Beruflich Dokumente
Kultur Dokumente
EXTENSION
GRANTED
Return of Private Foundation
990 PF I
I
Form
Department
of !heTreasurv
1n1ema1
Rewnueserv,ce
4947(a)(1) Nonexempt
Charitable
Trust
Treated as a Private Foundatiol"!
Note: The foundation may be able to use a copy of this return to salisfy state reporting requirements
I I
I I Amended
Final return
Initial return
G Check all that aoolv
Name of foundation
KS
lxJ Section
501(cM
exempt
1
3
Contnbut,ont:115'
grants,etc. received (attachschedule)
~
1fthe foundation1snot required to
C
heck
attachSch B. .
Interest on savingsand temporarycash investments
125,
........
LJ Cash LxJAccrual
:o
......
private foundation
method
20
I 316 l 828-5552
apphcatoon
1s
c If exemption
pending,
checkhere
orgarnzatoons,
checkhere
D 1. F ore1gn
2. F ore1gn
organizations
meeting
the
85%test,checkhereandattach
computation
J Accounting
I I
Address change
Name change
A Employeridentification number
48-0935563
Room/suite
67201-2256
Fair market
I I
return
~08
2008 , an d en d"mg
OMB No 1545-0052
or Section
269.
125,
269.
59. 523.
59.
523.
606,
558.
791
350.
.~o
D
pnvatefoundabon
statuswas tennonated
undersecbon
507(b)(1)(A),
checkhere ~
If
If the foundation
IS 1n a Rll-mnnth t~,n~J,:V,
undersection
507(b)(1)(B),
checkhere
(c) Adjusted net
income
(d) Disbursements
for charitable
purposes
(cash basis onM
Sa Gross rents .
b Net rental mcomeor (loss)
Cl)
::,
c:
Cl)
(.fJ
()
)>
>
Cl)
0::
606,558.
........
9 Income mod1f1cat1ons
10 a Grosssalesless mums
and allowances
1
b Less Costof goo s s -
Rlf.=r.E!VED
m
0
c Gross profit or
(.)
il<:!(ltrre>zoo~
......
.....
r)
11
Other income I ~I
12
13
Compensationof pfficers,86~Wlj
--
,-L...
......
(/')
......
.
791
.\J 1
14
Other employee ~"""'es ana wages
en
Cl)
15
Pension plans, employee benefits
en
c:
& 16a Legal fees (attach schedule)
)(
b Accounting fees (attach schedule)S.T.MT .1.
w
350.
.....
.......
Cl)
>
17
en 18
,,e 20
21
111
22
c:
en
685.
4 84 5.
17
11.785.
NONE
960.
.....
c: 23
.;:::::
~ 24
. 4.
1 004.
004.
640.
640.
Cl)
..............
45
264.
25
2. 560,
300.
26
anddisbursements.
Add Iones24 and 25
TotaleXPenses
Subtract line 26 from line 12
Cl.
Taxes(attachschedule)(seepage14of the1nstrud1on,l')
*
19
<
,,
975.
960.
Interest
Ill
c:
16
17
27
-1
22
2?
605.564.
814.
805.
805.
JSA
8E14101000
11:
10:
NONE
463
92q.
-0-
For Privacy Act and Paperwork Reduction Act Notice, see page 30 of the instructions.**
10/27/2009
500.
768.545.
K932
4 29.
449.
214.
29145H
14
2
NONE
59
V08-8.
85651
STMT
11'11111
Balance
1
2
3
Sheets
Cash - non-interest-bearing
..
Beginning of year
5
6
.
..
End of year
(c) Fair Market Value
....
5, 685,
7.337
1 70.
267.
7 337
267.
NONE
Paoe2
48- 0935563
NONE
1. 334.
NONE
Pledges receivable
..
-------------
. . . ..
....
....
1. 216.
9 021.
9 021.
. .
....
------------------
.. . .
13
14
15
16
17
18
19
CD
;g 20
21
::i 22
t/1
:g
23
..
..
6 072,
204.
2 623
804.
2 041.
228.
9 970 092.
28.146.
9 388
850.
-----------------....____________________
11 758
..
Grants payable
590.
2 430.
. ...
...
Deferred revenue
..
)
....___________________
..
2, 4 30.
....
w
14 6 .
28
Foundations
that follow SFAS 117, check here
and complete
lines 24 through 26 and lines 30 and 31.
Cl)
24
c
ra 25
iii
m 26
"Cl
..
:::,
LI.
!lCD
:l
27
28
160.
9.941.946.
160.
9 941.
946.
9 970
092.
....
Permanently restricted
..
Foundations
that do not follow SFAS 117,
check here and complete lines 27 through 31.
....
o
..
..
instructions)
Total liabilities and net assets/fund balances (see page 17
11 756,
31
of the instructions)
11
CD
...
li!IDI11
Analysis
end-of-year
figure reported
Enter amount
not included
at beginning
.. . .
m hne 2 (itemize)
.. . . . . .
not included
7 5 8, 5 9 O.
Other increases
.... ..
11. 7 56
29
30
..
z
<(
Unrestricted
Temporarily restricted
..
m hne 2 (Itemize)..,..
or fund balances
..,..
-------------------------------------
.. .. ..
.......
----------------------------------------
........
at end of year (hne 4 minus hne 5) - Part II, column (b), hne 30 .
...
1
2
3
4
5
6
11
-1
7 56, 160.
814,214.
9 941
946.
9, 941
946 .
JSA
8E1420 1 000
2 9 1 4 5 H K9 3 2 1 0 I 2 7 I 2 0 0 9
11 : 1 0 : 5 9
VO8 - 8 . 1
85651
Form ~0-PF
(2008)
~.iiu-- Capital
48-0935563
(bl How
acquired
(a) List and describe the kind(s} of propertysold (e.g . real estate,
2-story brick warehouse. or commonstock. 200 shs. MLC Co}
1a
b
SEE PART
IV
Page
ld)
Date sold
mo., day,
(c) Date
acquired
(mo . day,yr )
yr }
SCHEDULE
c
d
e
(f}
Deprec1at1on
allowed
(or allowable}
a
b
c
d
e
Complete only for assets showing gain in column (h) and owned by the foundation on 12/31/69
(j) AdJustedbasis
(k) Excessof col. (1)
(i) FM V as of 12/31/69
as of 12/31 /69
over col {J),1fany
a
b
c
d
e
If gain, also enter m Part I, hne 7
If (loss), enter -0- 1nPart I, hne 7
3 Net short-term capital gain or (loss) as defined 1nsections 1222(5) and (6)
If gain, also enter m Part I, line 8, column (c) (see pages 13 and 17 of the 1nstruct1ons)
If (loss). enter -0- 1nPart I, hne 8 ........................
.....
...
..
Qualification
}
}3
606
558.
(For optional use by domestic private foundations subject to the section 4940(a) tax on net investment income.)
If section 4940(d)(2) applies, leave this part blank.
Was the foundation liable for the section 4942 tax on the distributable amount of any year 1nthe base period? .
If "Yes," the foundation does not qualify under section 4940(e). Do not complete this part.
Yes
[x]
No
1 Enter the appropriate amount m each column for each year, see page 18 of the instructions before making any entries
(a)
Base penod years
Calendar year (or tax year beginning 1n)
(b)
AdJusted qualifying
2007
2006
2005
2004
2003
2
3
(d)
D1stribut1on ratio
(col (b) divided by col (c))
(c)
d1stnbut1ons
4.085
4, 231
3. 796
3.110
2.377
15 540.
17,229
19.799
21 925
24. 494
883.
7 35.
938.
086.
850.
assets
497.
773.
4 54.
067.
757.
.....................................
0. 262918
0. 245606
0. 191770
0. 141851
0.097076
0.939221
..........
0. 187844
..........
Enter the net value of noncharitable-use assets for 2008 from Part X, hne 5
...................
11
492. 427.
...................
2 158. 783.
....................
7 685.
. . . . . .. . . . . .. . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . .
2. 166, 468 .
.........................
JSA
8E1430 1 000
2 9 1 4 5 H K9 3 2 1 0 / 2 7 / 2 0 0 9
Fonn
11 : 1 0 : 5 9
VO8 - 8 . 1
85651
990-PF
(2008)
.
'Form 990-PF (2008)
=.1~A~Excise
48-0935563
Page4
Income (Section 4940(a), 4940(b), 4940(e), or 4948 - see page 18 of the instructions)
LJ
~ [xJ
7. 685.
c All other domestic foundatJons enter 2% of hne 27b. Exempt foreign orgamzatJons enter 4% of Part I, hne 12, col (b)
Tax under section 511 (domestic section 4947(a)(1) trusts and taxable foundations only. Others enter -0-)
Tax based on investment income. Subtract line 4 from line 3. If zero or less, enter -O-
7.685.
16. 706.
NONE
Cred1ts/Payments
7. 685.
6a
6b
c Tax paid with application for extension of time to file (Form 8868).
6c
6d
16. 706.
NONE
NONE
Tax due. If the total of Imes 5 and 8 1smore than line 7, enter amount owed
8
~
~1--'1~0-t-------"'-9~0~2=1~.
Overpaymenl If line 7 1s more than the total of hnes 5 and 8, enter the amount overpaid
Enter the amount of hne 10 to be Credited to 2009 estimated tax ~
g Q 21. Refunded ~ 11
10
11
Statements
Reaardina Activities
Yes
1 a During the tax year, did the foundation attempt to influence any national, state, or local legislation or did 11
No
part1c1pateor intervene m any political campaign? . . . . . . l-'1-"a'-1----+--x=-=-b Did 11spend more than $100 during the year (either directly or md1rectly) for pol1t1calpurposes (see page 19
,__1b
,___x
of the instructions for definition)?
____
......
If the answer is "Yes to fa or 1b, attach a detailed descnpt1on of the acflvt11es and copies of any matenals
published or d1stnbuted by the foundation m connection wtlh the activt11es
x
x
Has the foundation made any changes, not previously reported to the IRS, m ,ts governing instrument, articles of
mcorporat,on, or bylaws, or other s1m1larinstruments? If "Yes, attach a conformed copy of the changes
4a
4a
Did the foundation have unrelated business gross income of $1,000 or more dunng the year?
NIA
4b
b If "Yes," has ,t filed a tax return on Form 990-T for this year?
Are the requirements of section 508(e) (relating to sections 4941 through 4945) satisfied either
By language m the governing instrument, or
By state legislation that effectively amends the governing instrument so that no mandatory d1rect1ons that
7
8b
mstruct,ons) ~ DC, KS, VA,---------------------------------------------------------b If the answer 1s ''Yes" to line 7, has the foundation furnished a copy of Form 990-PF to the Attorney General
9
(or designate) of each state as required by General Instruction G? If "No, attach explanation
Is the foundation claiming status as a private operating foundation w1thm the meaning of section 4942(])(3)
or 4942(])(5)
(see instructions
JSA
8E1440 1 000
2 9 1 4 5 H K9 3 2
10 I 27 I 200 9
11 : 1 0 : 5 9
VO8 - 8 1
85651
990-PF
x
(2008)
'
48-0935563
PageS
11 At any time during the year, did the foundation. directly or indirectly, own a controlled entity within the
meaning of section 512(b)(3)? If "Yes," attach schedule (see page 20 of the mstruct1ons)
. . . ...........
12 Did the foundation acquire a direct or indirect interest m any applicable insurance contract before
August 17, 2008?
......................................
..........
---------
12
13 Did the foundation comply with the public inspection requirements for its annual returns and exemption apphcat1on?
Website address ~ _____ NI A ___________________________________________________________________
14 The books are m care of ~- _Y.QllQ_l:LliQI:_I:_I_l'1)11l
___________
11
13
x
_
Telephone no ~ _____
--------rr
Located at ~jlll_
E._ 37TH STREET NORTH WICHITA,_ KS---------------ZIP+4 ~ 67220
15 Section 4947(a)(1) nonexempt charitable trusts filing Form 990-PF m lieu of Form 1041 - Check here
N/. A
and enter the amount of tax-exempt interest received or accrued during the year ~ 15
I I
=~mJII"!:
File Form 4720 if any item is checked in the "Yes" column, unless an exception applies.
No
[x)No
0Yes
(2) Borrow money from, lend money to, or otherwise extend credit to (or accept 1tfrom) a
disqualified person? . .
Yes
Yes
(4) Pay compensation to, or pay or reimburse the expenses of, a disqualified person? .
Yes
No
No
No
(5) Transfer any income or assets to a disqualified person (or make any of either available for
[x)No
0Yes
the foundation agreed to make a grant to or to employ the official for a period after
termination of government service, 1f terminating within 90 days.).
Yes
No
b If any answer 1s''Yes" to 1a(1)-(6), did any of the acts fail to qualify under the exceptions described in Regulations
section 53 4941 (d)-3 or in a current notice regarding disaster assistance (see page 20 of the 1nstruct1ons)?
Organizations relying on a current notice regarding disaster assistance check here
1b
1c
c Did the foundation engage m a prior year many of the acts described 1n1a, other than excepted acts, that
were not corrected before the first day of the tax year beginning m 2008?
2
Taxes on failure to distribute income (section 4942) (does not apply for years the foundation was a private
operating foundation defined 1nsection 4942(1)(3) or 4942(1)(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 ~ __________
Yes
No
b Are there any years listed m 2a for which the foundation 1snot applying the prov1s1onsof section 4942(a)(2)
(relating to incorrect valuation of assets) to the year's undistributed income? (If applying section 4942(a)(2)
to all years listed, answer "No" and attach statement - see page 20 of the instructions.)
2b
N/ A
3b
N/ A
c If the prov1s1onsof section 4942(a)(2) are being applied to any of the years listed 1n2a, list the years here.
~---------3a
---------
--------
--------
Did the foundation hold more than a 2% direct or 1nd1rectinterest 1nany business
enterprise at any time during the year? .
Yes
No
b If "Yes," did 11have excess business holdings in 2008 as a result of (1) any purchase by the foundation or
d1squalif1edpersons after May 26, 1969, (2) the lapse of the 5-year period (or longer period approved by the
Comm1ss1onerunder 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 penod? (Use Schedule C, Form 4720, to determine tf the
foundation had excess busmess holdings m 2008 )
4a
Did the foundation invest during the year any amount in a manner that would Jeopardizeits charitable purposes?
b Did the foundation make any investment in a prior year (but after December 31, 1969) that could Jeopardize its
charitable purpose that had not been removed from Jeopardy before the first day of the tax year beginning m 2008?
4a
. I--+---+--'-'-4b
Form
JSA
8E1450 1 000
29145H
K932
10/27/2009
11:10:
59
V08-8.1
85651
990-Pf
x
(2008)
Statements
:l;'riira~JI!!:
Regarding Activities
48-0935563
for Which Form 4720 May Be Required (contmued)
5 a During the year did the foundation pay or incur any amount to
(1) Carry on propaganda, or otherwise attempt to influence leg1slat1on
(section 4945(e))?
0Yes
[i)No
0Yes
0Yes
[ii
[i]
[i]Yes
0No
Page6
(2) Influence the outcome of any spec1f1cpublic election (see section 4955), or to carry on,
No
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 page 22 of the 1nstruct1ons)
(5) Provide for any purpose other than religious, charitable, saent1fic, literary, or
Yes
No
b If any answer 1s"Yes" to 5a(1)-(5), did any of the transactions fail to qualify under the exceptions described in
Regulations section 53 4945 or in a current notice regarding disaster assistance (see page 22 of the instructions)?
Organizations relying on a current notice regarding disaster assistance check here
c
If the answer 1s "Yes" to question 5a(4), does the foundation claim exemption from the tax
because it maintained expenditure respons1b1htyforthe grant? !:i~E.
?T~'I'.E.M~tfl.:
.6. .
Yes
t-5_b_+---+-~X~
~D
No
6a
Did the foundation, during the year, receive any funds, directly or indirectly, to pay premiums
6b
. I----+----+--
......
7b
N/ A
Information About Officers, Directors, Trustees, Foundation Managers, Highly Paid Employees,
and Contractors
directors,
trustees,
foundation
SEE_STATEMENT_C
~c,>
Compensation
not paid, enter
-0-1
(d) Contnbuoonsto
employeebenefitplans
and deferred comoensat,on
______________________
NONE
NONE
NONE
------------------------------------------------------------------------------------------------------------2
employees
(a) Name and address of each employee paid more than $50,000
(c) Compensation
(d) Contnbut1ons to
employee benefit
plans and deferred
compensation
NONE
Total
.
Form
JSA
BE 1460 1 000
29145H
K932 10/27/2009
11: 10:59
V08-8.1
85651
-~!NONE
990-PF
(2008)
48-0935563
About Officers, Directors, Trustees, Foundation Managers, Highly Paid Employees,
and Contractors (continued)
Page
Form 9'30-PF(2008)
U1ifl@jj1
Information
3 Five highest-paid
independent
contractors
for professional
(a) Name and address of each person paid more than $50,000
(c) Compensation
NONE
1@jf!t.j
...............................
NONE
List the foundation's four largest direct charitable act1vibes dunng the tax year. Include relevant statistical infonnabon such as the number
of organizations and other benefic,anes served, conferences convened. research papers produced, etc
E,cpenses
1_NONE---------------------------------------------------------------------2
~1111,.~=
Summary
investments made by the foundation dunng the tax year on lines 1 and 2
Amount
1_NONE---------------------------------------------------------------------2
3_NONE_____________________________________________________________________
JSA
8E14651 000
2 9 1 4 5 H K93 2 1 0 I 2 7 I 2 0 0 9 11 : 1 0 : 5 9 VO8 - 8 . 1
85651
990-PF
(2008)
Form 990-Pr
UtfiQ
1
4 8 -0 9 3556 3
(2008)
Minimum Investment Return (All domestic foundations must complete this part. Foreign foundations,
see page 24 of the instructions.)
Fair market value of assets not used (or held for use) directly 1ncarrying out charitable, etc,
purposes
a Average monthly fair market value of securities ....
b Average of monthly cash balances .....
c Fair market value of all other assets (see page 24 of the 1nstruct1ons).
d Total (add Imes 1a, b, and c) ........
e Reduction claimed for blockage or other factors reported on hnes 1a and
1c (attach detailed explanation) . . . . . ....
~1_e~-----------,
Acqu1s1t1onindebtedness applicable to line 1 assets
Subtract line 2 from line 1d ......................................................
Cash deemed held for charitable act1vrt1es.Enter 1 112% of line 3 (for greater amount, see page 25
2
3
4
Page8
1a
1b
1c
1d
11
667
4 39.
2
3
11
667
4 39.
6 110
5 557
421.
018.
NONE
NONE
175 012.
of the 1nstruct1ons) .
_ . . .
1--4-1--------=:....:....:"-L-=-=-=-=-Net value of noncharitable-use assets. Subtract line 4 from line 3. Enter here and on Part V, hne 4
5
11
492
4 27.
1---1------=-=c.L..c'--"--':.L--'--'=....!....:..._
Minimum investment return. Enter 5% of line 5 . . . . . . . . . . . .
6
574 621.
Distributable Amount (see page 25 of the instructions) (Section 4942(])(3) and (J)(5) private operating
foundations and certain foreign organizations check here ~
and do not complete this part.)
5
6
1
2a
b
c
3
4
5
6
7
......
....
....
ifii3ii Qualifying
1
a
b
2
3
a
b
4
5
6
. -i 2~i ..
..
. ..
....
..
..
.-
..
..
574. 621.
2c
3
4
5
6
7. 685.
566. 936 .
7 68 5 .
I
.. .. .. .. .
. . ..
....
...
........
.. . .. . .
. . . -.
. . . .. . .. . . .
.. ..
..
.. . . . .
......
...
..
566
936.
566
936.
..
purposes ...................
Amounts set aside for spec1f1ccharitable proJects that satisfy the
Su1tab11ity
test (prior IRS approval required) ............................................
Cash d1stribut1ontest (attach the required schedule) .........................................
Qualifying distributions. Add Imes 1a through 3b. Enter here and on Part V, hne8, and Part XIII. hne4 .........
Foundations that qualify under section 4940(e) for the reduced rate of tax on net investment income
Enter 1% of Part I, line 27b (see page 26 of the instructions)
1a
1b
2. 463. 929.
NONE
NONE
3a
3b
4
NONE
NONE
2 463
929.
5
7. 685.
6
Adjusted qualifying distributions. Subtract line 5 from line 4 ...........
2 4 56 244.
Note: The amount on line 6 will be used in Part V, column (b), m subsequent years when calculating whether the foundation
qualifies for the section 4940(e) reduction of tax in those years.
Fonn
JSA
BE1470 1 000
2 9 1 4 5 H K9 3 2 1 0 I 2 7 I 2 0 0 9
11 : 1 0 : 5 9
VO8 - 8 . 1
8 5 6 51
990-PF
(2008)
Form 990-PF(2008)
..,. -111
(a)
Page9
48-0935563
Undistributed
Corpus
.....................
(c)
2007
(d)
2008
566. 936.
..........
. 2 0___
, 2 0 __
L 158, 372.
2.020
055.
2, 373, 221.
3.384.774.
3, 348, 840.
a From 2003
.
.
b From 2004
c
From 2005
d From 2006
e From 2007
f
.........
12.285
262.
......
.....
566
..
936.
1. 896, 993.
14
182
255.
1. 158
372.
....
.............
...............
....
Excess distributions
carryover
Subtract lines 7 and 8 from line 6a
Analysis of line 9
a Excess from 2004
to
2009.
.......
10
2
2
3
3
1
020 055.
373. 221.
384.774.
348 840.
896 993.
Form 990-PF (2008)
JSA
BE14BO 1 000
29145H
K932
10/27/2009
11: 10: 59
V08-8.
85651
'Form
1a
990-PF (2008)
48-0935563
see page 27 of the instructions and Part VII-A, question 9)
b
2a
~ -p~1v~t~-o~e-ra.tin~ I
I I
4942{])(3) or
I I
Prior 3 years
(a) 2008
(c) 2006
(b) 2007
10
Check box to indicate whether the foundation 1s a private operating foundation described in section
Tax year
Page
NOT APPLICABLE
4942{])(5)
(e) Total
(d) 2005
.......
.....
85% of line 2a
...
49420)(3)(8)(1)
"Endowment" alternatl'./8 testenter 213
ot
minimum
invest-
..
(4)
.....
-.:,:;i..:.,.~upplem_entary
Information (Complete t~is part _only if the foundation had $5,000 or more in assets at any
time durmg the year - see page 27 of the mstruct1ons.)
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
Check here~
1f the foundation only makes contributions to preselected charitable organizations and does not accept
unsolicited requests for funds If the foundation makes gifts, grants, etc. (see page 28 of the instructions) to ind1v1duals or
organizations under other cond1t1ons,complete items 2a, b, c, and d.
a The name, address, and telephone number of the person to whom apphcat1onsshould be addressed
SEE
STATEMENT
b The form in which applications should be submitted and information and materials they should include
SEE
STATEMENT
c Any subm1ss1ondeadlines
NONE
d Any restrictions or hmitatmns on awards, such as by geographical areas, charitable fields, kinds of inst1tut1ons, or other
factors
SEE
STATEMENT
JSA
Fonn
8E1490 1 000
29145H
K932 10/27/2009
11:10:
59
V08-8.1
85651
990-PF
(2008)
4 8-0 9 3 556 3
ifif:VJ
Supplementary
3
Page
11
Information (continued)
Grants and Contributions Paid During the Year or Approved for Future Payment
Rec1p1ent
Name and address (home or business)
or substantial contnbutor
status of
rec1p1ent
Purpose of grant or
contnbut,on
Amount
Total
3a
3b
2, 560,
300.
2 560.
300.
Total
Fonn
JSA
BE1491 1 000
2 9 1 4 5 H K9 3 2 1 0 I 2 7 I 2 0 0 9
11 : 1 0 : 5 9
VO8 - 8 . 1
85651
990-PF
(2008)
:.:I.
Page
48-0935563
12
(b)
Amount
Businesscode
1 Program serv1cerevenue
(e)
Related or exemgt
function incom
See page 28 of
he instructions )
(d)
Amount
a
b
c
d
e
f
g
...
14
14
125. 269.
59, 523.
18
606
Debt-financed property
Not debt-financed property
......
.........
558.
.
Gross profit or (loss) from sales of inventory .
11 Other revenue a
b
c
d
e
....
791
~u~I
Line No.
~
350 .
791
13
350.
NOT APPLICABLE
Form
JSA
8E1492 1 000
2 9 1 4 5 H K9 3 2 1 0 I 2 7 I 2 0 0 9
11 : 1 0 : 5 9
VO8 - 8 . 1
85651
990-PF
(2008)
Page 13
With Noncharitable
48- 0935563
2008
and Relationships
Did the orgamzallon directly or indirectly engage in any of the following with any other organization described in section
No
Yes
501 (c) of the Code (other than section 501 (c)(3) organizations) or in section 527. relating to pol11icalorganizations?
a Transfers from the reporting foundation to a nonchantable exempt organization of
(1) Cash
b Other transactions
(1) Sales of assets to a noncharitable exempt organization
x
x
x
x
x
x
x
1bl11
1b(2)
x
x
1al1l
1al21
1bl3l
.
.
..
.
1b(4l
1b(5}
1bl61
1c
d If the answer to any of the above 1s 'Yes," complete the following schedule Column (b) should always show the fair market value of the goods,
other assets, or services given by the reporting foundation. If the foundation received less than fair market value in any transaction or sharing
arrangement, show in column (d) the value of the goods, other assets, or services received
(a) Line no
exempt orgamza!Jon
N/A
2a
N/A
Is the foundation directly or indirectly affiliated with, or related to, one or more tax-exempt orgamzat1ons described
in
section 501 (c) of the Code (other than section 501(c)(3)) or in section 527? .
b If "Yes" comolete the followma schedule.
(a) Name of organization
Yes
No
Under penalties of periury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and
belief, 111s true, correct, and complete Declaration of preparer (other than taxpayer or fiduciary) 1s based on all information of which preparer has any knowledge
... ~
GI
I 11-J..-,2.()ot.. ~
o(~~
Signature of officer or trustee
GI
:::c
c:
Date
.!=>"'!~~
c
(/)
Preparer's
-ca O signature
: g,:: Firm's name (or yours 1f
ii::::, self-employed), address,
and ZIP code
~~A.
~BKD
1551
,,(bl-iooq
Check1f
self-employed~
LLP
N WATERFRONT
WICHITA,
PKWY,
KS
STE
Ll"eff.J.q_rer
Title
Date
Preparer's 1dent1fymgnumber
(See Signature
instruclJons)
P00770702
EIN ~ 44-0160260
300
67206-6601
PhooenQ 316-265-2811
Form
JSA
8E1493 1 000
2 9 1 4 5 H K9 3 2
10 I 27I 200 9
11 : 1 0 : 5 9
VO8 - 8 1
85651
on page 30 of the
990-PF
(2008)
Deprec1ahon
allowed/
allowab'"'
Cost or
other
"'"~,~
SEE
['OTAL
4, 939,
GA! N( LOSS)
STATEMENT
PROPERTY
5 545, 823.
bl
D
Description
Kind of Property
TYPE:
FMV
as of
1?/'H/i:;n
AdJ basis
as of
1 '>l':11 /l,Q
Excess of
FMVover
ad, basis
Date
acquired
Gain
or
lloss\
VAA
SEC URI TI ES
606, 558.
265.
----------
. . .. . . . . ...........................................
606, 558.
----------
JSA
8E1730 1 000
29145H
K913)421,02,o~~/20.Cll.9):$~:10: 59 VOS-8. 1
85651
Date sold
VAA
-------
STATEMENT A
(c)
Date acquired
(mo. day, yr)
3/30/2004
10/31/2008
04/04 - 07/08
01/08 - 12/08
7/21/2008
7/21/2008
1a
d
e
f
g
(e) Gross sales pnce
(g) Cost or
(or allowable)
other basis
4,118,053
3,366,293
751,760
1,427,723
1,572,972
(145,249)
47
47
Complete only for assets showing gain in column (h) and owned by the foundation on 12/31/69
(1) FMV
asof12/31/69
as of 12/31/69
751,760
(145,249)
47
606,558
3 Net short-term capital gain or (loss) as defined m sections 1222(5) and (6)
If gain, also enter 1nPart I, hne 8, column (c) (see pages 11 and 16 of the
instructions)
STATEMENT B
Pursuant to IRC Regulation section 53.4945-5(d)(2), the CLAUDE R. LAMBE CHARITABLE FOUNDATION
provides the following information-
General program operating support for the Allen-Lambe House Foundation, an educational
foundation which operates a museum and study center in a house located in Wichita. Kansas.
designed by Frank Lloyd Wright 1n1915 The house museum is open to the general public.
The program of the Foundation includes restoration and conservation of the house, gardens,
and its interiors, with furnishings to showcase the "Prairie Style" designs of Frank Lloyd Wright,
and to maintain a library archive study center for the study of FrankLloyd Wright and other
interrelated areas of design
Reports received from the Allen-Lambe House Foundation show the following expenditures
$64,882 of the remaining February, 2007 grant was spent for operating support of the museum
$24,596 of the April, 2008 grant was spent for operating support of the museum.
(v) Diversions
To the knowledge of this grantor foundation, no funds have been diverted to any
activity other than the activity for which the grant was originally made.
On May 15, 2009, the Allen-Lambe House Foundation submitted a full and complete
report of its expenditures of the February 2007 and April 2008 operating support grants
(v1) Verification
The grantor has no reason to doubt the accuracy or reliability of the report from
the grantee. therefore, no independent verification of the reports were made
Managers, Etc.
STATEMENTC
(d) Contributions
to employee
benefit plans
(c) Compensation
(e) Expense
account, other
allowances
President I Director
1 hour per week
Secretary
Logan Moore
1515 N Courthouse Rd, Suite 200
Arlington, VA 22201
Vonda Holliman
PO Box 2256
Wichita, KS 67201
Treasurer
Charles G Koch
P 0. Box 2256
W1ch1ta,KS 67201
Director
Less than 1 hour per week
Elizabeth B Koch
P.O Box 2256
W1ch1ta,KS 67201
Director
Less than 1 hour per week
Elizabeth R. Koch
PO Box 2256
W1ch1ta,KS 67201
Director
Less than 1 hour per week
Charles C. Koch
PO Box 2256
W1ch1ta,KS 67201
Director
Less than 1 hour per week
TOTAL
Rec1p1ent
Foundation
status of
rec1p1ent
STATEMENT D
Purpose of grant
or contribution
Amount
or substantialcontnbutor
Private
110,800
..
Public
100,000
Public
50,000
Public
1,000,000
Public
Educational Programs
Cato Institute
Washington, DC
Public
260,000
Public
65,000
Public
10,000
Public
70,000
Public
Educational Programs
225,000
Public
200,000
Public
5,000
Public
40,000
Public
Educational Programs
90,000
Reason Foundation
Los Angeles, CA
Public
50,000
Tax Foundation
Washington, DC
Public
Educational Programs
50,000
Public
Educational Programs
74,500
Public
10,000
150,000
Paae 1 of 1
2,560,300
48-0935563
FORM 990PF,
DESCRIPTION
ACCOUNTING FEES
INVESTMENT ACCTG SERVICE FEES
TOTALS
29145H
K932 10/27/2009
11:10:59
V08-8.1
NET
INVESTMENT
INCOME
CHARITABLE
PURPOSES
11,785.
12,130.
4,845.
4,845.
16,975.
4,845.
85651
ADJUSTED
NET
INCOME
NONE
11,785.
STATEMENT 1
48-0935563
FORM 990PF,
DESCRIPTION
REVENUE
AND
EXPENSES
PER BOOKS
NET
INVESTMENT
INCOME
17,960.
17,960.
17,960.
17,960.
INVESTMENT MANAGEMENTFEES
TOTALS
29145H
K932 10/27/2009
11:10:59
V08-8.1
85651
STATEMENT 2
FORM 990PF,
48-0935563
PART I - TAXES
REVENUE
AND
EXPENSES
PER BOOKS
DESCRIPTION
FEDERAL EXCISE TAX
7,685.
7,685.
TOTALS
STATEMENT 3
29145H
K932 10/27/2009
11:10:
59 V08-8.1
85651
FORM 990PF,
48-0935563
..
DESCRIPTION
INSURANCE
BANK FEES
TOTALS
29145H
K932 10/27/2009
11:10:59
V08-8.1
CHARITABLE
PURPOSES
1,350.
290.
1,350.
290.
1,640.
1,640.
85651
STATEMENT 4
PART II
48-0935563
- OTHER INVESTMENTS
ENDING
BOOK VALUE
DESCRIPTION
ZAZOVE SALES PENDING
ZAZOVE ASSOC CONVERTIBLE BONDS
TOTALS
29145H
K932 10/27/2009
11:10:59
V08-8.1
85651
ENDING
FMV
5,167.
2,618,637.
NONE
2,041,228.
2,623,804.
2,041,228.
STATEMENT 5
FORM 990PF,
PART VII-B,
48-0935563
LINE SC-EXPENDITURE
RESPONSIBILITY
STATEMENT
==============----------=-====-------------------------------------GRANTEE'S NAME:
GRANTEE'S ADDRESS:
CITY, STATE & ZIP:
GRANT DATE:
GRANT AMOUNT:
GRANT PURPOSE:
SEE STATEMENT B
AMOUNT EXPENDED:
ANY DIVERSION?
NO
DATES OF REPORTS:
VERI FI CATI ON DATE:
RESULTS OF VERIFICATION:
STATEMENT
29145H
K932 10/27/2009
11:10:59
V08-8.l
85651
FORM 990PF,
48-0935563
GRANT ADMINISTRATOR
1515 N. COURTHOUSE RD.,
ARLINGTON, VA 22201
703-875-1601
SUITE
200
STATEMENT
29145H
K932 10/27/2009
11: 10:59
V08-8. 1
85651
990PF,
48-0935563
-----=-----------------------====================-----=-====
STATEMENT 8
29145H
K932 10/27/2009
11:10:59
VOS-8. 1
85651
48-0935563
990PF,
PART XV - RESTRICTIONS
OR LIMITATIONS
ON AWARDS
------------------------------=-============----------
STATEMENT
29145H
K932 10/27/2009
11:10:59
V08-8. 1
85651
If you are filing for an Additional (Not Automatic) 3-Month Extension, complete only Part II and check this box . . . . . .
Note. Only complete Part II 1fyou have already been granted an automatic 3-month extension on a previously filed Form 8868
If ou are film for an Automatic 3-Month Extension, com lete on Part I on a e 1
Additional
Type or
print
Fde by the
Not Automatic
3-Month Extension of Time. Onl file the ori inal no co ies needed .
CLAUDE R.
Page 2
.,..(RJ
LAMBE CHARITABLE
48-0935563
FOUNDATION
Number, street, and room or suite no. If a P.O. box, see instructions
~:'~~for
~P...,....._O_._B_O_X_2_2--:-5~6::-----,-,---,-,:::-::,--,----=-----::---:----:--,--------..,.,---t--City, town or post office, state, and ZIP code. For a foreign address, see instructions.
filing the
return. See
instructions.
.......
----------------,
WICHITA,
KANSAS
67201-2256
Check type of return to be filed (File a separate application for each return)
Form 1041-A
Form 6069
Form 990
X
Form 990-PF
Form 4720
Form 8870
Form 990-BL
Form 990-T (sec. 401(a) or 408(a) trust)
Form 5227
Form 990-T trust other than above
Form 990-EZ
STOP! Do not complete Part II if you were not already granted an automatic 3-month extension on a previously flied Fonn 8868.
The books are in the care of .... _V_O_N_D_A
__ H_O_L_L_I_MA_N
_____________________
_
TelephoneNo .,.. 316 828-5552
FAX No . .,..
If the organization does not have an office or place of business in the United States, check this box . . . . . . . . . . .,..
If this is for a Gro~ Return, enter the organization's four digit Group Exemption Number (GEN)
If this IS
for the whole group, check this box . . . .,..
If 1t1sfor part of the group, check this box ..
.,..
and attach a
hst with the names and EINs of all members the extension is for
NOVEMBER 15, 2009
4 I request an additional 3-month extension of time until
LJ
5
6
State in detail why you need the extension -------------------------------THE TAXPAYER REQUESTS ADDITIONAL
TIME IN ORDER TO GATHER THE NECESSARY
INFORMATION FOR A COMPLETE AND ACCURATE RETURN.
LJ
endmg---,--.-----------Final return
Change in accounting period
LJ
Sa If this application is for Form 990-BL, 990-PF, 990-T, 4720, or 6069, enter the tentative tax, less any
nonrefundable credits. See instructions
b If this application 1sfor Form 990-PF, 990-T, 4 720, or 6069, enter any refundable credits and estimated
tax payments made. Include any prior year overpayment allowed as a credit and any amount paid
previously with Form 8868.
c Balance Due. Subtract hne Bb from line Ba Include your payment with this form, or, 1f required, deposit
with F1D coupon or, if reauired, by using EFTPS(Electronic Federal Tax Payment System). See instructions.
Sa $
--
Sb $
Sc $
Signature ....
Tiiie....
C. P.A.
Date.,..
1/2 I /zooei
Form
BKD,
LLP
1551
N.
WICHITA,
JSA
8F8055 3 000
67206
300
8868
(Rev 4-2009)