Return of Private Foundation. , 2011, and ending, 20 Name of foundation THE SCHMIDT FAMILY FOUNDATION Amended return

Transcription

1 Return of Private Foundation OMB No or Section 4947(a)(1) Nonexept Charitable Trust Departent of the Treasury Treated as a Private Foundation Internal Revenue Service Note. The foundation ay be able to use a copy of this return to satisfy state reporting requireents. À¾µµ For calendar year 2011 or tax year beginning, 2011, and ending, 20 Nae of foundation A Eployer identification nuber For 990-PF Nuber and street (or P.O. box nuber if ail is not delivered to street address) Roo/suite B City or town, state, and ZIP code Telephone nuber (see instructions) I I I I I C If exeption application is pending, check here PALO ALTO, CA G Check all that apply: Initial return Initial return of a forer public charity D 1. Foreign organizations, check here Final return Aended return 2. Foreign organizations eeting the 85% test, check here and attach Address change Nae change coputation H Check type of organization: Section 501(c)(3) exept private foundation E If private foundation status was terinated Section 4947(a)(1) nonexept charitable trust Other taxable private foundation under section 507(b)(1)(A), check here I Fair arket value of all assets at end J Accounting ethod: Cash Accrual F If the foundation is in a 60-onth terination of year (fro Part II, col. (c), line Other (specify) under section 507(b)(1)(B), check here 16) I $ 178,017,994. (Part I, colun (d) ust be on cash basis.) Part I Analysis of Revenue and Expenses (The (d) Disburseents total of aounts in coluns (b), (c), and (d) (a) Revenue and (b) Net investent (c) Adjusted net for charitable ay not necessarily equal the aounts in expenses per incoe incoe purposes colun (a) (see instructions).) books (cash basis only) 1 Contributions, gifts, grants, etc., received (attach schedule) 21,660,363. ATCH 1 if the foundation is not required to 2 Check attach Sch. B Revenue Operating and Adinistrative Expenses THE SCHMIDT FAMILY FOUNDATION BRYANT STREET 370 I 3 Interest on savings and teporary cash investents 4 Dividends and interest fro securities 5 a Gross rents b Net rental incoe or (loss) 6 a Net gain or (loss) fro sale of assets not on line 10 b Gross sales price for all 29,974,400. assets on line 6a 7 Capital gain net incoe (fro Part IV, line 2) 8 Net short-ter capital gain 9 Incoe odifications 10 a Gross sales less returns and allowances b Less: Cost of goods sold c Gross profit or (loss) (attach schedule) 11 Other incoe (attach schedule) 12 Total. Add lines 1 through Copensation of officers, directors, trustees, etc. 14 Other eployee salaries and wages 15 Pension plans, eployee benefits 16a Legal fees (attach schedule) ATCH 5 b Accounting fees (attach schedule) ATCH 6 c Other professional fees (attach schedule) * 17 Interest 18 Taxes (attach schedule) (see instructions) 19 Depreciation (attach schedule) and depletion 20 Occupancy 21 Travel, conferences, and eetings 22 Printing and publications 23 Other expenses (attach schedule) 24 Total operating and adinistrative expenses. Add lines 13 through Contributions, gifts, grants paid 26 Total expenses and disburseents. Add lines 24 and Subtract line 26 fro line 12: 20,199. (650) , ,777. ATCH 2 3,756,645. 3,756,645. ATCH 3 20, ,199. 2,239, ,875, ,103, ,103,208. ATCH 4 26,611, ,587, , , , , , , , , , , , ,250. ** 170, , , , , , , , , ATCH 9 1,758, ,265. 1,412,937. 3,969, ,946. 3,048, ,990, ,102, ,959, , ,150, ,651,928. a Excess of revenue over expenses and disburseents b Net investent incoe (if negative, enter -0-) 20,891,149. c Adjusted net incoe (if negative, enter -0-) For Paperwork Reduction Act Notice, see instructions. * ATCH 7 JSA ** ATCH 8 For 990-PF (2011) 1E AN 702M 11/13/2012 1:46:51 PM V PAGE 1

2 For 990-PF (2011) Page 2 Assets Liabilities Net Assets or Fund Balances Attached schedules and aounts in the Balance Sheets description colun should be for end-of-year aounts only. (See instructions.) 1 Cash - non-interest-bearing 2 Savings and teporary cash investents 3 Accounts receivable Part II I I Less: allowance for doubtful accounts I I 4 Pledges receivable Less: allowance for doubtful accounts 5 Grants receivable 6 Receivables due fro officers, directors, trustees, and other disqualified persons (attach schedule) (see instructions) 7 Other notes and loans receivable (attach schedule) I Less: allowance for doubtful accountsi 8 Inventories for sale or use 9 Prepaid expenses and deferred charges 10 a Investents - U.S. and state governent obligations (attach schedule) b Investents - corporate stock (attach schedule) ATCH 11 c Investents - corporate bonds (attach schedule) 11 Investents - land, buildings, and equipent: basis Less: accuulated depreciation (attach schedule) I 12 Investents - ortgage loans 13 Investents - other (attach schedule) ATCH Land, buildings, and equipent: basis Less: accuulated depreciation (attach schedule) I 15 Other assets (describe I ATCH ) 16 Total assets (to be copleted by all filers - see the instructions. Also, see page 1, ite I) 17 Accounts payable and accrued expenses 18 Grants payable 19 Deferred revenue 20 Loans fro officers, directors, trustees, and other disqualified persons 21 Mortgages and other notes payable (attach schedule) 22 Other liabilities (describe I ) 23 Total liabilities (add lines 17 through 22) Foundations that follow SFAS 117, check here I and coplete lines 24 through 26 and lines 30 and Unrestricted 25 Teporarily restricted 26 Peranently restricted Foundations that do not follow SFAS 117, check here and coplete lines 27 through 31. I 27 Capital stock, trust principal, or current funds 28 Paid-in or capital surplus, or land, bldg., and equipent fund 29 Retained earnings, accuulated incoe, endowent, or other funds 30 Total net assets or fund balances (see instructions) 31 Total liabilities and net assets/fund balances (see instructions) Beginning of year End of year (a) Book Value (b) Book Value (c) Fair Market Value 171,697, ,017,994. Part III Analysis of Changes in Net Assets or Fund Balances Total net assets or fund balances at beginning of year - Part II, colun (a), line 30 (ust agree with end-of-year figure reported on prior year's return) 1 168,551,869. Enter aount fro Part I, line 27a 10,651,928. Other increases not included in line 2 (iteize) IATTACHMENT 14 45,000. Add lines 1, 2, and 3 179,248,797. Decreases not included in line 2 (iteize) I ATTACHMENT 15 4,319,358. Total net assets or fund balances at end of year (line 4 inus line 5) - Part II, colun (b), line ,929, THE SCHMIDT FAMILY FOUNDATION ,232,990. 7,561,523. 7,561,523. * * 2,300,422. ATCH 10 3,584,931. 2,300,422. 2,300, , , ,128. ATCH 20,579, ,742, ,742,256. ATCH 136,071, ,127, ,127,127. 9,099,482. 1,198,427. 7,899,430. 7,901,055. 7,901,055. ATCH , , , ,697, ,017, ,017, , ,100. 2,354,643. 2,242,455. 3,145,422. 3,088, ,551, ,929, ,551, ,929, For 990-PF (2011) JSA 1E AN 702M 11/13/2012 1:46:51 PM V PAGE 2

3 For 990-PF (2011) Page 3 Part IV 1a b c d e a b c d e Capital Gains and Losses for Tax on Investent Incoe (e) Gross sales price (a) List and describe the kind(s) of property sold (e.g., real estate, 2-story brick warehouse; or coon stock, 200 shs. MLC Co.) SEE PART IV SCHEDULE (f) Depreciation allowed (or allowable) (g) Cost or other basis plus expense of sale Coplete only for assets showing gain in colun (h) and owned by the foundation on 12/31/69 (i) F.M.V. as of 12/31/69 THE SCHMIDT FAMILY FOUNDATION (j) Adjusted basis as of 12/31/69 (k) Excess of col. (i) over col. (j), if any (b) How acquired P-Purchase D-Donation a b c d e 2 Capital gain net incoe or (net capital loss) If gain, also enter in Part I, line 7 $ If (loss), enter -0- in Part I, line 7 &2 3 Net short-ter capital gain or (loss) as defined in sections 1222(5) and (6): If gain, also enter in Part I, line 8, colun (c) (see instructions). If (loss), enter -0- in & Part I, line 8 3 Part V Qualification Under Section 4940(e) for Reduced Tax on Net Investent Incoe (For optional use by doestic private foundations subject to the section 4940(a) tax on net investent incoe.) (c) Date acquired (o., day, yr.) (h) Gain or (loss) (e) plus (f) inus (g) (d) Date sold (o., day, yr.) (l) Gains (Col. (h) gain inus col. (k), but not less than -0-) or Losses (fro col. (h)) 18,875, If section 4940(d)(2) applies, leave this part blank. Was the foundation liable for the section 4942 tax on the distributable aount of any year in the base period? If "Yes," the foundation does not qualify under section 4940(e). Do not coplete this part. 1 Enter the appropriate aount in each colun for each year; see the instructions before aking any entries. (a) (b) (c) (d) Base period years Distribution ratio Calendar year (or tax year beginning in) Adjusted qualifying distributions Net value of noncharitable-use assets (col. (b) divided by col. (c)) ,930, ,207, ,123, ,249,890. 1,218, ,742, ,207, ,297, ,057, ,023, Total of line 1, colun (d) 2 3 Average distribution ratio for the 5-year base period - divide the total on line 2 by 5, or by the nuber of years the foundation has been in existence if less than 5 years 3 4 Enter the net value of noncharitable-use assets for 2011 fro Part, line Multiply line 4 by line Enter 1% of net investent incoe (1% of Part I, line 27b) 6 7 Add lines 5 and Enter qualifying distributions fro Part II, line ,471,789. If line 8 is equal to or greater than line 7, check the box in Part VI, line 1b, and coplete that part using a 1% tax rate. See the Part VI instructions. JSA For 990-PF (2011) 1E Yes ,712, ,744, , ,953, AN 702M 11/13/2012 1:46:51 PM V PAGE 3 No

4 For 990-PF (2011) Page 4 Part VI Excise Tax Based on Investent Incoe (Section 4940(a), 4940(b), 4940(e), or see instructions) 1a Exept operating foundations described in section 4940(d)(2), check here I and enter "N/A" on line 1. 7 Date of ruling or deterination letter: (attach copy of letter if necessary - see instructions) b Doestic foundations that eet the section 4940(e) requireents in Part V, check * 1 208,911. I 8 here and enter 1% of Part I, line 27b c All other doestic foundations enter 2% of line 27b. Exept foreign organizations enter 4% of 9 Part I, line 12, col. (b). 2 Tax under section 511 (doestic section 4947(a)(1) trusts and taxable foundations only. Others enter -0-) 2 3 Add lines 1 and Subtitle A (incoe) tax (doestic section 4947(a)(1) trusts and taxable foundations only. Others enter -0-) 4 5 Tax based on investent incoe. Subtract line 4 fro line 3. If zero or less, enter Credits/Payents: a 2011 estiated tax payents and 2010 overpayent credited to a b Exept foreign organizations - tax withheld at source 6b c Tax paid with application for extension of tie to file (For 8868) 6c d Backup withholding erroneously withheld 6d 7 Total credits and payents. Add lines 6a through 6d 7 8 Enter any penalty for underpayent of estiated tax. Check here if For 2220 is attached 8 9 Tax due. If the total of lines 5 and 8 is ore than line 7, enter aount owed 9 10 Overpayent. If line 7 is ore than the total of lines 5 and 8, enter the aount overpaid Enter the aount of line 10 to be: Credited to 2012 estiated taxi 0 Refunded I11 Part VII-A Stateents Regarding Activities 1a b During the tax year, did the foundation attept to influence any national, state, or local legislation or did it participate or intervene in any political capaign? 1a Did it spend ore than $100 during the year (either directly or indirectly) for political purposes (see page 19 of the instructions for definition)? 1b If the answer is "Yes" to 1a or 1b, attach a detailed description of the activities and copies of any aterials published or distributed by the foundation in connection with the activities. c Did the foundation file For 1120-POL for this year? 1c d Enter the aount (if any) of tax on political expenditures (section 4955) iposed during the year: (1) On the foundation. (2) I $ On foundation anagers. I$ e Enter the reiburseent (if any) paid by the foundation during the year for political expenditure tax iposed I on foundation anagers. $ 2 Has the foundation engaged in any activities that have not previously been reported to the IRS? 2 If "Yes," attach a detailed description of the activities. 3 Has the foundation ade any changes, not previously reported to the IRS, in its governing instruent, articles of incorporation, or bylaws, or other siilar instruents? If "Yes," attach a confored copy of the changes 3 4a Did the foundation have unrelated business gross incoe of $1,000 or ore during the year? 4a b If "Yes," has it filed a tax return on For 990-T for this year? 4b 5 Was there a liquidation, terination, dissolution, or substantial contraction during the year? 5 If "Yes," attach the stateent required by General Instruction T. 6 Are the requireents of section 508(e) (relating to sections 4941 through 4945) satisfied either: % By language in the governing instruent, or By state legislation that effectively aends the governing instruent so that no andatory directions that conflict with the state law reain in the governing instruent? 6 7 Did the foundation have at least $5,000 in assets at any tie during the year? If "Yes," coplete Part II, col. (c), and Part V 7 8a b Enter the states to which the foundation reports or with which it is registered (see instructions) CA,MA, THE SCHMIDT FAMILY FOUNDATION If the answer is "Yes" to line 7, has the foundation furnished a copy of For 990-PF to the Attorney General (or designate) of each state as required by General Instruction G? If "No," attach explanation 205, Is the foundation claiing status as a private operating foundation within the eaning of section 4942(j)(3) or 4942(j)(5) for calendar year 2011 or the taxable year beginning in 2011 (see instructions for Part IV)? If "Yes," coplete Part IV 9 10 Did any persons becoe substantial contributors during the tax year? If "Yes," attach a schedule listing their naes and addresses 10 I 8b 208, , ,278. ATTACHMENT 16 3,797. Yes No For 990-PF (2011) JSA 1E AN 702M 11/13/2012 1:46:51 PM V PAGE 4

5 Stateents Regarding Activities (continued) For 990-PF (2011) Page 5 Part VII-A At any tie during the year, did the foundation, directly or indirectly, own a controlled entity within the eaning of section 512(b)(13)? If "Yes," attach schedule (see instructions) 11 Did the foundation ake a distribution to a donor advised fund over which the foundation or a disqualified person had advisory privileges? If "Yes," attach stateent (see instructions) Did the foundation coply with the public inspection requireents for its annual returns and exeption application? Website address I I I The books are in care of Located at ZIP Section 4947(a)(1) nonexept charitable trusts filing For 990-PF in lieu of For Check here and enter the aount of tax-exept interest received or accrued during the year I At any tie during calendar year 2011, did the foundation have an interest in or a signature or other authority over a bank, securities, or other financial account in a foreign country? 16 See the instructions for exceptions and filing requireents for For TD F If "Yes," enter the nae of I the foreign country Part VII-B Stateents Regarding Activities for Which For 4720 May Be Required File For 4720 if any ite is checked in the "Yes" colun, unless an exception applies. 1a 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? Yes No (2) Borrow oney fro, lend oney to, or otherwise extend credit to (or accept it fro) a 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 (d)-3 or in a current notice regarding disaster assistance (see instructions)? 1b Organizations relying on a current notice regarding disaster assistance check here I c Did the foundation engage in a prior year in any of the acts described in 1a, other than excepted acts, that were not corrected before the first day of the tax year beginning in 2011? 1c 2 Taxes on failure to distribute incoe (section 4942) (does not apply for years the foundation was a private a At the end of tax year 2011, did the foundation have any undistributed incoe (lines 6d and 6e, Part III) for tax year(s) beginning before 2011? Yes No If "Yes," list the years I,,, b Are there any years listed in 2a for which the foundation is not applying the provisions of section 4942(a)(2) all years listed, answer "No" and attach stateent - see instructions.) c If the provisions of section 4942(a)(2) are being applied to any of the years listed in 2a, list the years here. I,,, 3a Did the foundation hold ore than a 2% direct or indirect interest in any business enterprise b If "Yes," did it have excess business holdings in 2011 as a result of (1) any purchase by the foundation or I 13 THESCHMIDTFAMILYFOUNDATION.ORG JEANNE HUEY Telephone no. I (650) BRYANT STREET #370 PALO ALTO, CA b I the 10-, 15-, or 20-year first phase holding period? (Use Schedule C, For 4720, to deterine if the foundation had excess business holdings in 2011.) 3b 4a Did the foundation invest during the year any aount in a anner that would jeopardize its charitable purposes? 4a b Did the foundation ake any investent in a prior year (but after Deceber 31, 1969) that could jeopardize its charitable purpose that had not been reoved fro jeopardy before the first day of the tax year beginning in 2011? 4b For 990-PF (2011) disqualified person? Yes No (3) Furnish goods, services, or facilities to (or accept the fro) a disqualified person? Yes No (4) Pay copensation to, or pay or reiburse the expenses of, a disqualified person? Yes No (5) Transfer any incoe or assets to a disqualified person (or ake any of either available for the benefit or use of a disqualified person)? Yes No (6) Agree to pay oney or property to a governent official? (Exception. Check "No" if the foundation agreed to ake a grant to or to eploy the official for a period after terination of governent service, if terinating within 90 days.) Yes No operating foundation defined in section 4942(j)(3) or 4942(j)(5)): (relating to incorrect valuation of assets) to the year's undistributed incoe? (If applying section 4942(a)(2) to at any tie during the year? Yes No disqualified persons after May 26, 1969; (2) the lapse of the 5-year period (or longer period approved by the Coissioner under section 4943(c)(7)) to dispose of holdings acquired by gift or bequest; or (3) the lapse of Yes Yes No No JSA 1E AN 702M 11/13/2012 1:46:51 PM V PAGE 5

6 For 990-PF (2011) THE SCHMIDT FAMILY FOUNDATION Page 6 Part VII-B Stateents Regarding Activities for Which For 4720 May Be Required (continued) 5 a During the year did the foundation pay or incur any aount to: (1) Carry on propaganda, or otherwise attept to influence legislation (section 4945(e))? Yes No (2) Influence the outcoe of any specific public election (see section 4955); or to carry on, directly or indirectly, any voter registration drive? Yes No (3) Provide a grant to an individual for travel, study, or other siilar purposes? Yes No (4) Provide a grant to an organization other than a charitable, etc., organization described in b c 6 a b section 509(a)(1), (2), or (3), or section 4940(d)(2)? (see instructions) Yes No (5) Provide for any purpose other than religious, charitable, scientific, literary, or educational purposes, or for the prevention of cruelty to children or anials? Yes No If any answer is "Yes" to 5a(1)-(5), did any of the transactions fail to qualify under the exceptions described in Regulations section or in a current notice regarding disaster assistance (see instructions)? Organizations relying on a current notice regarding disaster assistance check here If the answer is "Yes" to question 5a(4), does the foundation clai exeption fro the tax because it aintained expenditure responsibility for the grant? Yes No If "Yes," attach the stateent required by Regulations section (d). Did the foundation, during the year, receive any funds, directly or indirectly, to pay preius on a personal benefit contract? Yes No Did the foundation, during the year, pay preius, directly or indirectly, on a personal benefit contract? If "Yes" to 6b, file For ATTACHMENT 17 7 a At any tie during the tax year, was the foundation a party to a prohibited tax shelter transaction? Yes No b If "Yes," did the foundation receive any proceeds or have any net incoe attributable to the transaction? 7b Part VIII Inforation About Officers, Directors, Trustees, Foundation Managers, Highly Paid Eployees, and Contractors 1 List all officers, directors, trustees, foundation anagers and their copensation (see instructions). (b) Title, and average (c) Copensation (d) Contributions to (a) Nae and address (e) Expense account, hours per week (If not paid, enter eployee benefit plans devoted to position -0-) other allowances and deferred copensation ATTACHMENT I 5b 6b 2 Copensation of five highest-paid eployees (other than those included on line 1 - see instructions). If none, enter "NONE." (a) Nae and address of each eployee paid ore than $50,000 (b) Title, and average hours per week devoted to position (c) Copensation (d) Contributions to eployee benefit plans and deferred copensation (e) Expense account, other allowances ATTACHMENT , , Total nuber of other eployees paid over $50,000 I 4 For 990-PF (2011) JSA 1E AN 702M 11/13/2012 1:46:51 PM V PAGE 6

7 For 990-PF (2011) Page 7 Part VIII Inforation About Officers, Directors, Trustees, Foundation Managers, Highly Paid Eployees, and Contractors (continued) 3 Five highest-paid independent contractors for professional services (see instructions). If none, enter "NONE." (a) Nae and address of each person paid ore than $50,000 (b) Type of service (c) Copensation CUTLASS RACING LLC NEWPORT, RI EVENT CONSULTING 56,875. NETWORK CONCEPTS CASTRO VALLEY, CA IT CONSULTANT 63,136. HILLSPIRE, LLC MENLO PARK, CA ACCTG,INVST & MGT 184,996. MANUKA SPORTS MANAGEMENT LLC NEWPORT, RI EVENT CONSULTING 55,725. BDO USA, LLP SAN FRANCISCO, CA AUDIT & TA SERVICE 53,625. Total nuber of others receiving over $50,000 for professional services 0 Part I-A Suary of Direct Charitable Activities List the foundation's four largest direct charitable activities during the tax year. Include relevant statistical inforation such as the nuber of organizations and other beneficiaries served, conferences convened, research papers produced, etc THE SCHMIDT FAMILY FOUNDATION I Expenses 11TH HOUR PROJECT - FUNDED EVENTS AND ACTIVITIES TO INCREASE EDUCATION AND AWARENESS AROUND CLIMATE CHANGE, RENEWABLE ENERGY, SUSTAINABLE FOOD AND AGRICULTURE AND HUMAN RIGHTS. 3,982,192. GREENHOUND - FUNCTIONED AS A BUS STATION DURING THE SUMMER SEASON TO PROMOTE PUBLIC TRANSPORTATION AND AS A CAMPUS FOR THE LOCAL ADULT COMMUNITY SCHOOL DURING THE WINTER SEASON. 338,650. REMAIN NANTUCKET - SPONSORED COMMUNITY EVENTS WITH SOCIAL AND CLIMATE ENVIRONMENTAL MESSAGES. 412,217. Part I-B Suary of Progra-Related Investents (see instructions) Describe the two largest progra-related investents ade by the foundation during the tax year on lines 1 and RUDOLF STEINER FOUNDATION - BELOW MARKET LOAN TO MAKE LOANS IN AREA OF FOOD & AGRICULTURE INCLUDING PROJECTS SUPPORTING LOCAL FOOD SYSTEMS BASED ON SUSTAINABLE AGRICULTURE. 100,000. ROOT CAPITAL INC - BELOW MARKET LOAN TO PROVIDE FINANCING FOR COMMUNITY BASED ENTERPRISES ENGAGED IN ACTIVITIES THAT FOSTER ENVIRO. CONSERVATION/SOCIALLY EQUITABLE DEVELOPMENT. 100,000. All other progra-related investents. See instructions. 3 GREENHOUND - ADDITIONAL FIED ASSETS ADDED TO THE PROPERTY. BANYAN WATER INC - BELOW MARKET LOAN TO FUND INSTALLATION OF WATER SAVING SOLUTIONS TECHNOLOGY ON CUSTOMER SITES. 121,255. Total. Add lines 1 through 3 I 321,255. For 990-PF (2011) Aount JSA 1E AN 702M 11/13/2012 1:46:51 PM V PAGE 7

8 For 990-PF (2011) Page Part a b c d e Miniu Investent Return (All doestic foundations ust coplete this part. Foreign foundations, see instructions.) Fair arket value of assets not used (or held for use) directly in carrying out charitable, etc., purposes: Average onthly fair arket value of securities 1a Average of onthly cash balances 1b Fair arket value of all other assets (see instructions) 1c Total (add lines 1a, b, and c) 1d Reduction claied for blockage or other factors reported on lines 1a and 1c (attach detailed explanation) 1e Acquisition indebtedness applicable to line 1 assets 2 Subtract line 2 fro line 1d 3 Cash deeed held for charitable activities. Enter 1 1/2 % of line 3 (for greater aount, see instructions) 4 Net value of noncharitable-use assets. Subtract line 4 fro line 3. Enter here and on Part V, line 4 5 Miniu investent return. Enter 5% of line 5 6 Distributable Aount (see instructions) (Section 4942(j)(3) and (j)(5) private operating foundations and certain foreign organizations check here and do not coplete this part.) 5 6 Part I 1 Miniu investent return fro Part, line a Tax on investent incoe for 2011 fro Part VI, line 5 2a 208,911. b Incoe tax for (This does not include the tax fro Part VI.) 2b c Add lines 2a and 2b 2c 3 Distributable aount before adjustents. Subtract line 2c fro line Recoveries of aounts treated as qualifying distributions 4 5 Add lines 3 and Deduction fro distributable aount (see instructions) 6 7 Distributable aount as adjusted. Subtract line 6 fro line 5. Enter here and on Part III, line 1 Part II Qualifying Distributions (see instructions) THE SCHMIDT FAMILY FOUNDATION I 7 1 Aounts paid (including adinistrative expenses) to accoplish charitable, etc., purposes: a Expenses, contributions, gifts, etc. - total fro Part I, colun (d), line 26 1a b Progra-related investents - total fro Part I-B 1b 2 Aounts paid to acquire assets used (or held for use) directly in carrying out charitable, etc., purposes 2 3 Aounts set aside for specific charitable projects that satisfy the: a Suitability test (prior IRS approval required) 3a b Cash distribution test (attach the required schedule) 3b 4 Qualifying distributions. Add lines 1a through 3b. Enter here and on Part V, line 8, and Part III, line Foundations that qualify under section 4940(e) for the reduced rate of tax on net investent incoe. Enter 1% of Part I, line 27b (see instructions) 5 6 Adjusted qualifying distributions. Subtract line 5 fro line 4 6 Note. The aount on line 6 will be used in Part V, colun (b), in subsequent years when calculating whether the foundation qualifies for the section 4940(e) reduction of tax in those years. 93,575,301. 4,133, ,542, ,251, ,251,199. 2,538, ,712,431. 8,335,622. 8,335, ,911. 8,126,711. 8,126,711. 8,126, ,150, , ,471, , ,262,878. For 990-PF (2011) JSA 1E AN 702M 11/13/2012 1:46:51 PM V PAGE 8

9 For 990-PF (2011) Page 9 Undistributed Incoe (see instructions) Part III 1 Distributable aount for 2011 fro Part I, line 7 2 Undistributed incoe, if any, as of the end of 2011: a Enter aount for 2010 only b Total for prior years: ,2 0 08, Excess distributions carryover, if any, to 2011: a Fro 2006 b Fro 2007 c Fro 2008 d Fro ,801,544. e Fro ,381,345. f Total of lines 3a through e 4 Qualifying distributions for 2011 fro Part II, line 4: I$ 15,471,789. a Applied to 2010, but not ore than line 2a b Applied to undistributed incoe of prior years (Election required - see instructions) c Treated as distributions out of corpus (Election required - see instructions) d Applied to 2011 distributable aount e Reaining aount distributed out of corpus 5 Excess distributions carryover applied to 2011 (If an aount appears in colun (d), the sae aount ust be shown in colun (a).) 6 Enter the net total of each colun as indicated below: a Corpus. Add lines 3f, 4c, and 4e. Subtract line 5 b Prior years' undistributed incoe. Subtract line 4b fro line 2b c Enter the aount of prior years' undistributed incoe 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 fro line 6b. Taxable aount - see instructions e Undistributed incoe for Subtract line 4a fro line 2a. Taxable aount - see instructions f Undistributed incoe for Subtract lines 4d and 5 fro line 1. This aount ust be distributed in Aounts treated as distributions out of corpus to satisfy requireents iposed by section 170(b)(1)(F) or 4942(g)(3) (see instructions) 8 Excess distributions carryover fro 2006 not applied on line 5 or line 7 (see instructions) 9 Excess distributions carryover to Subtract lines 7 and 8 fro line 6a 10 Analysis of line 9: a Excess fro 2007 b Excess fro 2008 c Excess fro ,801,544. d Excess fro ,381,345. e Excess fro ,345,078. THE SCHMIDT FAMILY FOUNDATION (a) (b) (c) (d) Corpus Years prior to ,182,889. 7,345,078. ATCH 20 32,527, ,527,967. 8,126,711. 8,126,711. For 990-PF (2011) JSA 1E AN 702M 11/13/2012 1:46:51 PM V PAGE 9

10 Private Operating Foundations (see instructions and Part VII-A, question 9) NOT APPLICABLE For 990-PF (2011) Page 10 Part IV 1 a If the foundation has received a ruling or deterination letter that it is a private operating foundation, and the ruling is effective for 2011, enter the date of the ruling I b Check box to indicate whether the foundation is a private operating foundation described in section 4942(j)(3) or 4942(j)(5) 2 a Enter the lesser of the adjusted net incoe fro Part I or the iniu investent return fro Part for each year listed b 85% of line 2a c d Qualifying distributions fro Part II, line 4 for each year listed Aounts included in line 2c not used directly for active conduct of exept activities e Qualifying distributions ade directly for active conduct of exept activities. Subtract line 2d fro line 2c 3 Coplete 3a, b, or c for the alternative test relied upon: a "Assets" alternative test - enter: (1) Value of all assets b c (2) Value of assets qualifying under section 4942(j)(3)(B)(i) "Endowent" alternative testenter 2/3 of iniu investent return shown in Part, line 6 for each year listed "Support" alternative test - enter: (1) (2) Total support other than gross investent incoe (interest, dividends, rents, payents on securities loans (section 512(a)(5)), or royalties) Support fro general public and 5 or ore exept organizations as provided in section 4942 (j)(3)(b)(iii) (3) Largest aount of support fro an exept organization (4) Gross investent incoe Part V 1 a b Tax year Prior 3 years (a) 2011 (b) 2010 (c) 2009 (d) 2008 (e) Total Suppleentary Inforation (Coplete this part only if the foundation had $5,000 or ore in assets at any tie during the year - see instructions.) Inforation Regarding Foundation Managers: List any anagers of the foundation who have contributed ore than 2% of the total contributions received by the foundation before the close of any tax year (but only if they have contributed ore than $5,000). (See section 507(d)(2).) ATTACHMENT 21 List any anagers of the foundation who own 10% or ore 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. 2 a b c NONE Inforation Regarding Contribution, Grant, Gift, Loan, Scholarship, etc., Progras: I Check here if the foundation only akes contributions to preselected charitable organizations and does not accept unsolicited requests for funds. If the foundation akes gifts, grants, etc. (see instructions) to individuals or organizations under other conditions, coplete ites 2a, b, c, and d. The nae, address, and telephone nuber of the person to who applications should be addressed: ATTACHMENT 22 The for in which applications should be subitted and inforation and aterials they should include: ATTACHMENT 23 Any subission deadlines: d ATTACHMENT 24 Any restrictions or liitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other factors: ATTACHMENT 25 JSA For 990-PF (2011) 1E AN 702M 11/13/2012 1:46:51 PM V PAGE 10

11 For 990-PF (2011) Page 11 Part V Suppleentary Inforation (continued) 3 Grants and Contributions Paid During the Year or Approved for Future Payent Recipient Nae and address (hoe or business) a Paid during the year ATTACHMENT 26 THE SCHMIDT FAMILY FOUNDATION If recipient is an individual, show any relationship to any foundation anager or substantial contributor Foundation status of recipient Purpose of grant or contribution Aount Total b Approved for future payent ATTACHMENT 27 3a I 12,102,228. Total 3b I 3,913,600. For 990-PF (2011) JSA 1E AN 702M 11/13/2012 1:46:51 PM V PAGE 11

12 For 990-PF (2011) Page 12 Part VI-A Analysis of Incoe-Producing Activities Enter gross aounts unless otherwise indicated. 1 Progra service revenue: a b c d e f g Fees and contracts fro governent agencies 2 Mebership dues and assessents 3 Interest on savings and teporary cash investents 4 Dividends and interest fro securities 5 Net rental incoe or (loss) fro real estate: a Debt-financed property b Not debt-financed property 6 Net rental incoe or (loss) fro personal property 7 Other investent incoe 8 Gain or (loss) fro sales of assets other than inventory 9 Net incoe or (loss) fro special events 10 Gross profit or (loss) fro sales of inventory 11 Other revenue: a b c d Unrelated business incoe Excluded by section 512, 513, or 514 (a) Business code (b) Aount (c) Exclusion code (d) Aount e 12 Subtotal. Add coluns (b), (d), and (e) 13 Total. Add line 12, coluns (b), (d), and (e) 13 (See worksheet in line 13 instructions to verify calculations.) Part VI-B Relationship of Activities to the Accoplishent of Exept Purposes Line No. L THE SCHMIDT FAMILY FOUNDATION , ,756, , ,103, ,875, ,587,095. (e) Related or exept function incoe (See instructions.) 21,587,095. Explain below how each activity for which incoe is reported in colun (e) of Part VI-A contributed iportantly to the accoplishent of the foundation's exept purposes (other than by providing funds for such purposes). (See instructions.) JSA For 990-PF (2011) 1E AN 702M 11/13/2012 1:46:51 PM V PAGE 12

13 Inforation Regarding Transfers To and Transactions and Relationships With Noncharitable Exept Organizations For 990-PF (2011) Page 13 Part VII 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 fro the reporting foundation to a noncharitable exept organization of: (1) Cash 1a(1) (2) Other assets 1a(2) b Other transactions: (1) Sales of assets to a noncharitable exept organization 1b(1) (2) Purchases of assets fro a noncharitable exept organization 1b(2) (3) Rental of facilities, equipent, or other assets 1b(3) (4) Reiburseent arrangeents 1b(4) (5) Loans or loan guarantees 1b(5) (6) Perforance of services or ebership or fundraising solicitations 1b(6) c d Sharing of facilities, equipent, ailing lists, other assets, or paid eployees 1c If the answer to any of the above is "Yes," coplete the following schedule. Colun (b) should always show the fair arket value of the goods, other assets, or services given by the reporting foundation. If the foundation received less than fair arket value in any transaction or sharing arrangeent, show in colun (d) the value of the goods, other assets, or services received. (a) Line no. (b) Aount involved (c) Nae of noncharitable exept organization (d) Description of transfers, transactions, and sharing arrangeents N/A N/A Yes No 2a Is the foundation directly or indirectly affiliated with, or related to, one or ore tax-exept organizations described in section 501(c) of the Code (other than section 501(c)(3)) or in section 527? Yes No b If "Yes," coplete the following schedule. (a) Nae of organization (b) Type of organization (c) Description of relationship Sign Here Under penalties of perjury, I declare that I have exained this return, including accopanying schedules and stateents, and to the best of y knowledge and belief, it is true, correct, and coplete. Declaration of preparer (other than taxpayer) is based on all inforation of which preparer has any knowledge. M M May the IRS discuss this return with the preparer shown below Signature of officer or trustee Date Title (see instructions)? Yes No Paid Preparer Print/Type preparer's nae Preparer's signature Date Check if PTIN self-eployed MICHAEL CAMPBELL P BDO USA, LLP Fir's address ONE MARKET ST-SPEAR TOWER, STE 1100 SAN FRANCISCO, CA Fir's nae I Fir's EIN I Use Only Phone no. For 990-PF (2011) JSA 1E AN 702M 11/13/2012 1:46:51 PM V PAGE 13

14 FORM 990-PF - PART IV CAPITAL GAINS AND LOSSES FOR TA ON INVESTMENT INCOME P Kind of Property Description or Date D acquired Gross sale Depreciation Cost or FMV Adj. basis Excess of Gain price less allowed/ other as of as of FMV over or expenses of sale allowable basis 12/31/69 12/31/69 adj basis (loss) TOTAL CAPITAL GAIN DISTRIBUTIONS 171,152. Date sold FIDELITY # VAR VAR 508, , ,621. FIDELITY # VAR VAR ACCEL STRATEGIC PARTNERS VAR VAR ACCEL STRATEGIC PARTNERS VAR VAR 40, ,245. ACCOLADE PARTNERS III, LP VAR VAR 67, ,838. ACCOLADE PARTNERS III, LP VAR VAR 189, ,289. BENCHMARK FOUNDERS' FUND VI VAR VAR 107, ,882. DE SHAW OCULUS FUND, LLC VAR VAR 359, ,192. DE SHAW OCULUS FUND, LLC VAR VAR 343, ,748. DUNE REAL ESTATE PARALLEL FUND II VAR VAR DUNE REAL ESTATE PARALLEL FUND II VAR VAR GENERAL ATLANTIC PARTNERS 86 VAR VAR JSA 1E AN 702M 11/6/2012 1:41:24 AM V PAGE 14

15 FORM 990-PF - PART IV CAPITAL GAINS AND LOSSES FOR TA ON INVESTMENT INCOME P Kind of Property Description or Date D acquired Gross sale Depreciation Cost or FMV Adj. basis Excess of Gain price less allowed/ other as of as of FMV over or expenses of sale allowable basis 12/31/69 12/31/69 adj basis (loss) Date sold GENERAL ATLANTIC PARTNERS 87 VAR VAR 90, ,419. GENERAL ATLANTIC PARTNERS 88 VAR VAR 7,030. 7,030. KLEINER PERKINS CAUFIELD & BYERS III VAR VAR 113, ,571. ROCKWOOD CAPITAL R E PTNRS FD VIII VAR VAR 40, ,472. SCHF US, LP VAR VAR 131, ,086. SCHF US, LP VAR VAR 16, ,550. LEGACY VENTURE IV VAR VAR 2,482. 2,482. LEGACY VENTURE IV VAR VAR 15, ,573. HIGHVISTA II LIMITED PARTNERSHIP VAR VAR 13, ,812. HIGHVISTA II LIMITED PARTNERSHIP VAR VAR 41, ,171. FARALLON CAPITAL INSTITUTIONAL PARTNERS VAR VAR 9,706. 9,706. FARALLON CAPITAL INSTITUTIONAL PARTNERS VAR VAR 33, ,924. JSA 1E AN 702M 11/6/2012 1:41:24 AM V PAGE 15

16 FORM 990-PF - PART IV CAPITAL GAINS AND LOSSES FOR TA ON INVESTMENT INCOME P Kind of Property Description or Date D acquired Gross sale Depreciation Cost or FMV Adj. basis Excess of Gain price less allowed/ other as of as of FMV over or expenses of sale allowable basis 12/31/69 12/31/69 adj basis (loss) Date sold GENERAL ATLANTIC PARTNERS (BERMUDA) VAR VAR 128, ,444. PIMCO LOAN OPPORTUNITIES FUND VAR VAR 103, ,048. PARTNERSHIP INCOME - SEC VAR VAR 140, ,326. PARTNERSHIP INCOME - SEC VAR VAR 210, ,490. TOTAL GAIN(LOSS) JSA 1E AN 702M 11/6/2012 1:41:24 AM V PAGE 16

17 Schedule B (For 990, 990-EZ, or 990-PF) Departent of the Treasury Internal Revenue Service Nae of the organization THE SCHMIDT FAMILY FOUNDATION Organization type (check one): I Schedule of Contributors Attach to For 990, For 990-EZ, or For 990-PF. OMB No À¾µµ Eployer identification nuber Filers of: Section: For 990 or 990-EZ 501(c)( ) (enter nuber) organization 4947(a)(1) nonexept charitable trust not treated as a private foundation For 990-PF 527 political organization 501(c)(3) exept private foundation 4947(a)(1) nonexept charitable trust treated as a private foundation 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 For an organization filing For 990, 990-EZ, or 990-PF that received, during the year, $5,000 or ore (in oney or property) fro any one contributor. Coplete Parts I and II. Special Rules For a section 501(c)(3) organization filing For 990 or 990-EZ that et the 33 1/3 % support test of the regulations under sections 509(a)(1) and 170(b)(1)(A)(vi) and received fro any one contributor, during the year, a contribution of the greater of (1) $5,000 or (2) 2% of the aount on (i) For 990, Part VIII, line 1h, or (ii) For 990-EZ, line 1. Coplete Parts I and II. For a section 501(c)(7), (8), or (10) organization filing For 990 or 990-EZ that received fro any one contributor, during the year, total contributions of ore than $1,000 for use exclusively for religious, charitable, scientific, literary, or educational purposes, or the prevention of cruelty to children or anials. Coplete Parts I, II, and III. For a section 501(c)(7), (8), or (10) organization filing For 990 or 990-EZ that received fro any one contributor, during the year, contributions for use exclusively for religious, charitable, etc., purposes, but these contributions did not total to ore 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 coplete any of the parts unless the General Rule applies to this organization because it received nonexclusively religious, charitable, etc., contributions of $5,000 or ore during the year I $ Caution. An organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (For 990, 990-EZ, or 990-PF), but it ust answer "No" on Part IV, line 2, of its For 990; or check the box on line H of its For 990-EZ or on Part I, line 2, of its For 990-PF, to certify that it does not eet the filing requireents of Schedule B (For 990, 990-EZ, or 990-PF). For Paperwork Reduction Act Notice, see the Instructions for For 990, 990-EZ, or 990-PF. Schedule B (For 990, 990-EZ, or 990-PF) (2011) JSA 1E AN 702M 11/13/2012 1:46:51 PM V PAGE 17

18 Schedule B (For 990, 990-EZ, or 990-PF) (2011) Page 2 Nae of organization THE SCHMIDT FAMILY FOUNDATION Part I Contributors (see instructions). Use duplicate copies of Part I if additional space is needed. Eployer identification nuber (a) No. (b) Nae, address, and ZIP + 4 (c) Total contributions (d) Type of contribution 1 THE SCHMIDT INVESTMENT LP FUND 2 Person Payroll 555 BRYANT STREET, #347 $ 21,660,363. Noncash PALO ALTO, CA (Coplete Part II if there is a noncash contribution.) (a) No. (b) Nae, address, and ZIP + 4 (c) Total contributions (d) Type of contribution $ Person Payroll Noncash (Coplete Part II if there is a noncash contribution.) (a) No. (b) Nae, address, and ZIP + 4 (c) Total contributions (d) Type of contribution $ Person Payroll Noncash (Coplete Part II if there is a noncash contribution.) (a) No. (b) Nae, address, and ZIP + 4 (c) Total contributions (d) Type of contribution $ Person Payroll Noncash (Coplete Part II if there is a noncash contribution.) (a) No. (b) Nae, address, and ZIP + 4 (c) Total contributions (d) Type of contribution $ Person Payroll Noncash (Coplete Part II if there is a noncash contribution.) (a) No. (b) Nae, address, and ZIP + 4 (c) Total contributions (d) Type of contribution $ Person Payroll Noncash (Coplete Part II if there is a noncash contribution.) JSA Schedule B (For 990, 990-EZ, or 990-PF) (2011) 1E AN 702M 11/13/2012 1:46:51 PM V PAGE 18

19 Schedule B (For 990, 990-EZ, or 990-PF) (2011) Page 3 Nae of organization Eployer identification nuber THE SCHMIDT FAMILY FOUNDATION Part II Noncash Property (see instructions). Use duplicate copies of Part II if additional space is needed (a) No. fro Part I (b) Description of noncash property given (c) FMV (or estiate) (see instructions) (d) Date received 1 38,500 SHS OF GOOGLE INC. $ 21,660,363. VAR (a) No. fro Part I (b) Description of noncash property given (c) FMV (or estiate) (see instructions) (d) Date received $ (a) No. fro Part I (b) Description of noncash property given (c) FMV (or estiate) (see instructions) (d) Date received $ (a) No. fro Part I (b) Description of noncash property given (c) FMV (or estiate) (see instructions) (d) Date received $ (a) No. fro Part I (b) Description of noncash property given (c) FMV (or estiate) (see instructions) (d) Date received $ (a) No. fro Part I (b) Description of noncash property given (c) FMV (or estiate) (see instructions) (d) Date received $ JSA Schedule B (For 990, 990-EZ, or 990-PF) (2011) 1E AN 702M 11/13/2012 1:46:51 PM V PAGE 19

20 Schedule B (For 990, 990-EZ, or 990-PF) (2011) Page 4 Nae of organization Eployer identification nuber Part III (a) No. fro Part I THE SCHMIDT FAMILY FOUNDATION Exclusively religious, charitable, etc., individual contributions to section 501(c)(7), (8), or (10) organizations that total ore than $1,000 for the year. Coplete coluns (a) through (e) and the following line entry. For organizations copleting Part III, enter the total of exclusively religious, charitable, etc., contributions of $1,000 or less for the year. (Enter this inforation once. See instructions.) I$ Use duplicate copies of Part III if additional space is needed. (b) Purpose of gift (c) Use of gift (d) Description of how gift is held (e) Transfer of gift Transferee's nae, address, and ZIP + 4 Relationship of transferor to transferee (a) No. fro Part I (b) Purpose of gift (c) Use of gift (d) Description of how gift is held (e) Transfer of gift Transferee's nae, address, and ZIP + 4 Relationship of transferor to transferee (a) No. fro Part I (b) Purpose of gift (c) Use of gift (d) Description of how gift is held (e) Transfer of gift Transferee's nae, address, and ZIP + 4 Relationship of transferor to transferee (a) No. fro Part I (b) Purpose of gift (c) Use of gift (d) Description of how gift is held (e) Transfer of gift Transferee's nae, address, and ZIP + 4 Relationship of transferor to transferee JSA Schedule B (For 990, 990-EZ, or 990-PF) (2011) 1E AN 702M 11/13/2012 1:46:51 PM V PAGE 20

21 FORM 990PF, PART I - CONTRIBUTIONS, GIFTS AND GRANTS RECEIVED ATTACHMENT 1 DIRECT PUBLIC NAME AND ADDRESS DATE SUPPORT THE SCHMIDT INVESTMENT LP FUND 2 VAR 21,660, BRYANT STREET, #347 PALO ALTO, CA TOTAL CONTRIBUTION AMOUNTS 21,660,363. ATTACHMENT AN 702M 11/13/2012 1:46:51 PM V PAGE 21

22 ATTACHMENT 2 FORM 990PF, PART I - INTEREST ON TEMPORARY CASH INVESTMENTS REVENUE AND NET EPENSES INVESTMENT DESCRIPTION PER BOOKS INCOME WELLS FARGO INTEREST INTEREST RECEIVABLE ON NOTE 36, ,776. FIDELITY INTEREST OTHER INTEREST TOTAL 37, ,777. ATTACHMENT AN 702M 11/13/2012 1:46:51 PM V PAGE 22

23 ATTACHMENT 3 FORM 990PF, PART I - DIVIDENDS AND INTEREST FROM SECURITIES REVENUE AND NET EPENSES INVESTMENT DESCRIPTION PER BOOKS INCOME FIDELITY INVESTMENT 2,681,089. 2,681,089. HIGHVISTA II LIMITED PARTNERSHIP 18, ,807. FARALLON CAPITAL INSTITUTIONAL PARTNERS 237, ,074. LEGACY VENTURE IV, LLC 13, ,715. PIMCO LOAN OPPORTUNITIES FUND 4,596. 4,596. ACCEL STRATEGIC PARTNERS GENERAL ATLANTIC PARTNERS DUNE RE PARALLEL FUND II 13, ,951. GENERAL ATLANTIC PARTNERS 84 15, ,969. ACCOLADE PARTNERS III 18, ,715. DE SHAW OCULUS FUND 378, ,077. KPCB GREEN GROWTH FUND 14, ,707. GENERAL ATLANTIC PARTNERS 85 6,662. 6,662. GENERAL ATLANTIC PARTNERS GENERAL ATLANTIC PARTNERS GENERAL ATLANTIC PARTNERS 88 4,674. 4,674. GENERAL ATLANTIC BRAZIL FUND KLEINER PERKINS CAUFIELD & BYERS III 3,934. 3,934. ROCKWOOD CAPITAL REAL ESTATE PARTNERS FD 9,742. 9,742. RODA GROUP INVESTMENT FUND SCHF US, LP 209, ,246. GENERAL ATLANTIC PARTNERS (BERMUDA) II 27, ,574. GENERAL ATLANTIC PARTNERS (BERMUDA) 2,691. 2,691. REGIMENT CAPITAL LTD 94, ,170. GENERAL ATLANTIC PARTNERS 89B PROGRAM RELATED INVESTMENT INCOME TOTAL 3,756,645. 3,756,645. ATTACHMENT AN 702M 11/13/2012 1:46:51 PM V PAGE 23

24 Taxpayer's Nae DESCRIPTION OF PROPERTY TYPE OF PROPERTY: RENT AND ROYALTY INCOME Yes No Did you actively participate in the operation of the activity during the tax year? OTHER INCOME: TOTAL GROSS INCOME OTHER EPENSES: Identifying Nuber THE SCHMIDT FAMILY FOUNDATION REMAIN 54 REAL RENTAL INCOME 6,000. 6,000. DEPRECIATION (SHOWN BELOW) LESS: Beneficiary's Portion AMORTIZATION LESS: Beneficiary's Portion DEPLETION LESS: Beneficiary's Portion TOTAL EPENSES TOTAL RENT OR ROYALTY INCOME (LOSS) Less Aount to Rent or Royalty Depreciation Depletion Investent Interest Expense Other Expenses Net Incoe (Loss) to Others Net Rent or Royalty Incoe (Loss) Deductible Rental Loss (if Applicable) SCHEDULE FOR DEPRECIATION CLAIMED 6,000. 6,000. (d) (e) (g) Depreciation (i) Life (b) Cost or (c) Date (f) Basis for (h) (j) Depreciation (a) Description of property ACRS Bus. in or unadjusted basis acquired depreciation Method for this year des. % prior years rate Totals JSA 1E AN 702M 11/13/2012 1:46:51 PM V PAGE 24