Form 990-PF ~ Return of Private Foundation 2004990s.foundationcenter.org/990pf_pdf_archive/134/134112185/134112185... · 7 Total credits and payments. Add lines 6a through 6d 8 Enter

Form 990-PF ~ Return of Private Foundation or Section 4947(a)(1) Nonexempt Charitable Trust

Treated as a Private Foundation ation may be able to use a copy of this return to satisfy state reporting requirements

OMB No 1545-0052

2004 Department of the Treasury Internal Revenue Service Note : The orgy

or tax vear beainn For calendar and endin

Use the IRS Name of organization A Employer identification number label .

Otherwise, PETER AND HELEN HAJE FOUNDATION 13-4112185 print Number and street (or P O box number if mail is not delivered to street address) Room/suite B Telephone number

ortype . 44 WEST 77TH STREET 14W 212-275-1500 See Specific Instructions . City or town, state, and ZIP code C If exemption application is pending, check nee 1

NEW YORK NY 1002 4 D 1 . Foreign organizations, check here 10. 0 the = H Check type of organization: ~ Section 501(c)(3) exempt private foundation 2' Foreign ~`e organiz a tions

comtpuf at on 5% test, , =1 Section 4947(a)(1) nonexempt charitable trust [] Other taxable private foundation

E If private foundation status was terminated I Fair market value of all assets at end of year J Accounting method : DO Cash 0 Accrual under section 507(b)(1)(A), check here 1D (from Part Il, co/ (c), line 16) = Other (specify) F If the foundation is m a 60-month termination

$ 9 2 0 4 3 8 7 . (Part l, column (d) must be on cash basis .) under section 507(b )( 1 B ) , check here Part I Analysis of Revenue and Expenses d Disbursements

(The total of amounts in columns (b), (c), and (d) may not (a) Revenue and (b) Net investment (c) Adjusted net for charitable purposes necessarily equal the amounts in column (a)) expenses per books income income (cash basis only)

1 Contributions, gifts, grants, etc., received N/A Q Cneck o*M d the foundahon is not required to attach Sch B

Intere st ~d

temporary 65 , 342 . 65 , 342 . STATEMENT 1 4 Dividends and interest from securities 44 , 471 . 44 , 471 . STATEMENT 2 5a Gross rents

Net rental income or (loss) Nat gain or (loss) from sale of assets not on 6a line 10 ~ 713 , 707 .

7 Gross sales price for all y b assets on line ea 713 ,7 0 7

Capital pain net income (from Part IV, line 2) 713 , 707 . cc 8 Net short-term capital gam I.~1

9 Income modifications Gross sales less returns 10a and allowances Lass Cast of goods sold

c Gross profit or (loss) 11 Other income 80 , 836 . 80 , 836 . STATEMENT 3 12 Total . Add lines 1 through 11 904 , 356 . 904 , 356 . 13 Compensation of officers, directors, trustees, etc 0 . 0 . - 0 .

14 Other employee salaries and wages y 15 Pension plans, employee benefits y 16a Legal fees a b Accounting fees STMT 4 33 , 208 . 33 , 208 . ~ 0 . W c Other professional fees S > 17 Interest 2 18 Taxes STMT 5 21 , 626 . 21 , 626 . 0 . ~ 19 Depreciation and depletion " L\ . 4

E 20 Occupancy a 21 Travel, conferences, and meetings

22 Printing and publications ~ 23 other expenses STMT 6 34 , 826 . 34 , 826 . 4,, Ir 0 . 0 24 Total operating and administrative yv~"

expenses . Add lines 13 through 23 89 , 660 . 89 , 660 . CL X 0 . 0 25 Contributions, gifts, grants paid 6 6 5 0 0 0 . 665 , 000 .

26 Total expenses and disbursements . Addlines 24and25 754 660 . 89 , 660 . 665 000 .

27 Subtract line 26 from line 12: 3 Excess of revenue over expenses and disbursements 149 , 696 .

b Net investment income (if negative, enter -o-> 814 , 696 . 1 c Adjusted net income (if negative, enter -o-) N/A

LHA For Privacy Act and Paperwork Reduction Act Notice, see the instructions . Form 990-PF (2004) 423501 01-03-05

1 ID 10491110 350288 HAJE 2004 .06030 PETER AND HELEN HAJE FOUNDA HAJE1

Beginning of year (a) Book Value

75

7

Organizations that follow SFAS 117, check here " U and complete lines 24 through 26 and lines 30 and 31 .

N 24 Unrestricted 25 Temporarily restricted .

m 26 Permanently restricted Organizations that do not follow SFAS 117, check here

U- and complete lines 27 through 31 . .. N 27 Capital stock, trust principal, or current funds a+ °y' 28 Paid-in or capital surplus, or land, bldg ., and equipment fund a 29 Retained earnings, accumulated income, endowment, or other funds .. Z 30 Total net assets or fund balances , .

0 . 0 7,833,163 .

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)

2 Enter amount from Part 1, line 27a 3 Other increases not included m line 2 (itemize) " -4 Add lines 1, 2, and 3 5 Decreases not included in line 2 (itemize) " AMORTIZATION / ACCRETION OF BONDS s Total net assets or fund balances at end of vear (line 4 ~mnus line 51- Part II, column (b). line 30

Form 990-PF (2004)

2

10491110 350288 HAJE 2004 .06030 PETER AND HELEN HAJE FOUNDA HAJE 1

Form 990-PF (2004) PETER AND HELIEN HAJE F

Part 11 Balance Sheets Attached schedulesand amourtsinthadescnpBon column should befor end-ot-y~~aramounts only

1 Cash - non-interest-bearing 2 Savings and temporary cash investments 3 Accounts receivable

Less: allowance for doubtful accounts 4 Pledges receivable Ill

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 1

Less: allowance for doubtful accounts Y 8 Inventories for sale or use N y 9 Prepaid expenses and deferred charges a 10a Investments -U.S. and state government obligations STMT 7

b Investments - corporate stock STMT 8 c Investments - corporate bonds , STMT 9

11 investments -Wnd,hulldinqs,and equipment basis 1

Less accumulated depreciation 10. 12 Investments-mortgage loans 13 Investments-other . . . . STMT 10 14 Land, buildings, and equipment basis

Less accumulated depreciation 1110 15 Other assets (describe

17 Accounts payable and accrued expenses 18 Grants payable 19 Deferred revenue . _ 20 Loans horn officers, directors, trustees, and other disqualified persons

m 21 Mortgages and other notes payable . _ "~ 22 Other liabilities (describe 1

607 163

13-4112185 Page 2 End of year

b) Book Value (c) Fair Market Value

1 , 093 , 733 . 1 , 093 , 733 .

4 . 4 .

228 028 . 220 994 . 2 , 343 , 164 . 3 , 138 , 514 .

445 641 . 434 543 .

3 , 863 , 688 . 4 , 316 , 599 .

258 .1 9,204,387

423511 01-03-0S

Form s90-PF (2004) 1 PETER AND HELEN HAJE FOUNDATION 13-4112185 Pal Part IV Capital Gains and Losses for T ax on Investment Income

(a) List and describe the kind(s) of propel ty sold (e .g ., real estate, (bLHow acqwred (c Date acquired (d) Date sold 2-story brick warehouse; or common stock, 200 shs . MLC Co .) ~' - Purchase No., day, yr.) (mo., day, yr .) D - Donation

is b SEE ATTACHED STATEMENT c d e

(e) Gross sales price (f) Depreciation allowed (g) Cost or other basis (h) Gam or (loss) (or allowable) plus expense of sale (e) plus (f) minus (g)

m column (h) and owned by the foundation on 12/31/69 (j) Adjusted basis (k) Excess of col . (i) as of 12/31/E9 over col. (1), if any

a

If am, also enter in Part I, line 7 2 Capital gam net income or (net capital loss) . t Ifloss), enter -0- m Part I, line 7 ~ .

3 Net short-term capital gam or (loss) as defined m sections 1222(5) and (6): If pain, also enter m Part I, line 8, column (c) . If (loss) . enter -0- in Part 1 . line 8

7

I Part V I Qualification Under Section 4:114O(e) for Reduced Tax on Net Investment Income

(For optional use by domestic private foundations subject to the section 4940(a) tax on net investment income .)

If section 4940(4)(2) applies, leave this part blank.

Was the organization liable for the section 4942 tax on the distributable amount of any year m the base period? Yes [f) No If 'Yes,'the orpan¢ation does not qualify under section 4940(e) . Do not complete this part . 1 Enter the appropriate amount m each column for each year ; see instructions before making any entries.

Base per od years Adjusted ~aualifying distributions Net value of noncha)ritable-use assets Distribution ratio Calendar vear for tax year beainmno in) (col. (b) divided by col. (c)1

626,000 . 1 ~ V V 1 V J'! V

.4329507

.6353722

.1588431

9,329,708 .

1,481,960 .

8,147 .

2 Total of line 1, column (d) 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 m existence d less than 5 years

4 Enter the net value of noncharnable-use assets for 2004 from Part X, line 5

5 Multiply line 4 by line 3 .

6 Enter 1% of net investment income (1% of Part 1, line 2 7b)

7 Add lines 5 and 6

B Enter qualifying distributions from Part XII, line 4

If line 8 is equal to or greater than line 7, check the box m Part VI, line ib, and complete that part using a 1% tax rate. See the Part VI instructions.

423521/01-03-OS Form 990-PF (2004) 3


e 713,707 .1 Complete only for assets showin

(i) F.M .V. as of 12/31/69

713,707 . (I) Gams (Col. (h) gam minus

col. (k), but not less than -0-) or Losses (from col . (h))

1

Form 990-PF (2004) PETER AND HEL EN HAJE FOUNDATION Part VI Excise Tax Based on Investment Income (Section 4940(a), 4940(b), 4940(e), or q

1a Exempt operating foundations described in section 4!)40(4)(2), check here 10 and enter "N/A' on line 1 .

Date of ruling letter: (attach copy of ruling letter if necessary-see instructions) b Domestic organizations that meet the section 4940(e} requirements in Part V, check here " 0 and enter 1% of Part 1, line 27b

c All other domestic organizations enter 2% of line 27b Exempt foreign organizations enter 4% of Part 1, line 12, col . (b)

2 Tax under section 511 (domestic section 4947(a)(1) rusts and taxable foundations only. Others enter -0-)

3 Add lines 1 and 2 4 Subtitle A (income) tax (domestic section 4947(a)(1) trusts and taxable foundations only. Others enter -0-)

5 Tax based nn investment income . Subtract line 4 from line 3. If zero or less, enter -0-

6 Credits/Payments : . a 2004 estimated tax payments and 2003 overpayment credited to 2004 6a 1,981

b Exempt foreign organizations - tax withheld at source 6b c Tax paid with application for extension of time to file (Form 8868) 6c 25 , 000 . d Backup withholding erroneously withheld 6d

7 Total credits and payments. Add lines 6a through 6d 8 Enter any penalty for underpayment of estimated tax. Check here El if Form 2220 is attached

9 Tax due . If the total of lines 5 and 8 is more than line 7, enter amount owed . . . 00. 10 Overpayment. If line 7 is more than the total of lines 15 and 8, enter the amount overpaid 00.

I Refunded 1 11 Enter the amount of line 10 to be : Credited to 2005 e: ;timated tax 1 10 , 3 0 0 .1

Part VII-A Statements Regarding Activities

t - see

16 .294 .

4 .

11 Did the organization comply with the public inspection requirements for its annual returns and exemption application? 11

4 10491110 3 .̀10288 HAJE 2004 .06030 PETER AND HELEN HAJE FOLTNDA HAJE 1

1a During the tax year, did the organization attempt to influence any national, state, or local legislation or did it participate or intervene m

any political campaign? . , b Did it spend more than $100 during the year (either directly or indirectly) for political purposes (see instructions for definition)?

If the answer is 'Yes' to 1a or 1b, attach a deladed description of the activities and copies of any materials published or distributed by the organ¢ation in connection with the activities .

c Did the organization file Form 1120-POL for this year d Enter the amount (if any) of tax on political expenditures (section 4955) imposed during the year :

(1) On the organization . " $ 0 . (2) On organization managers. t$ 0 . e Enter the reimbursement (rf any) paid by the organration during the year for political expenditure tax imposed on organization

managers. " $ 0 . 2 Has the organization engaged m any activities that have not previously been reported to the IRS?

If "Yes," attach a detailed description of the activities.

3 Has the organization made any changes, not previou : :ly reported to the IRS, m its governing instrument, articles of incorporation, or bylaws, or other similar instruments? If 'Yes,' attach a conformed copy o/ the changes

4a Did the organization have unrelated business gross income of $1,000 or more during the year? b If 'Yes,* has it filed a tax return on Form 990-T for thF, years _ N/A 5 Was there a liquidation, termination, dissolution, or substantial contraction during the year?

If "Yes," attach the statement required by General Instruction T.

6 Are the requirements of section 508(e) (relating to sections 4941 through 4945) satisfied either : " By language m 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 m the governing instrument? 7 Did the organization have at least $5,000 m assets at any time during the year?

If "Yes,' complete Part ll, coL (c), and Part XV. 8a Enter the states to which the foundation reports or with which it is registered (see instructions) NEW YORK

b If the answer is 'Yes' to line 7, has the organization furnished a copy of Form 990-PF to the Attorney General (or designate) of each state as required by General Instruction G? It "No, " attach explanation

9 Is the organization claiming status as a private operating foundation within the meaning of section 4942(j)(3) or 4942(j)(5) for calendar year 2004 or the taxable year beginning m 2004 (see instructions for Part XIV)? 1/ "Yes, ° complete Part XIV

10 Did any persons become substantial contributors dw trig the tax years it "Yes," attach a schedule listing their names and addresses

1b X

is X

2 X

3 IX

Web site address " N/A 12 The books are in care of " TAG ASSOCIATES, LLC Telephone no . " 212 - 2 7 5 -15 0 0

located at " 7 5 ROCKEFELLER PLAZA SUITE 900, NEW YORK, NY ZIP+4 .10 019 13 Section 4947(a)(1) nonexempt charitable trusts filing Form 990-PF m lieu of Form 1041- Check here " 0

and enter the amount of tax-exempt interest received or accrued during the veer 10- 1 13 ~ N/A

of 3 oos Form 990-PF (2004)

3b

b Did the organization, during the year, pay premiums directly or indirectly, on a personal benefit contract? If you answered "Yes' to 6b . also file Form 88i'0.

X

Form 990-PF (2004)

Form 990-PF (2004) PETER AND HELEN HAJE FOUNDATION 13 - 41 ; 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 . 1a During the year did the organization (either directly or indirectly):

(1) Engage m the sale or exchange, or leasing of prop~:rty with a disqualified persons ED Yes EY] No (2) Borrow money from, lend money to, or otherwise ;xtend credit to (or accept it from)

a disqualified persons ~ Yes ERI No (3) Furnish goods, services, or facilities to (or accept ihem from) a disqualified persons ~ Yes EY1 No (4) Pay compensation to, or pay or reimburse the expenses of, a disqualified person? 0 Yes Ef] No (5) Transfer any income or assets to a disqualified pet son (or make any of either available

for the benefit or use of a disqualified person) ~ Yes EY] No (6) Agree to pay money or property to a government official? (Exception . Check 'No"

if the organization 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 EY1 No

b If any answer is "Yes" to 1a(1)-(6), did any of the acts lad to qualify under the exceptions described m Regulations section 53 .4941(d)-3 or m a current notice regarding disaster assistance (see page 20 of the instructions)? N/A Organizations relying on a current notice regarding disaster assistance check here No. Li

c Did the organization engage m a prior year m any of the acts described m 1a, other than excepted acts, that were not corrected before the first day of the tax year beginning m 2004? _ _ . .,

2 Taxes on failure to distribute income (section 4942) (does not apply for years the organization was a private operating foundation defined in section 4942(j)(3) or 4942(j)(5)):

a At the end of tax year 2004, did the organization have any undistributed income (lines 6d and 6e, Part XIII) for tax year(s) beginning before 2004? 0 Yes EKI No It 'Yes,' list the years

b Are there any years listed in 2a for which the organiza! ion 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

c If the provisions of section 4942(a)(2) are being appli ;d to any of the years listed m 2a, list the years here.

3a Did the organization hold more than a 2% direct or indirect interest m any business enterprise at any time during the years ~ Yes 5D No

b If 'Yes," did it have excess business holdings m 2004 as a result of (1) any purchase by the organization or disqualified persons after May 26,1969; (2) the lapse of the 5-year period (or longer period approved by the Commissioner under section 4943(c)(7)) to dispose of holdings acquired by gift or bequest; or (3) the lapse of the 10-,15-, or 20-year first phase holding period? (Use Schedule C, Form 4720, to determine i/ the organization had excess business holdings in 2004 .) N/A

4a Did the organization invest during the year any amount m a manner that would jeopardize its charitable purposes? b Did the organization make any investment m 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 2004? . .

5a During the year did the organization pay or incur any amount to : (1) Carry on propaganda, or otherwise attempt to mlluence legislation (section 4945(e))9 0 Yes [I] No (2) Influence the outcome of any specific public election (see section 4955) ; or to carry on, directly or indirectly,

any voter registration drive? EJ Yes ETO No (3) Provide a grant to an individual for travel, study, or other similar purposes? 0 Yes Eil No (4) Provide a grant to an organization other than a charitable, etc., organization described m section

509(a)(1), (2), or (3), or section 4940(d)(2)9 _ _ = Yes EXI No (5) Provide for any purpose other than religious, c1hirdable, scientific, literary, or educational purposes, or for

the prevention of cruelty to children or animals? _ = Yes Ell No b If any answer is "Yes' to 5a(1)-(5), did any of the transactions fad to qualify under the exceptions described m Regulations

section 53 .4945 or in a current notice regarding disaster assistance (see instructions)? . . . . ., . . . N/A Organizations relying on a current notice regarding disaster assistance check here . . " 0

c If the answer is 'Yes* to question 5a(4), does the organization claim exemption from the tax because it maintained expenditure responsibility for the grants N/A EJ Yes 0 No If 'Yes,' attach the statement required by Regulations section 53.4945-5(d) .

6a Did the organization, during the year, receive any funds, directly or indirectly, to pay premiums on a personal benefit contracts El Yes Ef] No

Page 5

X

X

423541 01-03-OS


CE PRESID

,. . CE PRESIDE ~ , SECRE Y IE HAJE

C/O TAG ASSOCIATES LLC, SUITE 900 NEW YORK, NY 10019 0 I 0 2 Compensation of five highest-paid employees (other than those included on line 1). H none, enter "NONE."

(b1 Title and average (a) Name and address of each employee paid moi e than $50,000 hours per week (c) Compensation

devoted to aosition

Total number of other employees paid over $50,000 3 Five highest-paid independent contractors foi professional services. If none, enter "NONE."

(a) Name and address of each person paid more than $50,000 (b) Type of service

Expenses

4

0 3oa os Form 990-PF (2004) 6


- PETER AND HELEN HAJE FOUNDATION 13-4112185

Part VIII Information About Officers, Directors, Trustees, Foundation Managers, Highly Page s ~ Paid Employees, and Contractors 1 List all officers, directors, trustees, foundation managers and their compensation .

(b) Title, and average (c) Compensation (d~ comr~euuonsio (e) Ex p ense (a) Name and address hours p er week devoted (If not paid, emp enee benefit ieaplans account, other

to position enter-0- compenubon allowances PETER R . HAJE CHAIRMAN

SIDENT, TREASURER

Total number o1 others receiving over $50,000 far profes sional services Part IX-A Summary of Direct Charitable Activities

List the foundation's four largest direct charitable activities during the tax year . Include relevant statistical information such as the number of organizations and other beneficiaries served, conferences convened, research papers produced, etc. 1 N/A

2

3

(e) Ex pense account, other allowances

(c) Compensation

Form 99o-PF (2004) PETER AND HELEN HAJE FOUNDATION 13-4112185 Page 7

Part IX-B Summary of Program-Related Investments

Describe the two largest program-related investments made by the foundation during the tax year on lines 1 and 2 . Amount

2

All other program-related investments. See instructions. 3

11111. Total. Add lines 1 through 3

Part X Minimum investment Return (All domestic foundations must complete this pan. Foreign foundations, see instructions

1 Fair market value of assets not used (or held for use) directly m carrying out charitable, etc., purposes: a Average monthly fair market value of securities . b Average of monthly cash balances c Fair market value of all other assets d Total (add lines 1a, b, and c) . . . e Reduction claimed for blockage or other factors reported on lines la and

Ic (attach detailed explanation) 1e 2 Acquisition indebtedness applicable to line 1 assets _ . 3 Subtract line 2 from line 1d 4 Cash deemed held for charitable activities. Enter 11/2% of line 3 (for greater amount, see instructions) 5 Net value of noncharitable-use assets . Subtract line 4 from line 3. Enter here and on Part V, line 4 6 Minimum investment return . Enter 5% of line 5

1,496,54 3,956,57

Part XI Distributable Amount (see instructions) (Section 4942(1(3) and (j)(5) private operating foundations and certain foreign organizations check here " 0 and do not complete this part .)

f Minimum investment return front Part X, line 6 2a tax on investment income for 2004 from Part VI, line 5 2a 16 , 29 4 . b Income tax for 2044 . (This does not include the tax tram Part VI.) 2b c Add lines 2a and 2b 3 Distnbutable amount before adjustments. Subtract line 2c from line 1 4 Recoveries of amounts treated as qualifying distributions _ . 5 Add lines 3 and 4 6 Deduction from distnbutable amount (see instructions) 7 Distributable amount as adjusted. Subtract line 6 from line 5 . Enter here and on Part XIII, line 1

Part XII Qualifying Distributions (see instructions)

450 .1


1 Amounts paid (including administrative expenses) to ;accomplish charitable, etc., purposes: a Expenses, contributions, gifts, etc. - total from Part I, i :olumn (d), line 26 t o 665 , 000 . b Program-related investments - total from Part IX-B ib 0 .

2 Amounts paid to acquire assets used (or held for use) directly m 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 is through 3b . Enter here and on Part V, fine 8, and Part XIII, line 4 4 665 , 000 . 5 Organizations that qualify under section 4940(e) for the reduced rate of tax on net investment

income. Enter 1% of Part I, line 27b 5 0 . 6 Adjusted qualifying distributions . Subtract line 5 from line 4 ~6 ~ 665,000 .

Note : The amount on line 6 will be used in Part V, column (b), m subsequent years when calculating whether the foundation qualifies for the section 4940(e) reduction of tax in those years .

Form 990-PF (2004)

423581 01-03-OS

Page 8 Form 99o-PF (2004) PETER AND HELIEN HAJE FOUNDATION 13-4112185

Part XIII Undistributed Income see rnsiructions)

~ 3 Excess distributions carryover, if any, to 2004: a From 1999 b From 2000 c From 2001 dFrom 20o2 200 928 . eFrom 20o3 530 000 . f Total of lines 3a through e

4 Qualifying distributions for 2004 from Part XI I, line 4 : 11110- $ 665,000 .

a Applied to 2003, but not more than line 2a . b Applied to undistributed income of prior years (Election required - see instructions)

c Treated as distributions out of corpus Election required-see instructions) .

d Applied to 2004 distributable amount e Remaining amount distributed out of corpus

5 Excess distributions carryover applied to 2004 (I1 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:

8 Corpus Add lines 31, 4c, and 4e Sub4act line 5

b Prior years' undistributed income. Subtract line 4b from line 2b

c Enter the amount of prior years' undistributed income for which a notice of deficiency has been issued, or on which the section 4942(a) tax has been previously assessed

d Subtract line 6c from line 6b . Taxable amount - see instructions

e Undistributed income for 2003. Subtract line 4a from line 2a. Taxable amount- see mstr.

f Undistributed income for 2004. Subtract lines 4d and 5 from line 1 . This amount must be distributed m 2005

7 Amounts treated as distributions out of corpus to satisfy requirements imposed by section 170(b)(1)(E) or 4942(8)(3)

8 Excess distributions carryover from 1999 not applied on line 5 or line 7

9 Excess distributions carryover to 2005 . Subtract lines 7 and 8 from line 6a

10 Analysis of line 9 : a Excess from 2000 b Excess from 2001 c Excess from 2002 d Excess from 2003 280,737 .

V J V V V

0 . 50 , 191 . 450 191 .

45 , 737 .

0 .

0 .

0 .

0 .

0 .

0 .

0 .

45 , 737 .

Form 990-PF (2004)

O

?0491110 350288 HAJE 2004 .06030 PETER AND HELEN HAJE FOUNDA HAJE 1

1 Distnbutable amount for 2004 from Part X1, line 7

2 Undistributed income, if any, as of the end of 2003

a Enter amount for 2003 only . p Total for prior years:

(a) (b) (c) (d) Corpus Years prior to 2003 2003 2004

450 191 .

0 .

730 928 .

0 .

0 .

423571 01-03-OS

Form 990-PF 2004 Part XIV Private fiS (see instructions and Part VII-A, question 9) 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 2004, enter the date of the ruling 00.

Prior 3 years (b) 2003 (c) 2002 (d) 2001 (e) Total

each year listed b 85% of line 2a c qualifying distributions from Part XII,

line 4 for each year listed d Amounts included m 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 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(1)(3)(B)()

b "EndowmenC alternative test - enter 2/3 of minimum investment return shown m Part X, line 6 for each year listed

c 'SupporC 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 m section 4942(1)(3)(B)(oi)

(3) Largest amount of support from an exempt organization

9 10491110 350288 HAJE 2004 .06030 PETER AND HELEN HAJE FOUNDA HAJE 1

b Check box to indicate whether the organization is a nuat 2 a Enter the lesser of the adjusted net Tax year

income from Part I or the minimum (a) 2004

investment return from Part X for

Part ?PV Supplementary Information (Complete this part only if the organization had $5,000 or more in assets at any time during the year-see page 26 of the instructions .)

1 Information Regarding Foundation Managers : a List any managers of the foundation who have contrbuted 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(4)(2) .)

PETER R . HAJE D List any managers of the foundation who own 10% cr more of the stock of a corporation (or an equally large portion of the ownership of a partnership or

other entrry) of which the foundation has a 10% or greater interest.

2 Information Regarding Contribution, Grant, Gift, Loan, Scholarship, etc., Programs Check here " [X-1 if the organization only makes contributions to preselected charitable organizations and does not accept unsolicited requests for funds. It the organization makes gifts, grants, etc . (see instructions) to individuals or organizations under other conditions, complete items 2a, b, c, and d.

a The name, address, and telephone number of the pei son to whom applications should be addressed:

b The form m which applications should be submitted and information and materials they should include :

c Any submission deadlines:

v Any restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other factors:

az3savo1-os-os Form 990-PF (2004)

10

Purpose of grant or contribution Amount

Total 423801/01-03-05

10 2004 .06030 PETER AND HELEN HAJE FOUNDA HAJE 1 10491110 350288 HAJE

Form 990-PF (200'4) PETER AND HELEN HAJE FOUNDATION Fart XV Supplementary Information (continued) 3 Grants and Contributions Paid During the Year or Approved for Future Payment

Recipient If recipient is an individual, -- show any relationship to I Foundation

Name and address (home or business) any foundation manager status of or substantial contributor recipient

a Paid during the year

Total b Approved for future payment

NONE

3a

3b 1 0 . Form 990-PF (2004)

ofo3 os Form 990-PF (2004) 11


Form 990-PF(2004)PETER AND HELEN HAJE FOUNDATION 13-4112185 Page 11

[Paint XVI-A Analysis of Income-Producing Activities

Enter gross amounts unless otherwise indicated. Unrelated business income sxci~dea b section 512, s,s or 514 (a) (b) E~~~�_ (d) Related or exempt

Business Amount Scode '°" Amount function income 1 Program service revenue: code a b c d e f g Fees and contracts from government agencies

2 Membership dues and assessments 3 Interest on savings and temporary cash

investments 14 65 , 342 . 4 Dividends and interest from securities 14 44 , 471 . 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 property

7 Other investment income 01 80 , 836 . 8 Gam or (loss) from sales of assets other

than inventory _ 18 713 , 707 . 9 Net income or (loss) from special events

10 Gross profit or (loss) from sales of inventory 11 Other revenue :

a b c d e

12 Subtotal. Add columns (b), (d), and (e) 0 . 90 4 , 356 . 0 . 13 Total . Add line 12, columns (b), (d), and (e) . . _ 13 90 4 ,356 . Lee worksheet in line 13 instructions to verify calculations.)

Tart XVI-B Relationship of Activities to the Accomplishment of Exempt Purposes

Line No . Explain below how each activity for which income is reported m column (e) of Part XVI-A contributed importantly to the accomplishment of the organization's exempt purposes (other than by providing funds for such purposes) .

Form 990-PF (2004) PETER AND HELEN HAJE FOUNDATION 13-4112185 Page 12 [5iiirt XVII Information Regarding Transfers To and Transactions and Relationships With Noncharitable

Exempt Organizations -- -

1 Did the organization directly or indirectly engage m any of the following with any other organization described m section 501(c) of Yes No

the Code (other than section 501(c)(3) organizations) or m section 527, relating to political organizations? a Transfers from the reporting organization to a nonch 3ritable exempt organization of:

(1) Cash _ 1a( l ) X (2) Other assets la(2) X

b Other transactions: (1) Sales of assets to a nonchantable exempt organization 1b 1 X (2) Purchases of assets from a nonchantable exempt organization 1b 2 X (3) Rental of facilities, equipment, or other assets 1b 3 X (4) Reimbursement arrangements 1b 4 X

1D 5 X (5) Loans or loan guarantees (6) Performance of services or membership or fundraising solicitations 1b 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 assets,

or services given by the reporting organization . If the organization received less than fair market value in any transaction or sharing arrangement, show in

,!a Is the organization directly or indirectly affiliated with, or related to, one or more tax-exempt organizations described m section 501(c) of the Code (other than section 501(c)(3)) or m section 527? E] Yes 0 No

Type of organization Name of oraamzation

ants, and to the best of my knowledge and belief, it is true, correct, has any knowledge

423821 0'i-03-05

2004 .06030 1049'1110 350288 HAJE

Under penalties of penury{I dec that I have x fined ~s re t n, including accompanying schedules and and complete Declaraho then taxpay or fid iary) is ba9ed on all information of hich p

v ~ Signature of officer or trustee D Preparer's' signature 0--c - /~l

0 Flrm'sname (oryours TAG ASSOCIATES, LLC j d self-employed), ' 7 5 ROCKEFELLER PLAZA, 9

a0dress,andZIPcode NFW V(1RK Mr i nnia

Description of relationship

Capital Gains and Losses for Tax on Investment Income (a) List and describe the kind(S) Df property sold, e.g., real estate, 2-story brick warehouse; or common stock, 200 shs. MLC Co.

,,'RGER BERMAN (SEE SCHEDULE ATTACHE -',RGER BERMAN (SEE SCHEDULE ATTACHE ZON CAPITAL ~LON CAPITAL ZON CAPITAL ZON CAPITAL SECTION 1256 ZON CAPITAL SECTION 1256 OF NY - BONDS ON MEZZACAPPA DISPOSAL ~LON CAPITAL

1

P VARIOUS ARI P VARIOUS VARI P (VARIOUS VARI P VARIOUS VARI

(f) Depreciation allowed (g) Cost or other basis (or allowable) plus expense of sale (e) Gross sales price

349,586 . 110,385 . <1,924 . 31,306 .

117,308 . <4,374 . <6,560 . 37,439 .

<15,447 .

m n 0

omplete only for assets showing gam m column (h) and owned by the foundation on 12/31/69

iF M V as of 12/31/69 (1) Adjusted basis (k) Excess of col . (i) as of 12/31/69 over col . (j), if any

(I) bosses (from col. (h)) Gams (excess of col. (h) gain over col . (k),

but not less than'-0-')

349,586 . 110,385 . <1,924 . 31,306 .

117,308 . <4,374 . <6,560 . 37,439 .

d e f

k I m n 0

If Pain, also enter in Part I, line 7 7 2 Capital gain net income or (net capital loss) ~ If loss), enter '-0-" in Part I, line 7 ~ 2 713 , 70

3 Net short-term capital gam or (loss) as defined in sections 1222(5) and (6) : If gam, also enter m Part I, line 8, column (c) . If (loss), enter"-Vin Part I, line 8 3 N/A

4:'3581 OS-01-04


.f F

mB .~ L

k .I

CONTINUATION FOR 990-PF, PART IV 13-4112185 PAGE 1 OF 1

(b) How acquired (c Date acquired (d) Date sold P fl

- - flnnatinnPurcha

natinn se ~mo., day, yr.) (mo ., day, yr.)

(h) Gam or (loss) (e) plus (f) minus (g)

349,586 . 110,385 . <1,924 . > 31,306 .

117,308 . <4,374 . > <6,560 . > 37,439 .

13-4112185 PETER AND HELEN HAJE FOUNDATION

FORM 990-PF INTEREST ON SAVINGS AND TEMPORARY CASH INVESTMENTS STATEMENT 1

65,342 .

14 STATEMENT S) 1 2004 .06030 PETER AND HELEN HAJE FOUNDA HAJE 1 10491110 350288 HAJE

SOURCE

BANK OF NEW YORK - BONDS NEUBERGER BERMAN - INTEREST

TOTAL TO FORM 990-PF, PART I, LINE 3, COLUMN A

AMOUNT

64,158 . 1,184 .

PETER AND .HEL9N HAJE FOUNDATION 13-4112185

FORM 990-PF DIVIDEND.S) AND INTEREST FROM SECURITIES STATEMENT 2

CAPITAL GAINS COLUMN (A) GROSS AMOUNT DIVIDENDS AMOUNT

487 . 0 . 487 . 1,222 . 0 . 1,222 .

37,687 . 0 . 37,687 . 3,243 . 0 . 3,243 . 1,832 . 0 . 1,832 .

44,471 . 0 . 44,471 . TOTAL TO FM 990-PF, PART I, L19 4

15 STATEMENT(S) 2 10491110 350288 HAJE 2004 .06030 PETER AND HELEN HAJE FOUNDA HAJE I

SOURCE

BANK OF NEW YORK - BONDS BANK OF NY - HAMILTON FUNDS NEUBERGER BERMAN PARTNERSHIP - FARALLON DIVIDENDS PARTNERSHIP - FARALLON INTEREST

13-4112185 PETER AND HELEN HAJE FOUNDATION I

TOTAL TO FORM 990-PF, PART I, LINE 11, COLUMN A 80,836 .

16 STATEMENT(S) 3 2004 .06030 PETER AND HELEN HAJE FOUNDA HAJE 1 10491110 350288 HAJE

FORM 990-PF OTHER INCOME STATEMENT 3

DESCRIPTION AMOUNT

PARTNERSHIP - FARALLON CAPITAL INSTITUTIONAL PARTNERS 80,336 . 990-T TAX REFUND 500 .

PETER AND HELEN HAJE FOUNDATION 13-4112185

FORM 990-PF ACCOUNTING FEES STATEMENT 4

(A) (B) EXPENSES NET INVEST-PER BOOKS MENT INCOME

33,208 . 33,208 .

33,208 . 33,208 .

0 .

0 .


DESCRIPTION

TAG ASSOCIATES, LLC FEE

TO FORM 990-PF, PG 1, LN 16B

(C) (D) ADJUSTED CHARITABLE NET INCOME PURPOSES

FORM 990-PF

(C) (D) ADJUSTED CHARITABLE NET INCOME PURPOSES

0 .

0 . 0 .

0 .

(A) (B) EXPENSES NET INVEST-PER BOOKS MENT INCOME

21,000 . 21,000 .

382 . 382 . 244 . 244 .

21,626 . 21,626 .


PETER AND HELEN HAJE FOUNDATION

DESCRIPTION

FEDERAL TAXES FOREIGN T20CES - NEUBERGER BERMAN FOREIGN TAXES - FARALLON

TO FORM 990-PF, PG 1, LN 18

TAXES

13-4112185

STATEMENT 5

19 STATEMENT(S) 6 10491110 350288 HAJE 2004 .06030 PETER AND HELEN HAJE FOUNDA HAJE 1

PETER AND.HELEN HAJE FOUNDATION 13-4112185

FORM 990-PF OTHER EXPENSES STATEMENT 6

(A) (B) (C) (D) EXPENSES NET INVEST- ADJUSTED CHARITABLE

DESCRIPTION PER BOOKS MENT INCOME NET INCOME PURPOSES

NYS DEPT OF LAW - FILING FEE 250 . 250 . 0 . PORTFOLIO DEDUCTIONS - FARALLON CAPITAL INSTITUTIONAL PARTNERS 385 . 385 . 0 . INVESTMENT FEES - NEUBERGER BERIN.[AN 23,776 . 23,776 . 0 . INVESTMENT FEES - BANK OF NY 10,000 . 10,000 . 0 . GENERAL FEE - BNY 170 . 170 . 0 . INVESTMENT FEES - MERRILL LYNCH 150 . 150 . 0 . ADVERTISEMENT FEE 95 . 95 . 0 .

TO FORM 990-PF, PG 1, LN 23 34,826 . 34,826 . 0 .


FORM 990-PF U .S . AND STATE/CITY GOVERNMENT OBLIGATIONS STATEMENT 7

U . S . OTHER DESCRIPTION GOV'T GOV'T

FEDERAL HOME LOAN MTG CORP 5 .25% x DUE 1-15-06 FEDERAL HOME LOAN MTG CORP 5 .5% DUE x 09-15-11 UNITED STATES STL CORP NEW 9 .75% x DUE 5-15-10

TOTAL U .S . GOVERNMENT OBLIGATIONS

TOTAL STATE AND MUNICIPAL GOVERNMENT OBLIGATIONS

TOTAL TO FORM 990-PF, PART II, LINE 10A

FAIR MARKET BOOK VALUE VALUE

228,028 . 220,994 .

20 STATEMENT(S) 7 2004 .06030 PETER AND HELEN HAJE FOUNDA, HAJE I 10493.110 350288 HAJE

108,492 . 102,156 .

109,736 . 107,438 .

9,800 . 11,400 .

228,028 . 220,994 .



118,760 . 378,575 . 0 . 0 . 0 . 0 .

37,950 . 37,920 . 0 . 0 . 0 . 0 .

71,843 .132,878 . 0 . 0 . 0 . 0 . 0 . 0 . 0 . 0 . 0 . 0 .

49,104 . 70,840 . 0 . 0 . 0 . 0 . 0 . 0 . 0 . 0 .

62,203 . 85,927 . 0 . 0 . 0 . 0 . 0 . 0 . 0 . 0 .

42,452 . 43,960 . 0 . 0 .

VOTING SHARES 0 . 0 . 0 . 0 .

58,270 . 53,780 . 45,487 . 58,980 .

0 . 0 . 66,667 .110,676 .

0 . 0 . 114,024 . 105,531 .

0 . 0 . 0 . 0 . 0 . 0 . 0 . 0 .

117,529 . 116,254 . 97,160 .117,180 .

106,052 . 134,754 . 87,256 . 96,052 .

120,168 . 165,357 . 72,265 . 92,464 . 82,416 .117,512 .

115,985 . 121,368 . 23,433 . 47,790 . 65,680 . 80,712 . 57,755 . 83,536 .

TIME WARNER INC DHB INDUSTRIES, INC EVEREST RE GROUP LTD GENERAL MOTORS ACCEP CORP ACE LTD ORD BRASCAN CORP CL A CIT GROUP INC DOLLAR THRIFTY AUTOMOTIVE WALT DISNEY COMPANY 4 KIDS ENTERTAINMENT INC CADBURY SCHWEPPES PLC ADR COLE NATIONAL CORP NEW CRIIMI MAE INC DANA CORP HARTE HANKS COMM (NEW) HEWLETT PACKARD CO HIBERNIA CORP CL A INDIA FD INC INTERNATIONAL BUSINESS MACHINES INTERPUBLIC GROUP OF COMPANIES JOY GLOBAL INC L3 COMMUNICATIONS HLDG LIBERTY CORP - SOUTH CAROLINP.. METRO GOLDWYN MAYER ONEX CORPORATION - SUBORDINATE PIONEER DRILLING COMPANY PFIZER INC RPM INTERNATIONAL INC RICHARDSON ELECTRONICS LTD SYNNEX CORPORATION UNION PACIFIC CORP VIACOM INC CL B WEATHERFORD INTERNATIONAL COl;'.P WHITING PETE CORP NEW YELLOW ROADWAY CORP FOREST OIL CORP COM NEW ALCOA INC CSK AUTO CORP CEMEX SA ADR COMMERCIAL VEHICLE GRP COMPANHIA VALE DO RIO ADR FEDERATED DEPT STORES KINGSWAY FINL SVCS INC LINCOLN NATIONAL CORP LIONS GATE ENTMT CRP MATTSON TECH INC NETGEAR INC

21 STATEMENT(S) 8 1049,1110 350288 HAJE 2004 .06030 PETER AND HELEN HAJE FOUNDA HAJE 1

FORM 990-PF

DESCRIPTION

CORPORATE STOCK STATEMENT 8

2,343,164 . 3,138,514 . TOTAL TO FORM 990-PF, PART II, LINE 10B

22 STATEMENT(S) 8 10491110 350288 HAJE 2004 .06030 PETER AND HELEN HAJE FOUNDA HAJE I


PRIDE INTERNATIONAL INC PRIVATE MEDIA GROUP SCS TRANSPORTATION INC SUPERIOR ENERGY SERVICES TEXAS INDUSTRIES INC UNITED STATIONERS INC UNITED GLOBAL COM CL A WEB MD CORPORATION YORK INTERNATIONAL CORP

13-4112185

67,785 . 69,836 . 78,750 .106,250 .

107,057 . 133,209 . 51,373 . 86,296 . 63,868 .118,522 . 89,467 . 97,020 .

103,869 . 104,367 . 74,272 . 74,256 . 94,264 . 96,712 .


FORM 990-PF CORPORATE BONDS STATEMENT 9

BOOK VALUE

109,692 . 115,963 .

106,311 .

113,675 .

445,641 . 434,543 . TOTAL TO FORM 990-PF, PART II, LINE 10C


DESCRIPTION

COCA COLA ENTERPRISES INC 5 .75% DUE 11-1-08 WAL-MART STORES 6 .875% DUE 8-10-09 INTERNATIONAL BUSINESS MACHINES 4 .875% DUE 10-1-06 GENERAL ELECTRIC CAP CORP MTN BE 6 .875% DUE 11-15-10

FAIR MARKET VALUE

106,971 . 112,289 .

102,683 .

112,600 .


3,344,041 . 3,721,535 . 519,647 . 595,064 .

0 . 0 .

3,863,688 . 4,316,599 . TOTAL TO FORM 990-PF, PART II, LINE 13

24 STATEMENT(S) 10 2004 .06030 PETER AND HELEN HAJE FOUNDA HAJE 1 104,31110 350288 HAJE


FORM 990-PF OTHER INVESTMENTS

DESCRIPTION

FARALLON CAPITAL INSTITUTIONAL PARTNERS, LP TAG HEDGED EQUITY OFFSHORE FUND MEZZACAPPA CONCENTRATED FUND OFFSHORE

13-4112185

STATEMENT 10

PETER AND .HELEN HAJE FOUNDATION 13-4112185

FORM 990-PF GPP.JNTS AND CONTRIBUTIONS STATEMENT 11 PAID DURING THE YEAR

RECIPIENT NAME AND ADDRESS

LEGAL AID SOCIETY, 199 WATER STREET, NEW YORK, NY 10038 60,000 .

NEW ALTERNATIVES FOR E-01(C)(3) CHARITABLE CHILDREN, 37 WEST 26TH STREET, NEW YORK, NY 10010

GEORGE BALANCHINE 501(C)(3) CHARITABLE FOUNDATION, 161 WEST 61 ST, NEW YORK, NY 10023

AUBIN PICTURES, PO BOX 214, 501(C)(3) CHARITABLE NEW YORK, NY 10012

SCHOOL OF AMERICAN BALLET, 501(C)(3) CHARITABLE 70 LINCOLN CENTER PLAZA, NEW YORK, NY 10023

DANCE CONTINUUM INC, 269 501(C)(3) CHARITABLE PEEKSKILL HOLLOW ROAD, PUTNAM VALLEY, NY 10579

LAWYERS COMMITTEE FOR CIVIL 501(C)(3) CHARITABLE RIGHTS, 1401 NEW YORK AVENUE, NW, WASHINGTON, DC

CHESS IN THE SSHMOC$(3520 CHARITABLE 8TH AVENUE, FLOOR 2, NEW YORK, NY 10018

LEGAL AID SOCIETY, 199 501(C)(3) CHARITABLE WATER STREET, NEW YORK, NY 10038

FRIENDS OF THE FRANCES !501(C)(3) CHARITABLE LEHMAN LOEB ART CENTER, VASSAR COLLEGE BOX 102,

WORKS AND PROGRESS 501(C)(3)

LAWYERS COMMITTEE FOR CIVIL !501(C)(3) RIGHTS, 1401 NEW YORK AVENUE, NW, WASHINGTON, DC

N/A

N/A CHARITABLE

15,000 .

25 STATEMENT(S) 11 2004 .06030 PETER AND HELEN HAJE FOUNDA HAJE I 10491110 350288 HAJE

RECIPIENT RECIPIENT STATUS PURPOSE OF GRANT RELATIONSHP AMOUNT

501(C)(3) CHARITABLE N/A

CHARITABLE

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

50,000 .

2,000 .

7,000 .

15,000 .

10,000 .

15,000 .

10,000 .

5,000 .

2,000 .

3,000 .

PETER AND,HELI~N HAJE FOUNDATION 13-4112185

QUEENS COLLEGE FOUNDATION, 501(C)(3) CHARITABLE N/A 65-30 KISSENA BLVD, FLUSHING, NY 11367 5,000 .

BALLET NEW YORK 501(C)(3) CHARITABLE N/A 3,500 .

SCHOOL OF AMERICAN BALLET, 501(C)(3) CHARITABLE NIA 70 LINCOLN CENTER PLAZA, NEW YORK, NY 10023 10,000 .

CHILDREN FOR CHILDREN, 985 5,01(C)(3) CHARITABLE N/A FIFTH AVENUE, NEW YORK, NY 10021 2,500 .

APPLESEED FOUNDATION, 727 501(C)(3) CHARITABLE N/A 15TH STREET, NW 11TH FLOOR, WASHINGTON, DC 20005 12,500 .

DANCE THEATER WORKSHOP, 219 501(C)(3) CHARITABLE N/A W 19TH ST , NEW YORK, NY 10011 15,000 .

NEW ALTERNATIVES FOR 501(C)(3) CHARITABLE N/A CHILDREN, :37 WEST 26TH STREET, NEW YORK, NY 10010 25,000 .

QUEENS COLLEGE FOUNDATION, 501(C)(3) CHARITABLE N/A 65-30 KISSENA BLVD, FLUSHING, NY 11367 5,000 .

HARVARD LAW SCHOOL FUND 501(C)(3) CHARITABLE N/A 50,000 .

HUMAN RIGHTS FIRST 501(C)(3) CHARITABLE N/A 25,000 .

AMERICAN JEWISH COMMITTEE 501(C)(3) CHARITABLE N/A 5,000 .

NYC OPERA 501(C)(3) CHARITABLE N/A 10,000 .

NEW ALTERNATIVES FOR 501(C)(3) CHARITABLE N/A CHILDREN 2,500 .

PREP FOR PREP !501(C)(3) CHARITABLE N/A 2,000 .

SCHOOL OF AMERICAN BALLET !501(C)(3) CHARITABLE N/A 12,000 .

NEW ALTERNATIVES FOR '501(C)(3) CHARITABLE N/A CHILDREN 25,000 .

HUMAN RIGHTS FIRST 501(C)(3) CHARITABLE N/A 3,000 .

MAII40NIDES MEDICAL CENTER 501(C)(3) CHARITABLE N/A 3,000 .

26 STATEMENT(S) 11 2004 .06030 PETER AND HELEN HAJE FOUNDA HAJE I 10491110 350288 HAJE

TOTAL TO FORM 990-PF, PART X-7, LINE 3A 665,000 .


PETER AND .HELEN HAJE FOUNDATION 13-4112185

LAWYERS COMMITTEE FOR CIVIL 501(C)(3) CHARITABLE N/A RIGHTS 5,000 .

N .S .-LIJ HEALTH SYSTEM 501(C)(3) CHARITABLE N/A 2,000 .

CORNELL UNIVERSITY 501(C)(3) CHARITABLE N/A 25,000 .

APPLESEED FOUNDATION 501(C)(3) CHARITABLE N/A 12,500 .


NAACP LD&E FUND 501(C)(3) CHARITABLE N/A 5,000 .


BALLET NEW YORK 501(C)(3) CHARITABLE N/A 5,000 .

INTERNATIONAL RESCUE 501(C)(3) CHARITABLE N/A COMMITTEE 3,000 .


DEVEROUX FOUNDATION 501(C)(3) CHARITABLE N/A 5,000 .

DOCTORS WITHOUT BORDERS 501(C)(3) CHARITABLE N/A 3,000 .

THE BREARLEY SCHOOL 501(C)(3) CHARITABLE N/A 15,000 .

HARVARD LAW SCHOOL FUND 501(C)(3) CHARITABLE N/A 25,000 .

DOROT 501(C)(3) CHARITABLE N/A 3,000 .

ROBIN HOOD FOUNDATION 501(C)(3) CHARITABLE N/A 2,500 .

NRDC 50l(C)(3) CHARITABLE N/A 3,000 .

TEACHERS COUNT501(C)(3) CHARITABLE N/A 3,500 .


YALE: LAW SCHOOL, CT 501(C)(3) CHARITABLE N/A 20,000 .

DANCE THEATER WORKSHOP 501(C)(3) CHARITABLE N/A 70,000 .

DANCE THEATER WORKSHOP !501(C)(3) CHARITABLE N/A 20,000 .

LIMAN PUBLIC INTEREST !501(C)(3) CHARITABLE N/A PROJECT 2,500 .

Underpayment of Estimated Tax by Corporations 0- See separate instructions .

lop. Attach to the corporation's tax return . FORM 990-E

OMB No 1545-0142

2004 Department of the Treasury InternaJ Revenue Service

Name Employer identification number 13-4112185

Note : In most cases, the corporation is not required to file Form 2220. (see Part I below for exceptions) because the IRS will figure any penalty owed and bill the corporation. Even if Form 2220 is not required, the corporation may still use it to figure the penalty. In such a case, enter the amount from page 2, line 38 on the estimated tax penalty line of the corporation's income tax return, but do not attach Form 2220.

part I Reasons for Filing - Check the bo)es belowthatapply . If any boxes arechecked, and line 6, below, is $500 or more,the corporation must file Form 2220, even if it does not owe a penalty.

I The corporation is using the adjusted seasonal installment method . 2 The corporation is using the annualized incomi, installment method .

Part III Figuring the 4 Total tax (see instructions) 4 .

c Credit for Federal tax paid on fuels (see instructions) 5c d Total . Add lines 5a through 5c

6 Subtract line 5d from line 4. If the result is less than $,'POO, do not complete or file this form. The corporation does not owe the penalty

7 Enter the tax shown on the corporation's 2003 incomE, tax return . Caution : If the tax is zero or the tax ye ar was for less than 12 months, skip this line and enter the amount from line 6 on line 8 41 .

9 Installment due dates . Enter in col (a) throu_9h (d) the 15th day of the 4th (Form 990-PF filers : Use 5th month), 61h, 91h, and 12th mos of the corporation's tax year

Exception . if one of your installment due dates is Sept 15, 2004, see the instructions

10 Required installments . If the box on line 1 and/or line 2 above is chocked, enter the amounts from Schedule A, line 38 If the box on In 3 (but not 1 or 2) is chocked, see instructions for the amounts to enter If none of these boxes are chocked, enter 25% of In 8 above in each column

11 Estimated tax paid or credited for each period (see instructions) . For column (a) only, enter the amount from line 11 on line 15 Complete lines 12 through 18 of one column before going to the next column .

id, Enter amount, if any, from line 18 of the preceding column

13 Add lines 11 and 12 idl Add amounts on lines 16 and 17

of the preceding column 15 Subtract line 14 from line 13. If

zero or less, enter -0- 1 6 If the amount on line 15 is zero, subtract

line 13 from line 14 Otherwise, enter -0-

17 Underpayment . If line 15 is less than or equal to line 10, subtract line 15 from line 10 Then go to line 12 of the next column Otherwise, go to line 18

113 Overpayment . If line 10 is less than line 15 . subtract line 10 from line 15

1 .981 .

V .

4,590 . 7,21

2 .628 . 65

1 .304 .

27 .1 10491110 350288 HAJE 2004 .06030 PETER AND HELEN HAJE FOUNDA HAJE 1

Foi m 2220

5 a Personal holding company tax (Schedule PH (Form 1120), line 26) included on line 4 5a b Look-back interest included on line 4 under section 460(b)(2) for completed long-term contracts or of section 167(g) for depreciation under tie income forecast method r5b

8 Enter the smaller of line 6 or line 7. If the ired to skID line 7. enter the amount from line

Go to Part III on pane 2 to finure the penalty Do not an to Part III if there are no entries on line 17 - no penalty is owed . 411801 0

, -03-0, JWA For Paperwork Reduction Act Notice, see separate instructions . Form 2220 (2004)

FORM 990-PF Form 2220 (2004) ' PETER AND HELEN HAJE FOUNDATION 13-4112185 PaQe 2

F-F) a Figuring the Penalty

37' Add lines 22, 24,26,28, 30,32, 34, & 36

38 Penalty . Add columns (a) through (e), of line 37 . Ent.,r the total here and on Form 1120; line 33, Form 1120-A, line 29;

19 Enter the date of payment or the 15th day of the 3rd month after the close of the tax ~ipear, whichever is earlierC(see instructions) orm 990-PF and

F I rm 990-T

le rS : Use 5th month instead of 3rd month )

Number of days from due date of install-20 ment on In

9 to the date shown on line 19

Nu ber ofdays online 20 after 21 4/1M5/2004 and before 7/1/2004

22 Underpayment on line 17 x

Number of days on line 21 x 5% 366

Number of day on line 20 after 23 0130/2004 anclsbefore 10/1/2004


Number of days on line 23 x 4% 366

Number of day on line 20 after 25 0/30/2004 and"before 1/1/2005


Number of days on line 25 x 5% 3BO

Number of days on line 20 after 27 12/31/2004 and before 4/1/2005


Number of days on line 27 X 5% 365



Number of days on line 29 x 365

Number of days on line 20 after 31 (1/3012005 and before 10/1/2005



Number of day on line 20 after 33 9/30/2005 and'before 11112006


Number of days on line 3 x *% 385


36, Underpayment on line 17 x


* For underpayments paid after March 31, 2005 : For Iine3 30, 32, 34, and 36, use the penalty interest rate for each calendar quarter, which the IRS will determine during the first month in the preceding quarter . These rates are published quarterly in an IRS News Release and in a revenue ruling in the Internal Revenue Bulletin . To obtain this information oil the Internet, access the IRS website at www.irs gov. You can also call 1-800-829-1040 to got interest rate information.

JIVA Form =0 (2004)

4 ~21302 0 -24-05


FORM 990-PF UNDERPAYMENT OF ESTIMATED TAX WORKSHEET

Name(s) Identifying Number

PETER AND HELEN HAJE FOUNDATION 13-4112185 (A) (B) (C) (D) (E) (F)

Adjusted Number Days Daily Date Amount Balance Due Balance Due Penalty Rate Penalty

-0-

05/15/04 3,285 . 3,285 .

05/15/04 <1,981 .> 1,304 . 31 .000136612 6 .

06/15/04 3,286 . 4,590 . 15 .000136612 9 .

06/30/04 0 . 4,590 . 77 .000109290 39 .

09/15/04 2,628 . 7,218 . 15 .000109290 12 .

~D9/30/04 0 . 7,218 . 1 .000136612 1 .

-10101/04 657 . 7,875 . 75 .000136612 81 .

-12115/04 3,285 . 11,160 . 16 .000136612 24 .

12/31/04 0 . 11,160 . 90 .000136986 138 .

03/31/05 0 . 11,160 . 42 .000164384 77 .

05/12/05 <25,000 .> <13,840 .>

Penalty Due (Sum of Column F) . 387 .

Date of estimated tax payment, withholding credit date or installment due date.

412511 0,5 -01-04


Taxpayer, the Peter and Helen Haje Foundation (EIN 13-4112185) hereby elects under Regulation 53.392(a)-3(d)(2) to treat all qualifying distributions made during the current taxable year as made out of corpus .

EIN : 13-4112185

PETER AND HELEN HAJE FOUNDATION CALENDAR YEAR ENDED DECEMBER 31, 2004

ELECTION STATEMENT UNDER REGULATIONS 53.392(a)-3(d)(2) .

TAG Associates LLC REALIZED GAINS AND LOSSES

Haje Foundation - Bank of New York Bonds # 148121 From 01-01-04 Through 12-31-04

Cost Ainort. or Basis _ -Accretion __ Proceeds

99,17300 144 87 110,04200

100,85200 -249 95 110,841 00

99,36200 272 28 106,53700

108,30800 -2,14606 116,48600

108,49200 -3,551 66 103,90300

219,47200 -3,08022 216,67800

000 38,47668 000 -1,03734 0.00 37,439.35

,rOTAL GAINS rOTAL LOSSES

rOTAL REALIZED GAIN/LOSS 37,43935 735,659.00 -8,611 .35 764,487.00

Open Close Date Date - Quantity Sevirity

03-01-02 03-29-04 100,000 Federal Home Loan MTG Corp 5 500% Due 09-15-11

12-10-01 04-01-04 100,000 Coca Cola Ent-!rprises Inc 5 750% Due I 1 -01 -08

03-01-02 04-01-04 100,000 International Busmes Machs 4 875% Due 10-0 1 -06

12-10-01 04-01-04 100,000 Wal-Mart StOTIS 6 875% Due 03-10-09

04-03-03 06-09-04 100,000 Federal Home Loan MTG Corp 5 250% Due 0 1- 15-06

04-03-03 10-19-04 200,000 Federal Home Loan MTG Corp 5 500% Due 09- 15-11

Gain Or Loss

Short Term Long Term

10,724 13

10,23895

6,90272

10,32466

-1,03734

28622

I

TAG Associates LLC

REALIZED GAINS AND LOSSES

Haje Foundation - Neuberger Berman 45-48985 H85 (Art Winston) From 01-01-04 Through 12-31-04

Gain Or Loss Open Close Cost Amort . or Date Date Quantity Seciii-ity Basis Accretion Proceeds Short Term Long Term

12-18-03 01-12-04 30000 Weatherford In(emational 10,75920 11,80223 1,04303 Corp

10-01-03 01-13-04 1,00000 Joy Global Inc 17,13240 26,66674 9,534 34 09-15-03 01-15-04 1,00000 India Fund Inc 14,833 20 27,17672 12,343 52 11-18-03 01-20-04 50000 Dana Corp 7,51980 10,98628 3,46648 11-25-03 01-20-04 1,80000 Yellow Roadway Corp 55,32300 67,59601 12,27301 10-30-03 01-26-04 30000 L3 COMITIL111 icat ions Hldg 14,04306 15,669 .26 1,62620 06-06-03 01-26-04 1,80000 Cole National,--orp New 18,001 62 39,688 13 21,686 5 1 10-01-03 01-26-04 80000 Joy Globalinc 13,70592 22,28423 8,578 31 06-12-03 01-27-04 70000 Forest 011 Coq) Com New 18,77379 17,90208 -871 71 08-07-03 01-27-04 70000 Forest Oil Coq) Com New 14,15498 17,90208 3,747 10 09-25-03 01-27-04 30000 Forest 011 Corp Com New 6,93000 7,67232 742 32 06-06-03 01-27-04 381 00 MGM Mirage 4,69022 6,22971 1,53949 08-21-03 01-27-04 1,00000 4 Kids Entertamment Inc 20,21900 29,82450 9,60550 10-30-03 01-27-04 70000 L3 Communic itions Hldg 32,767 14 37,30825 4,541 11 12-18-03 01-29-04 80000 Weatherford Irternational 28,691 20 32,781 10 4,08990

Corp 08-11-03 02-04-04 2,00000 Harte Hanks Comm (New) 38,04340 44,01413 5,97073 01-20-04 02-06-04 1,20400 UmtedGlobalCom Inc - Rts 4,58868 4,58868 000

021204 10-11-02 02-13-04 2,60000 Wait Disney Company 41,169 18 70,88021 29,711 03 10-01-03 02-17-04 70000 Joy Global Inc 11,99268 19,561 98 7,56930 02-18-04 02-27-04 6,60000 FTI Consulting Inc 101,12784 108,04833 6,92049 05-28-03 03-08-04 60000 Interpublic Group of 7,983 84 9,83697 1,853 13

Companies, In - 10-28-03 03-09-04 1,10000 Union Pacific Corp 6756827 67,641 30 7303 11-18-03 03-10-04 60000 Dana Corp 9:023 76 12,06552 3,041 76 05-28-03 03-10-04 1,40000 Inter-public Group of 18,62896 22,677 85 4,04889

Companies, Inz 06-12-03 03-10-04 60000 Inter-public Group of 8,60808 9,71908 1,111 00

Companies, ln~ 09-19-03 03-10-04 1,00000 Cadbury Schweppes PLC 25,26830 32,80631 7,53801

ADR 01-28-04 03-16-04 40000 Lions Gate En,mnt Crp New 2,08296 2,119.67 3671 11-18-03 03-18-04 90000 Dana Corp 13,53564 17,30641 3,77077 07-05-02 03-22-04 30000 Everest R-E Gr :)up Ltd 15,93630 25,195 12 9,25882 02-04-03 03-22-04 20000 Everest RE Gr :)up Ltd 9,851 76 16,79674 6,94498 12-11-03 03-22-04 8,00000 PIONEER DRILLING 39,535 20 51,83797 12,30277

COMPANY 12-16-03 03-25-04 50000 Whiting Pete Corp New 8,70480 11,100 11 2,39531 12-04-03 04-12-04 7,20000 DHB Industries Inc 49,57200 72,18982 22,61782 02-27-04 04-13-04 4,00000 Advanced Nlicio D(,vices Inc 60,641 60 69,033 98 8,392 38 03-04-04 04-13-04 1,00000 Advanced Micro Devices Inc 14,91990 17,25849 2,33859 09-15-03 04-13-04 50000 India Fund Inc 7,41660 14,1897) 6,772 11 05-28-03 04-14-04 5,000 United Stites STL Corp New 4,90000 9 18 5,48750 578 32

9 750% Due 05-15-10 12-16-03 04-29-04 1,80000 Whiting Pete Corp New 31,33728 45,418 87 14,081 59 01-23-04 04-30-04 2,50000 Bluegreen Corp 23,11225 31,48676 8,37451 08-21-03 05-03-04 90000 4 Kids Entertainment Inc 18,197 10 20,23071 2,033 61 12-18-03 05-03-04 70000 4 Kids Entertainment Inc 17,80520 15,73500 -2,07020 01-23-04 05-04-04 2,00000 Bluegreen Corp 18,48980 24,05883 5,56903 04-08-04 05-07-04 1,00000 NRG Energy Inc 22,43420 19,641 93 -2,79227 02-26-04 05-10-04 1,40000 American Ax li .- & M fg 52,13866 48,833 93 -3,304 73 04-08-04 05-10-04 1,00000 NRG Energy Inc 22,43420 19,36454 -3,06966 10-17-02 05-12-04 50000 Ace Ltd OR-D 17,13405 20,65461 3,52056

Haje Foundation - Neuberger Berman 45-48985 H85 (Art Winston) F7-om 01-01-04 Throtigh 12-31-04

Gain Or Loss Open Close Cost Arnort. or Date Date Quantity Security -Basis Accretion Proceeds Short Term Long Term

1,00000 Ace Ltd ORD 40000 International Business

Machines 2,50000 Dollar Thrifty Automtv 4,40000 Unumprovideni Corp 3,00000 Mcdermott Int Inc 3,00000 Mcdermott Int Inc 1,30000 Brascan Corp C I A 2,00000 Onex

Corporation-Subordinate Voting Shares

1,30000 Onex Corporation-Subordinate Voting Shares

1,10000 Onex Corporation-Subordinale Voting Shares

2,40000 Comcast Corp-Special CL A 1,00000 Forest Oil Corp Com New 30000 Kerr McGee Corp

1,50000 Forest Oil Corp Com New 8,10000 Lions Gate EntiTmt Crp New 8,10000 Mitsubishi Tokyo Financial

ADR 80000 India Fund Inc 70000 Kerr McGee Corp

3,00000 Superior Energy Services 1,00000 Devon EnergyCorp New 1,00000 FTl Consulting Inc 1,40000 Brascan Corp CI A 1,20000 Richardson Elcctronics Ltd 4,00000 Richardson Electronics Ltd 2,20000 CBRL Group hic 1,70000 FTI Consulting Inc 1,90000 Hewlett Packard Co 60000 Joy Global Inc

2,00000 CP Ships Ltd 3,00000 Nam Tai Elect7onics Inc 50000 Energy Partner;, Ltd

1,40000 FTI Consulting Inc 1,70000 Fri Consulting Inc 50000 FTI Consulting hic

1,00000 Cemex SA Sprsrd ADR 2,60000 RPM international Inc 50000 USX US Steel Group

1,50000 Merrill Lynch& Co 60000 Hewlett Packaid Co 30000 Hewlett Packaid Co 10000 Hewlett Packaid Co

1,70000 USX US Steel Group 60000 Energy Partners, Ltd

1,50000 Netgear Inc 2,00000 Oneokinc 70000 Oneoklnc 30000 Oneoklnc

15,90992 71383

13,46224 969 10

65,68981 -2,871 47 27,08956 44346 16,48347 1,53843 40,26760 29845 52,73057 10,55063 74,22989 12,61967

12-04-03 06-21-04

11,86656 34,871 76 27,521 10 62,11040 16,15740 21,41067 12,25200 40,89920 70,01060 27,467 58 37,414 80 10,27944 34,051 20 60,09930 6,943 65 22,62036 28,557 28 7,931 75 28,42440 37,413 22 17.69605 90,69960 11,815 20 6,521 55 2,11756

60,132 57 8,332 38 19,822 75 44,30000 15,50500 6,64500

17,73526 35,86841 31,41046 67,34842 17,07849 40,15847 11,462 73 38,209 10 68,748 16 27,78992 32,853 84 18,29957 23,27945 56,409 17 7,94276

26,541 27 32,22869 9,47903

28,815 32 45,48255 19,525 .29 77,714 97 11,06974 5,534 86 1,84496

60,45636 10,52669 21,32094 53,114 35 18,65526 7.97900

09-15-03 04-08-04 05-25-04 04-26-04 04-16-04 07-05-02 12-01-03 12-01-03 06-28-04 04-16-04 10-01-03 10-01-03 07-21-04 06-09-04 04-26-04 04-16-04 05-27-04 07-16-04 05-21-04 10-15-03 08-25-04 03-17-04 10-01-03 10-21-03 10-23-03 08-25-04 04-26-04 08-30-04 02-27-04 02-27-04 02-27-04

07-26-04 07-27-04 07-27-04 07-27-04 07-30-04 08-04-04 08-04-04 08-04-04 08-06-04 08-06-04 08-12-04 08-12-04 08-17-04 09-18-04 09-09-04 09-15-04 09-15-04 09-15-04 10-11-04 10-11-04 10-11-04 10-12-04 10-14-04 10-14-04 10-14-04 10-14-04 10-28-04 10-28-04 10-29-04 11-01-04 11-03-04

74546 -98669 -27260 32379

2,19431 2,498 19 8,81435 3,15026 1,33400

TAG Associates LLC REALIZED GAINS AND LOSSES

07-24-03 05-12-04 06-06-03 05-12-04

05-27-03 05-12-04 04-13-04 05-12-04 03-05-04 05-19-04 03-05-04 05-24-04 07-05-02 06-21-04 09-30-03 06-21-04

10-09-03 06-21-04

04-02-04 03-08-04 04-08-04 03-08-04 01-28-04 01-15-04

06-23-04 06-24-04 06-24-04 06-25-04 06-30-04 07-14-04

32,13960 33,10024

46,541 25 69,543 76 29,437 20 29,43720 19,881 33 21,81000

15,19609

12,493 14

68,561 28 26,646 10 14,94504 39,969 15 42,17994 61,61022

41,30923 9,16963 34,62454 1,52430

62,52753 15,98628 60,538 17 -9,005 59 21,59379 -7,843 41 2 1,710 48 -7,726 72 34,761 18 14,87985 24,47680 2,66680

5,86870 99665

3,88936 5,23802 921 09

-78927 -2,690 10 -1,26244

32234 -4,56096 8,020 13

-10,771 75 -3,690 13

999 1 1 3,92091 3,671 41 1,547 28 39092

8,06933 1,93924

-12,98463

18,747 80

TAG Associates LLC REA_LIZED GAINS AND LOSSES

Haje Foundation - Neuberger Berman 45-48985 H85 (Art Winston) From 01-01-04 Through 12-31-04

Gain Or Loss Open Close Cost Amort. or Date Date Quantity Security - - Basis - __ -Accretion Proceeds ShortTerrn Long Term

05-19-04 11-03-04 1,00000 OneokInc 20,652 30 26,59667 5,94437 08-30-04 11-16-04 2,80000 Netgear Inc 35,135 80 43,11647 7,98067 07-21-04 11-19-04 2,90000 CP Ships Ltd 49,37424 37,011 54 -12,362 70 03-13-03 11-22-04 2,40000 Hibernia Corp CI A 40,24920 68,14544 27,89624 10-15-03 11-30-04 1,10000 RPM International Inc 15,928 67 20,291 88 4,463 21 04-26-04 11-30-04 3,90000 Energy Partner, Ltd ~4 160 47 75,02721 20,86674 06-03-04 12-Oo-04 1,00000 Chiquita Brands international 1 7,09() 70 20,351 22 2,66052 08-30-04 12-06-04 40000 Net-car Inc 501940 6,92959 1,910 19 06-03-04 12-07-04 3,50000 Chiquita Brands International 61 91745 72,52249 10,60504 08-13-04 12-09-04 1,20000 MBIA Inc 64,82868 73,25072 8,42204 01-23-04 12-09-04 2,00000 Bluegreen Corp 18.48980 35,14557 16,65577 09-29-04 12-09-04 60000 Federated Dept Stores Cum 27,09930 33,38003 6,28073 01-23-04 12-16-04 1,40000 Bluegreen Corp 12,942 86 27,06024 14,117 38 01-30-04 12-16-04 60000 Bluegreen CotTo 5,35062 11,59725 6,24663 11-24-04 12-16-04 6,00000 Cal Maine Foods Inc 78.94500 82,75605 3,811 05 03-14-03 12-20-04 1,10000 Pfizer Inc 32,071 27 27,77941 -4,291 86 05-21-04 12-20-04 90000 Pfizer Inc 31,413 60 22,72860 -8,68500 TOTAL GAINS 448,19777 115,42249 TOTAL LOSSES -98,61203 -5,03732

3,077,268 .25 9.18 3,537,248 .35 349,585 .74 110,385 .17 TOTAL REALIZED GAFN/LOSS 459,97091

3

Form8621

(Rev December 2004) Department of the Treasury

Return by a Shareholder of a Passive Foreign Investment Company or Qualified Electing Fund

IN- See separate instructions .

OMB No 1545-1002

Attachment

Identifying number (see page 2 of instructions)

13-4112185 Shareholder tax year calendar year .2004 ------ or other tax year beginning . .. . . .. . . . . . . . . . . . . . and ending .. . .. . . . . . . . . . . . . .

Name of shareholder

PE7ER & HELEN HAJE FOUNDA

14W City or town State ZIP code Country

NEW YORK NY 10024

Check type of shareholder filing the return : 1:1 Individual El CorporationElPartnership 1:1 S Corporation El Nongrantor Trust ElEstate Employer Identification number (if any) Name of passive foreign investment company (PFIC) or qualified electing fund (QEF)

lUZ71-1 L_11V1I1L_t_;

Address C/O MAPLES AND CALDER, UGLAND HOUSE city GEORGE TOWN State ZIP COLintry Cal

Tax year of company or fund calendar year --- 2004 --- or other

tax year beginning ------------------------------- and

Islands ending . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . .

Number, street, and room or suite no (if a P 0 box, see page 2 of instructions )

A _X~ Election to Treat the PFIC as a QEF. 1, a shareholder of a PFIC, elect to treat the PFIC as a QEF. Com#ete lines la through 2c of Part /L B Deemed Sale Election . 1, a shareholder on the first day of a PFIC's first tax year as a QEF, elect to recognize gain on

the deemed sale of my interest in the PFIC . Entergain orloss on line 10f of Part IV. C Deemed Dividend Election . 1, a shareholder on the first day of a PFIC's first tax year as a QEF that is a controlled

foreign corporation (CFC), elect to treatan amount equal to my share of the post-1986 earnings and profits of the CFC as an excess distribution . Enter this amoun,' on line 10e of Part IV.

D Election To Extend Time For Payment of Tax. 1, a shareholder of a QEF, elect to extend the time for payment of tax on the undistributed earnings and profits of the QEF until this election is terminated . Complete lines 3a through 4c of Part // to calculate the tax that may be deferred Note : If any portion of line la or line 2a of Part // is includible under section 551 or 951, you may not make this election. Also, see sections 1294(c) and 1294(o and the related regulations for events that terminate this election.

E I:] Election'To Recognize Gain on Deemed Sale of PFIC . 1, a shareholder of a former PFIC or a PAC to which section 1297(e) applies, elect to treat as an excess distribution the gain recognized on the deemed sale of my interest in the PFIC, or, if I qualify, my share of the PFIC's post-1986 earnings and profits deemed distributed, on the la,3t day of its last tax year as a PFIC under section 1297(a). Entergain on line 10f ofPart IV

F F-1 Election To Mark-To-Market PFIC Stock. 1, a shareholder of a PFIC, elect to mark-to-market the PFIC stock that is marketable within the meaning of sectio i 1296(e) . Complete Part ///.

Income From a Qualified Electing Fund (QEF) . All QEF shareholders complete lines la through 2c . If you are making Election D, also complete lines 3a through 4c (See page 5 of instructions.)

I a Enter your pro rata share of the ordinarl earnings of the QEF . . . . la NONE b Enter the portion of line 1 a that is included in income under

section 551 or 951 or that maybe excluded under section 1293(g) lb c; Subtract line 1 to from line 1 a . Enter this amount on your tax return as dividend income . . . . . Ic NONE

2a Enter your pro rata share of the total net capital gain of the QEF 2a INONE b Enter the portion of line 2a that is included in income under

section 551 or 951 or that may be exClUded under section 1293(g) 2b c Subtract line 2b from line 2a . This amount is a net long-term capital gain . Enter this amount

in Part 11 of the Schedule D used for your income tax return . (See instructions .) . . . . . . . 2c NONE 3 a Addlineslcand2c . . . . . . . . . . . . . . . . . . 3a NONE b Enter the total amount of cash and the fair market value of other

property distributed or deemed distributed to you during the tax year of the QEF. (See instructions .) . . . . . . . . . . . . . 3b NONE

c Enter the portion of line 3a not already included in line 3b that is attributable to shares in the QEF that you disposed of, pledged, or otherwise transferred during the tax,jear . . . . . . . . . 3c.

d Add lines 3b and 3c . . . . . . . . . . . . . . . . . . . . . . 3d NONE e Subtract line 3d from line 3a, and enter the difference (if zero or less, enter amount in brackets) 39 NONE

Important : If line 3e is greater than zeio, and no portion of line la or 2a is includible in income under section 551 or 95 1, you may mai~e Election D with respect to the amount on line 3e. 41

4 a Enter the total tax for the tax year (See instructions ) . . . . . . . . 4a INONE b Enter the total tax for the tax year determined without regard to

the amount entered on line 3e . . . . . . . . . . .

. . .

4b c Subtract line 4b from line 4a . This is the deferred tax, the time for payment of

which is extended by making Electi in D . See instructions . . . 4c For Paperwork Reduction Act Notice, see page 7 of separate instructions . Form 8621 (Rev 12-2004) (HTA)

3 Deferred tax . . . . . . .4 Interest accrued on deferred

tax (line 3) as of the filing date

5 Event terminating election ,6 Earnings distributed or deemed

distributed during the tax year 7 Deferred tax due with this

return 8 Accrued interest due with

this return 9 Deferred tax outstanding after

partial termination of election 10 Interest accrued after partial

termination of election Form 8621 (Rev 12-2004)

Form 8621 (Rev 12-2004) PETER & HELEN HAJE FOUNDATION 13-4112185 Page 2 N IIIIIIII:WRIM Gain or (Loss) From Mark-to-Market Election (See page 5 of instructions .) 5 Enter the fair market value of your PFIC stock at the end of the tax year . . . . . . 5 6 Enter your adjusted basis in the stock at the end of the tax year . . . . . . . . . . . . . 6 7 Excess . Subtract line 6 from line 5 . If a gain, stop here . Include this amount as ordinary income

on your tax return If a loss, go to line 8 . . . . . . . . . . . . . . . . . . . . . 7 0 8 Enter any unreversed inclusions (as defined in section 1296(d)) . See instructions. 8 Sl Enter the smaller of line 7 or line 8 InClUde this amount as an ordinary loss on your tax return 9 0 EMNMI -Distributions From and Dispositions of Stock of a Section 1291 Fund (See page 6 of instructions .)

Complete a separate Part /V for each excess distribution (see instructions) . 10 a Enter your total distributions from the section 1291 fund during the current tax year with respect to the

applicable stock . If the holding period of the stock began in the current tax year, see instructions . . . . . 10a b Enter the total distributions (reduced by the portions of such distributions that were excess

distributions but not included in income linder section 1291 (a)(1)(13)) made by the fund with respect to the applicable stock for each of the 3 years preceding the current tax year (or if shorter, the portion of the shareholder's holding period before the current tax year) . . . . . . 10b

c Divide line 1 Ob by 3 . (See instructions if the number of preceding tax years is less than 3 .) 10C 0 d Multiply line 10c by 125% (1 .25) . . . . . . . . . . . . . . . . . . . . . . . 10d 0 e Subtract line 1 Od from line 1 Oa . This amount, if more than zero, is the excess distribution with respect to

the applicable stock . If zero or less and you did not dispose of stock during the tax year, do not complete the rest of Part IV. See instructions if you received more than one distribution during the current tax year . Also, see instructions for rules for reporting a nonexcess distribution on your income tax return 10e 0

f Enter gain or loss from the disposition of stock of a section 1291 fund or former section 1291 fund . If a gain, complete line 11 . If a los% show it in brackets and do not complete line 11 . . . 10f

11 a Attach a statement for each distribution and disposition . Show your holding period for each share of stock or block of shares held . Allocate the excess distribution to each day in your holding period . Add all amounts that are allocated to days in each tax year .

b Enter the total of the amounts determined in line 11 a that are allocable to the current tax year and tax years before the foreign corporation became a PFIC (pre-PFIC tax years). Enter these amounts on your income tax return as other income . . . . . . . . . . . . . . . . . . 11b

c Enter the aggregate increases in tax (before credits) for each tax year in your holding period (other than the current tax year and pre- PFIC years) . (See instructions ) . . . . . . . . . . 11c

d Foreign tax credit . (See instructions ) . . . . . . . . . . . . . . . . . . 11d e Subtract line 11 d from line 11 c . Enter this amount on your income tax return as "additional

tax ." (See instructions .) . . . . . . * * * *

. . . . . . . . . . . . . . . . 11e 0 f Determine interest on each net increase in tax determined on line 11 e using the rates and

methods of section 6621 . Enter the aggregate amount of interest here (See instructions .) . . . lif Status of Prior Year Section 1294 Elections and Termination of Section 1294 Elections Complete a separate column for each outstanding election . Complete lines 9 and 10 only if there is a partial termination of the section 1294 election.

W (ii) (iii) (iv) (v) (vi) I Tax year of outstanding

election ----------------------------- ----------------------------------------------------------

:2 Undistributed earnings to which the election relates

Form8621 (Rev December 2004) Department of the Treasury Internal Revenue Service

OMB No 1545-1002

Attachment 0- See separate instructions.

13-4112185 HELEN HAJE FOUNDATION Number, street, and room or suite no (if a P 0 box, see page 2 of instructions ) Shareholder tax year calendar year 2004 ------ or other tax year

beginning . . .. . . . . . .. . . . . . .. . . and ending . . . . . . . . . . . .. . . . . . 44 City or town State ZIP code Country

NEW YORK NY 10024

Check type of shareholder filing the return : El Individual El CorporationEl Partnership El S Corporation 1:1 Nongrantor Trust El Estate-

Name of passive foreign investment company (PFIC) or qualified electing fund (QEF) Employer Identifilcation number (if any)

.WESTERN OIL SANDS INC . Address 440 SECOND AVENUE S.W., SUITE 2400 Tax year of company or fund calendar year --- 2004 --- or other City CALGARY, ALBERTA T2P 5E9 . tax year beginning ------------------------------- and State ZIP Country Canada ending . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

W,.Ms a E Elections (See instructions .)

A [:X] Election to Treat the PFIC as a QEF . 1, a shareholder of a PFIC, elect to treat the PFIC as a QEF . Corn#ete lines la through 2c of Pall fl .

B Deemed Sale Election . 1, a shareholder on the first day of a PFIC's first tax year as a QEF, elect to recognize gain on the deemed sale of my interest in the PFIC Entergain orloss on line 10f of Part IV.

C Deemed Dividend Election . 1, a shareholder on the first day of a PFIC's first tax year as a QEF that is a controlled foreign corporation (CFC), elect to treat an amount equal to my share of the post-1986 earnings and profits of the CFC as an excess distribution . Enter this amourt on line 10e of Part IV.

D F] Election To Extend Time For Payment of Tax . 1, a shareholder of a QEF, elect to extend the time for payment of tax on the undistributed earnings and profits of the QEF until this election is terminated . Complete lines 3a through 4c of Part // to calculate the tax that may be deferred. Note : If any portion of line la or line 2a of Part // is includible under section 551 or 951, you may not make this election. Also, see sections 1294(c) and 1294(oand the related regulations for events that terminate this election .

E [j Election To Recognize Gain on Deemed Sale of PFIC . 1, a shareholder of a former PFIC or a PFIC to which section 1297(e) applies, elect to treat as an excess distribution the gain recognized on the deemed sale of my interest in the PFIC, or, if I qualify, my share of the PFIC's post-1986 earnings and profits deemed distributed, on the last day of its last tax year as a PFIC under section 1297(a) . Entergain on line 10f of Part IV.

F F1 Election To Mark-To-Market PFIC Stock . 1, a shareholder of a PFIC, elect to mark-to-market the PFIC stock that is marketable within the meaning of secti n 1296(e) . Complete Part

Income From a Qualified Electing Fund (QEF). All QEF shareholders complete lines la through 2c . If you are making Election D, also complete lines 3a through 4c . (See page 5 of instructions

I a Enter your pro rata share of the ordinary earnings of the QEF la 23 b Enter the portion of line 1 a that is included in income under

section 551 or 951 or that may be eXCILided under section 1293(g) lb c Subtract line 1 b from line 1 a . Enter this amount on your tax return as dividend income . . . . . _1C 23

2 a Enter your pro rata share of the total nE.It capital gain of the QEF 2a b Enter the portion of line 2a that is included in income under

2b section 551 or 951 or that may be exchicled under section 1293(9 c Subtract line 2b from line 2a . This amount is a net long-term capital gain . Enter this amount

in Part 11 of the Schedule D used for your income tax return (See instructions .) . . . . . 2c 0 3 a Add lines 1 c and 2c . . . . . . . . . . . . . . . . . . . . . . . . . 3a 23 b Enter the total amount of cash and the fair market value of other

property distributed or deemed distributed to you during the tax year of the QEF. (See instructions .) . . . . . . . . . . 3b NONE

c Enter the portion of line 3a not already included in line 3b that is attributable to shares in the QEF that you disposed of, pledged, or otherwise transferred during the tax year . . . . . . . . . . 3c

d Add lines 3b and 3c . . . . . . . . . . . . . . . . . . . . . . . . 3d NONE e Subtract line 3d from line 3a, and enter the difference (if zero or less, enter amount in brackets) 3e 23

Important: If line 3e is greater than Zero, and no portion of line la or 2a is includible in income under section 551 or 951, you may make Election D with respect to the amount on line 3e.

4. a Enter the total tax for the tax year (See instructions .) . . . .

4a INONE b Enter the total tax for the tax year determined without regard to

the amount entered on line 3e 4b INONE c Subtract line 4b from line 4a . This is the deferred tax, the time for payment of

which is extended by making Electi in D . See instructions 4c NONE For Paperwork Reduction Act Notice, see page 7 of separate instructions. Form 8621 (Rev 12-2004) (HTA)

Return by, a Shareholder of a Passive Foreign Investment Company or Qualified Electing Fund

Narrie of shareholder Identifying number (see page 2 of instructions)

Form 8621 (Rev 12-2004)

Forn18621 (Rev 12-2004) - PETER AND HELEN HAJE FOUNDATION 13-4112185 Page 2 E~~Gai~nor (Loss) From mark-ta-Market Election (See page 5 of instructions .) 5 Enter the fair market value of your PFIC stock at the end of the tax year 5 6 Enter your adjusted basis in the stock at the end of the tax year . . . . . . . . . . . . 6 7 Excess . Subtract line 6 from line 5 . If a gain, stop here. Include this amount as ordinary income

on your tax return . If a loss, go to line 8 . . . . . . . . . . . . . . . . . . . . . . 7 0 8 Enter any unreversed inclusions (as defined in section 1296(d)) . See instructions . . .

* . . 8

9 Enter the smaller of line 7 or line 8 InClUde this amount as an ordinarv loss on vour tax return 9 0 JUEERM Distributions From and Dispositions of Stock of a Section 1291 Fund (See page 6 of instructions .)

Complete a separate Part IV for each excess distribution (see instructions). 10 a Enter your total distributions from the section 1291 fund during the current tax year with respect to the

applicable stock If the holding period of the stock began in the current tax year, see instructions . . . . . 10a b Enter the total distributions (reduced by the portions of such distributions that were excess

distributions but not included in income under section 1291 (a)(1)(8)) made by the fund with respect to the applicable stock for each of the 3 years preceding the current tax year (or if shorter, the portion of the shareholders holding period before the current tax year) . . . . . 10b

c Divide line 10b by 3 . (See instructions if the number of preceding tax years is less than 3 .) loc 0 d Multiply line 10c by 125% (1 .25) . . . . . . . . . . . . . . . . . . . . . . . . 10d 0 e Subtract line 1 Od from line 1 Oa . This amount, if more than zero, is the excess distribution with respect to

the applicable stock . If zero or less and you did not dispose of stock during the tax year, do not complete the rest of Part IV. See instructions if you received more than one distribution during the current tax year. Also, see instructions for rules for reporting a nonexcess distribution on your income tax return 100 0

f Enter gain or loss from the disposition of stock of a section 1291 fund or former section 1291 fund . If a gain, complete line 11 . If a loss, show it in brackets and do not complete line 11 . . . lof

11 a Attach a statement for each distribution and disposition . Show your holding period for each share of stock or block of shares held . Allocate the excess distribution to each day in your holding period . Add all amounts that are allocated to days in each tax year.

b Enter the total of the amounts determined in line 11 a that are allocable to the current tax year and tax years before the foreign corporation became a PFIC (pre-PFIC tax years) . Enter these amounts on your income tax return as other income . . . . . . . . . . . . . . llb

c Enter the aggregate increases in tax (before credits) for each tax year in your holding period (other than the current tax year and pre- PFIC years) . (See instructions .) . . . . . . . lic

d Foreign tax credit (See instructions ) . . . . . . . . . . . . . . . . . . . lid e Subtract line 11 d from line 11 c . Enter this amount on your income tax return as "additional

tax ." (See instructions .) . . . 110 0 f Determine interest on each net increasE' in tax determined on line 1 le using the rates and

methods of section 6621 Enter the aggregate amount of interest here (See instructions .) . . . lif ff~Statuis of Prior Year Section 1294 Elections and Termination of Section 1294 Elections

Complete a separate column for each outstanding election . Complete lines 9 and 10 only if there is a partial termination of the sechon 1294 election .

W (ii) (iii) (iv) (v) (vi) I Tax year of outstanding

election ---- ------------------------ ----------------------------------------------------------

2 Undistributed earnings to which the election relates

3 Deferred tax .4 Interest accrued on deferred


5 Event terminating election B Earnings distributed or deemed


return 8 Accrued interest due with

this return 9 Deferred tax outstanding after


Form8621- Return by a Shareholder of a Passive Foreign

(Rev December 2004) Investment Company or Qualified Electing Fund Department of the Treasury internal Revenue Service b- See separate instructions .

Name of shareholder Identifying number (see page 2 of instructions)

PETER AND HELEN HAJE FOUNDATION 1 13-4112185

Attachment Seauence No 69

Shareholder tax year calendar year 2004 ------ or other tax year beninninct and endinq

Number, street, and room or suite no (If a P 0 box, see page 2 of instructions

44 WEST 77TH STREET . Suite 14W ------------------ City or town State ZIP code Country NEW YORK NY 10024

Check type of shareholder filing the return . 1:1 Individual El Corporation 1:1 PartnershipEIS Corporation [:] Nongrantor Trust D Estate Name of passive foreign investment company (PFIC) or qualified electing fund (QEF) CALVISSON FINANCE CORP. & INDUSTRIAL CAPITAL CORP. Address CITCO BUILDING, WICKHAMS CAY, PO BOX 662 City ROAD TOWN, TORTOLA State ZIP country British Virgi

Employer Identification number (if any)

Tax year of company or fund calendar year --- 2004 --- or other

tax year beginning ------------------------------- and ending . . .. . .. . . . . . . . . . . . . . . . . . . . . . . . .

Elections (See instructions .

F Election To Mark-To-Market PFIC Stock. 1, a shareholder of a PFIC, elect to mark-to-market the PFIC stock that is marketable within the meaning of section 1296(e) Complete Part

Income From a Qualified Electing Fund (QEF). All QEF shareholders complete lines la through 2c. If you are making Election D, also complete lines 3a through 4c. (See page 5 of instructions )

I a Enter your pro rata share of the ordinary earnings of the QEF . . . la NONE lo Enter the portion of line 1 a that is included in income under

section 551 or 951 or that maybe excluded under section 1293(g) -1b c Subtract line 1 b from line 1 a. Enter this amount on your tax return as dividend income . . . . . Ic NONE

2a Enter your pro rata share of the total net capital gain of the QEF 2a INONE b Enter the portion of line 2a that is included in income under

section 551 or 951 or that may be excluded under section 1293(g) 2b c Subtract line 2b from line 2a . This amount is a net long-term capital gain . Enter this amount

in Part 11 of the Schedule D used for your income tax return (See instructions .) . . . . . . . . 2c NONE 3 a Add lines 1 c and 2c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3a NONE b Enter the total amount of cash and the fair market value of other

property distributed or deemed distributed to you during the tax year of the QEF. (See instructions .) . . . 3b NONE

c Enter the portion of line 3a not already included in line 3b that is attributable to shares in the QEF that yDu disposed of, pledged, or otherwise transferred during the tax year . . . . . . . 3c

d Add lines 3b and 3c . . . . . . . . . . . . . . . . . . . . . . . . .

. . . 3d INONE e Subtract line 3d from line 3a, and enter the difference (if zero or less, enter amount in brackets) 3e INONE

Important: If line 3e is greater than zero, and no portion of line la or 2a is includible in income under section 551 or 95 1, you may make Election D with respect to the amount on line 3e .

4 a Enter the total tax for the tax year (See instructions ) . ' '

4a INONE b Enter the total tax for the tax year determined without regard to

the amount entered on line 3e . . . . . . . . . . . .

Ab INONE c Subtract line 4b from line 4a . This is the deferred tax, the time for payment of

which is extended by making Electi in D. See instructions . . . . . . . For Paperwork Reduction Act Notice, see page 7of separate instructions . piTj%)

4c INONE Form 8621 (Rev 12-2004)

OMB No 1545-1002

A FRI Election to Treat the PFIC as a QEF. 1, a shareholder of a PFIC, elect to treat the PFIC as a QEF. Complete lines la through 2c of Part /L BE] Deemed Sale Election . 1, a shareholder on the first day of a PFIC's first tax year as a QEF, elect to recognize gain on

the deemed sale of my interest in the PFIC . Enter gain or loss on line 10f of Part IV. C FA Deemed Dividend Election . 1, a shareholder on the first day of a PFIC's first tax year as a QEF that is a controlled

foreign corporation (CFC), elect to treat an amount equal to my share of the post-1986 earnings and profits of the CFC as an excess distribution . Enter this amount on line 10e of Part IV.

DEJ Election To Extend Time For Payment of Tax. 1, a shareholder of a QEF, elect to extend the time for payment of tax on the undistributed earnings and profits of the QEF until this election is terminated . Complete lines 3a through 4c of Part // to calculate the tax that may be deferred. Note : ff any portion of line la or line 2a of Part // is includible under section 551 or 951, you may not make this election Also, see sections 1294(c) and 1294(o and the related regulations for events that terminate this election .

ED Election To Recognize Gain on Deemed Sale of PFIC . 1, a shareholder of a former PFIC or a PFIC to which section 1297(e) applies, elect to treat as an excess distribution the gain recognized on the deemed sale of my interest in the PFIC, or, if I quality, my share of the PFIC's post-1986 earnings and profits deemed distributed, on the la st day of its last tax year as a PFIC under section 1297(a). Entergaln on line 10f of Part IV.

Form 8621 (Rev 12-2004)

Form8621 (Rev 12-2004) PETER AND HELEN HAJE FOUNDATION 13-4112185 Page 2 7in or (Loss) F om Mark-to-Market Election (See page 5 of instructions .)

5 . . . . . 5 Enter the fair market value of your PFIC stock at the end of the tax year . 6 Enter your adjusted basis in the stock al the end of the tax year . . . . . . . . . . . . . 6 7' Excess. Subtract line 6 from line 5 . If again, stop here. Include this amount as ordinary income

on your tax return . If a loss, go to line 8 . . . . . . . . . . . . . . . . . . . . . 7 0 8 Enter any unreversed inclusions (as defined in section 1296(d)) See instructions . . . . . . . 8 9 Enter the smaller of line 7 or line 8 . Include this amount as an ordinary loss on your tax return 9 0 E-MM Distributions From and Dispositions of Stock of a Section 1291 Fund (See page 6 of instructions .)

Complete a separate Part Wfor each excess distribution (see instructions) . 10a Enter your total distributions from the section 1291 fund during the current tax year with respect to the

applicable stock . If the holding period of the , .tock began in the current tax year, see instructions . . . . 10a b Enter the total distributions (reduced by the portions of such distributions that were excess

distributions but not included in income under section 1291 (a)i made by the fund with respect to the applicable stock for each of the 3 years preceding the current tax year (or if shorter, the portion of the shareholders holding period before the current tax year) . . . . . . 10b

c Divide line 1 Ob by 3 . (See instructions if the number of preceding tax years is less than 3 .) 10c 0 d Multiply line 10c by 125% (1 .25) . . . . . . . . . . . . . . . . . . . . . . .

. . . 10d 0

o Subtract line 1 Od from line 1 Oa This amount, if more than zero, is the excess distribution with respect to the applicable stock . If zero or less and you (lid not dispose of stock during the tax year, do not complete the rest of Part IV . See instructions if you received more than one distribution during the current tax year. Also, see instructions for rules for reporting a nonexcess distribution on your income tax return . loe 0

f Enter gain or loss from the disposition of stock of a section 1291 fund or former section 1291 fund . If a gain, complete line 11 . If a loss, show it in brackets and do not complete line 11 . . . lof

11 a Attach a statement for each distribution and disposition . Show your holding period for each share of stock or block of shares held . Allocate the excess distribution to each day in your holding period . Add all amounts that are allocated to days in each tax year .

b Enter the total of the amounts determined in line 11 a that are allocable to the current tax year and tax years before the foreign corporation became a PFIC (pre-PFIC tax years). Enter these amounts on your income tax return as cther income . . . . . . . . . . . . . . . . . 11b

c Enter the aggregate increases in tax (before credits) for each tax year in your holding period (other than the current tax year and pre -PFIC years) (See instructions ) . . . . . . lic

d Foreign tax credit . (See instructions .) . . . . . . . . . . . . . . . . . . . . . Ild e Subtract line 1 ld from line 1 1c . Enter this amount on your income tax return as "additional

tax ." (See instructions .) . . . . . . . . . . .

11e 0 f Determine interest on each net increase in tax determined on line 11 e using the rates and

methods of section 6621 . Enter the aggregate amount of interest here (See instructions .) lif status of Prior Year Section 1294 Elections and Termination of Section 1294 Elections Complete a separate column for each outstanding election . Complete lines 9 and 10 only if there is a partial termination of the section 1294 election.

(iii) (IV) (v) (vi) I Tax year of outstanding

election ----------------------------- ---------------------------------------------------------- 2 Undistributed earnings to

which the election relates

3 Deferred tax 4 Interest accrued on deferred


5 Event terminating election 6 Earnings distributed or deemed


return . . . . . . . . 8 Accrued interest due with

this return . . . . . . . 9 Deferred tax outstanding after



Form no 8868' Application for Extension of Time To File an (Flev . December 2004) Exempt Organization Return OMB No 1545-1709 Depnirtment of the Treasury Internal Revenue StNvice- 10~ File a separate application for each return

" If you are filing for an Automatic 3-Month Extension, complete only Part I and check this box EY] " If you are filing for an Additional (not automaticl 3-Month Extension, complete only Part 11 (on page 2 of this form) . Do not complete Part 11 unless you have already been granted an automatic 3-month extension on a previously filed Form 8868

[F_~=rtl Automatic 3-Month Extension of Time - Only submit original (no copies needed)

Form 990-T corporations requesting an automatic 6-month extension - check this box and complete Part I only

All other corporations (including Form 990-C hifers)must use Form 7004 to request an extension of time to file income tax returns. Partnerships, REMICs, and trusts must use Form 8736 to request an extension of time to file Form 1065, 1066, or 1041

Electronic Filing (e-file) . Form 8868 can be filed electronically If you want a 3-month automatic extension of time to file one of the returns noted below (6 months for corporate Form 990-T filers). However, you cannot file it electronically if you want the additional (not automatic) 3-month extension, instead you must submit the fully completed signed page 2 (Part 11) of Form 8868 For more details on the electronic filing of this form, visit wwwJ-s.gov1efde.

Type or Name of Exempt Organization Employer identification number print

PETER AM HELEN HAJ13 FOUNDATION 13-4112185 File by the due date for Number, street, and room or suite no . If a P.O . box, see instructions . filing your 44 WEST 77TH STREET, NO . 14W return See insh,uctions City, town or post office, state, and ZIP code . For a foreign address, see instructions .

I NEW YORK, NY 10024

Check type of return to be filed (file a separate application for each return)-

[-] Form 990 Form 990-T (corporation) Fj Form 4720

E] Form 990-BL Form 990-T (sec . 401 (a) or 408(a) trust) Form 5227

[_1 Form 990.EZ Form 990-T (trust other than above) Form 6069

[Y] Form 990-PF Form 1041 -A Form 8870

The books are in the care of Pl- TAG ASSOCIATES , LLC TelephoneNo .Op- 212-275-1500 FAX No . 00-

" If the organization does not have an office or place of business in the United States, check this box 0 . = " If this is for a Group Return, enter the organization's four digit Group Exemption Number (GEN) If this is for the whole group, check this box 0- = . If it is for part of the group, check this box 0- = and attach a list with the names and EINs of all members the extension will cover.

I I request an automatic 3-month (6-months for a Form 990-T corporation) extension of time until -AUGUST 15, 2005 to file the exempt organization return for the organization named above. The extension is for the organization's return for : Oil- [X] calendar year 2 0 0 4 or P.- E:Jtax year beginning and ending

.2 If this tax year is for less than 12 months, chEck reason- F-1 Initial return Final return F I Change in accounting period

3a If this application is for Form 990-BL, 990-PF, 990-T, 4720, or 6069, Enter the tentative tax, less any nonrefundable credits. See instructions $ 37,081 .

b If this application is for Form 990-PF or 990-T, enter any refundable credits and estimated tax payments made . Include any prior year overpayment allowed as a credit $ 1,981 .

Balance Due . Subtract line 3b from line 3a . Include your payment with this form, or, if required, deposit with FrD coupon or, If required, by using EFTPS (Electi onic Federal Tax Payment System) . See instructions $ 35,100 .

Caution. If You are going to make an electronic fund withdrawal with this Form 8868, see Form 8453-EO and Form 8879-EO for payment instructions .

LHA For Privacy Act and Paperwork Reduction Act Notice, see instructions. Form 8868 (Rev . 12-2004)

4' 23831 01-10-05

Director Date

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

Name TAG ASSOCIATES, LLC ATTN:SHAWANA SCOTT

Typ e Number and street (include suite, room, or apt no.) or a P.O. box number or print 75 ROCKEFELLER PLAZA, 9 FL

City or town, province or state, and country (including postal or ZIP code) 423832 01-10-05 NEW YORK, NY 10019

Form 8M (Rev . 12-2004) 29


Form 8868 (Rev. 12-2004) ' Page 2 6 If you are filing for an Additional (not automatic) 3-Month Extension, complete only Part 11 and check this box 10~ FX1 Note : Only complete Part 11 if you have already been granted an automatic 3-month extension on a previously filed Form 8868 0 If you are filing for an Automatic 3-Month Extension, complete only Part I (on page 1). LEart 111 Additional (not automatic) 3-Month Extension of Time - Must file Original and One Copy.

Type or Name of Exempt Organization Employer identification number

print. LT?rPT?P AXM WT?T.R1N7 WA .7T? VOTTMnArPTOM 1 'A-Al 1 1)11 At, File by the exiended Number, street, and room or suite no . If a P.O. box, see instructions . For IRS use only due date for 44 WEST 77TH STREET, NO . 14W filing the return See City, town or post office, state, and ZIP code For a foreign address, see instructions . instructions NEW YORK . NY 10024 Check type of return to be filed (File a separate application for each return)- [--~] Form 990 D Form 990-EZ D Form 990-T (sec 401 (a) or 408(a) trust) E:1 Form 1041 -A Ej Form 5227 ED Form 8870 E-1 Form 990-BL EKI Form 990-PF E] Form 990-T ftrust other than above) =1 Form 4720 = Form 6069

STOP : Do not complete Part 11 if you were not already granted an automatic 3-month extension on a previously filed Form 8868 .

" The books are in thecare of lll~ TAG ASSOCIATES, LLC Telephone No.lp,- 212-275-1500 FAX No . Ill-

" If the organization does not have an office or place of business in the United States, check this box " If this is for a Group Return, enter the organization's four digit Group Exemption Number (GEN)_ If this is for the whole group, check this box 0, = If it isforpartof the group, checkthis boxII0, = and attach a list with the names and EINs of all members the extension is for . ,4 1 request an additional 3-month extension of ~ ime until NOVEMBER 15, 2005 . 5 For calendar year 2 0 0 4 , or other tax year beginning and ending 13 If this tax year is for less than 12 months, chock reason . = Initial return =1 Final return ED Change in accounting period 7 State in detail why you need the extension

Sa 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 $ 16,294 .

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 $ 981 .

c Balance Due. Subtract line 8b from line 8a . Include your payment with this form, or, if required, deposit with FTD coupon or, it required, by using EFTPS (Elect,onic Federal Tax Payment System) See instructions $ 14,313 .

Signature and Verification Under penalties of perlury, I declare that I have examined I his form, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete, and that I am authorized to prepare this form.

ajignature Title lo, CPA Date OP. Notice to Applicant - To Be Completed by the IRS

E-] We have approved this application . Please altach this form to the organization's return. E-1 We have not approved this application . Howaver, we have granted a 1 0-day grace period from the later of the date shown below or the due

date of the organization's return (including ary prior extensions) . This grace penod is considered to be a valid extension of time for elections otherwise required to be made on a timely rel urn . Please attach this form to the organization's return .

El We have not approved this application . After considering the reasons stated in item 7, we cannot grant your request for an extension of time to file We are not granting a 10-day grace penod . We cannot consider this application becausa rt was filed after the extended due date of the return for which an extension was requested . Other

Documents

Form 990-PF ~ Return of Private Foundation 2004990s.foundationcenter.org/990pf_pdf_archive/134/134112185/134112185... · 7 Total credits and payments. Add lines 6a through 6d 8 Enter