2008 NOT-FOR-PROFIT CORPORATION REINSTATEMENT FILED Nov 03, 2008 D0C UMENT# N96000002084 Secretary of State

2008 NOT-FOR-PROFIT CORPORATION REINSTATEMENT FILED Nov 03, 2008 D0C UMENT# N96000002084 Secretary of State Entity Name: THE KONI FOUNDATION. INC Current Principal Place of Business: New Principal Place of Business: 1 CLEARLAKE CENTER. #1402 250 AUSTRALIAN AVENUE WEST PALM BEACH, FL 33401 Current Mailing Address: New Mailing Address: 3265 LAWSON BLVD OCEANSIDE, NY 11572 FEI Number: 65.0676162 FEI Number Appaed For ( ) FEI Number Not Applkab4 ( ) Certificate of Status Desired ( ) In accordance with s. 607.153(2Kb). F.S., the corporation ad not receive the poor notice. Name and Address of Current Registered Agent: Name and Address of New Registered Agent: SIEGEL, HOWARD 250 AUSTRALIAN AVE S. #1402 WEST PALM BEACH, FL 33401 US The above named entity submits this statement for the purpose of changing its registered office or registered agent, or both, in the State of Florida. SIGNATURE: HOWARD SIEGEL Electronic Signature of Registered Agent Date OFFICERS AND DIRECTORS: ADDITIONSICHANGES TO OFFICERS AND DIRECTORS: Title D ( I Delete Title: ( ) Change ( ) Addlion Name: SIEGEL. HOWARD Name: Address Address: CI17•St•Z.p: City-St2sp: Title. D ( ) Delete Title ( )Charms ( ) Milton Name: KAPNER. LEWIS Name: Address 250 AUSTRALIAN AVEMJE Address. City-St-Zip WEST PALM BEACH. FL 33401 City-St-Lp: Tale D ( ) Delete Talc ( )Change ( )Adam, Name: WIENER. HOWARD Name: Address 777 S FLAGER DR WEST TWR STE 1601 Address City-St-Zip WEST PALM BEACH. FL 33401 City-SI-bp: I hereby certify that the information supplied with this filing does not qualify for the exemption stated in Chapter 119, Florida Statutes I further certify that the information indicated on this report or supplemental report is true and accurate and that my electronic signature shall have the same legal effect as if made under oath, that I am an officer or director of the corporation or the receiver or trustee empowered to execute this report as required by Chapter 617, Florida Statutes; and that my name appears above, or on an attachment with an address, with all other like empowered. SIGNATURE: HOWARD SIEGEL D 11/03/2008 Electronic Signature of Signing Officer or Director Date EFTA00192298 EFTA00192299 www.sunbiz.org - Department of State Page I of 2 FLORIDA DEPARTMENT OF STATE DIVISION OF CORPORATIONS Home Contact Us Document Searches Forms Help E-Filing Services Previous on List Next on List Return To List Events No Name History Detail by Entity Name Florida Non Profit Corporation THE KONI FOUNDATION, INC. Filing Information Document Number N96000002084 FEI Number 650676162 Date Filed 04/18/1996 State FL Status ACTIVE Effective Date 05/01/1996 Last Event CANCEL ADM DISS/REV Event Date Filed 11/03/2008 Event Effective Date NONE Principal Address 1 CLEARLAKE CENTER, #1402 250 AUSTRALIAN AVENUE WEST PALM BEACH FL 33401 Changed 03/26/2002 Mailing Address 3265 LAWSON BLVD OCEANSIDE NY 11572 Changed 09/05/2006 Registered Agent Name & Address SIEGEL. HOWARD 250 AUSTRALIAN AVE S, #1402 WEST PALM BEACH FL 33401 US Name Changed: 06/03/2005 Address Changed: 06/03/2005 Officer/Director Detail Name & Address Title D SIEGEL, HOWARD Entity Name Search http://www.sunbiz.org/scriptskordet.exe?action=DETFIL8cinq_doc_number=N9600000208486... 12/12/2008 EFTA00192300 www.sunbiz.org - Department of State Title D Page 2 of 2 KAPNER, LEWIS 250 AUSTRALIAN AVENUE WEST PALM BEACH FL 33401 Title D WIENER, HOWARD 777 S FLAGER DR WEST TWR STE 1601 WEST PALM BEACH FL 33401 Annual Reports Report Year Filed Date 2006 2007 2008 09/05/2006 10/16/2007 11/03/2008 Document Images 11/03/2008 -- REINSTATEMENT 10/16/2007 -- REINSTATEMENT 09/05/2006 -- ANNUAL REPORT 06/03/2005 -- ANNUAL REPORT 08/05/2004 -- ANNUAL REPORT 05/02/2003 -- ANNUAL REPORT 03/26/2002 -- ANNUAL REPORT 07/06/2001 -- ANNUAL REPORT 03/22/2001 -- DEBIT MEMO 03/09/2001 -- DEBIT MEMO 12/21/2000 -- ANNUAL REPORT 04/18/1996 -- DOCUMENTS PRIOR TO 1997 View image in PDF format View image in PDF format View image in PDF format View image in PDF format View image in PDF format View image in PDF format View image in PDF format View image in PDF format View image in PDF format View image in PDF format View image in PDF format View image in PDF format Note: This is not official record. See documents if question or conflict. Previous on List Next on List Events No Name History Return To List Home Contact us Document Searches E-Filing Services Forms Help Copyright and Privacy Policies Copyright 2007 State of Florida, Department of State. Entity Name Search Imp://www.sunbiz.org/seripts/cordet.exe?action=DETFIL&inq_doc_number=N96000002084&i... 12/12/2008 EFTA00192301 2007 NOT-FOR-PROFIT CORPORATION REINSTATEMENT FILED Oct 16, 2007 D0CUMENT# N96000002084 Secretary of State Entity Name: THE KONI FOUNDATION, INC Current Principal Place of Business: New Principal Place of Business: 1 CLEARLAKE CENTER 41402 250 AUSTRALIAN AVENUE WEST PALM BEACH, FL 33401 Current Mailing Address: New Mailing Address: FEI Number: 6541676162 FE Number Applied For ( ) FEI Number Not Applicable ( ) Carthame of Sides Desbed IX) In accordance with s. 607.193120). F.S., the corporation did not receive the prior notice. Name and Address of Current Registered Agent: Name and Address of New Registered Agent: SIEGEL, HOWARD 250 AUSTRALIAN AVE S, #1402 WEST PALM BEACH, FL 33401 US The above named entity submits this statement for the purpose of changing its registered office or registered agent, or both, in the State of Florida. SIGNATURE: HOWARD SIEGEL Electronic Signature of Registered Agent Date OFFICERS AND DIRECTORS: ADDITIONS/CHANGES TO OFFICERS AND DIRECTORS: rale D ( i Delete Title: ( )Change ( ) Addition Name: SIEGEL. HOWARD Nome: Address Address: CitySl-Zit: City-St-Zip: Tale. D ( ) Delete Title: ( ) Change ( ) Addition Name' KAPNER. LEWIS Name: Address 250 AUSTRALIAN AVENUE Abbess: CitySt•Zip: WEST PALM BEACH. FL 33401 City-St-Zip: Eat D ( ) Delete The: ( ) Change ( )Addition Name: WIENER. HOWARD Name: Metes. 777 5 FLAGER DR WEST TWR STE 1601 Wrest: City-St-Im WEST PALM BEACH, FL 33401 Oily-SI-Zip: I hereby certify that the information supplied with this filing does not qualify for the exemption stated in Chapter 119, Florida Statutes. I further certify that the information indicated on this report or supplemental report is true and accurate and that my electronic signature shall have the same legal effect as if made under oath; that I am an officer or director of the corporation or the receiver or trustee empowered to execute this report as required by Chapter 617, Florida Statutes; and that my name appears above, or on an attachment with an address, with all other like empowered. SIGNATURE STEVEN KAPLANSKY OIR 10/16/2007 Electronic Signature of Signing Officer or Director Date EFTA00192302 Comprehensive Business Report /'age I of 3 Important: The Public Records and commercially available data sources used on reports have errors Data is sometimes entered poorly. processed incorrectly and is generally not free from defect. This system should not be retied upon as definitively accurate Before relying on any data this system supplies. it should be independently verified. For Secretary of Stale documents. the following data is for information purposes only and is not an official record. Certified copes may be obtained from that individual state's Department of Slate Your DPPA Permissible Use: Court, Law Enforcement or Govemment Agencies Your GLBA Permissible Use: Law Enforcement Purposes Comprehensive Business Report Date: 12/09/08 Company Information: Company Name: THE COUO FOUNDATION. INC Address: 250 S AUSTRALIAN AVE STE 1404, WEST PALM BCH FL 33401-5016 Name Variations: Company Name: THE CO U O FOUNDATION. INC Address Variations: Address 250 S AUSTRALIAN AVE 1404, WEST PALM BCH FL 33401 County: PALM BEACH Ms* Description. West Palm Beach-Boca Raton, FL Phone Variations: [None Found) Parent Company: Name: THE KONI FOUNDATION INC Addres Comprehensive Business Report Summary: (Cr-tk on Ltnk to see detain industry Information. None Found Company ID Numbers. 1 Found Bankruptcies: None Found Liens and Judgments: None Found Corporation Filings: 1 Found Registered Agents: None Found Business Registration. None Found UCC Filings for Business: None Found Associated Businesses: 1 Found Business Contacts: None Found Motor Vehicles None Found Properties. None Found FAA Ascrafts: None Found Watercrafts None Found Internet Domain Names Registered to Business: None Found IRS 5500: https://secure.accurint.com/app/bps/report 12/9/2008 EFTA00192303 Comprehensive Business Report Page 2 of 3 None Found Executives. None Found Business Filings: Industry Information: (None Found] Company ID Numbers: State of Down FL Charter Number: F08000003048 Bankruptcies: (None Found] Liens & Judgments: [None Found] Corporation Filings: Corporation Filings # 1 THE C.O.U.Q. FOUNDATION, INC. - As of: 10/16/2008 Name Type: LEGAL Address: 250 S AUSTRALIAN AVE STE 1404, WEST PALM BEACH FL 33401-5016 Address Type: MAILING Status: ACTIVE Business Type: FOREIGN NON PROFIT Foreign Incorporation Date: 07/09/2008 Registered Agent. C T CORPORATION SYSTEM Registered Agent Address. PLANTATION, FL 33324 Place Incorporation: DELAWARE THE C.O.U.Q. FOUNDATION, INC. - As of: 07/1112008 Name Type: LEGAL Address: 250 S AUSTRALIAN AVE STE 1404, WEST PALM BEACH FL 33401-5016 Address Type: MAILING Status: ACTIVE Business Type: FOREIGN NON PROFIT Foreign Incorporation Date: 07/09/2008 Registered Agent: C T CORPORATION SYSTEM Registered Agent Address: PLANTATION, FL 33324 Place Incorporation: DELAWARE Officers and Directors: THE C.O.U.O. FOUNDATION, INC. • As of: 10/16/2008 Officer: JEFFREY E EPSTEIN, DP, 6100 RED HOOK OTRS STE B3. ST THOMAS VI 00802-1348 Officer: DARREN K INDYKE, DVS, Officer. RICHARD KAHN, DIRECTOR Registered Agents: [None Found] Business Registration: (None Found] UCC Filings for Business: [None Found) Associated Businesses: Name: THE KONI FOUNDATION. INC. Address: 250 S AUSTRALIAN AVE STE 1402, WEST PALM BCH FL 33401-5015 Associated People: Business Contacts: https://secure.accurint.com/app/bps/report 12/9/2008 EFTA00192304 Comprehensive Business Report Page 3 of 3 (None Found) Assets: Motor Vehicles: [None Found] Properties: [None Found) FAA Aircraft: (None Found] Watercraft: [None Found] Internet Domain Names Registered to Business: [None Found] IRS 5500 [None Found] Executives: (None Found] https://secure.accurint.com/app/bps/report 12/9/2008 EFTA00192305 Comprehensive Business Report Page I of 3 Important: The Public Records and commercially available data sources used on reports have errors. Data is sometimes entered poorly. processed incorrectly and is generally not free from defect. This system should not be relied upon as definitively accurate. Before relying on any data this system supplies. it should be independently verified For Secretary of State documents, the following data is for information purposes only and is not an official record. Certified copies may be obtained from that individual state's Department of State Your OPPA Permissible Use: Court. Law Enforcement or Government Agencies Your GLBA Permissible Use: Law Enforcement Purposes Comprehensive Business Report Date: 12/09/08 Company Information: Address:Company 11.1001.0.1 Name Variations: Company Name THE CO U O FOUNDATION, INC Address Variations: Address 110 E 59TH ST, NEW YORK NY 10022 County: NEW YORK Msa Description: New York, NY Phone Variations: (None Found] Comprehensive Business Report Summary: (ack on Link to see detail) Industry Information None Found Company ID Numbers 1 Found Bankruptcies: None Found Liens and Judgments None Found Corporation Filings: 1 Found Registered Agents: None Found Business Registration. None Found UCC Filings for Business. None Found Associated Businesses: None Found Business Contacts: None Found Motor vehicles None Found Properties. None Found FAA Aircrafts: None Found Wateruafts None Found Internet Domain Names Registered to Business: None Found IRS 5500: None Found Executives None Found Business Filings: https://secure.accurint.com/app/bps/report 12/9/2008 EFTA00192306 Comprehensive Business Report Page 2 of 3 Industry Information: (None Found] Company ID Numbers: Slate of Origin: NY Charter Number: 2380817 Bankruptcies: (None Found] Liens & Judgments: (None Found] Corporation Filings: Corporation Filings If 1 THE C.O.U.Q. FOUNDATION, INC. - As of: 10/22/2008 Name Trui• r rrtni Address Address Type PROCESS ADDRESS Status: ACTIVE - GOOD STANDING STATUS CAN ONLY BE DETERMINED BY PERFORMING A SEARCH IN THE RECORDS OF BOTH THE DEPARTMENT OF STATE CORPORATION RECORDS AND THE DEPARTMENT OF TAX AND FINANCE Business Type: FOREIGN NOT FOR PROFIT Filing Date: 0312611999 Date Incorporated: 03/26/1999 Foreign Incorporation Date: 0311611998 Term: PERPETUAL Type: EFFECTIVE DATE Place Incorporation: DELAWARE THE C.O.U.Q. FOUNDATION, INC. - As of: 07/23/2008 Name T Address IN Address Type: PROCESS ADDRESS Status: ACTIVE - GOOD STANDING STATUS CAN ONLY BE DETERMINED BY PERFORMING A SEARCH IN THE RECORDS OF BOTH THE DEPARTMENT OF STATE CORPORATION RECORDS AND THE DEPARTMENT OF TAX AND FINANCE Business Type: FOREIGN NOT FOR PROFIT Filing Date: 03126/1999 Date Incorporated: 03/26/1999 Foreign Incorporation Date: 03116/1998 Term: PERPETUAL Type: EFFECTIVE DATE Place Incorporation: DELAWARE THE C.O.U.Q. FOUNDATION, INC. - As of: 04/21/2008 Name Tr- r Prat Address Address Type. PROCESS AUCHIE55 Status: ACTIVE - GOOD STANDING STATUS CAN ONLY BE DETERMINED BY PERFORMING A SEARCH IN THE RECORDS OF BOTH THE DEPARTMENT OF STATE CORPORATION RECORDS AND THE DEPARTMENT OF TAX AND FINANCE Business Type: FOREIGN NOT FOR PROFIT Filing Date. 03/26/1999 Date Incorporated: 03/26/1999 Foreign Incorporation Date: 03/16/1998 Term: PERPETUAL Type: EFFECTIVE DATE Annual Report Filings: Status: MICROFILM NBR: 990326000255 Filed Date: 03/26/1999 Status: MICROFILM NBR :990326000255 Filed Date: 03/26/1999 Microfilm Number: 9903260002 Status: MICROFILM NBR :990326000255 Filed Date: 03/26/1999 hups://secure.accurint.com/app/bps/report 12/9/2008 EFTA00192307 Comprehensive Business Report Page 3 of 3 Microfilm Number 9903260002 Registered Agents: [None Found) Business Registration: (None Found UCC Filings for Business: (None Found} Associated Businesses: (None Found] Associated People: Business Contacts: (r. Assets: Motor Vehicles: [None Found) Properties: [None Found) FAA Aircraft: [None Found) Watercraft: :None Internet Domain Names Registered to Business: (None Found) IRS 5500 [None Found) Executives: (None Found) https://secure.accurint.com/app/bpsfreport 12/9/2008 EFTA00192308 Comprehensive Business Report Page 1 of 7 Important: The Public Records and commercially available data sources used on reports have errors. Data is sometimes entered poorly, processed incorrectly and is generally not free from defect. This system should not be relied upon as definitively accurate Before relying on any data this system supplies, it should be independently verified For Secretary of State documents, the blowing data is for information purposes only and is not an official record. Certified copes may be obtained from that individual state's Department of State. Your DPPA Permissible Use: Cowl. Law Enforcement or Government Agencies Your GLBA Permissible Use: Law Enforcement Purposes Comprehensive Business Report Date: 12/09/08 Company Information: Company Name: THE KONI FOUNDATION INC Address: Name Variations: Company Name. NICOLAUS KONI FOUNDATION Company Name: THE C O U Q. FOUNDATION, INC Company Name. THE KONI FOUNDATION. INC Address Variations: Address 250 S AUSTRALIAN AVE, WEST PALM BEACH FL 33401 County: PALM BEACH Msa Description West Palm Beach-Boca Raton, FL Address 250 S AUSTRALIAN AVE 1402, WEST PALM BCH FL 33401 County: PALM BEACH Msa Description West Palm Beach-Boca Raton, FL Address 250 S AUSTRALIAN AVE 1404, WEST PALM BCH FL 33401 County: PALM BEACH Msa Description West Palm Beach-Boca Raton, FL Address County' Msa Description: Nassau-Suffolk, NY Phone Variations: Phone 516 201 1521 Comprehensive Business Report Summary: (click on Link to see detail) Industry Information: None Found Company ID Numbers: 1 Found Bankruptcies: None Found Lens and Judgments: None Found Corporation Filings: 3 Found Registered Agents: 1 Found Business Registration. 1 Found UCC Filings for Business: None Found Associated Businesses: 23 Found Business Contacts: 6 Found Motor Vehicles: None Found https://secure.accurint.com/app/bps/report 12/9/2008 EFTA00192309 Comprehensive Business Report Page 2 of 7 Properties None Found FAA Aircrafts: None Found Watercraft None Found Internet Domain Names Registered to Business: 2 Found IRS 5500. None Found Executives 4 Found Business Filings: Industry Information: (None Found] Company ID Numbers: State of Origin: FL Charter Number: F08000003048 State of Origin: FL Charter Number. N96000002084 State of Origin: NY Charter Number. 2821493 Bankruptcies: [None Found) Liens & Judgments: (None Found) Corporation Filings: Corporation Filings a 1 THE KONI FOUNDATION INC. • As of: 1012212008 Name Tre LEGAL Address Address ype rtiVt.tbb ALJUKtbb Status. ACTIVE - GOOD STANDING STATUS CAN ONLY BE DETERMINED BY PERFORMING A SEARCH IN THE RECORDS OF BOTH THE DEPARTMENT OF STATE CORPORATION RECORDS AND THE DEPARTMENT OF TAX AND FINANCE Business Type. FOREIGN NOT FOR PROFIT Fang Date: 1011012002 Date Incorporated 1011012002 Foreign Incorporation Date. 04/1811996 Term: PERPETUAL Type: EFFECTIVE DATE Place Incorporation . FLORIDA THE KONI FOUNDATION INC. • As of: 07/23/2008 Name Tr LEGAI Address Address Status ACTIVE • GOOD STANDING STATUS CAN ONLY BE DETERMINED BY PERFORMING A SEARCH IN THE RECORDS OF BOTH THE DEPARTMENT OF STATE CORPORATION RECORDS AND THE DEPARTMENT OF TAX AND FINANCE Business Type: FOREIGN NOT FOR PROFIT Filing Date 10/10/2002 Date Incorporated 10/10/2002 Foreign Incorporation Date- 04/18/1996 Term: PERPETUAL Type: EFFECTIVE DATE Place Incorporation: FLORIDA THE KONI FOUNDATION INC. As of: 04/21/2008 Name Tye LEGAL Address. Address .vvrti-oo Status: ACTIVE GOOD STANDING STATUS CAN ONLY BE DETERMINED BY PERFORMING A SEARCH IN https://secure.accurint.com/app/bps/report 12/9/2008 EFTA00192310 Comprehensive Business Report Page 3 of 7 THE RECORDS OF BOTH THE DEPARTMENT OF STATE CORPORATION RECORDS AND THE DEPARTMENT OF TAX AND FINANCE Business Type: FOREIGN NOT FOR PROFIT Filing Date: 10/10/2002 Date Incorporated 10/10/2002 Foreign Incorporation Date 04/18/1996 Term: PERPETUAL Type: EFFECTIVE DATE Annual Report Filings Status: MICROFILM NBR: 021010000338 Filed Date 1011012002 Status: MICROFILM NBR :021010000338 Filed Date: 10110/2002 Microfilm Number: 0210100003 Status: MICROFILM NBR :021010000338 Filed Date: 10/10/2002 Microfilm Number: 0210100003 Corporation Filings a 2 THE C.O.U.O. FOUNDATION, INC. - As of: 1011612008 Name Type. LEGAL Address 250 S AUSTRALIAN AVE STE 1404, WEST PALM BEACH FL 33401-5016 Address Type: MAILING Status. ACTIVE Business Type: FOREIGN NON PROFIT Foreign Incorporation Date 07/0912008 Registered Agent. C T CORPORATION SYSTEM Registered Agent Address. PLANTATION, FL 33324 Place Incorporation: DELAWARE THE C.O.U.O. FOUNDATION, INC. - As of: 07/1112008 Name Type. LEGAL Address: 250 S AUSTRALIAN AVE STE 1404, WEST PALM BEACH FL 33401-5016 Address Type- MAILING Status. ACTIVE Business Type: FOREIGN NON PROFIT Foreign Incorporation Date 07/09/2008 Registered Agent C T CORPORATION SYSTEM Registered Agent Address. PLANTATION, FL 33324 Place Incorporation: DELAWARE Officers and Director: THE C.O.U.O. FOUNDATION. INC. - As of. 10/16/2008 Officer: JEFFREY E EPSTEIN, DP, 6100 RED HOOK OTRS STE B3 ST THOMAS VI 00802-1348 Officer: DARREN K INDYKE, DVS, Officer: RICHARD KAHN, DIRECTO Corporation Filings a 3 THE KONI FOUNDATION, INC. - As of: 10/16/2008 Name Twe I cr-•r Address- Address type. reaturru Status INACTIVE Business Type: DOMESTIC NON PROFIT Date Incorporated - 05101/1996 Registered Agent SIEGEL HOWARD Registered Agent Address: WEST PALM BEACH, FL 33401 FEIN: 65-0676162 Place Incorporation: FL THE KONI FOUNDATION, INC. - As of: 07/18/2008 Name Tye LEGAL Address Address Status. ACTIVE Business Type. DOMESTIC NON PROFIT Date Incorporated 0510111996 Registered Agent SIEGEL HOWARD Registered Agent Address. WEST PALM BEACH, FL 33401 FEIN: 65-0676162 https://secure.accurint.com/apprbps/report 12/9/2008 EFTA00192311 Comprehensive Business Report Page 4 of 7 Place Incorporation: FL THE KONI FOUNDATION, INC. As of: 03/31/2008 Name T ne I Frai Address Address Type MAILING Status ACTIVE Business Type. DOMESTIC NON PROFIT Date Incorporated: 05/0111996 Registered Agent: SIEGEL HOWARD Registered Agent Address: 250 S AUSTRALIAN AVE STE 1402, WEST PALM BEACH FL 33401.5015 FEIN: 65-0676162 Place Incorporation: FL Officers and Directors: THE KONI FOUNDATION, INC. - As of 10/16/2008 Officer: LEWIS KAPNER, DIRECTOR, 2ilailialialliallaiii.01-5018 Officer: HOWARD SIEGEL, DIRECTOR, Officer: HOWARD WIENER, DIRECTOR, 777 S FLAGLER DR STE 1601, WEST PALM BEACH FL 33401-6102 Officer: LEWIS KAPNER, DIRECTOR, liallailifiraliallifillir-5018 Officer: HOWARD SIEGEL, DIRECTOR, Officer: HOWARD WIENER, DIRECTOR, 777 S FLAGLER DR STE 1601, WEST PALM BEACH FL 334014102 Officer: HOWARD WIENER, DIRECTOR, 222 LAKEVIEW AVE FL 4, WEST PALM BEACH FL 334014147 Officer: LEWIS KAPNER, DIRECTOR, 250 S AUSTRALIAN AVE, WEST PALM BEACH FL 33401-5018 Officer: HOWARD SIEGEL, DIRECTOR, , Officer HOWARD WIENER, DIRECTOR, 777 S FLAGLER DR STE 1601, WEST PALM BEACH FL 33401.6102 Annual Report Filings: Filing Year: 2007 Filed Date: 10/16/2007 Filing Year: 2006 Filed Date: 09/05/2006 Filing Year: 2005 Filed Date: 06/03/2005 Filing Year: 2005 Filed Date: 06/03/2005 Filing Year: 2004 Filed Date: 08/05/2004 Filing Year: 2003 Filed Date: 05/02/2003 Filing Year. 2002 Status: 2002 Filed Date: 03/2612002 Filing Year. 2001 Status: 2001 Filed Date. 0710612001 Events: Date: 0912612008 Event: ADMIN DISSOLUTION FOR ANNUAL REPORT Date: 10/16/2007 Event: CANCEL ADM DISSIREV Date: 09/14/2007 Event: ADMIN DISSOLUTION FOR ANNUAL REPORT Date: 12/21/2000 Event: REINSTATEMENT Date: 09/26/1997 Event: ADMIN DISSOLUTION FOR ANNUAL REPORT Registered Agents: Name: SIEGEL HOWARD Address 250 S AUSTRALIAN AVE STE 1402, WEST PALM BCH FL 33401.5015 Date Last Seen: 3/3112008 https://secure.accurint.com/app/bps/report 12/9/2008 EFTA00192312 Comprehensive Business Report Page 5 of 7 Business Registration: Name. THE KONI rThour • Tirm Mailing Address. Filing Number: 02 V1WOUJSIS Corporation Code. SOS Expiration Date: 10130/2033 UCC Filings for Business: (None Found] Associated Businesses: Name: ADD-ON PROPERTIES LLC CO Address: Name: ALERT CORP Address Name: AMEIRCAN MEDICAL ALERT CORP Address: Name: AMERICAN MEDICAL ALERT CORP Address Name: AMERICAN MEDICONNECT ACQUISITION CORP Address: Name: ANSWER CONNECTICUT ACQUISITION CORP. Address Name: BASE PROPERTIES LLC Addcess Name: DO IT ENTERPRISES INC Address Name: H C I ACQUISITION CORP Address. Name: H r roPP Address Name. HCI ACQUISITION CORP Addre Name: HEALTH BUDDY Address Name. HOWARD M SIEGEL Address: Name: LIVE MESSAGE AMERICA ACQUISITION CORP. Addret Name: MD ONCALL ACQUISITION CORP Address: Name: NEW FOCUS SPORTSWEAR INC. A CORPORATION Address OCEANSIDE. NY Name: NM CALL CENTER. INC. Address Name: NORTH SHORE ANSWERING SERVICE, INC. Address Name: SAFE COM INC Address: Name: SAFECOM SILENT PARTNER. INC. Address https://secure.accurint.com/app/bps/report 12/9/2008 EFTA00192313 Comprehensive Business Report Page 6 of 7 Name: SIEGEL HOWARD M Address. Name: THE KONI FOUNDATION. INC Address: 250 S AUSTRALIAN AVE STE 1402. WEST PALM BCH FL 33401-5015 Name: TRIPS IN RESIN INC Address Associated People: Business Contacts: Name: JOHNSON JAMES Contact Ter - TECtriL Address.■ Date Last Seen: 41112002 Name: ALLISON KAPNER Contact Title • DOMAIN ADMINISTRATIVE CONTACT Address: 250 S AUSTRALIAN AVE STE 1402. WEST PALM BCH FL 33401.5015 Date Last Seen 6/13/2002 Name. LEWIS KAPNER SSN: xxx-xx-xxxx Contact Title - DIRECTOR . DIRECTOR Address: 250 S AUSTRALIAN AVE. WEST PALM BCH FL 33401-5018 Date Last Seen: 7/18/2008 Name: HOWARD SIEGEL Contact S CONTACT Address. Date Last Seen: 7/18/2008 Name: HOWARD WIENER Contact Title - DIRECTOR , DIRECTOR Address: 222 LAKEVIEW AVE FL 4, WEST PALM BEACH FL 334014147 Date Last Seen: 7/18/2008 Name. HOWARD WIENER Contact Title - DIRECTOR Address Date Last Assets: Motor Vehicles: [None Found] Properties: [None Found) FAA Aircraft: [None Found) Watercraft: [None Found] Internet Domain Names Registered to Business: (CI fated with that name) IRS 5500 None Found) https://secure.accurint.corn/app/bps/report 12/9/2008 EFTA00192314 Comprehensive Business Report Page 7 of 7 Executives: Name. HOWARD SiEGEL Contact Title - DIRECTOR , DIRECTOR Date Last Seen 7/18/2008 Name: HOWARD WIENER Contact Title - DIRECTOR , DIRECTOR Date Last Seen: 7/18/2008 Name: LEWIS KAPNER Contact Title - DIRECTOR , DIRECTOR Date Last Seen: 7/18/2008 Name: HOWARD WIENER Contact Title - DIRECTOR Date Last Seen: 3/2002 https://secure.accurint.com/appibps/report 12/9/2008 EFTA00192315 Comprehensive Business Report Page 1 of 3 Important: The Pubic Records and commercially available data sources used on reports have errors Data is sometimes entered Seedy. processed incorrectly and is generally not free from defect. This system should not be relied upon as definitivety accurate. Before relying on any data this system supplies. it should be independently verified For Secretary of State documents, the following data is for information purposes only and is not an official record. Certified copies may be obtained from that individual states Department of State. Your DPPA Permissible Use: Court. Law Enforcement or Government Agences Your GLBA Permissible Use: Law Enforcement Purposes Comprehensive Business Report Date: 12/09/08 Company Information: Company Name: FLORIDA SCIENCE FOUNDATION Address: 250 S AUSTRALIAN AVE, WEST PALM BCH FL 33401-5018 Phone: 561.366-0084 Name Variations: Company Name THE FLORIDA SCIENCE FOUNDATION. INC Address Variations: Address: 250 5 AUSTRALIAN AVE, WEST PALM BCH FL 33401 County PALM BEACH Msa Description. West Palm Beach-Boca Raton, FL Address: 250 S AUSTRALIAN AVE 1400, WEST PALM BCH FL 33401 County PALM BEACH Msa Description: West Palm Beach-Boca Raton, FL Phone Variations: Phone 561.366.0084 Comprehensive Business Report Summary: (Click on Link to see detail) Industry Information. None Found Company ID Numbers. I Found Bankruptcies. None Found Liens and Judgments: None Found Corporation Filings. I Found Registered Agents. None Found Business Registration 1 Found UCC Filings for Business. None Found Associated Businesses None Found Business Contacts None Found Motor Vehicles. None Found Properties . None Found FAA Aircsafts None Found Watercrafts: None Found Internet Domain Names Registered to Business None Found IRS 5500 hups://secure.accurint.com/app/bps/report 12/9/2008 EFTA00192316 Comprehensive Business Report Page 2 of 3 None Found Executives None Found Business Filings: Industry Information: (None Found) Company ID Numbers: Stale of ()Nun: FL Charter Number N07000010684 Bankruptcies: (None Found) Liens & Judgments: (None Found) Corporation Filings: Corporation Filings M 1 THE FLORIDA SCIENCE FOUNDATION, INC. • As of: 1011612008 Name Type. LEGAL Address 250 S AUSTRALIAN AVE STE 1400, WEST PALM BEACH FL 33401.5016 Address Type: MAILING Status ACTIVE Business Type: DOMESTIC NON PROFIT Date Incorporated 11/01/2007 Registered Agent. C T CORPORATION SYSTEM Registered Agent Address PLANTATION, FL 33324 Place Incorporation: FL THE FLORIDA SCIENCE FOUNDATION, INC. - As of: 07/18/2008 Name Type LEGAL Address. 250 S AUSTRALIAN AVE STE 1400, WEST PALM BEACH FL 33401.5016 Address Type: MAILING Status. ACTIVE Business Type: DOMESTIC NON PROFIT Date Incorporated. 1110112007 Registered Agent C T CORPORATION SYSTEM Registered Agent Address. PLANTATION, FL 33324 Place Incorporation: FL THE FLORIDA SCIENCE FOUNDATION, INC. - As of: 03/3112008 Name Type. LEGAL Address: 250 S AUSTRALIAN AVE STE 1400, WEST PALM BEACH FL 33401.5016 Address Type: MAILING Status. ACTIVE Business Type: DOMESTIC NON PROFIT Date Incorporated 11/01/2007 Registered Agent. C T CORPORATION SYSTEM Registered Agent Address 1200 S PINE ISLAND RD. PLANTATION FL 33324-4413 Place Incorporation: FL Officers and Directors: THE FLORIDA SCIENCE FOUNDATION, INC. - As of 10/16/2008 Officer: DARREN K INDYKE, ASSISTANT DIRECTOR, 457 MADISON AVE, NEW YORK NY 10022-6843 Annual Report Filings: Filing Year: 2008 Filed Date. 09/17/2008 Registered Agents: (None Found] Business Registration: Name. THE FLORIDA SCIENCE FOUNDATION INC Mailing Address. 250 S AUSTRALIAN AVE STE 1400, WEST PALM BEACH FL 33401.5016 Filing Number. N07000010684 State of Registration. FL lutps://secure.accurint.com/app/bps/report 12/9/2008 EFTA00192317 Comprehensive Business Report Page 3 of 3 Status Active Corporation Code. SOS Expiration Date 5/1/20O8 UCC Filings for Business: (None Found] Associated Businesses: (None Found) Associated People: Business Contacts: [None Found] Assets: Motor Vehicles: [None Found] Properties: [None Found) FAA Aircraft: [None Found) Watercraft: [None Found] Internet Domain Names Registered to Business: [None Found] IRS 5500 [None Found] Executives: [None Found] https://secure.accurint.com/app/bps/report 12/9/2008 EFTA00192318 EFTA00192319 KJ EFTA00192320 EFTA00192321 LI Li Li EFTA00192322 EFTA00192323 U EFTA00192324 EFTA00192325 Li EFTA00192326 1459 1.000 EFTA00192327 .., U C.1 ..1 EFTA00192328 SE ¶460¶00 EFTA00192329 LI Li EFTA00192330 JSA 9E1170 2.1103 EFTA00192331 U U EFTA00192332 EFTA00192333 U EFTA00192334 EFTA00192335 c) L) L) EFTA00192336 EFTA00192337 U L.) EFTA00192338 frE141.2 1.000 EFTA00192339 Li U U EFTA00192340 EFTA00192341 U L.) EFTA00192342 STATE OF NEW YORK County of New York, s: THE ANNUAL RETURN OF C.O.U.O. FOUNDATION for the Racal year ended Fob-,ruary a 20001• eve IIa bite at Its principal office located at 0,0 Dalton Associate,. 110 East :tlijiall2Streel. New York_ NY Rtzfulorntrusintscegrd4 Juries citizen who requests It within by any .100 days hereof. Principal Manager of the Foundation is 'JEFFREY E. EPSTEIN. Leslie Francis, being duly sworn, says that she is the PRINCIPAL CLERK of the Publisher of the NEW YORK LAW JOURNAL, a Daily Newspaper, that the Advertisement hereto annexed has been published in the said NEW YORK LA OURN one time on the 5th day of January, 200 TO WIT: JANUARY 5, 2001 SWORN TO BEFORE ME, this 5th day Of Janu Christine A. Allen Notary Public, State of New York . No. 0IAL5072870 . 'Qualified in Nassau County Commission Expires Feb.10, 2001 } ; EFTA00192343 L) EFTA00192344 THE C.O.U.Q. FOUNDATION 13-3996471 Y/E 02/29/00 FORM 990PF STATEMENT 1 FART L LINE 1 CONTRIBUTIONS RECEIVED Jeffrey E. Epstein 6100 Red Hook Quarters #2 St. Thomas, VI 00802 John J. Hannan William Mack do Apollo Management, LP Leon Black do A ollo Mana ement, LP 75,000 166,667 166,666 166,667 575,000 STATEMENT 2 TART I. LINE 23 OTHER EXPENSES Bank Charges 21 Research 75,000 Filing Fees 619 Health Insurance 3,436 Miscellaneous 25 Office Expense 850 Payroll Expense 1,402 Telephone 2,758 Total 84,111 EFTA00192345 ..) EFTA00192346 THE C.O.U.Q. FOUNDATION 13-3996471 WE 02/29/00 FORM 990PF STATEMENT 3 PART II. LINE 10(b) JNVESTMENTS, CORPORATE STOCK 13ook Value Market Value 7,650 SH AT&T 405,581 343,294 STATEMENT 4 PART XV. LINE 3 CONTRIBUTIONS PAD) 05/03/99 World Economic Forum $3,000 EFTA00192347 LJ EFTA00192348 EFTA00192349 U EFTA00192350 EFTA00192351 U ..J EFTA00192352 EFTA00192353 \ .1 Li L.1 EFTA00192354 EFTA00192355 \.J EFTA00192356 EFTA00192357 ..) U EFTA00192358 EFTA00192359 Li ..) EFTA00192360 EFTA00192361 U EFTA00192362 EFTA00192363 ..) EFTA00192364 EFTA00192365 U ..d ..1 EFTA00192366 EFTA00192367 EFTA00192368 EFTA00192369 U ..) EFTA00192370 EFTA00192371 EFTA00192372 EFTA00192373 J EFTA00192374 S THE C.O.U.Q. FOUNDATION 13-3996471 Y/E 02/28/01 FORM 990PF PART I. IJNE 21 OTHER EXPENSES Bank Charges 36 Consulting & Research 50,000 Filing Fees 180 Health Insurance 3,974 Office Expense 145 Payroll Expense 1,284 Telephone 226 Total 55,845 PART II. LINE 101b1 JNYESTMENTS. CORPORATE STOCK 2,100 SH AT&T Book Value Market Value 111,329 44,100 PART XV. LINE 1 CONTRIBUTIONS PAID 07/06/00 World Economic Forum 05/04/00 Ionia, Inc. Total $50,000 $50,000 $100,000 STATEMENT 1 STATEMENT 2 STATEMENT 3 EFTA00192375 LI ..1 ..1 EFTA00192376 EFTA00192377 EFTA00192378 EFTA00192379 KJ Li EFTA00192380 EFTA00192381 ..) L. EFTA00192382 EFTA00192383 cJ ..1 ..J EFTA00192384 EFTA00192385 LI EFTA00192386 EFTA00192387 EFTA00192388 EFTA00192389 EFTA00192390 EFTA00192391 U EFTA00192392 EFTA00192393 ..f EFTA00192394 EFTA00192395 EFTA00192396 EFTA00192397 EFTA00192398 EFTA00192399 EFTA00192400 THE C.O.U.Q. FOUNDATION, INC. 13-3996471 FORM 990-PF - Y/E 2/28/02 STATEMENT 1 Part 1. Line I and Part VU-A. Line 10 Comnbutmns Received From Leslie H Wexner, as Grantor of The Wexner Children's Trust 600,000 shares of Too, Inc common stock having a market value of $11,205,000 at date of gift recorded on the Foundation's books at the donor's basis EFTA00192401 U ..) EFTA00192402 THE C.O.U.Q. FOUNDATION STATEMENT 13-3996471 FORM 990-PF - Y/E 2/28/02 PART 1. LINE 23 OTHER EXPENSES Bank Charges 85 Consulting & Research 50,000 Filing Fees 419 Office Expense 305 Total 50,809 EFTA00192403 EFTA00192404 THE C.O.U.Q. FOUNDATION, INC. 13-3996471 FORM 990-PF - Y/E 2/28/02 STATEMENT 3 PART IV, CAPITAL GAINS AND LOSSES Number of Shares Descnpuon How Acquired Date Acquired Date Sold Sales Price Cost Gain (Loss) 2,000 Too, Inc D 4123/01 4/22/01 38,939 1 38,938 23,000 Too, Inc D 4/23/01 4/27/01 444,802 2 444,800 3,200 Too, Inc D 4123/01 5/2/01 63,901 1 63,900 50,000 Too, Inc D 4/23/01 5/8/01 932,799 3 932,796 15,700 Too, Inc D 423/01 5/10/01 297,830 2 297,828 18,800 Too, Inc D 4/23/01 5/10/01 353,692 3 353,689 70,000 Too, Inc D 4/23/01 5/16/01 1,333,687 3 1,333,684 17,300 Too, Inc D 4/23/01 5/17/01 365,487 2 365,485 2,100 AT&T P 6/8/99 5/21/01 44,883 111,329 -66,446 100,000 Too, Inc D 4/23/01 5/24/01 2,433,051 5 2,433,046 143,600 Too, Inc D 4/23/01 5/31/01 3,321,141 5 3,321,136 136,200 Too, Inc D 4/23/01 6/6/01 3 583 100 5 3 583 095 13,213,312 111,361 13 101 951 EFTA00192405 \-1 ..) EFTA00192406 THE C.O.U.Q. FOUNDATION, INC.. 13-3996471 FORM 990-PF Y/E 2/28/02 STATEMENT 4 PART 1, LINE 25 AND PART LINE 3 CONTRIBUTIONS PAID UNRESTRICTED 6/11/01 University of Maryland 50,000 6/15/01 Institute of Advanced Study 400,000 6/21/01 Nelson Mandela Children's Fund 50,000 7/27/01 UNM Foundation 100,000 8/24/01 Edge Foundation 25,000 10/2/01 Ackerman Institute for the Family 10,000 10/9/01 The Pr= for Promise 50,000 10/9/01 New York University School of Medicine 10,000 12/20/01 Harvard University 125,000 2/28/01 The Prize for Promise 25.000 845,000 EFTA00192407 ..J U EFTA00192408 EFTA00192409 EFTA00192410 EFTA00192411 Li ..) EFTA00192412 EFTA00192413 ..) EFTA00192414 EFTA00192415 EFTA00192416 EFTA00192417 U ..) EFTA00192418 EFTA00192419 U L.i EFTA00192420 EFTA00192421 L.) L.) U EFTA00192422 EFTA00192423 U U U EFTA00192424 EFTA00192425 \-1 EFTA00192426 EFTA00192427 Li EFTA00192428 EFTA00192429 ..i EFTA00192430 EFTA00192431 U Li EFTA00192432 EFTA00192433 U Li EFTA00192434 THE C.O.U.Q. FOUNDATION 13-3996471 FORM 990-PF -Y/E 02/28/03 STATEMENT 1 PART I, LINE 23 OTHER EXPENSES Bank Charges Filing Fees 60 855 Total 915 EFTA00192435 U EFTA00192436 THE C.O.U.Q. FOUNDATION, INC.. 13-3996471 FORM 990-PE Y/E 2/28/03 STATEMENT 2 PART 1, LINE 25 AND PART LINE 3 CONTRIBUTIONS PAID UNRESTRICTED -CASH 5/6/02 Stockholm School of Economics 25,000 5/6/02 Santa Fe Institute 50,000 5/14/02 Engines for Education 62,500 5/28/02 The Prize for Promise 10,000 5/30/02 Harvard University 200,000 6/20/02 Engines for Education 62,500 9/3/02 Council on Foreign Relations 25,000 9/3/02 Trilateral Commission 25,000 9/5/02 New York University 7,000 9/9/02 The Prize for Promise 71,000 9/11/02 Santa Fe Institute 100,000 9/23/02 Massachusetts Institute of Technology 100,000 10/4/02 Ballet Florida 15,000 11/11/02 The Schneider Fund 7,000 2/1/03 Neurosciences Research Foundation, Inc. 250,000 2/7/03 The Dalton School 75,000 2/19/03 Harvard University 110,000 2/25/03 Edge Foundation, Inc. 50,000 1,245,000 EFTA00192437 L) L.) EFTA00192438 EFTA00192439 V L.) EFTA00192440 EFTA00192441 l.) L.) EFTA00192442 EFTA00192443 EFTA00192444 EFTA00192445 EFTA00192446 EFTA00192447 l) 0 EFTA00192448 EFTA00192449 U EFTA00192450 EFTA00192451 U Li EFTA00192452 EFTA00192453 ..1 EFTA00192454 EFTA00192455 ..) L.) EFTA00192456 EFTA00192457 Lid ..) EFTA00192458 EFTA00192459 EFTA00192460 EFTA00192461 c.i ..) EFTA00192462 EFTA00192463 U U U EFTA00192464 EFTA00192465 ..) EFTA00192466 EFTA00192467 ..1 EFTA00192468 EFTA00192469 I' EFTA00192470 EFTA00192471 L) L) L.) EFTA00192472 EFTA00192473 L.) U U EFTA00192474 n„„...0a112.70001' pea 2 • If you are filing for an Additional (not automatic) 3-Month Extension, complete only Part II and check this box ap,. Note: Only complete Part Elf you hove already been granted an automatic 3-month extension on a previously filed Form OVA • If ou are filing for an Automatic 3-Month Extension, complete only Part I (on page ). Part II Additional (not automatic) 3-Month Extension of Time - Must File Od anal and One Copy. Type or print File by IM toxiende* due Oaks sat Piing the ZIP code For a foreign address. see instructions whim See insituCiattl Check type of return to be filed (File a separate application for each return) Form 990 Form 990-EZ Form 990-T (sec 401(a) or 408(a) trust) Form 1041-A Form 52270 Form 8870 Form 990-91. X Form 990-PF _ Form 990-T (trust other than above) Form 4720 Form 6069 STOP: Do not complete Part II if you were not already granted an automatic 3-month extension on a previously flied Form 8868. Name of Exempt Orgivilrauxi THE C .0.0 .Q . FOUNDATION, INC. Number. street. and morn or state no. If a P.O. tot see instructions C/O GEORGE V. DELSON ASSOCIATES • If the organization does not have an office or place of business in the linked States, check this box • if this is for a Group Return, enter the or ionization's four digit Group Exemption Number (GEN) if this Is for the whole group. chock this box ► if it is for part of the group. check this box ► Li and attach a list with the names and EINs of all members the extension is for. 4 I request an additional 3-month extension of time untd January 15, 2005 5 For calendar year or other tax year beginning March 1, 2003 and ending February 29, 2004 6 If this tax year is for less than 12 months, check reason U Initial return U Final return U Change in accounting puled 7 State in detail why you need the extension Certain information necessary for the proper completion of the return is not yet available. 8a If this application is for Form 990-81, 990-PF, 990.T. 4720, or 6069, enter the tentative tax. !ass any nonrefundable credits See instruction f 5,000 b If this application is for Form 990-PF, 990-T. 4720. or 6069, enter any refundable credits and estimated tax payments made. Include any prior year overpayment allowed as a credit and any amount paid previously with Form 8868 $ 5,000 c Balance Due. Subtract line 80 from line 8a. Include your payment with this form, or, if required, deposit with FTD coupon or, if required, by using EFTPS (Electronic Federal Tax Payment System) See instructions 0 IttAPPR0VED S bee Signature and Verification penetes 01 peljury. I d Millen exarneted the form. including aCcOnteernfoe IfeettMet and Stfilietenles and 10 IS best ot my knneloOos and bullet corfsfe OCT 2 5 2004 ... 4 7/"</te.. - - -• - - - - - .... Title IP a a llotice to Applicant - To Be Completed by the IRS We have approved this application. Please attach this form to the organization's return. We have not approved this application. However, we have granted a 10-day grace period from the later of the date shown below or the due date or the organization's return (Including any prior extensions). This grace period is considered to be efittleffildifingpIR0VEDions otherwise required to be made on a timely return. Please attach this form to the organisation's return. We have not approved this application. After considering the reasons stated in item 7. we cannot grant your reftert y r Mural of time to file We are not granting a 10-day grace period. i, We cannot consider this application because it was filed after the due dale of the return for which an Gdansk wirlabeit .. Other flteettlatiG :ltr I te ...v.v. By COITele. . loft Madam anew:mod to omen me brill .Lj emo( t T N Alternate Melling Address - Enter the address if you want the copy of this application for an additional 3-month extension returned to an address different than the one entered above. Name George V. Deleon Associates Type or print $A 3111055 000 'lul':lt'1'.'Iue•ll'xim'tI':l lril., 1Number and street (Inckide suite, room, or apt. no.) Or a P.O. box number country (including postal or ZIP code) roll 8868 (12-2000) EFTA00192475 Li EFTA00192476 EFTA00192477 I EFTA00192478 EFTA00192479 C..i Lii EFTA00192480 EFTA00192481 ..1 EFTA00192482 EFTA00192483 ..) EFTA00192484 EFTA00192485 U u U EFTA00192486 EFTA00192487 EFTA00192488 EFTA00192489 LI Li EFTA00192490 EFTA00192491 U EFTA00192492 EFTA00192493 Li ..J EFTA00192494 EFTA00192495 ..1 EFTA00192496 EFTA00192497 _ L, EFTA00192498 EFTA00192499 Li Li U EFTA00192500 EFTA00192501 EFTA00192502 EFTA00192503 Li Li LI EFTA00192504 EFTA00192505 L., U EFTA00192506 EFTA00192507 Li Li ..) EFTA00192508 EFTA00192509 Li Li Li EFTA00192510 EFTA00192511 U Li EFTA00192512 Form lea (17.7000)' • If you are filing for an Additional Mot automatic) 3-Month Extension, complete only Part N and check this box pi. X Note: Only complete Part Nil you have already been granted an automatic 3-month extension on a previously filed Form 886& you are filing for an Automatic 3-Month Extension, complete only Pert I (on page I). Additional (not automatic) 3-Month Extension of Time - Must File Original and One Copy. Type or print F le by the dIilet e date Ming the See Name of Exempt CMPltalal THE C . 0 . U.Q . FOUNDATION, INC. NSW member Number. street. and room or state no. If a P.O. box see instmcnons GEORGE V. DELSON ASSOCIATES, : Fix IRS use arty ,C/O Cdy. ffice. 2IP Fora for InstructionsS • -. tovm or post o state, and code address. see two instructions RCheck type of return to be filed (Fie a separate application for each return) Form 990 Form 990-EZ Form 990-1 (sec 401(e) or 408(a) trust) Form 990-BL X Form 990-PF Form 990.1 (trust other than above) Form 1041-A Form 4720 Form 52270 Form 8870 Form 6069 STOP: Do not complete Part II if you were not already granted an automatic 3-month extension on a previously filed Form 8868. • If the organization does not have an office or place of business in the United Slates, check this box • If this is for a Group Return, enter the olgapization's four digit Group Exemption Number (GEN) If thus is for the whole group, check this box M If it is for part of the group, check this box lei U and attache fist with me names and EINs of all members the extension is for 4 I request an additional 3-month extension of time unto January 15, 2005 5 For calendar year , or other tax year beginning March 1, 2003 and ending February 29, 2004 6 If this tax year is for less than 12 months. Check reason' j Initial return U Final return LI Change in accounting period 7 State in detail why you need the extension Certain information necessary for the proper completion of the return is not yet available. Ba If this application is for Form 990-BL. 990-PF, 990-T. 4720, or 6069, enter the tentative tax, less any nonrefundable credits See Instructions b If this application is for Form 990-PF, 990-1. 4720, or 6069. enter any refundable credits and estimated tax payments made. Include any prior year overpayment allowed as a credit and any amount paid previously with Form 8868 5, 000 c Balance Due. Subtract line 8b from line 8a. Include your payment with this form, or, if required, deposit with ETD coupon or, if required, by using EFTPS (Electronic Federal Tax Payment System). See instructions 5,000 Signature and Verification affit8ttAAPPNOW:5 Undo( penalties of perjury. 1 dacha Wig I haw examined this form, including accompanying schoduko and sucvnents anti lo ire Pest 01 ny An‘9,100ye anC Daley OCT 2 5 2004 it is Clue. correct. end c . and 19911arn authcnrod 10 prepare thn Icon Sg lure le toe ► GM stemssi Notice to Applicant - To Be Completed by the IRS We have approved this application. Please attach this form to the organization's return. We have not approved this application. However, we have granted a 10-day grace period from the later of the date shown below or the due dale of the organization's return (including any prier extensions). This grace period is considered to be otherwise required to be made on a timely return. Please attach this tom to the crowdances return. We have not approved this application. Alter considering the reasons slated in Item 7. we cannot grant your Titer if 2fitRion 0 time to file. We are not granting a 10-day grate period. We cannot consider this application because it was filed alter the due date of the return fix which an egens whIGNIu9II Other lUINE?:# 4,1t4WWMGI I BY 1 (." %.. ifjD:. Alternate Mailing Address - Enter the address if you want the copy of this application for an additional 3-month extension returned to an address different than the one entered above. Dade:t. afttfINSVPROVEirrns Typo or print Ise sr loss I clod Name George V. Deleon Associates room, or apt. no.) Or • P.O. box number and country (including postal or ZIP code) Form 8668 (12.20%) EFTA00192513 Li Li EFTA00192514 EFTA00192515 Li L. EFTA00192516 EFTA00192517 Li EFTA00192518 EFTA00192519 Li Li EFTA00192520 EFTA00192521 Li Li EFTA00192522 EFTA00192523 Li Li EFTA00192524 EFTA00192525 U EFTA00192526 EFTA00192527 .) EFTA00192528 EFTA00192529 EFTA00192530 EFTA00192531 U EFTA00192532 EFTA00192533 I-, EFTA00192534 EFTA00192535 U ..1 EFTA00192536 EFTA00192537 ..) EFTA00192538 EFTA00192539 ..i EFTA00192540 EFTA00192541 Li EFTA00192542 EFTA00192543 Li EFTA00192544 EFTA00192545 Li Li EFTA00192546 EFTA00192547 .., ..1 EFTA00192548 Form 8%6 eft 17-700ft • If you we filing for an Additional (not automatic) 3-Month Extension, complete only Part II and check this box h Note. Only complete Part II if you have already been granted an automatic 3-month extension on a previously hied Form 8868. • tf you are filing for an Automatic 3-Month Extension, complete only Part I (on page C. Additional (not automatic) 3-Month Extension of Time—Must File Original and One Copy. Type or Name of Exempt Organization ..*'.tV- number print The C.O.U.G Foundation. Inc. et: ;Joey V. blended cks deb tor c/o George V. Debson Associat llIM Number, street, an a room suite i 'ructions z Or use on ,. & fame the Sete. ern 21P Cede For address. see nstructicns ,,-77rekm See r: wetwelOW Check type of return to be filed (File a separate application for each return). O Form 990 O Form 990-BL O Fonn 990-EZ (Z) Form 990.PF STOP: Do not complete Part II if you were not already granted an automatic 3-month extension on a previously pled Fenn 8868. • The books are In Telephone No. ► FAX No P • If the organization does not have an office or place of business In the United States. check the box P 0 • It this is for a Group Return, enter the organization's four digit Group Exemption Number (GEN) If this is for the whole group. check this box h D. If 4 is for part of the gr0Up, check this box W 0 and attach a list with the names and EINs of all members the extension is for Pop 2 O Form 990-T (sec. 401(a) or 408(a) trust) O Form 990-T (trust other than above) O Form 1041-A O Form 4720 O Form 5227 O Form 6069 O Form 8870 4 I request an additional 3-month extension of time until January( 15 , gg 06 5 For calendar yew .... .. or other tax year beginning . March 1 20.9.5 . 20 04 and ending February 28 6 If this tax year is for less than 12 months, check reason. 0 Initial return 0 Final return 0 Change in accounting period 7 State in detail why you need the extension Certain information necessary for the proper completion of the return is not yet available. Ilia If this application is for Form 990-BL, 990-PF, 990.7, 4720, or 6069, enter the tentative tax. less any nonrefundable credits. See Instructions b If this application is for Form 990-PF, 990-T. 4720, or 6069, enter any refundable credits and estimated tax payments made. Include any p