G Check all that apply: Initial returnInitial return of a former public charity
Final returnAmended return
Address change Name change 2. Foreign organizations meeting the 85%
test, check here and attach computation ...

H Check type of organization: Section 501(c)(3) exempt private foundation
Section 4947(a)(1) nonexempt charitable trust Other taxable private foundation

I Fair market value of all assets at end
of year (from Part II, col. (c),
line 16)$6,954,990J Accounting method: Cash Accrual
Other (specify)  
(Part I, column (d) must be on cash basis.)

1 List all officers, directors, trustees, foundation managers and their compensation. See instructions

2 Compensation of five highest-paid employees (other than those included on line 1—see instructions). If none, enter “NONE."

1Information Regarding Foundation Managers:

aList any managers of the foundation who have contributed more than 2% of the total contributions received by the foundation
before the close of any tax year (but only if they have contributed more than $5,000). (See section 507(d)(2).)

bList 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.

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