EXTENDED TO NOVEMBER 15, 2017 Return of Private Foundation Form 990-PF or Section 4947(a)(1) Trust Treated as Private Foundation Do not enter social security numbers on this form as it Department of the Treasury ► may be made public 2016 Internal Revenue Service ► Information about Form 990-PF and its separate instructions is at www.irs.gov/forn For calendar year 2016 or tax year beginning and ending Name of foundation A Employer identification number
FALCONWOOD FOUNDATION. INC. 13-34SF47F, Number and street (or P 0 box number if mail is not delivered to street address) Room /suite B Telephone number 20 GRAMERCY PARK SOUTH 212-984-1444
City or town, state or province , country, and ZIP or foreign postal code C If exemption application is pending , check here NEW YORK , NY 10003 G Check all that apply: 0 Initial return 0 Initial return of a former public charity D 1. Foreign organizations , check here 0 Final return 0 Amended return 85% test, ► ^ ® Add ress c han g e 0 N ame c hange 2 check her e and attach computation H Check type of organization : ® Section 501 ( c)(3) exempt private foundation E If private foundation status was terminated Section 4947 ( a )( 1 ) nonexem pt charitable trust 0 Other taxable p rivate foundation under section 507(b)(1)(A), check here I Fair market value of all assets at end of year Accounting method: J ® Cash Accrual F If the foundation is in a 60-month termination (from Part ll, col (c), line 16) 0 Other ( specify ) under section 507(b)(1)(B), check here Part 1, column (d) must ► $ 5 0 3 0 4 . ( be on cash basis) Part I Analysis of Revenue and Expenses ( Disbursements (The total a) Revenue and (b ) Net investment (c) Adjusted net (d) of amounts in columns ( b), (c), and (d) may not expenses er for charitable purposes necessarily equal the amounts in column (a)) p books income i nco m e (cash basis only) 1 Contributions , gifts, grants, etc., received 4 , 340 , 263 2 Check ► F-1 if the foundation is not required to attach Sch B 3 Interest on savings and temporary cash investments 4 Dividends and interest from securities e r 5a Gross rents (`.
b Net rental income or (loss)
6a Net gain or (loss) from sale of assets not on line ON Gross sales price for all b assets on line 6a
7 Capital gain net income ( from Part IV , line 2) VniI 0 , °C 8 Net short-term capital gain 9 Income modifications Gross sales less returns 10a and allowances
b Less Cost of goods sold c Gross profit or (loss) 11 Other income 12 Total Add lines 1 through 11 4 , 340 , 263. 0. 0.
13 Compensation of officers , directors, trustees , etc 0. 0 , 0. 0. 14 Other employee salaries and wages 15 Pension plans, employee benefits 16a Legal fees STMT 1 12 , 090. 0. 0. 6 , 045. a b Accounting fees STMT 2 12 , 019. 0. 0. 6 , 010. X c Other professional fees STMT 3 287 , 610 . 0. 0. 287 , 610. 17 Interest 18 Taxes STMT 4 25. 0. 0. 25. 19 Depreciation and depletion E 20 Occupancy a 21 Travel, conferences , and meetings 3 , 509 . 0. 0. 3 , 509. cJ c 22 Printing and publications L I 23 Other expenses STMT 5 5 91 . 0 . 0 . 5 91 . M 24 Total operating and administrative C, expenses Add lines 13 through 23 315 844. 0 0 . 303 , 790. W 0 25 Contributions , gifts, grants paid 3 997 , 455. 3 997 , 455. 26 Total expenses and disbursements w Add lines 24 and 25 4 313 z 299. 0. 0. 4 301 , 245. z 27 Subtract line 26 from line 12. a Excess of revenue over expenses and disbursements 26 , 964. L) b Net investment income (if negative, enter -0-) 0 , U, c Ad j usted net income ( if negative , enter -0-) 0 , 623501 11-23-16 LHA For Paperwork Reduction Act Notice, see instructions Form 990-PF (20161 2 11501103 802100 49431.087 2016.04030 FALCONWOOD FOUNDATION, INC. 49431171 / Form 990-PF (20161 FATLCONWOOT) FC)TTNT)ATT(TN - TNC - 1 1-1dc,9d7c tDsno1) Attached schedules and amounts in the description Beginning of year End of year Part II Balance Sheets column should be for end -of-year amounts only (a) Book Value (b) Book Value (c) Fair Market Value 1 Cash - non-interest-bearing 10 , 204. 50 , 304. 50 , 304. 2 Savings and temporary cash investments 3 Accounts receivable ► Less: allowance for doubtful accounts ► 4 Pledges receivable ► Less: allowance for doubtful accounts ► 5 Grants receivable 6 Receivables due from officers, directors, trustees, and other disqualified persons
7 Other notes and loans receivable ► Less: allowance for doubtful accounts ► , 8 Inventories for sale or use 9 Prepaid expenses and deferred charges 10a Investments - U.S. and state government obligations b Investments - corporate stock c Investments - corporate bonds
11 Investments - land, buildings , and equipment basis ►
Less accumulated depreciation ► 12 Investments - mortgage loans 13 Investments - other 14 Land, buildings, and equipment: basis ► Less accumulated depreciation ► 15 Other assets (describe ► 16 Total assets (to be completed by all filers - see the instructions. Also, see pag e 1 , item I 10 , 204. 50 , 304. 50 , 304. 17 Accounts payable and accrued expenses 18 Grants payable w 19 Deferred revenue
20 Loans from officers, directors, trustees , and other disqualified persons 21 Mortgages and other notes payable 22 Other liabilities (describe ► OTHER LIABILITIES ) 54 , 966. 68 , 102.
23 Total liabilities ( add lines 17 throu g h 22 ) 54 , 966. 68 , 102. Foundations that follow SFAS 117, check here ► and complete lines 24 through 26 and lines 30 and 31 24 Unrestricted -44 , 762. -17 , 798. m 25 Temporarily restricted m 26 Permanently restricted Foundations that do not follow SFAS 117 , check here ► LL and complete lines 27 through 31 °u, 27 Capital stock, trust principal, or current funds 28 Paid-in or capital surplus, or land, bldg., and equipment fund Q 29 Retained earnings, accumulated income, endowment, or other funds zd) 30 Total net assets or fund balances -44 , 762. -17 , 798.
31 Total liabilities and net assets/fund balances 10 2 0 4 . 50 , 304. Part III 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 -44 , 762 2 Enter amount from Part I, line 27a 2 26 , 964 3 Other increases not included in line 2 (itemize) ► 3 0 4 Add lines 1, 2, and 3 4 -17 , 798 Decreases not line 5 included in 2 (itemize) ► 5 0 6 Total net assets or fund balances at end of year (line 4 minus line 5) - Part II, column (b), line 30 6 - 17 , 7 9 8 Form 990-PF (2016)
623511 11-23-16 3 11501103 802100 49431.087 2016.04030 FALCONWOOD FOUNDATION, INC. 49431171 Form 990-PF (2016) FALCONWOOD FOUNDATION , INC. 13-3456475 Page 3 Part IV Capital Gains and Losses for Tax on In vestment Income (a) List and describe the kind(s) of property sold (e.g., real estate, (b How acquired (c Date acquired (d) Date sold ^ - Purchase 2-story brick warehouse; or common stock, 200 shs. MLC Co.) D - Donation ^mo., day, yr.) (mo., day, yr.) la b NONE C d e (e) Gross sales price (f) Depreciation allowed (g) Cost or other basis (h) Gain or (loss) (or allowable) plus expense of sale (e) plus (f) minus (g) a b c d e Complete only for assets showing gain in column (h) and owned by the foundation on 12/31/69 (I) Gains (Col. (h) gain minus (j) Adjusted basis (k) Excess of col. (i) col. less than or (i) F.M.V. of 12/31/69 (), as as of 12/31/69 over col. (I), if any Lossesbut not(from col ())(h)) a b c d e If gain, also enter in Part I, line 7 2 Capital gain net income or (net capital loss) If (loss), enter -0- in Part I, line 7 ) 2 3 Net short-term capital gain or (loss) as defined in sections 1222(5) and (6): If gain, also enter in Part I, line 8, column (c). If loss enter -0- in Part I line 8 3 I rari y uua n ricaiuon un de r ) ecuon ' u te) ror rseaucea i ax 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 ? Yes ® 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 the instructions before makinn any entrjes_ a Base period years (c) Distribution ratio Calendar year or tax year beginning in Adjusted qualifying) distributions Net value of noncharitable-use assets (col. (b) divided by col. (c)) y 2015 4 , 711 , 658. 12 , 996. 362.546784 2014 3 , 921 , 258. 30 , 999. 126.496274 2013 4 , 031 , 465. 5 , 030. 801.484095 2012 4 , 012 , 010. 1 4 , 716. 850.723070 2011 2 , 661 , 3 6. 8 , 508. 312.805125
2 Total of line 1, column (d) 2 2 454.055348 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 3 490.811070
4 Enter the net value of noncharitable-use assets for 2016 from Part X, line 5 4 14 , 446.
5 Multiply line 4 by line 3 5 7 , 090 , 257.
6 Enter 1% of net investment income (1% of Part I, line 27b) 6 0.
7 Add lines 5 and 6 7 7 , 090 , 257.
8 Enter qualifying distributions from Part XII, line 4 8 4 , 301 , 245. If line 8 is equal to or greater than line 7, check the box in Part VI, line 1b, and complete that part using a 1% tax rate See the Part VI instructions
623521 11-23-16 Form 990-PF (2016) 4 11501103 802100 49431.087 2016.04030 FALCONWOOD FOUNDATION, INC. 49431171 orm 990-PF (2016) FALCONWOOD FOUNDATION, INC. 13-3456475 Paae 4 Part VI Excise Tax Based on Investment Income (Section 4940(a), 4940(b), 4940(e), or 4948 - see instructions) la Exempt operating foundations described in section 4940(d)(2), check here ► 0 and enter "N/A" on line 1. Date of ruling or determination letter: (attach copy of letter if necessary- see instructions) b Domestic foundations that meet the section 4940(e) requirements in Part V, check here ► 0 and enter 1% 1 0. 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-) 2 0. 3 Add lines 1 and 2 3 0, 4 Subtitle A (income) tax (domestic section 4947(a)(1) trusts and taxable foundations only. Others enter -0-) 4 0. 5 Tax based on investment income . Subtract line 4 from line 3. If zero or less, enter -0- 5 0. 6 Credits/Payments* a 2016 estimated tax payments and 2015 overpayment credited to 2016 6a b Exempt foreign organizations - tax withheld at source 6b c Tax paid with application for extension of time to file (Form 8868) 6c d Backup withholding erroneously withheld 6d 7 Total credits and payments. Add lines 6a through 6d 7 0. 8 Enter any penalty for underpayment of estimated tax. Check here [^ if Form 2220 is attached 8 9 Tax due If the total of lines 5 and 8 is more than line 7, enter amount owed ► 9 0. 10 Overpayment If line 7 is more than the total of lines 5 and enter 8, the amount overpaid ► 10 11 Enter the amount of line 10 to be: Credited to 2017 estimated tax Refunded 01, 11 Part VII-A Statements Regarding Activities la During the tax year, did the foundation attempt to influence any national, state, or local legislation or did it participate or intervene in Yes No any politicalcampaign2 1a X b Did it spend more than $100 during the year (either directly or indirectly) for political purposes (see instructions for the definition)? 1b X If the answer is "Yes" to la or 1b, 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 for this year's 1c X d Enter the amount (if any) of tax on political expenditures (section 4955) imposed during the year: (1) On the foundation. $ ► 0. (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? 2 X 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? lf\"Yes," attach a conformed copy of the changes 3 X 4a Did the foundation have unrelated business gross income of $1,000 or more during the years 4a X b If "Yes," has it filed a tax return on Form 990 -T for this year? N/A 4b 5 Was there a liquidation, termination, dissolution, or substantial contraction during the year? 5 X 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? 6 X 7 Did the foundation have at least $5,000 in assets at any time during the year? If "Yes," complete Part Il, col (c), and Part XV 7 X
Enter the states to which the foundation 8a reports or with which it is registered (see instructions) ► NY b If the answer is "Yes" to line 7, has the foundation furnished a copy of Form 990-PF to the Attorney General (or designate) of each state as required by General Instruction G' If "No," attach explanation 8b X 9 Is the foundation claiming status as a private operating foundation within the meaning of section 4942(l)(3) or 4942(t)(5) for calendar year 2016 or the taxable year beginning in 2016 (see instructions for Part XIV)' If "Yes," complete Part XIV 9 X 10 Did any persons become substantial contrib utors during the tax year'? if "Yes," attach a schedule listing their names and addresses 10 X Form 990-PF (2016)
623531 11-23-16 5 11501103 802100 49431.087 2016.04030 FALCONWOOD FOUNDATION, INC. 49431171 JIIII'JV-FI LUIV r 1' V IJLV LCL I IVLV 1LVL..• 1J-JYJuY/J rAua Part VII -A Statements Regarding Activities (continued) Yes No 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 instructions) 11 X 12 Did the foundation make a distribution to a donor advised fund over which the foundation or a disqualified person had advisory privileges9 If Yes,' attach statement ( see instructions) 12 X 13 Did the foundation comply with the public inspection requirements for its annual returns and exemption applications 13 X Website address ► N/A 14 The books are in care of ► DR. STANLEY A. LEFKOWITZ Telephone no. ► 212 - 9 8 4 -14 4 4 Located at ► 2 0 GRAMERCY PARK SOUTH, NEW YORK , NY ZIP+4 ►10 0 0 3 Section 4947(a)(1) nonexempt charitable trusts filing Form 990 -PF in lieu of 15 Form 1041 - Check here ► 0 and enter the amount of tax-exempt interest received or accrued during the year ► 15 N/A 16 At any time during calendar year 2016, did the foundation have an interest in or a signature or other authority over a bank, Yes No securities, or other financial account in a foreign country 16 X See the instructions for exceptions and filing requirements for FinCEN Form 114. If "Yes ," enter the name of the foreign country ► I Part VII-B Statements Regarding Activities for Which Form 4720 May Be Required File Form 4720 if any item is checked in the "Yes" column, unless an exception applies. Yes No 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 money from, lend money to, or otherwise extend credit to (or accept it from) a disqualified persons Yes ®No (3) Furnish goods, services, or facilities to (or accept them from) a disqualified person? 0 Yes ® No (4) Pay compensation to, or pay or reimburse the expenses of, a disqualified person? 0 Yes ® 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)' 0 Yes ® 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.) Yes ® No b If any answer is "Yes" to la(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 instructions)' N/A lb relying Organizations on a current notice regarding disaster assistance check here ► c Did the foundation engage in a prior year in any of the acts described in la, other than excepted acts, that were not corrected before the first day of the tax year beginning in 20169 1 c X 2 Taxes on failure to distribute income (section 4942) (does not apply for years the foundation was a private operating foundation defined in section 4942(1)(3) or 4942(I)(5)): a At the end of tax year 2016, did the foundation have any undistributed income (lines 6d and 6e, Part XIII) for tax year(s) beginning before 20169 0 Yes ® 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 ) N/A 2b 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? 0 Yes ® No b If "Yes," did it have excess business holdings in 2016 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 4 720, to determine if the foundation had excess business holdings in 2016) N/A 3b 4a Did the foundation invest during the year any amount in a manner that would jeopardize its charitable purposes' 4a X b Did the foundation make any investment in a prior year (but after December 31, 1969) that could jeopardize its charitable purpose that had not been removed from jeopardy before the first day of the tax year beginning in 20162 4b X Form 990-PF (2016)
623541 11-23-16 6 11501103 802100 49431.087 2016.04030 FALCONWOOD FOUNDATION, INC. 49431171 Form 990-PF 2016 FALCONWOOD FOUNDATION , INC. 13-3456475 Page 6 Part VII - B Statements Regarding Activities for Which Form 4720 May Be Required (continued) 5a During the year did the foundation pay or incur any amount to (1) Carry on propaganda , or otherwise attempt to influence legislation ( section 4945 (e))? E^ Yes ® No (2) Influence the outcome of any specific public election (see section 4955 ); or to carry on, directly or indirectly, any voter registration drive's 0 Yes ® No (3) Provide a grant to an individual for travel, study, or other similar purposes El Yes ® No (4) Provide a grant to an organization other than a charitable, etc ., organization described in section 4945(d)(4)(A)? ( see instructions ) 0 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 animals = Yes ® 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 ) ? N/A 5b Organizations relying on a current notice regarding disaster assistance check here ► 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? N/A 0 Yes 0 No 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 on a personal benefit contracts 0 Yes ® No b Did the foundation , during the year, pay premiums, directly or indirectly, on a personal benefit contract'? 6b X If "Yes" to 6b, file Form 8870 7a At any time during the tax year, was the foundation a party to a prohibited tax shelter transactions Yes ® No b If "Yes," did the foundation receive any proceeds or have any net income attributable to the transaction? N/A 7b Part VIII Information About Officers, Directors, Trustees, Foundation Managers, Highly Paid Employees, and Contractors 1 List all officers, directors, trustees, foundation managers and their compensation. (b) Title, and average (c) Compensation ( d) Contributions to Expense employee benefit plans (e) (a) Name and address hours per week devoted ( If not paid , and deterred account, other to position enter - 0 -) compensation allowances DR HENRY G JARECKI RES/TREAS DI RECTOR 10 TIMBER TRAIL RYE , NY 10580 0.25 0. 0. 0. THOMAS A RUSSO DIRECTOR 1170 5TH AVE #12-B NEW YORK , NY 10029 0.05 0. 0. 0. DR STANLEY A LEFKOWITZ ICE-PRES/SEC DIRECTO R 60 EAST 8TH STREET , #22-J NEW YORK , NY 10003 0.50 0. 0. 0.
c L.ompensatron or rive nrgnest-pata emptovees lotner man those Included on line 11. If none. enter "NONE." (b) Title, and average (d) Contributions to (e) Expense Name and address (a) of each employee paid more than $50,000 hours per week (c) Compensation emp anddeferrfetlplans account, other devoted to position compensabon allowances NONE
Total number of other employees paid over $50,000 ► 1 0 Form 990-PF (2016)
623551 11-23-16 7 11501103 802100 49431.087 2016.04030 FALCONWOOD FOUNDATION, INC. 49431171 Form 990-PF 2016 FALCONWOOD FOUNDATION , INC. 13-3456475 Page 7 Part VIII Information About Officers , Directors, Trustees , Foundation Managers , Highly Paid Employees , and Contractors (continued) 3 Five highest-paid independent contractor s 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 GRATIAS PARTNERS , LLC 20 HASKEL DRIVE , PRINCETON , NJ 08550 CONSULTING 285 600.
Total number of others receivin g over $50,000 for p rofessional services ► 0 Part IX-A I Su mmary oT utrect C: narltaoie 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
Part IA-Li I Su mmary of Proaram-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 throu g h 3 ► 0. Form 990-PF (2016)
623561 11-23-16 8 11501103 802100 49431.087 2016.04030 FALCONWOOD FOUNDATION, INC. 49431171 Form 990-PF (2016) FALCONWOOD FOUNDATION, INC. 13-3456475 Page 8 Part X Minimum Investment Return (All domestic foundations must complete this part Foreign foundations , see instructions)
1 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 la 0. b Average of monthly cash balances 1b 14 , 666. c Fair market value of all other assets 1c d Total (add lines 1a, b, and c) 1d 14 , 666 . e Reduction claimed for blockage or other factors reported on lines la and 1c (attach detailed explanation) le 0. 2 Acquisition indebtedness applicable to line 1 assets 2 0 . 3 Subtract line 2 from line 1d 3 14 , 666 . 4 Cash deemed held for charitable activities. Enter 1 1/2% of line 3 (for greater amount, see instructions) 4 220 . 5 Net value of noncharitable - use assets Subtract line 4 from line 3. Enter here and on Part V, line 4 5 14 , 446 . 6 Minimum investment return . Enter 5% of line 5 6 722 . Part XI Distributable Amount (see instructions) (Section 4942(j)(3) and (1)(5) private operating foundations and certain foreign organizations check here ► Eland do not complete this part.) 1 Minimum investment return from Part X, line 6 1 722 . 2a Tax on investment income for 2016 from Part VI, line 5 2a b Income tax for 2016. (This does not include the tax from Part VI.) 2b c Add lines 2a and 2b 2c 0 . 3 Distributable amount before adjustments. Subtract line 2c from line 1 3 722 . 4 Recoveries of amounts treated as qualifying distributions 4 0 . 5 Add lines 3 and 4 5 722 . 6 Deduction from distributable amount (see instructions) 6 0 . 7 Distributable amount as ad justed. Subtract line 6 from line 5. Enter here and on Part XIII , line 1 7 722 . Part XII Qualifying Distributions (see instructions)
1 Amounts paid (including administrative expenses) to accomplish charitable, etc., purposes: a Expenses, contributions, gifts, etc. - total from Part I. column (d), line 26 la 4 , 301,245. b Program-related investments - total from Part IX-B 1b 2 Amounts paid to acquire assets used (or held for use) directly in carrying out charitable, etc., purposes 2 3 Amounts 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 la through 3b. Enter here and on Part V, line 8, and Part XIII, line 4 4 4 , 3 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 5 6 Adjusted qualifying distributions Subtract line 5 from line 4 6 4 , 3 1,645. 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 (2016)
623571 11 23-16 9 11501103 802100 49431.087 2016.04030 FALCONWOOD FOUNDATION, INC. 49431171 Form 990-PF (2016) FALCONWOOD FOUNDATION, INC. 13-3456475 Page 9 Part XIII Undistributed Income (see instructions)
(a) (b) (c) (d) Corpus Years prior to 2015 2015 2016 1 Distributable amount for 2016 from Part XI, line7 722. 2 Undistributed income, if any, as of the end of 2016 a Enter amount for 2015 only 0. b Total for prior years: 0. 3 Excess distributions ca rryover, if any, to 2016: aFrom 2011 6 640 , 015. bFrom 2012 3 341 , 362. c From 2013 4 , 031 , 213 . dFrom 2014 3 919 , 708. e From 2015 4 711 , 008 . f Total of lines 3a throu gh e 22 , 643 , 306. 4 Qualifying distributions for 2016 from Part Xll, line 4: ► $ 4 , 301 , 245. a Applied to 2015, but not more than line 2a 0. b Applied to undistributed income of prior years (Election required - see instructions) 0. c Treated as distributions out of corpus (Election required - see instructions) 0. d Applied to 2016 distributable amount 722. e Remaining amount distributed out of corpus 4 3 0 0 5 2 3.
5 Excess distributions carryover applied to 2016 0. 0 (if an amount appears in 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 3f , 4c, and 4e Subtract line 5 26 9 4 3 8 2 9. b Prior years' undistributed income. Subtract line 4b from line 2b 0. 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 0 , d Subtract line 6c from line 6b. Taxable amount - see instructions 0 , e Undistributed income for 2015. Subtract line 4a from line 2a Taxable amount - see instr. 0 f Undistributed income for 2016. Subtract lines 4d and 5 from line 1. This amount must be distributed in 2017 0 7 Amounts treated as distributions out of corpus to satisfy requirements imposed by section 170(b)(1)(F) or 4942(g)(3) (Election may be required - see instructions) 0 8 Excess distributions carryover from 2011 not applied on line 5 or line 7 6 , 640 , 015. 9 Excess distributions carryover to 2017. Subtract lines 7 and 8 from line 6a 20 , 303 , 814. 10 Analysis of line 9 a Excess from 2012 3 , 341 , 362. b Excess from 2013 4 0 31 213 . c Excess from 2014 3 , 919 , 708. d Excess from 2015 4 711 0 0 8. e Excess from 2016 4 , 300 , 523. 623581 11-23-16 Form 990-PF (2016) 10 11501103 802100 49431.087 2016.04030 FALCONWOOD FOUNDATION, INC. 49431171 Form 990-PF 10 I Part XIV J Private Operating Foundations (see instructions and Part VII-A, question 9) 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 2016, enter the date of the ruling ► b Check box to indicate whether the foundation is a private operating foundation described in section 4942 (j)( 3 ) or U 4942(j)(5) 2 a Enter the lesser of the adjusted net Tax year Prior 3 years income from Part I or the minimum (a) 2016 (b) 2015 (c) 2014 (d) 2013 ( e) Total investment return from Part X for each year listed b 85% of line 2a c 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(t)(3)(B)(i) b "Endowment" alternative test - enter 2/3 of minimum investment return shown in Part X, line 6 for each year listed c "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(f)(3)(B)(m) (3) Largest amount of support from an exempt organization ( 4 ) Gross investment income Part XV Supplementary Information (Complete this part only if the foundation had $5, 000 or more in assets at any time during the year-see instructions.) 1 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) ) DR HENRY G JARECKI 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 ► 0 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 or e-mail address of the person to whom applications should be addressed:
SEE STATEMENT 6 b The form in which applications should be submitted and information and materials they should include.
c Any submission deadlines:
d Any restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other factors:
623601 11-23-16 Form 990-PF (2016) 11 11501103 802100 49431.087 2016.04030 FALCONWOOD FOUNDATION, INC. 49431171 Form 990-PF 2016 FALCONWOOD FOUNDATION , INC. 13-3456475 Page 11 Part XV Supplementary Info rmation (continued) 3 Grants and Contributions Paid Durm the Year or Approved for Future Payment Recipient If recipient is an individual, show any relationship to Foundation Purpose of grant or contribution Amount Name and address (home or business) any foundation manager status of or substantial contributor recipient a Paid during the year
SEE ATTACHED SCHEDULE 3 997 455.
Total ► 3a 3 997 455 , b Approved for future payment
NONE
Total ► 3b 1 0. Form 990-PF (2016)
623611 11-23-16 12 11501103 802100 49431.087 2016.04030 FALCONWOOD FOUNDATION, INC. 49431171 Form 990-PF (2016) FALCONWOOD FOUNDATION, INC. 13-3456475 Page 12 Part XVI-A Analysis of Income - Producing Activities
Enter Iross amounts unless otherwise indicated . Unrelate d business income Exclu ded by section 512 , 513, or 514 (e ) (a) (b) Eic „- (d) Related or exempt Business Amount Sion 1 Pri gram service revenue: code code Amount function income a b c d e f 9 Fees and contracts from government agencies 2 Me mbership dues and assessments 3 IntBrest on savings and temporary cash Investments 4 Div idends and interest from securities 5 Net rental income or (loss) from real estate: a Debt-financed property b Not debt-financed property 6 Net rental income or (loss) from personal pro perty 7 0th er investment income 8 Gal n or (loss) from sales of assets other tha n inventory 9 Net income or (loss) from special events 10 Grass profit or (loss) from sales of inventory 11 0th errevenue: a b c d e 12 Subtotal. Add columns (b), (d), and (e) 0 . 0 . 0 . Total. Add line 12, columns (b), (d), and (e) 13 0. (See worksheet in line 13 instructions to verify calculations Part XVI- B Relationship of Activities to the Accomplishment of Exempt Purposes
623621 11 -23-16 Form 990-PF (2016) 13 11501103 802100 49431.087 2016.04030 FALCONWOOD FOUNDATION, INC. 49431171 Form 990-PF ( 2016 ) FALCONWOOD FOUNDATION INC. 13-3456475 Pag e 13 Part XVII Information Regarding Transfers To and Transactions and Relationships With Noncharitable Exempt Organizations 1 Did the organization directly or indirectly engage in any of the following with any other organization described in section 501( c) of Yes No the Code (other than section 501(c)(3) organizations) or in section 527, relating to political organizations' a Transfers from the reporting foundation to a noncharitable exempt organization of: (1) Cash la ( l ) X (2) Other assets la ( 2 ) X b Other transactions: (1) Sales of assets to a noncharitable exempt organization lb ( l ) X (2) Purchases of assets from a noncharitable exempt organization lb ( 2 ) X (3) Rental of facilities, equipment, or other assets lb (3 ) X (4) Reimbursement arrangements lb ( 4 ) X (5) Loans or loan guarantees lb ( 5 ) X (6) Performance of services or membership or fundraising solicitations lb ( 6 ) X c Sharing of facilities, equipment, mailing lists, other assets, or paid employees 1c X 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 ass ets, or services given by the reporting foundation. If the foundation received less than fair market value in any transaction or sharing arrangement, sh ow in
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 5279 0 Yes ® No h If "Yas " cmmnlete the fnllnwlnn sched111a (a) Name of organization ( b) Type of organization (c) Description of relationship N/A
Under penalties of perjury , I clare that I have exams this return , including accompanying schedules and statements , and to the best of my knowledge May the IR S resa this and belief , it is true , co d co pl a Decla at n of preparer (other than taxpayer ) is based on all information of which preparer has any knowledge Sign return with the re rer Here %\ 7 t 1 Signature of offlc or ustee Dat Print/Type preparer ' s name Preparer ' s sl a re
Paid PHILLIP A. BOTTARI vreparer Firm's name ► FRIEDMAN LLP v Use Only Firm 's address ► 50 CHARLES LINDBERGH ] UNIONDALE , NY 11553-31
623622 11-23-16
11501103 802100 49431.087 2016.04030 Schedule B Schedule of Contributors OMB No 1545-0047 (Form 990, 990-EZ, 00, Attach to Form 990, Form 990-EZ, or Form 990-PF. or 990-PF) Information about Schedule B (Form 990, 990-EZ, or 990-PF) and Department of the Treasury ► 2016 Internal Revenue Service its instructions is at www.irs.gov/form990 . Name of the organization Employer identification number
F FOUNDATION. INC. Organization type (check one)
Filers of: Sect ion:
Form 990 or 990-EZ 0 501(c)( ) (enter number) organization
LI 4947(a)(1) nonexempt charitable trust not treated as a private foundation
LI 527 political organization
Form 990-PF E2j 501 (c)(3) exempt private foundation
LI 4947(a)(1) nonexempt charitable trust treated as a private foundation
0 501 (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 Form 990, 990-EZ, or 990-PF that received, during the year, contributions totaling $5,000 or more (in money or property) from any one contributor Complete Parts I and II See instructions for determining a contributor's total contributions
Special Rules
D For an organization described in section 501 (c)(3) filing Form 990 or 990-EZ that met the 33 1/3% support test of the regulations under sections 509(a)(1) and 170(b)(1)(A)(vi), that checked Schedule A (Form 990 or 990-EZ), Part II, line 13, 16a, or 16b, and that received from any one contributor, during the year, total contributions of the greater of (1) $5,000 or (2) 2% of the amount on (I) Form 990, Part VIII, line 1 h, or (ii) Form 990-EZ, line 1 Complete Parts I and 11
D For an organization described in section 501(c)(7),(8), or (10) filing Form 990 or 990-EZ that received from any one contributor , during the year , total contributions of more than $1 , 000 exclusively for religious , charitable , scientific, literary, or educational purposes, or for the prevention of cruelty to children or animals Complete Parts I, II, and III
0 For an organization described in section 501 (c)(7), (8), or ( 10) filing Form 990 or 990-EZ that received from any one contributor , during the year, contributions exclusively for religious , charitable, etc , purposes , but no such contributions totaled 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 Don ' t complete any of the parts unless the General Rule applies to this organization because it received nonexclusively
religious, charitable , etc , contributions totaling $5,000 or more during the year ► $
Caution: An organization that isn't covered by the General Rule and/or the Special Rules doesn't file Schedule B (Form 990, 990-EZ, or 990-PF), but it must answer "No" on Part IV, line 2, of its Form 990, or check the box on line H of Its Form 990-EZ or on its Form 990-PF, Part I, line 2, to certify that it doesn't meet the filing requirements of Schedule B (Form 990, 990-EZ, or 990-PF)
LHA For Paperwork Reduction Act Notice , see the Instructions for Form 990, 990-EZ , or 990-PF. Schedule B (Form 990 , 990-EZ, or 990 - PF) (2016)
623451 10-18-16 Schedule B (Form 990, 990-EZ, or 2 Name of organization Employer identification number
TION. INC.
Part I Contributors (See instructions) Use duplicate copies of Part I if additional space is needed
(a) (b) (c) (d) No. Name, address , and ZIP + 4 Total contributions Type of contribution
1 ANDREW R. JARECKI Person I-XI Payroll 0 131 EAST 66TH STREET, APT. 4-D $ 6,000. Noncash 0 (Complete Part II for NEW YORK, NY 10021 noncash contributions )
(a) (b) (c) (d) No. Name , address, and ZIP + 4 Total contributions Type of contribution
2 DR. HENRY G. JARECKI Person Ex] Payroll 0 10 TIMBER TRAIL $ 4,291,863. Noncash 0 (Complete Part II for RYE, NY 10580 noncash contributions )
(a) (b) (c) (d) No. Name , address, and ZIP + 4 Total contributions Type of contribution
5 LIANNA JARECKI Person Payroll 0 101 DERBY LANE $ 6,000, Noncash (Complete Part II for CHAPEL HILL, NC 27514 noncash contributions )
(a) (b) (c) (d) No. Name, address, and ZIP + 4 Total contributions Type of contribution
6 PAUL BRODY Person Payroll 673 WEED STREET $ 12,000. Noncash (Complete Part II for NEW CANAAN, CT 0 6 8 4 0 noncash contributions )
(a) (b) (c) (d) No. Name , address , and ZIP + 4 Total contributions Type of contribution
3 SAMANTHA BRODY Person Payroll 417 EAST 6TH STREET, APT. 12 $ 6,000. Noncash 0 (Complete Part II for NEW YORK, NY 10009 noncash contributions )
(a) (b) (c) (d) No. Name , address , and ZIP + 4 Total contributions Type of contribution
4 BRIGHTWATER FUND Person If] Payroll 0 10 TIMBER TRAIL $ 12,500. Noncash 0 (Complete Part II for RYE, NY 10580 noncash contributions ) 623452 10-1e-1e Schedule B (Form 990, 990-EZ, or 990-PF) (2016) 16 11501103 802100 49431.087 2016.04030 FALCONWOOD FOUNDATION, INC. 49431171 Schedule B (Form 990, 990-EZ, or 3 Name of organization Employer identification number
Part II Noncash Property (See instructions) Use duplicate copies of Part II if additional space is needed
(a) (c) No. (b) FMV(See (or estimate) from Description of noncash property given Date received (See instructions) Part I
(a) No. (b) (c) FMV(See i estimate) from Description of noncash property given Date received (See instructions) Part 1
(a) (c)
FMV (or from Description of noncash property given nstrructionsmats) Date received (See instructions) Part I
(a) No. (c) FMV (or estimate) Description of noncash property given Date received (See instructions)instruc) Part I
(a) No. (b) FMV (or(estimate) (d) from Description of noncash property given Date received (See instructions) Part 1
(a) (c) No. (b) FMV (or estimate) (d) from Description of noncash property given Date received (See instructions) Part I
623453 10- 18-16 Schedule B (Form 990 , 990-EZ , or 990 - PF) (2016) 17 11501103 802100 49431.087 2016.04030 FALCONWOOD FOUNDATION, INC. 49431171 Schedule B (Form 990, 990-EZ, or 990-PF) (2016) Page 4 Name of organization Employer identification number
FALCONWOOD FOUNDATION , INC. 13-3456475 Part III Exclusively religious , charitable , etc , contributions to organizations described in section 501 (c)(7), (8), or ( 10) that total more than $ 1 , 000 for the year from any one contributor Complete columns (a) through ( e) and the following line entry. For organizations completing Part III, enter the total of exclusively religious, charitable, etc, contributions of $1,000 or less for the year (En let this info once) $ I Ica diinhnafa cnnlac of Part III if aririitunnAI anaca is naariorll (a) No. from (b) Purpose of gift (c) Use of gift (d) Description of how gift is held Part I
(e) Transfer of gift
Transferee's name , address , and ZIP + 4 Relationshi p of transferor to transferee
(a) No. from (b) Purpose of gift (c) Use of gift (d) Description of how gift is held Part I
(e) Transfer of gift
Transferee's name , address , and ZIP + 4 Relationshi p of transferor to transferee
(a) No. from (b) Purpose of gift (c) Use of 9 ift (d) Description of how gift is held Part I
(e) Transfer of gift
Transferee's name , address , and ZIP + 4 Relationshi p of transferor to transferee
(a) No. from (b) Purpose of gift (c) Use of gift (d) Description of how gift is held Part I
(e) Transfer of gift
Transferee's name , address , and ZIP + 4 Relationshi p of transferor to transferee
623454 10- 18 16 Schedule B (Form 990 , 990-EZ, or 990-PF) (2016) 18 11501103 802100 49431.087 2016.04030 FALCONWOOD FOUNDATION, INC. 49431171 FALCONWOOD'FOUNDATION, INC. 13-3456475
FORM 990-PF LEGAL FEES STATEMENT 1
(A) (B) (C) (D) EXPENSES NET INVEST- ADJUSTED CHARITABLE DESCRIPTION PER BOOKS MENT INCOME NET INCOME PURPOSES
WITHERS BERGMAN LLP - LEGAL FEES 12,090. 0. 0. 6,045.
TO FM 990-PF, PG 1, LN 16A 12,090. 0. 0. 6,045.
FORM 990-PF ACCOUNTING FEES STATEMENT 2
(A) (B) (C) (D) EXPENSES NET INVEST- ADJUSTED CHARITABLE DESCRIPTION PER BOOKS MENT INCOME NET INCOME PURPOSES
ELLEN BRODY CHANDLER - ACCOUNTING 6,019. 0. 0. 3,010. FRIEDMAN LLP - ACCOUNTING 6,000. 0. 0. 3,000.
TO FORM 990-PF, PG 1, LN 16B 12,019. 0. 0. 6,010.
FORM 990-PF OTHER PROFESSIONAL FEES STATEMENT 3
(A) (B) (C) (D) EXPENSES NET INVEST- ADJUSTED CHARITABLE DESCRIPTION PER BOOKS MENT INCOME NET INCOME PURPOSES
GRATIAS PARTNERS, LLC - CONSULTING FEES 285,600. 0. 0. 285,600. NGO SOURCE - FEES 2,010. 0. 0. 2,010.
TO FORM 990-PF, PG 1, LN 16C 287,610. 0. 0. 287,610.
19 STATEMENT(S) 1, 2, 3 11501103 802100 49431.087 2016.04030 FALCONWOOD FOUNDATION, INC. 49431171 FALCONWOOD'FOUNDATION, INC. 13-3456475
FORM 990-PF TAXES STATEMENT 4
(A) (B) (C) (D) EXPENSES NET INVEST- ADJUSTED CHARITABLE DESCRIPTION PER BOOKS MENT INCOME NET INCOME PURPOSES
NEW YORK STATE FILING FEE 25. 0. 0. 25.
TO FORM 990-PF, PG 1, LN 18 25. 0. 0. 25.
FORM 990-PF OTHER EXPENSES STATEMENT 5
(A) (B) (C) (D) EXPENSES NET INVEST- ADJUSTED CHARITABLE DESCRIPTION PER BOOKS MENT INCOME NET INCOME PURPOSES
MISCELLANEOUS EXPENSES 386. 0. 0. 386. TELEPHONE 205. 0. 0. 205.
TO FORM 990-PF, PG 1, LN 23 591. 0. 0. 591.
20 STATEMENT(S) 4, 5 11501103 802100 49431.087 2016.04030 FALCONWOOD FOUNDATION, INC. 49431171 FALCONWOOD FOUNDATION, INC. 13-3456475
FORM 990-PF GRANT APPLICATION SUBMISSION INFORMATION STATEMENT 6 PART XV, LINES 2A THROUGH 2D
NAME AND ADDRESS OF PERSON TO WHOM APPLICATIONS SHOULD BE SUBMITTED
THE FALCONWOOD FOUNDATION, INC. C/O STANLEY A. LEFTKOWITZ, VP/SECRETARY 20 GRAMERCY PARK SOUTH NEW YORK, NY 10003
FORM AND CONTENT OF APPLICATIONS
NO SET FORM; APPLICANTS ARE REQUESTED TO SEND DETAILED INFORMATION REGARDING EACH REQUEST.
ANY SUBMISSION DEADLINES
NONE
RESTRICTIONS AND LIMITATIONS ON AWARDS
NONE
21 STATEMENT(S) 6 11501103 802100 49431.087 2016.04030 FALCONWOOD FOUNDATION, INC. 49431171 The Falconwood Foundation Inc. EIN: 13-3456475 Tax Year End: December 31, 2016 Attachment to IRS Form 990-PF
Part XV, Line 3(a) Grants & Contributions Paid During the Year:
Organization Foundation Status Purpose Amount
5 Under 40 Foundation PC General Support, Unrestricted 5,000.00 36 West 9th Street, IA New York, NY 10010
American Civil Liberties Union Foundation PC General Support, Unrestricted 10,000.00 125 Broad Street, 17th Floor New York, NY 10004 Attn: Katie Cecil
Allen Institute Pc General Support, Unrestricted 100,000.00 615 Westlake Avenue N Seattle, WA 98109 Attn: Allan R. Jones
American Assistance for Cambodia, Inc. PC General Support, Unrestricted 45,000.00 4-1-7-605 Hiroo Shibuya-ku, Tokyo 150-0012, Japan
American Cancer Society PC General Support, Unrestricted 1,000.00 2 Lyon Place White Plains, NY 10601
American Film Institute PC General Support, Unrestricted 20,000.00 2021 North Western Avenue Los Angeles, CA 90027 Attn: Greg Copeland
American Heart and Stroke Association PC General Support, Unrestricted 22,000.00 122 East 42nd Street, 18th Floor New York, NY 10168 Attn: Lauren Grosz amfAR, The Foundation for Aids Research PC General Support, Unrestricted 5,000.00 Ms. Nicole Carlotti Manager: Grant of Inspiration Project 120 Wall Street, 13th Floor New York, NY 10005
Anthology Film Archives PC General Support, Unrestricted 25,000.00 32 2nd Avenue New York, NY 10003 Attn: John Mhiripiri
AOPA Foundation PC General Support, Unrestricted 2,000.00 421 Aviation Way Fredrick, MD 21701 Attn: Justin Biassou
Apollo Theatre Foundation PC General Support, Unrestricted 5,000.00 253 West 125th Street New York, NY 10027 Attn: Keshave Sattur The Falconwood Foundation Inc. EIN: 13-3456475 Tax Year End: December 31, 2016 Attachment to IRS Form 990-PF
Part XV, Line 3(a) Grants & Contributions Paid During the Year:
Organization Foundation Status Purpose Amount Artists Association of Nantucket PC General Support, Unrestricted 1,000.00 P.O. Box 1104 Nantucket, MA 02554
Artists For Peace and Justice PC General Support, Unrestricted 32,500.00 87 Walker Street, #6B New York, NY 10013 Attn: David Belle, CFO
Bard College PC General Support, Unrestricted 50,000.00 P.O. Box 5000 Annadale-on-Hudson, NY 12504 Attn: President Leon Botstein
Bard Prison Initiative PC General Support, Unrestricted 25,000.00 Bard College P.O. Box 5000 Annadale-on-Hudson, NY 12504 Attn: Laura Liebman
Boys & Girls Club of Mercer County PC General Support, Unrestricted 2,000.00 212 Center Street Trenton, NJ 08611 Attn: Kelly Watts Development Director
Boys & Girls Clubs Monmouth County PC General Support, Unrestricted 20,000.00 1201 Monroe Avenue Asbury Park, NJ 07712 Attn: Douglas Eagles
Boys & Girls Club of Nantucket County PC General Support, Unrestricted 1,000.00 61 Sparks Avenue P.O. Box 269 Nantucket, MA 02554 Attn: Phyllis McInerney
Breast Cancer Research Foundation Pc General Support, Unrestricted 2,000.00 60 East 56th Street 8th Floor New York, NY 10022 Attn: Myra Biblowit
British Virgin Islands Health Services Authority PC General Support, Unrestricted 100,000.00 Peebles Hospital P.O. Box 439 Road Town, Tortola VG 1110, BVI
Camp Arcadia Scholarship Foundation PC General Support, Unrestricted 2,500.00 Pleasant Lake P.O. Box 158 Casco, Maine 04015 The Falconwood Foundation Inc. EIN: 13-3456475 Tax Year End: December 31, 2016 Attachment to IRS Form 990-PF
Part XV, Line 3(a) Grants & Contributions Paid During the Year:
Organization Foundation Status Purpose Amount Center for Study of Responsive Law PC General Support, Unrestricted 50,000.00 P.O. Box 19367 Washington, DC 20036 Attn: Ralph Nader
Centurion Ministries PC General Support, Unrestricted 15,000.00 1000 Herrontown Road Princeton, NJ 08540 Attn: Kate Germond
Chapel Hill-Carrboro Public School Foundation PC General Support, Unrestricted 1,500.00 P.O. Box 877 Carrboro, NC 27510 Attn: Lynn Lehmann
Chapel Hill Public Library Foundation PC General Support, Unrestricted 1,000.00 100 Library Drive Chapel Hill, NC 27514
Children of the Night PC General Support, Unrestricted 20,000.00 14530 Sylvan Street Van Nuys, CA 91411 Attn: Lois Lee
Children's Health Fund PC General Support, Unrestricted 45,000.00 215 West 125th Street, Suite 301 New York, NY 10027 Attn: Dennis Wolto
City Harvest PC General Support, Unrestricted 900.00 575 Eighth Avenue, 4th Floor New York, NY 10018 Attn: Elizabeth Weinberg
Classical Theatre of Harlem PC General Support, Unrestricted 25,000.00 566 West 159th Street, Suite #44 New York, NY 10032 Attn: Ty Jones
Cold Spring Harbor Laboratory PC General Support, Unrestricted 30,000.00 One Bungtown Road Cold Spring Harbor, NY 11724 Attn: Ms. Diane Fagiola, Senior Director, Philanthropy
Columbia Business School PC General Support, Unrestricted 7,500.00 33 West 60th Street, 7th Floor New York, NY 10023-7905 Attn: Barbara Clapp
Columbia University PC General Support, Unrestricted 1,199,862.00 Herbert Irving Comprehensive Cancer Center Columbia University Milstein Hospital Building 177 Fort Washington Avenue New York, NY 10032 The Falconwood Foundation Inc. EIN: 13-3456475 Tax Year End: December 31, 2016 Attachment to IRS Form 990-PF
Part XV, Line 3(a) Grants & Contributions Paid During the Year:
Organization Foundation Status Purpose Amount CPTV & WNPR PC General Support, Unrestricted 25.00 1049 Asylum Avenue Hartford, CT 06105
CRKEEF, Inc. PC General Support, Unrestricted 5,000.00 304 Spring Landing Lane P.O. Box 26 Crumpton, MD 21628-0026 Attn: Dr. Dian Dudderar
Discover Life in America PC General Support, Unrestricted 1,500.00 1316 Cherokee Orchard Road Gatlinburg, TN 37738 Attn: Tood P. Witcher
Doctors Without Borders USA, Inc. PC General Support, Unrestricted 40,000.00 333 Seventh Avenue, 2nd FL New York, NY 10001-5004
Drug Policy Alliance PC General Support, Unrestricted 15,000.00 70 West 36th Street 16th Floor New York, NY 10018 Attn: Ethan Nadelman
Durham Literacy Center Pc General Support, Unrestricted 2,500.00 1905 Chapel Hill Road Durham, NC 27707 Attn: Lizzie Ellis Furlong
E.O. Wilson Biodiversity Foundation PC General Support, Unrestricted 5,000.00 Environment Hall 9 Circuit Drive Box 90328 5th Floor, Room 5101 Durham, NC 27708 Attn: Paula Ehrlich
Eno River Foundation PC General Support, Unrestricted 2,500.00 4404 Guess Road Durham, NC 27712 Attn: Cynthia Satterfield
Environmental Defense Fund PC General Support, Unrestricted 15,000.00 257 Park Avenue South New York, NY 10010 Attn: Adrienne Allen
Environmental Working Group PC General Support, Unrestricted 13,500.00 1436 U Street NW, Suite 100 Washington, DC 20009 Attn: Joclyn Babuscio The Falconwood Foundation Inc. EIN: 13-3456475 Tax Year End: December 31, 2016 Attachment to IRS Form 990-PF
Part XV, Line 3(a) Grants & Contributions Paid During the Year:
Organization Foundation Status Purpose Amount Everytown for Gun Safety PC General Support, Unrestricted 8,500.00 P.O. Box 4184 New York, NY 10163 Attn: Shannon Watts
Film Forum Inc. PC General Support, Unrestricted 25,000.00 209 West Houston Street New York, NY 10014 Attn: Denyse Owens
FIRE PC General Support, Unrestricted 10,000.00 510 Walnut Street, Suite 1250 Philadelphia, PA 19106
Food Bank For New York City PC General Support, Unrestricted 57,500.00 39 Broadway, #10 New York, NY 10006 Attn: Emily Mead
Forman School's Annual Fund PC General Support, Unrestricted 1,000.00 12 Norfolk Road Litchfield, CT 06759
FoodCorp, Inc. PC General Support, Unrestricted 10,000.00 281 Park Avenue South New York, NY 10010
Freedom of the Press Foundation Pc General Support, Unrestricted 28,000.00 601 Van Ness Avenue Suite E73 San Francisco, CA 94102
Friends of Chapel Hill Parks & Recreation Pc General Support, Unrestricted 1,000.00 c/o Department of Chapel Hills Parks and Recreation 200 Plant Road Chapel Hill, NC 27514
Friends of the HLSCC PC General Support, Unrestricted 4,000.00 via Lester Hyman, Esq. 3826 Van Ness Street NW Washington, DC 20016
Friends of the Jewish Museum Berlin Pc General Support, Unrestricted 2,500.00 227 Ridgeview Road Princeton, NJ 08540
Friends of the North Carolina Museum of Natural Sciences Pc General Support, Unrestricted 5,000.00 PO Box 26928 Raleigh NC 27611-6928
German School of Brooklyn PC General Support, Unrestricted 3,000.00 17 Eastern Parkway, 5th Floor Brooklyn, NY 11238-5675 The Falconwood Foundation Inc. EIN: 13-3456475 Tax Year End: December 31, 2016 Attachment to IRS Form 990-PF
Part XV, Line 3(a) Grants & Contributions Paid During the Year:
Organization Foundation Status Purpose Amount Girls Leadership Istitute, Inc. PC General Support, Unrestricted 22,000.00 111 Myrtle Street, Suite 101 Oakland, CA 94607 Attn: Ms. Rachel Simmons & Ms. Simone Marean
GO Campaign PC General Support, Unrestricted 5,000.00 Mr. Scott Fifer Founder and CEO 2461 Santa Monica Blvd. #437 Santa Monica, CA 90404
Gramercy Neighborhood Associates Pc General Support, Unrestricted 200.00 Box 678, Madison Square Station New York, NY 10159
Gramercy Park Block Association Pc General Support, Unrestricted 8,000.00 34 Gramercy Park East New York, NY 10003
Greenpeace, Inc. PC General Support, Unrestricted 15,000.00 702 H Street NW Suite 300 Washington DC 20001
Harlem School of the Arts PC General Support, Unrestricted 195,400.00 645 St. Nicholas Avenue New York, NY 10030
Harrison Emergency Medical Services Pc General Support, Unrestricted 100.00 P.O. Box 68 Harrison, NY 10528
Harrison Fire Department PC General Support, Unrestricted 300.00 206 Harrison Avenue Harrison, NY 10528
Harrison Police Association PC General Support, Unrestricted 2,500.00 650 North Street Harrison, NY 10528
Harrison Volunteer Ambulance Pc General Support, Unrestricted 300.00 P.O. Box 68 Harrison, NY 10528
Heidelberg University Association PC General Support, Unrestricted 186,368.00 Ms Irmintraud Jost Executive Director 871 United Nations Plaza New York, NY 10017
Hereditary Disease Foundation Pc General Support, Unrestricted 5,000.00 3960 Broadway, 6th Floor New York, NY 10032 The Falconwood Foundation Inc. EIN: 13-3456475 Tax Year End: December 31, 2016 Attachment to IRS Form 990-PF
Part XV, Line 3(a) Grants & Contributions Paid During the Year:
Organization Foundation Status Purpose Amount HomeFront PC General Support, Unrestricted 30,000.00 1880 Princeton Avenue Lawrenceville, NJ 08648 Attn: Connie Mercer
Illinois Holocaust Museum & Education Center PC General Support, Unrestricted 1,000.00 9603 Woods Drive Skokie, IL 60077
Institute of International Education Pc General Support, Unrestricted 45,000.00 Ms. Daniel Kaisth 809 United Nations Plaza New York, NY 10017
International Rescue Committee Pc General Support, Unrestricted 45,000.00 122 East 42nd Street New York, NY 10169 Attn: David Miliband
J/P HRO PC General Support, Unrestricted 22,500.00 6464 Sunset Blvd., Ste 1170 Los Angeles, California 90036
Keewaydin Foundation PC General Support, Unrestricted 25,000.00 10 Keewaydin Road Salisbury, VT 05679
King Hussein Cancer Foundation - USA PC General Support, Unrestricted 5,000.00 c/o Andras Kosaras/Arnold & Porter LLP 601 Massachusetts Ave, NW Washington, DC 20001-3743
KIPP NYC PC General Support, Unrestricted 5,000.00 470 7th Avenue, 10th Floor New York, NY 10018
LAC DCFS-Santa Clarita PC General Support, Unrestricted 7,500.00 28490 Avenue Stanford Suite 100 Santa Clarita, CA 91355
Leo Baeck Institute PC General Support, Unrestricted 15,000.00 15 West 16th Street New York, NY 10011 Attn: Carol Kahn Strauss, International Director
Literacy, Inc. PC General Support, Unrestricted 18,000.00 5030 Broadway Suite 641 New York, NY 10034
Los Angeles Regional Food Bank Pc General Support, Unrestricted 10,000.00 1734 E 41st Street Los Angeles, California 90058-1502 The Falconwood Foundation Inc. EIN: 13-3456475 Tax Year End: December 31, 2016 Attachment to IRS Form 990-PF
Part XV , Line 3(a) Grants & Contributions Paid During the Year:
Organization Foundation Status Purpose Amount Los Angeles County Museum of Art PC General Support, Unrestricted 5,000.00 5905 Wilshire Blvd Los Angeles , CA 90036
Mad River Valley Community Fund Pc General Support, Unrestricted 5,000.00 P.O. Box 353 Waitsfield , VY 05673
Nantucket Maria Mitchel Association Pc General Support , Unrestricted 7,000.00 4 Vestal Street Nantucket, MA 02554
Marijuana Policy Project PC General Support , Unrestricted 5,000.00 P.O. Box 77492 Capital Hill Washington , DC 20013 Attn : Robert Kampia
Museum of the Jewish Heritage Pc General Support, Unrestricted 2,500.00 36 Battery Place New York , NY 10280
Icahn School of School of Medicine at Mount Sinai Pc General Support, Unrestricted 65,000.00 One Gustave L. Levy Place , Box 1049 New York , NY 10029 Attn : Richard Friedman
Nantucket Cottage Hospital PC General Support, Unrestricted 7,000.00 57 Prospect Street Nantucket, MA 02554
Nantucket Police Charitable Association Pc General Support, Unrestricted 1,000.00 4 Fairgrounds Road Nantucket, MA 02554
Naomi Berrie Diabetes Center Pc General Support , Unrestricted 20,000.00 Jamie Gutter Director of Development Columbia University Medical Center 100 Haven Avenue, Suite 29D New York , NY 10032
National Center for Reason and Justice Pc General Support , Unrestricted 48,000.00 77 Highland Street #3 Roxbury, MA 02119
Natural Resources Defense Council PC General Support , Unrestricted 56,000.00 40 W 20th Street New York , NY 10011
Neighbor to Neighbor PC General Support , Unrestricted 9,000.00 248 E Putnam Avenue Creenwich , CT 06830 The Falconwood Foundation Inc. EIN 13-3456475 Tax Year End: December 31, 2016 Attachment to IRS Form 990-PF
Part XV, Line 3(a) Grants & Contributions Paid During the Year:
Organization Foundation Status Purpose Amount NET Research Foundation Pc General Support, Unrestricted 10,000.00 20 Park Plaza Suite 748 Boston, MA 02116
New York-Presbyterian Hospital PC General Support, Unrestricted 50,000.00 525 East 68th Street Payson #122 New York, NY 10021 Attn: Dr. Steven J. Corwin, CEO
New York City Rescue Mission PC General Support, Unrestricted 2,500.00 P.O. Box 275 Canal St Station New York, NY 10013-0275 Attn: Craig A. Mayes, PhD Executive Director
New York Civil Liberties Union Foundation PC General Support, Unrestricted 20,000.00 125 Broad Street, 19th Floor New York, NY 10004 Attn: Donna Lieberman
NSSR Annual Fund PC General Support, Unrestricted 1,500.00 79 Fifth Avenue, 17th Floor New York, NY 10003
One to World PC General Support, Unrestricted 2,000.00 285 West Brodway, Sute 450 New York, NY 10013
Patient Airlift Services PC General Support, Unrestricted 6,500.00 120 Adams Boulevard Farmingdale, NY 11735
Planned Parenthood Federation of America PC General Support, Unrestricted 35,000.00 President 's Circle P.O. Box 97166 Washington , DC 20090-7166
Princeton Friends School PC General Support, Unrestricted 10,000.00 470 Quaker Road Princeton , NJ 08540 Attn• Lisa Belshaw Ham Director of Development
Princeton University PC General Support, Unrestricted 39,500.00 Box 46 Princeton, NJ 08543-3373
ProCon.org PC General Support, Unrestricted 2,500.00 233 Wilshire Blvd. Suite 200 Santa Monica, CA 90401 Attn: Steve Markoff The Falconwood Foundation Inc. EIN: 13-3456475 Tax Year End: December 31, 2016 Attachment to IRS Form 990-PF
Part XV, Line 3(a) Grants & Contributions Paid During the Year:
Organization Foundation Status Purpose Amount Remote Area Medical Foundation PC General Support, Unrestricted 33,000.00 2200 Stock Creek Vlvd Rockford, Tennessee 37853
Robin Hood Foundation Pc General Support, Unrestricted 147,000.00 826 Broadway, 9th Floor New York, NY 10003
The Sapling Foundation Pc General Support, Unrestricted 5,000.00 250 Hudson Street, #1002 New York, NY 10013
Southern Connecticut State University Foundation Pc General Support, Unrestricted 5,000.00 501 Cresent Street New Haven, CT 06515
Selfhelp PC General Support, Unrestricted 2,000.00 520 Eighth Avenue, 5th Floor New York. NY 10018
Social Tees Animal Rescue PC General Support, Unrestricted 30,000.00 325 East 5th Street New York, NY 10003
Southern Environmental Law Center Pc General Support, Unrestricted 47,000.00 201 West Main Street, Suite 14 Charlottesville, VA 22902 Attn: Marie Hawthorne Director of Development & Marketing
Speyer Legacy School PC General Support, Unrestricted 2,500.00 925 Ninth Avenue New York, NY 10019
The Sundance Institute PC General Support, Unrestricted 25,000.00 5900 Wilshire Blvd Los Angeles, CA 90036
Southern Poverty Law Center Pc General Support, Unrestricted 49,000.00 400 Washington Avenue Montgomery, AL 36104 Attn. Elizabeth Spears Regional Advancement Director
Sponsors for Educational Opportunity PC General Support, Unrestricted 30,000.00 55 Exchange Place New York, NY 10005
Temple University PC General Support, Unrestricted 50,000.00 Senior Vice President Institutional Development Temple University Philadelphia, PA 19182 The Falconwood Foundation Inc. EIN: 13-3456475 Tax Year End: December 31, 2016 Attachment to IRS Form 990-PF
Part XV, Line 3(a) Grants & Contributions Paid During the Year:
Organization Foundation Status Purpose Amount The Alexandria Trust PC General Support, Unrestricted 29,750.00 The Jamiya Project 96 High Street Kensington, London W8 4SG United Kingdom
The Baruch College PC General Support, Unrestricted 1,500.00 One Bernard Baruch Way Box A-1603 New York, NY 10010-5585
The Carver Center PC General Support, Unrestricted 10,000.00 400 Westchester Avenue Port Chester, NY 10573
The Center for Study of Responsive Law PC General Support, Unrestricted 25,000.00 P.O. Box 19367 Washington, D.C. 20036
The Conservation Agency PC General Support, Unrestricted 4,000.00 1140 Monroe Street Jackson, MS 39202 Attn: Dr. James Lazell
The Film Noir Foundation PC General Support, Unrestricted 5,000.00 1411 Paru Street Alameda, CA 94501
The Gere Foundation PC General Support, Unrestricted 2,500.00 c/o WG&G, LLP P.o. Box 1760 Santa Monica, CA 90406
The GlobalGiving Foundation PC General Support, Unrestricted 15,000.00 1110 Vermont Ave, NW, Suite 550 Washington, DC 20005
The Marshall Project PC General Support, Unrestricted 35,000.00 156 West 56th Strret Suite 701 New York, NY 10019 Attn: Bill Keller and Mr. Neil Barsky
The Opportunity Network Pc General Support, Unrestricted 1,000.00 55 Exchange Place, Suite 503 New York, NY 10005
The Petey Greene Program PC General Support, Unrestricted 8,000.00 9 Mercer Street 2nd Floor Princeton, NJ 08540 Attn: Rosemary Parish Development Manager c
The Falconwood Foundation Inc. EIN: 13-3456475 Tax Year End: December 31, 2016 Attachment to IRS Form 990-PF
Part XV, Line 3(a) Grants & Contributions Paid During the Year:
Organization Foundation Status Purpose Amount The Picture House PC General Support, Unrestricted 12,500.00 175 Wolfs Lane Pelham, NY 10803 Attn: Laura deBuys
The Wende Museum PC General Support, Unrestricted 10,000.00 5741 Buckingham Parkway Suite E Culver City, CA 90230
The West Point Class of 1998 Memorial Scholarship Foundation Pc General Support, Unrestricted 2,000.00 197 Main Street Hingham, MA 02043
Triangle Land Conservancy Pc General Support, Unrestricted 5,000.00 514 South Duke Street Durham, NC 27701
TriState Public Communications Inc. PC General Support, Unrestricted 500.00 c/o WHDD 67 Main Street Sharon, CT 06069
The University at Albany Foundation Pc General Support, Unrestricted 25,000.00 1400 Washington Ave, UAB 226 Albany, NY 12222
Vera Institute of Justice PC General Support, Unrestricted 17,500.00 233 Broadway, 12th Fl. New York, NY 10279
Weill Cornell Medical College Pc General Support, Unrestricted 5,000.00 1300 York Avenue Box 314 New York, NY 10131
Mr. Jeffrey Tiese, Senior VP and COO PC General Support, Unrestricted 25,000.00 Dr. Michael Palumbo, Medical Director White Plains Hospital 41 East Post Road White Plains, NY 10601
Weissman Center for Intl Business Pc General Support, Unrestricted 38,000.00 Baruch College One Bernard Baruch Way Box J-0810 New York, NY 10010-5585
City of Heidelberg Gov General Support, Unrestricted 110,000.00 Rathaus, Marktplatz 10 69117 Heidelberg Germany The Falconwood Foundation Inc. EIN: 13-3456475 Tax Year End: December 31, 2016 Attachment to IRS Form 990-PF
Part XV, Line 3(a) Grants & Contributions Paid During the Year:
Organization Foundation Status Purpose Amount Wildlife Conservation Society PC General Support, Unrestricted 30,000.00 Global Resources 2300 Southern Blvd Bronx, NY 10460 Attn: Catherine Durand-Brault, Regional Strategic Development
WNET/Thirteen PC General Support, Unrestricted 2,500.00 450 West 33rd Street New York, NY 10001
YIVO Institute for Jewish Research Pc General Support, Unrestricted 750.00 15 W. 16th Street New York, NY 10011-6301
John H. Krystal, M.D. PC General Support, Unrestricted 25,000.00 Office of the Chair Yale University School of Medicine Chief of Psychiatry, Yale-New Haven Hospital 300 George Str., Suite 901 New Haven, CT 06511
Young Women's Leadership Network PC General Support, Unrestricted 30,000.00 322 8th Avenue, 14th Floor New York, NY 10001 Attn: Maya Crawford, Director of Development
City of Heidelberg (1/27/2017 void) (110,000.00)
Total Contributions to Charity 3,997,455.00