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ZIEDUAL

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120 Broadway

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Title

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Fo,mCHAR410

Registration

New York State

Statement for Charitable Organizations

Department of Law (Office of the Attorney General)

Charities Bureau - Registration Section

New York, NY 10271

www.charitiesnys.corn/

46-81-05

Part A -

Identification

of Registrant

 

1.

Full

name of organization

(exactly as

it appears

in

Pacific Park Conservancy,

Inc.

2.

do Name (if applicable)

Atlantic Yards Venture,

LLC

 

3.

Mailing address (Number and

street)

1

Metrotech

Center, 18th

Floor

City or town,

state or country and ZIP+4

 

Brooklyn, NY 11201

4.

Principal NYS address (Number and street)

 

1 Metrotech

Center,

18th

Floor

City or town,

state or country and ZIP+4

Brooklyn, NY 11201

your organizing document)

5. Fed.

employer ID

no.

(EIN)

 

8

2

-2

56

7

239

 

6

Organization's website

 
 

N/A

 

Room/suite

7

Primary contact

 
 

Ashley Cotton

Title

Chairperson and

President

Room/suite

Phone

 

Fax

(718) 559-5115

 

N/A

Email

acotton@Ilmag.com

Part B - Certification - Two Signatures

Required

We

certify

under penalties

for

perjury that we

knowledge and

belief, they are true,

correct and

reviewed this

compl

e 1

1. President or Authorized Officer/Trustee

2.

Chief Financial

Officer or Treasurer

Sig

t

Signatu

'

c or

tration

Statement,

including

all

schedules

and

attachments,

and

to the

best

of our

c with the laws of the State of New York applicable to this statement.

Ashle

Cotton

_~~:,~-:8,lated Name

ifford Schwartz

Printed Name

Chair

erson and

Treasurer

Title

President

8/10/18

Date

8/10/18

Date

Part C - Fee Submitted

If registering to solicit contributions, fee is $25.

If not registering to solicit contributions,

no fee is owed.

Check <> IW

if you are submitting $25 fee to

register to solicit contributions .

Submit check or money

order,

payable to

"NYS Department of Law."

Part D - Attachments - All Documents Required

Attach all of the following documents to this

Registration

Statement,

even

if you are claiming an exemption from

registration:

• Certificate of incorporation, trust agreement or other organizing document, and any amendments; and See Exhibit A, Attachment 2

Bylaws or other organizational rules, and any amendments;

and See

Exhibit A, Attachment 3

· IRS Form 1023 or 1024 Application for Recognition of Exemption (if applicable); and See Exhibit A

IRS tax exemption determination letter (if applicable) To be provided upon receipt from IRS

Part E - Request for Registration Exemption

Is the organization

requesting

exemption from

registration

* if "Yes", complete Schedule E.

under either or both Article 7-A or the

Page 1 of 3

EPTL?

.

.

0 Yes*

E)

No

 

Form

CHAR410 (2010)

D El

B El

N/A

N/A

Part F - Organization

Structure

1. Incorporation / formation

a. Type of organization:

Corporation

Limited

liability company (LLC)

Partnership

.

Sole proprietorship

Trust

Unincorporated

association

* If Other, describe:

2. chapters,

List all

branches and affiliates of your organization

(attach

Name

El

El

b. Type of corporation

if New York not-for-profit corporation

c El

c.

Date

incorporated

if a corporation or formed

if other than a

m 07/11/20

El

d.

State

in which

New York

incorporated

1

7

or formed

corporation

additional

sheets

if necessary)

Relationship

Mailing

address

City or town,

(number and

street,

room/suite,

state or country and zip+4)

3. officers,

List all

directors,

trustees and

key employees

 

Mailing

address

(number and

street, room/suite,

Name

Title

city or town,

state or country and zip+4)

See

Exhibit B

End of term

(if applicable)

1 1

1 1

1 1

4.

Other Names and

Registration

Numbers

a.

List all

N/A

other names

used

by your organization,

including

any prior names

b.

List all

prior New York State charities

registration

numbers for the organization,

including those from the

Charities

Bureau or the

New York State

Department of State's

Office of Charities

Registration

1 1

1 1

1 1

1 1

1 1

New York State Attorney General's

Start date:

Part G - Organization Activities

1.

Month the annual

12

accounting

period

ends

(01-12)

2.

NTEE code

N32

3.

4.

Date organization

began doing each of following

a. conducting activity

b. maintaining assets.

.

in

New York State:

c. soliciting contributions (including from residents, foundations, corporations, government agencies, etc.)

··311/11/-2018

.

.

.

.

.

.

.

.

.

_N/A-/

/_-

Describe the

purposes of your organization

The

purpose of the organization

is to own,

plan,

program,

operate,

maintain,

secure,

and

improve for

in the

public recreational and other charitable purposes the publicly accessible open space located

Borough

of Brooklyn,

City and

State of New York, to

be

known as

Pacific Park,

being

developed as

part of the

Atlantic Yards

Land

Use

Improvement and

Civic Project.

5.

Has your organization or any of your officers,

directors, trustees or key employees been:

a.

enjoined or otherwise prohibited

by a government agency or court from soliciting

contributions?

.

*

If "Yes",

describe:

b.

found to have engaged

in

unlawful

practices in connection with the solicitation or administration of charitable assets?

.

6.

* if "Yes", describe:

Has your organization's

* if "Yes", describe:

registration or license been suspended

by any government agency?

.

0

Yes* 13 No

.

0 Yes*

~ No

0

Yes*

1 No

7.

8.

Does your organization

solicit or intend to solicit contributions

(including from

residents,

agencies,

*

If "Yes",

etc.)

in

New York State?

describe the

purposes for which

contributions are or will

be solicited:

foundations,

corporations,

government

Il Yes* ZA No

The organization

does

not currently solicit or have

plans to solicit contributions in

New York State.

However,

in the future,

it may decide to solicit contributions to be used solely in furtherance of its charitable purposes related to the operation

and

maintenance of Pacific

Park,

for the

benefit of the

public.

List all fund

necessary)

Name

N/A

raising

professionals

(FRP) that your organization

Type of FRP

(see instructions for definitions)

PFR

0

FRC

0

CCV

PFR

0

FRC

0

CCV

PFR

FRC

CCV

0

has engaged for fund

raising

activity in

NY State (attach

Mailing address

city or town,

(number and street,

room/suite,

state or country and zip+4)

additional sheets

if

Dates of contract

End date:

Start date:

End date:

Start date:

End date:

Part H

- Federal

Tax Exempt Status

1.

If applicable,

list the date your organization:

 

a.

applied for tax exempt

status

 

.08/03_/2-018

b.

was granted tax exempt status

.M/8-/

/

c.

was denied tax exempt status

_NIA/

/

d.

had

its tax exempt status revoked

 

2.

Provide

Internal

Revenue Code

provision:

501(c)(3)

EXHIBIT B

BOARD OE

DIRECTORS

End of Term

(and until such

Director's

successor has

been

Name

Title

Address

 

appointed and

 

qualified)

 

Brooklyn Community Board 8

Glinda Andrews

1291 St. Marks Avenue

 
 

Director

Brooklyn, NY 11213

 

12/15/18

 

Empire State Development

 

Corporation

 

633 Third Avenue

 

Alyson Beha

Director

New York, NY 10017

 

12/15/18

 

1

Metrotech Center,

18th

Floor

John Bowen

Director

Brooklyn, NY 11201

 

12/15/18

 

1

Metrotech Center,

18th

Floor

Christina Chao

Director

Brooklyn, NY 11201

 

12/15/18

 

L &

L MAG

 

Ashley Cotton

Director, Chairperson,

594

Dean Street

 

and President

Brooklyn,

NY 11238

 

12/15/18

 

1

Metrotech Center,

18th

Floor

Jen Kuang

Director

Brooklyn, NY 11201

 

12/15/18

 

NYU Tandon School of

 

Engineering

 
 

15

Metro Tech Center, 6th

Floor

Sayar Lonial

Director

Brooklyn,

NY

11201

12/15/18

 

New York City Department of

Parks and Recreation

 

The Arsenal

 

Central Park

Ma rtin M a her

Director (non-voting)

New York, NY 10065

 

12/15/18

Brooklyn Bridge Park

Corporation

334 Furman Street

Suma Mandel

Director

Brooklyn, NY 11201 550 Vanderbilt Avenue, Unit

 

1009

Josie Mok

Director

Brooklyn, NY 11238

Stephanie Rosenberg

Clifford Schwartz

Scott Solish

Director and Secretary

Director and Treasurer

Director

1

Metrotech

Center,

18th

Floor

Brooklyn, NY 11201

 

1

Metrotech

Center,

18th

Floor

Brooklyn,

NY

1-1201

1 Metrotech

Center,

18th

Floor

Brooklyn, NY 11201

12/15/18

12/15/18

12/15/18

12/15/18

12/15/18

COPY OF WITHIN PAPER

RECEIVED

SEP 0 4 2018

GENS'F~\t,

NYS OFFICE OF THE ATTORNEY

CHARITIES BUREAU