The foundation may be able to use a copy of this return to satisfy state reporting requirements. If the foundation's status was terminated, check here.
The foundation may be able to use a copy of this return to satisfy state reporting requirements. If the foundation's status was terminated, check here.
The foundation may be able to use a copy of this return to satisfy state reporting requirements. If the foundation's status was terminated, check here.
The foundation may be able to use a copy of this return to satisfy state reporting requirements. If the foundation's status was terminated, check here.
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Department of the Treasury Internal Revenue Service
Return of Private Foundation
or Section 4947(a)(1) Nonexempt Charitable Trust Treated as a Private Foundation
Note. The foundation may be able to use a copy of this return to satisfy state reporting requirements.
2008
~ 1
Form 990-PF
OMS No. 1545-0052
800 THIRD AVE
Room/suite B Telephone number
212-583-6066
BLOOMBERG FAMILY FOUNDATION INC
20-5602483
C If exemption application is pending, check here ••. ~
D 1. Foreign organizations, check here ~ D
----..<:..:.::;:..;:..;...._::....:...;;.;."-'-'-r~;...._----:;:....;;.....;;-;;;;..;::.-----------------__1 2. Foreign organizations meeting the 85% test, ~ D
check here and attach computation ...••.•..•..
E If private foundation status was terminated D under section 507(b)(1 )(A), check here ... ~
",,,,,,,,,.,,,, ... ; ..... ;. Analysis of Revenue and Expenses
=.;== [The total of amounts in columns (b), (c), and may not
the amounts in column
1 Contributions, gifts, grants, etc., received .
2 Check ~ D if the foundation is not required to al1ach Sch. B
15 Other assets (describe~ STATEMENT 12) I--:::....L-=-.:~L.::...:::..==....:.t------......::.-=+--------=-::..
, Form 99V-PF
THE BLOOMBERG FAMILY
Fpiiifi(\1 Balance Sheets Atlached schedules and amounls in Ihe description
.,. "'. ., '.:11:,.:.:. column should be for end-of·~r amounls only.
8 Inventories for sale or use .
9 Prepaid expenses and deferred charges .
17 Accounts payable and accrued expenses .
18 Grants payable .
gj 19 Deferred revenue .
~ 20 Loans from officers, directors, trustees, and other disqualified persons .
:c
cu
:J
21 Mortgages and other notes payable .
22 Other liabilities (describe ~ -' f---------t---------
Foundations that follow SFAS 117, check here ~
and complete lines 24 through 26 and lines 3D and 31.
III
~ 24 Un restricted .
e
-m 25 Temporarily restricted .
m 26 Permanently restricted .
~ Foundations that do not follow SFAS 117, check here ~ 0
:= u.. ..
~ 27 Capital stock, trust principal, or current funds .
Gi
III 28 Paid-in or capital surplus, or land, bldg., and equipment fund .
:l 29 Retained earnings, accumulated income, endowment, or other funds .
Gi
z 3D Total net assets or fund balances .
and complete lines 27 through 31 .
1400116000.
1391631010.
[Pittjjj::::1 Analysis of Changes in Net Assets or Fund Balances
1 Total net assets or fund balances at beginning of year - Part II, column (a), line 30
(must agree with end-of-year figure reported on prior year's return) ........................................................................ _ ........ 1 1361904648.
2 Enter amount from Part I, line 27a .............................................................................................................................. 2 210,679,364.
3 Other increases not included in line 2 (itemize) ~ 3 o.
4 Add lines 1, 2, and 3 ................................................................................................................................................ 4 1572584012.
5 Decreases not included in line 2 (itemize) ~ PRIOR PERIOD ADJUSTMENT 5 15,292.
6 Total net assets or fund balances at end of vear (line 4 minus line 5) - Part II column (b), line 30 ............................................. 6 1572568720. 823511 01-02-09
Form 990-PF (2008)
2
2008.05000 THE BLOOMBERG FAMILY FOUNDA BLOOMFAI
13421116 737725 BLOOMFAMFND
, Form 99f)-PF (2008)
THE BLOOMBERG FAMILY FOUNDATION INC
20-5602483
nWi#l\t:1 Capital Gains and Losses for Tax on Investment Income
(a) List and describe the kind(s) of property sold (e.g., real estate, (b~HOW acquired (e~ Date acquired (d) Date sold
2-story brick warehouse; or common stock, 200 shs. MLC Co.) - Purchase mo., day, yr.) (mo., day, yr.)
0- Donation
1a SALE OF PUBLICLY TRADED SECURITIES VARIOUS VARIOUS
b SALE OF PUBLICLY TRADED SECURITIES VARIOUS VARIOUS
e FROM K-1 - QAM SELECT INVESTORS VARIOUS VARIOUS
d
e FROM K-1 - QAM PRIVATE INVESTORS P VARIOUS VARIOUS
(e) Gross sales price (f) Depreciation allowed (0) Cost or other basis (h) Gain or (loss)
(or allowable) plus expense of sale (e) plus (f) minus (g)
a 366,635,901. 371,355,249. <4,719,348.
b 69,867,516. 75,016,947. <5,149,431.
e 63,282,697. <63,282,697.
d O.
e 972,439. 972,439.
Complete only for assets showing gain in column (h) and owned by the foundation on 12131/69 (I) Gains (Col. (h) gain minus
(j) Adjusted basis (k) Excess of col. (i) col. (k), but not less than -0-) Dr
(i) F.MV. as of 12131/69 as of 12/31/69 over col. (j), if any Losses (from col. (h))
a <4,719,348.
b <5,149,43l.
e <63,282,697.
d O.
e 972,439.
{ If gain, also enter in Part I, line 7 .................. } <72,179,037.
2 Capital gain net income or (net capital loss) If (loss), enter -0- in Part I, line 7 2
3 ~~{~~~ ~:~:~~~~~~:~il~ IE:r~~.I~~~e~~)~d. in. ~e.cti.o~S .. 1. ~2.2(~) .a~d .. (6) .................................... }
3 N/A
1:mi1~Y:~~~1 Qualification Under Section 4940(e) for Reduced Tax on Net Investment Income (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 in the base period? D Yes EX] No
If "Yes," the foundation does not qualify under section 4940(e). Do not complete this part.
1 Enter the appropriate amount in each column for each year' see instructions before making any entries
(a) (b) (e) . . (d.l ti
Base period years Dlstributlon ra 10
Calendar year-Cor tax year beginning in) Adjusted qualifying distributions Net value of noncharitable-use assets (col. (b) divided by col. (c))
2007 36,012,612. 501,603,409. .071795
2006 o. 21,949,603. .000000
2005
2004
2003
2 Total of line 1, column (d) ................................................................................................................................. 2 .071795
3 Average distribution ratio for the 5-year base period - divide the total on line 2 by 5, or by the number of years
the foundation has been in existence if less than 5 years .......................................................................................... 3 .035898
4 Enter jne net value of noncharitable-use assets for 2008 from Part X, line 5 ............................................................... 4 1,322,117,206.
5 Multiply line 4 by line 3 .................................................................................................................................... 5 47,461,363.
6 Enter 1% of net investment income (1% of Part I,line 27b) .................................................................................... 6 335,695.
7 Add lines 5 and 6 .......................................................................................................................................... 7 47,797,058.
8 Enter qualifying distributions from Part XII, line 4 ................................................................................................... 8 31,690,900. If line 8 is equal to or greater than line 7, check the box in Part VI, line 1 b, and complete that part using a 1% tax rate. See the Part VI instructions.
823521 01-02-09
Form 990-PF (2008)
3
13421116 737725 BLOOMFAMFND
2008.05000 THE BLOOMBERG FAMILY FOUNDA BLOOMFA1
Page 3
> > >
> > >
>
Form 990-PF (2008)
1 a Exempt operating foundations described in section 4940(d)(2), check here
Date of ruling letter: (attach copy of ruling letter if necessary-see instructions)
b Domestic foundations that meet the section 4940(e) requirements in Part V, check here ~ D and enter 1 %
of Part I, line 27b .
c All other domestic foundations enter 2% of line 27b. Exempt foreign organizations enter 4% of Part I, line 12, col. (b)
2 Tax under section 511 (domestic section 4947(a)(1) trusts and taxable foundations only. Others enter -0-) .
3 Add lines 1 and 2 .
4 Subtitle A (income) tax (domestic section 4947(a)(1) trusts and taxable foundations only. Others enter -0-) .
5 Tax based on investment income. Subtract line 4 from line 3. If zero or less, enter-O- 6 Credits/Payments:
a 2008 estimated tax payments and 2007 overpayment credited to 2008 .
b Exempt foreign organizations - tax withheld at source .
c Tax paid with application for extension oftime to file (Form 8868) .
d Backup withholding erroneously withheld .
7 Total credits and payments. Add lines 6a through 6d .
8 Enter any penalty for underpayment of estimated tax. Check here [X] if Form 2220 is attached .
9 Tax due. If the total of lines 5 and 8 is more than line 7, enter amount owed ~
10 ~
1 a During the tax year, did the foundation attempt to influence any national, state, or local legislation or did it participate or intervene in
any political campaign? .
b Did it spend more than $100 during the year (either directly or indirectly) for political purposes (see instructions for definition)? .
If the answer is "Yes" to ta or1b, attach a detailed description of the activities and copies of any materials published or distributed by the foundation in connection with the activities.
c Did the foundation file Form 1120-POL forthis year? .
d Enter the amount (if any) of tax on political expenditures (section 4955) imposed during the year:
(1) On the foundation. ~ $ o. (2) On foundation managers. ~ $ 0_.
e Enter the reimbursement (if any) paid by the foundation during the year for political expenditure tax imposed on foundation
managers. ~ $ 0 •
2 Has the foundation engaged in any activities that have not previously been reported to the IRS? .
If "Yes, " attach a detailed description of the activities. 3 Has the foundation made any changes, not previously reported to the IRS, in its governing instrument, articles of incorporation, or
bylaws, or other similar instruments? If "Yes," attach a conformed copy of the changes .
4a Did the foundation have unrelated business gross income of $1 ,000 or more during the year? .
b If "Yes," has it filed a tax return on Form 990-T for this year? N.I..~ · I--'=--t--t--
5 Was there a liquidation, termination, dissolution, or substantial contraction during the year? .
If "Yes, " attach the statement required by General Instruction T. 6 Are the requirements of section 508(e) (relating to sections 4941 through 4945) satisfied either:
• By language in the governing instrument, or
• By state legislation that effectively amends the governing instrument so that no mandatory directions that conflict with the state law
remain in the governing instrument? .
7 Did the foundation have at least $5,000 in assets at any time during the year? .
If "Yes, " complete Part II, col. (c), and Part xv.
8a Enter the states to which the foundation reports or with which it is registered (see instructions) ~ _
DE,NY
b If the answer is 'Yes' to line 7, has the foundation fumished a copy of Form 990-PF to the Attomey General (or designate)
of each state as required by General Instruction G? If "No, " attach explanation .
9 Is the foundation claiming status as a private operating foundation within the meaning of section 49420)(3) or 4942(j)(5) for calendar
year 2008 or the taxable year beginning in 2008 (see instructions for Part XIV)? If "Yes," complete Part XIV .
823531 01-02-09
13421116 737725 BLOOMFAMFND
4
2008.05000 THE BLOOMBERG FAMILY FOUNDA.BLOOMFA1
• Form 99~-PF (2008) THE BLOOMBERG FAMILY FOUNDATION INC
11 At any time during the year, did the foundation, directly or indirectly, own a controlled entity within the meaning of
section 512(b)(13)? If "Yes,' attach schedule (see instructionsl......................................................................................................... 11 X
12 Did the foundation acquire a direct or indirect interest in any applicable insurance contract before
August 17, 2008? 12 X
13 Did the foundation comply with the public inspection requirements for its annual returns and exemption application? .
14 The books are in care of ~ DIANE RIZZO, C/O GELLER & CO LLC Telephone no.~212-583-6000
Located at ~ 800 THIRD AVENUE, NEW YORK, NY ZIP+4 ~10022
13
X
15 Section 4947(a)(1) nonexempt charitable trusts filing Form 990-PF in lieu of Form 1041 - Check here ~ D
~e N
File Form 4720 if any item is checked in the "Yes" column, unless an exception applies. 1 a During the year did the foundation (either directly or indirectly):
(1) Engage in the sale or exchange, or leasing of property with a disqualified person? DYes 00 No
(2) Borrow money from, lend money to, or otherwise extend credit to (or accept it from)
a disqualified person? DYes 00 No
(3) Furnish goods, services, or facilities to (or accept them from) a disqualified person? 00 Yes D No
(4) Pay compensation to, or payor reimburse the expenses of, a disqualified person? DYes 00 No
(5) Transfer any income or assets to a disqualified person (or make any of either available
for the benefit or use of a disqualified person)? , DYes 00 No
(6) Agree to pay money or property to a government official? (Exception. Check "No"
if the foundation agreed to make a grant to or to employ the official for a period after
termination of government service, if terminating within 90 days.) DYes 00 No
b If any answer is "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 instructions)? .
Organizations relying on a current notice regarding disaster assistance check here ~ D
c Did the foundation engage in a prior year in any of the acts described in 1 a, other than excepted acts, that were not corrected
before the first day of the tax year beginning in 2008? .
2 Taxes on failure to distribute income (section 4942) (does not apply for years the foundation was a private operating foundation
defined in section 49420)(3) or 49420)(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? DYes 00 No
If 'Yes,' list the years ~ _
b Are there any years listed in 2a for which the foundation is not applying 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.) NI.:A ·
c If the provisions of section 4942(a)(2) are being applied to any of the years listed in 2a, list the years here.
~------
3a Did the foundation hold more than a 2% direct or indirect interest in any business enterprise at any time
during the year? 00 Yes D No
b If 'Yes," did it have excess business holdings in 2008 as a result of (1) any purchase by the foundation or disqualified persons after May 26, 1969; (2) the lapse of the 5-year period (or longer period approved by the Commissioner under section 4943(c)(7)) to dispose of holdings acquired by gift or bequest; or (3) the lapse of the 10-, 15-, or 20-year first phase holding period? (Use Schedule C,
Form 4720, to determine if the foundation had excess business holdings in 2008.) .
4a Did the foundation invest during the year any amount in a manner that would jeopardize its charitable purposes? .
b Did the foundation make any investment in a prior year (but after December 31, 1969) that could jeopardize its charitable purpose that
823541 01-02-09
13421116 737725 BLOOMFAMFND
5
2008.05000 THE BLOOMBERG FAMILY FOUNDA BLOOMFA1
Form 990-PF (2008)
5a During the year did the foundation payor incur any amount to:
(1) Carry on propaganda, or otherwise attempt to influence legislation (section 4945(e»? DYes
(2) Influence the outcome of any specific public election (see section 4955); or to carry on, directly or indirectly,
any voter registration drive? DYes
Provide a grant to an individual for travel, study, or other similar purposes? DYes
00 No
(3) (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)? 00 Yes D No
(5) Provide for any purpose other than religious, charitable, scientific, literary, or educational purposes, or for
the prevention of cruelty to children or animals? DYes 00 No
b If any answer is "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 instructions)? .
Organizations relying on a current notice regarding disaster assistance check here ~ D
c If the answer is 'Yes' to question 5a(4), does the foundation claim exemption from the tax because it maintained
expenditure responsibility for the grant? $.~.~ $.'r.~'r.~ . .M:~.N'r LL 1XJ Yes D No
00 No 00 No
If "Yes, n attach the statement required by Regulations section 53.4945-5(d).
6a Did the foundation, during the year, receive any funds, directly or indirectly, to pay premiums on
a personal benefit contract? DYes 00 No
b Did the foundation, during the year, pay premiums, directly or indirectly, on a personal benefit contract?
If you answered "Yes" to 6b, also file Form 8870.
7a At any time during the tax year, was the foundation a party to a prohibited tax shelter transaction? DYes 00 No
? .
1 List all officers directors trustees foundation managers and their compensation
, . •
(b) Title, and average (c) Compensation (d~ Contributions to (e) Exfense
(a) Name and add ress hours ~er week devoted (If notpa~~, emp oyee benefilflans accoun , other
and delerre
o position enter -0- compensation allowances
MICHAEL R. BLOOMBERG DIRECTOR
C/O GELLER&CO, 800 THIRD AVE
NEW YORK, NY 10022 0.25 O. O. O.
PATRICIA HARRIS PRESIDENT & CEO
C/O BFF, INC. , 1440 BROADWAY
NEW YORK, NY 10018 0.25 O. O. O. 2 Compensation of five highest-paid employees (other than those Included on hne 1) If none enter "NONE"
.
(b) Title, and average (d~ Contributions to (e) Exr,ense
(a) Name and address of each employee paid more than $50,000 hours ~er week (e) Compensation emp oyee benefilflans accoun , other
and deferre
devoted 0 position compensation allowances
NONE
Total number of other emolovees oaid over $50000 ....................................................... , .............................................................. ~I 0 823551 01-02-09
13421116 737725 BLOOMFAMFND
6
2008.05000 THE BLOOMBERG FAMILY FOUNDA BLOOMFA1
• Form 9~0-PF (2008)
THE BLOOMBERG FAMILY FOUNDATION INC
20-5602483
Page 7
PP'arfiVUlJJj Inf~rmation About Officers, Directors, Trustees, Foundation Managers, Highly
.· ·.· ·.· H·.·. Paid Employees, and Contractors (continued)
3 Five highest-paid independent contractors for professional services. If none, enter "NONE."
(a) Name and address of each person paid more than $50,000 (b) Type of service (c) Compensation
GELLER & COMPANY
800 THIRD AVE. , 25TH FLOOR, NY, NY 10022 7\CCOUNTING 248,811.
LUNTZ, MASLANSKY STRATEGIC
1101 KING ST, ALEXANDRIA, VA 22314 ~ONSULTING 51,710.
QUADRANGLE ASSET MANAGEMENT LP
375 PARK AVENUE, NEW YORK, NY 10152 ASSET MANAGEMENT 4445577.
WILLKIE FARR & GALLAGHER LLP
787 SEVENTH AVENUE, NEW YORK, NY 10019 LEGAL 250,464.
Total number of others receivino over $50000 for professional services ................................................................................................ ~ 0
kP'arUXf,AJ Summary of Direct Charitable Activities
List the foundation's four largest direct charitable activities during the tax year-Include relevant statistical information such as the Expenses
number of organizations and other beneficiaries served, conferences convened, research papers produced, etc.
1 N/A
2
3
4
FPiftJX;61 Summary of Program-Related Investments
Describe the two largest program-related investments made by the foundation during the tax year on lines 1 and 2. Amount
1 N/A
2
All other program-related investments. See instructions.
3
Total. Add lines 1 throuah 3 ........................................................................................ - ........................................... ~ o. Form 990-PF (2008)
823561 01·02·09
13421116 737725 BLOOMFAMFND
7
2008.05000 THE BLOOMBERG FAMILY FOUNDA BLOOMFA1
, Form 900-PF (2008)
THE BLOOMBERG FAMILY FOUNDATION INC
20-5602483
PageS
!:J1Mif:Xtmm Minimum Investment Return (All domestic foundations must complete this part. Foreign foundations, see instructions.)
Fair market value of assets not used (or held for use) directly in carrying 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 .
d Total (add lines ta, b, and c) .
e Reduction claimed for blockage or other factors reported on lines 1 a and
1 c (attach detailed explanation) .
2 Acquisition indebtedness applicable to line 1 assets .
S Subtract line 2 from line 1d .
4 Cash deemed held for charitable activities. Enter 11/2% of line 3 (for greater amount, see instructions) .
5 Net value of noncharitable-use assets. Subtract line 4 from line 3. Enter here and on Part V, line 4 .
6 Minimum investment return. Enter 5% of line 5
".UUL; •.• onSI (Section 4942(j)(3) and (j)(5) private operating foundations and certain complete this part.)
~mF.ma:Ximiil Distributable Amount (see
!.......... fa check here ~
Minimum investment return from Part X, line 6 .
2a Tax on investment income for 2008 from Part VI, line 5 .
b Income tax for 2008. (This does not include the tax from Part VI.) .
c Add lines 2a and 2b .
S Distributable amount before adjustments. Subtract line 2c from line 1 .
4 Recoveries of amounts treated as qualifying distributions .
5 Add lines 3 and 4 .
6 Deduction from distributable amount (see instructions) .
7
bP..:J~llil Qualifying Distributions (see instructions)
Amounts paid (including administrative expenses) to accomplish charitable, etc., purposes:
a Expenses, contributions, gifts, etc. - total from Part I, column (d), line 26 .
b Program-related investments - total from Part IX-8 .
2 Amounts paid to acquire assets used (or held for use) directly in carrying out charitable, etc., purposes .
S Amounts set aside for specific charitable projects that satisfy the:
a Suitability test (prior IRS approval required) " .
b Cash distribution test (attach the required schedule) .............................................................................•...... : .
4 Qualifying distributions. Add lines 1a through 3b. Enter here and on Part V, line 8, and Part XIII, line 4 .
5 Foundations that qualify under section 4940(e) for the reduced rate of tax on net investment
income. Enter 1 % of Part I, line 27b .
6 Adjusted qualifying distributions. Subtract line 5 from line 4 .
Note. The amount on line 6 will be used in Part V, column (b), in subsequent years when calculating whether the foundation qualifies for the section 4940(e) reduction of tax in those years.
Form 990-PF (2008)
823571 01·02·09
13421116 737725 BLOOMFAMFND
8
2008.05000 THE BLOOMBERG FAMILY FOUNDA BLOOMFA1
20-5602483
THE BLOOMBERG FAMILY FOUNDATION INC
Page 9
Undistributed Income (see instructions)
Distributable amount for 2008 from Part XI,
line 7
2 Undistributed income, II any, as 01 the end 012007:
a Enter amount for 2007 only b Total for prior years:
---' ---'
3 Excess distributions carryover, if any, to 2008: a From 2003
bFrom 2004
c From 2005 d From 2006 e From 2007
b Applied to undistributed income of prior years (Election required - see instructions) ... c Treated as distributions out of corpus
(Election required - see instructions) .
d Applied to 2008 distributable amount .
e Remaining amount distributed out of corpus
5 Excess distributions carryover applied to 2008 .
(II an amount appears '" column (d), the same amount must be shown In column (a).)
6 Enter the net total of each column as indicated below:
a Corpus. Add lines 31, 4c, and 4e. Subtract line 5 .
b Prior years' undistributed income. Subtract
line 4b from line 2b .
c Enter the amount of prior years' undistributed income for which a notice of deficiency has been issued, or on which
the section 4942(a) tax has been previously
assessed .
d Subtract line 6c from line 6b. Taxable
amount - see instructions .
e Undistributed income for 2007. Subtract line 4a from line 2a. Taxable amount - see instr.
f Undistributed income for 2008. Subtract
lines 4d and 5 from line 1. This amount must
be distributed in 2009 .
7 Amounts treated as distributions out of corpus to satiSfy requirements imposed by
section 170(b)(1 )(F) or 4942(g)(3) .
8 l:xcess distributions carryover from 2003
not applied on line 5 or line 7 .
9 Excess distributions carryover to 2009.
Subtract lines 7 and 8 from line 6a
10 Analysis of line 9: a Excess from 2004 b Excess from 2005 c Excess from 2006 d Excess from 2007
823581 01-02-09
13421116 737725 BLOOMFAMFND
(d) 2008
Form 990-PF (2008)
9
2008.05000 THE BLOOMBERG FAMILY FOUNDA BLOOMFA1
20-5602483
Page 1D
N/A
1 a If the foundation has received a ruling or determination letter that it is a private operating
foundation, and the ruling is effective for 2008, enter the date of the ruling ~
D
D
b Check box to indicate whether the foundation is a orivate ooeratin_g_ foundation described in section ......... 4942(i)(3) or 4942(i)(5)
2 a Enter the lesser of the adjusted net Tax year Prior 3 years
income from Part I or the minimum (a) 2008 (b) 2007 (e) 2006 (d) 2005 (e) Total
investment return from Part X for
each year listed ...........................
b 85% of line 2a ..............................
e Qualifying distributions from Part XII,
line 4 for each year listed ...............
d Amounts included in line 2c not
used directly for active conduct of
exempt activities ...........................
e Qualifying distributions made directly
for active conduct of exempt activities.
Subtract line 2d from line 2c ............
3 Complete 3a, b, or c for the
alternative test relied upon:
a 'Assets" alternative test - enter:
(1) Value of all assets ..................
(2) Value of assets qualifying
under section 4942(j)(3)(8)(i) ...
b 'Endowmenf alternative test - enter
2/3 of minimum investment retu rn
shown in Part X, line 6 for each year
listed ..........................................
e "Support' alternative test - enter:
(1) Total support other than gross
investment income (interest,
dividends, rents, payments on
securities loans (section
512(a)(5)), or royalties) ............
(2) Support from general public
and 5 or more exempt
organizations as provided in
section 4942(j)(3)(8)(iii) .........
(3) Largest amount of support from
an exempt organization ............
(4) Gross investment income .........
kJ1mXV::::::j Supplementary Information (Complete this part only if the foundation had $5,000 or more in assets
.. .. at any time durmg the year-see the lnstructions.)
Information Regarding Foundation Managers:
a List 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 $5,000). (See section 507(d)(2).)
MICHAEL R. BLOOMBERG
b List any managers of the foundation who own 10% or more of the stock of a corporation (or an equally large portion of the ownership of a partnership or other entity) of which the foundation has a 10% or greater interest.
NONE
2 Information Regarding Contribution, Grant, Gift, Loan, Scholarship, etc., Programs:
Check here ~ [XJ if the foundation only makes contributions to preselected charitable organizations and does not accept unsolicited requests for funds. If the foundation makes gifts, grants, etc. (see instructions) to individuals or organizations under other conditions, complete items 2a, b, c, and d.
a The name, address, and telephone number of the person to whom applications should be addressed:
b The form in which applications should be submitted and information and materials they should include:
e Any submission deadlines:
d Any restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other factors:
823601 01-02-09
Form 990-PF (2008)
13421116 737725 BLOOMFAMFND
10
2008.05000 THE BLOOMBERG FAMILY FOUNDA BLOOMFAI
• Form~0-PF(2008) THE BLOOMBERG FAMILY FOUNDATION INC !a?$.1'!KY@ Supplementary Information (continued)
20-5602483 page11
Pu rpose of g rant or contribution
3 Grants and Contributions Paid During the Year or Approved for Future Payment
Name and address (home or business)
Recipient If recipient is an individual,
show any relationship to any foundation manager or substantial contributor
Foundation status of recipient
Amount
a Paid during the year
SEE STATEMENT 14
41838303.
Total ~ 3b 0 •
Total
b Approved for future payment
NONE
~ 3a
13421116 737725 BLOOMFAMFND
823611 01-02-09 Form 990-PF (2008)
11
2008.05000 THE BLOOMBERG FAMILY FOUNDA BLOOMFAI
Form 990-PF (2008)
THE BLOOMBERG FAMILY FOUNDATION INC
2 0 - 5602 4 83 Page 12
nP:m:MifAtl Analysis of Income-Producing Activities
Enter gross amounts unless otherwise indicated. Unrelat Id business income Excluded by section 512, 513, or514 (e)
(~) (b) J~L (d) Related or exempt
Bu~ci~:sS Amount ston Amount function income
1 Program service revenue: code
a
b
c
d
e
f
g Fees and contracts from government agencies .........
2 Membership dues and assessments ...........................
3 Interest on savings and temporary cash
investments ............................................................ 14 20,927.
4 Dividends and interest from securities ........................ ~ Mj ~]_g 1.22 • -
5 Net rental income or (loss) from real estate: ::::m:::::m:m:m:m:m:m:m: ??im:m:\:?:\ii???????:??:::::::\i
a Debt-financed property .......................................
b Not debt-financed property ....................................
6 Net rental income or (loss) from personal
property ...............................................................
7 Other investment income .......................................... 14 2,754,805.
8 Gain or (loss) from sales of assets other 18
than inventory ......................................................... <279,176,963. >
9 Net income or (loss) from special events .....................
10 Gross profit or (loss) from sales of inventory .... _ ..........
11 Other revenue:
a
b
c
d
e
12 Subtotal. Add columns (b), (d), and (e) ........................ O. :41,048,009. ~ O.
13 Total. Add line 12, columns (b), (d), and (e) ................................................................................................ ~ ................. 13 <241,048,009. (See worksheet in line 13 instructions to verify calculations.)
[m:~ftmXVm~:H Relationship of Activities to the Accomplishment of Exempt Purposes
Line No.
T
Explain below how each activity for which income is reported in column (e) of Part XVI-A contributed importantly to the accomplishment of the foundation's exempt purposes (other than by providing funds for such purposes).
823621 01-02-09
Form 990-PF (2008)
13421116 737725 BLOOMFAMFND
12
2008.05000 THE BLOOMBERG FAMILY FOUNDA BLOOMFAI
Form 990-PF (2008)
20-5602483
1 Did the organization directly or indirectly engage in any of the following with any other organization described in section 501 (c) of the Code (other than section 501 (c)(3) organizations) or in section 527, relating to pOlitical organizations?
a Transfers from the reQ2rting foundation to a noncharitable exempt organization of:
(1) Cash .
(2) Other assets .
b Other transactions:
(1) Sales of assets to a noncharitable exempt organization .
(2) Purchases of assets from a noncharitable exempt organization .
(3) Rental of facilities, equipment, or other assets .
(4) Reimbursement arrangements - , .
(5) Loans or loan guarantees ..........................................................................................................................................•........
(6) Performance of services or membership or fund raising solicitations .
e Sharing of facilities, equipment, mailing lists, other assets, or paid employees .
d If the answer to any of the above is '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. (b) Amount involved (e) Name of noncharitable exempt organization (d) Description of transfers, transactions, and sharing arrangements
N/A 2a Is the foundation directly or indirectly affiliated with, or related to, one or more tax-exempt organizations described
in section 501(c) of the Code (other than section 501 (c)(3)) or in section 527? DYes [][] No
b If'Y' I t th f II· h d I
es cornea e e 0 oWlna sc e u e.
(a) Name of organization (b) Type of organization (e) Description of relationship
N/A
-. .,"
Under penalties of pe~Uly, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct,
and co~arati7_:~orfid~) ';ed on ali infu~ati;lf:/;;erhasany ~n;w~~~TOR
GI ~ Signature of officer gytflistee / Date ~ Title
..
GI
::I: Preparer's ~ ~L. ~ I. D~h0 I Check if D I Preparer's identifying number
C
CI _0 >- signature A.A. ~ // ? P f ~~-IOyed ~
en -etc
._ :;0 Rrm's name (or yours GELLER & COMPANY LLC I EIN ~
I'll Co GI
Il.GlIn ifsell-employad), ~800 THIRD AVENUE 25TH FLOOR
~:J
address, and ZIP code NEW YORK, NY 10022 Phone no. 212- 583- 6000 823622 01-02-09
21451109 737725 BLOOMFAMFND
13
2008.04051 THE BLOOMBERG FAMILY FOUNDA BLOOMFA1
~ Attach to Form 990, 990-EZ, and 990-PF.
2008
Schedule of Contributors
. Sch·edule B
(Form 990, 990-EZ, or 990-PF)
Department of the Treasury Internal Revenue Service
OMB No. 1545-0047
THE BLOOMBERG FAMILY FOUNDATION INC
20-5602483
Name of the organization
Employer identification number
Organization type (check one):
Filers of:
Section:
Form 990 or 990-EZ
D 501 (c) (
) (enter number) organization
D 4947(a)(1) nonexempt charitable trust not treated as a private foundation
D 527 political organization
Form 990-PF
[XJ 501 (c)(3) exempt private foundation
D 4947(a)(1) nonexempt charitable trust treated as a private foundation D 501 (c)(3) taxable private foundation
Check if your organization is covered by the General Rule or a Special Rule. (Note. Only a section 501 (c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.)
General Rule
[XJ For organizations filing Form 990, 990-EZ, or 990-PF that received, during the year, $5,000 or more (in money or property) from anyone contributor. Complete Parts I and II.
Special Rules.
D For a section 501 (c)(3) organization filing Form 990, or Form 990-EZ, that met the 33 1/3% support test of the regulations under sections 509 (a)(1 )/170(b)(1 )(A)(vij, and received from anyone contributor, during the year, a contribution of the greater of (1) $5,000 or (2) 2% of the amount on Form 990, Part VIII, line 1 h or 2% of the amount on Form 990·EZ, line 1. Complete Parts I and II.
D For a section 501 (c)(7) , (8), or (10) organization filing Form 990, or Form 990-EZ, that received from anyone contributor, during the year, aggregate contributions or bequests of more than $1,000 for use exclusively for religious, charitable, scientific, literary, or educational purposes, or the prevention of cruelty to children or animals. Complete Parts I, II, and III.
D For a section 501 (c)(7), (8), or (10) organization filing Form 990, or Form 990-EZ, that received from anyone contributor, during the year, some contributions for use exclusively for religious, charitable, etc., purposes, but these contributions did not aggregate to more than $1,000. (If this box is checked, enter here the total contributions that were received during the year for an exclusively religious, charitable, etc., purpose. Do not complete any of the parts unless the General Rule applies to this organization because it received nonexclusively
religious, charitable, etc., contributions of $5,000 or more during the year.) .. ~ $ _
Caution. Organizations that are not covered by the General Rule and/or the Special Rules do not file Schedule B (Form 990, 990-EZ, or 990-PF), but they must answer' No' on Part IV, line 2 of their Form 990, or check the box in the heading of their Form 990-EZ, or on line 2 of their Form 990-PF, to certify that they do not meet the filing requirements of Schedule B (Form 990, 990-EZ, or 990-PF).
LHA For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990. These instructions will be issued separately.
Schedule B (Form 990, 99Q-EZ, or 990-PF) (2008)
823451 12-18-08
13421116 737725 BLOOMFAMFND
14
2008.05000 THE BLOOMBERG FAMILY FOUNDA BLOOMFA1
·
Schedule B (Form 990, 990-EZ, or 990-PF) (2008)
Page 1 of 1 of Part I
THE BLOOMBERG FAMILY FOUNDATION INC
20-5602483
Name of organization
Employer identification number
IE~~t~I~ Contributors (see instructions)
(a) (b) (c) (eI)
No. Name, address, and ZIP + 4 Aggregate contributions Type of contribution
1 MICHAEL R. BLOOMBERG Person 00
--- D
Payroll
C/O GELLER & CO, 800 THIRD AVE $ 460,000,000. Noncash D
(Complete Part II if there
NEW YORK, NY 10022 is a noncash contribution.)
(a) (b) (c) (eI)
No. Name, address, and ZIP + 4 Aggregate contributions Type of contribution
--- Person D
Payroll D
$ Noncash D
(Complete Part II if there
is a noncash contribution.)
(a) (b) (c) (eI)
No. Name, address, and ZIP + 4 Aggregate contributions Type of contribution
--- Person D
Payroll D
$ Noncash D
(Complete Part II if there
is a noncash contribution.)
(a) (b) (c) (d)
No. Name, address, and ZIP + 4 Aggregate contributions Type of contribution
--- Person D
Payroll D
$ Noncash D
(Complete Part II if there
is a noncash contribution.)
(a) (b) (c) (eI)
No. Name, address, and ZIP + 4 Aggregate contributions Type of contribution
--- Person D
Payroll D
$ Noncash D
(Complete Part II if there
is a noncash contribution.)
(a) (b) (c) (eI)
No. Name, address, and ZIP + 4 Aggregate contributions Type of contribution
--- Person D
Payroll D
$ Noncash D
(Complete Part II if there
is a noncash contribution.) 823452 12-18-08
Schedule B (Form 990, 990-EZ, or 990-PF) (2008)
13421116 737725 BLOOMFAMFND
15
2008.05000 THE BLOOMBERG FAMILY FOUNDA BLOOMFAI
o.
Form 8,,868 (Rev. 4-2009) Page 2
• If you are filing for an Additional (Not Automatic) 3-Month Extension, complete only Part" and check this box . [XJ
Note. Only complete Part II if you have already been granted an automatic 3-month extension on a previously filed Form 8868.
for an Automatic 3-Month Part I
print Flle by the extended
Check type of return to be filed (Rle a separate application for each return):
D Form 990 D Form 990'EZ D Form 990-T (sec. 401 (a) or 408(a) t;Ust) D Form 1041·A D Form 990-Bl [Xl Form 990-PF D Form 990-T (trust other than above) D Form 4720
D Form 5227 D Form 6069
D Form 8870
STOP! Do not complete Part II if you were not already granted an automatic 3-month extension on a previously filed Form 8868.
DIANE RIZZO, C/O GELLER & CO LLC
• The books are in the care of" 8 0 0 THIRD AVENUE - NEW YORK, NY 1 0 0 2 2
TelephoneNo." 212-583-6000 FAX No ... 212-583-6241
• If the organization does not have an office or place of business in the United States, check this'box D
• If this is for a Group Retum, enter the organization's four digit Group Exemption Number (GEN) . If this is for the whole group, check this
box .. D. If it is for part of the group, check this box" D and attach a list with the names and EINs of all members the extension is for.
4 I request an additional3·month extension of time until NOVEMBER 16, 2009.
5 For calendar year 2008 ,or'other tax year beginning _===-- -.==_' and ending _==;-- .
6 If this tax year is for less than 12 months, check reason: D Initial return D Rnal return D Change in accounting period
7 State in detail why you need the extension
AN ADDITIONAL EXTENSION OF TIME IS REQUIRED TO FILE A COMPLETE AND
ACCURATE RETURN BECAUSE ALL INFORMATION IS NOT AVAILABLE
791 172.
8a If this application is for Form 990-Bl, 990-PF, 990·T, 4720, or 6069, enter the tentative tax, less any
b If this application is for Form 990·PF, 990-T, 4720, or 6069, enter any refundable credits and estimated tax payments made. Include any prior year overpayment allowed as a credit and any amount paid
791 172.
c Balance Due. Subtract line 8b from line 8a. Include your payment with this form, or, if required, deposit
Under penalties of pe~ury, I declare that I have examined this form, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and c m lete, and that I am thorized to prepare this form.
Si nature .. Title" CPA Date" 7
Form 8868 (Rev. 4-2009)
823832 05-26-09
14190728 737725 BLOOMFAMFND
2008.04010 THE BLOOMBERG FAMILY FOUNDA BLOOMFA1
PO 44 200812
200925 036157
~ Departrncnt of the Treasury Internal Revenue Service OGDEN UT 84201-0074
APPLICATION FOR EXTENSION OF TIME TO FILE AN EXEMPT ORGANIZATION RETURN - APPROVED
We have received your Form 8868, Application for Extension of Time to File an Exempt Organization Return, for the return (form) and tax period identified above.
We have approved your request and have extended the due date to file your return to August 15,2009.
If you have any questions, please call us at the number shown above, or you may write us at the address shown at the top left of tins letter.
Reminder - You May Be Required to File Electronically
Exempt organizations may be required to file certain returns electronically. For tax years ending on or after December 31, 2006, the electronic filing requirement applies to exempt organizations with $10 million or more in total assets if the organization files at least 250 returns in a calendar year, including income, excise, employment tax and information returns. Private foundations and charitable trusts will be required to file Forms 990-PF electronically regardless of their asset size, if they file at least 250 returns annually. For more information, go to www.irs.gov.Click "Charities and Non-Profits" and look for the "e-file for Charities and Non-Profits" tab.
For tax forms, instructions and information visit www.irs.gov. (Access to this site will not provide you with your specific taxpayer account information.)
3a If this application is for Form 990-SL, 990-PF, 990-T, 4720, or 6069, enter the tentative tax, less any See
791 172.
Form *8868 (Rev. April 2009)
Application for Extension of Time To File an Exempt Organization Return
~ File a separate application for each return.
OMS No. 1545-1709
Department of the Treasury Internal ,Revenue Service
• If you are filing for an Automatic 3-Month Extension, complete only Part I and check this box ~ 00
• If you are filing for an Additional (Not Automatic) 3-Month Extension, complete only Part II (on page 2 of this form).
Do not complete Part II unless you have already been granted an automatic 3-month extension on a previously filed Form 8868.
Automatic 3-Month Extension of Time. Only submit original (no copies needed).
A corporation required to file Form 990-T and requesting an automatic 6-month extension - check this box and complete
Part I only . ~ D
All other corporations (including 1120-C filers), partnerships, REMICs, and trusts must use Form 7004 to request an extension of time to file income tax retums.
Electronic Filing [e-file], Generally, you can electronically file Form 8868 if you want a 3'month automatic extension of time to file one of the retums noted below (6 months for a corporation required to file Form 990-1). However, you cannot file Form 8868 electronically if (1) you want the additional (not automatic) 3-month extension or (2) you file Forms 990-SL, 6069, or 8870, group returns, or a composite or consolidated Form 990-T. Instead, you must submit the fully completed and signed page 2 (Part II) of Form 8868. For more details on the electronic filing of this form, visit www.irs.oovlefile and click on e-file for Charities & Nonorotits.
Type or Name of Exempt Organization
print
Employer identification number
THE BLOOMBERG FAMILY FOUNDATION INC
20-5602483
File by the due date for filing your return. See instructions.
Number, street, and room or suite no. If a P.O. box, see instructions. C/O GELLER & CO, 800 THIRD AVE
City, town or post office, state, and ZIP code. For a foreign address, see instructions. NEW YORK, NY 10022
Check type of return to be filed (file a separate application for each return):
D Form 990 D Form 990·SL D Form 990-EZ 00 Form 990-PF
D Form 990-T (corporation)
D Form 990-T (sec. 401 (a) or 408(a) trust) D Form 990-T (trust other than above) D Form 1041-A
D Form 4720 D Form 5227 D Form 6069 D Form 8870
DIANE RIZZO, C/O GELLER & CO LLC
• The books are in the care of ~ ...;.8-:::0:-:0~T=-H'-"=I""'R::::D--=:A.::.V.:..cE::::N::.:..::U-=E~-___:N=E:.:.W:.......:Y:..O:..R::.=.:K'"=,-:::--':N~Y"'-=-:::-1~0_0--:2:-:2~=-- _
TelephoneNo.~ 212-583-6000 FAX No. ~ 212-583-6241
• If the organization does not have an office or place of business in the United States, check this box ~ , ~ D
• If this is for a Group Return, enter the organization's four digit Group Exemption Number (GEN) . If this is for the whole group, check this
box ~ D. If it is for part of the group, check this box ~ D and attach a list with the names and EINs of all members the extension will cover.
1 I request an automatic 3-month (6-months for a corporation required to file Form 990-1) extension of time until
AUGUST 15, 2009 ,to file the exempt organization retum for the organization named above. The extension
is for the organization's retum for:
~ 00 calendar year 2 0 0 8 or ~ D tax year beginning
____________ , and ending _
2 If this tax year is for less than 12 months, check reason: D Initial return
D Rnal return
D Change in accounting period
b If this application is for Form 990-PF or 990-T, enter any refundable credits and estimated
541 172.
e Balance Due. Subtract line 3b from line 3a. Include your payment with this form, or, if required, deposit with FTD coupon or, if required, by using EFTPS (Electronic Federal Tax Payment System).
250 000.
Caution. If you are going to make an electronic fund withdrawal with this Form 8868, see Form 8453-EO and Form 8879-EOfor payment instructions.
LHA For Privacy Act and Paperwork Reduction Act Notice, see Instructions.
Form 8868 (Rev. 4-2009)
823831 03-11-09
13260514 737725 BLOOMFAMFND
P 2008.03051 THE BLOOMBERG FAMILY FOUNDA BLOOMFAl
THE BLOOMBERG FAMILY FOUNDATION INC
FORM 990-PF
20-5602483
GAIN OR (LOSS) FROM SALE OF ASSETS
STATEMENT
1
(A) DESCRIPTION OF PROPERTY
SALE OF PUBLICLY TRADED SECURITIES
(B) GROSS SALES PRICE
366,635,901.
(C) COST OR OTHER BASIS
371,355,249.
MANNER DATE
ACQUIRED ACQUIRED DATE SOLD
VARIOUS
VARIOUS
(D) EXPENSE OF SALE
(E)
(F)
DEPREC.
GAIN OR LOSS
o.
o.
<4,719,348.>
(A) DESCRIPTION OF PROPERTY
SALE OF PUBLICLY TRADED SECURITIES
(B) GROSS SALES PRICE
69,867,516.
(C) COST OR OTHER BASIS
75,016,947.
MANNER DATE
ACQUIRED ACQUIRED DATE SOLD
VARIOUS
VARIOUS
(D) EXPENSE OF SALE
(E)
(F)
DEPREC.
GAIN OR LOSS
o.
o.
<5,149,431.>
(A) DESCRIPTION OF PROPERTY
FROM K-1 - QAM SELECT INVESTORS
(B) GROSS SALES PRICE
(C) COST OR OTHER BASIS
o.
263,636,049.
MANNER DATE
ACQUIRED ACQUIRED DATE SOLD
PURCHASED VARIOUS VARIOUS
(D) EXPENSE OF SALE
(E)
(F)
DEPREC.
GAIN-OR LOSS
o.
o.
<263,636,049.>
13421116 737725 BLOOMFAMFND
16 STATEMENT(S) 1
2008.05000 THE BLOOMBERG FAMILY FOUNDA BLOOMFA1
CAPITAL GAINS DIVIDENDS FROM PART IV
O.
THE BLOOMBERG FAMILY FOUNDATION INC
.
20-5602483
(A) DESCRIPTION OF PROPERTY
MANNER DATE
ACQUIRED ACQUIRED DATE SOLD
PURCHASED
(B) (C) (D) (E) (F)
GROSS COST OR EXPENSE OF
SALES PRICE OTHER BASIS SALE DEPREC. GAIN OR LOSS
O. O. O. O. O.
(A) MANNER DATE
DESCRIPTION OF PROPERTY ACQUIRED ACQUIRED DATE SOLD
FROM K-1 - QAM PRIVATE INVESTORS PURCHASED VARIOUS VARIOUS
(B) (C) (D) (E) (F)
GROSS COST OR EXPENSE OF
SALES PRICE OTHER BASIS SALE DEPREC. GAIN OR LOSS
972,439. 6,644,574. O. O. <5,672,135.> TOTAL TO FORM 990-PF, PART I, LINE 6A
<279,176,963.>
FORM 990-PF INTEREST ON SAVINGS AND TEMPORARY CASH INVESTMENTS STATEMENT 2
SOURCE
AMOUNT
BANK OF AMERICA BIG TOBACCO CONTROL FIDELITY MONEY MARKET
15,251. 5,676.
TOTAL TO FORM 990-PF, PART I, LINE 3, COLUMN A
20,927.
FORM 990-PF DIVIDENDS AND INTEREST FROM SECURITIES STATEMENT 3
CAPITAL GAINS COLUMN (A)
SOURCE GROSS AMOUNT DIVIDENDS AMOUNT
BANK OF AMERICA 7,784,593. O. 7,784,593.
BEAR STEARNS 1,000,649. O. 1,000,649.
CHARLES SCHWAB 5,887,766. O. 5,887,766.
CHARLES SCHWAB 148,500. O. 148,500.
FIDELITY INVESTMENTS 1,401,501. O. 1,401,501. 13421116 737725 BLOOMFAMFND
17 STATEMENT(S) 1, 2, 3
2008.05000 THE BLOOMBERG FAMILY FOUNDA BLOOMFA1
THE ~LOOMBERG FAMILY FOUNDATION INC FIDELITY INVESTMENTS
LEHMAN BROTHERS
QAM PRIVATE INVESTORS LLP QAM SELECT INVESTORS LLP QAM SELECT INVESTORS LLP VANGUARD ADMIRAL TSY MM VANGUARD PRIME MM FD INST
FORM 990-PF OTHER INCOME STATEMENT 4
(A) (B) (C)
REVENUE NET INVEST- ADJUSTED
DESCRIPTION PER BOOKS MENT INCOME NET INCOME
FROM PASS THROUGH 2,754,805. 2,754,805.
FROM PASS THROUGH O. 1,050,802.
TOTAL TO FORM 990-PF, PART I, LINE 11 2,754,805. 3,805,607. FORM 990-PF LEGAL FEES STATEMENT 5
(A) (B) (C) (D)
EXPENSES NET INVEST- ADJUSTED CHARITABLE
DESCRIPTION PER BOOKS ME NT INCOME NET INCOME PURPOSES
PROS KAUER ROSE LLP 19,118. O. 19,118.
WILLKIE FARR & GALLAGHER
LLP 262,629. o. 250,464.
TO FM 990-PF, PG 1, LN 16A 281,747. O. 269,582. FORM 990-PF
ACCOUNTING FEES
DESCRIPTION
(A) EXPENSES PER BOOKS
(C) ADJUSTED NET INCOME
(B)
NET INVESTMENT INCOME
GELLER & CO
233,811.
116,906.
TO FORM 990-PF, PG 1, LN 16B
233,811.
116,906.
STATEMENT
6
(D) CHARITABLE PURPOSES
124,406.
124,406.
13421116 737725 BLOOMFAMFND
18 STATEMENT(S) 3, 4, 5, 6
2008.05000 THE BLOOMBERG FAMILY FOUNDA BLOOMFAI
THE BLOOMBERG FAMILY FOUNDATION INC
.
20-5602483
7
FORM 990-PF
OTHER PROFESSIONAL FEES
STATEMENT
DESCRIPTION
(A) EXPENSES PER BOOKS
CONSULTING FEE 101,710.
QUADRANGLE INVESTMENT
MANAGEMENT LP 4,910,577.
TO FORM 990-PF, PG 1, LN 16C 5,012,287.
(B)
NET INVESTMENT INCOME
(C) ADJUSTED NET INCOME
(D) CHARITABLE PURPOSES
O.
51,710.
4,910,577.
O.
4,910,577.
51,710.
FORM 990-PF
TAXES
STATEMENT
8
DESCRIPTION
(A) EXPENSES PER BOOKS
FEDERAL EXCISE TAX FOREIGN TAX WITHHELD FEDERAL UBTI TAX NYS UBTI TAX
521,002. 326,369. 225,000.
60,000.
TO FORM 990-PF, PG 1, LN 18
1,132,371.
(B)
NET INVESTMENT INCOME
(C) ADJUSTED NET INCOME
(D) CHARITABLE PURPOSES
O. 326,369.
O. O.
O. O. O. O.
326,369.
O.
FORM 990-PF
OTHER EXPENSES STATEMENT 9
(A) (B) (C) (D)
EXPENSES NET INVEST- ADJUSTED CHARITABLE
PER BOOKS MENT INCOME NET INCOME PURPOSES
8,024. 4,012. 4,012.
3,892. O. 2,392.
495. O. 495.
12,411. 4,012. 6,899. DESCRIPTION
EXPENDITURE RESPONSIBILITY STATEMENT PART VII-B, LINE 5C
STATEMENT 13
GRANTEE'S NAME
SALAAM BOMBAY FOUNDATION
GRANTEE'S ADDRESS
46 MAKER CHAMBERS III NARlMAN POINT, INDIA, INDIA
GRANT AMOUNT
DATE OF GRANT
AMOUNT EXPENDED
1,500,000.
OS/26/08
1,214,368.
PURPOSE OF GRANT
ORGANIZE AND ADMINISTER THE 14TH WORLD CONFERENCE ON TOBACCO OR HEALTH FOR 2009.
DATES OF REPORTS BY GRANTEE
OCTOBER 13, 2008
ANY DIVERSION BY GRANTEE
NONE
13421116 737725 BLOOMFAMFND
21 STATEMENT(S) 13
2008.05000 THE BLOOMBERG FAMILY FOUNDA BLOOMFA1
THE BLOOMBERG FAMILY FOUNDATION INC
.
FORM 990-PF
20-5602483
GRANTS AND CONTRIBUTIONS PAID DURING THE YEAR
STATEMENT 14
RECIPIENT NAME AND ADDRESS
DEPT OF PREVENTIVE MEDICINE AND ENVIRON. HEALTH, MINISTRY OF HEALTH,VIETNAM
138A, GIANG VO STREET, HANOI, VIETNAM
WORLD LUNG FOUNDATION, 61 BROADWAY - 6TH FL, NEW YORK, NY 10006
RECIPIENT RELATIONSHIP RECIPIENT
AND PURPOSE OF GRANT STATUS AMOUNT
NONE FOREIGN
GOVERNMENT
SUPPORT ASIA PACIFIC INJURY PREVENTION CONFERENCE
100,000.
NONE PUBLIC
CHARITY
END WORLDWIDE DEPENDENCY ON TOBACCO
THE WORLD HEALTH ORGANIZATION, CH NONE - 1211, GENEVA 2, SWITZERLAND
SALAAM BOMBAY FOUNDATION, 46 MAKER CHAMBERS I I I, NARlMAN POINT, MUMBAI INDIA
FUNDS RECEIVED FROM GATES FOUNDATION FOR CAMPAIGN FOR TOBACCO FREE KIDS
1400 EYE STREET, NW SUITE 1200, WASHINGTON, DC 20005
FUNDS RECEIVED FROM GATES FOUNDATION FOR WORLD LUNG FOUNDATION
61 BROADWAY - 6TH FL, NEW YORK, NY 10006
PREVENTION AND ADVOCACY OF ROAD TRAFFIC INJURY PROJECTS
NONE
ORGANIZE AND ADMINISTER 14TH WORLD CONFERENCE ON TOBACCO OR HEALTH
NONE
COLLABORATION WITH GATES FND TO END DEPENDENCY ON TOBACCO
NONE
COLLABORATION WITH GATES FND TO END DEPENDENCY ON TOBACCO
25138303.
EXECUTIVE ORDER
4500000.
FOREIGN NON EXEMPT
1500000.
PUBLIC CHARITY
1310000.
PUBLIC CHARITY
9290000.
13421116 737725 BLOOMFAMFND
22 STATEMENT(S) 14
2008.05000 THE BLOOMBERG FAMILY FOUNDA BLOOMFA1
THE BLOOMBERG FAMILY FOUNDATION INC
20-5602483
TOTAL TO FORM 990-PF, PART XV, LINE 3A
41,838,303.
13421116 737725 BLOOMFAMFND
23 STATEMENT(S) 14
2008.05000 THE BLOOMBERG FAMILY FOUNDA BLOOMFA1
390.
Form·2220
OMS No. 1545-0142
Underpayment of Estimated Tax by Corporations
~ See separate instructions.
~ Attach to the corporation's tax return. FORM 990 - PF
Department of the Treasury Internal Revenue Service
2008
THE BLOOMBERG FAMILY FOUNDATION INC
Employer identification number 20-5602483
Name
Note: Generally, the corporation is not required to file Form 2220 (see Part II below for exceptions) because the IRS will figure any penalty owed and bill the corporation. However, the corporation may still use Form 2220 to figure the penalty. If so, enter the amount from page 2, line 38 on the estimated tax penalty line of the corporation's income tax return, but do not attach Form 2220.
1 Total tax (see instructions) .
2 a Personal holding company tax (Schedule PH (Form 1120), line 26) included on line 1 .
b Look-back interest included on line 1 under section 460(b )(2) for completed long-term
contracts or section 167(g) for depreciation under the income forecast method .
c Credit for federal tax paid on fuels (see instructions) c •••••••••••
d Total. Add lines 2a through 2c .
3 Subtract line 2d from line 1. If the result is less than $500, do not complete or file this form. The corporation
does not owe the penalty .
4 Enter the tax shown on the corporation's 2007 income tax return (see instructions). Caution: If the tax is zero
or the tax year was for less than 12 months, skip this line and enter the amount from line 3 on line 5 .
499.
5 Required annual payment. Enter the smaller of line 3 or line 4. If the corporation is required to skip line 4,
Reasons for Filing - Check the boxes below that apply. If any boxes are checked, the corporation must file Form 2220 even if it does not owe a penalty (see instructions).
6 D The corporation is using the adjusted seasonal installment method. 7 D The corporation is using the annualized income installment method.
9 Installment due dates. Enter in columns (a) through (d) the 15th day ofthe 4th (Form 990-PF filers:
Use 5th month), 6th, 9th, and 12th months of the corporation's tax year ..........................................•.....
10 Required installments. If the box on line 6 and/or line 7 above is checked, enter the amounts from Sch A, line 38. If the box on line 8 (but not 6 or 7) is checked, see instructions for the amounts to enter. If none of these boxes are checked,
enter 25% of line 5 above in each column 1-'-"+ __ ~~~....;;...+ __ ....;_'-<-...:.....;__:_-+ 6;.._O.;:.....<.....;8;.._7;.....;;;4_.+- __ 6_0~;.._7_5_.
11 Estimated tax paid or credited for each period (see instructions). For column (a) only, enter the amount
from line 11 on line 15 .
Complete lines 12 through 18 of one column before going to the next column.
12 Enter amount, if any, from line 18 ofthe preceding column
13 Add lines 11 and 12 .
14 Add amounts on lines 16 and 17 ofthe preceding column
15 Subtract line 14 from line 13. Ifzero or less, enter -0- .
16 If the amount on line 15 is zero, subtract line 13 from line
14. Otherwise, enter -0- .
17 Underpayment. If line 15 is less than or equal to line 10, subtract line 15 from line 10. Then go to line 12 01 the next
column. Otherwise, go to line 18 .
Overpayment. If line 10 is less than line 15, subtract line 10
09/15/08
12/15/08
05/15/08
06 15/08
50 000.
JWA For Paperwork Reduction Act Notice, see separate instructions.
Form 2220 (2008)
812801 02-26-09
13421116 737725 BLOOMFAMFND
24
2008.05000 THE BLOOMBERG FAMILY FOUNDA BLOOMFAI
FORM 990-PF
.
Form 2220 (2008) THE BLOOMBERG FAMILY FOUNDATION INC
20-5602483
Page 2
!f::PartiNq Figuring the Penalty
-xc : '.: : .:.:.
tal (b) (e) tdl
19 Enter the date of payment or the 15th day of the 3rd month
after the close of the tax year, whichever is earlier (see
instructions). (Form 990-PF and Form 990-T filers: Use 5th
month instead of 3rd month.) .................................... 19
20 Number of days from due date of installment on line 9 to the
date shown on line 19 ................................................... 20
21 Number of days on line 20 after 411512008 and before 71112008 ...... 21
22 Underpayment on line 17 x Number of days on line 21 x 6% ......... 22 s s $ 9;
366
23 Number of days on line20 after 0613012008 and before 101112008 ... 23
24 Underpayment on line 17 x Number of days on line 23 x 5% ......... 24 $ $ $ $
366
25 Number of days on line 20 after 913012008 and before 11112009 ...... 25
26 Underpayment on line 17 x Number of days on line 25 X 6% ......... 26 $ $ $ $
366
27 Number of days on line 20 after 1213112008 and before 4/112009 ... 27
28 Underpayment on line 17 x Number of days on line 27 x 5% ......... 28 '$ s 1$ 9;
365
29 Number of days on line 20 after 313112009 and before 7/112009 ...... 29
3D Underpayment on line 17 x Number of days on line 29 x'% ......... 3D 1$ $ 11 $
365
31 Number of days on line 20 after 613012009 and before 1010112009 ... 31
32 Underpayment on line 17 x Number of days on line 31 x '% ......... 32 $ $ li $
365
33 Number of days on line 20 after 913012009 and before 11112010 ...... 33
34 Underpayment on line 17 x Number of days on line 33 x '% ......... 34 $ $ $ s
365
35 Number of days on line 20 after 1213112009 and bemre2l1612010 ... 35
36 Underpayment on line 17 x Number of days on line 35 x .% ......... 36 $ $ $ 9;
365
37 Add lines 22,24,26,28,30,32,34, and 36 ........................... 37 $ $ $ $
38 Penalty. Add columns (a) through (d) of line 37. Enter the total here and on Form 1120; line 33;
or the comoarable line for other income tax returns ............................................................................................................ 38 $ O. * Use the penalty interest rate for each calendar quarter, which the IRS will determine during the first month in the preceding quarter. These rates are published quarterly in an IRS News Release and in a revenue ruling in the Internal Revenue Bulletin. To obtain this information on the Internet, access the IRS website at www.irs.gov. You can also call 1-800-829-4933 to get interest rate information.
JWA
Form 2220 (2008)
812802 02-26-09
13421116 737725 BLOOMFAMFND
25
2008.05000 THE BLOOMBERG FAMILY FOUNDA BLOOMFA1
14 Compensation of officers, directors, and trustees (Schedule K) .
15 Sala ries and wages , .
16 Repairs and maintenance .
17 Bad debts .
18 Interest (attach schedule) .
19 Taxes and licenses .
20 Charitable contributions (See instructions for limitation rules.) .
21 Depreciation (attach Form 4562) 1-2::.;1=-+ _
22 Less depreciation claimed on Schedule A and elsewhere on return .
23 Depletion .
24 Contributions to deferred compensation plans , .
25 Employee benefit programs .
26 Excess exempt expenses (Schedule I) .
27 Excess readership costs (Schedule J) .
28 Other deductions (attach schedule) .
29 Total deductions. Add lines 14 through 28 .
3D Unrelated business taxable income before net operating loss deduction. Subtract line 29 from line 13 .
31 Net operating loss deduction (limited to the amount on line 30) .
32 Unrelated business taxable income before specific deduction. Subtract line 31 from line 30 .
33 Specific deduction (Generally $1,000, but see instructions for exceptions) .
34 Unrelated business taxable income. Subtract line 33 from line 32. If line 33 is greater than line 32, enter the smaller
ofzero or line 32 .
. OMB No. 1545-0687
Form 990-T Exempt Organization Business Income Tax Return 2008
Department of the Treasury (and proxy tax under section 6033(e»
Internal Revenue Service For calendar year 2008 or other tax year beginning ,and ending ~6'1(c)(tg) 6~~~i~"a'lfo~g~l~r
A o Check box if Name of organization ( 0 Check box if name changed and see instructions.) o Employer identification number
(Employees' trust, see instructions
add ress changed for Block D on page 9.)
B Exempt under section Print THE BLOOMBERG FAMILY FOUNDATION INC 20-5602483
[X] 501 (C )( 3 ) or Number, street, and room or suite no. If a P.O. box, see page 9 of instructions. E Unrelated business activity codes
Type (See instructions for Block E
o 408(e) 0220(e) C/O GELLER & CO, 800 THIRD AVE on page 9.)
0408A 0530(a) City or town, state, and ZIP code
o 529(a) NEW YORK, NY 10022 523000
C Book value of all assets F Group exemption number (See instructions for Block F.l ~
at end of yea r G Check organization type ~ 00 501(c) corporation o 501 (c) trust o 401(a) trust o Other trust
1573135222. I During the tax year, was the corporation a subsidiary in an affiliated group or a parent-subsidiary controlled group? ~ 0 Yes 00 No
If of the ~
H Describe the organization's primary unrelated business activity. ~ UBTI FROM .FLOW THROUGH ACTIVITY.
Less retu rns and allowances c Balance
2 Cost of goods sold (Schedule A, line 7) .
3 Gross profit. Subtract line 2 from line 1c .
4 a Capital gain net income (attach Schedule D) .
b Net gain (loss) (Form 4797, Part II, line 17) (attach Form 4797) .
c Capital loss deduction for trusts .
5 Income (loss) from partnerships and S corporations (attach statement) .
6 Rent income (Schedule C) .
7 Unrelated debt-financed income (Schedule E) .
8 Interest, annuities, royalties, and rents from controlled organizations (Sch. F) .
9 Investment income of a section 501 (c)(7), (9). or (17) organization
(Schedule G) .
10 Exploited exempt activity income (Schedule I) .
11 Advertising income (Schedule J) .
12 Other income (See instructions; attach schedule.) .
Deductions Not Taken Elsewhere (see instructions for limitations on deductions.)
(Except for contributions, deductions must be directly connected with the unrelated business income.)
3-09-09 LHA For Privacy Act and Paperwork Reduction Act Notice, see instructions.
26 13421116 737725 BLOOMFAMFND 2008.05000 THE BLOOMBERG FAMILY FOUNDA BLOOMFA1
Preparer's III.. signature ,..
Date
No
INC
20-5602483
Page 2
35 Organizations Taxable as Corporations. See instructions for tax computation.
Controlled group members (sections 1561 and 1563) check here ~ D See instructions and: a Enteryour share of the $50,000, $25,000, and $9,925,000 taxable income brackets (in that order):
(1) 1$ 1 (2) 1$ 1 (3) =1$ --'
b Enter organization's share of: (1) Additional 5% tax (not more than $11,750) I..!!I $'---- --'
(2) Additional 3% tax (not more than $100,000) ""I $'---- --'
c Income tax on the amount on line 34 .
36 Trusts Taxable at Trust Rates. See instructions for tax computation. Income tax on the amount on line 34 from:
D Tax rate schedule or D Schedule 0 (Form 1041) .
37 Proxy tax. See instructions .
o.
38 Altemative minimum tax
T~~~~~~~~~~~~~~~~~-=~~~~~~~~~~~~~~~~~~~ ~~
4D a Foreign tax credit (corporations attach Form 1118; trusts attach Fomn 1116) .
b Other credits (see instructions) ' .
c General business credit. Attach Form 3800 .
d Credit for prior year minimum tax (attach Fomn 8801 or 8827) .
e Total credits. Add lines 40a through 40d .
41 Subtract line 40e from line 39 ..............................................................................................................•............... 42 Other taxes. Check if from: D Form 4255 D Form 8611 D Form 8697 D Form 8866 D Other (attach schedule)
43 Total tax. Add lines 41 and 42
44 a Payments: A 2007 overpayment credited to 2008 .
b 2008 estimated tax payments .
c Tax deposited with Form 8868 .
d Foreign organizations: Tax paid or withheld at source (see instructions) .
e Backup withholding (see instructions) .
f Other credits and payments: D Form 2439
D Form 4136 D Other
--------
45 Total payments. Add lines 44a through 44f .
46 Estimated tax penalty (see instructions). Check if Fomn 2220 is attached ~ D .
Tax due. If line 45 is less than the total of lines 43 and 46, enter amount owed ~
Overpayment. If line 45 is larger than the total of lines 43 and 46, enter amount overpaid ~
225 000 ~
At any time during the 2008 calendar year, did the organization have an interest in or a Signature or other authority over a financial account (bank, securities, or other) in a foreign country? If YES, the organization may have to file Form TO F 90-22.1, Report of Foreign Bank and
Financial Accounts. If YES, enter the name ofthe foreign country here ~ VARIOUS
2 During the tax year, did the organization receive a distribution from, or was it the granto'"'r O~f,C::o:-;r tra=n=sZ:te=ro:'ir t=-o,-::a"fo:=",,:;::'g::-n tru=st7;;;--------------
If YES, see page 5 of the instructions for other forms the organization may have to file. .. .
1 Inventory at beginning of year .
2 Pu rchases .
3 Cost of labor ..
Additional section 263A costs .
N/A
6 Inventory at end of year .
7 Cast of goads sold. Subtract line 6
from line 5. Enter here and in Part I, line 2 .
8 Do the rules of section 263A (with respect to property produced or acquired for resale) apply to
Sign Here
~ Signature of officer
Date
III.. DIRECTOR "'Title
Under penalties of pe~ury, I declare that I have examined this retum, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than taxpaye~ is based on all information of which preparer has any knowledge.
May the IRS discuss this retum with the preparer shown below (see
Paid Preparer's Use Only
LLC
25TH FLOOR 2
Phone no.
823711 03-09-09
13421116 737725 BLOOMFAMFND
27
2008.05000 THE BLOOMBERG FAMILY FOUNDA BLOOMFA1
QAM PRIVATE INVESTORS I LLC QAM SELECT INVESTORS I LP
<7,351.> <179,174.>
THE BLOOMBERG FAMILY FOUNDATION INC
"
20-5602483
FORM 990-T
INCOME (LOSS) FROM PARTNERSHIPS
STATEMENT 15
DESCRIPTION
AMOUNT
TOTAL TO FORM 990-T, PAGE 1, LINE 5
<186,525.>
13421116 737725 BLOOMFAMFND
28 STATEMENT(S) 15
2008.05000 THE BLOOMBERG FAMILY FOUNDA BLOOMFAI
SCHEDULE D Capital Gains and Losses OMS No. 1545-0123
(Form 1120) ~ Attach to Form 1120, 1120-C, 1120-F, 1120-FSC, 1120-H, 1120-IC-DISC, 1120-L, 1120-ND, 2008
Department of the Treasury 1120-PC, 1120-POL, 1120-REIT, 1120-RIC, 1120-SF, or certain Forms 990-T.
Internal Revenue Service ~ See separate instructions.
Name Employer identification number
THE BLOOMBERG FAMILY FOUNDATION INC 20-5602483
!}]tiia:::rr:d Short-Term CaDital Gains and Losses - Assets Held One Year or Less
(a) Description of property (b) Date acquired (c) Date sold (d) Sales price (e) Cost or other basis (f) Gain or (loss)
(Example: 100 shares of Z Co.) (mo., day, yr.) (mo., day, yr.) (see instructions) (see instructions) (Subtract (e) from (d))
1 FROM K-1 - QAM
SELECT INVESTORS I
LP <810,286.
2 Short-term capital gain from installment sales from Form 6252, line 26 or 37 ............................................................... 2
3 Short-term gain or (loss) from like-kind exchanges from Form 8824 ........................................................................ 3
4 Unused capital loss carryover (attach computation) ................. - ........................................................................... 4 ( )
5 Net short-term caoital gain or (loss). Combine lines 1 through 4 .............................................................................. 5 <810,286.
i:rPiiflHrl Long-Term Oapltal Gains and Losses - Assets Held More Than One Year
6
7 Enter gain from Form 4797, line 7 or 9 ............................................................................................................... 7
8 Long-term capital gain from installment sales from Form 6252, line 26 or 37 ............................................................... 8
9 Long-term gain or (loss) from like-kind exchanges from Form 8824 ........................................................................... 9
10 Capital gain distributions (see instructions) ......................................................................................................... 10
11 Net long-term capital gain or(loss). Combine lines 6 th rouch 10 ................................. ............................................ 11
1:/piaaUU Surnrnarv of Parts I and "
12 Enter excess of net short-term capital gain (line 5) over net long-term capital loss (line 11) .............................................. 12
13 Net capital gain. Enter excess of net long-term capital gain (line 11) over net short-term capital loss (line 5) ........................ 13
14 Add lines 12 and 13. Enter here and on Form 1120, page 1, line 8, or the proper line on other returns. If the corporation has
qualified timber gain, also complete Part IV ...... , ..................................................................................................... 14 O. >
>
Alternative Tax for Corporations with Qualified Timber Gains. Complete Part IV only if the corporation has qualified
timber under section 1201 Skip this part if you are filing Form 1120-R/C. See instructions.
15 Enter qualified timber gain (as defined in section 1201 (b )(2)) .
16 Enter taxable income from Form 1120, page 1, line 30, or the applicable line of your tax return I---'-~ _
17 18 19 20
Enter1l1e smallest at (a) 1I1e amount on line 15; (b) 1I1e amount on line 16; or (c) 1I1e amount on Part 1II,line 13 .•..........••.... L._!..!.....J _
Multiply line 17 by 15% : .
Subtract line 13 from line 16. If zero or less, enter -0- .
Enter the tax on line 19, figured using the Tax Rate Schedule (or applicable tax rate) appropriate for the return with which
Schedule D (Form 1120) is being filed . .
21 22 23 24 25
Add lines 17 and 19
Subtract line 21 from line 16. If zero or less, enter -0- .
Multiply line 22 by 35% .
Add lines 18, 20, and 23 .
Enter the tax on line 16, figured using the Tax Rate Schedule (or applicable tax rate) appropriate for the return
with which Schedule D (Fomn 1120) is being filed .
JWA For Paperwork Reduction Act Notice, see the Instructions for Form 1120.
821051
12-31-08
Schedule 0 (Form 1120) (2008)
13421116 737725 BLOOMFAMFND
29
2008.05000 THE BLOOMBERG FAMILY FOUNDA BLOOMFAI
,
Form 8868 (Rev. April 2009)
Department of the Treasury Internal Revenue Service
Application for Extension of Time To File an Exempt Organization Return
~ File a separate application for each return.
OMS No. 1545·1709
• If you are filing for an Automatic 3-Month Extension, complete only Part I and check this box ~ D
• If you are filing for an Additional (Not Automatic) 3-Month Extension, complete only Part II (on page 2 of this form).
Do not complete Part II unless you have already been granted an automatic a-month extension on a previously filed Form 8868.
Automatic 3-Month Extension of Time. Only submit original (no copies needed).
A corporation required to file Form 990-T and requesting an automatic 6-month extension - check this box and complete
Part I only " , ~ 00
All other corporations (including 1120-C filers), partnerships, REMICs, and trusts must use Form 7004 to request an extension of time to file income tax returns.
Electronic Filing (e-file). Generally, you can electronically file Form 8868 if you want a 3-month automatic extension of time to file one of the returns noted below (6 months for a corporation required to file Form 990-1). However, you cannot file Form 8868 electronically if (1) you want the additional (not automatic) 3-rnonth extension or (2) you file Forms 990-BL, 6069, or 8870, group returns, or a composite or consolidated Form 990-T. Instead, you must submit the fully completed and signed page 2 (Part II) of Form 8868. For more details on the electronic filing of this form, visit www,jrs.Qov/efile and click on e-file for Charities & Nonorotits,
File by the
due date for Number, street, and room or suite no. If a P.O. box, see lnstructions.
filing your C/O GELLER & CO, 800 THIRD AVE
return. See
instructions. City, town or post office, state, and ZIP code. For a foreign address, see instructions.
NEW YORK, NY 10022
20-5602483
Type or Name of Exempt Organization
print
Employer identification number
THE BLOOMBERG FAMILY FOUNDATION INC
Check type of return to be filed (file a separate application for each return):
D Form 990 00 Form 990-T (corporation)
D Form 990-BL D Form 990-T (sec. 401 (a) or 408(a) trust)
D Form 990-EZ D Form 990-T (trust other than above)
D Form 990-PF D Form 1041-A
D Form 4720 D Form 5227 D Form 6069 D Form 8870
DIANE RIZZO, C/O GELLER & CO LLC
• The books are in the care of ~ 800 THIRD AVENUE - NEW YORK, NY 10022
~~~~~~~~~~--~~~~~~~~~~~~~~---------------------
TelephoneNo.~ 212-583-6000 FAX No. ~ 212-583-6241
• If the organization does not have an office or place of business in the United States, check this box .- ~ D
• If this is for a Group Retum, enter the organization's four digit Group Exemption Number (GEN) . If this is for the whole group, check this
box ~ D. If it is for part of the group, check this box ~ D and attach a list with the names and EINs of all members the extension will cover.
1 I request an automatic 3-month (6'months for a corporation required to file Form 990-1) extension of time until
NOVEMBER 15, 2009 , to file the exempt organization return for the organization named above. The extension is for the organization's retum for:
~ 00 calendar year 2 0 0 8 or
~ D tax year beginning , and ending _
2 If this tax year is for less than 12 months, check reason: D Initial return
D Final return
D Change in accounting period
3a If this application is for Form 990-BL, 990-PF, 990-T, 4720, or 6069, enter the tentative tax, less any
o.
o.
b If this application is for Form 990-PF or 990-T, enter any refundable credits and estimated
225 000.
c Balance Due. Subtract line 3b from line 3a. Include your payment with this form, or, if required, deposit with FTD coupon or, if required, by using EFTPS (Electronic Federal Tax Payment System).
Caution. If you are going to make an electronic fund withdrawal with this Form 8868, see Form 8453-EO and Form 8879·EO for payment instructions.
LHA For Privacy Act and Paperwork Reduction Act Notice, see Instructions.
Form 8868 (Rev. 4·2009)
823831 05-26-09
13421116 737725 BLOOMFAMFND
30
2008.05000 THE BLOOMBERG FAMILY FOUNDA BLOOMFA1
o.
,
Form 8868 (Rev. 4-2009) Page 2
• If you are filing for an Additional (Not Automatic) 3-Month Extension, complete only Part" and check this box ~ [X]
print
E BLOOMBERG FAMILY FOUNDATION INC
Rle by the extended
Number, street, and room or suite no. If a P.O. box, see instructions. /0 GELLER & CO 800 THIRD AVE
Check type of return to be filed (File a separate application for each retum):
D Form 990 D Form 990·EZ D Form 990-T (sec. 401 (a) or 408(a) trust) D Form 1041·A
D~~L[X]~~FD~~~~~~ D~~
D Form 5227 D Form 6069
D For~8870
STOP! Do not complete Part" if you were not already granted an automatic 3-month extension on a previously filed Form 8868.
DIANE RIZZO, C/O GELLER & CO LLC
• The books are in the care of ~ 800 THIRD AVENUE - NEW YORK, NY 10022
• If the organization does not have an office or place of business in the United States, check this box ~ D
• If this is for a Group Retum, enter the organization's four digit Group Exemption Number (GEN) . If this is for the whole group, check this
box ~ D. If it is for part of the group, check this box ~ D and attach a list with the names and EINs of all members the extension is for.
4 I request an additlonal a-month extension of time until NOVEMBER 16, 2009.
5 For calendar year 2008 ,or other tax year beginning _;==,,- -;==-_ ' and ending _=:;-- _
D Initial return D Final return D Change in accounting period
6
If this tax year is for less than 12 months, check reason:
7 State in detail why you need the extension
AN ADDITIONAL EXTENSION OF TIME IS REQUIRED TO FILE A COMPLETE AND
b If this application is for Form 990-PF, 990-T, 4720, or 6069, enter any refundable credits and estimated tax payments made. Include any prior year overpayment allowed as a credit and any amount paid
with
Sa If this application is for Form 990'BL, 990·PF, 990·T, 4720, or 6069, enter the tentative tax, less any
791 172.
791 172.
c Balance Due. Subtract line 8b from line 8a. Include your payment with this form, or, if required, deposit
Signature and Verification
Under penalties of perjury, I declare that I have examined this form, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete, and that I am authorized to prepare this form.
Signature ~ Title ~ CPA Date ~
Form 8868 (Rev. 4-2009)
823832 05-26-09
13421116 737725 BLOOMFAMFND
31
2008.05000 THE BLOOMBERG FAMILY FOUNDA BLOOMFA1
Form '8886
(Rev. December 2007) Department of the Treasury Internal Revenue Service
Reportable Transaction Disclosure Statement
OMS No. 1545-1800
~ Attach to your tax return. ~ See separate instructions.
Attachment Sequence No. 137
Name(s) shown on return (individuals enter last name, first name, middle initial)
Identifying number
THE BLOOMBERG FAMILY FOUNDATION INC
20-5602483
Number) street, and room or suite no.
C/O GELLER & CO, 800 THIRD AVE
City or town, state, and ZIP code
NEW YORK, NY
10022
A If you are filing more than one Form 8886 with your tax return, sequentially number each Form 8886 and enter the statement number
for this Form 8886 ~ Statement number 1 of 2
B Enter the form number of the tax return to which this form is attached or related ~ .::.9...;9_0_-...;T=- _
Enter the year ofthe tax retum identified above ~ .=2_:0_0'-8.:.._ _
Is this Form 8886 being filed with an amended tax return?
DYes [K] No
C Check the box(es) that apply (see instructions). [K] Initial year filer
D Protective disclosure
1 a Name of reportable transaction
FOREIGN CURRENCY LOSS PURSUANT TO IRC SECTION 988
2008
1 c Reportable transaction or tax shelter registration number (9 digits or 11 digits)
1 b Initial year participated in transaction
2 Identify the type of reportable transaction. Check all boxes that apply (see instructions).
a D Listed c D Contractual protection
b D Confidential d [K] Loss
e D Brief asset holding period D Transaction of interest
3 If you checked box 2a or 2f, enter the published guidance number for the listed transaction
or transaction of interest ~
4 Enter the number of 'same as or substantially similar" transactions reported on this form . ~
5 If you participated in the transaction through another entity, check all applicable boxes and provide the information below for the entity (see instructions). (Attach
additional sheets, if necessary.) a Type of entity:
[K] Partnership D S corporation D Trust
D Foreign
LP
D Partnership D S corporation D Trust
D Foreign
b Name
~ QAM SELECT INVESTORS I
c Employer identification number (EIN), if known ~ .=2~6:._---=.1-=6..::3:._4=-3=-..::.0~8~ _
d Date Schedule K-1 received from entity (enter 'none"
if Schedule K-1 not received) ~ ..::.0..::.9_:./_:1=-5=...!.../-=2:...:0:._0::_:9=---'-- _
6 Enter below the name and address of each individual or entity to whom you paid a fee with regard to the transaction if that individual or entity promoted, solicited, or recommended your participation in the transaction, or provided tax advice related to the transaction. (Attach additional sheets, if necessary.)
a Name
!Identifying number (if known) ! ~ees paid
Number, street, and room or suite no.
City or town, state, and ZIP code
b Name
!Identifying number (if known) ! ~ees paid
Number, street, and room or suite no.
City or town, state, and ZIP code
g~~~~~8 LHA For Paperwork Reduction Act Notice, see separate instructions.
Form 8886 (Rev. 12-2007)
13421116 737725 BLOOMFAMFND
32
2008.05000 THE BLOOMBERG FAMILY FOUNDA BLOOMFA1
Form 8886 (Rev. 12-2007)
Pa e2
THE BLOOMBERG FAMILY FOUNDATION INC
20-5602483
7 Facts
a Identify the type of tax benefit generated by the transaction. Check all the boxes that apply (see instructions).
D Deductions D Capital loss 00 Ordinary loss
D Exclusions from gross income D Nonrecognition of gain
D Adjustments to basis
D Tax credits D Other
-------------------------
D Deferral
D Absence of adjustments to basis
b Further describe the amount and nature of the expected tax treatment and expected tax benefits generated by the transaction for all affected years. Include facts of each step ofthe transaction that relate to the expected tax benefits including the amount and nature of your investment. Include in your description your participation in the transaction and all related transactions regardless ofthe year in which they were entered into. Also, include a description of any tax result protection with respect to the transaction.
FOREIGN CURRENCY LOSS OF 73,380 OF BRAZILIAN CURRENCY PURSUANT TO IRC
SECTION 988
8 Identify all tax-exempt, foreign, and related entities and individuals involved in the transaction. Check the appropriate box(es) (see instructions). Include their names(s), identifying number(s), address(es), and a brief description of their involvement. For each foreign entity, identify its country of incorporation or existence. For each related entity, explain how it is related. (Attach additional sheets, if necessary.)
a Type of entity:
D Tax-exempt
D Foreign
D Related
Name
I Identifying number
Address
Descri tion
b Type of entity:
D Tax-exempt
D Foreign
D Related
Name
I Identifying number
Address
Descri tion
Form 8886 (Rev. 12-2007)
810812 04-25-08
13421116 737725 BLOOMFAMFND
33
2008.05000 THE BLOOMBERG FAMILY FOUNDA BLOOMFA1
Form 8886
(Rev. December 2007) Department of the Treasury Intemal Revenue Service
OMS No. 1545-1800
Reportable Transaction Disclosure Statement ~ Attach to your tax return.
~ See separate instructions.
Attachment Sequence No. 137
Name(s) shown on return (Individuals enter last name, first name, middle initial)
Identifying number
THE BLOOMBERG FAMILY FOUNDATION INC
20-5602483
Number, street, and room or suite no.
clo GELLER & CO, 800 THIRD AVE
City or town, state, and ZiP code
NEW YORK, NY
10022
A If you are filing more than one Form 8886 with your tax return, sequentially number each Form 8886 and enter the statement number
for this Form 8886 ~ Statement number 2 of 2
B Enter the form number ofthe tax retum to which this form is attached or related ~ .;;_9..,:9_0_-....:T::._ _
Enter the year of the tax retum identified above ~ .;::2...:0_0:......:,.8 _
Is this Form 8886 being filed with an amended tax return?
DYes [XJ No
C Check the box(es) that apply (see instructions). [XJ Initial year filer
D Protective disclosure
1 a Name of reportable transaction
FOREIGN CURRENCY LOSS PURSUANT TO IRC SECTION 988
2008
1 c Reportable transaction or tax shelter registration number (9 digits or 11 digits)
1b Initial year participated in transaction
2
Identify the type of reportable transaction. Check all boxes that apply (see instructions).
a D Listed c D Contractual protection
b D Confidential d [XJ Loss
If you checked box 2a or 2f, enter the published guidance number for the listed transaction or transaction of interest
e D Brief asset holding period D Transaction of interest
3
4 Enter the number of "same as or substantially similar" transactions reported on this form .. ~
5 If you participated in the transaction through another entity, check all applicable boxes and provide the information below for the entity (see instructions). (Attach additional sheets, if necessary.)
a Type of entity: [XJ Partnership D Partnership
D S corporation D S corporation
D Trust D Trust
b Name D Foreign D Foreign
~ QAM SELECT INVESTORS I LP
c Employer identification number (EIN), if known ~ .::2'-'6:....-.....::;1...:6...;3:....4=-:..3...:0...;8'-1 _
d Date Schedule K-1 received from entity (enter "none'
if Schedule K-1 not received) ~ .=0..=9:...:/_1=5..!.../-=2:...:0:...0=-=..9-.1... _
6 Enter below the name and address of each individual or entity to whom you paid a fee with regard to the transaction if that individual or entity promoted, solicited, or recommended your participation in the transaction, or provided tax advice related to the transaction. (Attach additional sheets, if necessary.)
a Name
I Identifying number (if known) I ~ees paid
Number, street, and room or suite no.
City or town, state, and ZIP code
b Name
I Identifying number (if known) I ~ees paid
Number, street, and room or suite no.
City or town, state, and ZIP code
~!~:~18 LHA For Paperwork Reduction Act Notice, see separate instructions.
Form 8886 (Rev. 12-2007)
13421116 737725 BLOOMFAMFND
34
2008.05000 THE BLOOMBERG FAMILY FOUNDA BLOOMFA1
Form 8886 (Rev. 12-2007)
Pa e2
THE BLOOMBERG FAMILY FOUNDATION INC
20-5602483
7 Facts
a Identify the type oftax benefit generated by the transaction. Check all the boxes that apply (see instructions).
D Deductions D Capital loss [K] Ordinary loss
D Exclusions from gross income D Nonrecognition of gain
D Adjustments to basis
D Tax credits D Other
-------------------------
D Deferral
D Absence of adjustments to basis
b Further describe the amount and nature of the expected tax treatment and expected tax benefits generated by the transaction for all affected years. Include facts of each step of the transaction that relate to the expected tax benefits including the amount and nature of your investment. Include in your description your participation in the transaction and all related transactions regardless of the year in which they were entered into. Also, include a description of any tax result protection with respect to the transaction.
FOREIGN CURRENCY LOSS OF 243,955 OF EURO CURRENCY PURSUANT TO IRC SECTION 988
8 Identify all tax-exempt, foreign, and related entities and individuals involved in the transaction. Check the appropriate box(es} (see instructions). Include their names(s), identifying number(s}, address(es), and a brief description of their involvement. For each foreign entity, identify its country of incorporation or existence. For each related entity, explain how it is related. (Attach additional sheets, if necessary.)
a Type of entity:
D Tax-exempt
D Foreign
D Related
Name
I Identifying number
Address
Descri tion
b Type of entity:
D Tax-exempt
D Foreign
D Related
Name
I Identifying number
Address
Descri tion
Form 8886 (Rev. 12-2007)
810812 04-25-08
13421116 737725 BLOOMFAMFND
35
2008.05000 THE BLOOMBERG FAMILY FOUNDA BLOOMFA1
Form 926 Return by a U.S. Transferor of Property
(Rev. December 2008) to a Foreign Corporation
Department of the Treasury
Intemal Revenue Service ~ Attach to your Income tax return for the year of the transfer or distribution.
OMB No. 1545-0026
!:::P&it:¥@il U.S. Transferor Information (see instructions)
20-5602483
Name of transferor
Identifying number (see instructions)
THE BLOOMBERG FAMILY FOUNDATION INC
1 If the transferor was a corporation, complete questions 1 a through 1 d.
a If the transfer was a section 361 (a) or (b) transfer, was the transferor controlled (under section 368(c» by 5 or
fewer domestic corporations? D Ves
b Did the transferor remain in existence after the transfer? 00 Ves
If not, list the controlling shareholder(s) and their identifying number(s):
00 No DNo
Controlling shareholder
00 No
Identifying number
c If the transferor was a member of an affiliated group filing a consolidated return, was it the parent corporation? D Ves
If not, list the name and employer identification number (EIN) of the parent corporation:
Name of parent corporation
00 No
EIN of parent corporation
d Have basis adjustments under section 367(a)(5) been made? .. D Ves
2 If the transferor was a partner in a partnership that was the actual transferor (but is not treated as such under section 367), complete questions 2a through 2d.
a List the name and EIN of the transferor'S partnership:
Name of partnership
EIN of partnership
b Did the partner pick up its pro rata share of gain on the transfer of partnership assets? D Ves
c Is the partner disposing of its entire interest in the partnership? D Ves
d Is the partner disposing of an interest in a limited partnership that is regularly traded on an established
00 No 00 No
DVes
IX! No
see instructions
Name of transferee (foreign corporation)
NONE
4 Identifying number, if any
VARDE MAURITIUS LTD
5 Address (including country)
IFS COURT, TWENTY-EIGHT CYBER CITY, EBENE MAURITIUS
6 Country code of country of incorporation or organization
MP
7 Foreign law characterization (see instructions)
8 Is the transferee foreign corporation a controlled foreign corporation?
Dves
LHA For Paperwork Reduction Act Notice, see separate instructions. 824531
02-16-09
Form 926 (Rev. 12·2008)
13421116 737725 BLOOMFAMFND
36
2008.05000 THE BLOOMBERG FAMILY FOUNDA BLOOMFA1
Pa e2
Type of (a) (b) (c) (eI) (e)
Date of Description of Fair market value on Cost or other Gain recognized on
property transfer ~(/r{::: . .: I dateoftr~
Cash 293,975.
Stock and
securities
Installment obligations,
account receivables or
similar property
Foreign currency or other
property denominated in
foreign currency
Inventory
Assets subject to
depreciation recapture
(see Temp. Regs. sec.
i.se ((a)-4~'b))
Tangible property used in
trade or business not listed
under another category
Intangible
property
Property to be leased
(as described in
Temp. Regs. sec.
1.367(a)-4T(c))
Property to be sold
(as described in
Temp. Regs. sec.
1 3€~(a)-4Tlc'"
Transfers of oil and gas
working interests (as
described in Temp.
Reas. sec. 1.367Ia)-4Tle))
Other property
Supplemental Information Required To Be Reported (see instructions):
824532 02-16-09
Form 926 (Rev. 12-2008)
13421116 737725 BLOOMFAMFND
37
2008.05000 THE BLOOMBERG FAMILY FOUNDA BLOOMFA1
see instructions
Pa e3
9 Enter the transferor's interest in the foreign transferee corporation before and after the transfer:
(a) Before % (b) After %
10 Type of nonrecognition transaction (see instructions) ~ _
11 Indicate whether any transfer reported in Part III is subject to any of the following:
a Gain recognition under section 904(1)(3) .
b Gain recognition under section 904(1)(S)(F) .
c Recapture under section 1S03(d) .
d Exchange gain under section 987 .
12 Did this transfer result from a change in the classification of the transferee to that of a foreign corporation? .
13 Indicate whether the transferor was required to recognize income under Temporary Regulations sections
1.367(a)-4T through 1.367(a)·6T for any of the following:
a Tainted property .
b Depreciation recapture , .
c Branch loss recapture. . .
d Any other income recognition provision contained in the above-referenced regulations .
14 Did the transferor transfer assets which qualify for the trade or business exception under section 367(a)(3)? .
15 a Did the transferor transfer foreign goodwill or going concern value as defined in Temporary Regulations section
1.367(a)-1T(d)(S)(iii)? .
b If the answer to line 1Sa is 'Yes," enter the amount of foreign goodwill or going concern value
transferred ~ $ _
DYes 00 No
DYes 00 No
DYes 00 No
DYes 00 No
DYes 00 No DYes 00 No
DYes 00 No
DYes 00 No
DYes 00 No
DYes 00 No
DYes 00 No DNo
16 Was cash the only property transferred? 00 Yes
17 a Was intangible property (within the meaning of section 936(h)(3)(B)) transferred as a result of the transaction?
b If 'Yes," describe the nature of the rights to the intangible property that was transferred as a result of the transaction:
DYes
00 No
824533 02·16-09
Form 926 (Rev. 12·2008)
38
2008.05000 THE BLOOMBERG FAMILY FOUNDA BLOOMFA1
13421116 737725 BLOOMFAMFND
Form 926 Return by a U.S. Transferor of Property
(Rev. December 2008) to a Foreign Corporation
Department of the Treasury
Internal Revenue Service ~ Attach to your Income tax return for the year of the transfer or distribution.
OMS No. 1545-0026
[PMiHt:tl U.S. Transferor Information.(see instructions)
20-5602483
Name of transferor
Identifying number (see ins1ruclions)
THE BLOOMBERG FAMILY FOUNDATION INC
1 If the transferor was a corporation, complete questions 1 a through 1 d.
a If the transfer was a section 361 (a) or (b) transfer, was the transferor controlled (under section 368(c)) by 5 or
fewer domestic corporations? D Ves
b Did the transferor remain in existence after the transfer? 00 Ves
If not, list the controlling shareholder(s) and their identifying number(s):
00 No DNo
Controlling shareholder
00 No
Identifying number
c If the transferor was a member of an affiliated group filing a consolidated return, was it the parent corporation? D Ves
If not, list the name and employer identification number (EIN) of the parent corporation:
Name of parent corporation
00 No
EIN of parent corporation
d Have basis adjustments under section 367(a)(5) been made? _....... D Ves
2 If the transferor was a partner in a partnership that was the actual transferor (but is not treated as such under section 367), complete questions 2a through 2d.
a List the name and EIN of the transferor's partnership:
Name of partnership
EIN of partnership
b Did the partner pick up its pro rata share of gain on the transfer of partnership assets? D Ves
c Is the partner disposing of its entire interest in the partnership? D Ves
d Is the partner disposing of an interest in a limited partnership that is regularly traded on an established
00 No 00 No
3 Name of transferee (foreign corporation)
4 Identifying number, if any
BJJ UNIVERSUL DEVELOPMENT LTD
NONE
5 Address (including country) 58 GRIVA DIGHENI
CITY HOUSE P.C. 8103, PAPHOS CYPRUS
6 Country code of country of incorporation or organization CY
7 Foreign law characterization (see instructions)
8 Is the transferee foreign corporation a controlled foreign corporation?
DVes
00 No
LHA For Paperwork Reduction Act Notice, see separate instructions. 824531
02-16-09
Form 926 (Rev. 12·2008)
13421116 737725 BLOOMFAMFND
39
2008.05000 THE BLOOMBERG FAMILY FOUNDA BLOOMFA1
Pa e2
Type of (a) (b) Ie) ~
Date of Description of Fair market value on Cost or other Gain recognized on
property transfer ~ date of transfer basis transfer
Cash 562,250.
Stock and
securities
Installment obligations,
account receivables or
similar property
Foreign currency or other
property denominated in
foreign currency
Inventory
Assets subject to
depreciation recapture
(see Temp. Regs. sec.
1.367(a)-4T(b))
Tangible property used in
trade or business not listed
under another category
Intangible
property
Property to be leased
(as described in
Temp. Regs. sec.
1.367(a)-4T(c))
Property to be sold
(as described in
Temp. Regs. sec.
1.367(a)-4T(d))
Transfers of oil and gas
working interests (as
described in Temp.
Regs. sec. L:SbflaJ-4 {el
Other property
Supplemental Information Required To Be Reported (see instructions):
824532 02-16-09
Form 926 (Rev. 12-2008)
13421116 737725 BLOOMFAMFND
40
2008.05000 THE BLOOMBERG FAMILY FOUNDA BLOOMFA1
see instructions
Pa e3
9 Enter the transferor's interest in the foreign transferee corporation before and after the transfer:
(a) Before % (b) After _--- %
10 Type of nonrecognition transaction (see instructions) ~ _
11 Indicate whether any transfer reported in Part III is subject to any of the following:
a Gain recognition under section 904(f)(3) .
b Gain recognition under section 904(f)(5)(F) .
c Recapture under section 1503(d) .
d Exchange gain under section 987 .
12 Did this transfer result from a change in the classification of the transferee to that of a foreign corporation? .
13 Indicate whether the transferor was required to recognize income under Temporary Regulations sections
1.367(a)-4T through 1.367(a)-6T for any of the following:
a Tainted property .
b Depreciation recapture .
c Branch loss recapture .
d Any other income recognition provision contained in the above-referenced regulations .
14 Did the transferor transfer assets which qualify for the trade or business exception under section 367(a)(3)? .
15 a Did the transferor transfer foreign goodwill or going concern value as defined in Temporary Regulations section
1.367(a)-1T(d)(5)Oii)? .
b If the answer to line 15a is 'Ves,' enter the amount of foreign goodwill or going concem value
transferred ~ $ _
Dves IX] No
DVes IX] No
DVes IX] No
DVes IX] No
DVes IX] No Dves IX] No
DVes IX] No
DVes IX] No
DVes IX] No
DVes IX] No
DVes IX] No 16 Was cash the only property transferred? IX] Ves
17 a Was intangible property (within the meaning of section 936(h)(3)(B)) transferred as a result of the transaction?
b If 'Ves,' describe the nature of the rights to the intangible property that was transferred as a result of the transaction:
DNo
Dves
IX] No
824533 02-16-09
Form 926 (Rev. 12-2008)
41
2008.05000 THE BLOOMBERG FAMILY FOUNDA BLOOMFA1
13421116 737725 BLOOMFAMFND
Form 926 Return by a U.S. Transferor of Property
(Rev. December2008) to a Foreign Corporation
Department of the Treasury
Intemal Revenue Service ~ Attach to your Income tax return for the year of the transfer or distribution.
OMB No. 1545-0026
Name of transferor
Identifying number (seeinSlruc1ions)
!:':Piiiflffl U.S. Transferor Information (see instructions)
THE BLOOMBERG FAMILY FOUNDATION INC
20-5602483
1 If the transferor was a corporation. complete questions 1 a through 1 d.
a If the transfer was a section 361 (a) or (b) transfer. was the transferor controlled (under section 368(c)) by 5 or
fewer domestic corporations? DYes
b Did the transferor remain in existence after the transfer? [X] Yes
If not. list the controlling shareholder(s) and their identifying number(s):
[X] No DNo
Controlling shareholder
Identifying number
[X] No
c If the transferor was a member of an affiliated group filing a consolidated return. was it the parent corporation? DYes
If not. list the name and employer identification number (EIN) of the parent corporation:
Name of parent corporation
EIN of parent corporation
[X] No
d Have basis adjustments under section 367(a)(5) been made? DYes
2 If the transferor was a partner in a partnership that was the actual transferor (but is not treated as such under section 367). complete questions 2a through 2d.
a Ust the name and EIN of the transferors partnership:
Name of partnership
EIN of partnership
[X] No [X] No
b Did the partner pick up its pro rata share of gain on the transfer of partnership assets? .. D Ves
c Is the partner disposing of its entire interest in the partnership? D Ves
d Is the partner disposing of an interest in a limited partnership that is regularly traded on an established
securities market? D Yes [X] No
FpMiJj)n Transferee Foreign Corporation Information (see instructions)
3 Name of transferee (foreign corporation) 4 Identifying number. if any
GRUPO QUALICORP NONE
5 Address (including country)
ALAMEDA SANTOS, 415-14TH FLOOR, 01419-000 SAO PAULO, SP BRAZIL
6 Country code of country of incorporation or organization BR
7 Foreign law characterization (see instructions)
8 Is the transferee foreign corporation a controlled foreign corporation?
DVes
[X] No
LHA For Paperwork Reduction Act Notice, see separate instructions. 824531
02-16-09
Form 926 (Rev. 12·2008)
42
2008.05000 THE BLOOMBERG FAMILY FOUNDA BLOOMFA1
13421116 737725 BLOOMFAMFND
Type of (a) ~ (c) (d) (e)
Date of Fair market value on Cost or other Gain recognized on
property transfer date of transfer basis transfer
f
Cash . 304,909 •
Stock and
securities
Installment obligations,
account receivables or
similar property
Foreign currency or other
property denominated in
foreign currency
Inventory
Assets subject to
depreciation recapture
(see Temp. Regs. sec.
1.367Cal·4TCb))
Tangible property used in
trade or business not listed
under another category
Intangible
property
Property to be leased
(as described in
Temp. Regs. sec.
1.367Ca)·4TCc))
Property to be sold
(as described in
Temp. Regs. sec.
1.367Ca)·4TCdll
Transfers of oil and gas
working interests (as
described in Temp.
Reos, sec. 1.367Ca)·4TCell
Other property
Supplemental Information Required To Be Reported (see instructions):
824532 02·16·09
Form 926 (Rev. 12·2008)
13421116 737725 BLOOMFAMFND
43
2008.05000 THE BLOOMBERG FAMILY FOUNDA BLOOMFA1
Pa e2
see instructions
Pa e3
9 Enter the transferor's interest in the foreign transferee corporation before and after the transfer:
(a) Before % (b) After %
10 Type of nonrecognition transaction (see instructions) ~ _
11 Indicate whether any transfer reported in Part III is subject to any of the following:
a Gain recognition under section 904(f)(3) .
b Gain recognition under section 904(f)(5)(F) .
c Recapture under section 1503(d) .
d Exchange gain under section 987 .
12 Did this transfer result from a change in the classification of the transferee to that of a foreign corporation? .
13 Indicate whether the transferor was required to recognize income under Temporary Regulations sections
1.367(a)-4T through 1.367(a)-6T for any of the following:
a Tainted property .
b Depreciation recapture .
c Branch loss recapture .
d Any other income recognition provision contained in the above-referenced regulations .
14 Did the transferor transfer assets which qualify for the trade or business exception under section 367(a)(3)? .
15 a Did the transferor transfer foreign goodwill or going concern value as defined in Temporary Regulations section
1.367(a)-1T(d)(5)(iiij? .
b If the answer to line 15a is 'Yes,' enter the amount of foreign goodwill or going concern value
transferred ~ $ _
DYes 00 No
DYes 00 No
DYes 00 No
DYes 00 No
DYes 00 No DYes 00 No
DYes 00 No
DYes 00 No
DYes 00 No
DYes 00 No
DYes 00 No DNo
16 Was cash the only property transferred? ;...................................................... 00 Yes
17 a Was intangible property (within the meaning of section 936(h)(3)(B)) transferred as a result of the transaction?
b If 'Yes,' describe the nature of the rights to the intangible property that was transferred as a result of the transaction:
00 No
DYes
824533 02-16-09
Form 926 (Rev_ 12-2008)
44
2008.05000 THE BLOOMBERG FAMILY FOUNDA BLOOMFA1
13421116 737725 BLOOMFAMFND
Form 926 Return by a U.S. Transferor of Property
(Rev. December2oo8) to a Foreign Corporation
Department of the Treasury
Internal Revenue Service ~ Attach to your Income tax return for the year of the transfer or distribution.
OMS No. 1545-0026
Name of transferor
Identifying number (seeins1ructions)
!~Piftlf:J U.S. Transferor Information (see instructions)
THE BLOOMBERG FAMILY FOUNDATION INC
20-5602483
1 If the transferor was a corporation, complete questions 1 a through 1 d.
a If the transfer was a section 361 (a) or (b) transfer, was the transferor controlled (under section 368(c)) by 5 or
fewer domestic corporations? D Ves
b Did the transferor remain in existence after the transfer? [XJ Ves
If not, list the controlling shareholder(s) and their identifying number(s):
[XJ No DNo
Controlling shareholder
Identifying number
c If the transferor was a member of an affiliated group filing a consolidated return, was it the parent corporation? D Ves
If not, list the name and employer identification number (EIN)of the parent corporation:
[XJ No
Name of parent corporation
EIN of parent corporation
d Have basis adjustments under section 367(a)(5) been made? D Ves
[XJ No
2 If the transferor was a partner in a partnership that was the actual transferor (but is not treated as such under section 367), complete questions 2a through 2d.
a List the name and EIN of the transferor's partnership:
Name of partnership
EIN of partnership
b Did the partner pick up its pro rata share of gain on the transfer of partnership assets? .
c Is the partner disposing of its entire interest in the partnership? .
d Is the partner disposing of an interest in a limited partnership that is regularly traded on an established
securities market? D Ves
DVes DVes
[XJ No [XJ No
[XJ No
3 Name of transferee (foreign corporation)
4 Identifying number, if any
FPift:lm] Transferee Foreign Corporation Information (see instructions)
K.K. BCJ-1
NONE
5 Address Oncluding country)
8F KISHIMOTO BLDG, 2-2-1 MARUNOUCHI CHIYODA-KU, TOKYO 100-0005 JAPAN
6 Country code of country of incorporation or organization JA
7 Foreign law characterization (see instructions)
Form 926 (Rev. 12-2008)
8 Is the transferee foreign corporation a controlled foreign corporation?
Dves
[XJ No
LHA For Paperwork Reduction Act Notice, see separate instructions. 824531
02-16-09
45
2008.05000 THE BLOOMBERG FAMILY FOUNDA BLOOMFA1
13421116 737725 BLOOMFAMFND
Pa e2
Type of (a) ~(CI~
Date of Fair market value on Cost or other Gain recognized on
property transfer date of transfer basis transfer
Cash 110~
Stock and
securities
Installment obligations,
account receivables or
similar property
Foreign currency or other
property denominated in
foreign currency
Inventory
Assets subject to
depreciation recapture
(see Temp. Regs. sec.
1.367Ial-4T(t"
Tangible property used in
trade or business not listed __c_
under another category
Intangible
property
Property to be leased
(as described in
Temp. Regs. sec.
1.367(a\-4T(c\\
Property to be sold
(as described in
Temp. Regs. sec.
1.367(a\-4Tldll
Transfers of oil and gas
working interests (as
described in Temp.
Reas. sec. 1.3671a)-4Tlell
Other property
Supplemental Information Required To Be Reported (see instructions):
824532 02-16-09
Form 926 (Rev_ 12-2008)
13421116 737725 BLOOMFAMFND
46
2008.05000 THE BLOOMBERG FAMILY FOUNDA BLOOMFA1
see instructions
Pa e3
9 Enter the transferor's interest in the foreign transferee corporation before and after the transfer:
(a) Before % (b) After %
10 Type of nonrecognition transaction (see instructions) ~ _
11 Indicate whether any transfer reported in Part III is subject to any of the following:
a Gain recognition under section 904(f)(3) .
b Gain recognition under section 904(f)(S)(F) .
c Recapture under section 1S03(d) .
d Exchange gain under section 987 .
12 Did this transfer result from a change in the classification of the transferee to that of a foreign corporation? .
13 Indicate whether the transferor was required to recognize income under Temporary Regulations sections
1.367(a)·4T through 1.367(a)·6T for any of the following:
a Tainted property .
b Depreciation recapture .
c Branch loss recapture .
d Any other income recognition provision contained in the above·referenced regulations .' .
14 Did the transferor transfer assets which qualify for the trade or business exception under section 367(a)(3)? .
15 a Did the transferor transfer foreign goodwill or going concem value as defined in Temporary Regulations section
1.367(a)·1T(d)(S)(iii)? .
b If the answer to line 1Sa is 'Yes," enter the amount of foreign goodwill or going concern value
transferred ~ $ _
DYes [X] No
DYes [X] No
DYes [X] No
DYes [X] No
DYes [X] No DYes [X] No
DYes [X] No
DYes [X] No
DYes [X] No
DYes [X] No
DYes [X] No DNo
16 Was cash the only property transferred? [X] Yes
17 a Was intangible property (within the meaning of section 936(h)(3)(B)) transferred as a result of the transaction?
b If "Yes," describe the nature of the rights to the intangible property that was transferred as a result of the transaction:
DYes
[X] No
824533 02·16-09
Form 926 (Rev. 12·2008)
47
2008.05000 THE BLOOMBERG FAMILY FOUNDA BLOOMFA1
13421116 737725 BLOOMFAMFND
Form 926 Return by a U.S. Transferor of Property
(Rev. December2008) to a Foreign Corporation
Department of the Treasury
Internal Revenue Service ~ Attach to your Income tax return for the year of the transfer or distribution.
OMS No. 1545-0026
Name of transferor
Identifying number (see ins1ruCtions)
kpia:t::::m:1 U.S. Transferor Information (see instructions)
THE BLOOMBERG FAMILY FOUNDATION INC
20-5602483
1 If the transferor was a corporation, complete questions 1 a through 1 d.
a If the transfer was a section 361 (a) or (b) transfer, was the transferor controlled (under section 368(c)) by 5 or
fewer domestic corporations? 0 Ves
b Did the transferor remain in existence after the transfer? [X] Ves
If not, list the controlling shareholder(s) and their identifying number(s):
[X] No ONo
Controlling shareholder
Identifying number
c If the transferor was a member of an affiliated group filing a consolidated return, was it the parent corporation? ......... 0 Ves If not, list the name and employer identification number (EIN) of the parent corporation:
[X] No
Name of parent corporation
EIN of parent corporation
d Have basis adjustments under section 367(a)(5) been made? ,............................................. 0 Ves
[X] No
2 If the transferor was a partner in a partnership that was the actual transferor (but is not treated as such under section 367), complete questions 2a through 2d.
a Ust the name and EIN of the transferor'S partnership:
Name of partnership
EIN of partnership
[X] No [X] No
b Did the partner pick up its pro rata share of gain on the transfer of partnership assets? 0 Ves
c Is the partner disposing of its entire interest in the partnership? 0 Ves
d Is the partner disposing of an interest in a limited partnership that is regularly traded on an established
securities market? , 0 Ves [X] No
FP.':umn Transferee Foreign Corporation Information (see instructions)
ETON PARK OVERSEAS FUND, LTD
3 Name of transferee (foreign corporation) 4 Identifying number, if any
5 Address (including country)
NONE
6 Country code of country of incorporation or organization
7 Foreign law characterization (see instructions)
Form 926 (Rev. 12·2008)
8 Is the transferee foreign corporation a controlled foreign corporation?
OVes
[X] No
LHA For Paperwork Reduction Act Notice, see separate instructions. 824531
02-16-09
48
2008.05000 THE BLOOMBERG FAMILY FOUNDA BLOOMFA1
13421116 737725 BLOOMFAMFND
824532 02-16-09
Form 926 (Rev. 12-2008)
Form 9261Rev. 12·2008) Paoe2
!::P&ijjj{llnformation Regarding Transfer of Property (see instructions)
Type of (a) (b) (c) (d) (e)
Date of Description of Fair market value on Cost or other Gain recognized on
property transfer ~ dateoftra~
Cash . 24,601,577.
Stock and
securities
Installment obligations,
account receivables or
similar property
Foreign currency or other
property denominated in
foreign currency
Inventory
Assets subject to
depreciation recapture
(see Temp. Regs. sec.
1.367(a)·4T(bll
Tangible property used in
trade or business not listed
under another category
Intangible
property
Property to be leased
(as described in
Temp. Regs. sec.
1 .367(a)·4T(c))
Property to be sold
(as described in
Temp. Regs. sec.
1.3b(al·4~·a))
Transfers of oil and gas
working interests (as
described in Temp.
Regs. sec. 1.367(al·4Tiel]
Other property
Supplemental Information Required To Be Reported (see instructions):
13421116 737725 BLOOMFAMFND
49
2008.05000 THE BLOOMBERG FAMILY FOUNDA BLOOMFA1
see instructions
Pa e3
9 Enter the transferor's interest in the foreign transferee corporation before and after the transfer:
(a) Before % (b) After %
10 Type of nonrecognition transaction (see instructions) ~ _
11 Indicate whether any transfer reported in Part III is subject to any of the following:
a Gain recognition under section 904(1)(3) .
b Gain recognition under section 904(1)(S)(F) .
c Recapture under section 1S03(d) .
d Exchange gain under section 987 .
12 Did this transfer result from a change in the classification of the transferee to that of a foreign corporation? .
13 Indicate whether the transferor was required to recognize income under Temporary Regulations sections
1.367(a)-4T through 1.367(a)-6T for any of the following:
a Tainted property .
b Depreciation recapture .
c Branch loss recapture .
d Any other income recognition provision contained in the above-referenced regulations .
14 Did the transferor transfer assets which qualify for the trade or business exception under section 367(a)(3)? .
15 a Did the transferor transfer foreign goodwill or going concern value as defined in Temporary Regulations section
1.367(a)-1 T(d)(S)(iii)? .
b If the answer to line 1Sa is 'Yes,' enter the amount of foreign goodwill or going concern value
transferred ~ $ _
DYes IX] No
DYes IX] No
DYes IX] No
DYes IX] No
DYes IX] No Dyes IX] No
DYes IX] No
DYes IX] No
DYes IX] No
DYes IX] No
DYes IX] No DNo
16 Was cash the only property transferred? _ .. _ _.............................................................. IX] Yes
17 a Was intangible property (within the meaning of section 936(h)(3)(B)) transferred as a result of the transaction?
b If 'Yes,' describe the nature of the rights to the intangible property that was transferred as a result of the transaction:
DYes
IX] No
824533 02-16-09
Form 926 (Rev. 12-2008)
50
2008.05000 THE BLOOMBERG FAMILY FOUNDA BLOOMFA1
13421116 737725 BLOOMFAMFND
Form 926 Return by a U.S. Transferor of Property
(Rev. December2008) to a Foreign Corporation
Department of the Treasury
Internal Revenue Service ~ Attach to your Income tax return for the year of the transfer or distribution.
OMB No. 1545-0026
Name of transferor
Identifying number (seeinstruc1ions)
1]:~m$f{1 U.S. Transferor Information (see instructions)
THE BLOOMBERG FAMILY FOUNDATION INC
20-5602483
1 If the transferor was a corporation, complete questions 1 a through 1 d.
a If the transfer was a section 361 (a) or (b) transfer, was the transferor controlled (under section 368(c)) by 5 or
fewer domestic corporations? ..................................................................................................................•.............. 0 Ves
b Did the transferor remain in existence after the transfer? [XJ Ves
If not, list the controlling shareholder(s) and their identifying number(s):
[XJ No ONo
Controlling shareholder
Identifying number
c If the transferor was a member of an affiliated group filing a consolidated return, was it the parent corporation? 0 Ves
If not, list the name and employer identification number (EIN) of the parent corporation:
[XJ No
Name of parent corporation
EIN of parent corporation
[XJ No
d Have basis adjustments under section 367(a)(5) been made? 0 Ves
2 If the transferor was a partner in a partnership that was the actual transferor (but is not treated as such under section 367), complete questions 2a through 2d.
a Ust the name and EIN of the transferor'S partnership:
Name of partnership
EIN of partnership
b Did the partner pick up its pro rata share of gain on the transfer of partnership assets? 0 Ves
c Is the partner disposing of its entire interest in the partnership? 0 Ves
d Is the partner disposing of an interest in a limited partnership that is regularly traded on an established
[XJ No [XJ No
[p;a:jfi@1 Transferee Foreign Corporation Information (see instructions)
securities market? .
OVes
[XJ No
3 Name of transferee (foreign corporation)
4 Identifying number, if any
HIGHFIELDS CAPITAL LTD
NONE
5 Address Qncluding country)
6 Country code of country of incorporation or organization
7 Foreign law characterization (see instructions)
Form 926 (Rev. 12·2008)
8 Is the transferee foreign corporation a controlled foreign corporation?
o Ves [XJ No
LHA For Paperwork Reduction Act Notice, see separate instructions. 824531
02-16-09
51
2008.05000 THE BLOOMBERG FAMILY FOUNDA BLOOMFA1
13421116 737725 BLOOMFAMFND
Pa e2
Type of (a) ~ (e) (eI) (e)
Date of Fair market value on Cost or other Gain r~~~~~~ed on
property transfer date of transfer ~
Cash 71,049,355. :::::::::::::::::::::::::::(::mmm:::::::::::::::::::::::t:
Stock and
securities
Installment obligations,
account receivables or
similar property
Foreign currency or other
property denominated in
foreign currency
Inventory
Assets subject to
depreciation recapture
(see Temp. Regs. sec.
1.367(al-4T(bll
Tangible property used in
trade or business not listed
under another category
Intangible
property
Property to be leased
(as described in
Temp. Regs. sec.
1.367(: _AT/~\\
Property to be sold
(as described in
Temp. Regs. sec.
1.367(a)-4T(dll
Transfers of oil and gas
working interests (as
described in Temp.
Reas. sec. 1.367(a)-4T(e))
Other property
Supplemental Information Required To Be Reported (see instructions):
824532 02-16-09
Form 926 (Rev. 12-2008)
13421116 737725 BLOOMFAMFND
52
2008.05000 THE BLOOMBERG FAMILY FOUNDA BLOOMFA1
see instructions
Pa e3
9 Enter the transferor's interest in the foreign transferee corporation before and after the transfer:
(a) Before % (b) After %
10 Type of nonrecognition transaction (see instructions) ~ _
11 Indicate whether any transfer reported in Part III is subject to any of the following:
a Gain recognition under section 904(f)(3) .
b Gain recognition under section 904(f)(S)(F) .
c Recapture under section 1S03(d) .
d Exchange gain under section 987 .
12 Did this transfer result from a change in the classification of the transferee to that of a foreign corporation? .
13 Indicate whether the transferor was required to recognize income under Temporary Regulations sections
1.367(a)-4T through 1.367(a)-6T for any of the following:
a Tainted property _ .
b Depreciation recapture .
c Branch loss recapture .
d Any other income recognition provision contained in the above-referenced regulations _ .
14 Did the transferor transfer assets which qualify for the trade or business exception under section 367(a)(3)? .
15 a Did the transferor transfer foreign goodwill or going concern value as defined in Temporary Regulations section
1.367(a)-1 T(d)(S)(iii)? _ .
b If the answer to line 1Sa is 'Yes," enter the amount of foreign goodwill or going concern value
transferred ~ $ _
Dves 00 No
DVes 00 No
DVes 00 No
DVes 00 No
Dves 00 No DVes 00 No
DVes 00 No
DVes 00 No
DVes 00 No
DVes 00 No
DVes 00 No 16 Was cash the only property transferred? 00 Ves
17 a Was intangible property (within the meaning of section 936(h)(3)(B)) transferred as a result of the transaction?
b If "Yes," describe the nature of the rights to the intangible property that was transferred as a result of the transaction:
DNo
DVes
00 No
824533 02-16-09
Form 926 (Rev. 12-2008)
53
2008.05000 THE BLOOMBERG FAMILY FOUNDA BLOOMFA1
13421116 737725 BLOOMFAMFND
Form 926 Return by a U.S. Transferor of Property
(Rev. December 2008) to a Foreign Corporation
Department of the Treasury
Internal Revenue Service ~ Attach to your Income tax return for the year of the transfer or distribution.
OMS No. 1545-0026
Name of transferor
Identifying number (see instructions)
[1&11::/::1 U.S. Transferor Information (see instructions)
THE BLOOMBERG FAMILY FOUNDATION INC
20-5602483
1 If the transferor was a corporation, complete questions 1 a through 1 d.
a If the transfer was a section 361 (a) or (b) transfer, was the transferor controlled (under section 368(c)) by 5 or
fewer domestic corporations? DYes
b Did the transferor remain in existence after the transfer? [X] Yes
If not, list the controlling shareholder(s) and their identifying number(s):
[X] No DNo
Controlling shareholder
Identifying number
c If the transferor was a member of an affiliated group filing a consolidated return, was it the parent corporation? ......... DYes If not, list the name and employer identification number (EIN) of the parent corporation:
[X] No
Name of parent corporation
EIN of parent corporation
d Have basis adjustments under section 367(a)(5) been made? DYes
[X] No
2 If the transferor was a partner in a partnership that was the actual transferor (but is not treated as such under section 367), complete questions 2a through 2d.
a List the name and EIN of the transferor'S partnership:
Name of partnership
EIN of partnership
I
b Did the partner pick up its pro rata share of gain on the transfer of partnership assets? DYes
c Is the partner disposing of its entire interest in the partnership? DYes
d Is the partner disposing of an interest in a limited partnership that is regularly traded on an established
[X] No [X] No
IJi)'iWtJJ/ii Transferee Foreign Corporation Information (see instructions)
securities market? D Yes [X] No
AMBASSADOR TE SARL
3 Name of transferee (foreign corporation) 4 Identifying number, if any
5 Address (including country) 20,RU DE LA POSTE
LU L-2346, LUXEMBOURG
NONE
6 Country code of country of incorporation or organization LU
7 Foreign law characterization (see instructions)
Form 926 (Rev. 12·2008)
8 Is the transferee foreign corporation a controlled foreign corporation?
Dyes
[X] No
LHA For Paperwork Reduction Act Notice, see separate instructions. 824531
02-16-09
54
2008.05000 THE BLOOMBERG FAMILY FOUNDA BLOOMFA1
13421116 737725 BLOOMFAMFND
Pa e2
Type of (a) (b) (e) ~
Date of Description of Fair market value on
property transfer ,:?i/\():n::r--T ;':\':: :::' j date7 or ~a~~~ 1 •
Cash n
Stock and
securities
Installment obligations,
account receivables or
similar property
Foreign currency or other
property denominated in
foreign currency
Inventory
Assets subject to
depreciation recapture
(see Temp. Regs. sec.
1.;;sf7(a)-4~(b))
Tangible property used in
trade or business not listed
under another category
Intangible
property
Property to be leased
(as described in
Temp. Regs. sec.
1.367(a)-4T(c))
Property to be sold
(as described in
Temp. Regs. sec.
1.367Ial-4Tld))
Transfers of oil and gas
working interests (as
described in Temp.
Reas. sec. 1.367(al-4T(ell
Other property
Supplemental Information Required To Be Reported (see instructions):
824532 02-16-09
Form 926 (Rev. 12-2008)
13421116 737725 BLOOMFAMFND
55
2008.05000 THE BLOOMBERG FAMILY FOUNDA BLOOMFA1
see instructions
Pa e3
9 Enter the transferor's interest in the foreign transferee corporation before and after the transfer:
(a) Before % (b) After __ -- %
10 Type of nonrecognition transaction (see instructions) ~ _
11 Indicate whether any transfer reported in Part III is subject to any of the following:
a Gain recognition under section 904(f)(3) .
b Gain recognition under section 904(f)(S)(F) .
c Recapture under section 1S03(d) .
d Exchange gain under section 987 , .
12 Did this transfer result from a change in the classification of the transferee to that of a foreign corporation? .
13 Indicate whether the transferor was required to recognize income under Temporary Regulations sections
1.367(a)-4T through 1.367(a)-6T for any of the following:
a Tainted property .
b Depreciation recapture .
c Branch loss recapture .
d Any other income recognition provision contained in the above-referenced regulations .
14 Did the transferor transfer assets which qualify for the trade or business exception under section 367(a)(3)? .
15 a Did the transferor transfer foreign goodwill or going concern value as defined in Temporary Regulations section
1.367(a)-1T(d)(S)(iiQ? .
b If the answer to line 1Sa is "Yes," enter the amount of foreign goodwill or going concern value
transferred ~ $ _
DYes [Xl No
DYes [Xl No
DYes [Xl No
DYes rx No
DYes [Xl No DYes [Xl No
DYes [Xl No
DYes [Xl No
DYes [Xl No
DYes [Xl No
DYes [Xl No 16 Was cash the only property transferred? [Xl Yes
17 a Was intangible property (within the meaning of section 936(h)(3)(B)) transferred as a result of the transaction?
b If 'Yes," describe the nature of the rights to the intangible property that was transferred as a result of the transaction:
DNo
[Xl No
DYes
824533 02-16-09
Form 926 (Rev. 12-2008)
56
2008.05000 THE BLOOMBERG FAMILY FOUNDA BLOOMFA1
13421116 737725 BLOOMFAMFND
Form 926 Return by a U.S. Transferor of Property
(Rev. December2oo8) to a Foreign Corporation
Department of the Treasury
Internal Revenue Service ~ Attach to your Income tax return for the year of the transfer or distribution.
OMB No. 1545-0026
Name of transferor
Identifying number (seeinstruc1ions)
[pm?I"tM U.S. Transferor Information (see instructions)
THE BLOOMBERG FAMILY FOUNDATION INC
20-5602483
1 If the transferor was a corporation, complete questions 1 a through 1 d.
a If the transfer was a section 361 (a) or (b) transfer, was the transferor controlled (under section 368(c)) by 5 or
fewer domestic corporations? DYes
b Did the transferor remain in existence after the transfer? [X] Yes
If not, list the controlling shareholder(s) and their identifying number(s):
[X] No DNo
Controlling shareholder
Identifying number
c If the transferor was a member of an affiliated group filing a consolidated return, was it the parent corporation? ......... DYes If not, list the name and employer identification number (EIN) of the parent corporation:
[X] No
Name of parent corporation
EIN of parent corporation
d Have basis adjustments under section 367(a)(5) been made? DYes
[X] No
2 If the transferor was a partner in a partnership that was the actual transferor (but is not treated as such under section 367), complete questions 2a through 2d.
a Ust the name and EIN of the transferor's partnership:
Name of partnership
EIN of partnership
b Did the partner pick up its pro rata share of gain on the transfer of partnership assets? DYes
c Is the partner disposing of its entire interest in the partnership? DYes
d Is the partner disposing of an interest in a limited partnership that is regularly traded on an established
securities market? D Yes [X] No
[X] No [X] No
Ei&MJt:M Transferee Foreign Corporation Information (see instructions)
BVP-IV CAYMAN LIMITED
3 Name of transferee (foreign corporation) 4 Identifying number, if any
5 Address (including country) PO BOX 309
GRAND CAYMAN, BWI CAYMAN ISLANDS
NONE
6 Country code of country of incorporation or organization CJ
7 Foreign law characterization (see instructions)
8 Is the transferee foreign corporation a controlled foreign corporation?
Dyes
[X] No
LHA For Paperwork Reduction Act Notice, see separate instructions. 824531
02-16-09
Form 926 (Rev. 12·2008)
57
2008.05000 THE BLOOMBERG FAMILY FOUNDA BLOOMFA1
13421116 737725 BLOOMFAMFND
Pa e2
Type of (a) (b) (e) (d) (e)
t~~:f~~ Description of Fair market value on Cost or other Gain recognized on
property ..... date of transfer basis transfer
Cash 384,937.
.
Stock and
securities
Installment obligations,
account receivables or
similar property
Foreign currency or other .
property denominated in
foreign currency
Inventory
Assets subject to
depreciation recapture
(see Temp. Regs. sec.
i.se r(a)·4Tlbl
Tangible property used in
trade or business not listed
under another category
Intangible
property
Property to be leased
(as described in
Temp. Regs. sec.
1 .;j(j lta)·4T«
Property to be sold
(as described in
Temp. Regs. sec.
1.367(al·4Tldll
Transfers of oil and gas
working interests (as
described in Temp.
Reas. sec. 1 3f~(al·4Tte))
Other property
Supplemental Information Required To Be Reported (see instructions):
824532 02-16-09
Form 926 (Rev. 12·2008)
13421116 737725 BLOOMFAMFND
58
2008.05000 THE BLOOMBERG FAMILY FOUNDA BLOOMFA1
see instructions
Pa e3
9 Enter the transferor's interest in the foreign transferee corporation before and after the transfer:
(a) Before % (b) After %
10 Type of nonrecognition transaction (see instructions) ~ _
11 Indicate whether any transfer reported in Part III is subject to any of the following:
a Gain recognition under section 904(f)(3) .
b Gain recognition under section 904(f)(S)(F) .
c Recapture under section 1S03(d) .
d Exchange gain under section 987 .
12 Did this transfer result from a change in the classification of the transferee to that of a foreign corporation? .
13 Indicate whether the transferor was required to recognize income under Temporary Regulations sections
1.367(a)-4T through 1.367(a)-6T for any of the following:
a Tainted property .
b Depreciation recapture .
c Branch loss recapture .
d Any other income recognition provision contained in the above-referenced regulations .
14 Did the transferor transfer assets which qualify for the trade or business exception under section 367(a)(3)? .
15 a Did the transferor transfer foreign goodwill or going concern value as defined in Temporary Regulations section
1.367(a)-1T(d)(5)(iii)? .
b If the answer to line 1Sa is 'Yes,' enter the amount of foreign goodwill or going concern value
transferred ~ $ _
DYes 00 No
DYes 00 No
DYes 00 No
DYes 00 No
DYes 00 No DYes 00 No
DYes 00 No
DYes 00 No
DYes 00 No
DYes 00 No
DYes 00 No 16 Was cash the only property transferred? 00 Yes
DNo
17 a Was intangible property (within the meaning of section 936(h)(3)(B)) transferred as a result of the transaction? DYes
b If 'Yes,' describe the nature of the rights to the intangible property that was transferred as a result of the transaction:
00 No
824533 02-16-09
Form 926 (Rev. 12-2008)
59
2008.05000 THE BLOOMBERG FAMILY FOUNDA BLOOMFA1
13421116 737725 BLOOMFAMFND
Form 926 Return by a U.S. Transferor of Property
(Rev. Decembe(2008) to a Foreign Corporation
Department of the Treasury
Intemal Revenue Service ~ Attach to your Income tax return for the year of the transfer or distribution.
OMB No. 1545-0026
Name of transferor
Identifying number (see inS1ructions)
[p~tt:lrrl U.S. Transferor Information (see instructions)
THE BLOOMBERG FAMILY FOUNDATION INC
20-5602483
1 If the transferor was a corporation, complete questions 1 a through 1 d.
a If the transfer was a section 361 (a) or (b) transfer, was the transferor controlled (under section 368(c)) by 5 or
fewer domestic corporations? D Ves
b Did the transferor remain in existence after the transfer? [X] Ves
If not, list the controlling shareholder(s) and their identifying number(s):
[X] No DNo
Controlling shareholder
Identifying number
c If the transferor was a member of an affiliated group filing a consolidated return, was it the parent corporation? ......... D Ves If not, list the name and employer identification number (EIN) of the parent corporation:
[X] No
Name of parent corporation
EIN of parent corporation
d Have basis adjustments under section 367(a)(5) been made? D Ves
[X] No
2 If the transferor was a partner in a partnership that was the actual transferor (but is not treated as such under section 367), complete questions 2a through 2d.
a Ust the name and EIN of the transferor'S partnership:
Name of partnership
EIN of partnership
[X] No [X] No
b Did the partner pick up its pro rata share of gain on the transfer of partnership assets? D Ves
c Is the partner disposing of its entire interest in the partnership? D Ves
[Piifdtr:j Transferee Foreign COrPoration Information (see instructions)
d Is the partner disposing of an interest in a limited partnership that is regularly traded on an established
securities market? D Ves [X] No
GAVEA INVESTMENT FUND III C LP
3 Name of transferee (foreign corporation) 4 Identifying number, if any
5 Address (including country)
PO BOX 309, UGLAND HOUSE
GRAND CAYMAN, KY1-1104 CAYMAN ISLANDS
NONE
6 Country code of country of incorporation or organization CJ
7 Foreign law characterization (see instructions)
Form 926 (Rev. 12-2008)
8 Is the transferee foreign corporation a controlled foreign corporation?
DVes
[X] No
LHA For Paperwork Reduction Act Notice, see separate instructions. 824531
02-16-09
60
2008.05000 THE BLOOMBERG FAMILY FOUNDA BLOOMFA1
13421116 737725 BLOOMFAMFND
Pa e2
Type of (a) (b) (e) (eI) (e)
Date of Description of Fair market value on Cost or other Gain recognized on
property transfer ~ date of transfer
Cash 1,139,556.
Stock and
securities
Installment obligations,
account receivables or
similar property
Foreign currency or other
property denominated in
foreign currency
Inventory
Assets subject to
depreciation recapture
(see Temp. Regs. sec.
1.;;10 (a)-4 I (t
Tangible property used in
trade or business not listed
under another category
Intangible
property
Property to be leased
(as described in
Temp. Regs. sec.
1.367(a)-4T<c))
Property to be sold
(as described in
Temp. Regs. sec.
1.367(a)-4T(d))
Transfers of oil and gas
working interests (as
described in Temp.
Reas. sec. 1.367(a)-4T(e))
Other property
Supplemental Information Required To Be Reported (see instructions):
824532 02-16-09
Form 926 (Rev. 12-2008)
13421116 737725 BLOOMFAMFND
61
2008.05000 THE BLOOMBERG FAMILY FOUNDA BLOOMFA1
see instructions
Pa e3
9 Enter the transferor's interest in the foreign transferee corporation before and after the transfer:
(a) Before % (b) After %
10 Type of nonrecognition transaction (see instructions) ~ _
11 Indicate whether any transfer reported in Part III is subject to any of the following:
a Gain recognition under section 904(f)(3) , .
b Gain recognition under section 904(f)(5)(F) .
c Recapture under section 1503(d) .
d Exchange gain under section 987 .
12 Did this transfer result from a change in the classification of the transferee to that of a foreign corporation? .
13 Indicate whether the transferor was required to recognize income under Temporary Regulations sections
1.367(a)-4T through 1.367(a)-6T for any of the following:
a Tainted property .
b Depreciation recapture .
c Branch loss recapture .
d Any other income recognition provision contained in the above-referenced regulations .
14 Did the transferor transfer assets which qualify for the trade or business exception under section 367(a)(3)? .
15 a Did the transferor transfer foreign goodwill or going concern value as defined in Temporary RegUlations section
1.367(a)-1T(d)(5)(iiij? : .
b If the answer to line 15a is "Yes," enter the amount of foreign goodwill or going concern value
transferred ~ $ _
Dves [X] No
DVes [X] No
DVes [X] No
DVes [X] No
DVes [X] No DVes [X] No
DVes [X] No
DVes [X] No
DVes [X] No
DVes [X] No
DVes [X] No 16 Was cash the only property transferred?................................................................................................................. [X] Ves
17 a Was intangible property (within the meaning of section 936(h)(3)(B)) transferred as a result of the transaction?
b If "Yes," describe the nature of the rights to the intangible property that was transferred as a result of the transaction:
DNo
DVes
[X] No
824533 02-16-09
Form 926 (Rev. 12-2008)
62
2008.05000 THE BLOOMBERG FAMILY FOUNDA BLOOMFA1
13421116 737725 BLOOMFAMFND
Form 926 Return by a U.S. Transferor of Property
(Rev. December2008) to a Foreign Corporation
Department of the Treasury
Internal Revenue Service ~ Attach to your Income tax return for the year of the transfer or distribution.
OMB No. 1545-0026
Name of transferor
Identifying number (seeinSlrUc1ions)
[Pdii?I.I:::j U.S. Transferor Information (see instructions)
THE BLOOMBERG FAMILY FOUNDATION INC
20-5602483
1 If the transferor was a corporation, complete questions 1 a through 1 d.
a If the transfer was a section 361 (a) or (b) transfer, was the transferor controlled (under section 368(c)) by 5 or
fewer domestic corporations? DYes
b Did the transferor remain in existence after the transfer? [XJ Yes
If not, list the controlling shareholder(s) and their identifying numberts):
[XJ No DNo
Controlling shareholder
Identifying number
c If the transferor was a member of an affiliated group filing a consolidated return, was it the parent corporation? ......... DYes If not, list the name and employer identification number (EIN) of the parent corporation:
[XJ No
Name of parent corporation
EIN of parent corporation
d Have basis adjustments under section 367(a)(5) been made? DYes
[XJ No
2 If the transferor was a partner in a partnership that was the actual transferor (but is not treated as such under section 367), complete questions 2a through 2d.
a Ust the name and EIN of the transferors partnership:
Name of partnership
EIN of partnership
b Did the partner pick up its pro rata share of gain on the transfer of partnership assets? DYes
c Is the partner disposing of its entire interest in the partnership? DYes
d Is the partner disposing of an interest in a limited partnership that is regularly traded on an established
securities market? DYes [XJ No
[XJ No [XJ No
KPdaliI] Transferee Foreign Corporation Information (see instructions)
REGIMENT CAPITAL LTD
3 Name of transferee (foreign corporation) 4 Identifying number, if any
5 Address (including country)
NONE
6 Country code of country of incorporation or organization
7 Foreign law characterization (see instructions)
8 Is the transferee foreign corporation a controlled foreign corporation?
Dyes
[XJ No
LHA For Paperwork Reduction Act Notice, see separate instructions. 824531
02-16-09
Form 926 (Rev. 12·2008)
63
2008.05000 THE BLOOMBERG FAMILY FOUNDA BLOOMFA1
13421116 737725 BLOOMFAMFND
Pa e2
Type of (a) ~ Ie} (d) (e)
Date of Fair market value on Cost or other Gain recognized on
property transfer date of transfer basis transfer
Cash ':,:::::::::::::::::: 2 4 60 1 5 7 7
::::::::::::::::::::::, , , ·1
Stock and
securities
Installment obligations,
account receivables or
similar property
Foreign currency or other
property denominated in
foreign currency
Inventory
Assets subject to
depreciation recapture
(see Temp. Regs. sec.
1.367(a)·4T(b))
Tangible property used in
trade or business not listed
under another category
Intangible
property
Property to be leased
(as described in
Temp. Regs. sec.
1.;:10 ((a)·4T(c))
Property to be sold
(as described in
Temp. Regs. sec.
1.3e"'(a)·4T(c"'
Transfers of oil and gas
working interests (as
described in Temp.
Heos, sec, 1.367(a)·4T(ell
Other property
Supplemental Information Required To Be Reported (see instructions):
824532 02-16-09
Form 926 (Rev. 12·2008)
13421116 737725 BLOOMFAMFND
64
2008.05000 THE BLOOMBERG FAMILY FOUNDA BLOOMFA1
see instructions
Pa e3
9 Enter the transferor's interest in the foreign transferee corporation before and after the transfer:
(a) Before % (b) After %
10 Type of nonrecognition transaction (see instructions) .. _
11 Indicate whether any transfer reported in Part III is subject to any of the following:
a Gain recognition under section 904(f)(3) .
b Gain recognition under section 904(f)(S)(F) .
c Recapture under section 1S03(d) .
d Exchange gain under section 987 .
12 Did this transfer result from a change in the classification of the transferee to that of a foreign corporation? .
13 Indicate whether the transferor was required to recognize income under Temporary Regulations sections
1.367(a)-4T through 1.367(a)-6T for any of the following:
a Tainted property .
b Depreciation recapture .
c Branch loss recapture .
d Any other income recognition provision contained in the above-referenced regUlations .
14 Did the transferor transfer assets which qualify for the trade or business exception under section 367(a)(3)? .
15 a Did the transferor transfer foreign goodwill or going concern value as defined in Temporary Regulations section
1.367(a)-1T(d)(S)(iii)? .
b If the answer to line 1Sa is "Yes,' enter the amount of foreign goodwill or going concern value transferred" $
-----------
DYes [X] No
DYes [X] No
DYes [X] No
DYes [X] No
DYes [X] No Dyes [X] No
DYes [X] No
DYes [X] No
DYes [X] No
DYes [X] No
DYes [X] No 16 Was cash the only property transferred? [X] Yes
17 a Was intangible property (within the meaning of section 936(h)(3)(B)) transferred as a result of the transaction?
b If "Yes," describe the nature of the rights to the intangible property that was transferred as a result of the transaction:
DNo
[X] No
DYes
824533 02-16-09
Form 926 (Rev_ 12-2008)
65
2008.05000 THE BLOOMBERG FAMILY FOUNDA BLOOMFA1
13421116 737725 BLOOMFAMFND
Form 926 Return by a U.S. Transferor of Property
(Rev. December2008) to a Foreign Corporation
Department of the Treasuoy
Intemal Revenue Service ~ Attach to your Income tax return for the year of the transfer or distribution.
OMS No. 1545-0026
Name of transferor
Identifying number (see ins1ruc1ions)
[PaRaff] U.S. Transferor Information (see instructions)
THE BLOOMBERG FAMILY FOUNDATION INC
20-5602483
1 If the transferor was a corporation, complete questions 1 a through 1 d.
a If the transfer was a section 361 (a) or (b) transfer, was the transferor controlled (under section 368(c)) by 5 or
fewer domestic corporations? D Ves
b Did the transferor remain in existence after the transfer? [XJ Ves
If not, list the controlling shareholder(s) and their identifying number(s):
[XJ No DNo
Controlling shareholder
Identifying number
c If the transferor was a member of an affiliated group filing a consolidated return, was it the parent corporation? D Ves
If not, list the name and employer identification number (EIN) of the parent corporation:
[XJ No
Name of parent corporation
EIN of parent corporation
d Have basis adjustments under section 367(a)(5) been made? D Ves
[XJ No
2 If the transferor was a partner in a partnership that was the actual transferor (but is not treated as such under section 367), complete questions 2a through 2d.
a List the name and EIN of the transferor'S partnership:
Name of partnership
EIN of partnership
b Did the partner pick up its pro rata share of gain on the transfer of partnership assets? D Ves
c Is the partner disposing of its entire interest in the partnership? D Ves
d Is the partner disposing of an interest in a limited partnership that is regularly traded on an established
securities market? D Ves [XJ No
[XJ No [XJ No
FPii£UfJ Transferee Foreign Corporation Information (see instructions)
BLUE RIDGE OFFSHORE LP
3 Name of transferee (foreign corporation) 4 Identifying number, if any
5 Address Oncluding country)
NONE
6 Country code of country of incorporation or organization
7 Foreign law characterization (see instructions)
Form 926 (Rev. 12·2008)
8 Is the transferee foreign corporation a controlled foreign corporation?
DVes [XJ No
LHA For Paperwork Reduction Act Notice, see separate instructions. 824531
02-16-09
66
2008.05000 THE BLOOMBERG FAMILY FOUNDA BLOOMFA1
13421116 737725 BLOOMFAMFND
Pa e2
Type of (a) ~ (e) (eI) (e)
Date of Fair market value on Cost or other Gain recognized on
property transfer date of transfer
Cash 39,362,524.
Stock and
securities
Installment obligations,
account receivables or
similar property
Foreign currency or other
property denominated in
foreign currency
Inventory
Assets subject to
depreciation recapture
(see Temp. Regs. sec.
1.367(a)·4T(b
Tangible property used in
trade or business not listed
under another category
Intangible
property
Property to be leased
(as described in
Temp. Regs. sec.
1 "H~7{~'·4T(c))
Property to be sold
(as described in
Temp. Regs. sec.
1.367Ia)·4Tld))
Transfers of oil and gas
working interests (as
described in Temp.
Reas. sec. 1.367Ia)·4T(e))
Other property
Supplemental Information Required To Be Reported (see instructions):
824532 02-16-09
Form 926 (Rev. 12·2008)
13421116 737725 BLOOMFAMFND
67
2008.05000 THE BLOOMBERG FAMILY FOUNDA BLOOMFA1
see instructions
Pa e3
9 Enter the transferor's interest in the foreign transferee corporation before and after the transfer:
(a) Before % (b) After %
10 Type of nonrecognition transaction (see instructions) ~ _
11 Indicate whether any transfer reported in Part III is subject to any of the following:
a Gain recognition under section 904(f)(3) .
b Gain recognition under section 904(f)(5)(F) .
c Recapture under section 1503(d) .
d Exchange gain under section 987 .
12 Did this transfer result from a change in the classification of the transferee to that of a foreign corporation? .
13 Indicate whether the transferor was required to recognize income under Temporary Regulations sections
1.367(a)-4T through 1.367(a)-6T for any of the following:
a Tainted property .
b Depreciation recapture .
c Branch loss recapture .
d Any other income recognition provision contained in the above-referenced regulations .
14 Did the transferor transfer assets which qualify for the trade or business exception under section 367(a)(3)? .
15 a Did the transferor transfer foreign goodwill or going concern value as defined in Temporary Regulations section
1.367(a)-1T(d)(5)(iii)? .
b If the answer to line 15a is 'Yes,' enter the amount of foreign goodwill or going concem value
transferred ~ $ _
DVes [X] No
DVes [X] No
DVes [X] No
DVes [X] No
DVes [X] No DVes [X] No
Dves [X] No
DVes [X] No
DVes 00 No
DVes [X] No
DVes [X] No DNo
16 Was cash the only property transferred? [X] Ves
17 a Was intangible property (within the meaning of section 936(h)(3)(B)) transferred as a result of the transaction?
b If "Yes," describe the nature of the rights to the intangible property that was transferred as a result of the transaction:
Dves
[X] No
824533 02-16-09
Form 926 (Rev. 12-2008)
68
2008.05000 THE BLOOMBERG FAMILY FOUNDA BLOOMFA1
13421116 737725 BLOOMFAMFND
Form 926 Return by a U.S. Transferor of Property
(Rev. December2008) to a Foreign Corporation
Department of the Treasury
Internal Revenue Service ~ Attach to your Income tax return for the year of the transfer or distribution.
OMB No. 1545-0026
Name of transferor
Identifying number (see instructions)
EpatfJtfl U.S. Transferor Information (see instructions)
THE BLOOMBERG FAMILY FOUNDATION INC
20-5602483
1 If the transferor was a corporation, complete questions 1 a through 1 d.
a If the transfer was a section 361 (a) or (b) transfer, was the transferor controlled (under section 368(c)) by 5 or
fewer domestic corporations? 0 Ves
b Did the transferor remain in existence after the transfer? 00 Ves
If not, list the controlling shareholder(s) and their identifying number(s):
00 No ONo
Controlling shareholder
Identifying number
c If the transferor was a member of an affiliated group filing a consolidated return, was it the parent corporation? 0 Ves
If not, list the name and employer identification number (EIN) of the parent corporation:
00 No
Name of parent corporation
EIN of parent corporation
d Have basis adjustments under section 367(a)(5) been made? ,....................... 0 Ves
00 No
2 If the transferor was a partner in a partnership that was the actual transferor (but is not treated as such under section 367), complete questions 2a through 2d.
a List the name and EIN of the transferor's partnership:
Name of partnership
EIN of partnership
b Did the partner pick up its pro rata share of gain on the transfer of partnership assets? 0 Ves
c Is the partner disposing of its entire interest in the partnership? 0 Ves
d Is the partner disposing of an interest in a limited partnership that is regularly traded on an established
securities market? ,.......................................................................................... 0 Ves 00 No
00 No 00 No
kPAit:U{1 Transferee Foreign Corporation Information (see instructions)
BROOKSIDE CAYMAN LTD
3 Name of transferee (foreign corporation) 4 Identifying number, if any
5 Address Qncluding country)
CAYMAN ISLANDS
NONE
6 Country code of country of incorporation or organization CJ
7 Foreign law characterization (see instructions)
8 Is the transferee foreign corporation a controlled foreign corporation?
OVes
00 No
LHA For Paperwork Reduction Act Notice, see separate instructions. 824531
02-16-09
Form 926 (Rev. 12·2008)
69
2008.05000 THE BLOOMBERG FAMILY FOUNDA BLOOMFA1
13421116 737725 BLOOMFAMFND
Pa e2
Type of (a) ~ (eJ (eI) (e)
Date of Fair market value on Cost or other Gain recognized on
property transfer date of transfer basis
cash 67_, 801 , 947 • I==':=}}:{
Stock and
securities
Installment obligations,
account receivables or
similar property
Foreign currency or other
property denominated in
foreign currency
Inventory
Assets subject to
depreciation recapture
(see Temp. Regs. sec.
1 3€7(aj·4T'b))
Tangible property used in
trade or business not listed
under another category
Intangible
property
Property to be leased
(as described in
Temp. Regs. sec.
1.367{a)-4T{c))
Property to be sold
(as described in
Temp. Regs. sec.
1.367(a)-4T{d))
Transfers of oil and gas
working interests (as
described in Temp.
Regs, sec. 1.367{a)-4 {ej
Other property
Supplemental Information Required To Be Reported (see instructions):
824532 02-16-09
Form 926 (Rev_ 12-2008)
13421116 737725 BLOOMFAMFND
70
2008.05000 THE BLOOMBERG FAMILY FOUNDA BLOOMFA1
see instructions
Pa e3
9 Enter the transferor's interest in the foreign transferee corporation before and after the transfer:
(a) Before % (b) After %
10 Type of nonrecognition transaction (see instructions) ~ _
11 Indicate whether any transfer reported in Part "lis subject to any of the following:
a Gain recognition under section 904(f)(3) .
b Gain recognition under section 904(f)(S)(F) .
c Recapture under section 1S03(d) .
d Exchange gain under section 987 .
12 Did this transfer result from a change in the classification of the transferee to that of a foreign corporation? .
13 Indicate whether the transferor was required to recognize income under Temporary Regulations sections
1.367(a)-4T through 1.367(a)-6T for any of the following:
a Tainted property .
b Depreciation recapture .
c Branch loss recapture .
d Any other income recognition provision contained in the above-referenced regulations .
14 Did the transferor transfer assets which qualify for the trade or business exception under section 367(a)(3)? .
15 a Did the transferor transfer foreign goodwill or going concern value as defined in Temporary Regulations section
1.367(a)-1T(d)(S)(iiij? .
b If the answer to line 1Sa is "Yes," enter the amount of foreign goodwill or going concern value
transferred ~ $ _
DYes [X] No
DYes [X] No
DYes [X] No
DYes [X] No
DYes [X] No DYes [X] No
DYes [X] No
DYes [XJ No
DYes [X] No
DYes [X] No
DYes [X] No 16 Was cash the only property transferred? [X] Yes
17 a Was intangible property (within the meaning of section 936(h)(3)(B)) transferred as a result of the transaction?
b If "Yes," describe the nature of the rights to the intangible property that was transferred as a result of the transaction:
DNo
[X] No
DYes
824533 02-16-09
Form 926 (Rev _ 12-2008)
71
2008.05000 THE BLOOMBERG FAMILY FOUNDA BLOOMFA1
13421116 737725 BLOOMFAMFND
Form 926 Return by a U.S. Transferor of Property
(Rev. December2008) to a Foreign Corporation
Department of the Treasury
Internal Revenue Service ~ Attach to your Income tax return for the year of the transfer or distribution.
OMS No. 1545-0026
Name of transferor
Identifying number (seeinstruc1ions)
Ifp~tff)1 U.S. Transferor Information (see instructions)
THE BLOOMBERG FAMILY FOUNDATION INC
20-5602483
1 If the transferor was a corporation, complete questions 1 a through 1 d.
a If the transfer was a section 361 (a) or (b) transfer, was the transferor controlled (under section 368(c» by 5 or
fewer domestic corporations? DYes
b Did the transferor remain in existence after the transfer? [X] Yes
If not, list the controlling shareholder(s) and their identifying number(s):
[X] No DNo
Controlling shareholder
Identifying number
c If the transferor was a member of an affiliated group filing a consolidated retum, was it the parent corporation? DYes
If not, list the name and employer identification number (EIN) of the parent corporation:
[X] No
Name of parent corporation
EIN of parent corporation
[X] No
d Have basis adjustments under section 367(a)(5) been made? ,....................... DYes
2 If the transferor was a partner in a partnership that was the actual transferor (but is not treated as such under section 367), complete questions 2a through 2d.
a List the name and EIN of the transferor'S partnership:
Name of partnership
EIN of partnership
[X] No [X] No
b Did the partner pick up its pro rata share of gain on the transfer of partnership assets? DYes
c Is the partner disposing of its entire interest in the partnership? DYes
d Is the partner disposing of an interest in a limited partnership that is regularly traded on an established
securities market? D Yes [X] No
IU:fM::m::J Transferee Foreign Corporation Information (see instructions)
MERCHANTS' GATE OFFSHORE FUND, LTD
3 Name of transferee (foreign corporation) 4 Identifying number, if any
5 Address (including country)
NONE
6 Country code of country of incorporation or organization
7 Foreign law characterization (see instructions)
8 Is the transferee foreign corporation a controlled foreign corporation?
D Yes [X] No
LHA For Paperwork Reduction Act Notice, see separate instructions. 824531
02-16-09
Form 926 (Rev. 12-2008)
72
2008.05000 THE BLOOMBERG FAMILY FOUNDA BLOOMFA1
13421116 737725 BLOOMFAMFND
Pa e2
Type of (a) (b) IC)~
Date of ~ Fair market value on Cost or other Gain recognized on
property transfer date of transfer basis transfer
Cash 14,760,946.
Stock and
securities
Installment obligations,
account receivables or
similar property
Foreign currency or other
property denominated in
foreign currency
Inventory
Assets subject to
depreciation recapture
(see Temp. Regs. sec.
1.367Ia)·4Tlb))
Tangible property used in
trade or business not listed
under another category
Intangible
property
Property to be leased
(as described in
Temp. Regs. sec.
1.367Ia)·4Tlc))
Property to be sold
(as described in
Temp. Regs. sec.
1.367Ia)·4Tld))
Transfers of oil and gas
working interests (as
described in Temp.
Reas. sec. 1.367Ia)·4Tle))
Other property
Supplemental Information Required To Be Reported (see instructions):
824532 02·16-09
Form 926 (Rev. 12·2008)
13421116 737725 BLOOMFAMFND
73
2008.05000 THE BLOOMBERG FAMILY FOUNDA BLOOMFA1
see instructions
Pa e3
9 Enter the transferor's interest in the foreign transferee corporation before and after the transfer:
(a) Before % (b) After %
10 Type of nonrecognition transaction (see instructions) ~ ~ _
11 Indicate whether any transfer reported in Part III is subject to any of the following:
a Gain recognition under section 904(f)(3) .
b Gain recognition under section 904(f)(5)(F) .
c Recapture under section 1503(d) .
d Exchange gain under section 987 .
12 Did this transfer result from a change in the classification of the transferee to that of a foreign corporation? .
13 Indicate whether the transferor was required to recognize income under Temporary Regulations sections
1.367(a)-4T through 1.367(a)-6T for any of the following:
a Tainted property .
b Depreciation recapture .
c Branch loss recapture .
d Any other income recognition provision contained in the above-referenced regulations .
14 Did the transferor transfer assets which qualify for the trade or business exception under section 367(a)(3)? .
15 a Did the transferor transfer foreign goodwill or going concern value as defined in Temporary Regulations section
1.367(a)·1 T(d)(5)(iii)? .
b If the answer to line 15a is "Yes," enter the amount of foreign goodwill or going concern value
transferred ~ $ _
DYes [XJ No
DYes [XJ No
DYes [XJ No
DYes [XJ No
DYes [XJ No DYes [XJ No
DYes [XJ No
DYes [XJ No
DYes [XJ No
DYes [XJ No
DYes [XJ No 16 Was cash the only property transferred? _.............. [XJ Yes
17 a Was intangible property (within the meaning of section 936(h)(3)(B» transferred as a result of the transaction?
b If "Yes," describe the nature of the rights to the intangible property that was transferred as a result of the transaction:
DNo
[XJ No
DYes
824533 02-16-09
Form 926 (Rev. 12-2008)
74
2008.05000 THE BLOOMBERG FAMILY FOUNDA BLOOMFAI
13421116 737725 BLOOMFAMFND
Form 926 Return by a U.S. Transferor of Property
(Rev. December2008) to a Foreign Corporation
Department of the Treasury
Internal Revenue SeNice ~ Attach to your Income tax return for the year of the transfer or distribution.
OMB No. 1545-0026
Name of transferor
Identifying number (see ins1ructions)
[pm::r:tJ U.S. Transferor Information (see instructions)
THE BLOOMBERG FAMILY FOUNDATION INC
20-5602483
1 If the transferor was a corporation, complete questions 1 a through 1 d.
a If the transfer was a section 361 (a) or (b) transfer, was the transferor controlled (under section 368(c)) by 5 or
fewer domestic corporations? 0 Yes
b Did the transferor remain in existence after the transfer? CXJ Yes
If not, list the controlling shareholder(s) and their identifying number(s):
CXJ No ONo
Controlling shareholder
Identifying number
c If the transferor was a member of an affiliated group filing a consolidated return, was it the parent corporation? ......... 0 Yes If not, list the name and employer identification number (EIN) of the parent corporation:
CXJ No
Name of parent corporation
EIN of parent corporation
d Have basis adjustments under section 367(a)(5) been made? ~....................... 0 Yes
[X] No
2 If the transferor was a partner in a partnership that was the actual transferor (but is not treated as such under section 367), complete questions 2a through 2d.
a List the name and EIN of the transferor'S partnership:
Name of partnership
EIN of partnership
[X] No [X] No
b Did the partner pick up its pro rata share of gain on the transfer of partnership assets? 0 Yes
c Is the partner disposing of its entire interest in the partnership? 0 Yes
d Is the partner disposing of an interest in a limited partnership that is regularly traded on an established
3 Name of transferee (foreign corporation) 4 Identifying number, if any
5 Address Qncluding country)
BERMUDA
NONE
6 Country code of country of incorporation or organization BD
7 Foreign law characterization (see instructions)
Form 926 (Rev. 12·2008)
8 Is the transferee foreign corporation a controlled foreign corporation?
o Yes
[X] No
LHA For Paperwork Reduction Act Notice, see separate instructions. 824531
02-16-09
75
2008.05000 THE BLOOMBERG FAMILY FOUNDA BLOOMFA1
13421116 737725 BLOOMFAMFND
Pa e2
Type of (a) (b) (c) (eI) (e)
Date of Description of Fair market value on Cost or other Gain recognized on
property transfer date of transfer - transfer
Cash tt!{f::{{m///!{m::::!'//::/::/:::m::m:::::,::mm:m:l 19,681,262. t::!:!Il:@iEMfillillIEf!!!::::::::!:!!::!:
Stock and
securities
Installment obligations,
account receivables or
similar property
Foreign currency or other
property denominated in
foreign currency
Inventory
Assets subject to
depreciation recapture
(see Temp. Regs. sec.
1.367{a)-4~'b\\
Tangible property used in
trade or business not listed
under another category
Intangible
property
Property to be leased
(as described in
Temp. Regs. sec.
1.367Ia\·4Tlc\\
Property to be sold
(as described in
Temp. Regs. sec.
1.367Ial·4Tld\\
Transfers of oil and gas
working interests (as
described in Temp.
Reas. sec. 1.367Ial·4Tlell
Other property
Supplemental Information Required To Be Reported (see instructions):
824532 02·16-09
Form 926 (Rev. 12·2008)
13421116 737725 BLOOMFAMFND
76
2008.05000 THE BLOOMBERG FAMILY FOUNDA BLOOMFA1
see instructions
Pa e3
9 Enter the transferor's interest in the foreign transferee corporation before and after the transfer:
(a) Before % (b) After %
10 Type of nonrecognition transaction (see instructions) ~ _
11 Indicate whether any transfer reported in Part III is subject to any of the following:
a Gain recognition under section 904(f)(3) ,.
b Gain recognition under section 904(f)(S)(F) .
c Recapture under section 1S03(d) _ .
d Exchange gain under section 987 , .
12 Did this transfer result from a change in the classification of the transferee to that of a foreign corporation? .
13 Indicate whether the transferor was required to recognize income under Temporary Regulations sections
1.367(a)·4T through 1.367(a)-6T for any of the following:
a Tainted property .
b Depreciation recapture _ .
c Branch loss recapture .
d Any other income recognition provision contained in the above-referenced regulations .
14 Did the transferor transfer assets which qualify for the trade or business exception under section 367(a)(3)? .
15 a Did the transferor transfer foreign goodwill or going concern value as defined in Temporary Regulations section
1.367(a)-1T(d)(S)(iii)? .
b If the answer to line 1Sa is "Yes," enter the amount of foreign goodwill or going concern value
transferred ~ $ _
DYes [Xl No
DYes [Xl No
DYes [Xl No
DYes [Xl No
DYes [Xl No DYes [Xl No
DYes [Xl No
Dyes [Xl No
DYes [Xl No
DYes [Xl No
DYes [Xl No 16 Was cash the only property transferred? [Xl Yes
17 a Was intangible property (within the meaning of section 936(h)(3)(B)) transferred as a result of the transaction?
b If "Yes," describe the nature of the rights to the intangible property that was transferred as a result of the transaction:
DNo
DYes
[Xl No
824533 02-16-09
Form 926 (Rev. 12-2008)
77
2008.05000 THE BLOOMBERG FAMILY FOUNDA BLOOMFA1
13421116 737725 BLOOMFAMFND
Form 926 Return by a U.S. Transferor of Property
(Rev. December2008) to a Foreign Corporation
Department of the Treasury
Internal Revenue Service ~ Attach to your Income tax return for the year of the transfer or distribution.
OMB No. 1545-0026
Name of transferor
Identifying number (see ins1ruc1ions)
EPm:l::mH U.S. Transferor Information (see instructions)
THE BLOOMBERG FAMILY FOUNDATION INC
20-5602483
1 If the transferor was a corporation, complete questions 1 a through 1 d.
a If the transfer was a section 361 (a) or (b) transfer, was the transferor controlled (under section 368(c)) by 5 or
fewer domestic corporations? D Ves
b Did the transferor remain in existence after the transfer? 00 Ves
If not, list the controlling shareholder(s) and their identifying number(s):
[XJ No DNo
Controlling shareholder
Identifying number
c If the transferor was a member of an affiliated group filing a consolidated return, was it the parent corporation? D Ves
If not, list the name and employer identification number (EIN) of the parent corporation;
[XJ No
Name of parent corporation
EIN of parent corporation
d Have basis adjustments under section 367(a)(5) been made? :....................... D Ves
[XJ No
2 If the transferor was a partner in a partnership that was the actual transferor (but is not treated as such under section 367), complete questions 2a through 2d.
a Ust the name and EIN of the transferor's partnership:
Name of partnership
EIN of partnership
b Did the partner pick up its pro rata share of gain on the transfer of partnership assets? . D Ves
c Is the partner disposing of its entire interest in the partnership? D Ves
d Is the partner disposing of an interest in a limited partnership that is regularly traded on an established
securities market? D Ves [XJ No
[XJ No [XJ No
Fpift~ld] Transferee Foreign Corporation Information (see instructions)
TPG-AXON PARTNERS (OFFSHORE) LTD
3 Name of transferee (foreign corporation) 4 Identifying number, if any
5 Address (including country)
NONE
6 Country code of country of incorporation or organization
7 Foreign law characterization (see instructions)
Form 926 (Rev. 12·2008)
8 Is the transferee foreign corporation a controlled foreign corporation?
Dves
[XJ No
LHA For Paperwork Reduction Act Notice, see separate instructions. 824531
02-16-09
78
2008.05000 THE BLOOMBERG FAMILY FOUNDA BLOOMFA1
13421116 737725 BLOOMFAMFND
Pa e2
Type of (a) (b) (e) (d) (e)
Date of .. Fair market value on Cost or other Gain recognized on
property transfer date of transfer ~ -
Cash ~t . ::: .. , 24,601,577 •
::::.::::::::r
Stock and
securities
Installment obligations,
account receivables or
similar property
Foreign currency or other
property denominated in
foreign currency
Inventory
Assets subject to
depreciation recapture
(see Temp. Regs. sec.
1.367(a}-4T(b))
Tangible property used in
trade or business not listed
under another category
Intangible
property
Property to be leased
(as described in
Temp. Regs. sec.
1 3E"7(al-4""·'-\\
Property to be sold
(as described in
Temp. Regs. sec.
1.367(a}-4T(d))
Transfers of oil and gas
working interests (as
described in Temp.
Regs. sec. 1.367(a}-4T(e»
Other property
Supplemental Information Required To Be Reported (see instructions):
824532 02-16-09
Form 926 (Rev. 12-2008)
13421116 737725 BLOOMFAMFND
79
2008.05000 THE BLOOMBERG FAMILY FOUNDA BLOOMFA1
see instructions
Pa e3
9 Enter the transferors interest in the foreign transferee corporation before and after the transfer:
(a) Before % (b) After %
10 Type of nonrecognition transaction (see instructions) ~ _
11 Indicate whether any transfer reported in Part Illi is subject to any of the following:
a Gain recognition under section 904(f)(3) .
b Gain recognition under section 904(f)(5)(F) .
c Recapture under section 1503(d) .
d Exchange gain under section 987 .
12 Did this transfer result from a change in the classification of the transferee to that of a foreign corporation? .
13 Indicate whether the transferor was required to recognize income under Temporary Regulations sections
1.367(a)-4T through 1.367(a)-6T for any of the following:
a Tainted property .
b Depreciation recapture .
c Branch loss recapture .
d Any other income recognition provision contained in the above-referenced regulations .
14 Did the transferor transfer assets which qualify for the trade or business exception under section 367(a)(3)? .
15 a Did the transferor transfer foreign goodwill or going concern value as defined in Temporary Regulations section
1.367(a)-1T(d)(5)(iii)? .
b If the answer to line 15a is 'Yes,' enter the amount of foreign goodwill or going concern value
transferred ~ $ ~ __
DVes [Xl No
DVes [Xl No
DVes [Xl No
DVes [Xl No
DVes [Xl No Dves [Xl No
DVes [Xl No
DVes [Xl No
DVes [Xl No
DVes [Xl No
DVes [Xl No DNo
16 Was cash the only property transferred? [Xl Ves
[Xl No
17 a Was intangible property (within the meaning of section 936(h)(3)(B)) transferred as a result of the transaction? D Ves
b If 'Yes,' describe the nature of the rights to the intangible property that was transferred as a result of the transaction:
824533 02-16.Q9
Form 926 (Rev. 12-2008)
80
2008.05000 THE BLOOMBERG FAMILY FOUNDA BLOOMFA1
13421116 737725 BLOOMFAMFND
Fonn 926 Return by a U.S. Transferor of Property
(Rev. December2008) to a Foreign Corporation
Department of the Treasury
Internal Revenue Service ~ Attach to your Income tax return for the year of the transfer or distribution.
OMS No. 1545-0026
Name of transferor
Identifying number (see instructions)
IJ1iffltti U.S. Transferor Information (see instructions)
THE BLOOMBERG FAMILY FOUNDATION INC
20-5602483
1 If the transferor was a corporation, complete questions 1 a through 1 d.
a If the transfer was a section 361 (a) or (b) transfer, was the transferor controlled (under section 368(c» by 5 or
fewer domestic corporations? 0 Yes
b Did the transferor remain in existence after the transfer? 00 Yes
If not, list the controlling shareholder(s) and their identifying number(s):
00 No ONo
Controlling shareholder
Identifying number
00 No
c If the transferor was a member of an affiliated group filing a consolidated retum, was it the parent corporation? ......... 0 Yes If not, list the name and employer identification number (EIN) of the parent corporation:
Name of parent corporation
EIN of parent corporation
00 No
d Have basis adjustments under section 367(a)(5) been made? :....................... 0 Yes
2 If the transferor was a partner in a partnership that was the actual transferor (but is not treated as such under section 367), complete questions 2a through 2d.
a List the name and EIN of the transferor'S partnership:
Name of partnership
EIN of partnership
00 No 00 No
b Did the partner pick up its pro rata share of gain on the transfer of partnership assets? 0 Yes
c Is the partner disposing of its entire interest in the partnership? 0 Yes
d Is the partner disposing of an interest in a limited partnership that is regularly traded on an established
securities market? 0 Yes 00 No
[pili/If:] Transferee Foreign Corporation Information (see instructions)
JUPITER TM IV LTD
3 Name of transferee (foreign corporation) 4 Identifying number, if any
5 Address Oncluding country)
MAURITIUS
NONE
6 Country code of country of incorporation or organization
MP
7 Foreign law characterization (see instructions)
Form 926 (Rev. 12·2008)
8 Is the transferee foreign corporation a controlled foreign corporation?
DYes
00 No
LHA For Paperwork Reduction Act Notice, see separate instructions. 824531
02-16-09
81
2008.05000 THE BLOOMBERG FAMILY FOUNDA BLOOMFA1
13421116 737725 BLOOMFAMFND
824532 02-16-09
Form 926 (Rev. 12·2008)
Form 926 (Rev. 12·2008) Paae2
Id:ijlitJItJ Information Regarding Transfer of Property (see instructions)
Type of (a) (b) IC}~
Date of Description of Fair market value on Cost or other Gain recognized on
jJ'UjJ'" '1 . trarl!!fer ~ date of transfer basis transfer
Cash 407,129'1
Stock and
securities
Installment obligations,
account receivables or
similar property
Foreign currency or other
property denominated in
foreign currency
Inventory
Assets subject to
depreciation recapture
(see Temp. Regs. sec.
1.367(a)·4T(b))
Tangible property used in
trade or business not listed
under another category
Intangible
property
Property to be leased
(as described in
Temp. Regs. sec.
1.367(a)·4T(c))
Property to be sold
(as described in
Temp. Regs. sec.
1.36·fla)·4~'a))
Transfers of oil and gas
working interests (as
described in Temp.
Regs. sec. 1.367(a)-4T(e))
Other property
Supplemental Information Required To Be Reported (see instructions):
13421116 737725 BLOOMFAMFND
82
2008.05000 THE BLOOMBERG FAMILY FOUNDA BLOOMFA1
see instructions
Pa e3
9 Enter the transferor's interest in the foreign transferee corporation before and after the transfer:
(a) Before % (b) After %
10 Type of nonrecognition transaction (see instructions) ~ _
11 Indicate whether any transfer reported in Part III is subject to any of the following:
a Gain recognition under section 904(f)(3) .
b Gain recognition under section 904(f)(S)(F) .
c Recapture under section 1S03(d) .
d Exchange gain under section 987 .
12 Did this transfer result from a change in the classification of the transferee to that of a foreign corporation? .
13 Indicate whether the transferor was required to recognize income under Temporary Regulations sections
1.367(a)-4T through 1.367(a)-6T for any of the following:
a Tainted property .
b Depreciation recapture .
c Branch loss recapture .
d Any other income recognition provision contained in the above-referenced regulations .
14 Did the transferor transfer assets which qualify for the trade or business exception under section 367(a)(3)? .
15 a Did the transferor transfer foreign goodwill or going concern value as defined in Temporary Regulations section
1.367(a)-1T(d)(S)(iii)? .
b If the answer to line 1Sa is "Yes,' enter the amount of foreign goodwill or going concern value
transferred ~ $ ~--_
DYes [X] No
DYes [X] No
DYes [X] No
DYes [X] No
DYes [X] No DYes [X] No
DYes [X] No
DYes [X] No
DYes [X] No
DYes [X] No
DYes [X] No 16 Was cash the only property transferred? [X] Yes
17 a Was intangible property (within the meaning of section 936(h)(3)(B)) transferred as a result of the transaction?
b If 'Yes,' describe the nature of the rights to the intangible property that was transferred as a result of the transaction:
DNo
DYes
[X] No
824533 02-16-09
Form 926 (Rev. 12-2008)
83
2008.05000 THE BLOOMBERG FAMILY FOUNDA BLOOMFA1
13421116 737725 BLOOMFAMFND
Fonn 926 Return by a U.S. Transferor of Property
(Rev. Decernber2008) to a Foreign Corporation
Department of the Treasury
Internal Revenue Service ~ Attach to your Income tax return for the year of the transfer or distribution.
OMB No. 1545-0026
Name of transferor
Identifying number (see instructions)
!:::P3hmft::J U.S. Transferor Information (see instructions)
THE BLOOMBERG FAMILY FOUNDATION INC
20-5602483
If the transferor was a corporation, complete questions 1 a th rough 1 d.
a If the transfer was a section 361 (a) or (b) transfer, was the transferor controlled (under section 368(c)) by 5 or
fewer domestic corporations? 0 Yes
b Did the transferor remain in existence after the transfer? 00 Yes
If not, list the controlling shareholder(s) and their identifying number(s):
00 No ONo
Controlling shareholder
Identifying number
c If the transferor was a member of an affiliated group filing a consolidated return, was it the parent corporation? 0 Yes
If not, list the name and employer identification number (EIN) of the parent corporation:
00 No
Name of parent corporation
EIN of parent corporation
d Have basis adjustments under section 367(a)(5) been made? c....................... 0 Yes
00 No
2 If the transferor was a partner in a partnership that was the actual transferor (but is not treated as such under section 367), complete questions 2a through 2d.
a Ust the name and EIN of the transferor's partnership:
Name of partnership
EIN of partnership
b Did the partner pick up its pro rata share of gain on the transfer of partnership assets? 0 Yes
c Is the partner disposing of its entire interest in the partnership? 0 Yes
d Is the partner disposing of an interest in a limited partnership that is regularly traded on an established
securities market? 0 Yes 00 No
00 No 00 No
[eiH]t:rl Transferee Foreign Corporation Information (see instructions)
GEOTECH OIL SERVICES HOLDINGS LTD
3 Name of transferee (foreign corporation) 4 Identifying number, if any
5 Address (including country)
CYPRUS
NONE
6 Country code of country of incorporation or organization CY
7 Foreign law characterization (see instructions)
Form 926 (Rev. 12·2008)
8 Is the transferee foreign corporation a controlled foreign corporation?
o Yes
00 No
LHA For Paperwork Reduction Act Notice, see separate instructions. 824531
02-16-09
84
2008.05000 THE BLOOMBERG FAMILY FOUNDA BLOOMFAI
13421116 737725 BLOOMFAMFND
Pa e2
Type of (.) ~ (e) (eI) (e)
Date of Description of Fair market value on Cost or other Gain recognized on
property transfer date of transfer basis transfer
Casll_ 09/23/200 ::.::.:. . .<) _1.04,703.1
Stock and
securities
Installment obligations,
account receivables or
similar property
Foreign currency or other
property denominated in
foreign currency
Inventory
Assets subject to
depreciation recapture
(see Temp. Regs. sec.
1~_67"(a)"4""'b))
Tangible property used in
trade or business not listed
under another category
Intangible
property
Property to be leased
(as described in
Temp. Regs. sec.
1~Ema)-4T{c\\
Property to be sold
(as described in
Temp. Regs. sec.
1 3€"'(al-4T(c'"
Transfers of oil and gas
working interests (as
described in Temp.
Regs. sec. 1.367(a)-4T(e»
Other property
Supplemental Information Required To Be Reported (see instructions):
824532 02-16-09
Form 926 (Rev. 12-2008)
13421116 737725 BLOOMFAMFND
85
2008.05000 THE BLOOMBERG FAMILY FOUNDA BLOOMFA1
see instructions
Pa e3
9 Enter the transferor's interest in the foreign transferee corporation before and after the transfer:
(a) Before % (b) After %
10 Type of nonrecognition transaction (see instructions) ~ _
11 Indicate whether any transfer reported in Part III is subject to any of the following:
a Gain recognition under section 904(f)(3) .
b Gain recognition under section 904(f)(S)(F) .
c Recapture under section 1S03(d) .
d Exchange gain under section 987 .
12 Did this transfer result from a change in the classification of the transferee to that of a foreign corporation? .
13 Indicate whether the transferor was required to recognize income under Temporary Regulations sections
1.367(a)-4T through 1.367(a)-6T for any of the following:
a Tainted property .
b Depreciation recapture .
c Branch loss recapture .
d Any other income recognition provision contained in the above-referenced regulations .
14 Did the transferor transfer assets which qualify for the trade or business exception under section 367(a)(3)? .
15 a Did the transferor transfer foreign goodwill or going concern value as defined in Temporary Regulations section
1.367(a)-1T(d)(S)Oii)? .
b If the answer to line 1Sa is "Yes,' enter the amount of foreign goodwill or going concern value transferred ~ $
----------
DYes [XJ No
DYes [XJ No
DYes [XJ No
DYes [XJ No
Dyes [XJ No DYes [XJ No
DYes [XJ No
DYes [XJ No
DYes [XJ No
DYes [XJ No
DYes [XJ No 16 Was cash the only property transferred? [XJ Yes
17 a Was intangible property (within the meaning of section 936(h)(3)(B)) transferred as a result of the transaction?
b If "Yes," describe the nature of the rights to the intangible property that was transferred as a result of the transaction:
DNo
DYes
[XJ No
824533 02-16-09
Form 926 (Rev. 12-2008)
86
2008.05000 THE BLOOMBERG FAMILY FOUNDA BLOOMFA1
13421116 737725 BLOOMFAMFND
PAGE 3
PARTNER NAME:
ID#
THE BLOOMBERG FAMILY FOUNDATION 20-5602483
QUADRANGLE PRIVATE INVESTORS (TAX EXEMPT) I LLC ATTACHMENT TO FORM SCHEDULE K-1
INFORMA TION REqUIRED UNDER SECTION 603B (REPORTING OF TRANSFERS TO FORE1GN PARTNERSHIPS)
ARVO INVESTMENT HOLDINGS S.A.R.L
DURING 2008, OAM PRIVATE INVESTORS (TAX EXEMPT) I LP HAD A DIRECT INVESTMENT IN VARDE FUND IX, L.P. rFUND IX"). FUND IX CONTRIBUTED $155,714,011 OF CASH TO ARVO INVESTMENT HOLDINGS SAR.L ..
A FOREIGN LIMITED PARTNERSHIP. IN ACCORDANCE WITH FEDERAL TAX FlUNG REQUIREMENTS,
FUND IX FILED FORM 8865 "RETURN OF U.S. PERSON WITH RESPECT TO CERTAIN FOREIGN PARTNERSHIPS"
AS A CATEGORY 3 FILER ON BEHALF OF ITS PARTNERS UNDER THE CONSTRUCTIVE OWNERS FILING EXCEPTION PURSUANT TO TREASURY REG. SECTION 1.60:J8B-2(A)(2).
PLEASE INCLUDE THE BELOW STATEMENT WITH YOUR TAX RETURN.
CONTROLLED FOREIGN PARTNERSHIP REPORTING
THE TAXPAYER MAY BE REQUIRED TO FILE FORM 8865 FOR THE FOREIGN PARTNERSHIPS LISTED BELOW BUT IS NOT DOING SO UNDER THE CONSTRUGT1VE OWNERS FILING EXCEPTION PURSUANT TO TREASURY REG. SECTION 1.6038B-2(A)(2). THE TAXPAYER HAS AN INDIRECT PARTNERSHIP INTEREST IN:
VARDE FUND IX, L.P.
8500 NORMANDALE LAKE BLVD. SUITE 1500
MINNEAPOLIS, MN 55437
VARDE FUND IX, L.P. INVESTS EITHER DIRECTLY OR INDIRECTLY IN THE FOLLOWING FOREIGN PARTNERSHIP:
ARVO INVESTMENTS HOLDINGS SAR.L. BC, PARC D'ACTMTlES
SYRDALL, LUXEMBOURG L-5365
Form 8865
Attachment Sequence No. 118
Return of U.S. Persons With Respect to Certain Foreign Partnerships
OMS No. 1545-1668
~@08
~ Attach to your tax return. See separate instructions.
Department of the Treasury Information furnished for the foreign partnership's tax year
Internal Revenue Service beginning , 2008, and ending , 20
Name of person filing this retum I Filer's identifying number
THE BLOOMBERG FAMILY FOUNDATION INC 20-5602483
Filer's address (if you are not filing this form with your tax return)
B Filer's tax year beginning , 20 ,and ending , 20 _
A Category of fil~r (see Categories of Filers in the instructions and check applicable box(es)):
10 20 31Zi 40
CIO GELLER & CO
800 THIRD AVENUE, 25TH FLOOR NEW YORK, NY 10022
C Filer's share of liabilities: Nonrecourse $
Other $
Qualified nonrecourse financing $
o If filer is a member of a consolidated group but not the parent, enter the following information about the parent:
Name EIN
Address
E Information about certain other partners (see instructions)
(1) Name (2) Address (3) Identifying number (4) Check applicable box(es)
Category 1 Category 2 Constructive owner
F1 Name and address of foreign partnership 2 EIN Qf any)
HIREF INTERNATIONAL FUND, LLC 98-0556426
IFS COURT, 28 CYBERCITY 3 Country under whose laws organized
EBENE, MAURITIUS MAURITIUS
4 Date of 5 Principal place 6 Principal business 7 Principal business Sa Functional currency 8b Exchange rate
organization of business activity code number activity (see instr.) G Provide the following information for the foreign partnership's tax year:
3 Name and address of foreign partnership's agent in country of organization, if any
4 Name and address of person(s) with custody of the books and records of the foreign partnership, and the location of such books and records, if different
1 Name, address, and identifying number of agent (if any) in the 2 Check if the foreign partnership must file:
United States 0 Form 1042 0 Form 8804 0 Form 1065 or 1065-8 Service Center where Form 1065 or 1065-8 is filed:
5 Were any special allocations made by the foreign partnership?
~ 0 Yes 0 No
6 Enter the number of Forms 8858, Information Return of U.S. Persons With Respect To Foreign Disregarded Entities,
attached to this return (see instructions) ~
7 How is this partnership classified under the law of the country in which it is organized? ~ ------------
8 Did the partnership own any separate units within the meaning of Regulations section 1.1503-2(c)(3), (4), or
1.1503(d)-1(b)(4)? ~ 0 Yes 0 No
9 Does this partnership meet both of the following requirements?
• The partnership's total receipts for the tax year were less than $250,000 and
• The value of the partnership's total assets at the end of the tax year was less than $1 million. If "Yes," do not complete Schedules L, M-1, and M-2.
}
~ 0 Yes 0 No
Under penalties of perjury, I declare that I have examined this retum, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than general partner or limited liability company member) is based on all information of which preparer has any knowledge.
Sign Here Only If You Are Filing This Form Separately and Not With Your Tax Return.
~ Signature of general partner or limited liability company member
~ Date
I Date
Check if I
self-employed ~ 0
Preparer's ~ signature ,
Preparer's SSN or PTIN
Paid Prepare Sign and Complete Only If Form is Filed Separately.
I EIN ~
Firm's name (or ~
yours if self-employed), address, and ZIP code
I Phone no.
For Privacy Act and Paperwork Reduction Act Notice, see the separate instructions.
Form 8865 (2008)
Cat. No. 25852A
Form 8865 (2008)
Page 2
Constructive Ownership of Partnership Interest. Check the boxes that apply to the filer. If you check box b, enter the name, address, and U.S. taxpayer identifying number (if any) of the person(s) whose interest you constructively own. See instructions.
a 0 Owns a direct interest b 0 Owns a constructive interest
Name
Identifying number (if any)
Check if foreign person
Check if direct partner
Address
Schedule A-1
Certain Partners of Foreign Partnership (see instructions
Check if foreign erson
Name
Identifying number Of any)
Address
Does the partnership have any other foreign person as a direct partner? . . . . . . . . . 0 Yes 0 No
t111@mrt!J'j Affiliation Schedule. List all partnerships (foreign or domestic) in which the foreign partnership owns a direct interest or indirectly owns a 10% interest.
EIN Total ordinary Check if
Name Address foreign
(if any) income or loss partnership
I..-r.l ir:Ti m r:1I:1 Income Statement-Trade or Business Income
Caution. Include only trade or business income and ""/-''''''''''''' on lines 1a throuph 22 below. See the instructions for more information.
1 a Gross receipts or sales 1a
b Less returns and allowances . 1b 1c
2 Cost of goods sold . 2
(l) Gross profit. Subtract line 2 from line 1 c . 3
E 3
0 4 Ordinary income (loss) from other partnerships, estates, and trusts (attach statement) 4
e
.E 5 Net farm profit (loss) (attach Schedule F (Form 1040)} . 5
6 Net gain (loss) from Form 4797, Part II, line 17 (attach Form 4797) 6
7 Other income (loss) (attach statement). 7
8 Total income Ooss). Combine lines 3 through 7 8
9 Salaries and wages (other than to partners) Oess employment credits) . 9
10 Guaranteed payments to partners 10
"'W 11 Repairs and maintenance . 11
c
j 12 Bad debts. 12
~ 13 Rent. 13
.g
.. 14 Taxes and licenses 14
c
:g 15 Interest.
2
"t;; 1'16~ 1 '1
.S 16a Depreciation (if required, attach Form 4562)
'" 16b 16c
'"
$ b Less depreciation reported elsewhere on return
II) 17 Depletion (Do not deduct oil and gas depletion.) 17
e
0 Retirement plans, etc. 18
;; 18
o 19
::I 19 Employee benefit programs
"0 Other deductions (attach statement) 20
CI) 20
C
21 Total deductions. Add the amounts shown in the far right column for lines 9 through 20. 21
22 Ordinary business income (loss) from trade or business activities. Subtract line 21 from line 8 22
Form 8865 (2008)
Form 8865 (2008)
Page 3
~1§ft'Mmtjl) Capital Gains and Losses
I@II Short-Term Capital Gains and Losses-Assets Held One Year or Less
(a) Description of property (b) Date acquired (c) Date sold (d) Sales price (e) Cost or other basis (f) Gain or (loss)
(Example: 100 shares (month, day, year) (month, day, year) (see instructions) (see instructions) Subtract (e) from (d)
of "Z" Co.)
1
2 Short-term capital gain from installment sales from Form 6252, line 26 or 37. 2
3 Short-term capital gain (loss) from like-kind exchanges from Form 8824 3
4 Partnership's share of net short-term capital gain (loss), including specially allocated short-term capital
gains (losses), from other partnerships, estates, and trusts. 4
5 Net short-term capital gain or (loss). Combine lines 1 through 4 in column (f). Enter here and on
Form 8865, Schedule K, line 8 or 11 5 I@III Long-Term Capital Gains and Losses-Assets Held More Than One Year
(a) Description of property (b) Date acquired (c) Date sold (d) Sales price (e) Cost or other basis (f) Gain or (loss)
(Example: 100 shares
of rz: Co.) (month, day, year) (month, day, year) (see instructions) (see instructions) Subtract (e) from (d)
6
7 Long-term capital gain from installment sales from Form 6252, line 26 or 37 . 7
8 Long-term capital gain (loss) from like-kind exchanges from Form 8824. 8
9 Partnership's share of net long-term capital gain (loss), including specially allocated long-term capital
gains (losses), from other partnerships, estates, and trusts. 9
10 Capital gain distributions 10
11 Net long-term capital gain or (loss). Combine lines 6 through 10 in column (f). Enter here and on
Form 8865, Schedule K, line 9a or 11 . 11 Form 8865 (2008)
Form 8865 (2008)
Page 4
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1 Ordinary business income (loss) (page 2, line 22)
2 Net rental real estate income (loss) (attach Form 8825) . 3a Other gross rental income (loss) .
b Expenses from other rental activities (attach statement).
c Other net rental income {loss). Subtract line 3b from line 3a 4 Guaranteed payments .
5 Interest income .
6 Dividends: a Ordinary dividends b Qualified dividends
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6b
7 Royalties
8 Net short-term capital gain (loss) . 9a Net long-term capital gain (loss) .
b Collectibles (28%) gain (loss) .
c Unrecaptured section 1250 gain (attach statement) 10 Net section 1231 gain {loss) (attach Form 4797)
11 Other income ..
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15
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12 Section 179 deduction (attach Form 4562). 13a Contributions .
b Investment interest expense . c Section 59(e)(2) expenditures: d Other deductions
(1) Type" .
..
(2) Amount ..
14a Net earnings (loss) from self-employment b Gross farming or fishing income. .
c Qualified rehabilitation expenditures (rental real estate) (attach Form 3468).
d Other rental real estate credits (see instructions) Type" _
e Other rental credits (see instructions) Type" .
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16a Name of country or U.S. possession ~ _
b Gross income from all sources .
c Gross income sourced at partner level .
Foreign gross income sourced at partnership level
d Passive category ~ e General category ~ f Other (attach statement) ~
Deductions allocated and apportioned at partner level
9 Interest expense ~ h Other. . ~
Deductions allocated and apportioned at partnership level to foreign source income
i Passive category ~ j General category ~ k Other (attach statement) ~
I Total foreign taxes (check one):" 0 Paid 0 Accrued
m Reduction in taxes available for credit (attach statement)
n Other tax information
17a Post-1986 depreciation adjustment b Adjusted gain or loss
c Depletion (other than oil and gas)
d Oil, gas, and geothermal properties-gross income e Oil, gas, and geothermal properties-deductions
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18a Tax-exempt interest income b Other tax-exempt income . c Nondeductible expenses .
19a Distributions of cash and marketable securities
b Distributions of other property 20a b
Form 8865 (2008)
Assets
1
Cash ....
2a Trade notes and accounts receivable
b Less allowance for bad debts. 3 Inventories . . . . . .
4 U.S. government obligations . 5 Tax-exempt securities . . .
6 Other current assets (attach statement) 7 Mortgage and real estate loans . . . 8 Other investments (attach statement) . 9a Buildings and other depreciable assets.
b Less accumulated depreciation 10a Depletable assets. . . . . b Less accumulated depletion . 11 Land (net of any amortization).
12a Intangible assets (amortizable only) . b Less accumulated amortization
13 Other assets (attach statement) . 14 Total assets. . . . . . . .
Liabilities and Capital 15 Accounts payable. . . . . .
16 Mortgages, notes, bonds payable in less than 1 year. 17 Other current liabilities (attach s_tatement). . . 18 All nonrecourse loans . . . . . . . . . 19 Mortgages, notes, bonds payable in 1 year or more. 20 Other liabilities (attach statement)
21 Partners' capital accounts
22 Total liabilities and
Form 8865 (2008)
Schedule M-1
6
(a) Beginning of tax year
(b) End of tax year
1 Total U.S. assets. . 2 Total foreign assets: a Passive category .
b General category. .
c Other(attach~~~·~~t~.n~,~.~tL~~~~~~~~~~~~~~~~~ ~~ __
Reconciliation of Income (Loss) per Books With Income (Loss) per Return. (Not required if Item G9, page 1, is answered "Yes.")
Ana YSIS of Partners' Capital Accounts. (Not required If Item G9, page 1, IS answered "Yes.")
1 Net income (loss) per books
2 Income included on Schedule K, lines 1, 2, 3c, 5, 6a, 7, 8, 9a, 10, and 11 not recorded on books
this year (itemize): _ .. __ .. _
3 Guaranteed payments (other than health insurance)
4 Expenses recorded on books this year not included on Schedule K, lines 1 through 13d, and 161 (itemize):
a Depreciation $ _
b Travel and entertainment $
Shdl M2
c e ue -
6 Income recorded on books this year not included on Schedule K, lines 1 through 11 (itemize):
a Tax-exempt interest $ _
7 Deductions included on Schedule K, lines 1 through 13d, and 161 not charged against book income this year (itemize):
a Depreciation $ _
1 Balance at beginning of year .
2 Capital contributed:
a Cash
b Property
3 Net income (loss) per books
4 Other increases (itemize): _
5 Add lines 1 through 4
6 Distributions: a Cash .
b Property.
7 Other decreases (itemize): _
8 Add lines 6 and 7
9 Balance at end of year. Subtract line 8 from line 5
Form 8865 (2008)
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Form 8865 (2008) Page 7
,-m@mtja Transactions Between Controlled Foreign Partnership and Partners or Other Related Entities Important: Complete a separate Form 8865 and Schedule N for each controlled foreign partnership. Enter the totals for each type of transaction that occurred between the foreign partnership and the persons listed in columns (a) through (d)
(b) Any domestic (e) Any other foreign (d) Any U.S. person with a
Transactions (a) U.S. person corporation or partnership corporation or partnership 10% or more direct interest
of filing this return controlling or controlled controlling or controlled in the controlled foreign
foreign partnership by the U.S. person filing by the U.S. person filing partnership (other than the
this return this return U.S. person filing this return)
1 Sales of inventory .
2 Sales of property rights
(patents, trademarks, etc.)
3 Compensation received for
technical, managerial,
engineering, construction,
or like services .
4 Commissions received
5 Rents, royalties, and
license fees received .
6 Distributions received.
7 Interest received
8 Other
9 Add lines 1 through 8.
10 Purchases of inventory
11 Purchases of tangible
property other than
inventory .
12 Purchases of property
rights (patents,
trademarks, etc.)
13 Compensation paid for
technical, managerial,
engineering, construction,
or like services .
14 Commissions paid .
15 Rents, royalties, and
license fees paid
16 Distributions paid
17 Interest paid .
18 Other
19 Add lines 10 through 18 .
20 Amounts borrowed (enter
the maximum loan
balance during the year)
-see instructions.
21 Amounts loaned (enter the
maximum loan balance
during the year)-see
instructions Form 8865 (2008)
SCHEDULE 0 (Form 8865)
Transfer of Property to a Foreign Partnership (under section 6038B)
~@08
OMB No. 1545-1668
Department of the Treasury Internal Revenue Service
~ Attach to Form 8865. See Instructions for Form 8865.
Name of transferor
Filer's identifying number 20-5602483
THE BLOOMBERG FAMILY FOUNDATION INC
Name of foreign partnership
HIREF INTERNATIONAL FUND, LLC
I@il
Transfers Reportable Under Section 6038B
(a) (b) (c) (d) (e) (f) (g)
Type of Date of Number of Fair market Cost or other Section 704(c) Gain Percentage interest
property transfer items value on date basis allocation recognized on in partnership after
transferred of transfer method transfer transfer
Cash VARIOUS $218,117
Marketable
securities
Inventory
Tangible
property
used in trade
or business
Intangible
property
Other
property Supplemental Information Required To Be Reported (see instructions):
Imill
Dispositions Reportable Under Section 6038B
(b) (e) (f) (g) (h)
(a) Date of (c) (d) Gain Depreciation Depreciation
Type of original Date of Manner of recognized by recapture Gain allocated recapture allocated
property disposition disposition recognized to partner
transfer partnership bv oartnershio to partner
1:I:Ti. II I Is any transfer reported on this schedule subject to gain recognition under section 904(f)(3) or section 904(f)(5)(F)?
.. DYes
D No
For Paperwork Reduction Act Notice, see the Instructions for Form 8865.
Cat. No. 25909U
Schedule 0 (Fenm 8865) 2008
* Printed on recycled paper
Department of the Treasury Internal Revenue Service
Acquisitions, Dispositions, and Changes of Interests in a Foreign Partnership
(under section 6046A)
~ Attach To Form 8865. See Instructions for Form 8865.
~@08
•
SCHEDULE P (Form 8865)
OMB No. 1545-1668
Name of person filing Form 8865
Filer's identifying number
Name of foreign partnership
.:miD Acquisitions
(a) (b) (c) (d) (e) (f)
Name, address, and identifying number of FMVof Basis in % of interest % of interest
person from whom your interest was acquired Date of acquisition interest acquired interest acquired before acquisition after acquisition
1:mi.11 Dispositions
(a) (b) (e) (d) (e) (f)
Name, address, and identifying number of FMVof Basis in % of interest % of interest
person who acquired your interest Date of disposition interest disposed interest disposed before disposition after disposition
1:miIllI Change in Proportional Interest
(a) (b) (e) (d) (e) (f)
Description of change Date of change FMVof Basis in % of interest % of interest
interest interest before change after change
l:miill'. Supplemental Information Required To Be Reported (see instructions) For Paperwork Reduction Act Notice, see the Instructions for Form 8865.
Cat. No. 25943Q
Schedule P (Form 8865) 2008
Form
5471
Information Return of U.S. Persons With Respect To Certain Foreign Corporations
,.. See separate instructions.
Information furnished for the foreign corporation's annual accounting period (tax year required by
(Rev. December 2007) Department at the Treasury Internal Revenue Service
Attachment Sequence No. 121
A identifying number 20-5602483
Nunber, _I, and rccm or suile no. (PI" P.o. .box number ~ mail is nat delivered to street addmss)
C/O GELLER &. CO., 800 THIRD AVENUE
B Category of filer (See instructions. Check applicable box(es):
1 (repealed) 20 31X] 40 50
City or town, state. and ZlP code
NEW YORK, NY 10022
C Enter the· total percentage of the fOreign corporation's voting s1cdI you
owned at the end of ils annual ac:counting period 0 . 0 0 %
Filer's tax year begillnil1lg 1 / 0 1
,2008
,and ending
12/31
,20 08
o Person(s) on whose behalf this information return is filed'
(11 Name (2) Address (3) Identifying number (4) Check applicable boX(es)
Sha!!llclder Officer Diredor Important: Fill in all applicable Imes and schedules. All mformatlon must be tn English. All amounts must be stated in U.S. dollars unless otherwise indicated
1 a Name and address of fOreign corporation b Employer identification number, if any
QAM SELECT INVESTORS (OFFSHORE) I LP 83-0501786
C/O QUADRANGLE GROUP LLC, 375 PARK AVENUE e Country under whose laws illGOrpor.lted
NEW YORK, NY 10152 CAYMAN ISLANDS
d Date of incorporation e Principal place of business f Principal business activity 9 Principal business activity b Functional currency
code number
11/21/2007 CAYMAN ISLANDS 523900 INVESTING USD Z Provide the fOllowing Informa1ion forthe foreign corporation's ac:counting period slated above
a Name, address. and identifying number of branch ofIice or agent Of any) in b "a U.s. income tax return was filed. enter:
the United States
(i) Taxable income or (lOss) (Ii) U.s. income tax paid
(after aD credits)
c Name and address of foreign corpoliltion's slatufDry or resident agent in d Name and address (Including corporate depar1ment, it applicable) of
country of Incorporation . person (or persons) wiIIl CUstody'of the books and A!COrds of tI1e foreign
corporation, and the location 01 such books and records, if different
STEVEN DAVIDSON, clo QUADRANGLE GROUP LLC
375 PARK AVENUE
NEW YORK, NY 10152
~lof'l· .t1I[~!. Stock of the Foreign Corporation
{b} Number of shares issued and outstanding
(al Description of each class of stock (iJ Beginning of annual (li) End of annual
aa:ounting period accounting period
SHARE 100 0 For Paperwork Reduction Act Notice, see instructions. (SA