Form 990-PF

OMS No 1545 0052

Return of Private Foundation

or Section 4947(aXl) Nonexempt Charitable Trust Treated as a Private Foundation

2008

H

If exemption apphcation IS pending, check here ~

1 Foreign organizations, check here ~

2 Foreign organizations meeting the 85% test, check 0

here and attach computation ~

If private foundation status was terminated

under section 507(bXl )(A), check here ~ 0

F If the foundation IS In a GO-month termination

under section check here ~

Expenses (The total of amounts In columns (b), (c), and (d) may not necessarily equal the amounts In column (a)

(b) Net Investment Income

(d) Disbursements for charitable purposes (cash basts only)

R E V E N U E

Contributions. gifts. grants. etc. received (at! sch) I-,-,:::-:-="::OL-=~~-=:!....!..-=+..,.,....--F=--:+

2 Ck ~ 0 If the foundn IS not req to at! Sch S 3 Interest on savings and temporary cash Investments

4 DIvidends and I nterest from secunties Sa Gross rents

b Net renlal Income or (loss

6 a Net galn/(loss) from sale of assets not on hne 10 b Gross sales price for ali 14 191 8 6 6

assets on hne 6a -=c..:.J'-=-=-=:..L..;::....::.-=-=·+':-:::...,...-':-:::--;5--;,.-'£f---"'''-''''-'''''---':''-~-;--;~-+...,...55--;

7 Capital gain net Income (from Part IV. line 2)

8 Net short-term capital galll

9 Income modifications

10 a Gross sales less returns and

allowances -,

b Less Cost of

goods sold

c Gross proflt/(loss) (att sch)

11 Other Income (attach schedule)

12
13 Compensation of officers. directors. trustees. etc
14 Other employee salaries and wages
15 Pension plans, employee benefits
A 16a Legal fees (attach schedule) See St 1
~ D b Accounting fees (attach sch) See St 2
M
I c Other prof fees (attach sch) See St 3
t=) N
c...s 0 I 17 Interest
p s
§ E T 18 Taxes (attach schedule) See Stmt 4
R R
~ A A 19 Depreciation (attach
:z: T T sch) and depletion
I I
:::::> N v 20 Occupancy
---, G E 21 Travel, conferences, and meetings
a A E 22 Printing and publications
N x
W D p 23 Other expenses (attach schedule)
Z E
Z N
s 24 Total operating and administrative
-c E
5 expenses. Add lines 13 through 23
(.) 25 Contributions, qifts, grants paid Part XV
en
26 Total expenses and disbursements.
a Excess of revenue over expenses
and disbursements TEEA0504L 09117/08

Form 99O·"F ~ ~

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Form 990-PF (2008) .Io Li e-Pd t t; Foundatl0n - 1 Page 2
IPart II I Balance Sheets Attached schedules and amounts In the description Beginning of year End of year
column should be tor end-ot-year amounts only (a) Book Value (b) Book Value (c) Fair Market Value
(See Instructions)
1 Cash - non-mterest-beannq
2 Savings and temporary cash Investments 268,621. 7 945 717. 7 945 717.
3 Accounts receivable ~ l' .J
----------- -'
Less allowance for doubtful accounts ~
---------- I
4 Pledges receivable ~ -, -j
----------- ~--
Less allowance for doubtful accounts ~
----------
5 Grants receivable
6 Receivables due from officers, directors, trustees, and other
disqualified persons (attach schedule) (see the instructions)
7 Other notes and loans receivable (attach sch) ~ , x i
--- '"
A ------------
S Less allowance for doubtful accounts ~ ----------
S 8 lnventones for sale or use
E 9 Prepaid expenses and deferred charges
T
S 10a Investments - U_S_ and state government
obligations (attach schedule) Statement 6 617,718. 2,003,237. 2,004,429.
b Investments - corporate stock (attach schedule) 373,481.
c Investments - corporate bonds (attach schedule) Statement 7 3,933,889. 2,230,990. 2,221,319.
11 Investments - land, burldmqs, and I:J,;!:; }?!-:' : N~ ". :. ~ il" x ~/U
equipment baSIS ~ , i ~~ :"'j
::'.t.::.... c r~ > : ?
-----------
Less accumulated deprecration
(attach schedule) ~
----------
12 Investments - mortgage loans
13 Investments - other (attach schedule)
14 Land, buildmqs, and equipment baSIS ~ ___________ " .i.J!' A D~ 1 ''!:'h '" ~ , - 4'- - " ',::~~.s:_>_" __ ~j
~"~l.~ t-> r " ~~
Less: accumulated depreciation
(attach schedule) ~
----------
15 Other assets (describe ~ )
16 Total assets (to be compieied-by ailfders = - - - - - - - -
see Instructions Also, see osoe 1, Item I) 5 193 709. 12 179 944. 12 171 465.
L 17 Accounts payable and accrued expenses "Zi,~~~ )::,f
I 18 Grants payable
A ;
B 19 Deferred revenue ,;:
I 20 Loans from officers, directors, trustees, & other disqualified persons
L ~' J~l
I 21 Mortgages and other notes payable (attach schedule) '~ :t t ':
T -~: 1~~~
22 Other liabilities (describe ~ ) "
I ----------------- :' J,;;
E
S 23 Total liabilities (add lines 17 through 22) O. O. ->.
Foundations that follow SFAS 117, check here ~L "
and complete lines 24 through 26 and lines 30 and 31. ;,,,
/
N F 24 Unrestricted ::IJ t~j [.;~~>, "
E U 25 Temporarily restricted [1' '
T N
0 26 Permanently restricted "
e.
A Foundations that do not follow SFAS 117, check here ~[K
S B ;,
SA and complete lines 27 through 31. .
E L 27 Capital stock, trust principal, or current funds t j',
T A ;
S N 28 Paid-In or capital surplus, or land, buildmq, and equipment fund "
C , ,
o E 29 Retamed earnings, accumulated mcome, endowment, or other funds 5,193,709. 12,179,944.
R S 30 Total net assets or fund balances (see the Instructions) 5,193,709. 12,179,944.
31 Total liabilities and net assets/fund balances
(see the Instructions) 5 193 709. 12 179,944. .' I
..m • ~
IPart III I Analysis of Changes in Net Assets or Fund Balances
1 Total net assets or fund balances at beginning of year - Part II, column (a), line 30 (must agree With
end-of-year figure reported on prior year's return) 1 5,193 709.
2 Enter amount from Part I, line 27a 2 6 986 235.
3 Other increases not Included mime 2 (Itemize) ~ 3
-----------------------------
4 Add lines 1, 2, and 3 4 12,179 944.
5 Decreases not Included In line 2 (Itemize) ~ 5
6 Total net assets or fund balances at end of yea-; (i;;e "4 -;;,~~ Ir~ 5)--- P~rt ii: ~oIu;;;; (b)~I;;:;; 30 - - - - - 6 12,179 944. 20 5 76706

BAA

TEEA0302L 09117/08

Form 990-PF (2008)

- -- - - - - ----------------

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Form 990·PF (2008) Jolie-Pitt Foundation 20-5176706 Page 3
I Part IV 1 Capital Gains and Losses for Tax on Investment Income
(a) List and describe the klnd(s) of property sold (e g , real estate, (b) How acqinred (e) Date acquired (d) Date sold
2-story brick warehouse, or common stock, 200 shares MLC Company) P - Purchase (month, day, year) (month _ day _ year)
D - Donation
1a PUblicly-traded securities P Various Various
b
e
d
e
(e) Gross sales price (I) Depreciation allowed (g) Cost or other basts (h) Gain or (loss)
(or allowable) plus expense of sale (e) plus (I) minus (g)
a 14 191 866. 14 181 676. 10 190.
b
e
d
e
Complete only for assets showino cam In column (h) and owned by the foundation on 12/31/69 (I) Gains (Column (h)
(i) Fair Market Value (j) Adjusted baSIS (k) Excess of column (I) gam minus column (k), but not less
as of 12/31/69 as of 12/31169 over column (j), If any than -0-) or Losses (from column (h»
a 10 190.
b
e
d
e
2 Capital gain net Income or (net capital loss). {If gain, also enter In Part I, line 7 }
If (loss), enter -0- In Part I, line 7 2 10,190.
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 the mstructrons) If (loss), enter -0- } o.
In Part I, line a 3
I Part V I Qualification Under Section 4940(e) for Reduced Tax on Net Investment Income (For optronal use by domestic private foundations subject to the section 494O(a) tax on net Investment mcorne.)

If section 4940(d)(2) applies, leave thrs part blank

Was the foundation liable for the sectron 4942 tax on the distributable amount of any year In the base period? If 'Yes,' the foundation does not qualify under section 494O(e) Do not complete thrs part

DYes

[R] No

1 E f

nter the appropriate amount In each column or each year; see the instructions before making any entries
(a) (b) (e) (d)
Base period years Adjusted qualifying distributions Net value of Distribution ratio
Calendar year (or tax year nonchantable-use assets (column (b) divided by column (c)
beginning In)
2007 3 630 748. 6 827,344_ 0.531795
2006 2 494 834. 2 501 918. 0.997169
2005
2004
2003
2 Total of line 1, column (d) 2 1.528964
3 Average distribution ratio for the 5-year base period - divrde the total on line 2 by 5, or by the
number of years the foundation has been In existence If less than 5 years 3 0_764482
4 Enter the net value of nonchantable-use assets for 2008 from Part X, line 5 4 8 281,502.
5 Multiply line 4 by line 3 5 6 331,059.
6 Enter 1 % of net Investment Income (1 % of Part I, line 27b) 6 2 752.
7 Add lines 5 and 6 7 6 333,811.
s Enter qualifying drstrrbutrons from Part XII, line 4 S 6 714,545_ If line 8 IS 'equal to or greater than line 7, check the box In Part VI, line 1 b, and complete that part usmq a 1 % tax rate See the Part VI instructions

BAA

Form 990·PF (2008)

TEEA0303L 09118108

-- ------ - --------------------------

Form 990-PF(2008) 0 le- ltt oun atl0n - Page 4
IPart VI I Excise Tax Based on Investment Income lSection 4940(a), 4940(b),4940(e), or 4948- see the instructions)
1 a Exempt operating foundations described In section 4940(dX2), check here ~ U and enter 'N/A' on line 1 } , " ~-~
Date of ruling letter ________ (attach copy of ruling letter if necessary - see instructions)
b Domestic foundations that meet the section 4940(e) requirements In Part V, 1 2 752.
check here ~ [R] and enter 1 % of Part I, line 27b ,'0/ +;
c All other domestic foundations enter 2% of line 27b. Exempt foreign orqamzatrons enter 4% of Part I, line 12, column (b) '?t: . " .2
2 Tax under section 511 (domestic section 4947(a)(1) trusts and taxable ... ~ : ,
~
foundations only Others enter -0-) 2 O.
3 Add lines 1 and 2 3 2 752.
4 Subtitle A (Income) tax (domestic section 4947(a)(1) trusts and taxable foundations only Others enter -0-) 4 O.
5 Tax based on investment income.Subtract line 4 from line 3. If zero or less, enter -0- 5 2 752.
6 Credits/Payments ~'\ > ']
a 2008 estimated tax pmts and 2007 overpayment credited to 2008 6a 4,500. 0',
."
b Exempt foreign organizations - tax withheld at source 6b #;'!'" , '1
c Tax paid with application for extension of time to file (Form 8868) 6c
"
d Backup withholding erroneously withheld 6d
7 Total credits and payments Add lines 6a through 6d 7 4 500.
a Enter any penalty for underpayment of estimated tax Check here [R] If Form 2220 IS attached a
9 Tax due. If the total of lines 5 and 8 IS more than line 7, enter amount owed ~ 9 O.
10 Overpayment If line 7 IS more than the total of lines 5 and 8, enter the amount overpaid ~ 10 1 748.
11 Enter the amount of line 10 to be: Credited to 2009 estimated tax. ~ 1 748.1 Refunded ~ 11 O.
IRart VII-A I Statements Regarding Activities
1a DUring the tax year, did the foundation attempt to Influence any national, state, or local legislation or did It Yes No
participate or Intervene In any political campaign? 1a X
b Did It spend more than $100 dUrln~ the year (either directly or indirectly) for political purposes X
(see the Instructions for definition). 1b
If the answer IS 'Yes' to 1 a or 1 b, attach a detailed aescnption of the activities and copies of any matenals pub/tshed :~. 14j.,~
or dlstnbuted by the foundation In connection with the activities b il~· ~*
c Did the foundation file Form 1120-POL for this year? 1c X
d Enter the amount (If any) of tax on political expenditures (section 4955) Imposed dunnq the year , +;It~, ~
(1) On the foundation ~$ O. (2) On foundation managers ~$ O.
e Enter the reimbursement (If any) paid by the foundation dunnq the year for political expenditure tax Imposed on p , '
foundation managers ~$ O.
2 Has the foundation engaged In any activities that have not previously been reported to the IRS? 2 X
If 'Yes, ' attach a detailed descnptton of the activities .,' ~TI
3 Has the foundation made any changes, not previously reported to the IRS, In ItS governing Instrument, articles t... __ ~-
of Incorporation, or bylaws, or other Similar Instruments? If 'Yes, ' attach a conformed copy of the changes 3 X
4a Did the foundation have unrelated business gross Income of $1,000 or more durmq the year? 4a X
b If 'Yes,' has It filed a tax return on Form 990-T for thrs year? 4b N A
5 Was there a hquidanon, terrmnanon, dissolution, or substantial contraction dUring the year? See Statement 8 5 X
If 'Yes, ' attach the statement requued by General instruction T tll
6 Are the requirements of section 508(e) (relating to sections 4941 through 4945) satisfied either: o't if
• By language In the governing Instrument, or
,
• By state legislation that effectively amends the governing Instrument so that no mandatory directions that conflict X ]
with the state law remain In the governing Instrument? 6
7 Did the foundation have at least $5,000 In assets at any lime dunnq the year? If 'Yes,' complete Part II, column (c), and Part XV 7 X
Ba Enter the states to which the foundation reports or with which It IS registered (see the instructions) ~ J ~~
CA DE
b If the answer IS 'Yes' to line 7, has the foundation furnished a copy of Form 990-PF to the Attorney General --
(or desiqnate) of each state as required by General Instruction G1 If 'No, ' attach explanation ab X
9 Is the foundation claiming status as a private operating foundation within the meaning of section 4942CJ)(3) or 4942CJ)(5) ~I
for calendar year 2008 or the taxable year beginning In 2008 (see Instructions for Part XIV)? If 'Yes,' complete Part XIV 9 X
10 Did any persons become substantial contributors dunnq the tax year? If 'Yes, ' attach a schedule /tstlng their names
and addresses 10 X J I'

p'

F

d

20 5176706

BAA

Form 990-PF (2008)

ITEA0304L 0911 BlOB

Form 990-PF (2008) Jolie-Pitt Foundation 20-5176706 Page 5
IPart VII-A I Statements Regarding Activities Contmued
11 At any time dunnq the year, did the foundation, directly or Indirectly, own a controlled entity
within the meaning of section 512(b)(13)? If 'Yes', attach schedule (see Instructions) 11 X
12 Did the foundation acquire a direct or Indirect Interest In any applicable Insurance contract before
August 17, 2008' 12 X
13 Did the foundation comply with the public inspection requirements for Its annual returns and exemption application' 13 X WebSite address

~~L~ _

14 The books are In care of ~ J'.2~n_dE t:loll_ ~O.ll!:~e_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Telephone no ~ Jl.!) Q::_B] ~::_11 ~!. _

Located at ~ 501 Silverside Road, Ste 123 Wilminq.,.ton DE ZIP + 4 ~ 19B09-1377

15 Section 4947(a)(1) ~;;-e;e;~t ~h~;rt.;bi; tru~i; hil;;-g-F~r;;:; 990-PFI;;- ~~ cl Fo-;:;;;041-=- Check here - - - - - - - -ii/A - -;- IT'"

~115 I

and enter the amount of tax-exempt Interest received or accrued dunnq the year

N/A

IF?art,VII-B I Statements Regarding Activities for Which Form 4720 May Be Required

File Fonn 4720 if any item is checked in the 'Yes' column, unless an exception applies. 1 a DUring the year did the foundation (either directly or Indirectly):

(1) Engage In the sale or exchange, or leasmq of property with a disqualified person'

(2) Borrow money from, lend money to, or otherwise extend credit to (or accept It from) a

disqualified person'

(3) Furnish goods, services, or tacrlrtres to (or accept them from) a disqualified person' (4) Pay compensation to, or payor reimburse the expenses of, a disqualified person'

(5) Transfer any Income or assets to a disqualified person (or make any of either available for the benefit or use of a disqualified person)?

DYes ooNo

§yes

Yes Yes

~NO

No No

DYes ooNO

(6) Agree to pay money or property to a government offtcial? (Exception, Check 'No' If the foundation agreed to make a grant to or to employ the otncral for a period after termination of government service, If terminating Within 90 days)

DYes ooNo

b If any answer IS 'Yes' to 1a(1)-(6), did any of the acts fall to qualify under the exceptions descnbed In Regulations section 534941 (d)-3 or In a current notice regarding disaster assistance (see the Instructions)'

Organizations relyrnq on a current notice regarding disaster assistance check here

c Did the foundation engage In a prior year In any of the acts descnbed In l a, other than excepted acts, that were not corrected before the first day of the tax year beginning In 2008'

2 Taxes on failure to distribute Income (section 4942) (does not apply for years the foundation was a private operating foundation defined In section 4942CJ)(3) or 4942CJ)(5)):

a At the end of tax year 2008, did the foundation have any undistributed Income (lines 6d and 6e, Part XIII) for tax year(s) beginning before 2008'

If 'Yes,' list the years ~ 20_ _ ,20_ _ ,20_ _ ,20 __

DYes ooNo

b Are there any years listed In 2a for which the foundation IS not applymq the provrsions of section 4942(a)(2) (relating to Incorrect valuation of assets) to the year's undistributed Income? (If applyrnq section 4942(a)(2) to all years listed, answer No' and attach statement - see the mstructions.)

c If the provrsions of section 4942(a)(2) are being applied to any of the years listed In 2a, list the years here ~ 20_ _ ,20_ _ ,20_ _ ,20 __

3a Did the foundation hold more than a 2% direct or Indirect Interest In any business enterprise at any time durrnq the year?

DYes 00 No

b If 'Yes: did It have excess business holdings In 2008 as a result of (1) any purchase by the foundation or disqualified persons after May 26, 1969; (2) the lapse of the 5-year period (or longer period approved by the Commissioner under section 4943(c)(7)) to dispose of holdings acqurred by gift or bequest, or (3) the lapse of the 1 0-, 15-, or 20-year first phase holding period? (Use Schedule C, Form 4720, to determine" the foundation had excess bustness holdings In 2008.)

4a Did the foundation Invest dunnq the year any amount In a manner that would Jeopardize ItS charitable purposes'

b Did the foundation make any Investment In a prior year (but after December 31, 1969) that couJd Jeopardize ItS charrtable purpose that had not been removed from Jeopardy before the first day of the tax year beginning In 2008'

BAA

TEEA0305L 01/02109

Yes No

3b N A
4a X
" ) l' '"
fY '* if :t
4b X
Form 990-PF (2008) Form 99D-PF (2008) Jolie-Pitt Foundation 20-5176706

IPart VII·B I Statements Reqardinq Activities for Which Form 4720 May Be Required (contmued)

P<!\!e 6
; ·-1
«
.
> "
~ '0 ' .
-0:t
"* ." " 5a DUring the year did the foundation payor Incur any amount to'

(1) Carry on propaganda, or otherwise attempt to Influence legislation (section 4945(e»)7

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

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

(4) Provide a grant to an organization other than a charitable, etc, organization described In section 509(a)(l), (2). or (3), or section 4940(d)(2)? (see Instructions)

(5) Provide for any purpose other than rehqious. charitable, SCientific, literary, or educational purposes, or for the prevention of cruelty to children or animals?

Dves ~No
Bves ~NO
Ves No
Dves ~NO
Dves ~No b If any answer IS 'Yes' to 5a(l)-(5). did any of the transactions fall to qualify under the exceptions described In Regulations section 53 4945 or In a current notice regarding disaster assistance (see Instructions)?

Organizations relyrnq on a current notice regarding disaster assistance check here

NfA Dye:~NO . ~ , .. ,; ~

'it ,;, . t ".~

6a Old the foundation, dunnq the year, receive any funds, directly or Indirectly, to pay premiums 8,' oJ

on a personal benefit contract' D Ves ~ No :.L~'" ~

b Old the foundation, dunnq the year, pay premiums, directly or Indirectly, on a personal benefit contract? 6b X

7a :::~y~~~:e~~~~;~~~t~a~b~e~~,O:~: ~::%::~tlon a party to a prohibited tax shelter transaction? D Ves ~ No ~<h ~ ~ $-,< ~

b If yes, did the foundation receive any proceeds or have any net Income attributable to the transaction? 7b N A

c If the answer IS 'Yes' to question 5a(4), does the foundation claim exemption from the tax because It maintained expenditure responsibility for the grant?

If 'Yes, ' attach the statement reauued by Requtetions section 534945-5(d)

I p~<rt ~1It..< I Information About Officers, Directors, Trustees, Foundation Managers, Highly Paid Employees, and Contractors

1 List all officers, directors, trustees, foundation managers and their compensation (see instructions),
(b) Title and average (c) Compensation (d) Contributions to (e) Expense account,
(a) Name and address hours per week (If not paid, enter -D-) employee benefit other allowances
devoted to POSition plans and deferred
compensation
_~r~gY~1t ________________ Co-P/Dir/Sec o. o. O.
501 Silvers ide Road, Ste 123 5 hrs/wk
Wilmington DE 19809-1377
_~~~~i~~Y~1i~ ____________ Co-Pres/Dir O. O. O.
501 Silvers ide Road, Ste 123 5 hrs/wk
Wilmington DE 19809-1377
------------------------
------------------------
2 Compensation of five highest-paid employees (other than those included on line 1- see instructions), If none enter 'NONE:
(a) Name and address of each employee (b) Title and average (c) Compensation (d) Contributions to (e) Expense account,
paid more than $50,000 hours per week employee benefit other allowances
devoted to posrnon plans and deferred
compensation
~Qrr~ ____________________
------------------------
------------------------
------------------------
------------------------
Total number of other employees paid over $50,000 .. 0 BAA

TEEA0306L 09/18108

Form 99D-PF (2008)

3 Five highest-paid independent contractors for professional services- (see instructions). If none, enter 'NONE

Pa e 7

(a) Name and address of each person paid more than $50,000 (b) Type of service (c) Compensation
_G1:Q.~1: ]_h1-J:.'!...n!!!~..o.py _G.!'Q1:!P2 _~L.s:.!. _f.!t~ _Mj1:~s_tQ~e_ ~Q.IJ oration
1500 Fourth Ave, Ste 600
Seattle, WA 98101 Grant management 224,564.
--------------------------------------
--------------------------------------
--------------------------------------
--------------------------------------
Total number of others receiving over $50,000 for professional services ~ 0
, . I Part IX-A I Summary of Direct Charitable Activities

List the foundation's four largest direct charitable activities during the tax year. Include relevant statistical information such as the number of organizations and other beneficiaries served, conferences convened, research papers produced, etc

Expenses

~L~ _

2

3

4

I Part IX-8 I Summary of Program-Related Investments (see instructions)

, ~L~ _

Amount

Descnbe the two largest proqrarn-related Investments made by the foundation dunng the tax year on lines 1 and 2.

2

All other program-related Investments See Instructions 3

BAA

Form 990-PF (2008)

Total, Add lines 1 through 3

TEEA0307L 09/18108

~ O.

Form 990-PF 2008 Jolie-Pitt Foundation 20-5176706 Pa e 8

Pa X Minimum Investment Return (All domestic foundations must complete this part. Foreign foundations,

see rnstructions.)

1 Fair market value of assets not used (or held for use) directly In carrying out chantable, etc. purposes _1
a Average monthly fair market value of secunties 1a 5 189 223.
b Average of monthly cash balances 1b 3,218,393.
c Fair market value of all other assets (see Instructions) 1c
d Total (add lines 1 a. b. and c) 1d 8 407,616.
e Reduction claimed for blockage or other factors reported on lines la and lc I 1 e I
(attach detailed explanation) O.
2 Acquisitron Indebtedness applicable to line 1 assets 2 O.
3 Subtract line 2 from line 1 d 3 8 407 616.
4 Cash deemed held for chantable actrvitres. Enter 1-112% of line 3
(for greater amount. see Instructions) 4 126,114.
5 Net value of noncharitable-use assets.Subtract line 4 from line 3. Enter here and on Part V, line 4 5 8,281 502.
6 Minimum investment return. Enter 5% of line 5 6 414,075.
I:ParfwXI I Distributable Amount (see instructions) (Section 4942{J)(3) and (J)(5) pnvate operating foundations and do not com

Minimum Investment return from Part X, line 6

2a Tax on Investment Income for 2008 from Part VI, line 5

b Income tax for 2008. (This does not Include the tax from Part VI ) c Add lines 2a and 2b

3 Distnbutable amount before adjustments Subtract line 2c from line 1 4 Recovenes of amounts treated as qualifying drstnbutrons

5 Add lines 3 and 4

6 Deduction from drstnbutable amount (see Instructions)

7 Distributable amount as ad usted Subtract line 6 from line 5_ Enter here and on Part XIII, line 1

2 752.

414 075.
2c 2 752.
3 411,323.
4
5 411 323.
6
7 411,323. I PartlXWI Qualifying Distributions (see instructions)

'''Ii
1 Amounts paid (Including administrative expenses) to accomplish chantable, etc, purposes -----'
a Expenses, contnbutrons, giftS, etc - total from Part I, column (d), line 26. 1a 6,714 545.
b Program-related Investments - total from Part IX-S 1b
2 Amounts paid to acquire assets used (or held for use) directly In carrying out chantable, etc, purposes 2
"
3 Amounts set aside for specific charitable projects that satisfy the. .----'1.
a SUitability test (prior IRS approval required) 3a
b Cash distribution test (attach the required schedule) 3b
4 Qualifying distributions. Add lines 1 a through 3b Enter here and on Part V, line 8, and Part XIII, line 4 4 6 714 545.
5 Foundations that qualify under section 494D(e) for the reduced rate of tax on net Investment Income
Enter 1 % of Part I, line 27b (see Instructions) 5 2 752.
6 Adjusted qualifying distributions. Subtract line 5 from line 4 6 6,711,793. Note: The amount on line 6 will be used In Part V, column (b), In subsequent years when calculating whether the foundation qualifies for the section 4940(e) reduction of tax In those years.

BAA

Form 990-PF (2008)

TEEA0308L 01102/09

20-5176706

Form 990-PF (2008) Jolie-Pitt Foundation

Page 9

I Part Xliii Undistributed Income (see Instructions)

Distributable amount for 2008 from Part XI, line 7

2 Undistributed mcorne, If any, as of the end of 2007' a Enter amount for 2007 only

b Total for prior years 20 , 20 , 20

3 Excess distributions carryover If any, to 2008: a From 2003

b From 2004 c From 2005 d From 2006 e From 2007

f Total of lines 3a through e 4 Qualifying distributions for 2008 from Part

XII,line4 ~ $ 6,714,545.

a Applied to 2007, but not more than line 2a

b Applied to undistributed Income of prior years (Election required - see Instructions)

c Treated as distributions out of corpus (Election required - see Instructions)

d Applied to 2008 distributable amount

e Remaining amount distributed out of corpus 5 Excess distributions carryover applied to 2008

(If an amount appears In column (d), the same amount must be shown In column (a) )

(a) Corpus

(b)

Years prior to 2007

(d) 2008

(c) 2007

6 Enter the net total of each column as indicated below:

a Corpus Add hnes 3f, 4c, and 4e Subtract Ime 5

b Prior years' undistributed Income. Subtract line 4b from line 2b

c Enter the amount of prior years' undistributed Income for which a notice of denciency has been Issued, or on which the section 4942(a) tax has been previously assessed

d Subtract line 6c from line 6b Taxable amount - see Instructions

e Undistributed mcome for 2007. Subtract Ime 4a from Ime 2a Taxable amount - see mstruetrons

f Undistributed Income for 2008. Subtract lines 4d and 5 from line 1 Thrs amount must be distributed In 2009

7 Amounts treated as distributions out of corpus to satisfy requirements Imposed by section 170(b)(1)(F) or 4942(g)(3) (see Instructions)

8 Excess distributions carryover from 2003 not applied on line 5 or line 7 (see Instructions)

9 Excess distributions carryover to 2009.

Subtract lines 7 and 8 from line 6a

'0 Analysis of line 9

a Excess from 2004 b Excess from 2005 c Excess from 2006. d Excess from 2007 e Excess from.200a

o.

o.

BAA

Form 990-PF (2008)

TEEA0309L 09/19/08

Form 990·PF (2008) o l.e- l.tt oun atl.On - Page 10
IPart<XIV I Private Operating Foundations (see Instructions and Part VII·A Question 9) N/A
1 a If the foundation has received a ruling or determination letter that It IS a pnvate operating foundation, and the ruling ~
IS effective for 2008, enter the date of the ruling
b Check box to Indicate whether the foundation IS a pnvate operating foundation descnbed In section n 4942<1)(3) or I 4942{J)(5)
2a Enter the lesser of the adjusted net Tax year Pnor 3 years
Income from Part I or the minimum (a) 2008 (b) 2007 (c) 2006 (d) 2005 (e) Total
Investment return from Part X for
each year listed
b 85% of line 2a
c Qualifying drstnbuuons from Part XII,
line 4 for each year listed
d Amounts Included In line 2c not used directly
for active conduct of exempt acnvmes
e Qualifying distnbutrons 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 4942{J)(3)(B)(I}
b 'Endowment' alternative test - enter 213 of
minimum Investment return shown m Part X,
lme 6 for each year listed
c 'Support' alternative test - enter.
(1) Total support other than gross
Investment Income (Interest,
drvidends. rents, payments
on secunnes loans (section
512(a)(5», or royalties)
(2) Support from general public and 5 or
more exempt oruanzanons as provided
m section 4942(j)(3)(B)(III)
(3) Largest amount of support from
an exempt organization
(4) Gross Investment Income
IPart XV I Supplementary Information (Complete this part o.nly if the organization had $5,000 or more in J l'

P'

F

d

20 5176706

assets at any time during the year - see lnstructions.)

Information Regarding Foundation Managers:

a List any managers of the foundation who have contnbuted more than 2% of the total contnbutions received by the foundation before the close of any tax year (but only If they have contnbuted more than $5,000) (See section 507(d)(2) )

See Statement 9

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

None

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

Check here ! [R] If the foundation only makes contnbutrons to preselected chantable organizations and does not accept unsolrcrted requests for funds If the foundation makes giftS, grants, etc, (see instructions) to Individuals or organizations under other condmons, 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 matenals they should Include'

c Any subrrnssron deadlines

d Any restnctrons or limitations on awards, such as by geographical areas, chantable fields, kinds of Institutions, or other factors

BAA

TEEA031 OL 09119/08

Form 990·PF (2008)

20-5176706

Pa e"

rants an ontn utions al unng t e ear or ipprove or ure ayment
Recrpient If recrpient IS an individual, Foundation
show any relanonstnp to Purpose of grant or
any foundation manager or status of contnbution Amount
Name and address (home or business) substantial contnbutor reciprent
a PaId dunng the year
See attachment N/A Public See attachment 6,435,278.
Total ~ 3a 6 435 278.
b Approved for future payment
Total ~ 3b d f Fut P

BAA

TEEA050 1 L 09/19108

Form 990-PF (2008)

Form 990-PF (2008) Jolie-Pi tt Foundation

20-5176706

Page 12

IPart XVI-A I Analysis of Income-Producing Activities

Enter gross amounts unless otherwise mdrcated. Unrelated business Income Excluded by section 512, 513, or 514
(a) (b) (c) (d) (e)
Business Amount Exclu- Amount Related or exempt
code sion function Income
1 Program service revenue- code (see the instructions)
a
b
c
d
e
f
9 Fees and contracts from government agencies
2 Membership dues and assessments
3 Interest on savings and temporary cash Investments
4 DIvidends and Interest from securities 14 272,794.
-;,( n,' "F ';::: ~ , " w ' :.;~<~ : - I
5 Net rental Income or (loss) from real estate. ' t -er
a Debt-financed property
b Not debt-financed property
6 Net rental Income or (loss) from personal property
7 Other Investment Income
8 Gain or (loss) from sales of assets other than Inventory 18 10,190.
9 Net Income or (loss) from special events
10 Gross profit or (loss) from sales of Inventory
11 Other revenue tt:,J:' , '~ ,:r'0 "',,~t fT ~ ') - .. 5-1
a
b
c
d
e
12 Subtotal Add columns (b), (d), and (e) \\ 282,984. 13 Total. Add line 12, columns (b), (d), and (e)

(See worksheet In the mstructions for line 13 to verify calculations )

13

282,984.

IPart ~I-B I Relationship of Activities to the Accomplishment of Exempt Purposes

,
Line No. Explain below how each activity for which Income IS reported In column (e) of Part XVI-A contributed Importantly to the
,. accomplishment of the foundation's exempt purposes (other than by providing funds for such purposes) (See the mstructrons )
N/A BAA

TEEA0502L 09119/08

Form 990·PF (2008)

- ---- ----------

L!....=~=:!..__1lnformation Regarding Transfers To and Transactions and Relationships With Noncharitable Exempt Organizations

Jolie-Pitt Foundation

20-5176706

Pa e 13

Yes No
1 Did the organization directly or Indirectly engage In any of the following with any other organization J
described In section 501 (c) of the Code (other than section 501 (c) (3) organizations) or m section 527, if
relating to political orqaruzatrons?
a Transfers from the reporting foundation to a nonchantable exempt organization of -----
(1) Cash 1 a_(1) X
(2) Other assets. 1 a (2) X
b Other transactions: --, .1" ,,*J
(1) Sales of assets to a nonchantable exempt organization 1b(1) X
(2) Purchases of assets from a nonchantable exempt orqaruzatron 1 b (2) X
(3) Rental of facrlrtres. equrprnent, or other assets 1 b (3) X
(4) Reimbursement arrangements 1 b(4) X
(5) Loans or loan guarantees 1 b (5) X
(6) Performance of services or membership or fundrarsmq sohcrtatrons 1b(6) X
e Shanng of facrhtres, equipment. mailing lists, other assets, or paid employees. 1e X d If the answer to any of the above IS 'Yes: complete the followmq schedule. Column (b) should always show the fair market value of the goods, other assets, or services given by the reporting foundation. If the foundation received less than fair market value In

any transaction or shanng arrangement, show In column (d) the value of the goods, other assets, or services received
. (a) Line no lb) Amount Involved (e) Name of nonchantable exempt orqarazanon (d) Descnption of transfers transactions, and shanng arrangements
N/A 2a Is the foundation directly or Indirectly affiliated With, or related to, one or more tax-exempt organizations descnbed In section 501 (c) of the Code (other than section 501 (c) (3» or In section 5277

b If 'Yes: complete the tollowmo schedule.

(a) Name of organization

(b) Type of organization

(e) Descnptron of relatronshrp

N/A

Under penailies of r,errar:tElare tha:~ve examined tms ~~IUdlng accomran!c,ng schedules and statements. and to the best of my knowledge and belief. It IS true. correct. and

complete Declara 10.,. arer (oth t n taxJpayer or fl w; ~ased on al In ormation of which preparer ha: ;ny kn;ledge

S ~ \,~...'" Cli I 5/18 /()9 ~ & -flt€:~dif?£l12

~ Signature of officer or trustee ~ Date f I

N If' l • - fl., 1Qi'te

~R Paid ~~e"pa':~~~s ~ ~(l.~~.Ir:: JJ.~ ~T 0 6 _

Pre- :......J-

E parer's Use Only

Title

Firm's name (or ..::F':-O::.,u=.:n:.=d:,:a::,t;:=i"'0c=:n:.......;S=o-=u:..:r:.cc::.e:::::...- ..:...... __ -t..::E:::..IN,--_~ _

yours If selt- ~ W 1 .

~~Jr~t:~j,d 55 al 5 Dn.ve

ZIP code Fairfield, CT 06824

Check If self employed

nlpreparer.s Identifying number (See Signature In the mstrs)

~

Phone no

~ (800)

839-1754

BAA

Form 990-PF (2008)

TEEA0503L 01102109

------ --- ---------

Departmenl of Ihe Treasury Internal Revenue Servrce

OMS No 1545 0047

Schedule of Contributors

• Attach to Form 990, 990-EZ and 990-PF • See separate instructions.

2008

Schedule B (Form 990, 990-EZ, or 990-PF)

Name of the organozat,on Jolie-Pi tt Foundation

Employer Identification number

20-5176706

Organization type (check one) Filers of:

Form 990 or 990·EZ

Section:

§ 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

Check If your organization IS covered by the General Rule or a Special Rule. (Note: Only a section 501 (c) (7) , (8), or (10) organization can check boxes for both the General Rule and a Special Rule See Instructions)

General Rule -

[R] For organizations filing Form 990, 990·EZ, or 990·PF that received, durrnq the year, $5,000 or more (In money or property) from anyone contributor (Complete Parts I and II )

Special Rules -

o For a section 501 (c) (3) organization filing Form 990, or Form 990·EZ, that met the 33·113% support test of the regulations under sections 509(a)(1 )/170(b)(1 )(A) (VI) and received from anyone contributor, dunnq the year, a contribution of the greater of (1) $5,000 or (2) 2% of the amount on Form 990, Part VIII, line 1 h or 2% of the amount on Form 990·EZ, line 1. Complete Parts I and II

DFor a section 501 (c) (7) , (8), or (10) organization filing Form 990, or Form 990·EZ, that received from anyone contributor, dunnq the year, aggregate contributions or bequests of more than $1,000 for use exclusively for religious, charitable, screntmc, literary, or educational purposes, or the prevention of cruelty to children or animals Complete Parts I, II, and III

o For a section 501 (c) (7) , (8), or (10) organization filing Form 990, or Form 990·EZ, that received from anyone contributor, dunnq the year, some contributions for use exclusively for religious, charitable, etc, purposes, but these contnbutrons did not aggregate to more than $1,000 (If this box IS checked, enter here the total contributions that were received dunng the year for an exclusively religious, chantable, etc, purpose. Do not complete any of the Parts unless the General Rule applies to this organization because It received nonexclusively

religious, chantable, etc, contnbutions of $5,000 or more dunng the year.) ~ $

------------------

Caution: Organizations that are not covered by the General Rule and/or the Special Rules do not file Schedule B (Form 990, 990·EZ, or 990·PF) but they must answer 'No' on Part IV, line 2 of their Form 990, or check the box In the heading of their Form 990·EZ, or on line 2 of their Form 990·PF, to certify that they do not meet the filing requirements of Schedule B (Form 990, 990·EZ, or 990·PF).

BAA For Privacy Act and Paperwork Reduction Act Notice, see the Instructions Schedule B (Form 990, 990·EZ, or 990·PF) (2008)

for Form 990. These instructions will be issued separately.

TEEA0701L 12118108

Schedule B Form 990, 990·EZ, or 990·P

of 1

of Part I

Name of organization

Jo1ie-Pitt Foundation

20-5176706

I Part! 'I Contributors (see instructions)

(a) (b) (c) (d)
Number Name, address, and ZIP + 4 Aggregate Type of contribution
contributions
1 ~q~ll~~~Q~i~ ___________________________ Person ~
Payroll
_cLQ _C.h~mE~ -Pl!:<!. E!:~_ ~ _T~~~l~f ______________ $ ___ .JiL!6~L~3~..!. Noncash
LQ~_~q~1~~L~~3~Q~~ _____________________ (Complete Part II If there
IS a noncash contribution)
(a) (b) (c) (d)
Number Name, address, and ZIP + 4 Aggregate Type of contnbution
contributions
2 Potter Inc. Person ~
-- -------------------------------------
Payroll
91QQ. !J!.~s.h!.~e_~~v.Q. ________________________ $ ___ .JiL~51L ~5.Ji..!. Noncash
~~y~rly~ll~~-~-~~~~-------------------- (Complete Part II If there
IS a noncash contnbutron.)
(a) (b) (c) (d)
Number Name, address, and ZIP + 4 Aggregate Type of contribution
contributions
3 Robert Offer Person ~
-- ~-------------------------------------
Payroll
~~Q~!J!.~.h!.~~~~v.Q.------------------------ $ ______ l.!>L~Oil.!. Noncash
~~y~lY~ll~~-~~~~21Q-------------------- (Complete Part II If there
IS a noncash contribution)
(a) (b) (c) (d)
Number Name, address, and ZIP + 4 Aggregate Type of contribution
contributions
r------------------------------------- Person §
--
Payroll
r------------------------------------- $_---------- Noncash
(Complete Part II If there
r------------------------------------- IS a noncash contnbutron.)
(a) (b) (c) (d)
Number Name, address, and ZIP + 4 Aggregate Type of contribution
contributions
r------------------------------------- Person §
--
Payroll
~------------------------------------- $_---------- Noncash
(Complete Part II If there
-------------------------------------- IS a noncash contribution)
(a) (b) (c) (d)
Number Name, address, and ZIP + 4 Aggregate Type of contribution
contributions
-------------------------------------- Person §
--
Payroll
-------------------------------------- $_---------- Noncash
(Complete Part II If there-
------------------------------------- IS a noncash contribution) BAA

TEEA0702L 08105/08

Schedule B (Form 990, 990·EZ, or 990·PF) (2008)

2008 Federal Statements Page 1
Jolie-Pitt Foundation
20-5176706
Statement 1
Form 990-PF, Part I, Line 16a
Legal Fees
(a) (b) Net (c) (d)
Expenses Investment Adjusted Charitable
Pf:I: BQoks IncQme Nf:t In!::Qme Pu;rgose~
Formation of LLC $ 5,165. $ 5,165.
General governance and counseling 151411. 151411.
Total $ 201576. $ o. $ 201576.

Statement 2
Form 990-PF, Part I, Line 16b
Accounting Fees
(a) (b) Net (c) (d)
Expenses Investment Adjusted Charitable
ge:r.: BQoks IncQme Net In!::Qmf: :EYI:go~es
Audit services $ 31850. $ 31850.
Total $ 31850. $ o. $ 31850.

Statement 3
Form 990-PF, Part I, Line 16c
Other Professional Fees
(a) (b) Net (c) (d)
Expenses Investment Adjusted Charitable
ge;r BQQks Income Net In~Qme ~lJ,;rgo~es
Grant Program Management $ 224,564. $ 224,564.
Investment management services 71763. $ 71763.
Total $ 2321327. $ 71763. $ 2241564.

Statement 4
Form 990-PF, Part I, Line 18
Taxes
(a) (b) Net (c) (d)
Expenses Investment Adjusted Charitable
DeI: BOQk~ Income Net Income ~uq:lose~
Excise tax $ 51128.
Total $ 51128. $ o. $ o.
2008

Federal Statements Jolie-Pitt Foundation

Page 2

20-5176706

Statement 5

Fonn 990-PF, Part I, Line 23 Other Expenses

$

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

Expenses Investment Adjusted Charitable

per Books Income Net Income Pur:poses

29,227. $ 29,227.

1,050. 1,050.

30,277. =$=======0::::::. ===== =$===30=,=2::::7=7::::::.

Administrative fees

State or local filing fees

Total $

Statement 6

Form 990-PF, Part II, Line lOa

Investments - U.S. and State Government Obligations

U.S. Government Obligations

Valuation Book Fair Market
Methog Value Value
Cost $ 2l003l237. $ 2l004l429.
$ 2,003,237. $ 2,004,429.
Total $ 2l003l237. $ 2l004l429. Government obligations - see attachment

Statement 7

Form 990-PF, Part II, Line 10c Investments - Corporate Bonds

Valuation Method

Book Value

Fair Market Value

Corporate Bonds

Corporate bonds - see attachment

Cost $ 2,230,990 . .:z.$_-;;2;.'-,*2*"21~,.....,3~1",,9...!...

Total $ 2l230l990. =$==2::!::l=2=21:=!l~3=1=9=.

Statement 8

Form 990-PF, Part VII-A, Line 5 Liquidation, Dissolution, Termination, Etc.

Substantial Contraction

This statement is submitted to report the distribution of certain assets during the tax year. The distributions resulted in a substantial contraction of assets. The following information is submitted in accordance with Treasury Regulation Section 1.6043-3(a) (1) and the Form 990-PF instructions: During the taxable year ending December 31, 2008, Jolie-Pitt Foundation (the "Foundation") made distributions from assets from sources other than current income. Collectively, the distributions in excess of current income totaled $6,435,278. This amount represents over 25% of the Foundation's net assets of $5,226,538 (as measured by fair market value) at the beginning of the Foundation's taxable year ending December 31, 2008. Although the Foundation technically experienced a "substantial contraction," it will continue in existence and has no plans for dissolution. The Foundation made distributions of cash to the grantees listed in the attachment to Part XV, Line 3a; each such grant was made solely for the charitable purpose specified therein.

20-5176706

2008

Federal Statements Jolie-Pitt Foundation

Page 3

Statement 9

Form 990-PF, Part XV, Line 1a

Foundation Managers - 2% or More Contributors

Brad Pitt Angelina Jolie

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Jolie-Pitt Foundation 20-5176706

2008 Form 990-PF

Part VII-B, Question 5c Expenditure Responsibility Statement for 2008

Pursuant to IRC Regulation 53.4945-5(d)(2), Jolie-Pitt Foundation provides the following information:

(i)

Grantee:

(ii)

Amount of Grant:

(iii)

Purpose of Grant:

(iv) & (vi) Reports of Amounts Expended:

(v)

Diversions:

(vii)

Verification:

Cherokee Gives Back Foundation 702 Oberlin Rd, Raleigh, NC 27605

2/27/07

$200,000

General Support

Cherokee Gives Back Foundation submitted a full and complete report of its expenditure of the February, 2007 grant on April 24, 2008.

To the knowledge of the grantor, no funds have been diverted to any activity other than the activity for which the grant was originally made.

The grantor has no reason to doubt the accuracy or reliability of the report from the grantee; therefore, no independent verification of the report was made.

Attachment to Part VII-B, Question 5c

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Form 8868

Application for Extension of Time To File an Exempt Organization Return

Department of the Treasury Internal Revenue Service

~ File a separate application for each return.

OMS No 1545 1709

(Rev April 2008)

• If you are filing for an Automatic 3-Month Extension, complete only Part land check this box ~ X

• If you are filing for an Additional (Not Automatic) 3-Month Extension, complete only Part lI(on page 2 of this form)

Do not complete Part II unless you have already been granted an automatic 3-month extension on a previously filed Form 8868

I Part I I Automatic 3-Month Extension of Time. Only submit anginal (no copies needed).

A corporation required to file Form 990-T and requesting an automatic 6-month extension - check this box and complete Part I only ~ 0

All other corporetions (mcludmg 1120-C filers), partnerships, REMICS, and trusts must use Form 7004 to request an extension of time to file income tax returns

Electronic Filing (e-file). Generally, you can electronically file Form 8868 If you want a 3-month automatic extension of time to file one of the returns noted below (6 months for a corporation required to file Form 990-T) 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 www IfS gov/eflle and click on e-tue for Chanties & Nonproflts

Type or print

Jolie-Pitt Foundation

20-5176706

Name of Exempt Organization

Employer Identification number

FIle by the due date for fdlng your return See Instructions

Number. street. and room or surte number If a PObox. see Instructions

501 Silverside Road #123

City. town or post oHtce. state, and ZIP code For a foreign address, see instructions

Wilmington, DE 19809-1377

Check type of return to be filed (file a separate application for each return)

r-r- ,-

Form 990

r- Form 990-BL r~ Form 990-EZ

X Form 990-PF

Form 990-T (corporation) ;-

__ Form 990-T (section 401 (a) or 408(a) trust)

- Form 4720

-

_ Form 5227

_ Form 6069

Form 8870

_ Form 990-T (trust other than above) Form 1041-A

• The books are In the care of ~ Foundation Source

------------------------------------

Telephone No. ~ _8 Q Q. -_8] ~::...1.1 ~ 1. _ _ _ _ _ _ _ FAX No, ~ _

• If the organization does not have an office or place of business In the United States, check thrs box ~ 0

• If ttus IS for a Group Return, enter the organization's four digit Group Exemption Number (GEN) If this IS for the whole group,

check thrs box. ~ 0 If It IS for part of the group, check thrs box ~ D and attach a list With the names and EINs of all members

the extension Will cover

I request an automatic 3-month (6 months for a corporation required to file Form 990-T) extension of time

until _ .!!Ll.5 , 20 _o~ _, to file the exempt organization return for the organization named above

The extension IS for the organization's return for

~ [R] calendar year 20 _o.!! _ or

~ 0 tax year beginning ,20

,and ending

________ ,20

2 If this tax year IS for less than 12 months, check reason

D Initial return

D Final return

o Change In accounting period

3a If thrs application IS for Form 990-BL, 990-PF, 990-T, 4720, or 6069, enter the tentative tax, less any 3a $ 2 752.
nonrefundable credits. See Instructions.
b If thrs application IS for Form 990-PF or 990-T, enter any refundable credits and estimated tax payments 3b $ 4 500.
made Include any prior year overpayment allowed as a credit
jj
c Balance Due. Subtract line 3b from line 3a Includer;our payment With thrs form, or, If required,
deposit With FTD coupon or, If required, by usmq E TPS (ElectrOnic Federal Tax Payment System) -
See Instructions 3c $ ° . Caution. If you are gOing to make an electronic fund Withdrawal With thrs Form 8868, see Form 8453-EO and Form 8879-EO for payment Instructions

BAA For Privacy Act and Paperwork Reduction Act Notice, see instructions.

Form 8868 (Rev 4-2008)

FIFZ0501 L 04116/08