Income m difi - Charity Blossom

Form 990-PF (2009) Page 6
Statements Regarding Activities for Which Form 4720 May Be Required (continued)
5a During the year did the foundation pay or incur any amount to D
(1) Carry on propaganda, or otherwise attempt to influence legislation (section 4945(e))? I I I II I CI Yes X
(2) Influence the outcome of any specific public election (see section 4955), or to carry on, *
(3) directly Provide a or grant indirectly, to an individual any voter for registration travel, study, drive? or I other I I I similar I I I I I purposes? I I I I I I I I I I I I I II I I E I II Yes I Yes -7-4. L
(4) Provide a grant to an organization other than a charitable, etc , organization described in 1
section 509(a)(1), (2), or (3), or section 4940(d)(2)"7 (see page 22 of the instructions) I I I I II I Cl Yes -X-I
(5) Provide for any purpose other than religious, charitable, scientific, literary. or educational ­
purposes, or for the prevention of cruelty to children or animals? I I I I I I I I I I I I I I II I lj Yes L
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 page 22 ofthe instructions)? . . . . . . . 5b N /A
Organizations relying on a current notice regarding disaster assistance check here , , I I I I I I I I I I II I P -c
lf the answer is "Yes" to question 5a(4), does the foundation claim exemption from the tax
because it maintained expenditure responsibility for the grant? I , I I I I I I I I I I I I I I ,, , lj YES
If "Yes, " 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 2
on a personal benent contract? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . tj Yes L
b Did the foundation, during the year, pay premiums, directly or indirectly, on a personal benefit contract? I I I I I
lf "Yes" to 6b, tile Form 8870
I 7a At any time during the tax year, was the foundation a party to a prohibited tax shelter transaction? I I lj Yes X
l b If yes, did the foundation receive any-proceeds or have any net income attributable to the transaction? . . . . . . .. . , 75 N/A
Part viii information
and Contractors
About Officers, Directors, Trustees, Foundation Managers, Highly Paid Employees,
1 List all officers, directors, trustees, foundation managers and their compensation (see page 22 of the instructions).
b Ttl , d c Compensation (d)c i bt t g
(3) Name and Hddfess ( )hdu?s aprer 3lYeeerl?ge ((If)not paid, enter em I iagilegelziwiaons P UV (B) P Expense th Ilaccaun
"
devoted to position -0-) and deferred compensation 0 er 8 owances
55ELfUYE%E@@@YE.4 ................... -­
2 Compensation of five highest-paid employees (other than those included on line 1 - see page 23 of the instructions).
If none, enter "NONE."
(d) Contributions to
(a) Name and address of each employee paid more than $50,000 how-g pe,-week (c) Compensation plan s an P erred yd def other allowances
99?? ............................... -,
(bl We and ave"-296 em io ee benem lvl Expense account.
devoted to position Compensauon
Total number of other employees paid over $50,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . ...vI
JSA
9E1460 1 000
. ll­
Form 990-PF (zoos)