000 for professional services
Part IX-A Summery of Direct Charitable Activities
tat We Mondale:all lour largest deem chanieb* activaief during the lax year Include relevant
staustscet information such as the Minter Expenses
OI oigararatrone sad other boneficianes served, conlerences convened. refasten paper* produced, etc
. .•
2 ........
..
.
••
,••••
•
3 • .. . • •• .... ••• • •
4
Fern 990-PF Poe
EFTA00224385
Paw 7
Form 990.PF (2004)
Part IX-B Summary of Program-Related Investments (see page 22 of the instructions)
yell on matins 2 Amour.:
Debate gm two largest movermralmod investments made by ins kundessn dung this
1
2
Al other prognonnolating investments See page 22 ei the IIIIIMMono
3
Total. Add lines 1 through 3 . . . . . . . . . . . . . . .►
Part X Minimum Investment Return (All domestic foundations must complete this part. Foreign foundations,
see page 22 of the instructions.)
1 Fair market value of assets not used (or held for use) directly in carrying out charitable, etc ,
purposes'
la
a Average monthh/ fair market value of securities. . 8 282 974
. . b
b Average of monthly cash balances 12 183,123
lc
c Fair market value of all other assets (sea page 22 of the instructions) 20 466,097
ld
d Total (add lines in, b, and c). . . . .
a Reduction claimed for blockage or other factors reported on lines la and
1c (attach detailed explanation) . . . . Lid
2
2 Acquisition indebtedness applicable to line 1 assets 20 468 097
. . . . . . . . . 3
3 Subtract tine 2 from line 1cl . . .
23
4 Cash deemed held for charitable activities. Enter 1'h% of line 3 (for greater amount, see page 4 308,991
of the instructions) . . . . . . . . .
5 20,159,106
5 Not value of noncharitable-use assets. Subtract line 4 from line 3. Enter here end on Pang, line 4 1,007,955
6 Minimum Investment return. Enter 5% of line 5 6
Distributable Amount (see page 23 of the instructions) (Section 4942(0(3) and 0)(5) private operating
Part Xl
foundations and certain foreign organizations check here lo• O and do not complete this Part
1 1,007.955
1 Minimum investment return from Part X, line 6 • •
14,912
. . 2a
2a Tax on Investment Income for 2004 from Part VI, line 5 .
not include the tax from Part VI ) 2b
b income tax for 2004 (The does 14,912
. . . . . 2e
e Add lines 2a and 2b 993,043
. 3
3 Distnbutable amount before adjustments. Subtract tine 2c from line 1 4
4 Recoveries of amounts, treated as qualifying distributions .
6 993,043
5 Add lines 3 and 4
6
6 Deduction from distributable amount (see page 23 of the Instructions) .
7 Distributable amount as adjusted Subtract One 8 from line 5 Enter here and on Part XIII, 993,043
line 1 . . . . . . 7
Part XII Qualifying Distributions (see page 23 of the instructions)
1 Amounts paid (including administrative expenses) to accomplish charitable, etc , purposes: 15 936.885
a Expenses, contributions, gifts, etc —total from Part I, column (d), line 26 . . . .
. . . . lb
b Program-related investments—total from Part IX-B .
2 Amounts paid to acquire assets used (or held for use) directly in carrying out charitable, etc.,
2
purposes . .
3 Amounts set aside for specific charitable projects that satisfy the' 3a
a Suitability test (prior IRS approval required) . . . .
schedule) 3b
b Cash distribution test (attach the required 936,665
and Part XIII, Me 4 4
4 Gasifying ristnbudons. Add lines to !trough 3b Enter here and on Part,, line 8,
on net investment
5 Organizations that qualify under section 4940(e) for the reduced rate of tax 5
income Enter 1% of Part I, tine 27b (see page 24 of the instructions) . .
. . 6 936 665
8 Adjusted qualifying distributions. Subtract line 5 from line 4 . . . . .
calculating whether the foundation
Note: The amount on tine 6 will be used in Part column (b), In subsequent years when
qualifies for the section 4940(e) reduction of tat those_years.
Form 990-PF Row)
EFTA00224386
par 8
Form 990•PF (2004)
Part XIII Undistributed Income (see page 24 of the instructions)
Ib) (c) id)
Corpus Years pace to 2003 2003 2004
1 Distributable amount for 2004 front Part XI
line 7 . 144?7,47raffisiTR
2 Utistrituted moony, if wry, as d the end of 20:C..
a Enter amount for 2003 only
b Total for prior years' 20 20 20
3 Excess distnbutions carryover d any, to 2004•
138,485
a From 1999
b From 2000 172,914
c From 2001 794,417
d From 2002 638 745
432,491
e From 2003
I Total of lines 3a through e
4 Qualifying distnbutions for 206046from Part
93 ,0 5
XII, line 4- ► $
a Applied to 2003. but not more than line 2a
b Applied to undistributed income of prior years
(Election required—see page 24 of the instructions)
e Treated as distributions out of corpus (Election Met
required—see page 24 of the instructions) 936 665
d Applied to 2004 distributable amount 1t1
e Remaining amount distributed out of corpus
5 Excess distributions carryover applied to 2004
(Il an amount appears in column (d). the
same amount must be shown in column (a) )
6 Enter the net total of each column as
Indicated below: I
a Corpus Add Nes 31, 4c, and 4e Subtract line $
b Prior years' undistnbuted income Subtract
line 4b from line 2b • . .
e Enter the amount of prior years' undistnbuted
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 page 25 of the Instructions
e Undistributed income for 2003. Subtract line
4a from line 2a. Taxable amount—see page 0
26 of the instructions
f Undistnbuted income for 2004. Subtract
lines 4d and 5 from line 1. This amountmust 0
be distributed in 2005 . .
7 Amounts treated as distributions out of
corpus to satisfy requirements imposed by
section 170(b)(1)(E) or 4942(0)(3) (see page
2$ of the instructions) . •
8 Excess distributions carryover from 1999 not
applied on line 5 or line 7 (see page 25 of 82,107
the instructions)
9 Excess distributions carryover to 2006. 2,038,567
Subtract lines 7 and 8 from line 6a
10 Analysis of line 8 ;)
a Excess from 2000 172,914
b Excess from 2001 794,411
c Excess frorn 2002 638,745
d Excess from 2003 432,491
e Excess from 2004
Farm990-PP poen
EFTA00224387
Pogo 9
Form 990-PF (2004)
Part XIV Private Operating Foundations (see page 25 of the instructions and Part MIA question
1a If the foundation has received a ruling or determination letter that it is a private operating
foundation, and the ruling is effective for 2004, enter the date of the ruling .
or 0 4942(g)_
b Check box to indicate whether the oritinization is a private operating foundation descnbed in section Q 4942()
2a Enter the lesser 01 the adjusted net Tax year Prior 3 years (a) Total
income from Part I or the minimum (a) 2034 (b)2003 lc) 2002 (0) 2031
investment return from Part X for each
year Mated .
b 65% or line 2a
c 0ualitymo distnbutions from Pad XII,
line 4 for each year listed
d Amountsincluded in line 2c not used directly
for active conduct of exempt admires . .
e 0ualilying distributions made directly
for active conduct of exempt activities
Subtract line 2d from line 2c
3 Complete 3a. b, or c for the
alternative test relied upon.
a "Assets" alternative test-enter
(1) Value of all assets .
(2) Value of assets qualifying
under section 49420)(3)(0)(1)
'Endatintair alternative test—enter /12
of minimum investment return shown in
Pad X, boo 6 l07 each year listed
ci "Support" alternative test—enter
(1) Total support other than gross
investment income (interest,
dividends, rents. Payments
on securities loans (section
512(aX5)), or royalties)
(2) Support from general public
and 5 or liters exempt
organizations as provided in
section 49420)(3XF:9M . .
(3) Largest amount of support
from an exempt organization
(4) Gross investment income
more in
Part XV Supplementary Information (Complete this part only if the organization had $5,000 or
assets at any time during the year—see page 26 of the instructions .)
1 Information Regarding Foundation Managers:
received by the foundation
a List any managers of the foundation who have contributed more than 2% of the total contributions
section 507(4(2))
before the close of any tax year (but only if they have contributed more than $5,000). (See
Jeffrey E. Epstein
(or an equally large portion of the
b List any managers of the foundation who own 10% or more of the stock of a corporation interest.
of which the foundation has a 10% or greater
ownership of a partnership or other entity)
2 Information Regarding Contribution, Grant, Gift, Loan, Scholarship, etc., Programs:
and does not accept
Check here Ito 0 if the organization only makes contnbutions to preselected charitable organizations
instructions) to individuals or
unsolicited requests for funds. If the organization makes gifts, grants, etc (see page 26 of the
organizations under other conditions, complete items 2a, b, c. and d
a The name, address, and telephone number of the person to whom applications should be addressed*
should include
b The form in which applications should be submitted and information and materials they
o Any submission deadlines*
fields, kinds of Institutions, or other
d Any rostrictions or limitations on awards, such as by geographical areas, charitable
factors.
Form 990-PF t2004)
EFTA00224388
•
Par 10
Form 9SPCFPF F2004)
Part XV Supplementary. Information (continued)
Payment
3 Grants and Contributions Paid During the Year or Approved for Future
If reopen aen Individual. F dsini
Recipient show any reSatronshp to „., : Purpose ol grant or
-"- .
..j &Mount
any faun:Wien manager —`u" — contnbution
reeved
Name and address (home or business) or subslantal corenbula
a Patd defog the year
Statement 5
. . . . . lio 3a 844,227
Total . . . . . . . . . . . . . . .
b Approved for Mum payment
. . . . . . . . . Po 3b 0
Total : .
Form 990-PF (2000
EFTA00224389
Page 11
Form freOPF (2004)
Part XVI-A Analysis of Income-Producing Activities
Unrelated trueness income Excluded by stolen 512. 513. Of 511 (e)
Enter gross amounts unless otherwise indicated Pealed Or exempt
(a) (b) (o) (d) lunchon income
Business code Amount Exclusion code AmouM (See page 26 of
the vntructons )
1 Program service revenue'
a
b
c
d
e
f
' g Fees and contracts from government agencies
2 Membership dues and assessments 412,220
14
3 Interest on savings and temporary cash investments
4 Dividends and interest from securities "r 1
: • iei 2.; f ' iii, -0Wri '- - ,..„:4::. t il;.; 3.14Kaci. •
5 Net rental income or (loss) from real estate:
a Debt-financed property . . . .
b Not debt-financed property. . . .
6 Net rental income or (loss) from personal property
7 Other investment income. . . . . .
18 191,906
8 Gain or (loss) from sales of assets other than inventory
9 Net income or (loss) from special events.
10 Gross profit or (loss) from sales of inventory 307,036
From Partnerships 14
11 Other revenue. a
b
c
d
e 911,162
)11/4..
Verani; ,ft.liikniatl
12 Subtotal. Add columns gal (dl. and fel 911,152
13 Total. Add line 12. columns (b), (d), and (e) . • 13
(See worksheet in line 13 instructions on page 26 to verify calculations.)
Man Relationship of Activities to the Accomplishment of Exempt Purposes
contnbuted importantly to
Explain below how each activity for which income is reported in column (e) of Part XVI-A
for such purposes) (See
LmiNo. the accomplishment of the organization's exempt purposes (other than by providing funds
page 27 of the instructions)
NIA
Form 990-PF (2004)
EFTA00224390
Page 12
Fonn 990-PF CROON)
le
Part XVII Information Regarding Transfers To and Transactions and Relationships With Noncharitab
Exempt Organizations •
No
1 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) of in section 521, relating to political organizations?
is Transfers from the reporting organization to a noncharitable exempt organization of
(1) Cash
(2) Other assets
b Other transactions:
(1) Sales of assets to a nonchantabte 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. , . . . . . . .
(8) Performance of services or membership or fundraising solicitations
• Shanng of facilities, equipment, mailing lists, other assets, or paid employees
show the air market
d If the answer to any of the above is 'Yes," complete the following schedule. Column (b) should always
organization, If the organization received less than fair
value of the goods, other assets, or services given by the reporting assets, or services
value in any transaction or sharing arrangement. Show in co umn (d) the value of the goods, other
ma ket
received.
(o) Name of nonchantable exempt omaneation (0) Description of translate, transactions, and during engagements
(a) One no ID) Amount involved
2e Is the organization directly or indirectly affiliated with, or related to, one or more tax-exempt organizations
described in section 501(c) of the Code (other than section 501(c)(3)) or in section 5272 . . . Dyes ®No
b If "Yes," complete the foll wing schedule
pa) Type of organization (o) DeecriptiOn of relatentehp
(a) Ian of orgargabon
I knowledge and
under penalties of pwluy tI h muted this return, ow:Iodine accompanying schedules end statements, and to the beef of my Knowledge
babel, a is kW, totfM tong e of proposer (Worthen taxpayer or fiduciary) is based on all information of otticharePlmar has WV
Dik 06 Tag
empl. oyed
is um-7,,,,
Tab
Sign Here (7(7,7,7 re.„....._.......7
Signature of officer or trustee
e Preparer's 99N or Pl1N
Check If ON Signature an PPP 20
0 01
O Preparees
aG s re .
0. 7 Firm's ISM) for yours it Associates EiN a.
sell'I
and ZIPmPl""i'
code
address.' 110 East 59th Street, Now York, NY ¶0022 Phone no (
I Form 990-PF pox)
EFTA00224391
THE C.O.U.Q. FOUNDATION, INC.
13-3996471
FORM 990-PF - Y/E 2/28/05
STATEMENT 1
Part I, Line 11
Other Income
Second City Capital Partners I, LP
K-I Entity 307,036
STATEMENT 2
Part 1, Line 16(c)
Other Professional Fees
Consulting 87,500
Bear Steams Asset Backed
Security Partners, L.P. K-1 Entity 20,482
Second City Capital Partners I, L.P.
K-I Entity 107,712
Total 215,694
EFTA00224392
THE C.O.U.Q. FOUNDATION, INC.
13-3996471
FORM 990-PF - Y/E 2/28105
STATEMENT 3
Part I, Line 23
Other Expenses
Bank Charges 220
Second City Capital Partners L.P.
K-1 entity 1,088
Bear Stearns Asset Backed Securities
Partners, L.P. K-I entity 2,636
Filing Fees 994
Other 2,578
Total 7,516
EFTA00224393
THE C.O.U.Q. FOUNDATION, INC.
EIN 13-3996471
FORM 990-PF - WE 2/28/05
STATEMENT 4
Part 11, Line 13
Other Investments
Fair
Book Value Market Value
Bear Steams Asset Backed
Securities Partners LP 10,289,911 10,289,911
Second City Capital
Partners I, LP 3,454,785 3,876,910
13,744,696 14,166,821
EFTA00224394
THE C.O.U.Q. FOUNDATION, INC..
13-3996471
FORM 990-PF - WE 2/28/05
STATEMENT 5
PART I, LINE 25 AND PART LINE 3
CONTRIBUTIONS PAID
Date Name Amount Purpose
3/2/04 New York Academy of Art 7,250 Unrestricted
4/5/04 School for Film and Television 1,000 Unrestricted
4/8/04 Stanford University 50,000 Unrestricted
4/12/04 New York University 25,000 Scholarship
4/29/04 New York Uniyersity 9,000 Scholarship
4/29/04 Ballet Florida 15,000 Unrestricted
5/4/05 Harvard University 30,000 Unrestricted
5/11/04 California School of Culinary Arts 21,172 Scholarship
5/11/04 South University 11,000 Scholarship
5/17/04 The 92nd Street Y Nursery School 25,000 Unrestricted
6/1/04 Stockholm School of Economics 25,000 Unrestricted
7/6/04 Academy of Achievement 50,000 Unrestricted
8/5/04 Edge Foundation, Inc. 50,000 Unrestricted
8/12/04 Columbia University 50,000 Unrestricted
8/19/04 Robin Hood 50,000 Unrestricted
8/23/04 Freestate Socer Alliance - Shooters 10,000 Unrestricted
8/31/04 Socratic Arts, Inc. 50,000 Unrestricted
9/28/04 Edge Foundation, Inc. 5,000 Unrestricted
9/29/04 The Julliard School 5,500 Scholarship
10/4/04 Ballet Florida 10,000 Unrestricted
10/5/04 Ovarian Cancer Research Fund 48,500 Unrestricted
10/13/04 Alliance for Lupus Research 1.000 Unrestricted
10/13/04 The Michael J. Fox Foundation 23,250 Unrestricted
10/22/04 Ted Med 1 I ,988 Unrestricted
10/26/04 Council on Foreign Relations 25,000 Unrestricted
12/2/04 Hunter College 2,500 Scholarship
12/8/04 American Ballet Theater 10,000 Unrestricted
12/14/04 Palm Beach Police Department Donation 90,000 Unrestricted
EFTA00224395
THE C.O.U.Q. FOUNDATION, INC..
13-3996471
FORM 990-PF - Y/E 2/28/05
STATEMENTS
PART I, LINE 25 AND PART LINE 3
CONTRIBUTIONS PAID
Date Name Amount Purpose
12/16/04 New York University 8,996 Scholarship
1/12/05 New York Film Academy 1,800 Scholarship
2/1/05 New York Film Academy 700 Scholarship
2/1/05 New York University 20,000 Scholarship
2/3/05 Santa Fe Institute 20,000 Unrestricted
2/3/05 South University 10,000 Scholarship
2/4/05 Titans Baseball Club 5,000 Unrestricted
2/8/05 NYJTL for Cary Leeds Center 50,000 Unrestricted
2/28/05 Ballet Florida 15,000 Unrestricted
2/28/05 Sundry 570 Unrestricted
844,227
EFTA00224396
Page 2
Form aece Via 12-2000
this box IP Pi
• If you are filing for an Additional (not automatic) 3-Month Extension, complete only Pad II and check
Form 8888.
Note. Only complete Pert II If you have already been granted an automatic 3-month extension on a previously filed
• If you are filing for an Automatic 3-Month Extension, complete only Part I (on page 1).
Part II Additional (not automatic) 3-Month Extension of Time—Must File Ori final and One Copy.
Name of Exempt Organization • Employer identification number
Type or 13 3996471
print The C.O.U.G Foundation, Inc.
Number str and room or suite no. II a P box, see instructions For IRS use only
Flaying,
extended Lialtinlit Associates, 110 E. 69th Street
due dab for
Noe the Oty, tom or post office, stale, and ZP code Fora foreign address, see insInicticon 3;1131 0 tit
return See r1;, •
• struciaes New York, NY 10022
Check type of return to be flied (File a separate application for each return).
O Form 990 O Form 990-1 (sec. 401(a) or 408(a) trust) O Form 5227
O Form 990-BL O Form 9904 (trust other then above) O Form 8089
O Form 1041-A O Form 8870
O Form 990-EZ
• Form 990-PF O Form 4720
a previously filed Form 8868.
STOP: Do not complete Part II if you were not already granted en automatic 3-month extension on
• The books are in the care of O. Ha Beller
Telephone No. lio ( . ) 750.9895 FAX No P. ( 212 )
In the United States,
7504208
check this box g• O
.
• if the organization does not have an office or place of business
If this is
• If this is for a Group Return, enter the organization's four digit Group Exemption Number (GEN)
le O and attach a list with the
for the whole group, check this box liii O. If it is for part of the group, check this box
names and EINs of all members the extension is for
January 15 , 20 SI
4 I request an additional 3-month extension of time until February 28
March 1 20 04 and ending . 20.9.5
5 For calendar year ..... .. or other tax year beginning
check reason. O Initial return O Final return O Change in accounting period
6 if this lax year is for less than 12 months,
the extension Certain information necessary for the proper completion of the return Is
7 Staten detail why you need
not yet available.
less any
8a If this application is for Form 990-BL, 990-PF, 990-T, 4720, or 6089, enter the tentative tax, 27,679
nonrefundable credits. See Instructions
and estimated
b If this application is for Form 990-PF, 990-T, 4720, or 8069, enter any refundable credits
payments made. Include any prior year overpayment allowed as a credit and any amount paid
tax 27,879
previously with Form 8868
required, deposit
c Balance Due. Subtract bne 8b from line 8a. Include your payment with this form, or, If 0
with FM coupon or, if requked. by using EFTPS (Electronic Federal Tax Payment System). See instructions. $
Signature and Verification
belief,
under penalties of Pflug .have examined this lam, inducing accompenyng schedules and statements. and to the best of my knowledge and
ii o two, correct, any lam authassed to prepare the loan
Signature
G
Wee O/17, one ► AZ/7/061,.5.
. / Notice to Applicant—To Be Completed by the IRS
*g We have approved this application Please attach this form to the organization's return.
We have not approved this application However, we have granted a 10-day graceispenod from the later of the date shown below or the due
date of the orgaruzabon's return (including any prior extensions) This gracetoperiod considered to be a valid extension of time for elections
otherwise required to be made on a limey retum Please attach this form the organization's return
request for an extension of time
We have not approved this application Alter considering the reasons stated in item 7, we cannot grant your
to file We we not granting a 10-day grace paned
for which an extension was requested
We cannot consider this application because it was filed after the extended duo date of the return
a Other
By
Date
Director
the address if you want the copy of this application for an additional 3-month extension
Alternate Mailing Address — Enter
returned to an address different than the one entered above
Name
Associates
Type or Number and street (Include suite, room, or apt. no.) or a P.O. box number
print 110 East 59th Street •
City or town, province or state, and country (Including postal or ZIP code) .••• • •••••
New York, NY 10022
Fault:RIM pri412-zeim
EFTA00224397
EXTENS1014 ATTACHED
OMB No. 1545-0052
Return of Private Foundation
Fat 990-PF or Section 4947(a)(1) Nonexempt Charitable Trust
OtP1M1Mcni of the Irmo?),
warm., Novena ficeMoe
Treated as a Private Foundation
Note: The °qv:ashen may be able to Use a copy of this return 10 satisfy state reporting reourrements.
NO5
March 1 , 2005, and ending February 28 , 20 06
For calendar year 2005, or tax year beginning
change
Check all that apply: 0 trtitiW return 0 Final return 0 Amended return 0 Address change 0 Namo
A Employer identification numb*.
Use the IRS Name i citanciat" 13 3996471
label. The C.O.U.Q. Foundation
Otherwise, Number and preµ (wilt) box number II Mad • real deemed to street address) eaccatatele a (sea page 10 of the Instructora)
print clot' . Dotson Associates, 110 East 59th St. 1 ( )
Of .
See Specific Gey or toes, state, and ZIP code C IlexemptioneoperAbon is pendtnecheck here lit. 0
Instructions. New York, NY 10022 CI 1. Foreign otgantzations, cheek nem . . 0 0
H Check type of organization: ( Section 501(cX3) exempt private foundation 2. Foreman orgammuons meeting Me 8514 test. in
foundation check hero and attach consolation . • U
0 Section 4947(a)(1) nonexempt charitable trust 0 Other taxable pnvate
ssesstoUnegjbV)11
it isfmr soval ennin.all El
::nowcakshipr e
I Fair market value of all assets at end J Accounting method: 0 Cash ❑0 Accrual
of year (from Pad ll, col, (c), • Other (specify) F II the foundation is in a 60montn temisnelon n
under section 507(b)(1)(0), check here . e. I...1
hno 16) le $ 21,863,038 (Pad I, column (d) must be on cash bests.)
(2) Revenue and (dl Disbursements
Lai Analysis of Revenue and Expenses (Me rebid equal expenses per (1)) Nµ Inv sImant initnted net
(c) Ad for charitable
amounts in columns (b), (c), and (d) may not necessary WIC04143 purposes
the amounts in column (a) (see page t I of the insfmcOonsn bootie (ash basis one,
1 Contributions, gilts, grants, etc., received (attach schedule)
2 Check li• r4 if lhe Inundation is not regured to attach Sch. B
3 Interest on savings and temporary cash investments 360,265
960,285
4 DMdends and interest from securities
5a Gross rents
b Net rental income or (loss) • '
460,721
Itta Net gain or (loss) from sale of assets not on Me 10
Revenue
031 685 • . •• •
b Gress sales price for all assets on line 6a 2
2) 460,721
7 Capital gain net income (from Part IV, tine
, .
8 Net short-term capital gain
9 Income modifications
10a Gross sales less returns and allowances I .. 3 • .
b Less: Cost of goods sold
e Gross profit or (loss) (attach schedule)
51,609 51,609
11 Other income (attach schedule)
12 Total. Add lines 1 through 11 872,595 872,595
13 Compensation of officers, directors, trustees etc
Operating and Administrative Expenses
14 Other employee salaries and wages
15 Pension plans, employee benefits
16a Legal fees (attach schedule)
9,123
b Accounting fees (attach schedule) 122,500
248,758 126,258
e Other professional fees (attach schedule)
17 Interest
30,000
18 Taxes (attach schedule) (see page 14 of the Instructions)
19 Depreciation (attach schedule) and depletion COVED
R
20 Occupancy .r..;
4,098 U) 4,098
21 Travel, conferences, and meetinga „•
22 Printing and publications ; JA 19 20n7 ,
4,064 rt 4,064
23 Other expenses (attach schedule) —
24 Total operating and administrative expenses.
Add lines 13 through 23
296,043 Q nFN. UT 130,662
1,125,133
paid 1,126,133
25 Contributions, gifts, grants 126,268 1,255,795
28 Total expenses and disbursements. Add lines 24 and 25 1,421,176
27 Subtract line 26 from line 12:
a Excess of revenue over expenses and disbursements (548,581)
746,337
b Net Investment Income (if negative, enter -0-)
c Adjusted net Income (if negative, enter -0-) .
Cot No. 11219X Form 990-PF Roos)
For Privacy Act and Paponvork Reduction Act Notice, see the Instructions.
EFTA00224398
FAT, 995-Pr f2005)
shoe 2
End of year
Attached schedvks and a-neents in the description cdumn Eassgavvng of year
Part II Balance Sheets shout be to end-olleu amounts only (See Instructions ) (a) Book vs, 0) Bcok View (0) Foe Market Vous
1 Cash—non-Interest-bearing 4,112,138 4,112,138
6,336,208
2 Savings and temporary cash investments
2
3 Accounts receivable Po.
Less: allowance for doubtful accounts 19
i
4 Pledges receivable 19
Less: allowance for doubtful accounts 1),
6 Grants receivable
6 Receivables due from officers, directors, trustees, and other
disqualified persons (attach schedule) (see page 15 of the
instructions)
I
7 Other notes and loans receivable (attach schedule) to
12 Less. allowance for doubtful accounts 19
8 Inventories for sale or use
6,000
9 Prepaid expenses and deferred charges
10a Investments—U S and slate government obligations (attach schedule)
b Investments—corporate stock (attach schedule)
a Investments—corporate bonds (attach schedule) . .
11 Investments—land, buildings, and equipment basis 9
_1
Less accumulated depredation (attach schedule) 19
12 Investments—mortgage loans . . . . . . . . .
13,744,696 15,458,186 17,750,902
13 Investments—other (attach schedule). St. 4
• • —i
14 Land, buildings, and equipment basis 19
Less. accumulated depreciation (attach schedule) P
32,000
15 Other assets (describe 19 }
18 Total assets (to be completed by all filers—see page 16 of 19,570,322 21,883,038
the instructions. Also, see page 1, Item I) 20,111904
17 Accounts payable and accrued expenses ... A e
18 Grants payable A .
te 19 Deterred revenue
m
it 20 Loans from officers, directors, trustees, and other disqualified persons
ll 21 Mortgages and other notes payable (attach schedule) .
:I 22 Other liabilities (describe lk )
23 Total liabilities (add lines 17 through 22)
Organizations that follow SFAS 117, chock here 9 0
and complete lines 24 through 28 and lines 30 and 31.
Net Assets or Fund Balances
24 Unrestricted .
25 Temporanly restricted
28 Permanently restricted . , .
Organizations that do not follow SFAS 117, check here 9 • .
and complete lines 27 through 31.
27 Capital stock, trust principal, or current funds
28 Paid-in or capital surplus, or land, bldg., and equipment fund 19,570,322
20,118,904
29 Retained earnings, accumulated income, endowment, or other funds
30 Total net assets or fund balances (see page 17 of the 19,574,322
instructions) 20,118,904
31 Total liabilities and net assets/fund balances (see page 17 of 20,118,904 19,570,322
the Instructions)
Part III Analysis of Changes In Net Assets or Fund Balances
agree with
1 Total net assets or fund balances at beginning of year—Part II, column (a), ins 30 (must 1 20,118,904
end-of-year figure reported on prior year's return). 2 (548,581)
2 Enter amount from Part I, line 27a 3
3 Other increases not included in line 2 (Itemize) 19 4 19,570,323
4 Add lines 1, 2, and 3 6 (1)
5 Decreases not Included in One 2 eternize) 19 Rounding 19,570 322
(b), Itne 30. . 8
8 Total net assets or fund balances at end of year One 4 minus line 5) -Part II, colurm
Form 9130-PF aroce
EFTA00224399
Page 3
Form 990-PF (2005)
Part IV Capital Gains and Losses for Tax on Investment Income
(b) How &Awed Data a ea (4 Date sold
IOW and descabe the kaid(s) of property sold Mg. real estate, P--Purchase M. cqui
Imo. day. yr) Imo. (talcs!)
2.slory bra warehouse. Or canon stoat. NO she MLC Co) D—Donalion
P 6/10/03 716/05
1e 39,800 New Century Financial Corp.
b From K-1
cs
d
it
Depreciabon allowed (00 Cost or other basis or ra,:r0,4:1 9)
(e) Gross sehts mica (I) (or &Taxable) plus expense of sale
2,048,247 (16,562)
a 2,031685
477,283
b
c
d
a
Complete only for assets showing gain in column (h) and owned by the foundation on 12/31/69 0) Gans (Col 06 gen minus
Ih../.. 0) or
0) Adjusted bests (k) Excess ol col 0j Losses
col (k), but less col 01))
not(from
0) F as ol 12/31/69 as ol 1241/69 ova col 9, if any
a
b
c
d
e
II ain so enter In Pert I line 7 }
2 Capital gain net income or (net capital loss) / If (l oss,),alenter -0- In Part I, line 7 2 460,721
g
3 Net short-term capital gain or (loss) as defined In sections 1222(5) and (0):
II gain, also enter In Part I, line 8, column (c) (see pages 19 and 17 of the instructions). I
If (loss), enter -0- in Part l; line 8 3
Qualification Under Section 4940(e) for Reduced Tax on Net Investment Income
investment Income.)
(For optional use by domestic private foundations subject to the section 4940(a) tax on net
If section 4940(0(2) applies, leave this part blank.
in the base period? CI Yes VI No
Was the organization liable for the section 4942 tax on the distributable amount of any year
II -Yes." the organization does not qualify under section 4940(0). Do not complete this part
before making any entries.
1 Enter the appropriate amount In oath column for each year; see page 18 of the instructions
(0) (c) (4
(b) Dratributco mho
Base penod yearn AOSUSIOO qualeyng disthbulions Net value of nonchanlatkaiuse assets (col lb) divided by col (a))
Candor year (cc tax year beginning tn)
936,665 20,159,106 0.046463
2004
1,041,580 12,227,806 0.085179
2003
1,243,916 12,221,528 0.101944
2002
902,103 7,498,097 0.120310
2001
183,255 208,595 0.878521
2000
2 1.232417
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 0.216483
the number of years the foundation has been in existence If less then 5 years 3
4 22,630,448
4 Enter the net value of nonchantablebse assets for 2005 from Part X, line 5
6 5,578,021
6 Multiply line 4 by line 3
6 7,463
6 Enter 1% of net investment income (1% of Part I, line 27b)
7 5,585,484
7 Add lines 5 and 6
8 1,255,795
8 Enter aualihnna distnbutions from Part XII. line 4
part using a 1% tax rate. See
II 8 is equal to or greater than line 7, check the box in Part VI, line lb, and complete the
the Part VI Instructions on page 18.
Form 990-PF Room
EFTA00224400
Page 4
Form 990.PF (20051
18 of the instructions)
Part VI Excise Tax Based on Investment Income (Section 4940(a), 4940(b), 4940(e), or 4948—see ogle
check here le • and enter "N/A' on line 1.
la Exempt operating foundations described in section 4940(d)(2),
Date of ruling letter: (attach copy of ruling letter if necessary—see Instructions)
1 14,927
b Domestic organizations that meet the section 4940(o) requirements in Part I check
here P LI and enter 1% of Part i, line 27b
(b)
c All other domestic organizations enter 2% of one 27b Exempt foreign organizations enter 4% of Part I, line 12. col
4947(3)(1) trusts and taxable foundations only. Others enter -01 • 2
2 Tax wider section 511 (domestic section
3 14,927
3 Add lines 1 and 2
4
4 Subtitle A (income) tax (domestic section 4947(a)(1) trusts and taxable foundations only. Others enter 49 14,927
3. If zero or less, enter -0- 6
5 Tax based on investment Income. Subtract One 4 from One
6 Credits/Payments:
ea 9,007
a 2005 estimated tax payments and 2004 overpayment credited to 2005
—tax withheld at source 6b
b Exempt foreign organizations
60 25,007
c Tax paid with application for extension of time to file (Form 8868)
6d I
d Backup withholding erroneously withheld 7 34,007 •
7 Total credits and payments. Add lines 6a through 8d
•
8 Enter any penalty for underpayment of estimated tax. Check here 0 if Form 2220 Is attached
lo 9
9 Tax due. If the total of lines 5 and 8 is more than line 7, enter amount owed 19,080
. IP 10
10 Overpayment. if line 7 is more than the total of lines 5 and 8, enter the amount overpaid.
19,0801 Refunded Pi 11
11 Enter the amount of line 10 to be: Credited to 2006 estimated tax P
Part VII-A Statements Regarding Activities
legislation or did
Yes No
1a During the tax year, did the organization attempt to Influence any national, state, or local Is
it participate or intervene in any political campaign?
purposes (see page
b Dld it spend more than $100 during the year (either directly or Indirectly) for political lb
19 of the instructions for definition)?
copies of any materials
if the answer is 'Yes" to Is or lb, attach a detailed description of the activities and
published or distributed by the organization in connection with the activities. to
c Did the organization file Form 1120-POL for this year?
imposed during the year:
d Enter the amount Of any) of tax on political expenditures (section 4955)
(1) On the organization. fe $ (2) On organization managers. 14 $
expenditure tax imposed
e Enter the reimbursement (if any) paid by the organization during the year for political
on organization managers. 14 $ 2
to the IRS? . .
2 Has the organization engaged in any activities that have not previously been reported
If "Yes," attach a detailed description of the activities.
instrument, articles
3 Has the organization made any changes, not previously reported to the IRS, in its governing $ ✓
of the changes
of incorporation, or bylaws, or other similar Instruments? If "Yes," attach a conformed copy 4a ✓
4a Did the organization have unrelated business gross income of $1,000 or more during the year? 4b
b If "Yes," has it filed a tax return on Form 990-T for this year?
5
5 Was there a liquidation, termination, dissolution, or substantial contraction during the year?
If "Yes," attach the statement required by General Instruction T
either:
6 Are the requirements of section 508(e) (relating to sections 4941 through 4945) satisfied
• By language in the governing instrument, or
• By state legislation that effectively amends the governing Instrument so that no mandatory directions
that conflict with the state law remain In the governing Instrument? 7 ✓
Part XV
7 Did the organization have al least $5,000 in assets at any time during the year? Ii 'Yes,' complete Part a, col (c), and
page 18 of the
8a Enter the states to which the foundation reports or with which it is registered (see
instructions) fe.t(0W.YOrk.
the Attorney
b If the answer is "Yes" to line 7, has the organization furnished a copy of Form 990-PF to 8b ✓
of each state as required by General Instruction GT If "No," attach explanation
General (or designate)
section 49420)(3)
9 Is the organization claiming status as a private operating foundation within the meaning of
Part XIV on
or 4942Q)(5) for calendar year 2005 or the taxable year beginning m 2005 (see instructions for 9 ✓
page 26)? If "Yes," complete Part XIV
tang their names and addresses. 10 „t
10 Did any persons become substantial contnbulorsdunng the tax yeelll 'Yes,"attach a schedule 11
exemption application?
11 Did the organization comply with the public inspection requirements for its annual returns end
Web site address 14
12 The books are in care of P Associates Telephone no. IP
110 East 59th Streets New York NY ZIP+4 ►
Located at Po
filing Form 990-PF h lee of Form 1041—Check here 0. 0
13 Section 4947(a)(1) nonexempt charitable trysts ►
and enter the amount of tax-exempt interest received or accrued during the year . . . . 1 13
Form 990-PF agog
EFTA00224401
Fern, seo-PF mai) Pep a
In4151 Statements Regarding Activities for Which Form 4720 May Be Required
Yee No
File Form 4720 if any Item is checked In the "Yes" column, unless an exception applies.
le During the year did the organization (either directly or indirectly):
(1) Engage in the sale or exchange, or leasing of property with a disqualified person? ❑ Yes El No
(2) Borrow monoy from, lend money to, or otherwise extend credit to (or accept It from)
❑ Ycs cu No
a disqualified person?
(3) Furnish goods, services, or facilities to (or accept them from) a disqualified person? ❑ Yea 0 No
(4) Pay compensation to, or pay or reimburse the expenses of, a disqualified person? ❑ Yes 0 No
(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)? ❑ Yes 2) No
(8) Agree to pay money or property to a government official? (Exception. Check "No"
if the organization agreed to make a grant to or to employ the official for a period
after termination of government service, if terminating within 90 days ) ❑ Yes 21 No
b If any answer Is 'Yee to 18(1)4), did any of the acts fall to qualify under the exceptions described In Regulations lb
section 63.4941(d)-3 or in a current notice regarding disaster assistance (see page 20 of the instructions)?.
►❑
Organizations relying on a current notice regarding disaster assistance check here
the organization engage in a prior year in any of the acts described in 1a, other than excepted acts,
c Did 1c
that were not corrected before the first day of the tax year beginning in 2005?
was a private
2 Taxes on failure to distribute income (section 4942) (does not apply for years the organization
operating foundation defined in section 49420)(3) or 49420(5)):
a At the end of tax year 2005, did the organization have any undistributed Income (lines 6d
and 6e, Part XIII) for tax year(s) beginning before 2005? ❑ Yes 0 No
If 'Yes," list the years ► 20. , 20 , 20 , 20
4942(a)(2)
b Are there any years listed In 2a for which the organization Is not applying the provisions of section
(relating to incorrect valuation of assets) to the year's undistnbuted income? (if applying section 4942(a)(2) 2b
to all years listed, answer "No" and attach statement—see page 20 of the Instructions.)
the yews here.
c If the provisions of section 4942(a)(2) are being applied to any of the years listed In 2a, Hat
► 20 .... , 20 .... , 20 . , 20
3a Did the organization hold more than a 2% direct or indirect interest in any business
enterprise at any time during the year? ❑ Yes 0 No
the organization
b if "Yes,' did it have excess business holdings in 2005 as a result of (1) any purchase by
after May 26, 1969; (2) the lapse of the 5-year period (or longer period approved
or disqualified persons
or (3)
by the Commissioner under section 4943(c)(7)) to dispose of holdings acquired by gift or bequest;
15-, or 20-year first phase holding period? (Use Schedule C, Form 4720, to determine
the lapse of the 10-, 3b
it the organization had excess business holdings In 2005)
manner that would jeopardize its charitable purposes? 4a
4a Did the organization invest during the year any amount in a
b Did the organization make any investment in a prior year (but after December 31. 1969) that could jeopardize
its chartable _J
4b ✓
purpose that had not been removed from Jeopardy before the first day of the tax year beginning in 2005?
5a Dunng the year did the organization pay or incur any amount to:
No
(1) Carry on propaganda, or otherwise attempt to Influence legislation (section 4945(e))? ❑ Yes 0
(2) Influence the outcome of any specific public election (see section 4955); or to carry
on, directly or indirectly, any voter registration drive? ❑ Yes No
(3) Provide a grant to an individual for travel, study, or other similar purposes?. . ❑ Yes 0 No
(4) Provide a grant to an organization other than a charitable, etc., organization descnbed
in section 509(a)(1), (2), or (3), or section 4940(d)(2)? ❑ Yes 0 No
(5) Provide for any purpose other than religious, charitable, scientific, literary, or
educational purposes, or for the prevention of cruelty to children or anmals? . ❑ Yes 0 No
b If any answer Is "Yes" to 5a(1)-(5), did any of the transactions fail to qualify under the exceptions described in
5b
Regulations section 53.4945 or In a current notice regarding disaster assistance (sec page 20 of the Instructions)?
Organizations relying on a current notice regarding disaster assistance check here Ow
c It the answer is "Yes" to question 5a(4), does the organization claim exemption from the
tax because it maintained expenditure responsibility for the grant? ❑ Yea ❑ No
If "Yes," attach the statement required by Regulations section 53.4945-5(d).
fla Did the organization, during the year, receive any funds, directly or indirectly, to pay
premiums on a personal benefit contract? ❑ Yes 0 No
premiums, directly or indirectly, on a personal benefit contract? 8b ✓
b Did the organization, during the year, pay
If you answered "Yes" to 6b, also file Form 8870.
Tom 990-PF (2005)
EFTA00224402
Form 890-FF (2005) Page 6
Information About Officers, Directors, Trustees, Foundation Managers, Highly Paid Employees,
Part VIII
and Contractors
21 of the instructions).
1 List all officers, directors, trustees, foundation managers and their compensation (see page
(b) Tee, and average pi) Compensation (dl Contributions to (el Expense account.
(a) Nemo end eddies; ham per week not paid, enter employee baneful plans other allowances
devoted to paid= -0-) end deferred compensation
Jeffrey E. Epstein Pres-Director 0 0 0
6100 Red Hook Qtrs, St. Thomas, USVI One hour
Darren K Indike Vice Pres/0lr. 0 0 0
457 Madison Ave., New York, NY Ono hour
Ghisialne Maxwell Treasurer 0 0 0
can.' Associates Ona hour
110 East 59th Street,. New York, NY
21 of the instructions).
2 Compensation of five highest-paid employees (other than those Included on fine 1—see page
if none, enter "NONE."
(d) Contributions to •
lel Title and average (c) Compensation employee benefit (t) (sponse account,
(a) Name and address of each employee paid more than $50,000 hours per wink glans end <Warred otraar allowance;
devoted to position compensation
None
0
Total number of other employees paid over $50.000
page 21 of the instructions). If none, enter
3. Five highest-paid Independent contractors for professional services—(tee
"NONE."
U) Nam and address of each parson PIS more that 55%000 (b) Type of seam (c) Compensation
.I.(yle Godfrey Consulting 12,500
200 West 54th St., New York, NY 10019
Seth Lloyd Consulting 100,000
18 Weston Road, Wellesley, MA 02462
May Huang Consulting 10,000
1 Brants Square, Cambridge, MA 02138
►1 0
Total number of others receiving over $50,000 for professional services
Part IX-A Summary of Direct Charitable Activities
List the bundstion's lour Largest direct charitable actmbes durng the tax year include relevant stinalacal information ouch aa the leather Expanse .
of organizations and other beneficiaries owed, codesince, convened, research papas produced. MO.
2
3
4
Fenn 990-PF cos
EFTA00224403
aaa• 7
Form 090•PF (2005)
Part IX-B Summary of Program-Related investments (see page 22 of the instructions
Describe the two tamest program-related investments made by the foundation dunng the lac year on lines I and 2 Amount
1
2
fra dee progrenertheed investmeats Bee Page 22 cd the estniebona
3
lo
Total. Add lines 1 through 3
Part X Minimum Investment Return (All domestic foundations must complete this part. Foreign foundations,
see page 22 of the Instructions.)
1 Fair market value of assets not used (or held for use) directly In carrying out charitable, etc.,
purposes:
to
a Average monthly fair market value of securities lb 5,224,172
b Average of monthly cash balances 1c 17,750,902
c Fair market value of all other assets (see page 23 of the Instructions) Id 22,975,074
d Total (add lines 1a, b, and c)
co Reduction claimed for blockage or other factors reported on lines la and
11e
1c (attach detailed explanation) 2
2 Acquisition indebtedness applicable to line 1 assets 3 22 975 074
3 Subtract line 2 from line 1d
4 Cash deemed held for charitable activities. Enter 11/4% of line 3 (for greater amount, see page 23 4 344,626
of the instructions) . . . . . . . . . . . . . . . . . . . . . . . 22,630,448
assets. Subtract line 4 from lie 3. Enter here and on Part, line 4 5
6 Net value of noncharitable-use 1,131,522
6 Minimum Investment return. Enter 5% of line 5 e
Distributable Amount (see page 23 of the Instructions) (Section 4942(PA3) and 0(5) private operating
Part XI
foundations and certain foreign organizations check here le O and do not complete this part
1 1,131,522
1 Minimum Investment return from Part X, line 6
2a 14,927
2a Tax on Investment Income for 2005 from Part VI, line 5
b Income tax for 2005. (This does not include the tax from Part VI) I 2b
2c 14,927
c Add Imes 2a and 2b 3 1,116,585
3 Distributable amount before adjustments. Subtract line 2c from line 1 4
4 Recovenes of amounts treated as qualifying distributions 5 1,116,595
5 Add lines 3 and 4
24 of the Instructions) 6
8 Deduction from distnbulabte amount (see page
7 Distributable amount as adjusted. Subtract line 6 from Me 6. Enter here and on Part XIII, 7 1,118,595
line 1
Part XII Qualifying Distributions (see page 24 of the Instructions)
1 Amounts paid (including administrative expenses) to accompbsh charitable, etc., purposes: 1,255,795
la
a Expenses, contributions, gifts, etc.—total from Part I, column (d), line 26
lb
b Program-related Investments—total from Part IX-B
2 Amounts paid to acquire assets used (or held for use) directly in carrying out charitable, etc., 2
purposes
3 Amounts set aside for specific charitable projects that satisfy the:
3a
a Suitability test (prior IRS approval required)
3b
b Cash distribution test (attach the required schedule) 4 1,266,795
4 Qualifying distributions. Add lines la through 3b Enter here and on Part', line 8, and Part XIII, lone 4
5 Organizations that qualify under section 4940(e) for the reduced rate of tax on net investment 5
income. Enter 1% of Part I, line 27b (see page 24 of the instructions) 1,255 795
6
6 Adjusted qualifying distributions. Subtract line 5 from line 4
the foundation
Note: The amount on line 6 will be used in Part' column (b), in subsequent years when calculating whether
qualifies for the section 4940(e) reduction of tax in those years.
Firm 990-PF (2005)
EFTA00224404
Form 990PF (2005) Pees 8
Part XIII Undistributed Income (see page 24 of the instructions)
CO 04 (c) Pr/
Corpus Vows prior lo 2004 2004 2005
1 Distributable amount for 2005 from Part Xi
line 7
1416,095
2 Undistnbuted Income, II any, as of the end of 2004:
a Enter amount for 2004 only 0
b Total for poor years: 20_____ 20_,20_ 0
3 Excess distributions carryover if any, to 2005:
' 172,914 •
a From 2000
b From 2001 794,417
c From 2002 638,745
d Fran 2003 432,491
e From 2004
I Total of lines 3a through e 2,038,567
4 Qualifying distributions for 2005 from Part
XII, lino 4: to $ 1.255.795
0
a Applied to 2004, but not more than line 2a
b Applied to undistributed income of prior years
(Election required—see page 25 of the instructions) 0
e Treated as distributions out of corpus (Election
required—see page 25 of the instructions) 0
1,110,595
d Applied to 2005 distributable amount
139,200
e Remaining amount distributed out of corpus 0
0
5 Excess dlstnbutlons carryover applied to 2005
(If an amount appears In column (d), the .
same amount must be shown in column (a).) i r . .
••• -
0 Enter the net total of each column as A •
'' •
indicated below:
2,177,767 , — ,,
a Corpus. Add lines 31, 4c, and 4e. Subtract line 5
b Prior years' undistributed Income. Subtract '
line Ob from line 2b c 0 . !.
, .
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)
0
tax has been previously aosiwied
d Subtract line 6c from line 6b. Taxable
amount—see page 25 of the Instructions .
e Undistributed Income for 2004. Subtract line • •
4a from line 2a. Taxable amount—see page .
25 of the Instructions
• 0
I Undistnbuted income for 2005. Subtract . • I
lines 4d and 5 from line 1. This amount must .
be distributed in 2008 ' 0
..
7 Amounts treated as distributions out of • •
corpus to satisfy requirements imposed by
section 170(b)(1)(E) or 4942(gX3) (see page
0
25 of the instructions)
8 Excess distributions carryover from 2000 not
applied on line 5 or line 7 (see page 25 of
172,914
the Instructions)
9 Excess distributions carryover to 2006.
2,004,853
Subtract lines 7 and B from line 6a .
10 Analysis of line 9:
a Excess from 2001 794,417
b Excess from 2002 638,745
e Excess from 2003 , . 432,491
d Excess from 2004 „
e Excess from 2005 . . 139,200
Form 990-PF 120051
EFTA00224405
Fenn 990-nr (2005) Page 9
Foundation s (see page 26 of the Instructions and Part VII-A, question 9)
Part XIV Private Operating
1a If the foundation has received a ruling or determination letter that it is a private operating
foundation, and the ruling Is effective for 2005, enter the date of the ruling . . . . lie
b Check box to indicate whether the orgenaation is a private opera foundation described in section 0 4842(613) or 0 49429)(5)
2a Enter the lesser of the adjusted net Tax year Pnor 3 years Of vow
income from Pan I or the minimum ittaxe (0) 2004 (0)200.3 (0) 2002
Investment return from Part X for each
year listed
b 85% of line 2a
c 0uakir% distributions from Part XII,
line 4 for each year listed
d Amounts included in Me 2c not used directly
for active conduct of exempt activities
auablying distributions made directly
br active conduct of exempt activities
Subtract line 2d from line 2c
3 Complete 3a, b, or c for the
alternative test relied upon:
a "Assets" alternative test—enter:
(1) Value of all assets
(2) Value of assets qualifying
under section 49420X3)(8)(;)
la ¶ndoement` alternative teat—enter %
of MAIMUM mestment return shown in
Part X, Ine 6 for each year listed
o 'Support" alternative test—enter:
(1) Total support other than gross
investment income (interest,
dividends, rents, payments
on securities loans (section
512(a)156, or royalties)
(2) Supped from general public
and 5 or more exempt
organizations as provided In
section 49426)(3)03)(w)
(3) Largest amount of support
from an exempt organization
(4) Gross investment income
Part XV Supplementary Information (Complete his part only if the organization had $5,000 or more In
assets at any time during the year-see page 26 of the Instructions.)
1 Information Regarding Foundation Managers:
received by the foundation
a List any managers of the foundation who have contributed more than 2% of the total contnbutions section 507(d)(2).)
before the close of any tax year (but only if they have contnbuted more than $5,000). (See
Jeffrey E. Epstein
(or an equally large portion of the
b List any managers of the foundation who own 10% or more of the stock of a corporation interest.
ownership of a partnership or other entity) of which the foundation has a 10% or greater
2 information Regarding Contribution, Grant, Gift, Loan, Scholarship, etc., Programs:
and does not accept
Check here Ile El If the organization only makes contnbutions to preselected charitable organizations to Individuals or
unsolicited requests for funds. If the organization makes gifts, grants, etc. (see page 26 of the instructions)
organizations under other conditions, complete items 2a, b, c, and d.
addressed:
a The name, address, and telephone number of the person to whom applications should be
Include:
b The form In which applications should be submitted and Information and materials they should
c Any submission deadlines:
kinds of institutions, or other
d Any restrictions or limitations on awards, such as by geographical areas, charitable fields,
factors:
Pam 990-PF Rove
EFTA00224406
Pago 10
Farm 990-PE (2005)
Part XV Supplementary Information (continue
3 Grants and Contributions Paid During the Year or Approved for Future Payment
Recipient =Pont la an 01dr"alaa& Foundation
11snow Purpose of grant or
arry rolatiortsnip to status 04 Amount
any foundation manager contribution
rampant
Name and address (home or business) cg substantial contnbutor
a Pwd during the year
Statement 5
•
P 3a 1,125,133
Total
b Approved for future payment
P 3b 0
Total
Fowl 900-PF (2026)
EFTA00224407
Page 11
Form elm-PE (20051
Part XVI-A Analysis of Income-Producing Activities
Unrelated baseness Income Excluded by section 512, 513, or 514 (el
Enter gross amounts unless otherwise indicated. Related or exempt
la) (b) (c) fel luidicri intone
Amount Exclusion code Amount (See page 2601
Business code the instiuctloas)
1 Program service revenue:
a
b
c
d
e
f
g Fees and contracts from government agencies
2 Membership dues and assessments 360,265
14
3 Interest on savings and temporary cash investments
4 Dividends and interest from secuntios I
5 Net rental Income or (loss) from real estate:
a Debt-financed property
b Not debt-financed property
6 Net rental income or (loss) from personal property .
7 Other Investment Income 480,721
18
8 Gain or (loss) from sales of assets other than inventory
9 Net income or (loss) from special events
10 Gross profit or (loss) from sales of inventory . 14 51,809
11 Other revenue: a From partnerships
b
c
d
e 872,595
•
12 Subtotal. Add columns lb). fdl. and fel 872,595
13 Total. Add line 12, columns (b), (d), and (e) 13
See worksheet In line 13 Instructions on page 27 to verify calculations.)
Relationship of Activities to the Accomplishment of Exempt Purposes
XVI-A contributed importantly to
Explain below how each activity for which income is reported mcolumn (e) of Part
Una No. the accomplishment of the organization's exempt purposes (other than by providing funds for such purposes). (See
V
page 27 of the Instructions.)
NIA
Form 99O-PF poos)
EFTA00224408
Pape 12
Fenn 990-PF NO05)
le
Part XVII Information Regarding Transfers To and Transactions and Relationships With Noncharitab
Exempt Organizations
Yes I No .
1 Old the organization directly or Indirectly engage in any of the following with any other organization described in section t
I
501(c) ol the Code (other than section 501(c)(3) organizations) or in section 627, relating to political organizations?
a Transfers from the reporting organization to a noncharitable exempt organization of:
tail)
(1) Cash 1a(21
(2) Other assets
b Other transactions: lb(t) ✓
(1) Sales of assets to a nonchantable exempt organization 11421
(2) Purchases of assets from a nonchantable exempt organization 11)(3) ✓
(3) Rental of facilities, equipment, or other assets 11(4)
(4) Reimbursement arrangements
1$15)
(5) Loans or loan guarantees 1i)(61
(8) Performance of services or membership or fundraising solicitations 1c
c Sharing of facilities, equipment, mailing lists, other assets, or paid employees
the following schedule. Column (o) should always show the fair market
d if the answer to any of the above is "Yes," complete received less than fair
value of the goods, other assets, or services given by the reporting organization. If the organization
other assets, or services
market value in any transaction or sharing arrangement, show In column (d) the value of the goods,
received.
M Name of nonchantable exempt orgenaabon (0) Damnpbon of translate, transactions, and shamg anangements
lof Line no (6) Amount involved
2a is the organization dl ectly or Indirectly affiliated with, or related to, one or more tax-exempt organizations
described in section 501(c) of the Code (other than section 501(c)(3)) or in section 527? 0 Yes ID No
b If "Yes," com late the following schedule.
(a) Name of °remember', (6) Typo or organalthm (c) Descnphon of relationShIP
------
Under proems of poen I d hell). ox e return, ncluding accompanying schedules and eloternente, and to the best of my knowledge and
belief, e rs IAN, correct, ompl e of at (other than taxpere or ()Outlaw) a bend on Si informetron ol whet plower has any N1026000
I il ia/al n tesitlaufri --
le
Sign Here
siunabn of veer or Iry
Date Preparer's SSN or KIN
, Check __. (See Signature on page 26
e a. , set "
employed e U or the 'encyclical
lie' Preparees
signature
( 4 P
er•-'" ---t-- tf 4iDi
o s
a= Finn's ran li ll Associates Eau b 13;2842281
sallimpIoyird), address. Phone no ( )
and ZIP code 110 East 59th Street, New York NY 10022
Form 990-PF P0051
EFTA00224409
THE C.O.U.Q. FOUNDATION INC. STATEMENT 5
13-3996471
FORM 990-PF Y/E 2/28/06
PART I, LINE 25 AND PART XV
CONTRIBUTIONS PAID
Pate Name Amount Purpose
3/3/2005 Friends of Israel Defense Forces 25,000 Unrestricted
3/3/2005 92nd Street Pillar Project 10,000 Unrestricted
4/19/2005 Edge Foundation, Inc. 50,000 Unrestricted
5/6/2005 Stockholm School of Economics 25,000 Unrestricted
5/12/2005 Palm Beach Academy 10,000 Unrestricted
5/12/2005 WNBT 13 100,000 Unrestricted
5/25/2005 Harvard University 10,000 Unrestricted
5/26/2005 Columbia Universitiy 25,000 Scholarship
6/20/2005 Edge Foundation, Inc. 150,000 Unrestricted
6/21/2005 The Jewish National Fund 15,000 Unrestricted
6/22/2005 Institute of International Education 35,000 Unrestricted
7/15/2005 Hillel Foundation 50,000 Unrestricted
7/21/2005 Sundry Charitable Organizations 1,158 Unrestricted
8/3/2005 Ballet Florida 10,000 Unrestricted
8/11/2005 Gergias Southern University 5,000 Scholarship
8/16/2005 Columbia Universitiy 58,600 Scholarship
8/19/2005 Freestate Soccer Alliance 25,000 Unrestricted
8/23/2005 Harvard University 100,000 Unrestricted
9/6/2005 Santa Fe Institute 100,000 Unrestricted
9/7/2005 Kingsboro Community College 2,500 Scholarship
9/7/2005 City College 27,875 Scholarship
9/12/2005 Fashion For Relief 10,000 Unrestricted
9/22/2005 The Alliance for Lupus Research 10,000 Unrestricted
10/20/2005 Academy of Achievement 50,000 Unrestricted
10/20/2005 National Council of Jewish Women 5,000 Unrestricted
11/18/2005 Columbia Universitiy 10,000 Unrestricted
11/28/2005 Ballet Florida 15,000 Unrestricted
12/6/2005 Columbia Universitiy 50,000 Unrestricted
1/18/2006 New Jersey Firebirds Baseball 15,000 Unrestricted
1/18/2006 Bay Point School 100,000 Unrestricted
1/25 /2006 Intrepid Fallen Heroes Fund 25,000
1,125,133
EFTA00224410
THE C.O.U.Q. FOUNDATION, INC.
13-3996471
FORM 990-PF - Y/E 2/28/06
STATEMENT 1
Part I, Line 11
Other Income
Second City Capital Partners 1, LP
K-1 Entity 51,609
STATEMENT 2
Part I, Linc 16(c)
Other Professional Fce
Consulting 122,500
Second City Capital Partners I, L.P.
K-1 Entity 126,258
Total 248,758
=========
EFTA00224411
THE C.O.U.Q. FOUNDATION, INC.
13-3996471
FORM 990-PF - WE 2/28/06
STATEMENT 3
Part I, Line 23
Other Expenses
Bank Charges 21
Second City Capital Partners L.P.
K-I entity 2,901
Filing Fees 1,004
Other 138
Total 4,064
EFTA00224412
THE C.O.U.Q. FOUNDATION, INC.
EIN 13-3996471
FORM 990-PF - VIE 2/28/06
STATEMENT 4
Part II, Line 13
Other Investments
Fair
Book Value Market Value
Bear Steams Asset Backed
Securities Partners LP 10,289,911 12,569,336
Second City Capital
Partners I, LP 5,168,275 5,181,566
15,458,186 17,750,902
EFTA00224413
.—
OFFICE COPY
an 2
Form ISM (nee 12.2004)
check this box . . le I0
• If you are filing for an Additional (not automatic) 3-Month Extension, complete only Part II and
Pan II it you have already been granted an automatic 3-m onth extension on a previously lied Form 8868.
Note. Only complete
1).
• II you are filing for an Automatic 3-Month Extension, complete only Part I (on page
Additional (not automatic) 3-M onth Extension of Time-Must File Original and One Copy.
Employer Identification number
Type or Name of Exempt Organization
13 i 3996471
print THE C.O.U.Q. FOUNDATION
and room or suite no. If a P.O. box, see instruchons. For IRS use only
Rio by the Number street,
extended a ASSOCIATES, 110 EAST 59TH STREET
duo date for
filing the City, town or pest office, state, and ZIP code. For a lorinn address, sea instructions.
return See
instructions. NEW YORK, NY 10022
Check type of return to be filed (File a separate application for each return):
❑ Form 990.7 (sec. 401(a) or 408(a) trust) O Form 5227
O Form 990
990-1 (trust other than above) ❑ Form 6069
O Form 990-BL O Form
O Form 1041-A O Form 8870
O Form 990-EZ
• Form 990-PF O Form 4720
extension on a previously flied Form 8868.
STOP: Do not complete Part II If you were not already granted an automatic 3-month
• The books are In the is of * HARRY BELLER
FAX No. * (..ill ) 750-2409
Telephone No. * (.NM ) 750-9895
in the United States, check this box . . . le O
• If the organization does not have an office or place of business
four digit Group Exemption Number (GEN) If this is
• If this Is for a Group Return, enter the organization's
list with the
for the whole group, check this box * O. If It is for part of the group, check this box le O and attach a
names and EINs of all members the extension is for.
4 I request an additional 3-month extension of time until
JANUARY 15 20 07 ,
FEBRUARY 28 20 06
begin:we MARCH 1 20 05 , and ending
5 For calendar year , or other tax year
return O Final return O Change in accounting period
6 If this tax year is for less than 12 months, check reason: O Initial
CERTAIN INFORMATIO N NECESSARY FOR THE PROPER COMPLETION
7 State in detail why you need the extension
OF THE RETURN IS NOT YET AVAILABLE.
the tentative tax, less any
8a If this application is for Form 990-BL, 990-PF, 99D-7, 4720, or 6069, enter 37,767
. . . . . . . . . . .
nonrefundable credits. See Instructions . . . .
4720, or 6069, enter any refundable credits arid estimated
b If this application Is for Form 990-PF, 990-1,
and any amount paid
tax payments made. Include any prior year overpayment allowed as a credit 37,787
$
previously with Form 8868 . .
form, or, If requited, deposit
c Balance Due. Subtract line 84 from line 8a. Include your payment with this $ 0
instructions.
with FTD coupon or, if required, by using EFTPS (Electronic Federal Tax Payment System). See
Signature and Verification
staloments, and to the best of my kerwiliedge and ballet
Under ponaibes of penury, 'declare that I have examned this kern, including accompanying schedules and
e is INO. cutout, end ownpreter. and that I am authorized to prepare the form
Tele h Data la /04 /16 /i l e
Signature h /5/-`-
Notice to Applicant—To Be Completed by the IRS
O We have approved this application. Please attach this form to the organization's return.
from the later of the date shown below or the duo
❑ We have not approved this application However, we have granted a 10-day grace period to be a valid extension of time for elections
date of the organization's return (including any prior extensions). This grace paned is consideredreturn.
otherwise required to be made on a timely return. Please attach this form to the organization's
dem 7, wo cannot grant your request for an extension of time
❑ We have not approved this application. After considering the reasons stated in
to hie. We are not granting a 10-day grace period.
the rotten for which an extension was requested
O we cannot consider this application because it was feed after the extended due date of
❑ Other
By.
Oats
Proctor
for en additional 3-month extension
Alternate Mailing Address - Enter the address If you want the copy of this application
returned to an address different than the one entered above.
ASSOCIATES
Typo or Number and street 5nelude suite, room, or apt. no.) or a P.O. box number
print 110 EAST 59TH STREET
City or town, province or date, end country (including postal or ZIP code)
NEW YORK, NY 10022
Form 8868 alev 12-2004)
EFTA00224414
OFFICE COPY
Far. 8868
(Rev. December 2001)
Application for Extension of Time To File an
Exempt Organization Return OMS No 1545.1709
Department of the Treasury * File a separate application for each return.
'memo Revenue Service
►
• If you are filing for an Automatic 3-Month Extension, complete only Part I and check this box
filing for an Additional (not automatic) 3-Month Extension, complete only Part II (on page 2 of this form)
• If you are
filed Form 8868.
Do not complete Part II unless you have already been granted an automatic 3-month extension on a previously
Part I Automatic 3-Month Extension of Time—Only submit original (no copies needed)
only . . PP. 0
Form 9904 corporations requesting an automatic 6-month extension-check this box and complete Part I
file income tax returns.
All other corporations (Including Form 990-C filers) must use Form 7004 to request an extension of time to
extension of time fo file Form 1065, 1066, or 1041.
Partnerships, REMICs, and trusts must use Form 8736 to request an
if you want a 3-month automatic extension of time to file one of the
Electronic Filing (e-file). Form 8888 can be flied electronically want the additional
returns noted below (8 months for corporate Form 990-T filers). However, you cannot file it electronically if you
Form 8868. For more
(not automatic) 3-month extension, instead you must submit the fully completed signed page 2 (Part II) of
details on the electronic filing of this form, visit www.IrsgovIe lfie.
Name of Exempt Organization Employer Identification number
Type or 13 3998471
print The C.O.D.O. Foundation
File by the Number skeet and room or suite no. If a P.O. box, see instructions.
due date for Associates, 110 East 59th Street
tang your
return. See City, town or post offico, slate. and ZIP code. For a foreign address. see instructions.
Instruction,.
New York, NY 10022
Check type of return to be tiled (file a separate application for each return):
0 Form 990-T (corporation) • Form 4720
O Form 990 O Form 5227
O Form 990-BL 0 Form 990-T (sec. 401(a) or 408(a) trust)
0 Form 9904 (trust other than above) O Form 6069
El Form 99042
0 Form 1041-A O Form 8870
V1 Form 990-PF
• The books are In the care of ► Berri Beller
) 750-9895 FAX No. 0. l . ) 750.2408
Telephone No. Iv- (..t
business in the United States, check this box 0 0
• If the organization does not have an office or place of
Number (GEN) II this
• If this is for a Group Return, enter the organization's four digit Group Exemption
is for the whole group, check this box 0.0 . If it is for part of the group, check this box 0 0 and attach
a list with the
names and EiNs of all members the extension will cover.
October 15 , 20 Pc,
1 I request an automatic 3-month (6-months for a Form 9904 corporation) extension of time until
above. The extension is for the organization's return for:
to file the exempt organization return for the organization named
O. 0 calendar year 20... or
March 1 20 9, and ending February , 2008.
0- ca tax year beginning
if this tax year Is for less than 12 months, check reason: 0 Initial return 0 Final return 0 Change in accounting period
2
less any
3a if this application is for Form 990-BL, 990-PF, 9904, 4720, or 6069, enter the tentative tax, $ 37,767
nonrefundable credits. See instructions
b II this application is for Form 990-PF or 990-T, enter any refundable credits and estimated tax payments 12,767
made. Include any prior year overpayment allowed as a credit
c Balance Due. Subtract line 3b from One 3a. Include your payment with this form, or, if required, deposit
See
with ETD coupon or, if required, by using EFTPS (Electronic Federal Tax Payment System). 25,000
instructions
and Form 8879-EO
Caution. If you are going to make an electronic fund withdrawal with this Form 8868, see Form 8453-E0
for payment instructions.
Cat No. 279160 Form 8868 (Rev ¶2.2004)
For Privacy Act and Paperwork Reduction Act Notice, see Instructions.
EFTA00224415
EXTENSION ATTACHED
Return of Private Foundation OMB No 1545.0052
Form990-PF or Section 4947(a)(1) Nonexempt Charitable Trust
Dtpartmem al the Teener/
Treated as a Private Foundation
Note: The foundation may be able to use a copy of this return to satisfy state reporting movements.
2006
friend Revenue sen, a
March 1 , 2006, and ending February 28 , 20 07
For calendar year 2006, or tax year beginning
El Check all that apply: O Initial return O Final return O Amended return O Address change n Name change
A Employer Identlflcabon number
Name or foundation
Use the IRS 13 i 3996471
label. The C.O.U.Q. Foundation
address) RoomMune B Telephone number (see page 11 of the instructions)
Otherwise, Number and street for P 0 box number a mail is not delNered to street
print c/o Associates, 110 East 59th St. ( )
or type. Il•
See Specific OW or town, stale. and ZIP code C II exemption appacatron is pending, chock here * CI
Instructions. New York, NY 10022 0 1. Foreign organizations, check hero . . le EI
H Check type of organization: I71 Section 501(0(3) exempt private foundation 2. Foreign organizations meeting the 8596 test, ,
attach computation • * u
• Section 4947(a)(1) nonexempt charitable trust O Other taxable private foundation check hare and
E It private foundation statue was terminated M _
I Fair market value of all assets at end J Accounting method: (Z) Cash O Acaual under section 507(b)(1)(A), check here . *
of year (from Pad If, cot (c), O Other (specify) F II the loundatoon is in a 60-month Wrmination ,
(o) must be on cash basis) under section S07(b)(1)(B), check hese . le Li
line 16) lo $ 22,832,814 part I, column
(d)Dieburaamenb
Part I Analysis of Revenue and Expenses (The tow of (a) Revenue and ON Net Inv stment (c) Adlusted net for chartable
amounts in catanns CV, (c), end (d1may no! necessarily equal expenses per income income purposes
the amounts rn column (a) (see page f l or the instructions)) books (cash bases oft)
.: •
•
1 Contnbutions, gifts grants, etc., received (attach schedule) i
'
.4 . A
2 Check Ile. 0 if the foundation is not required to attach Sch. 9 •• .1, . 1
3 Interest on savings and temporary cash investments ei }I
ties 414,846 414,646
4 Dividends and Interest from securi • ' •
5a Gross rents
b Not rental Income or (loss)
'1• s • r. . w -
(52,333) • i i 4##. 4? ••
4 . E ! 4 : • . ' t ..:I .
A4/„.
1
Revenue
Oa Not gain or (loss) from sale of assets not on Nne 10
b Gross saies price for all assets on bne 6a 0 ; Cr' . :it.! •?..it fi: ' •tit ••I
0 ''' 1,1 ?i.t'
7 Capital gain net income (from Part IV, line 2) ,. ,
! 1 ("; , t
8 Net short-term capital gain
..• - ! li ! - . ."... t ' " 't t .
9 Income modifications Ur • • , •• k * .
`• 9-) a 9
10a Gloss sales less returns and allowances
b Less: Cost of goods sold
c Gross profit or (loss) (attach schedule)
I I ' ' •" -
: t' k ? ' er .
t . •
t
•
..
• : . ► 4.1Z7 '
I
284,466 94,468 .. • p j
11 Other Income (attach schedule) St 1 . • I
648,761 509,114 .....•z -- _j
12 Total. Add lines 1 through 11 . . . . . . .
0 13 Compensation of officers, directors, trustees, etc.
co
in 14 Other employee salaries and wages
e
0 15 Pension plans, employee benefits
A 16a Legal fees (attach schedule)
b Accounting fees (attach schedule) 50,000
170,000 120,000
6..-.1 c OthittbeENEDss attach schedule) .•st • 2
olg 17 I
02 18 es (attach scheaa) (s ge 14 of the Instructions) 25,000
1 19 ."- eprIECoS agafs
--V_, 2C ac
le) and depletion
gil. __,
iil 21 TratgG tiettatlithd m setings
I 1,003
St 3 591.636 590,633
23 Other expenses (attach schedule)
24 Total operating and administrative expenses 786,636 710,633 51,003
Add lines 13 through 23 1,186,000
1,186,000
25 Contributions, gifts, grants paid 1,237,003
1,972,636 710,633
26 Total expenses and disbursements. Add lines 24 and 25
27 Subtract line 26 from line 12: —
(1,925,855)
a Excess of revenue over expenses and disbursements
Income (if negative, enter -0-) 0
b Net investment
c Adjusted not income (11 negative, enter -0-) . .
Instructions. cat. No, 11289X Form 990-PF (2C06)
For Privacy Act and Paperwork Reduction Act Notice, see the
EFTA00224416
Page 2
Form 990-PF ROOM
Beginning of year End of year
Attached schedUes and amounts in Ine descripton column
Part II Balance Sheets Medd be la endohytai amounts only (See nstructims) (a) Book Value {b) Book Value (c) Fair Market Value
1 Cash—non-interest-bearing 4,817,748 4,817,748
4,112,136
2 Savings and temporary cash investments
—. _ _ . _. — _
3 Accounts receivable le•
Less: allowance for doubtful accounts P•
4 Pledges receivable Pi.
Less: allowance for doubtful accounts le•
5 Grants receivable
6 Receivables due from officers, directors, trustees, and other
disqualified persons (attach schedule) (see page 16 of the
Instructions)
7 Other notes and loans receivable (attach schedule) Iii• ............ _ .._ ... _ __.4.... , _._ ..__ .— ... _
Less: allowance for doubtful accounts le.
B Inventories for sale or use
4 9 Prepakl expenses and deferred charges
10a Investments—U.S. and slate government obligations (attach schedule)
b Investments—corporate stock (attach schedule) •
c investments—corporate bonds (attach schedule) • 9 .; -
_ 4: i
11 Investments—land, buildings, and equipment: basis Po f :S.:.
Less: accumulated depreciation (attach schedule) Po .•
12 Investments—mortgage loans . . . . .
13 Investments—other (attach schedule)
St .4 15,458,186 13,426,719 18,015,066
. • i
14 Land, buildings, and equipment: basis III• •••-i - : • e Lel _._,LE.c. . ./se.J -
Less: accumulated depreciation (attach schedule) ili•
15 Other assets (describe lo )
18 Total assets (to be completed by all filers-see page 17 of '
19,579322 18,244,467 22,832,814
the Instructions. Also, see page 1, Item I)
•
17 Accounts payable and accrued expanses
18 Grants payable • ••
.1
19 Deferred revenue : • ,i
..„-
20 Loans from officers, directors, trustees, and other disqualified persons l -•
a 21 Mortgages and other notes payable (attach schedule)
it , -
"'i.e.i•
•J 22 Other liabilities (descnbe P. ) : -i 4
it • .: ltel
23 Total liabilities (add lines 17 through 22) to 4
Foundations that follow SFAS 117, check here le. O e
and complete lines 24 through 28 end lines 30 and 31.
Net Assets or Fund Balances
4
24 Unrestricted 0 . ;
•
25 Temporarily restricted
•
26 Permanently restricted
Foundations that do not follow SFAS 117, check here li. •
and complete lines 27 through 31. .
Capital stock, trust principal, or current funds
27
Paid-in or capital surplus, or land, bldg., and equipment fund
28
19,570,322 18,244,467
Retained earnings, accumulated income, endowment, or other funds
29
Total net assets or fund balances (see page 18 of the
30 19,570.322 18,244,467
instructions)
31 Total liabilities and net assets/fund balances (see page 18 of the
instructions) 19,570,322 18,244,467
part III Analysis of Changes in Net Assets or Fund Balances
agree with
1 Total net assets or fund balances at beginning of year—Part II, column (a), line 30 (must 1 19,570,322
end-of-year figure reported on prior year's return)
• 2 (1,325,855)
2 Enter amount from Part I, line 27a 3
3 Other increases not included in line 2 (itemize) Ow 16,244,467
4
4 Add lines 1, 2, and 3
6
5 Decreases not Included In line 2 (Iternize) Il• 18,244,467
(b), Ilne 30 8
8 Total net assets or fund balances at end of year pine 4 minus Ine 6)-Part II, column
Form 990-PF (2006)
EFTA00224417
Pay" 3
Form 99O-PF (2006)
Capital Gains and Losses for Tax on Investment Income
Part IV
(OW and drawee the ax16) of properly sold (8 fli. real estate,
2-story bnck warehouse, or common stock. 200 am MC Co.)
,_ shase otntrd,,„yaAgy
(b) How
puracquired
D—Oonation
oed (d) Date sold
0110. Mai. Yr /
la Statement 5
b
c
d
e
lg) Cost or other hams (h) WOO 01' Goss)
II) Deana-mace flawed
(e) Cross Wen lance r allowable) plus expense Of Wu (e) Plus 01 minus (9)
a
b
c
d
a
Complete only for assets showing gain In column (h) and owned by the foundation on 12/31/69 0) Gans (Coin awn minus
col 6), but not less than -0-) or
(I) /Waisted basis (k) Excess of COI f)
oFmg as of 12/31/69 over col Q). II any Losses (from cot (3))
as of 12/31/69
a
b
d
cs
. { if gain, also enter In Part I, Ilne 7 1
2 Capital gain net income or (net capital loss) If (loss) enter -0- In Pail I, line 7 2 (52,333)
3 Net short-term capital gain or (loss) as defined in sections 1222(5) and (6):
It gain, also enter in Part I, Ilne 8. column (c) (see pages 13 and 18 of the Instructions).
If (loss). enter -0- In Part I, line 8 - 3
n Under Section 4940(e) for Reduced Tax on Net Investment Income
Part Qualificatio
on net investment income.)
(For optional use by domestic pnvate foundations subject to the section 4940(a) tax
If section 4940(d)(2) applies, leave this part blank.
year In the base period? O Yes O No
Was the foundation liable for the section 4942 tax on the distributable amount of any
If "Yes," the foundation does not qualify under section 4940(e). Do not complete this part.
before making any entnes.
1 Enter the appropriate amount in each column for each year: see page 19 of the Instructions
.
Id)
he jb) DesInbubon ratio
Base penod years Adjusted quariyIng datribubone Net value of nonoVantable-tne assets kol (b) divided by co/ (0)
Calendar year (or lax year becennro in)
1,255,795 22,630,448 0.055491
2005
936,665 20,159,106 0.046463
2004
1,041560 12,227,806 0.085179
2003
1,243,915 12,221,528 0.101944
2002
902,103 7,498,097 0.120310
2001
2 0.409387
2 Total of line 1, column (d)
or by the
3 Average distribution ratio for the 5-year base period—divide the total on line 2 by 5, 3 0.081877
number of years the foundation has been in existence if less than 5 years
4 22,142,808
4 Enter the net value of noncharitable-use assets for 2006 from Part X, line 5
5 1,812 987
5 Multiply line 4 by lino 3
6 0
6 Enter 1% of net investment Income (1% of Part I, line 27b)
7 1 812 987
7 Add lines 5 and 6
• 8 1,237,003
a Enter nonkfolon rlininbutiona from Part XIL line 4
that part using a 1% tax rate. See
If line 8 is equal to or greater than line 7, check the box in Part VI, line lb. and complete
the Part VI Instructions on page 19.
Fain 990-RF polio
EFTA00224418
Pogo 4
Form (190.M- (2006)
page 19 of the instructions)
Part VI Excise Tax Based on investment Income (Section 4940(a), 4940(b), 4940(e), or 4948—see
on tine 1.
la Exempt operating foundations described in section 4940(d)(2), check here le. O and enter "N/A" I
(attach copy of ruling letter If necessary—see Instructions) _ .
Date of ruling letter:
b Domestic foundations that meet the section 4940(e) requirements in Part i
check 1 0
'
here 10 O and enter 1% of Part I, line 27b
— ..._.. ___ ___
c All other domestic foundations enter 2% of line 27b. Exempt foreign organizations enter 4%
of Part I, line 12, col. (D)
2 Tax under section 511 (domestic section 4947(eX1) trusts and taxable foundations only. Others enter -0-) 2
3 0
3 Add fines 1 and 2 4
enter -0-)
4 Subtitle A (income) tax (domestic section 4947(a)(1) trusts and taxable foundations only, Others 5 0
5 Tax based on Investment Income. Subtract line 4 from line 3. If zero or less, enter -0-
6 Credits/Payments: 18,872 • • ••
a 2006 estimated tax payments and 2005 overpayment credited to 2006 6a
fib r,
b Exempt foreign organizations—tax withheld at source 1 1
application for extension of time to file (Form 8868) 99 .
c Tax paid with te r.
6d
d Backup withholding erroneously withheld 7 18,872
7 Total credits and payments. Add lines 6a through 6d
8
a Enter any penalty for underpayment of estimated tax. Check here CI if Form 2220 is attached 0
8 is more than line 7, enter amount owed O. s
9 Tax due. If the total of lines 5 and 18,872
overpaid . 0. 10
10 Overpayment. If line 7 is more than the total of lines 5 and 8, enter the amount
18,872 I Refunded 0. 11
11 Enter the amount of line 10 to be: Credited to 2007 estimated tax 0.
P rt VII-A Statements R9parding Activities
..t ' Yes - No
or did a •
to During the tax year, did the foundation attempt to Influence any national, state, or local legislation to i
participate or intervene in any political campaign?
purposes (see page 20
b Did It spend more than $100 dunng the year (either directly or Indirectly) for political lb 1
of the Instructions for definition)?
any materials .- -
If the answer is "Yes' fo la or lb, attach a detailed description of the actiwfies and copies of
by the foundation in connection with the activities. ....t:; L:f.C.1
published or distributed
1c I
c Did the foundation file Form 1120-POL for this year? ..4
4955) Imposed during the year
d Enter the amount Of any) of tax on political expenditures (section ..1 4...:
(2) On foundation managers. Iii. .
(1) On the foundation. ill. $ $ .4l. • .4
during the year for political expenditure tax Imposed on I.; , I
e Enter the reimbursement (if any) paid by the foundation F.
foundation managers. ilo $ i
to the IRS? , 2
2 Has the foundation engaged in any activities that have not previously been reported
If "Yes," attach a detailed description of the activities.
instrument, articles of ...t... --r! ,.. ...
3 Has the foundation made any changes, not previously reported to the IRS, In as governing i
attach a conformed copy of the changes 3
Incorporation, or bylaws, or other similar Instruments? If "Yes,' 4a 1
the year? . . .
4a Did the foundation have unrelated business gross Income of $1,000 or more dunng 4b N A
b If "Yes," has it filed a tax return on Form 990-7 for this year?
the year? . . 5 DI
6 Was there a liquidation, termination, dissolution, or substantial contraction during
by General instruction T. . I
If "Yes," attach the statement required
4945) satisfied either
6 Are the requirements of section 508(e) (relating to sections 4941 through
• By language in the governing instrument, or . i
legislation that effectively amends the governing Instrument so that no mandatory directions that - • •
• By state 6 i
.
conflict with the state law remain in the governing instrument? . . . . . . . . . . . . . 7 i
Part It col island Part XV,
7 Did the foundation have at least $5,000 In assets at any time dunng the year?II Wes,' complete [
(see page 20 of the
8a Enter the states to which the foundation reports or with which it is registered
instructions) Il. New York
of Form 990-PF to the Attorney General ..--- ._
b if the answer is "Yes* to line 7, has the foundation furnished a copy H
07 If "No," attach explanation
(or designate) of each state as required by General Instruction
within the meaning of section 49420(3) ----- - --I
9 is the foundation claiming status as a private operating foundation
beginning in 2006 (see Instructions for Part XIV on
or 49426)(5) for calendar year 2006 or the taxable year 9 ✓
page 28)? If "Yes/' complete Part XIV
substantial contributors during the tax year? If "Yes,"attach a schedule listing their
10 Did any persons become 1
10
names andaddresses
Form 990-PF (2006)
EFTA00224419
Page 5
Earn 990•PF 8006)
Statements Regarding Activities Continued
within the
11a At any time during the year, did the foundation, directly or Indirectly, own a controlled entity
512(b)(13)? If "Yes," attach schedule. (see instructions) lla ✓
meaning of section
Interest,
b If "Yes," did the foundation have a binding written contract in effect on August 17, 2006, covering the A
11b
rents, royalties, and annuities described in the attachment for line 11a?
contract? 12
12 Did the foundation acquire a direct or indirect Interest in any applicable insurance 13
13 Did the foundation comply with the public inspection requirements for its annual returns and exemption application?
Website address ►
s
14 The books aro in care of In tillUMIlrAssociate Telephone no. ►
Located at *110 East 59th Street, New York, NY ZIP+4 ►
nonexempt chantable trusts filing Form 990-PF In lieu of Form 1041—Check hero ► ❑
15 Section 4947(a)(1)
and enter the amount of tax-exempt interest received or accrued during the year . . . . ► I 15 I
Statements Regarding Activities for Which Form 4720 May Be Required
Yes No
File Form 4720 if any item is checked in the "Yes" column, unless an exception applies.
la 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? ❑ Yes 0 No
(2) Borrow money from, lend money to, or otherwise extend credit to (or accept It from) a
disqualified person? ❑ Yes 0 No
(3) Furnish goods, services, or facilities to (or accept them from) a disqualified person? ❑ Yes V) No
(4) Pay compensation to, or pay or reimburse the expenses of, a disqualified person? ❑ Yes 0 No
(or make any of either available for
(5) Transfer any income or assets to a disqualified person
the benefit or use of a disqualified person)? ❑ Yes 12) 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 penod after
termination of government service, if terminating within 90 days ) ❑ Yes 2) No
under the exceptions described in Regulations
b If any answer is 'Yes" to 1a(1)-(6), did any of the acts fail to qualify lb N
notice regarding disaster assistance (see page 22 of the instructions)?
section 53.4941(d)-3 or in a current
. . ►❑
Organizations relying on a current notice regarding disaster assistance check here .
than excepted acts, that
_ c Did the foundation engage In a prior year in any of the acts described in 1a, other lc
were not corrected before the first day of the tax year beginning in 2006?
the foundation was a pnvate
2 Taxes on failure to distribute income (section 4942) (does not apply for years
operating foundation defined in section 49420)(3) or 49420X5)).
6d and
a At the end of tax year 2006, did the foundation have any undistributed income (lines
Be, Part XIII) for tax year(s) beginning before 2006? ❑ Yee ❑ No
If "Yes," list the years* 20 .... , 20.... , 20 , 20
b Are there any years listed In 2a for which the foundation Is not applying the provisions of section 4942(a)(2)
section 4942(8)(2)
(relating to Incorrect valuation of assets) to the year's undistributed income? (If applying 2b ✓
to all years listed, answer "No" and attach statement—s ee page 22 of the instructions.)
the years here.
c If the provisions of section 4942(e)(2) aro being applied to any of the years listed in 2a. list
► 20 .... , 20 .... , 20 . , 20
business
3a Did the foundation hold more than a 2% direct or indirect interest in any
enterprise at any time during the year? ❑ Yee CA No
by the foundation or
b II "Yes," did it have excess business holdings in 2006 as a result of (1) any purchase
disqualified persons after May 26, 1969; (2) the lapse of the 5-year penod (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
phase holding period? (Use Schedule C, Form 4720, to determine if the
of the 10-, 15-, or 20-year first 3b N A
foundation had excess business holdings in 2006) 4a
Its charitable purposes?
4a Did the foundation Invest during the year any amount in a manner that would jeopardize
31, 1969) that could jeopardize its chantable
b Did the foundation make any investment in a prior year (but after December in 2006? . . . 4b ✓
purpose that had not been removed from jeopardy before the first day of the tax year beginning
Form 990-PF 12006)
EFTA00224420
Page 6
Form 990-PF (2006)
Continued
Part VII-B Statements Regarding Activities for Which Form 4720 May Be Required
5a Dunng the year did the foundation pay or incur any amount to:
(1) Carry on propaganda, or otherwise attempt to Influence legislation (section 4945(e))? O Yes g] No
or to carry on,
(2) influence the outcome of any specific public election (see section 4955);
directly or indirectly, any voter registration drive? O Yes No
(3) Provide a grant to an Individual for travel, study, or other similar purposes? . . . O Yes [ZI No
(4) Provide a grant to an organization other than a charitable, etc., organization described In
section 509(a)(1), (2), or (3), or section 4940(d)(2)? (see Instructions) O Yes EZ) No
(5) Provide for any purpose other than religious, charitable, scientific, hterary, or
0 No
educational purposes, or for the prevention of cruelty to children or animals? . O Yes
under the exceptions described in
b If any answer is "Yes" to 5a(1)-(5), did any of the transactions fall to qualify
notice regarding disaster assistance (see page 23 of the instructions)?
Regulations section 53.4945 or in a current
►
Organizations relying on a current notice regarding disaster assistance check here
c If the answer is "Yes" to question 52(4), does the foundation claim exemption from the tax
because it maintained expenditure responsibility for the grant? O Yes O No
II "Yes," attach the statement required by Regulations section 53.4945-5(d).
ea Did the foundation, dunng the year, receive any funds, directly or indirectly, to pay premiums
on a personal benefit contract? D Yes El No
b Did the foundation, during the year, pay premiums, directly or indirectly, on a personal benefit contract?
if you answered "Yes" to 66, also We Form 8870.
O yes IZ No
75 At any time during the tax year, was the foundation a party to a prohibited tax shelter transaction?
receive an proceeds or have a net Income attributable to the transaction? .
b If es, did the foundation
Officers, Directors, Trustees, Foundation Managers, Highly Paid Employees,
Information About
and Contractors
of the Instructions).
1 Ust all officers, directors, trustees, foundation managers and their compensation (see page 23
(0) Teo. and average (o)Componsabon (d)Contnbutions to (o) Expanse account.
(a) Name end address hours per week Of not paid, enter employee benefit plans other allowances
devoted to position 41-) and deferred compensation
Jeffrey E. Epstein PresJDIrector 0 0 0
5100 Redtlook Quarters, St. Thomas, USVI rings luny
Darren K. Indyke VP/Director 0 0 0
457 Madison Ave., New York, NY nn. knife
Ghlsiaine Maxwell Treasurer 0 0 0
do . Associates Goo timer
110 East 59th Street, New York„ NY
line 1— see page 24 of the instructions).
2 Compensation of five highest-paid employees (other than those included on
If none, enter "NONE."
(d) Contnbutions to
(b) Tale, and average employee benefit (e) Expense account,
(a) Name and address of each employee paid more than $saeoci hours per week (o) Compensation plans and deterred other allowances
devoted to position compensation
None
Total number of other employees paid over 550,000
Form 990-PF (7006)
EFTA00224421
Page 7
Form 990-Pf (2000)
Highly Paid Employees,
Part VIII Information About Officers, Directors, Trustees, Foundation Managers,
and Contractors Continued
of the instructions) If none, enter
3 Five highest-paid independent contractors for professional services (see page 24
"NONE."
(b) Type of service (o) Compensation
(a) Name and address of each person paid more than $50,000
David Grosot Consulting 50,000
57 Bemis Street, San Francisco, CA 94131
► 150,000
Total number of others receiving over 550,000 for professional services
Part Di(-A Summary of Direct Charitable Activities
stateliest information such as the number
List the foundation's four largest direct chantede admit., dunng the tax year Include relevant Evens*.
produced. etc
of orga-ntrations and other ['took/ones served, conferences convened, research papers
1
2
3
4
Part tX-B Summary of Program-Related investments (see page 24 of the instructions
year on lines 1 and 2 AMAMI
Meant* the two largest program-related investments made by (ho foundation during Ihe tax
i
2
As other program-related investments See page 25 of the instructions.
3
- Pi.
Total. Add lines 1 through 3
Ram 990-PF pole
EFTA00224422
Pago 8
Form 990.PF (2006)
part. Foreign foundations ,
Part X Minimum Investment Return (All domestic foundations must complete this
see page 25 of the instructions .)
1 Fair market value of assets not used (or held for use) directly in carrying out charitable, etc ,
purposes:
la
a Average monthly fair market value of securities 4,464,942
lb
b Average of monthly cash balances 18,015,066
Ic
c Fair market value of all other assets (see page 25 of the instructions) 22,480,008
Id
d Total (add lines la, b, and c)
e Reduction claimed for blockage or other factors reported on lines to and
I le
lc (attach detailed explanation)
2 Acquisition indebtedness applicable to line 1 assets 22 480,008
3 Subtract lino 2 from line ld
4 Cash deemed held for charitable activities. Enter 1/1 2 % of line 3 (for greater amount, see page 26
4 337,200
of the Instructions) 22,142,808
line 4 5
.5 Not value of noncharitable-use assets. Subtract line 4 from line 3. Enter here and on Part,, 1 107 140
6 Minimum investment retum. Enter 5% of line 5 6
(Section 49420(3) and 0(5) pnvate operating •
Part XI Distributable Amount (see page 26 of the instructions)
foundations and certain foreign organizations check here ► O and do not complete this part )
1 1,107,140
1 Minimum investment return from Part X, line 6
2a
2a Tax on investment income for 2006 from Part VI, line 5
from Part VI ) 2b
b income tax for 2006. (This does not Include the tax 2c 0
c Add linos 2a and 2b 3 1,107,140
3 Distnbutable amount before adjustments. Subtract line 2c from line 1 4
4 Recoveries of amounts treated as qualifying distributions 6 1,107,140
5 Add lines 3 and 4 6
6 Deduction from distributable amount (see page 26 of the Instructions)
line 5. Enter here and on Part XIII,
7 Distributable amount as adjusted. Subtract lino 6 from 7 1 107,140
lino 1
Part XII Qualifying Distributions (see page 26 of the Instructions)
purposes:
1 Amounts paid (including administrative expenses) to accomplish charitable, etc., is 1,237603
a Expenses, contributions , gifts, etc.—total from Part I, column (d), line 26
lb
b Program-related Investments—total from Part IX-B
etc ,
2 Amounts paid to acquire assets used (or held for use) directly In carrying out chantable, 2
purposes
3 Amounts set aside for specific charitable projects that satisfy the; 3a
a Suitability test (pnor IRS approval required)
3b
b Cash distribution test (attach the required schedule) 4 1,237,003
line 8, and Part XIII, line 4
4 Qualifying distributions. Add lines la through 3b. Enter here and on Part',
on net investment income
5 Foundations that qualify under section 4940(e) for the reduced rate of tax 6 0
Enter 1% of Part I, tine 27b (see page 27 of the Instructions)
6 1,237,003
6 Adjusted qualifying distributions. Subtract line 5 from line 4
calculating whether the foundation
Note:The amount on line 6 will bo used in Part column (b), in subsequent years when
qualifies (or the section 4940(e) mduction I fax In those years.
Form 990-PF (2006)
EFTA00224423
Popo 9 •
form 990PF p006)
agil Undistributed Income (see page 27 of the instructions)
(s) (b) (0) (d)
comae Years poor lo 2005 2005 2006
1 Distributable amount for 2006 from Pail XI, 1,107,140
line 7
2 Undistnbuted income, if any, as of the end of 2005: . . _. _ .
0
a Enter amount for 2005 only
0
b Total for prior years' 20 20 20
3 Excess distributions carryover, if any, to 2006:
a From 2001 794,417
b From 2002 638,745
c From 2003 432,491
d From 2004
e From 2005 139,200 _ _.. _..
e 2,004,853
f Total of lines 3a through
4 Qualifying distributions for 2006 from Part XII,
One 4: lio $ 1,237,003 —_. __.„
: ' , 0
a Applied to 2005, but not more than line 2a . • .,
, ,•
: : . ..•
b Applied to undistributed income of prior years (Election • i
• • 9 'Y 0
required—see page 27 of the instructions) • . Z
•i%
C Treated as distributions out of corpus (Election
• • to
.. :i . C•
required—sort page 27 of the Instructions) . .. 0 .•
. . • I.e.' . • •
•.] : 1,107,140
d Appked to 2006 distributable amount .
129,863 . 4 ' I ' P ' ,,,-• ' 1 , •• •I
e Remaining amount distributed out of corpus
i‘ ... , ' c 0
5 Excess distributions carryover applied to 2006 :.. . r , a z , 2 •S
(II an amount appears In column (d), the same 1, C , ; .1
' :y ri. '7. r •
amount must be shown ln column (a).) - • .f') -$ ' if . • . , i
i • .:. i t .2 3 •
8 Enter the net total of each column as r i :•.,
Indicated below: il ".; . _ 1" '6'
a Corpus. Add linos 31, 4c, and 4e. Subtract line 5
2 134' 711: r
;
i. : .
,- '
• f .-• _.1 ; 4
;.. •
b Prior years' undistnbuted income. Subtract •1I
.., . : :et Z ;" --•• k. oti :4.1- '
2b i 0 ..
line 4b from line I •
' ; 11
c Enter the amount of prior yews' undistributed - if : I .) , •i
income for which a notice of deficiency has been : i:' ','
issued, or on which the section 4942(a) tax has 9: :' ii .il ' 10 ,
. 449 t :- i
been previously assessed •. -• - '
- •i V
d Subtract line 8c from line 6b. Taxable '
amount—see page 27 of the instructions 0 :• .- 14;
r:,
: ;
.,. . 9
e Undistributed income for 2005. Subtract line .•• . t
4a from line 2a. Taxable amount—see page r
0
27 of the matructions • .
. •.
f Undistnbuted Income for 2006. Subtract lines -
4d and 5 from line 1. This amount must be
distributed in 2007 0
7 Amounts treated as distnbutions out of corpus
to satisfy requirements Imposed by section
170(b)(1)(E) or 4942(9)(3) (see page 28 of the
0
Instructions)
8 Excess distnbutions carryover from 2001 not
applied on line 5 or line 7 (see page 28 of the
794,417
instructions)
9 Excess distributions carryover to 2007.
1,340,299
Subtract lines 7 and 8 from line 6a
10 Analysis of line 9:
638,745
a Excess from 2002
2003 432,491
b Excess from
c Excess from 2004
d Excess from 2005 . . 139,200
e Excess from 2006 . . 129,863 _
Form 990-PF 2005)
EFTA00224424
Page 10
FOITI1 990.PF (2006)
P rt XIV Private Operating Foundations (see page 28 of the Instructions and Part question 9)
1a if the foundation has received a ruling or determination letter that it is a private operating
foundation, and the ruling is effective for 2006, enter the date of the ruling . . . . ►
or 0 4942COP
b Check box to indicate whether the foundation is a private operating foundation descnbed in section 0 49420)(3)
2a Enter the lesser of the adjusted net Tax year Prior 3 years (a) Total
income from Part I or the minimum (a) 2006 (0) 2005 (c) 2004 Id) 2003
investment return from Part X for
each year hated
b 85% of line 2a
o Qualifying distributions from Part XII,
line 4 for each year listed
d Amounts Included in line 2c not used dire*
for active conduct of exempts:belies
e Qualifying distributions made directly
for active conduct of exempt activities.
Subtract line 2d from line 2c
3 Complete 3a, b, or c for the
alternative test rolled upon:
• "Assets" alternative test—enter:
(1) Value of all assets
(2) Value of assets qualifying
under section 49420)(3)(6)(1)
b "Endowment' alternative test—enter % of
minimum Investment return shown n Pan
X. Ina 6 tot each year listed
o "Support" alternative test—enter:
(1) Total support other than gross
Investment income (interest,
dividends, rents, payments on
securities loans (section
512(a)(6)), or royalties)
(2) Support from general pubic
and 5 or more exempt
organizations as provided In
section 49420)(30)0W
(3) Largest amount of support from
an exempt organization . . .
(4) Gross investment Income .
or more in assets
Part XV Supplementary Information (Complete his part only if the foundation had $5,000
at any time during the year—see page 28 of the Instruction s.)
1 Information Regarding Foundation Managers:
total contributions received by the foundation
a List any managers of the foundation who have contributed more than 2% of the$5,000).
before the close of any tax year (but only If they have contributed more than (See section 507(d)(2).)
Jeffrey E. Epstein
(or an equally large portion of the
b List any managers of the foundation who own 10% or more of the stock of a corporation interest.
ownership of a partnership or other entity) of which the foundation has a 10% or greater
2 Information Regarding Contribution, Grant, Gift, Loan, Scholarship, etc., Programs:
Check here P O If the foundation only makes contributions to preselected charitable of organizations and does not accept
unsolicited requsts for funds. If the foundation makes gifts, grants, etc. (see page 28 the instructions) to individuals or
organizations under other conditions, complete items 2a, b, c, and d.
a The name, address, and telephone number of the person to whom applications should be addressed:
b The form in which applications should be submitted and Information and materials they should include:
o Any submission deadlines:
institutions, or other
d Any restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of
factors:
Form 990-PF (2006)
EFTA00224425
Page i
Fonn 990-PF (2000)
Part XV Supplementary Information (continued)
.., MP.. vunuruuuuna ram a'aunrq ti ro 1 wow w rapyrvraa 1%/1 rutuvo rayon:ma
aa.mns
if recipient es an wicavidual, e mdabon
Recipient show arty relationship to re:utus of Purpose of grant or Amount
any foundation manager ceetnbution
Name and address (home or business) or substantial contributor rectl:" ^I
a Paid during the year
Statement 6
► 3a 1,186,000
Total
b Approved for future payment
► 3b 0
Total
Form 99O-PF (2006)
EFTA00224426
Page 12
'Fain 990-PF (2006)
art XVI-A Analysis of Income-Producing Activities
Unrelated business income Excluded by sect' n 512. 513. Of 514 (0)
Enter gross amounts unless otherwise Indicated. Related or exempt
fa) (b) (a) (d) function
on
Business code Amount Exclusion code Amount (See page 29 of
We instrucbons.)
I Program service revenue:
a
b
e
d
e
f
g Fees end contracts from government agencies
2 Membership dues and assessments
14 414,646
3 Interest on savings and temporary cash investments
4 Dividends and Interest from securities . I. I
5 Net rental income or (loss) from real estate:
a Debt-financed property
b Not debt-financed property
6 Net rental Income or (loss) from personal property
7 Other Investment Income
16 (52,333)
8 Gain or (loss) from sales of assets other than Inventory
9 Net income or (loss) from special events
10 Gross profit or (loss) from sales of inventory 94,468
14
11 Other revenue: a From partnerships
b
c
d
e 458,781
t . i r? .
12 Subtotal. Add columns (b). fdl. and le) 456,781
- 13 Total. Add Ilne 12, columns (b), (d), and (e) 13
ea worksheet in lino 13 Instructions on page 29 to verify calculations )
Relationship of Activities to the Accomplishment of Exempt Purposes
Line No. Explain below how each activity for which income is reported in column (a) of Part XVI-A contributed importantly to
such purposes). (See
the accomplishment of the foundation's exempt purposes (other than by providing funds for
page 29 of the Instructions.)
NIA
Form 990-PF 12006)
EFTA00224427
Page 13
'Form 990-FT (2006)
With Noncharitable
Part XVII Information Regarding Transfers To and Transactions and Relationships
Exempt Organizatio ns
Yes No
1 Dld the organization directly or Indirectly engage in any of the following with any other organization described
political
in section 501(c) of the Code (other than section 501(c)(3) organizations) or in section 527, relating to
organizations ?
a Transfers from the reporting foundation to a noncharitable exempt organization of:
✓
(1) Cash la(2) ✓
(2) Other assets
b Other transactions: 1141) ✓
(1) Sales of assets to a noncharitable exempt organization
lb(2)
(2) Purchases of assets from a noncharitable exempt organization lb(3)
(3) Rental of facilities, equipment, or other assets 1144) ✓
(4) Reimbursement arrangements lb(5),
(5) Loans or loan guarantees lb(6)
(6) Performance of services or membership or fundraising solicitations
lc
c Shanng of facilities, equipment, mailing lists, other assets, or paid employees
always show the air market
d II the answer to any of the above is "Yes," complete the following schedule. Column (b) should
received less than fair market
value of the goods, o her assets, or services given by the reporting foundation. If the foundation
assets, or services received.
value in any transaction or shanng arrangement, show in column (d) the value of the goods, other
Line no (b) Amount invoNed (o) Name of nonchantable exempt oraanstallon (d) Wiens.1ton of transfers, transactions, and sharing arrangements
tax-exempt organizations
2a is the foundation directly or indirectly affiliated with, or related to, one or more
Code (other than section 501(c)(3)) or In section 5277 0 Yes 0 No
described in section 501(c) of the
b If "Yes," complete the following schedule.
(a) Name of organization (b) Type of organization (a) Descopbon of relationship
I
Under penalties of pentsy. I declare that I . .Ss return, including accompanying schedules and statements, and le the best of my knoMsage and
'wt, it is true, correct, end corn a at grower r than taxpayer or bauccuy) 15 based on all of Wash power has any lawatedge.
--m. I la.A-O-1 ' kikti. enA.4".e9evt
intormabonn
I Title
Date
Sign Here
strustes
na ure ;office: or a
Date ReParer's SSN or PTIN
Check If .__, (Seff Signature on page II
SSWeniployed r. u of the instructions)
lig Preparent iritili)bb7
a: signature
E name (or yours If
seit.employed), address.
S Associates EIN la 13; 2842281
tie East 59th Street, New York, NY 10022 Phone no. (U)909-9680
and ZIP code
Form 990-PF Rte)
EFTA00224428
THE C.O.U.Q. FOUNDATION,INC.
13-3996471
FORM 990-PF - VIE 2/28/07
STATEMENT 1
Part I, Line II
Other Income
Second City Capital Partners I, LP
K-I Entity 94,468
Prior period adjustment 190,000
284,468
STATEMENT 2
Part I, Line 16(c)
Other Professional Fees
Consulting 50,000
Second City Capital Partners I, L.P.
K-I Entity 120,000
Total 170,000
I
EFTA00224429
THE C.O.U.Q. FOUNDATION, INC.
13-3996471
FORM 990-PF - VIE 2/28/07
STATEMENT 3
Part I, Line 23 •
Other Expenses
Second City Capital Partners L.P.
K-I entity 1,926
Filing Fees 1,003
Professional fees - Second City
Capital Partners L.P. K-1 entity 6,556
Bad debt expense - Second City
Capital Partners L.P. K-1 entity 582,151
Total 591,636
•
EFTA00224430
THE C.O.U.Q. FOUNDATION, INC.
UN 13-3996471
FORM 990-PF - Y/E 2/28/07
STATEMENT 4
Part II, Line 13
Other Investments
Fair
Book Value Market Value
Bear Steams Asset Backed
Securities Partners LP 7,289,911 11,870,413
Second City Capital
Partners I, LP 6,136,808 6,144,653
13,426,719 18,015,066
STATEMENT 5
Part IV, Line 2
Capital Gain Net Income (Lossl
Second City Capital
Partners I, LP K-1 entity (52,333)
EFTA00224431
STATEMENT 6
THE C.O.U.Q. FOUNDATION INC.
13-3996471
FORM 990-PF Y/E 2/28/07
PART I, LINE 25 AND PART XV
CONTRIBUTIONS PAID
Date Name Amoue Purpose
3/7/2006 Stockholm School of Economics 25,000 Unrestricted
5/3/2006 The Continium Center for Health & Hearing 25,000 Unrestricted
5/30/2006 Hunter College 3,000 Scholarship
6/1/2006 Martha Graham Dance Company 10,000 Scholarship
6/14/2006 Little Flower Children's Services 10,000 Unrestricted
6/28/2006 Robin Hood 50,000 Unrestricted
7/12/2006 Ballet Florida 20,000 Unrestricted
7/18/2006 Georgia Southern University 10,000 Scholarship
7/18/2006 William J. Clinton Foundation 25,000 Unrestricted
8/10/2006 Freestate Shooters 25,000 Unrestricted
8/11/2006 Zvi Tzedakah Fund 100,000 Unrestricted
9/1/2006 Institute of International Education 100,000 Unrestricted
9/6/2006 Alliance for Lupus Research 5,000 Unrestricted
9/8/2006 Happy Hearts Fund 100,000 Unrestricted
9/27/2006 Ovarian Cancer Research Fund 50,000 Unrestricted
10/3/2006 The Trilateral Commission 50,000 Unrestricted
10/5/2006 Faith in The Future, Inc. 5,000 Unrestricted
10/5/2006 National Council of Jewish Women 5,000 Unrestricted
1 1/10/2006 The Institute for Music & Brain Science 25,000 Unrestricted
11/16/2006 President and Fellows of Harvard College 100,000 Unrestricted
1 I /27/2006 Santa Fe Institute 75,000 Unrestricted
1/17/2007 Ballet Florida 15,000 Unrestricted
1/18/2007 Save Darfur Coalition 150,000 Unrestricted
2/7/2007 Stockholm School of Economics 50,000 Unrestricted
2/21/2007 Saint Peter's Prep 3,000 Unrestricted
2/22/2007 Scholar Rescue Fund 150,000 Unrestricted
1,186,000
EFTA00224432
OFF-10E COPY
Form8868
(Rev April 2007)
Application for Extension of Time To File an
Exempt Organization Return OW No 1S4S-1709
Oeparimeni of the Treasury le Flea separate application for each return.
Internal Revenue Stowe
• If you are filing for an Automatic 3-Month Extension, complete only Part I and check this box •
• If you aro filing for an Additional (not automatic) 3-Month Extension, complete only Part II (on page 2 of this form).
Do not complete Part ll unless you have already been granted an automatic 3-month extension on a previously Ned Form 8868.
Part I Automatic 3-Month Extension of Time. Only submit original (no copies needed).
Section 501(c) corporations required to file Form 990-T and requesting an automatic 6-month extension—check this box and
complete Part I only • 0
All other corporations (including 7120-C filers), partnersteps, REMtCs, and trusts must use Form 7004 to request an extension of
time to fro income tax returns.
Electronic Filing (e-file). Generally, you can electronically file Form 8868 if you want a 3-month automatic extension of lime to file
one of the returns noted below (6 months for section 501(c) corporations required to file Form 9904). However, you cannot file Form
8868 electronically if (1) you want the additional (not automatic) 3-month extension or (2) you file Forms 990-BL, 6069, or 8870, group
returns, or a composite or consolidated Form 990-T. Instead, you must submit the fully completed and signed page 2 (Part II) of Form
8868. For more details on the electronic filing of this form, visit wwwirs.govletile end click on a-fate for Charities & Nonpmfats.
Type or Name or Exempt Organization Employer Identification number
print THE C.O.U.Q. FOUNDATION, INC. 13 3996471
Fie by the Number, street, and room or suite no. It a P.O. boot, see instructions.
due date for
Mirth your Delson Associates, 110 East 59th Street
return See City, town or post office, state, and ZIP code. For a foreign address. see Instructions.
matructona
New York, NY 10022
Check type of return to be filed (file a separate application for each return):
O Form 990 0 Form 990-T (corporation) ❑ Form 4720
O Form 990-BL O Form 990-T (sec. 401(a) or 408(a) trust) ❑ Form 5227
O Form 990-EZ O Form 990-T (trust other than above) ID Form 6069
O Form 990-PF O Form 1041-A Form 8870
• The books are in the care of • Harry Beller
Telephone No. P ) 750-9895 FAX No. • 750-2408
• If the organization does not have an office or place of business in the United States, check this box
• If this Is for a Group Return, enter the organization's four digit Group Exemption Number (GEN) if this is
for the whole group, check this box P. 0 . If it is for part of the group, check this box • 0 and attach
a list with the names and EINs of all members the extension will cover.
1 I request an automatic 3-month (6 months for a section 501(c) corporation required to file Form 990-T) extension of time
until October 15 , 20.07 , to filo the exempt organization return for the organization named above. The extension is
for the organization's return fon
ir- 0 calendar year 20 or
March 1 , 20 06 and ending February 28 . gg 07
IP 0 tax year beginning
2 if this tax year is for less than 12 months, check reason: o initial return 0 Final return 0 Change m accounting period
3a if this application Is for Form 990-BL, 990-PF. 990-T, 4720, or 8069. enter the tentative tax,
less any nonrefundable credits. See instructions. 3a 8,000
b if this application is for Form 990-PF or 990-T, enter any refundable credits and estimated tax
payments made. Include any prior year overpayment allowed as a credit. 3b 18,872
c Balance Due. Subtract line 3b from line 3a. Include your payment with this form, or, if required,
deposit with FTD coupon or, if required, by using EFTPS (Electronic Federal Tax Payment
System). See instructions. 30 $ 0
Caution. If you am going to make an electronic fund withdrawal with this Form 8888. see Form 13453-E0 and Form 8879-EO
for payment Instructions.
For Privacy Act end Paperwork Reduction Act Notice, see Instructions. cat No 279160 Non 8888 (Rev. 4-2007)
EFTA00224433
OFFICE COPY
Form Nee Say. 4-2001) Papa 2
• If you are filing for an Additional (not automatic) 3-Month Extension, complete only Part H and check this box . . ► 0
Note. Only complete Part II If you have akoady been granted an automatics 3-month extension on a previously filed Form 8888.
• If you are filing for an Automatic 3-Month Extension, complete only Part I (on page 1).
Uglaill Additional (not automatic) Li-montn Extension or time. T OU mum rile onginar ana one copy.
Type or Name of Exempt Organization , . :...-. ' Employer Identification number
. .”. •:
print THE C.O.U.Q. FOUNDATION, INC. ,..r. - 13 I 3896471
no by the Number, street, and room or sate no. If a P 0 box, two instructions • ..: - , - , For IRS use only
enemata
due date for
rang the
ale 1 ASSOCIATES, 110 EAST 59TH STREET • "., •se: . •
• • i t" •
City, town or post dace, state, and ZIP code Fore kreign address, see Intimations. • :Irv* . li. • ., r.: 4' "- ") ; . ••• 5!
return. Sao f ••• 7•01 • ..... 1. .. , • ••• •• • ..... 1 •
WSW:WM NEW YORK, NY 10022 ...- .. .. .."4 ...-': I • —
Check type of return to be filed (File a separate application for each return):
O Form 990 0 Form 990-PF O Form 1041-A El Form 6069
O Form 990-BL O Form 090-T (sec. 401(a) or 408(e) trust) O Form 4720 O Fomi 8870 •
O Form 990-EZ O Form 9904 (trust other than above) O Form 5227
STOPI Do not complete Part it If you were not already granted an automatic 3-month extension one previously filed Form 8888.
• The books are In the cap of 0- HARRY BALER
Telephone No. lit (....M 760.81185 FAX No. * (._ iff )750.2408
• If the organization does not have an office or place of business in the United States, check this box 0. O
• If this Is for a Group Return, enter the organization's four digit Group Exemption Number (GEN) . If this is
for the whole group, check this box * O . If it is for part of the group, check this box so O 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 JANUARY 15 20 08
6 For calendar year or other tax year beginning MARCH? •20 06 , and ending FEBRUARY 28 20 07
6 If this tax yew Is for less than 12 months, check reason: O Initial return O Final return O Change in accounting period
7 State in detail why you need the extension CERTAIN INFORMATION NECESSARY FOR A COMPLETE AND ACCURATE RETURN
IS NOT YET AVAILABLE
If this application is for Fonn 990-EL, 990-PF, 990-7, 4720, or 8089, enter the tentative tax.
less any nonrefundable credits. See Instructions. 8a $ 8,000
b If this application is for Form 990-PF, 990-1, 4720, or 8089, 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 8888. 8b 18,872
c Balance Due. Subtract Ice 8b from line Ba. Include your payment with this form, or, if required, deposit
with FTD coupon or, if required, by usrig EFTPS (Electronic Federal Tax Payment System). See reductions. 8c $ 0
Signature and Verification
under parolees of palmy. I declare that I have examned rive form, Including accompanyne schedules and statements, and to the heel of my knowtodeo end betel,
d n true, correct, and comproto• and that I am outhunted to prepare has form.
Signature le nikl ► Data I.
Notice to Applicant. (To Be Completed by the IRS)
Wo have approved this application Please attach Nis form to the orgamation's return.
❑ We have not approved tit application However, we have granted a 10-day grace period from the later of the dale shown below or the due
dale of the organization's return (including any prior extensions). This grace period Is considered to be a valid extension of time for elections
otherwise required to be made on a timely return. Please attach this form to the organization's return.
We have not approved this appbcatlon. After considering the reasons stated In item 7, we cannot grant your request for an extension of time
to fie. We are not granting a 10-day grace period
We cannot consider this application because It was filed alter the extended due dale 01 the return for which an extension was requested
Other
Dacia Date
Alternate Mailing Address. Enter the address If you went the copy of this application for an additional 3-month extension
returned to an address different than the one entered above.
Name
Type or Number and street (Include suite, room, or apt. no.) or e P.O. box number
print
City or town, province or state, end country (Including postal or ZIP cods)
Form 8868 (Rev 4-2007)
EFTA00224434
o Pootillo non
•
Department of State
Division of Corporations
Public Access System
Electronic Filing Cover Sheet
Note; Please print this page and use it as a cover sheet. Type the fax audit
number (shown below) on the top and bottom of all pages of the document.
(((1{07000269606 3)))
IIIIIIIIIIIIIIIIIII11111 11113111111111111111
IIIIIII111{11111
IIIII11111
Note: DO NOT hit the REFRESIVRELOAD button on your browser from this
page. Doing so will generate another cover sheet. •
TO;
Division of Corporations
Pax Number (860)617-6381
Prong
Account NAms c C T CORPORATION NYSTSK
Account Number I ICA000000023
Phone a (850)222-1092
Pax NUmbor. : (830)878-3926
FLORIDA PROFTT/NON PROFIT CORPORATION
'The Florida Science Foundation, the.
Certificate of Status
Certified Copy 0
e Count 04
Estimated Charge S70.00
lecironic Filing Menu Corporate Filing Menu Help
t ems Klimaale
https://efile.sunbiz.org/scripts/eftleoNT.exe .111112007
. SZ63L88S8 IV:II Leer/10/II
LO/TB 30Vd WISAS NOlIVN0d600 ID
EFTA00224435
ARTICLES OF JINCORIPORATICIN
OF
1 ' FLORIDA SCIENCE FOUNDATION, INC.
In Compliance with Chanter 617, F.S. (Not for Profit)
FIRST: The rue= of the corporation is The Florida Science Foundation. Inc. (the
"Foundation")
tfECOND: The principal place of business and mailing address of the Foundation
shall be 250 Australian Avenue. Suite 1400, West Palm Beach, Florida 33418,
THIRD: The Foundation is a Not for Profit corporation organized and operated
exclusively fin one or more charitable, religious, literary, scientific and educational purposes
within the meaning of Section 501(e)(3) of the Internal Revenue Code of 7986, as amended (the
"Code"). In liatherence of such purposes, the Fotmdatiori Wilt iiovide financial WM:WC through
grants to oritsei7ations organized for the proposes tiespiTairafti Sided:id 501(e)(3) of the Code,
including those involved with the fields of science and research. Also in furtherance of such
purposes, the Foundation may from time to time establish programs to award scholarship and
research grants to qualified individuals on an objective and non-discriroloatory basis. The
oundatlort intents at all times to qualify and remain qualified as exempt from feriae' income
tax under Section 5010)(3) of the Code.
The Foundation is not formed for end shall not be conducted nor operated for pecutsiary
profit or financial gain, and no part of its assets, income or profit shall be distributed to or inure
to the benefit of any private individual or individuate, provided that nothing herein shall prevent
the Foundation from paying reasonable compensation to any person for services rendered to or
fbr the Foundation in farther-mice of one or more of its purposes.
No substantial part of the activities of the Foundation shall be devoted to (Ferrying on
propammds or otherwise attempting to influence legislation, except to the extent permitted by the
Code whether pursuant to an election under Section 501(h) of the Code or otherwise; and no part
of the activities of the Foundation shall be devoted to participating in or intervening in Ortolan
the pUblishieg or distributing of statements) arty political campaign on behalf of or in opposition
to any candidate for public office.
Vre Corporation shall not engage in or include among its purposes any activities not
permitted to be carried on by a corporation exempt from federal income tax under Section
501(c)(3) of the Code.
No private individual or individuals shall be entitled to share in the distribution of the
Fotiadation's property or assets in the event of the dissolution or vending up of the Foundation,
whether voluntary or involumary. In such event, all of the assets and property of the Foundation
raining after the proper payment of expenses and The set afeetion of all liabilities shall be
91698480S8 IP:IT L001/T0/TT
PO/l0 39Vd MILSAS N0I1V80d802 10
EFTA00224436
distributed in accordance with the Florida Not for Pm£tt Corporation Act, as it may be amended,
to further the not for profit pmposas of the Foundation andtor to such charitable and educational
organizations as shall qtialifyttnder Soother 50I(e)(3) oldie Code.
As long as the Foundation is a private foundation as defined in Section 509(a) of the
Code, Section 617.0835 of the Floridallot for Profit Corporation Act (or any successor provision
thereto) shall bo applicable to the Foundation.
Subject to the foregoing limitations end exclusively in furtherance of the retardation's
charitable, religions, literary, scleatifio and educational !imposes within the remising of Section
501(0(3) of the Code, the Foundation shall have the power to engage in any lawihl activity in
which a corporation organized. in the State of Florida may lawfully engage.
MU& The direction and managemeut of the affiths of the Foundation, and the
control and disposition of its property and funds, shall be invested in the Board of Directors of
the Foundation. The qualification election, tenure, powers and duties of the direct" oft'
Foundation shall be as provided isthe Bylaws of the Foundation. Elections of the directors of
the Foundation noed not be by written. ballot unless feeBylaws oft* Foundation shall so
provide.
ANT* The vetoes and Florida street address of the initial Registered Agent of the
Foundation are CT Corporatism System,,1200 South Pine Island Road, Plantation, Maids
33324.
arra; The tam and address of the Incorporator of the Emulation are Darren K.
ludyke, Esq., 457 Madison Avenue, 4th Floor,New York, New York 10022.
MINIM: The Foundation shalt have perpetual existence.
=Mk The Foundation shall have no members.
?INV:. The Foundation shall have no capital stock.
MTH: Ia fratherance, and not in limitation, of the powers conferred by statute,
the Board of Directors of the Formdadaa„ by an afftroaativo vote of not less than a majority of the
directors of the Board of Directors of the Foundation, is expressly authorized, from time to time,
to make, adopt, alter or repeal the Bylaws and regulations of the Foundation for the orderly
operation of rho Foundation.
RIMMED The Foundation shall intformitr, to the Aillest extent permitted by
applicable law, the directors, officers aid employees of the Foundation. The Foundation may
obtain appropriate liability instannee for the benefit of its officers and directors covering acts or
omissions by such officers and directors.
TWA: flutbaanue cite purposes fir which it is being organized, the
Foundation reserves the right to amend, alter, chttage or repeal any provision contained in these
Articles of Incorporation, in the manner now or hereafter prescribed by statute; =Nig
14:II Lest/lent
c. 'MS5840998
$41SAS NOIDAJO*000 10
40/E0 35Vd
EFTA00224437
howevg, that no amendment, alteration, change, or repeal shall be allowed to authorize the
Board of Directors of the Foundation to manage the property of the Foundation or to conduct the
affairs of the Foundation in any manner or for any purpose contrary to the pro-visions of Sec ion
501(c)(3) of the Code.
'THIRTEENTH: The books of the Foundation may be kept (subject to any applicable
provision of law) outside the State of Florida at such plime or places as may be designated from
time to time by the Board of the Foundation or in the Bylaws of the Foundation.
Mona .Any reference herein to a Section of the Code shall bo deemed to
include tt teftZtee to the corresponding provisions, if any, of any future internal revenue law.
*****i.***/******se***4*******JkkitA*IlitiAraik*O*Atitii***********ItCitirkkiNstrinilk*****
Having been named as registered agent 0 accept service ofprocessfor the above stated
corporation at the place designated be these Articles, t amfamiliar with and accept the
appointment as registered agent and agree to ad be this capacity.
CT CORPORATION SYStEM A5641
•HI:4ThErclar d
j I .( 1
Sign.ature/Regishatil Late
_S.-
t0 - -O1-
SiolettareIncorporator Date
3
• st698Leess tb is 4004HO/it
39Vd W1SAS NOI1V80/1800 10
PO/b0
EFTA00224438