Merare! TO+Y 01 $0 0001 Yery MMe Return of Private Foundation oF Section 4847(a)() Trust Treated as Private Foundation Do not entar Social Security numbers on this form as it may bo made public. i 2 s i 2 a For calendar year 2019 or fx year beginning and ending Tine of en 1 Spr Tea Adelson Family Foundation ‘Nonber and eet (0.0 ox robe Fa no eben RTE) Roa 7024330 300 Fist Ave. "Teo roe aden hy own Sam ae Needham Ma 2494 (781) 972-5950 Pea ema Teng oman rae fons [© vemnpti epatin penarg. cxartos >] S Check aiat apply; [] tial etum [tial alum ofa former public charly | © 1. Faceneqarasns, echo -o GF inatretn EE] Amend return 2. Fenestra ecg 8, TAddress change _C) Name Seateemeaeacmpae +E] H Check ype oforgantation: [x] Section 507(6\) exempt private foundation © apna astern G Section 4947(8)(1) nonexempt charitable trust_[] Other taxable private foundation _— e T Foirmarket value of ell assets at | J Accounting method: C] Cosh L) Accrual end of year (rom Pat co. (2), BH omer (epecity) Mi ' vacneroceeet ee +L ine 16)» $ 25,943] (Part, column () mutt been cach basis) TIN Analyois of Revenue and Expenses (The w/o! | 1) nevnand i Danaea amounts in columns (8). (c), end (@) may not necessanly | “‘bipeneaper | (©) Netlvaatrent | (0) Aduednet | tr chaabe equal the amounts in column (a) (see instructions).) poke foash basis ony) 1 Contributions, gifs, grants, etc, received (attach schedule) 53,250,124] ~ 2 Check >] he foundations nat required atch Sh. 8 z 3 Interest on savings and temporary cash investments Ti] Ties] 44 Dividends and interest fom secures, Ba Gross rents b_ Not rental income or (loss) 6a_Net gain or (loss) from sale of assals not on ine 10 1b Gross sales price forall asses on ine 62 2 Capital gain net income (from Part V.Tine 2). 8 Net short-term capital gain. - i 9 oa b Revenue Income modifications : i Gross sales less rtums and slowances Less: Cost of goods sold Gross proft or (loss) (attach schedule) E Other income (attach schedule) : a Total. Add ines 1 through 11. [33251367 1.188 of ‘Compensation officers, directors, rstees, ele = = 157214 serait Omer employee saianes anawages [== Pension plans, employee benefits. : 2435 738 Legaltees (tach schedule) ss. 751,840 751.000 Accounting fee (attach schedule) Other professional fees (attach schedule) 2268 2286 Interest cece Taxes (attach schoduie) (see instructors) 7007 ao Depreciation (atach schedule) and denietion 756 a E} 20 oceupaney 2... oe Z| 21 Travel, conferences, and meetings 1642 16482 | 22 Printing ne pubtcations 5] 23 omer expenses (atach schedule) ae 134540 as B) 24 Total operating and administrative expenses. B| Add ines +3 trough 23, 488,240 ol _ 487,404 §| 25 Contrbutons, gts, grants paid... s2Bi2216| wzs12216 [28 _Totlerpenses and disbursements Addins 2and25| 59,000 456 A 53,200,700 2 Subiract ine 26 from line 12: ae 1 . 2 Excess of revenue over expenses and disbursements... 49.068) i Net investment income (f negetve, enter -0-) RC <_ Adjusted net income (t negatve, enter 0) a For Paperwork Reduction Act Notice, see Instructions. om S50-PF cnt) a1 a / 3 7 2 Fem o00-PF (2019) Adelson Family Foundation 04-7024350 page 2 eu ‘Machel sees end avast escigin can |_Boginning f year En of year MEIETE Balance Sheet dba txendotyeaunantscy.(Sevsiusins) |" (yesoevxe | yBontvoue |) FarNare vw 1 Cash—norinterest bearing 73,334 25,000] 25,000, 2 Savings and temporary cash investments 3 Accounts receivable Less: allowance for doubtful accounts 4 Pledges receivable D Less: allowance for doubtful accounis 6 Grants receivable... 0... 6 Receivables due fom officers, directors, trustees, and other disqualified persons (attach schedule) (see instructions) 7 Other notes and inns reosivable(atiach schedule) Less allowance fo doubts accounts 8 Inventories for sale or use 9 Prepaid expenses and deferred charges 40a _Ivestnents-—U.S. end stat goremmenobigaons (tach schedule) Investments —corporate stock (attach schedule) € Investments—corporate bonds (aiach schedule). . 11 ivestnens—land bugs, and equpment bass 7 aa J Less: acme deprecation aac shade) 42 Investments—mortgage loans 13 Investments—other attach schedule) 44 Land, ulin, end equipment bass nn ; Less: acute depreciabon (atac schedie) oat 16 Otveraccote (doccribo m y 16 Total assets (io be competed by all fiere—see the instructions. Also, see page 1 er : 75,030] 25,941 25,941 17 Accounis payable and accrued expenses 1 18 Grants payable i 49 Deford revenue 20 Loans tom oftcers, crete, rstes, and oer equate percens | 21 Morigages and other notes payable (attach schedule) | ‘22 Other liabilities (descnbe > ) | 23 Total labiltes (add ines 17 though 28) : a] nH | Foundations that fotlow SFAS 117, check here > | 8] and completa tines 24 through 26 and tines 30 and 31. | El 26 Unestited ee 75,030] 2seai] « ; | 2% Temporary restricted i S| 26 Permanent restricted | S| Foundations that do not follow SFAS 117, check here ® | ©} and complete lines 27 through 31. : 5) 27 Capital stock, trust principal, or current funds 3 28 Paid-in or capital surplus, or land, bidg., and equipment fund | 29° Retained earings, accumuintd income, endowment, or oes funds <} 30 Total not assets or fund balances (see instuctons). . . =) 25,941 $|s1teultemtenatmoriemenes | instructions) ee 75,930] oat | ‘Analysis of Changes in Net Assets or Fund Balances Total sal or nd ances at begorig of yeat—Part cohen (ae 3 (ust apo wih end-of-year figure reported on prior year return) : 4 75,030 2. Enter amount from Part, tne 272 2 49,088 3. Other increases not included in line 2(temize) > 3 4 Addines 4,2, ond 3 4 259m 5 Decreases not included in line 2 itemize) > 6 6 Total net assets or fund balances at end of year (ie 4 ins ine Sf “PUA colin ie 25a Ferm 980-PF (2013)a 1 ‘ Fem200- 2013) __ Adelson Family Foundation 04-7024330 pape 3 3 ‘Capital Gains and Losses for Tax on Investment Income 7 Fox sonnet 7 (0) son ese ebro oper so (6.9, ret eae ‘€)oate cures | (6) Dew sos : ary bck wane, earner Sat MOR MUS CO Sees | taeccorey | tm.) a ie a b d e (beget awe (o) Cato ce ens (pha a tou (0) res aes rca ca Shs oxpoe tan copa mo b € : ‘Comptes on fo assets showing gain lh courn (i aed wared by the Foundation on T2769 erect nenee FAny ance 209K ed peat. 0 a etree hoe b € d e ! Tf gain, sso entarn Part, ino 7 2 Capita gainnatincome or(netcaptaltossy { 20m agaeniern Pont tee? yl - 3 Net short-term capita gain or (loss) a8 defined in sections 1222(5) and (6) i gehen entra 6, column sso takuctoneh. oma, are- +n} Parti, tne 8 3 o ‘Qualification Under Section 4940je) for Reduced Tax on Net Investment Income (For optional use by domestic private foundations subject tothe section 4940(a) tax on net investment income.) 1 section 4940(6)(2) apes, leave this part blank \Was the foundation able forthe section 4942 tax on the distibutable amount of any year in the base period? 1 Yes J No 117Yees, the foundation does not qualfy under section 4940). Do nat complete this part Enter the appropriate |mount in each column for each year, see the instructions before making eny enties. o @ ‘ase pai years o 2 Distation ato ee y_|__Mteduaihing devtiors | nett trondataboves ones | a, DEERE 2012 5 267,772 786,488] 242.845502 2011 21,914,855] 115,347] 168, 990706 Zow 1773629 Z0.982] 17.8796/7 2008 31,539 495| 47,244) 667.587313, 2008. 55,178,667] 210,192] 262.515543 2 Totalof ne 1, column (6) 2 2,100.816741 3 Average distribution ratio forthe S-year base period—divde the total online 2 by , or bythe number of years the foundation has been in existence iless than 5 years 3 436.183748 4 Enter the net velue of noncharitable-se assets for 2013 from Part X, tine 5 4 646,525 5 Multi tine 4 by tne 3 : ‘ -. [8 2,903,534 6 Enter 1% of net investment income (1% of Part, line 276) 6 42 7 Addlines Sané6 .. . . aoa z 281,903,546 8 Enter qualifying cistibutions from Part XI, Ene 4 8 53,209,700 {tine 8 is equal oor greater than Kine 7, check the box in Pat VI ine 1b, and complete that part using a 1% lax ale. Soe he Part i instructions. Farm 980-PF ois)Fomeesr ors) ___Aeton Family Foundation 04-7024330 paged EEN excise Tax Gased on investment income (Section 404(a), cOs0b) AAU), or AS49 eno structions) 1 Erenp open buain descibedin secon SHGK2, cece > L] and enfer"NA" online 4. —] Cate of ruling or determination fetter: (attach copy of letter if necessary—see instructions) Domestic foundatons tat mee he sean aB40(e) requirements in Pat V, check here > C) ard enter 1% of Pat, ne 70 i Aller domestic foundations entar 2% of tin 270. Exempt oeign organizations enter 4% of Part ne 12, 3. (0) 1 7 a 7 2 ° ‘ 2 Taxunder secon 511 (domestic section 4047(o)(1) tris and taxable foundations ony. Others enter.) |2 | | 3 Add lines t and 2 3 24] 4 Sail A (income tax (domestic section 4947) trust a taxable foundations ony. Others enter) 4 6 Tax based on investment income. Subtract line 4 from fine 3. zero or less, enter -0- 5 24] 6 Credits/Payments: 1 4 21Detinated tex yen and 2012 oepaymentcreteaio 2019 | a 29] | y. 1b Exempt foreign organizations —tax withheld at source sb | Tax pald wth application fo extension of tne to fle (Form 8868) 6c. 200) d_ Backup withholding erroneously withheld 64 ! 7 Total ceclis and payments. Addines 6athough Gd... Fe 8 Enter any penalty for underpayment of estimated tax, Check here] if Form 2220/is attached 5) Tax du. ifthe ltl of nes 3 and more than ne 7, eter amount owed > dl {9 Overpayment tne 7 er han tie and etre aout ove > Zs Enior he amount fine 10 tobe: Credited to 2014 estimatod tax 215| Refunded » [11 a Statements Regarding Activities ‘During the tx year, i he foundation attempt oinflvance any natnal wae, or ocal legion or idk = [ves no Participate or intervene in any political campaign? . . . . . . ta x 1b Did it spend mere than $100 during the y Instructions forthe definition)? . . 110 answor is “Yes"t0 1 oF 1b, ettech @ dotalod description ofthe actives and copies of any materials published or distributed by the foundation in connection with the activites, © Did the foundation file Form 1420-POL fortis year? . . . 4 Enter the amount (i any) of tax on politcal expenditures (section 4965) imposed during the year: (1) On the foundation. > $ (2) On foundation managers. >S ‘© Enter the reimbursement (any) paid By ihe foundation during the year for poltical expenditure tax imposed fon foundation managers. 2 Hes the foundation engaged in any actviies that have not previously been reported to the IRS? 11 Yes," attach a detailed description ofthe actives. 3. Hes the foundation made any changes, not previously reported tothe IRS, ints governing instrument, articles oficarprain,o bon, les sranans? "Yas tach a coomod cop fe changes Did the foundation have unrelated business gross income of $1,000 or more during the year? 17¥es,"has it fled a tax return on Form 990-T for this year? . : Was there 9 Byuidaion, termination, vnsoliin, or subslanial conbolion ding the year? |. I "Yes,"altach the statement required by Genre! Instruction T- 5 Are the requirements of section 608(e) (relating to sections 4941 through 4945) saisfied ether: ‘By language inthe governing instrument, oF ‘© By stato legisiaton that effectively amends the governing instrument so that no mandatory directions that confict withthe state law remain in the governing instrument? at 7 Didteunaten have test $5.00 ssa nye ig ha yea? Yes, complete Pa i, ek (9 and Pat XV 8a Enter the states to which the foundation reporss or with which itis registered (see instructions) (ether dvecty o indiecty) for pica purposes (see cot Ifthe answer is "Yes" ished a copy’ (0: designate) of each state as requited by Genera! Instruction G? If No," attach explanation 9 Is the foundation claiming status as a private operating foundation within the meaning of section 4942()(3) 428) aed yea 2013 tral yer Dein 2013 (senso fr Pan XN? ney Yes," comptote Part XIV 8 x 0 oes any arvons become substan contibuor ding the oe “yea? tes" tech 2 sched filing oir names and adcrossos 0 x Fam 990-PF (e013)FomssoPF 2013) Adelson Family Foundation 04-7024330 page 5 [EERIE Statements Regarding Activities (continued) 41 Atany ime during the year, did the foundation, directly or inirecly, own a controled entity witin the meaning of section 512(6\13)? If"Yes." attach schedule (see instructions) 12 Did the foundation make @ distribution to a donor advised fund over which the foundation ora disqualified person had advisory privileges? "Yes," attach statement (see instuctons) 13.0 tne foundation comply wth the pubic inspection requirements forts annual eluns and exemption appeation? Website address _waw.adelsonfoundationorg 1“ felephone no. ZiP4 18 Section 4947(a)(1) nonexempt charitable truss fling Form 960-PF in lieu of Form 1041—Check here ‘and enter the amount of tax-exempt interest received or accrued during the year ae > Ls a x I> 16 Atany time during calendar year 2013, did the foundation have en interest in or a signature or other authority over 2 bank, securities, or other financial account in a foreign country? . Sethe instructions for exceptions and fling requirements for Form TD F 80-22.1. "Yes enter the name of the foreign country En ‘Statements Regarding Activities for Which Form 4720 May Be Required File Form 4720 if any item Is checked in the "Yes" column, unless an exception applies. ta__Duting the year i the foundation (ether directly or indirecty) (1) Engage in the sale or exchange, or leasing of property with a disqualified person? Oves no (2) Borrow money from, lend money to, or otherwise extend credit to (or accept from) a Gisquaiified person? : Cres No (3) Furnish goods, services, of facies to (or accept them from) a disqualified person? ves Lo (4) Pay compensation to, or pay or reimburse the expenses of, a disqualified person? Byes Ono (8) Transfer any income or assets to a disqualified person (or make any of either available for the benef or use ofa cisqualfed pereon)? . Five Biv | (6) Agree to pay money or propery toa government oficial? (Exception. Check "Noi the foundation agreed to make a grant to or to employ the official for a period after termination of goverment serve, terminating win 80 days) Oves no b Ifany answer is "Yes" to 12(1)-{6), did any of the acts fall to qualify under the exceptions described in Regulations section §3,4941()-3 orn 2 current notice regarding disaster assistance (see instructions)? Organizatone ring on curennotce egardng deter asstance check here ‘oO € Did he foundation engage ina pir yearin any ofthe acts describe in 1a, otter than excepted acs, that ‘were not corrected before the first day of the tax year beginning in 2013? 2 Taxes on failure to cistrbute income (section 4942) (does not aply for years the foundation was a private ‘operating foundation defined in section 4942()(3) or 4942()(5)) a Atthe end of tax year 2013, cid the foundation have any undistributed income (ines 6¢ and 6e, Part Xi) for tax year(s) beginning before 20137 Oves (No ltrYes."listtheyeers 20.20.20, 20. b Ave there any years liste in 2a for which the foundation is not aoplving the provisions of 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 instructions.) ¢ Ifthe provisions of section 4942(a)(2) are being applied to any ofthe year listed in 2a, ist the years here, ‘arm 990-PF (2013)Form 99097 (2019) ‘Adelson Family Foundation 04-7024330__ page 7 GENEVE Information About Officers, Directors, Trustees, Foundation Managers, Highly Paid Employees, and Contractors (continued) 3 Five highest-paid independent contractors for professional services (sea instructions). if none, entor “NONE” ba ane een den pect pt ne Su Ooi cents ‘cee ‘bo Stte St, boston, Wa 8 Leger 151940 “Total ocers receiving ove $50,000 To prcessonal sanices efesereseccecece ‘Summary of Direct Charitable Activities ‘ss aia singed crane ech fo Pcs et a an er “ayers en ober bene tevez cferences Cowen, seme pages POS, 1 Farm 990-PF (013)1 7 a 7 2 ° ‘ Fameso7r (2013) Adelson Family Foundation ‘Minimum Investment Return (All domestic foundations must complete this part. Foreign foundations, see instructions.) 04-7024320 page 8 7 Fair market value of assets not used (or held for use) directly in carving out charitable, e., purposes: ‘Average monthly far market value of securities ‘Average of monthly cash balances Fair market value ofall other assets (see instructions) Total (add tines 12, b, and c) Reduction claimed for blockage or ther factors reported on lines 1 and ‘1c (attach detailed explanation) Acquisition indebtedness applicable to line 1 assets ‘Subtract line 2 fom line 1d. Cash deemed held for charitable activites. Entor 1 % % of fine 3 (for greater amount, soe instructions) Net value of nonchartable-vse assets. Subtract ne 4 from ine 3, Enter here and on PartV, tine 4 Minimum investment return. Enter 5% of ine 5 [| id 655,168 9,843 345,325 32316 Distributable Amount (see instructions) (Section 4942{)(3) and ()(8) private operating foundations end certain foreign organizations check here __ [_) and do not compete this part) Minimum investment retum from PartX,line6.. Tax on investment income for 2013 from Part VI tine 5 2a 2a 32516 Income tax for 2013. (This does not include the tax from Part VL)... 2 Addlines 2aand2 0... ee ee Distreutable amount before adjustments, Subtract ie 2c from fine 1 Recoveries of amounts treated as qualifying distributions ‘Add linee 3 ond 4 Deduction rom disbibutable amount (see insinctons) Distributable amount os austed. Suva ine fom Ine 5, Ener here and on Pari, line 1 24 32,292 33282 Jor ]on]a [eo] 32.202 Qualifying Distributions (see instructions) 7 > 2 "Amounts paid (including administrative expenses) to accormpish charitable, et, purposes: Expenses, contributions, gis, etc.—total from Pat |, column (d), ine 28 Programelated investirents—total from Part X-B ‘Amounts paid 1o acquire assets used (or held for use) deci in carrying out chartable, ete, purposes : ‘Amounts set aside for specific charitable projects that satisfy the: ‘Suitability test (prior IRS approval required) : Cash distribution test (attach the required schedule)... Qualtying distributions, Addins 1a tough 2b, Enter here and on Par V, fine 8, and Pert il ne 4 FFoungavions tnat quay under section 4940(0) for ie reduced rate of tax on net Investment income. Enter 1% of Part |, ine 27b (see instructions) Adjusted qualifying distributions, Subtract line 5 from line 4 $3,290,700 33,206,700, 53,298,700, Note. The amount on fine 6 willbe used in Part V, column (b) in subsequent years when calculating whether the foundation qualifies for he section 4940(6) reduction of tax in those years. Fam 990-PF (ory)2 f Fom9s0-PF (2013) Adelson Family Foundation 04-7024330 page 9 3 Undistributed Income (see instructions) i o 5 & a : 4. Disubutable amount for 2013 trom Part, com Yew prio 012 a =n i foe 7 ] 32,282 ‘ 2 Undistibuted income if any, 25 ofthe end of 2013: eee 8 Enter amount for 2012 only... : a Total for prioryears: 20 20__,20, | 3 Eset dan cmos ary. 1028 1 | 8 From 2008 : $4,059,671 ys » From2000 22... . [sissza77 | © From2010 17.135,194 4 From2011 © Fiom2012 2. 45,278,465] f Totatoflines 3a trough € 169,528,510 4 Quaiiying disibutons for 2013 fom Part Xl, fines: ® $53,290,700 2 Applied to 2012, butnot more than ine 23 - Applied to undistributed income of prior years (Elec required 200 instructions) Treated as distributions out of corpus (Election reauired—eee instructions) oe d Applied to 2073 distributable amount . . . | 4 32,292 © Remaining amount dstibuied out of corpus 3527 aa a 1 5 Excess distributions caryover applied to 2013, (fon emount eppeerin column (4) tho samo 1 1 ‘emount mist be shown in column (@},) | 6 Enter the net total ofeach column as indicated below: Corpus. Add nes 3, dc, and 4e, Subtract Ere 5 723,187,038 : Prior years undistibuted income, Subtract | tne 4 rom ine 2 : | ¢_Enter the amount of prior years’ undistributed | + | 1 | 1 21200 108 | | j } | | inoare for ich anos of clonoy hes | boon sued of on which he eecion 40020) | | Ie ‘tax has been previously assessed 4 4. Sublet ne erm ine 6, Taxable ameunt_ceetrevucions = Uncle ince for 2012 Soiac ine {arfom ine 2a Toxble omount_see acu : ce | | A 1 Uncistned income or 20%, bt ines tT 1 ‘end tom ine Tis amount mus be | dotibed 2004 17 -ameunia tested os dnons ou of conus to satisfy requirements imposed by section 170{b\{ IMF) or 4942(g)(3) (see instructions) 8 Excess dtrbutons caryover fom 2008 nt 1 sppied on ine Sone 7 (ee insbuctons) ssossen| : | ! 9 Excess distributions carryover to 2014. | Subtact nes 7 and 8 fom ine Sa 169,327,347 i 10 Anatesoftre 9 2 exces fom 2008 aiso7a7 Excess from 2010 17,125,191 | © Excess from 2081 21,509,106 | @ Excess from 2012. |». | 48276455 : | | i excess from 2019 | | | | 53267409 Fam 980-PF Gora)Form 990-PF (2013) Adelson Family Foundation 04-7024330 10 FREI _ Private Operating Foundations (cee insirucions and Pan VIFA, question) N/A ‘1a the foundation has received a ruling or determination letter that isa private operating foundation, and the ruling is effective for 2013, enter the date ofthe ruling > ‘Check box to indicate whether the foundation is @ private operating foundation described in section |] aadagryor [] a3da5) > 2a Enter the lesser ofthe adjusted net Texyeat Poe 3 years income from Part tor the minimum investment um fom Pe tor CED EM a 1a 10 (o) Tou each year listed b 85% of ine 2a €Quallying distibuions fom Part Xl, line 4 for each yesr listed Around in ine 2 nosed ety foc active conduct of exempt actos © Qualifying distibutions made directly for active conduc of exempt activities. ‘Subtractline 2d from line 2c... 3 Complete 32, b, or ¢for the atemative test relied upon: 2 “Assets” alternative test—enter (1) Value of al assets (2) Value of assats qualiyng uncer section 49425(3)(8)(!) 'b “Endowment siemative test—enter 23 cofrminimur investment returs chown in PartX, ine 6 foreach year Isles. “Support alternative test—enter (1) Totel suppor ether then gross investment income (interest, 30] 51,245,853 Fem 990-PF (2013)1 a / 3 7 2 Fem S807 (2013) ‘Adelson Famity Foundation 04-7024330_ page 12 ‘Analysis of income-Producing Activities Enter ross amounts unless otherwise indicated. Unekiedianessinane | Eebiethyoxin sz siase [ Oy © Cc) (| Stabe name 1. Program service revenue: Jevsiness cooe| amount excision cace} Amount | (See neivcors) 2 Contributions received "900089, 53,250,124 (9. Fees and contracts from goverment agencies ‘Membership dues and assessments Interest on savings and temporary cash Investments ‘900089 Dividends and intorest from securities Net rental income or (loss) from real estat: i ‘2 Debt-inanced property b Not debtfinanced property 0... Net cental income or (loss) from personal property (ter investment income = ‘Gain o (oss from sales of assets other nn inventory Net income or (loss) from special events Gross profit or (oss) from sales of inventory ‘Other revenue: @ IRS refund 2009 return "900089, a a 12 Subjotal Add columns (B), (@), and e) Q | o| 83,251,367 13 Total. Add line 12, columns (b), (2), nd (e) See cry 53,251,367 (See worksheet in line 13 instructions to verity calciations.) GEMEAUEY _ Relationship of Activities to the Accomplishment of Exempt Purposes: {Une No. | Explain below bow each acy for which income i report in column (6) of Part XVI-A contributed important tothe v accomplishment ofthe foundabon's exempt purposes (ther than by proving funds for such purposes) (See instruckons ) 1 [Contributions recelved suppor the Foundation’s grant making. 3 Interest eared directly supported the funding efforts for grants end donations given during the year, “11__[Other income received directly supports the Foundation’s funding efforts for grants and donations given during the year “11 income was from an IRS refund fora prior yea “11 [Funds were then used for curent year contributions, Farm 980-PF (2013)7 __ Did the organization direciy or indreclly engage in any of the folowing with any other organization described Tres] No, in section 501(c} ofthe Code (other than section 501()(3) organizations) or in section 627, relating topotteal | i coxganizations? ] 1 Taser tom he etn foudaton oa oncharal exempt epanzaon | 4 J (1) Cash see oe ait x (2) Other assets fail [x Other transactions: (eee ee (1) Sales of assets to a noncharitable exemot organization eee Heel (@) Purchases of assets ftom a nonchartable exempt organization + free Tox (3) Renta of facilis, equipment or other assets. fee eee ears : tao] [x (4) Reimbursement arrangements... : ee away] | x (6) Loans of loan guarantees ee laogeyf fc (6) Pecformance of services or membership or fundraising solicitations foie [x ‘¢ Sharing of aces, equipment, malng lists, other assets, or palé employees... te, x. 4 the ansne to any ofthe above is "Yes, complete the folowing schedule. Clurn(b) should aways show the at market ‘ae ote gods oer sr snes gen byte earn onan. foundston recedes than ret vale in any transaction or sharing arrangement, show in column (d) the value ofthe goods, other asses, or services received, Teitnene. | W)Anontiwohed | (e! Nae cancers enol operation (Gl Oeergten owners, wesecis and sare erengenerts 2a_ Is the foundation directly or direct affliated with, or related fo, one or more tax-exempt organizations described in section 501(c) ofthe Code (other than section 501(c)(3)) or in section 5277 Cl Yes 0 No b_tf"Yes." complete the following schedule. (a) Hae ot erpenzten [Wipe expen {EI Deseotan ot este Thi ey, gal a TGS NOT Te BDL iS DEL ET sian] cons Doe en re bad art wh pepe oe asa jo~34¥ Ye lem aa Here | mea ana mabe & inroamre Pag [oie peers ae are oa Or P™ Preparer Sesto O'Connor isco. potza7s14 Fiuissane + Stephen J O'Connor Finis GIN ® 27-3942383 Use ONIY| rns geese » 300 First Avenue, Needham, Mh 02604 781-707-2540 Fam 980-PF cars)Adeison Family Foundation Recipients) paid during the year Name Binai Brith Youth Organization ‘Street 2020 K St. NW, 7th Floor 04.7024330_Page 1 _of 9 Continuation of Part XV, Line 3a (990-PF) - Grants and Contributions Paid During the Year City ‘Washington [zip Code {20006 Foreign Country Relationship Foundation Status PC Purpose of graniicontribution General chartable purposes. Name nai Zion Foundation, ‘Street 136 Esat 30th St [Amount 509,000 City New York [Zip Code 10018 [Foreign Country Relationship Foundation Status PC. Purpose of granticontribution General charitable purposes Name Braille Institute of America ‘Street 70.251 Ramon Rd. [Amount 35,000 ity Rancho Mirage [Zip Code 192270 Foreign Country Relationship Foundation Status PC. Purpose of granticontribution General charitable purposes. Name Brandeis University ‘Street 415 South St. MS O14 [Amount ity Waltham Stato MA [zip Code jonas Foreign Country Relationship [Foundation Status Pc. Purpose of granticontribution General charitable purposes Name ‘Center for Jewish Community Studies ‘Street 7 Church Lane Suite 9 [Amount 1.000 ‘city Baltimore [zip Code 121208 [Foreign Country Relationship [Foundation Status PC. Purpose of granticontribution General chartable purposes. Name Chabad of Summertin ‘Street 2640 Regatta Or. [Amount 4,900,000, City Las Vegas [zip Code" 189128 [Foreign Country Relationship [Foundation Status Pc. Purpose of granticontribution General charitable puposes [Amount 6.500Adelson Family Foundation. 047024330 Pago 2 of 9 Continuation of Part XV, Line 3a (990-PF) - Grants and Contributions Paid During the Year Recipient(s) pald during the year Name Chelsea Jewish Nursing Home Foundation ‘Steet 17 Lafayette Ave, city State [Zip Code Foreign Country Chelsea MA_|o2150 Relationship [Foundation Status Purpose of grantcontibation amount ‘General cnartable puposes. 200,000 Name Christians United for sraet ‘Street £3520 North Buffalo Dr ciy Suave [Zip Code Foreign County Las Vegos nv_lesi29 Relationship [Foundation Status Ipc Purpose of granticontribution [Amount General charitable purposes 425,000 Name Gity Ans ‘Street 525 Broadway, Suite 602 city ‘State [Zip Code Foreign Country New York Ny [10012 Relationship [Foundation Status lec. Purpose of granticontribution [Amount ‘General charitable purposes 40,000 Name ‘Combined Jewish Phitanthropies ‘Street 126 High St city ‘State [Zip Code [Foreign Country Boston MA_|o2110 Relationship Foundation Status PC. Purpose of granticontribution [Amount General chantable purposes. 3,400,000 Name x Miriam and Sheldon G. Adelson Educational Insttule ‘Street ‘9700 West Hillpointe Rd. ity State [Zip code [Foreign Country Las Vegas ny_}e9134 Relationship [Foundation Status Pc. Purpose of grantcontribution [Amount General charitable purposes. 32,000 Name Drug Free America Foundation ‘Street 5999 Central Ave., Suite 301, city State [Zip Code Forelgn Country St Petersburg FL_ [33710 Relationship. [Foundation Status PC. Purpose of granticontribution [Amount General charitable purposes. 100,000,Adelson Family Foundation Recipient(s) paid during the year Name Endowment for Middle East Truth ‘Stroot 1050 Connecticut Ave, NW_ 10th Floor 04-7024330 Page 3_of 9 Continuation of Part XV, Line 3a (990-PF) - Grants and Contributions Paid During the Year city Washington ‘State [Zip Code [20036 Foreign Country Relationship [Foundation Status PC. Purpose of granticontribution ‘General chantable purposes Name Fideity Charitable Gift Fund ‘Street 200 Seaport Bd. [Amount ‘city Boston ‘State [Zip Code lo2210 [Foreign Country Rolationship Foundation Status Purpose of granticontribution General charitable purposes Name Ford's Theater Society ‘Street 514 10th St_ NW City ‘Washington, State oC. IZip Code Amount 2,000,000 [Foreign Country Relationship [Foundation Status Purpose of granticontribution General charitable purposes Name Friends of Israel Defense Forces ‘Street 1430 Broadway Suite 1901 [Amount 250,000 city New York Stato [zip Code 10018 [Foreign County Relationship Purpose of granticontribution General chantable purposes Name Friends of Israel initiative ‘Street 2950 SW 27th Ave. Suite 300 [Foundation Status lpc. [Amount 210,800 ‘city Mami State FL. [Zip Code 33133 [Foreign Country Relationship Foundation Status PC. Purpose of granticontribution General charitable purposes Name Friends of Israel Scouts ‘Steet 575 ath Ave., 11th Floor [Amount +,900,000, city New York [Zip Code 10018 Foreign Country Relationship [Foundation Status PC Purpose of granticontribution General chantable purposes. lAmount 300,000‘Adelson Family Foundation Recipient(s) paid during the year Name Gann Academy ‘Street 333 Forest St 047024330 Page 4 ot 9 Continuation of Part XV, Line 3a (990-PF) - Grants and Contributions Paid During the Year City Waltham [Zip Code lozase [Foreign Country Relationship [Foundation Status Purpose of granticoniribution General chantable purposes Name Gateways Aocess to Jewish Education ‘Street 333 Nahanton St [Amount 100,900 ity Newton [Zip Code Jozass [Foreign Country Relationship [Foundation Status Po. Purpose of granticontribution General charitable purposes Name Gideon Hausner Jewish Day Schoo! ‘Street 450 San Antonio Ro. City Palo Ato [Zip Code [Foreign Country [Amount 10,000 Relationship [Foundation Status pc. Purpose of granticoniribution General charitable purposes Name Gif of Lite Bone Marrow Foundation ‘Street £200 Yamato Rd. [Amount city Boca Raton State [zip Code 33434 Foreign Country Relationship Foundation Status PC Purpose of granticontribution General charitable purposes Name Gis TowrvOr Chadash ‘Street 1417 Coney Isiand Ave. [Amount ‘city Brooklyn, Sate NY. Zip Code 11230 [Foreign County Relationship Foundation Status pc. Purpose of granticontribution General charitable purposes Name Hebrew Senior Lite ‘Street 1200 Centre St. ity Boston [Amount 00,004 State MA [Zip Code 102134 Foreign County Relationship Foundation Status PC Purpose of granticontribution General charitable purposes. fAmount 600,000‘Adelson Family Foundation 047024330 Page 5 of 9 Continuation of Part XV, Line 3a (990-PF) - Grants and Contributions Paid During the Year Recipient(s) paid during the year Name International Association of Jewish Genealogical Societies ‘Street ‘55 Mandalay R¢. City ‘State [Zip Code [Foreign Country Newton Centre Ma_|o2459 Relationship [Foundation Status Purpose of grantcontribution [Amount General charitable purposes 40,000 Name Israel American Council Street $5900 Canoga Ave, Suite 390 City State [Zip Code [Foreign Country ‘Woodland Hils ca_|91367 Relationship [Foundation Status pc Purpose of granticontribation [amount General chartable purposes. 5,000,000, Name Israel Leadership Chub Street 5200 Canoga Ave., Sue 399 ity State [eip Code [Foreign County Woodland His cé_|ot367, Relationship [Foundation Status Pc Purpose of grandcontrbution [Amount General charitable purposes 250,000 Name Israfest Foundation ‘Street £8404 Wilshire Bivd, Sute 1030 city ‘State [Zip Code Foreign Country ‘Los Angeles, cA |90048 Relationship [Foundation Status PC Purpose of granticontribution rAmount ‘General charitable purposes 20,000 ‘Name Jewish Community Centers of Greater Boston ‘Street [333 Nahanton St city ‘Stato [Zip Code [Foreign County Newton a _loz459 Relationship Foundation Status PC. Purpose of granticontribution rAmount General charitable purposes 0,000 Name Jewish Community Center of Southern Nevada ‘Street +1400 N, Rampart Bivd,, Suite 105, ity ‘State [Zip Code Foreign Country Las Vegas Nv_]9123, Relationship Foundation Status Purpose of granticontribution [Amount General charitable purposes, 95,700Adelson Family Foundation. Recipient(s) paid during the year Name Jewish Agency for Israel ‘Street 633 Third Ave., 32nd Floor, Suite C 04-7024330_Page 6 of 9 Continuation of Part XV, Line 3a (990-PF) - Grants and Contributions Paid During the Year ty, New York State NY [Zip Code 10017 Foreign Country Relationship Foundation Status Purpose of granticontribution General chantable purposes Name Jewish Federation of Las Vegas ‘Street 2317 Renaissance Or [Amount 2,000,000 ity Las Vegas [Zip Code lest19 Foreign Country Relationship Foundation Status Purpose of granticontribution General charitable purposes Name Jewish News Service ‘Street 214 Lincotn St ‘city Boston [Zip Code Jozi [Amount [Foreign Country 919,045 Relationship [Foundation Status PC. Purpose of granticontribution General charitable purposes Name Lubavitch Foundation of Lexington ‘Street $ Burlington St. [Amount 300,000 City Lexington ‘State [Zip Code 102420 Relationship [Foundation Status Ipc. Purpose of granticontribution General charitable purposes Name Machne Israel ‘Street 770 Eastern Parkway [Amount 36,000 ‘city Brooklyn, State [Zip Code 31213 [Foreign County Relationship Foundation Status PC. Purpose of granticontribution General charitable purposes Name McGill University ‘Street 817 Sherbrooke St. West city Montreal, OC. Zip Code HBA 26, Foreign Country (Canada Relationship Foundation Status Po Purpose of granticontribution General charitable purposes. [Amount 27,000‘Adelson Family Foundation 04-7024330_Page 7 _of_9 Continuation of Part XV, Line 3a (990-PF) - Grants and Contributions Paid During the Year Recipient(s) pald during the year Name Middle East Media and Research Insitute ‘Street 1819. Street, NW, Sth Floor ity State ]zip Code Foreign Country Washington oc _|20036 Relationship Foundation Status PC Purpose of grantlcontribution [Amount {General chamtable purposes. 390,000 Name Nevada Partners in Education, Clark County Public Education Foundation ‘Street 4151 Philip stand St ity ‘State [Zip Code Foreign Country Relationship Foundation Status PC. Purpose of granticontribution [Amount General charitable purposes 50,000 Name Partnership for Excellence in Jewish Education ‘Street ‘88 Broad St, 6th Floor _ - City State |Zip Code [Foreign Country Boston MA_lo2110 Relationship [Foundation Status Pc. Purpose of granticontribution [Amount General charitable purposes 0,000 Name PE. F Israel Endowment Funds ‘Steet 317 Madison Ave., Suite 607 ity State [Zip Code Foreign Country New York Ny_|10017, Relationship [Foundation Status pc. Purpose of granticontribution ‘Amount General charitable purposes. 300,000 Name Rashi School ‘Steet [8000 Great Meadow Ro. City ‘State [zip Code [Foreign Country Dedham Ma _|o2026 Relationship Foundation Status Purpose of granticontribution [Amount General charitable purposes 4,900,000 Name Rethink israe initiative ‘Street 633 3rd Ave, Floor 21 city ‘State [Zip Code Foreign Country New York ny_|10017 Relationship [Foundation Status PC Purpose of grantcontribution fAmount General charitable purposes 937,500‘Adelson Family Foundation Recipient(s) pald during the year Name Rodman Ride. ‘Street 40 Lincoln Re 04-7024330 Page 8 of 9 Continuation of Part XV, Line 3a (990-PF) - Grants and Contributions Paid During the Year city Foxborough. [Zip Code Foreign Country Relationship [Foundation Status Purpose of granticontribution General charitable purposes Name Silicon Valley Jewish Film Festival ‘Stroet PO Box 2190, [Amount 40,000 city Cupertino [Zip Code 195015 Foreign Country Relationship Foundation Status Pc Purpose of granticontribution General charitable purposes Name Striar Hebcaw Academ ‘Stroct A00Ames Si. [Amount 6,000 city ‘Sharon [Zip Code 102067 Foreign Country Relationship Foundation Status pc. Purpose of granticontribution General charitable purposes Name Temple Emanuel ‘Street 385 Ward St [Amount 25,000 city Newton Centre State [Zip Code lozase [Foreign Country Relationship [Foundation Status Pc. Purpose of granticontribution General charitable purposes Name “This World - The Jewish Values Network ‘Street 394 Palisade Ave. [Amount 25,000 ‘city Englewood ‘State [Zip Code loves Foreign Country Relationship [Foundation Status lec. Purpose of granticontribution General charitable purposes. Name “Tough Mudder New England ‘Street 45 MetroTech Center, 7th Floor [Amount 639,000 city Brooklyn, ‘Stato Zip Code 11201 Foreign Country Relationship [Foundation Status PC. Purpose of granticontribution General charitable purposes 2,500Adelson Family Foundation 04-7024330 Page 9 of 9 Continuation of Part XV, Line 3a (990-PF) - Grants and Contributions Paid During the Year Recipient(s} paid during tho year Name “Touro Synagogue Strect £85 Touro St ‘city Newport [Zip Code Foreign Country Relationship Purpose of granticontribution ‘General chantable purposes Name Foundation Status PC Volunteers in Medicine of Southern Nevada ‘Street 44770 Hartson Dr, Suite 200 [Amount 10,000 ity Las Vegas [Zip Code jeo121 [Foreign Country Relationship Foundation Status PC. Purpose of granticontribution General chantable purposes Name Zionist Organization of America ‘Street 4 East 34th St. ity New York State iZip Code 10016 [Amount 209,000 [Foreign Country Relationship [Foundation Status Po. Purpose of granticontribution General charitable purposes Name [Amount 2,000,000 ‘Strost city State [Zip Code [Foreign Country Relationship [Foundation Status Purpose of granticontribution [Amount Name ‘Sreet hy State [Zip Code [Foreign Country Relationship [Foundation Status Purpose of grandcontribution [Amount ‘Street city State Foreign Country Relationship [Foundation Status Purpose of grantcontibution Amount‘Adelson Family Foundation 04-7024330_Page 1 of 1 Continuation of Part XV, Line 3b (980-PF) - Grants and Contributions Approved for Future Payment Recipients) approved for future payments. Name American Society of Yad Vashem ‘Street 500 Sth Ave 42 Floor City New York State [Zip Code Ny_|10180 [Foreign Country Relationship Foundation Status PC. Purpose of graniicentribution General charitable purposes. Name [Amount 21,333,333, ‘Street iy State [Zip Code [Foreign Country Relationship [Foundation Status Purpose of granticontribution [Amount Name ‘Steet iy ‘State [Zip Code Foreign Country Relationship [Foundation Status Purpose of granticontribution [Armount Sweet City State |Zip Code [Foreign Country Relationship [Foundation Status Purpose of graniicontribution [Amount Name ‘Street City ‘State [Zip Code Foreign County Relationship [Foundation Status Purpose of granticontribution [Amount Name ‘Sweet cy State Zip Code [Foreign Country Rolationship Foundation Status Purpose of granticontribution lAmount[ i I Part l, Line 44 (980-PF) - Other Income 7 7 7 Revenue and Expenses | Netinvestment | Adjusted Description per Books Income Not Income, TiRS reftind 2009 return: L 7 D Part |, Line 16a (980-PF) - Legal Fees EB 3 2 eo ments Revenue and for Chattable Expenses per | Netinvestment | Adjusted Not | Purposes Description Books Income Income | (Cash Basis Oni) 7 [toute & Cater 151620 } 151,840] 2 Part |, Line 16c (990-PF) - Other Professional Fees 2268 7 9 228 Dabureneris Revenue and for Chortable Expenses per | Netlavestment | AdustodNet | Purposes Descrtion Books income income __| (Cash Basis Ont Teper 20 2-200) 2 Abert Risk Management 89 a Part I, Line 18 (990-PF) - Taxes Toi a a Tor Revenue Dabumements and Expenses | Netinvesiment | Adjusted | for Chertable Description per Books Income Net income Purposes [7 ita Form PC lax expense "000 "boa ("3 JiR ae torpor year 77 7 os. 7020830,non FeniyFounation art, Line 19 (990-PF) - Depreciation and Depletion Bigaeg ate Motos ot Coster | Acamulted Dustin ewes _| __compuiaion Ascot ie tre sasis_| _Dewrecation 7 otis eget aise01t |S 3 152] 3] zy (©7013 CCH Sr Frm Seren, A nt reserves.i | i 2 { Part |, Line 23 (980-PF) - Other Expenses 3 Base 3 a So 7 ‘Revenue and Disbursements 8 Erpersee | Netinvestment | Adjusted Net | for Chattable : Deserioion per Books inom tnoome Purposes i 7 [eank ees a im] 2 Boks, eiSSCIGIGns, Ieee 33 a 3 [Data stooge a3 a3 auras 7318 7318 6 Menbership dues 75000 75.009 [ower expense = 3 7" [Postage shenia and dove TI a ‘8 |Office and computer suppli 405 405) 9 |Telsconmurcatione ma Ta 70 | Urcapiniced rire a SS Tie 7 1 [Shared serves TE 770104ke Fenty Foundeton 04.7024330 Part Il, Line 14 (990-PF) - Land, Buildings, and Eq) Ta at 3a Book Value Book Value Fwy Asset Description Bes. of Year End of Year End of Year "T[eemputer equipment 2017 1,558 oa oa 2 | 0) (©7019 CoH Sra Fem Sarieas, A lt revered| Part VI, Line 6a (990-PF) - Estimated Tax Payments Credit from prior year return First quarter estimated tax payment... ‘Second quarter estimated tax payment ‘Third quarter estimated tax payment Fourth quarter estimated tax payment Other payments: Total Dae ‘Aouti i i § 4.702433 Part Vill, Line 3 (990-PF) - Highest-Paid Independent Contractors for Professional Services Name and address of each person paid more than $50,000 10) Type of service ()Sompensaton Name Lourie & Cutler Tegal Bi 4, Sueet 60 State St "cy ‘Boston ‘ST MA__7P 02108 Explanation crwek i basess] X | Foreign County, Name 2, Sect * ory oF a Explanation cower Beans] —[ Foreign Gouniy Name 3 Set ty oF a. Explanation comer ousens] | Foreign County Name Street cay a ZP. Explanation comer auarens] | Foreign Country Narva 5 Beet * Giy 7 Zz Explanation comes fine] | Forign CountryBe vass20 “ Department of Treasury Notice CA, Internal Revenue Service Taxperiod ____decenber 31,2013 IRS Ogden UT 84201 7 Notice date August 25,2018 Employer 10 mummber 047024330 To contact us Phone 1-877-829-5500 FAX 801-620-5555 045920,477403.177583.10666 1 aT 0. AMET fanned ‘ADELSON FAMILY FOUNDATION ‘SHELDON G ADELSON ET AL TTEE 300 FIRST AVE NEEDHAM MA 02494-2736 Page Tort Important information about your December 31, 2013 Form 990PF We approved your Form 8868, Application for Extension of Time To File an Exempt Organization Return ‘We approved the Form 8868 for your What you need to do December 31. 2013 Form 990PF. Your new due dates Novenber 15,2014 File your December 31, 2013 Form 990PF by November 15, 2014. Visit wows govchaies to leam about aproved File provides, what types of fetuins canbe filed electronical, and whether you are required to le electronical Additional information Visit worms. govicp2 Ta, + For tax forms, instructions, and publications, visit wavs. gov or cll 1-800-TAX-FORM (1-800-829-3676), + Keep this notice for your records. Ifyou need assistance, please don’t hesitate to contact us.1 / 3 7 2 ° a 2 pet elely “Fomenn ta 205) 2 «yout ng fron Additonal (Not Aulomatle)3 Month Evenson, compete only Part and check tis box >i ‘Note Ory eompet Por if you have aead been ranean automate Smerih extension one previously led For G86, Ityou are fling for an Automatic 3-Month Extension, complete only Part | (on page 1). FEMTMII Additional (Not Automatic) 3-Month Extension of Time. Only fe the orginal (no copies needed) Enter filers identifying number, seo instructions Type or | Name of exempt organization or other fer, see instructions. Employer ereton nama (EIN) ot print [Adelson Family Foundation Jo4-7024330. "Number, Steet, ad room or sule no, Wa PO. box, see nsiuctons. ‘Social security number (SSN) flame |300 First Ave. ‘irgyor” | City, town or post office, stale, and ZIP code. For foreign address, see instructions. Sees [Neeunam, mA 02498 Enter the Return code for the return that this application is for (fle @ separate application for each return). 4 ‘Application Return [Application Is For Code_| is For Form 990 or Form 990-EZ or = ENE taasded 6 Form 990-8 02 __| Form 1047-4. Form 4720 (ingividval) (03 __| Fox 4720 (other than individual) 09 Form 690-PF (04 __[ Form 6227, 10 Form 960-T (see. 401{a) or 408(@) trust (05 | Form 6069 11 Form 960-1 (trust other than above) (06 [Fox 8870 2 ‘STOP! Do not complote Part If you wore not already granted an automatic 3-month extension on a previously filed Form 8868. The books are in the care of > David Bloo a Fax No. © (762) 72 i «ithe orgarizaton doe ceo iacsof business in he United Sats, check his bor . -O ¢ rss fora Group Return ener he organization's four digt Group Exempton Number (GEN) ints forthe whole group, check tis box > LA. tits or part ofthe group, check tis box TD and atacn a fist with the names and EINs of all members the extension is fot. 4 request en additional 3:month extension of time until 5 Forcalendar year | 2013. or other tax year beginning 6 Ifthe tax year entered inline 5 is for less than 12 months, check reason: (Change in accounting period 7 State in detail why you need the extension Additional ti an accurate return. ‘Ba __Irthis application is for Forms 960-BL, YBU-PF, YO, 4720, OF 6069, enter the tentative tax, less eny nonrefundable credits. See instructions. 'b ifthis application is for Forms $80-PF, 990-T, 4720, or 6068, enter any refundabie credits and ‘estimated tax payments made. include any prior year overpayment allowed as a credit and any _amount paid previously with Form 8868. ab Is 239 8. 24 © “Balance due, Subtract line &b from line 8a. Include your payment wth this form, i required, by using EFTPS (Electronic Federal Tax Payment System). See instructions. Signature and Verification must be completed for Part Il only. Under penalties of pejury, | dectare that have examined ths form, including sccompanying schedules and statements, and to the best of my knowledge and beet, tis te, corect, and complete, and that | em authorized to prepare this form. Sionance Tito_ Duly Authorized Agent pee For 8868 (Rev 1.2014)1 a / 3 7 2 £ ast s a 8868 Application for Extension of Time To File an (Rev. sanvery 2014), Exempt Organization Return OMB No, 1545-1709 patel Teny > Flea separateapplcation foreach retun wranaiRewre eves” | infomation about Form S868 an is Instructions st wo gowomnd8 *itycu.are ing for an Automate 3-Month Extension, complete only Part ard check hs box >O ‘+ Ifyou are fing for an Additional (Not Automatic) 3-Month Extension, complete only Part Il (on page 2 of this form). Do not complete Part il untess you have alieady been granted an automatic 3-month extension on a previously fled Form 8868. Electronic filing (e-file). You can electronically fle Form 8868 if you need a 3-month automatic extension of time to fe (6 months for 8 corporation required to fle Form 980-7), or an additional (not automatic) 3-month extension of time. You can electronically file Form {8868 to request an extension af ime to file any of the forms listed in Part | or Part Il wth the exception of Farm 8870, Information Return for Transfers Associated With Certain Personal Benefit Contracts, which must be sent to the IRS in paper format (see instructions). For more details on the electronic fling ofthis form, visit warwirs.govfefile and click on e-file for Charities & Nonprofits. HERTIEL__Automatic 3. Month Extension of Time. Only submit original (no copies needed) ‘A corporation required to file Form 880-T and requesting an automatic 6-month extension—check this box and compile Part | oniy > ‘All other corporations (including 1120-C filers), partnerships, REMICs, end trusts must use Form 7004 fo request an extension of time to file income tex returns, Enter filers Identtying number, see instructions Type or | Name of exempt ganization or ake Wr, see hsvaclons oly Were Donte (ER print [Acelson Family Foundation o4-7024350 Fie ye [ Number, eet, and room or site no, Wa PO, bor, se eile Social secuy number (SSN) sedate |300 First Ave ‘wun See | Cy, town or post ofc, sat, and ZIP code, Fo a foreign adaress, fee FTucTOns sservctont._|Needham, MA 02494 Enter the Return code for the retum that this application is for (fle a separate application for each return) 8 “Application Return [Application Rotum Is For Gode_| Is For Code Form $80 or Form 990-2, (1 _| Form 960-7 (corporation) o Form $90-BL ‘02 [ Form 1044-A. 08 Form 4720 (indiadual (03 | Form 4720 (other than Individual) 09 Fort 990.PF (04 | Form 5227 40, Form 990-T (sec. 401(a) or 408(@) ust) 05__| Form 6063 a4 Form $90-T (trust other than above) (06 [ Form 8870 2 ‘© The books are in the care of David Bt Teleghone No. 702-791-9400 a Fax No. > (702) 791-7819 Ifthe organization does not have an ofice or piace of Business in the United Statoe, chock thie bax + this fra Group Retum, eter the organization's fou digt Group Exemption Number (GEN) iri forthe whole group, check tis box... .. «itis or part ofthe group, check this box PE and atach a lis with the names and EINs ofall members ihe exnsion is for. ‘11 Trequest an automatic 3-month (6 months for a corporation required to fle Form 980-7) extension of time uni! to file the exempt organization return for the organization named above. The extension he organization's return for ‘calendar yesr 2013. or >] taxyear beginning and ending 2 tthe tax year entered in ina tis for lose than 12 monthe, check eason: [CJ niin” [-] Fina reurn [] Change in accounting period 32 this eopication is for Forms 990-BL, G80-PF, 6907, 4720, oF 6069, enter the lentalve tax, lose ony ‘nonrefundable cresis. See instructions. za|s 29 'b tris application is for Forms 990-PF, 880-7, 4720, or 6068, enter any refundable credis and eesimated tax payments made, Include any prior year overpayment alowed 28 a credit sols 39 € “Balance due. Subvact ine 20 from ine 33. Include your payment wth tis form, i required, by using EFTPS (Electronic Federal Tax Payment System). See instructions. acls 200, ‘Caution. you are going to make an elecronic nds withrewal (dee debi) wih bis Ferm GB56, S02 Farm 6459-60 and For 8873E0 for payer instructions For Privacy Act and Paperwork Reduction Act Notice, see Instructions, Fam 6868 (Rev 201)