" ..

Form990-PF

EXTENSION GRANTED Return of Private Foundation

or Section 4947(a)(1) Nonexempt Charitable Trust Treated as a Private Foundation

OMB No 1545-0052

Department ol the Treasury Internal Rever,'le Service Note: The foundabon ma be able to use a co of this return to sails rt1n re u1rements ~@09 F d or ca en ar year 2009 , or tax year b eamnma . 2009 ,an en mg . 20

G Check all that apply H Initial return LJ Initial return of a former public charity LJ Final return

Amended return n Address chanae n Name change Name of foundabon

Use the IRS label. DAVID H. KOCH CHARITABLE FOUNDATION

Otherwise, Number and street (or PO box number If ma1l 1s not dehvered to street address) Room/suite print

or type. 4111 E. 37TH ST. N. See Specific City or town, state, and ZIP code lnstrucbons.

WICHITA, KS 67220-3203

H Check type of organization llS.J Section 501 (cfli exempt private foundation n Section 4947(alC1l nonexempt chantable trust Other taxable private foundation

I Fair market value of all assets at end J Accounting method LJ Cash ~ Accrual

of year (from Part II, col (c), /me D Other (specify) ______________________

16) ... $ 95,264,998. (Part I, column (d) must be on cash basis)

·~··•• Analysis of Revenue and Expenses (The

QI :::, c: QI > QI

~ -c:, ~

cc ~

> 0 z a UJ z: z () CJ;,

CII QI CII c: QI Q, )(

w QI > .. C'CI ... .. CII ·2 ·e -c <(

-c c: C'CI Cl)

~ l!! QI Q,

0

total of amounts m columns (b), (c), and (d) may not necessanly equal the amounts m column (a) (see oage 1 k>f the mstrucllons) J

1 ContnbubonLJ grants, etc , received (attach schedule) •

2 Ch k ... If the foundation 1s not required to ec attach Sch B • , , , , , • • , •

3 Interest on savings and temporary cash investments

4 D1v1dends and interest from securities

5a Gross rents • • • • • • • • • • • • • • • •

b Net rental income or (loss)

6a Net gain or (loss) from sale of assets not on hne 1 O b Gross sales pnce for all

assets on line 6a 7 Capital gain net income ~om PartlV..JJne.21

8 Net sh6rt-term l1!ei!'&e. \VEO ... i 9 lncom~ mod1ficat1ons_!...-!-,-"--.-.--a (:)·

10 a Gross saJes l~ss re1ums I \ <;Q \ and allowffis · · , • ·

b Less colltofboodsl~V. 1>. '), 7_01U \ '!.\ 101 • j 1 c Gross piofit or (loss) (attach scheduleL 0:::

11 L ·-.

Other in ;ome1aomm LJ\ .... 12 Total. Aid lrnes :1'. t •• : • • •

13 Compensation of officers, directors, trustees, etc

14 Other employee salaries and wages

15 Pension plans, employee benefits .... 16 a Legal fees (attach schedule) • • • • • • •

b Accounting fees (attach schedule) ~T.c~ .2.

c Other professional fees (attach schedule) • *. 17 Interest •••••..••.••••••••

18 Taxes (attach schedule) (see page 14 or the ,nstrucbons,* * 19 Depreciabon (attach schedule) and deplebon

20 Occupancy •••••••.•••

21 Travel, conferences, and meebngs • • • • •

22 Pnnbng and publrcabons ......... 23 Other expenses (attach schedule) ~.'T:C.H. ? . 24 Total operating and administrative expenses

Add lrnes 13 through 23 .......... 25 Contnbubons. gifts, grants paid ....... 26 Total exoenses and disbursements Add lines 24 and 25

27 Subtract lrne 26 from line 12

a Excess of revenue over expenses and disbursements • •

b Net investment income (1f negabve, enter -0-)

c Ad1usted net income (1f neoabve, enter -0-l. .

(a) Revenue and (b) Net investment expenses per income

books

10,000,000.

986 986.

10,000,986. 986.

0

11,770. 0.

825

20

1,033.

13,648. 0.

13,648. 0.

9,987,338.

986.

A Employer ldentlflcatlon number

48-0926946

B Telephone number (1ee page 10 or the tnstruetJons)

(316) 828 -5552 c If exemptJon appllcallon 1s :o pending check here ...... D 1 Foreign organ1zat1ons, check here

2 Foreign orgamzations meet.Ing the 85% tes~ cheek here and attach .... o computatJon ........

E If pnvate foundation status was tennanated

under secbon 507(b)(1)(A), check here • ... o F If the foundation 1$ In 8 60-month terrmnatJon n

under secbon 507(b)(1 )(B) check here , ...

(d) Disbursements (c) AdJusted net for chantable

income purposes leash basis onlvl

ATCH 1

0. 9,695

1,245

1,033

0. 11, 973

0. 11, 973

-0-

For Privacy Act and Paperwork Reduction Act Notice, see page 30 of the instructions. 9

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85652

Form 990-PF (2009)

Form 990-PF (2009) 48-0926946 Page 2

lilnlll Balance Sheets Attached schedules and amounts 111 the Beginning of year End of year descnpt1on column should be for end--0f-year amounts only (See 1nstruct1ons ) (a) Book Value (b) Book Value

1 Cash - non-1nterest-beanng • • .. 3,697. 5,224.

2 Savings and temporary cash investments 272,255. 20,259,741.

3 Accounts receivable ... ------------------------Less allowance for doubtful accounts ... -------------

4 Pledges receivable ... 75,000,000 . ------------------------Less allowance for doubtful accounts ... 85,000,000. 75,000,000. -------------

5 Grants receivable . . .. 6 Receivables due from officers, directors, trustees, and other

d1squahfied persons (attach schedule) (see page 16 of the instructions)

7 Other notes and loans receivable (attach schedule) ... - - - - -

Less allowance for doubtful accounts ... -------------J!l 8 lnventones for sale or use . . .. . . QI 9 Prepaid expenses and deferred charges AT.CB. .6. 53. 33. Cl) Cl)

10 a < Investments - U S and state government obllgat1ons (attach schedule)

b Investments - corporate stock (attach schedule)

c Investments - corporate bonds (attach schedule) • . . .. 11 Investments - land, buildings, ... and equipment basis ------------------Less accumulated depreciation ... (attach schedule) -------------------12 Investments - mortgage loans

13 Investments - other (attach schedule) 14 Land, buildings, and ... equipment basis ------------------Less accumulated deprec1at1on ...

(attach schedule) ________ ------- _____

15 Other assets (describe ... ____________________ )

16 Total assets (to be completed by all filers - see the

1nstruct1ons Also, see page 1, item I) 85,276,005. 95,264,998.

17 Accounts payable and accrued expenses 1,545. 3,200.

18 Grants payable .. 85,000,000. 85,000,000.

xi 19 Deferred revenue .. . . ;§ 20 Loans from officers, directors, trustees, and other d1squallfied persons

'.g 21 Mortgages and other notes payable (attach schedule)

~ 22 Other hab1ht1es (describe ... ___________________ )

23 Total liabilities (add Imes 17 through 22) .. 85,001,545. 85,003,200.

Foundations that follow SFAS 117, check here ... w and complete lines 24 through 26 and lines 30 and 31.

xi 24 Unrestricted 274,460. 10,261,798. u ; 25 Temporanly restricted

ia 26 m Permanently restncted

"ti Foundations that do not follow SFAS 117, c: ... o ::, check here and complete lines 27 through 31. u.. 0 27 Capital stock, trust principal, or current funds

J!l 28 Paid-in or caprtal surplus, or land, bldg . and equipment fund QI

::l 29 Retained earnings, accumulated income, endowment, or other funds

~ 30 Total net assets or fund balances (see page 17 of the QI z mstrucllons) 274,460. 10,261,798. ..

31 Total liabilities and net assets/fund balances (see page 17

of the instructions) .. . . . . . . 85,276,005. 95,264,998.

·= , .. •m• Analysis of Chanaes 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 pnor year's return)

2 Enter amount from Part I, hne 27a .. . . 3 Other increases not included in hne 2 (1tem1ze) ... ------------------------------------4 Add Imes 1, 2, and 3 .. . . . . . . . . . . 5 Decreases not included in hne 2 (1tem1ze) ... 6 Total net assets or fund balances at end of vear (line 4 minus line 5) - Part II. column (bl, line 30

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. .

..

1

2

3 4

5 6

(c) Fair Market Value

5,224 20,259,741.

75,000,000 .

33

95,264,998

274,460 9,987,338

10,261,798

10,261,798 Form 990-PF (2009)

,. I ...

Fonn 990-PF (2009) 48-0926946 Pagel

·~··•lT-Cal>ital Gains and Losses for Tax on Investment Income . (a) List and descnbe the kind(s) of property sold (e g , real estate, \D)HOW (c) Date ld) Date sold acquired acquired P-Purdlase mo, day, yr)

2-story bnck warehouse, or common stock, 200 shs MLC Co ) "-""""b~n (mo, day, yr)

1a

b

c d e

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

a

b c d

e Complete only for assets showing gain in column (h} and owned bv the foundation on 12/31/69 (I) Gains (Col (h) gain minus

(i) FM V as of 12/31/69 U) AdJusted basis (k) Excess of col (1) col (k), but not less than -0-) or as of 12/31/69 over col (J), 1f any

a

b

c d e

2 Capital gain net income or (net capital loss} { If gain, also enter in Part I, line 7 } ..... If (loss). enter -0- in Part I, line 7 2

3 Net short-term capital gain or (loss) as defined 1n sections 1222(5) and (6)

If gain, also enter 1n Part I, line 8, column (c) (see pages 13 and 17 of the instructions) } If (loss), enter -0- in Part I, line 8 ............................. ..... 3

•::E:Ti••-Qualification Under Section 4940{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(d)(2) applies, leave this part blank

Was the foundation liable for the section 4942 tax on the distributable amount of any year in the base period? If ''Yes," the foundation does not qualify under section 4940(e) Do not complete this part

Losses (from col (h))

D Yes[K] No

1 Enter the appropriate amount in each column for each year, see page 18 of the instructions before making any entries (a)

(b) (c) (d) Base penod years D1stnbut1on ratio

Calendar year (or tax year beginning 1n) AdJusted qualifying d1stnbut1ons Net value of nonchantable-use assets (col (b) d1v1ded by col (cl)

2008 18,657,783. 1,531,990. 12.178789

2007 10,106. 3,737,419. 0.002704

2006 4,350,615. 982,416. 4.428485

2005 11,518. 218,181. 0.052791

2004 8,899. 13,600. 0.654338

2 Total of line 1, column (d) 2 17.317107 ................................... . . 3 Average d1stribut1on ratio for the 5-year base period - d1v1de the total on line 2 by 5, or by the

number of years the foundation has been in existence 1f less than 5 years . . . . . . . . . .. 3 3.463421

4 Enter the net value of noncharitable-use assets for 2009 from Part X, line 5 4 1,087,431. ..........

5 Multiply line 4 by line 3 . . . . . . . . . . . . . . . . . . .................... 5 3, 766,231.

6 Enter 1% of net investment income (1% of Part I, line 27b) 6 10. ....................

7 Add Imes 5 and 6 7 3,766,241. . . . . . . . . . . . . . . . . . .........................

8 Enter qualifying d1stribut1ons from Part XII, line 4 ......................... 8 11,973.

If line 8 1s equal to or greater than line 7, check the box in Part VI, line 1b, and complete that part using a 1% tax rate See the PartVI instructions on page 18

JSA 9E1430 1 000

Fonn 990-PF (2009)

14352G K932 11/11/2010 4: 33: 09 PM V 09-8.5 85652

Form 990-PF (2009) 48-0926946 Page4

Excise Tax Based on Investment Income (Section 4940(a), 4940(b), 4940(e), or 4948 - see page 18 of the instructions)

Date Of ruhng or determination letter ____________ (attach copy of ruling letter If necessary - see Instructions)

1a Exempt operai1ng founda~ons descnbed in section 4940(d)(2), check here ~ LJ and enter "N/A" on hne 1 . __ }

b Domesbc foundations that meet the secbon 4940(e) requirements m Part V, check t---1-t _________ 2_0_.

here ~ D and enter 1% of Part I, hne 27b • . • . . • . • • • • . • . • • • . • . • • • • • • • • •

2

3

4

5

s

7

8

9

10 11

c All other domestic foundations enter 2% of hne 27b Exempt foreign organizations enter 4%

of Part I, hne 12, col (b)

Tax under section 511 (domestic section 4947(a)(1) trusts and taxable foundabons only Others enter -0-)

Add Imes 1 and 2

Subtitle A (income) tax (domestic section 4947(a)(1) trusts and taxable foundations only Others enter-0-)

Tax based on investment income. Subtract line 4 from hne 3 If zero or less, enter -O­

Cred1ts/Payments

a 2009 estimated tax payments and 2008 overpayment credited to 2009 Sa

b Exempt foreign organizations-tax withheld at source • • • • • • Sb

c Tax paid with application for extension of time to file (Form 8868) Sc

d Backup w1thhold1ng erroneously withheld Sd

Total credits and payments Add Imes Sa through Sd

Enter any penalty for underpayment of estimated tax Check here

53. 0. 0.

2

3

4

5

7

8

~ 9

~ 10

Tax due. If the total of Imes 5 and 8 1s more than hne 7, enter amount owed ••.•••

Overpayment. If hne 7 1s more than the total of Imes 5 and 8, enter the amount overpaid Enter the amount of hne 10 to be Credited to 2010 estimated tax ~ 33. Refunded ~ 11

Statements Reaarding Activities 1a Dunng the tax year, did the foundation attempt to influence any national, state, or local leg1slat1on or did 11

20. 0.

20.

53.

33.

Yes No 1a x part1e1pate or intervene m any political campaign? • • • • . • • . . • • . • • • • • • . • • • • • • • • . . . . • . • !----+----<,.---

b Did 11 spend more than $100 during the year (either directly or indirectly) for political purposes (see page 19

of the instructions for defin1t1on)? • • • • . • • • • • • • . . • • • • • • • • • • • • • • • • • • • • • • • • •

If the answer is ""Yes" to 1a or 1b, attach a detailed descnpt1on of the act1v1t1es and copies of any matenals

published or d1stnbuted by the foundation m connection with the act1v1ties

c Did the foundation file Form 1120-POL for this year? • • • • • • • • • • • • • • • • • • • •

d Enter the amount (1f any) of tax on political expenditures (section 4955) imposed during the year

(1) On the foundation ~ $ (2) On foundation managers ~ $ __________ _

e Enter the reimbursement (1f any) paid by the foundation during the year for poht1cal expenditure tax imposed

on foundation managers ~ $ ___________ _

1b x

1c x

2 Has the foundation engaged 1n any act1V1t1es that have not previously been reported to the IRS? . . . . . . . . . . . . . . . . f--'2=---+---+--x-If "Yes," attach a detailed descnption of the activities

3 Has the foundation made any changes, not previously reported to the IRS, 1n its governing instrument, articles of

incorporation, or bylaws, or other s1m1lar instruments? If "Yes,'' attach a conformed copy of the changes • . • • . . • •

4a Did the foundation have unrelated business gross income of $1,000 or more during the year?

3 X . . . . . -~+-----,l---4a X

b If "Yes," has 11 filed a tax return on Form 990-T for this year? • • • •••••••••• 4b

5 Was there a hqu1dat1on, term1nat1on. d1ssolut1on, or substantial contraction during the year? 5 x If "Yes,• attach the statement required by General Instruction T

S Are the requirements of section 508(e) (relating to sections 4941 through 4945) satisfied either

• By language 1n the governing instrument, or

• By state leg1slat1on that effectively amends the governing instrument so that no mandatory d1rect1ons that

conflict with the state law remain m the governing instrument? • • • • • • • s x 7 Did the foundation have at least $5,000 m assets at any time during the year? If "Yes,• complete Part II, col (c}, and Part XV 7 x Ba Enter the states to which the foundabon reports or with which 1t 1s registered (see page 19 of the

instructions) ~ KS, ________________ ------- _____ ------------------------------------b If the answer 1s "Yes" to hne 7, has the foundation furnished a copy of Form 990-PF to the Attorney General

(or designate) of each state as required by Genera/Instruction G?lf "No,• attach explanation • . . • • . • • • • • • . • • • • . Sb X

9 Is the foundation da1mmg status as a private operating foundabon w1th1n the meaning of secbon 4942(1)(3) or

4942(1)(5) for calendar year 2009 or the taxable year beginning m 2009 (see mstrucbons for Part XIV on page

27)? If "Yes, "complete Part XIV.

10 Did any persons become substantial contributors during the tax year? If "Yes," attach a schedule llstmg their names and addresses

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9 x

10 x Form 990-PF (2009)

Form 990.PF (2009) 48-0926946 Page5

·~··-·41...-, .... Statements Rei:1ardini:1 Activities (continued)

11 At any time during the year, did the foundation, directly or indirectly, own a controlled entity w1th1n the

meai<11ng of section 512(b)(13)? If "Yes," attach schedule (see page 20 of the instrucllons) . . . . . ............. 11 x 12 Did the foundation acquire a direct or indirect interest in any applicable insurance contract before

August 17, 2008? ••••••••••••.••.•••••••••••••••••••••• 12 x . . . . . . . . .. 13 Did the foundation comply with the public inspection requirements for its annual returns and exemption application? 13 x

Website address ... ____ ~~~~ ___________________________________________________________________ _

14 The books are in care of ""-'~:C2~~~-li.~1=_1=_I_M_A_N ______________________ Telephone no ... _____ ~~~-=-~~~-=._5_~5-~ _____ _ Locatedat ... jlll_E._37TH_ST._N. WICHITA, KS _______________________ ZIP+ 4 ... 67220-3203 ____

11 15 Section 4947(a)(1) nonexempt chantable trusts filing Form 990-PF in lieu of Form 1041 - Check here • • • • · • · · • • • · • • • • • • ""L..J

and enter the amount of tax-exempt interest received or accrued during the year • • • • . • • • • • • • • • • • • • "" I 15 I •::r.111••.4111!1:• 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 Dunng the year did the foundation (either directly or indirectly)

(1) Engage in the sale or exchange, or leasing of property with a disqualified person?

(2) Borrow money from, lend money to, or otherwise extend credit to (or accept 11 from) a

disqualified person? • • • • • • • • . • . • • • • • . • • • • . • • • • • • • •

(3) Furnish goods, services, or facilities to (or accept them from) a disqualified person?

(4) Pay compensation to, or pay or reimburse the expenses of, a disqualified person?

.......

(5) Transfer any income or assets to a disqualified person (or make any of either available for

the benefit or use of a disqualified person)? • • • • • • • • • • • • • • • • • • • • • • .

(6) Agree to pay money or property to a government official? ( Exception. Check "No" 1f

0Yes

~y~ Yes

Yes

0Yes

G] No

~No No

No

GJ No

the foundation agreed to make a grant to or to employ the official for a period after

term1nat1on of government service, 1f terminating within 90 days ) • • • • • • • • • • • • • • • • D Yes GJ No

b If any answer 1s "Yes" to 1a(1)-(6), did any of the acts fail to qualify under the exceptions described 1n Regulations

section 53 4941(d)-3 or 1n a current notice regarding disaster assistance (see page 20 of the 1nstruct1ons)?

Organizations relying on a current notice regarding disaster assistance check here • • • • • • • • • • • .

c Did the foundation engage in a pnor year 1n any of the acts described 1n 1a, other than excepted acts, that

were not corrected before the first day of the tax year beginning 1n 2009?

2 Taxes on failure to d1stnbute income (section 4942) (does not apply for years the foundation was a pnvate

operating foundation defined in section 4942(])(3) or 4942(])(5))

a At the end of tax year 2009, did the foundation have any undistributed income (lines 6d and D 6e, Part XIII) for tax year(s) beginning before 2009? • • • • • • • • • • • • • • • • • • . . • • • . • Yes If "Yes," list the years ... __________ . _________ . ________ , _______ _

b Are there any years listed in 2a for which the foundation 1s not applying the prov1s1ons 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 page 20 of the instructions )

c If the prov1s1ons of section 4942(a)(2) are being applied to any of the years listed 1n 2a, list the years here

""---------- ·--------- ·-------- ·--------3a Did the foundation hold more than a 2% direct or indirect interest in any business D

enterprise at any time dunng the year? • • • • • • • • • • • . . • . • • • • . • • • • • • • • • • • Yes

b If "Yes," did 1t have excess business holdings in 2009 as a result of (1) any purchase by the foundation or

disqualified persons after May 26, 1969, (2) the lapse of the 5-year period (or longer period approved by the

Comm1ss1oner 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 if the

foundation had excess business holdings in 2009) • . • • • • . • . . . • • • • . . . • • • • • • • • • • .

4a Did the foundation invest during the year any amount in a manner that would Jeopardize its charitable purposes?

b Did the foundation make any investment in a pnor 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 2009?

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GJ No

Yes No

1b x

1c x

2b

3b

4a x

4b x Form 990-PF (2009)

Form 990-PF (2009) 48-0926946 Page6

•~··•·••l"I=• Statements Regarding Activities for Which Form 4720 Mav Be Required (continued)

5 a Dunng the y;ar did the foundabon pay or incur any amount to (1) Carry on propaganda, or otherwise attempt to influence leg1slat1on (secbon 4945(e))?

(2) Influence the outcome of any specific public electJon (see sechon 4955), or to carry on,

directly or indirectly, any voter reg1strat1on dnve? ••••••••..••••.•••

(3) Provide a grant to an ind1v1dual for travel, study, or other s1m1lar purposes? •••••••

(4) Provide a grant to an orgamzabon other than a charitable, etc , orgamzahon described in

section 509(a)(1), (2), or (3), or section 4940(d)(2)? (see page 22 of the instructJons) ••

(5) Provide for any purpose other than religious, charitable, sc1ent1fic, literary, or educational

purposes, or for the prevenhon of cruelty to children or animals? • • • • • • • • • • • •

. .... . . . . .

. . . . .

.....

D Yes [fil No

BYes Yes

tili No No

D Yes [fil No

0Yes [fil No

b If any answer 1s "Yes" to 5a(1)-(5), did any of the transactions fall to qualify under the excephons described in

Regulations section 53 4945 or in a current notice regarding disaster assistance (see page 22 of the instructions)? • • • • •

Orgamzat1ons relying on a current nobce regarding disaster assistance check here • • • • • • • • • • • • • . . .... D c If the answer 1s "Yes" to question 5a(4), does the foundation claim exemption from the tax

because 11 maintained expenditure respons1b11ity for the grant? • • • • • • • • • • • • • • 0Yes 0No

If "Yes,· attach the statement reqwred by Regulations section 53 4945-S(d)

6 a Did the foundation, during the year, receive any funds, directly or indirectly, to pay premiums

on a personal benefit contract? • • • • • • • • • • • • • • • • • • • • • • • • • • • • • 0Yes

•• Sb

x b Did the foundation, dunng the year, pay premiums, directly or 1nd1rectly, on a personal benefit contract? 6b . . . . . . . I-'-~+--+---If "Yes" to 6b, file Form 8870

7 a At any time during the tax year, was the foundation a party to a proh1b1ted tax shelter transaction? •• 0Yes [fil No

b If yes, did the foundation receive any proceeds or have any net income attributable to the transaction? • • • • • • • • • • • . • 7b

•~ .-.,.,,. Information About Officers, Directors, Trustees, Foundation Managers, Highly Paid Employees, and Contractors

List all officers, directors, trustees, foundation managers and their compensation (see page 22 of the instructions). (b) Trtle, and average (c) Compensation (d) Contnbu~ons to (e) Expense account,

(a) Name and address dehv~~~~~~r0~:~i~n (II not P]'.1· enter an~":i~:~:db:~:~~~;;on other allowances

ATTACHMENT 7 0. 0.

2 Compensation of five highest-paid employees (other than those included on line 1 - see page 23 of the instructions). If none, enter "NONE."

(a) Name and address of each employee paid more than $50,000 (b) Trtle, and average

hours per week devoted to posrt1on

(c) Compensation (d) Contnbut1ons to employee benefrt plans and deferred

compensation

(e) Expense account, other allowances

0.

Total number of other employees paid over $50,000 ........ I NONE

JSA

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Form 990-PF (2009)

85652

Form 990-PF (2009) 4 8-092 694 6 Page7

•iff C,)01 Information About Officers, Directors, Trustees, Foundation Managers, Highly Paid Employees, and Contractors (continued)

3 Five highest-paid independent contractors for professional services (see page 23 of the instructions). If none, enter "NONE." (a) Name and address of each person paid more than $50,000 (bl Type of service (c) Compensation

NONE

.............................. J NONE

•iff i®i Summary of Direct Charitable Activities

List the foundation's four largest direct chantable act1vrt1es dunng the tax year Include relevant stallst1cal information such as the number of organizations and other benefic1anes served, conferences convened, research papers produced, etc

1 N/A

2

3

4

·~•,.e:• Summarv of Proc:1ram-Related Investments (see oacie 23 of the rnstruct1ons) Descnbe the two largest program-related investments made by the foundation dunng the tax year on Imes 1 and 2

NONE

2

All other program-rela1ed investments See page 24 of the mstruct1ons

3 NONE

Total. Add Imes 1 throucih 3 ............................................... ....

JSA

9E14651000

14352G K932 11/11/2010 4: 33: 09 PM V 09-8.5 85652

Expenses

Amount

Form 990-PF (2009)

Form 990-PF (2009) 4 8-092 694 6

UiflQ Minimum Investment Return (All domestic foundations must complete this part. Foreign foundations, se~ page 24 of the 1nstruct1ons )

1 Fair market value of assets not used (or held for use) directly in carrying out charitable, etc .

purposes

2 3

a Average monthly fair market value of securities .......... .

b Average of monthly cash balances . . . . . . . . . . . . . . . . . . . c Fair market value of all other assets (see page 24 of the instructions)

d Total (add Imes 1 a, b, and c) . . . . . . . . . . . . . . . . . . . .. e Reduction claimed for blockage or other factors reported on Imes 1a and

1c (attach detailed explanation) . . . . . . . . . . . ......... I 1e I ~~~~~~~~~~~--1

Acqu1s1t1on indebtedness applicable to line 1 assets Subtract line 2 from line 1d

4 Cash deemed held for charitable ~ct1v"1t1es Enter 0

1 . 1/2 °/o 0

0f line 3 (fo0

r greater amount: see page 25

1a 1b

1c 1d

2 3

Page8

1,103,991.

0. 1,103,991.

0. 1,103,991.

of the instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 16, 5 6 o . 1--~1--~~~~~~......;.~~ 5 Net value of noncharitable-use assets. Subtract line 4 from line 3 Enter here and on Part V, line 4 5 1, o 8 7, 4 31 .

1--~1--~~~~-'-~---'-~~ 6 Minimum investment return. Enter 5% of line 5 . . . . . . . . . . . . . . . . . . . . . . . . . . 6 54, 372.

•~r·••• Distributable Amount (see page 25 of the 1nstruct1ons) (Section 4942(!)(3) and (J)(5) private operating foundations and certain foreign organizations check here ..,.. D and do not complete this part )

1 Minimum investment return from Part X, line 6 j ;a· j .. 1

2a Tax on investment income for 2009 from Part VI, line 5 20. . . .. b Income tax for 2009 (This does not include the tax from Part VI ) I 2b I c Add Imes 2a and 2b 2c .. . . . .

3 Distributable amount before adJustments Subtract line 2c from line 1 .. 3 4 Recoveries of amounts treated as qualifying d1stribut1ons .. . . . . . . 4 5 Add lines 3 and 4 5 .. . . . . . . . . . . . . 6 Deduction from distributable amount (see page 25 of the instructions) 6 . . .. 7 Distributable amount as adJusted Subtract line 6 from line 5 Enter here and on Part XIII,

line 1 .. . . . . . . 7

•#1311 Qualifying Distributions(see page 25 of the instructions)

1 a b

2

3 a b

4

5

6

Amounts paid (including adm1nistrat1ve expenses) to accomplish charitable, etc , purposes Expenses, contributions, gifts, etc - total from Part I, column (d), line 26 1a .. . . . . . . . . Program-related investments - total from Part IX-B 1b . ' ' .. '.' ........... . . . Amounts paid to acquire assets used (or held for use) directly in carrying out charitable, etc, purposes ...... 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ' .. . . . . . . Amounts set aside for specific charitable proiects that satisfy the Su1tab11ity test (prior IRS approval required) 3a . . . . . . . . . . . .......... . ......... Cash d1stribut1on test (attach the required schedule) 3b . . . . . . . . . . . . . . . . . . . . . . . . Qualifying distributions. Add lines 1a through 3b Enter here and on Part V, line 8, and Part XIII, line 4 4 . . ' ... Foundations that qualify under section 4940(e) for the reduced rate of tax on net investment income Enter 1 % of Part I, line 27b (see page 26 of the instructions) 5 Adjusted qualifying distributions. Subtract line 5 from line 4 ............... . . . . . 6

Note: The amount on line 6 will be used in Part V, column (b), in subsequent years when calculating whether the foundation qualifies for the section 4940(e) reduction of tax 1n those years

54,372.

20. 54,352.

54,352.

54,352.

11,973. 0.

0.

0. 0 .

11,973.

N/A 11,973.

Form 990-PF (2009)

JSA

9E1470 1 000

14352G K932 11/11/2010 4: 33: 09 PM V 09-8. 5 85652

Form 990-PF (2009) ' 48-0926946 . Undistributed Income (see page 26 of the instructions)

1 D1stnbutable amount for 2009 from Part XI,

line 7 ..................... 2 Und1stnbuted income, If any, as of the end of 2009

a Enter amount for 2008 only .......... b Total for pnor years 20 __ ,20 __ ,20 __

3 Excess d1stnbut1ons carryover, 1f any, to 2009

a From 2004

b From 2005

c From 2006 4,165,825.

d From 2007

e From 2008 18,582,189.

f Total of lines 3a through e .......... 4 Qualifying d1stnbut1ons for 2009 from Part XII,

line 4 ~ $ 11,973.

a Applied to 2008, but not more than line 2a ... b Applied to und1stnbuted income of pnor years (Election

required - see page 26 of the instructions) ...... c Treated as d1stnbubons out of corpus (Election

required - see page 26 of the instructions) •

d Applied to 2009 distributable amount .. e Remaining amount d1stnbuted out of corpus

5 Excess d1stnbutions carryover applied to 2009 • (If an amount appears m column (d), the same amount must be shown m column (a) J

6 Enter the net total of each column as indicated below:

a Corpus Add lines 3f, 4c, and 4e Subtract line 5

b Prior years' und1\,tributed 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 page 27 of the 1nstruct1ons ....

e Undistributed income for 2008 Subtract lme 4a from line 2a Taxable amount - see page 27 of the 1nstruct1ons .............

f Undistributed income for 2009 Subtract Imes 4d and 5 from line 1 This amount must be d1stnbuted m 2010 ...............

7 Amounts treated as d1stnbubons out of corpus to satisfy requirements imposed by section 170(bl(1l(F) or 4942(gl(3) (see page 27 of the 1nstruct1ons) • • • • • • • • • • . . • . • • • •

8 Excess d1stribut1ons carryover from 2004 not applied on line 5 or line 7 (see page 27 of the instructions) •••.•.••.••••• . . . .

9 Excess distributions carryover to 2010.

Subtract Imes 7 and 8 from line 6a ... . . . . 10 Analysis of line 9

a Excess from 2005

b Excess from 2006 4,123,446. c Excess from 2007

d Excess from 2008 18,582,189. e Excess from 2009

JSA

9E1480 1 000

(a)

Corpus

22,748,014.

0. 42,379.

22,705,635.

22,705,635.

14352G K932 11/11/2010 4:33:09 PM V 09-8.5

(b) Years pnor to 2008

85652

Page9

(c) (d) 2008 2009

54,352.

11,973.

42,379.

Form 990-PF (2009)

Form 990-PF (2009) 48-0926946 Page 10 •!-.,·•·~·-Private Operating Foundations see page 27 of the instructions and Part VII-A, question 9) NOT APPLICABLE

1a If the found'abon has received a ruling or determmabon letter that 1t 1s a pnvate operabng I found.abon, and the ruling 1s effecbve for 2009, enter the date of the ruling • • • • • • • • • • • • • ....

b Check box to indicate whether the foundabon 1s a pnvate operallng foundation descnbed in section I I 4942@3) or I I 4942~)(5)

2a Enter the lesser of the ad-Tax year Pnor 3 years

(e) Total Justed net income from Part (a) 2009 (b) 2008 (c) 2007 (d) 2006 I or the minimum investment return from Part X for each year listed

b 85% of line 2a

c Quahfy,ng d1stnbut1ons from Part

XI I, hne 4 for each year listed

d Amounts 1nduded 1n line 2c not

used d1rectty for actJve conduct

of exempt acllv1tJes • • • • •

e Quahfy1ng d1stnbutJons made directly for act.Jve conduct of

exempt actMlles Subtract line 2d from line 2c ......

3 Complete 3a, b, or c for the alternative test rehed upon

a "Assets• altemabve test - enter

(1) Value of all assets ... (2) Value of assets quahfy1ng

under section

4942~)(3)(8)!1). , • • •

b "Endowmenr alternative test-

enter 213 of minimum invest-

ment return shown in Part X,

hne 6 for each year hsted .. c RSupportR alternative test - enter

(1) Total support other than

gross 1nvesbnent income (interest, d1v1dends, rents, payments on secuntJes loans (section 512(a)(5)),

or royalties) • • • • • •

(2) Support from general public and 5 or more exempt organizations as provided 1n section 4942 @3)(8)(111) • • • , • •

(3) Largest amount of sup-port from an exempt organrzation

(4) Gross investment income •

•:r. Supplementary Information (Complete this pa~ only 1f the foundation had $5,000 or more in assets at any time during the year - see page 28 of the instructions.)

Information Regarding Foundation Managers: a List any managers of the foundation who have contributed more than 2% of the total contributions received by the foundation

before the close of any tax year (but only 1f they have contributed more than $5,000) (See section 507(d)(2) )

DAVID H. KOCH

b List any managers of the foundation who own 10% or more of the stock of a corporation (or an equally large portion of the ownership of a partnership or other entity) of which the foundation has a 10% or greater interest

N/A 2 Information Regarding Contribution, Grant, Gift, Loan, Scholarship, etc., Programs:

Check here ..,. 0 1f the foundation only makes contributions to preselected charitable organizations and does not accept unsohated requests for funds If the foundation makes gifts, grants. etc (see page 28 of the instructions) to md1v1duals or organizations under other cond11ions. complete items 2a, b, c. and d

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

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

c Any subm1ss1on deadlines

d Any restrictions or hm1tat1ons on awards, such as by geographical areas, charitable fields, kinds of mst1tut1ons, or other factors

JSA 9E1490 1 000

14352G K932 11/11/2010 4: 33: 09 PM V 09-8.5 Form 990-PF (2009)

85652

Form 990-PF (2009) 4 8-092 694 6 1:idf:\*j Supplementary lnfonnation (continued)

3 Grants and Contributions Paid During the Year or Approved for Future Payment Rec1p1ent

Name and address (home or business)

a Paid dunng the year

Total.

b Approved for future payment

Total.

JSA 9E14911000

If rec:1p:1ent as an ind1Y1dual, Foundation show any relatJonsh1p to status of any foundation manager

recipient or substantJal contnbutor

14352G K932 11/11/2010 4: 33: 09 PM V 09-8.5

Purpose of grant or contnbut1on

85652

Page 11

Amount

~ 3a

~ 3b Form 990-PF (2009)

Form 990-PF (2009) 48-0926946 •'!.t-:•• ·-Analysis of Income-Producing Activities Enter gross. amounts unless otherwise indicated Unrelated business income Exduded b, section 512 513 or 514

(a) (b) (c) (d)

1 Program service revenue Business code Amount E.xdusJOn code Amount

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

4 D1v1dends and interest from securities 14 .. 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 ........ 8 Ga,n or (loss) from sales of assets other than inventory

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) .... 13 Total. Add line 12, columns (b), (d), and (e) ••••••••••••••••••••••••.••.••••••• 13 (See worksheet in line 13 instructions on page 28 to verify calculations)

•:1:1·--•'f.U' =· Relationship of Activities to the Accomplishment of Exempt Purposes

986.

986.

Page 12

(e) Related or exempt function income ~ee page 28 of

e instructions )

986.

Line No. Explain below how each act1v1ty for which income 1s reported in column (e) of Part XVI-A contributed importantly to

y

JSA 9E14921000

the accomplishment of the foundation's page 29 of the instructions )

14352G K932 11/11/2010 4: 33: 09 PM

exempt purposes (other than by providing funds for such purposes) (See

NOT APPLICABLE

Form 990-PF (2009)

V 09-8.5 85652

Form 990-PF (2009) 48-0926946 Page 13

HffiNII Information Regarding Transfers To and Transactions and Relationships With Exempt Organizations

Noncharitable

1 Did • the organization directly or indirectly engage 1n any of the following with any other organization descnbed in section 501(c) of the Code (other than secbon 501(c)(3) organizations) or 1n secbon 527, relabng to polibcal orgam..zat1ons?

a Transfers from the reporting foundation to a nonchantable exempt organization ot

(1) Cash •

(2) Other assets

b Other transactions

(1) Sales of assets to a noncharitable exempt organization

(2) Purchases of assets from a nonchantable exempt organization

(3) Rental of facilibes. equipment. or other assets

(4) Reimbursement arrangements •

(5) Loans or loan guarantees

(6) Perfonnance of services or membership or fundra1s1ng solic1tat1ons

c Sharing of facilities, equipment, mailing lists. other assets. or paid employees

Yes No

1al1l x 1al21 x

1bl1l x 1bl2l x 1bl31 x 1bl41 x 1b(5) x 1b(6) x

1c x d If the answer to any of the above 1s "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 foundation If the foundation received less than fair market

value 1n any transacbon or sharing arrangement, show 1n column (d) the value of the goods. other assets. or services received

(a) Line no (b) Amount involved (c) Name of noncharrtable exempt organization (d) Descnpt1on of transfers. transactions, and sharing arrangements

N/A N/A

2a Is the foundation directly or indirectly affiliated with, or related to, one or more tax-exempt organizations descnbed 1n

section 501 (c) of the Code (other than section 501 (c)(3)) or in section 527? • • • • • • • • • • • . • • • • • • • • • • • • • D Yes [29 No

b If "Yes" comolete the followina schedule (a) Name of organization (b) Type of organization (c) Descnpt1on of relat1onsh1p

Under penalties of pe~ury, I declare that I have exam111ed this return. includ111g accompanying schedules and statements. and to the best of my knowledge and belief, rt 1s true, correct, and complete Declaration of preparer (other than taxpayer or fiduciary) 1s based on all information of which preparer has any knowledge

~ '1/~ ~ I J/-/5-~0/..Q ~ I r~q_ J ':!.C. e_r' e Signature of officer or trustee Date Trtle Cl)

Preparer's identifying :I: Date Check1f D c ~~A,

number (See Signature on Cl -~~ Preparer's ~ u/12.Ju;10 self-employed .... page 30 of the instructions)

en ,:, Q> c signature P00770702 ·;:; 0 D.. a. Q> Firm's name (or yours 1f ~BKD, LLP EIN .... 44-0160260 ~ Ill

D..::::, self-employed). address, 1551 N WATERFRONT PKWY, STE 300 and ZIP code WICHITA, KS 67206-6601 Phone no 316-265-2811

Form 990-PF (2009)

JSA 9E1493 1 000

14352G K932 11/11/2010 4: 33: 09 PM V 09-8.5 85652

Schedule B' (Form 990,.990-EZ, or 990-PF) Department ol the Treasury Internal Revenue Service

Name of the organization

Schedule of Contributors ..,. Attach to Fonn 990, 990-EZ, or 990-PF.

DAVID H. KOCH CHARITABLE FOUNDATION

Organization type (check one)

Filers of: Section:

Form 990 or 990-EZ D 501(c)( ) (enter number) organization

OMB No 1545-0047

~@09 Employer identification number

48-0926946

D 4947(a)(1) nonexempt charitable trust not treated as a private foundation

D 527 political organization

Form 990-PF 0 501(c)(3) exempt private foundation

D 4947(a)(1) nonexempt charitable trust treated as a private foundation

D 501 (c)(3) taxable private foundation

Check 1f your organization 1s covered by the General Rule or a Special Rule. Note. Only a section 501 (c)(7), (8), or (10) organ1zat1on can check boxes for both the General Rule and a Special Rule See instructions

General Rule

0 For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, $5,000 or more (1n money or

property) from any one contributor Complete Parts I and II

Special Rules

D For a section 501 (c)(3) organization filing Form 990 or 990-EZ that met the 33 113 % support test of the regulations under

sections 509(a)(1) and 170(b)(1 )(A)(v1), and received from any one contributor, during the year, a contnbut1on of the greater

of (1) $5,000 or (2) 2% of the amount on (1) Form 990, Part VIII, line 1 h or (11) Form 990-EZ, line 1 Complete Parts I and

II

D For a section 501(c)(7), (8), or (10) organization filing Form 990 or 990-EZ that received from any one contributor, during

the year, aggregate contributions of more than $1,000 for use exclus,vely for rel1g1ous, charitable, sc1ent1fic, literary, or

educational purposes, or the prevention of cruelty to children or animals Complete Parts I, II, and Ill

D For a section 501(c)(7), (8), or (10) organization filing Form 990 or 990-EZ that received from any one contributor, during

the year, contributions for use exclus1velyfor religious, charitable, etc, purposes, but these contnbut1ons did not

aggregate to more than $1,000 If this box 1s checked, enter here the total contributions that were received during the

year for an exclus,vely religious, charitable, etc , purpose Do not complete any of the parts unless the General Rule

applies to this organization because 11 received nonexclus1vely religious, charitable, etc , contributions of $5,000 or more

during the year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..,. $ ________ _

Caution. An organization that 1s not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990,

990-EZ, or 990-PF), but 1t must answer "No" on Part IV, line 2 of its Form 990, or check the box on line H of its Fonn 990-EZ,

or on line 2 of its Form 990-PF, to certify that 1t does not meet the filing requirements of Schedule B (Form 990, 990-EZ, or 990-PF)

For Privacy Act and Paperwork ReducUon Act NoUce, see the lnstrucUons for Form 990, 990-EZ, or 990-PF

JSA

9E12512000

14352G K932 11/11/2010 4:33:09 PM V 09-8.5

Schedule B (Form 990, 990-EZ, or 990-PF) (2009)

85652

Schedule B (Form 990, 99D-EZ, or 99D-PF) (2009)

Name of organization DAVID H. KOCH CHARITABLE FOUNDATION

lmll Contributors (see instructions)

(a) No.

1 ---

(a) No.

---

(a) No.

---

(a) No.

---

(a) No.

---

(a) No.

---

JSA

9E12531000

(b) Name, address, and ZIP + 4

DAVID H. KOCH

667 MADISON AVENUE

NEW YORK, NY 10021

(b) Name, address, and ZIP+ 4

(b) Name, address, and ZIP + 4

(b) Name, address, and ZIP + 4

(b) Name, address, and ZIP + 4

(b) Name, address, and ZIP + 4

14352G K932 11/11/2010 4:33:09 PM V 09-8.5

(c) Aggregate contributions

$ 10,000,000.

(c) Aggregate contributions

$

(c) Aggregate contributions

$

(c) Aggregate contributions

$

(c) Aggregate contributions

$

(c) Aggregate contributions

$

Page __ of __ of Part I

Employer ldentlflcatlon number

48-0926946

(d) Type of contribution

Person

~ Payroll

Noncash

(Complete Part II 1f there 1s a noncash contribution )

(d) Type of contribution

Person § Payroll Noncash

(Complete Part II 1f there 1s a noncash contribution )

(d) Type of contribution

Person § Payroll Noncash

(Complete Part II 1f there 1s a noncash contnbulion )

(d) Type of contribution

Person § Payroll Noncash

(Complete Part II 1f there 1s a noncash contribution )

(d) Type of contribution

Person § Payroll Noncash

(Complete Part II 1f there 1s a noncash contribution )

(d) Type of contribution

Person § Payroll Noncash

(Complete Part II 1f there 1s a noncash contribution )

Schedule B (Form 990, 990-EZ, or 990-PF) (2009)

85652

DAVID H. KOCH CHARITABLE FOUNDATION

FORM 990PF, PART I - DIVIDENDS AND INTEREST FROM SECURITIES

DESCRIPTION

GOLDMAN SACHS FUNDS

TOTAL

14352G K932 11/11/2010 4:33:09 PM V 09-8.5

REVENUE AND

EXPENSES PER BOOKS

85652

986.

986.

NET INVESTMENT

INCOME

48-0926946

ATTACHMENT 1

986.

986.

ATTACHMENT 1

DAVID H. KOCH CHARITABLE FOUNDATION

FORM 990PF, PART I - ACCOUNTING FEES

DESCRIPTION

ACCOUNTING

TOTALS

REVENUE AND

EXPENSES PER BOOKS

11,770.

lL 770.

14352G K932 11/11/2010 4:33:09 PM V 09-8.5

NET INVESTMENT

INCOME

85652

_O_.

48-0926946

ATTACHMENT 2

ADJUSTED NET

INCOME

O_.

CHARITABLE PURPOSES

9,695.

9.695.

ATTACHMENT 2

DAVID H. KOCH CHARITABLE FOUNDATION

FORM 990PF, PART I - OTHER PROFESSIONAL FEES

DESCRIPTION

GRANT ADMINISTRATION FEES

TOTALS

REVENUE AND

EXPENSES PER BOOKS

825.

_8_2_5~

14352G K932 11/11/2010 4:33:09 PM V 09-8.5 85652

48-0926946

ATTACHMENT 3

CHARITABLE PURPOSES

1,245.

1.245.

ATTACHMENT 3

DAVID H. KOCH CHARITABLE FOUNDATION

FORM 990PF, PART I - TAXES

DESCRIPTION

EXCISE TAX

TOTALS

REVENUE AND

EXPENSES PER BOOKS

14352G K932 11/11/2010 4:33:09 PM V 09-8.5

48-0926946

ATTACHMENT 4

20.

20.

ATTACHMENT 4 85652

- - -

DAVID H. KOCH CHARITABLE FOUNDATION

FORM 990PF, PART I - OTHER EXPENSES

DESCRIPTION INSURANCE BANK FEES CORPORATION REGISTRATION FEES

TOTALS

REVENUE AND

EXPENSES PER BOOKS

875. 69. 89.

L 033.

14352G K932 11/11/2010 4:33:09 PM V 09-8.5 85652

48-0926946

ATTACHMENT 5

CHARITABLE PURPOSES

875. 69. 89.

1. 033.

ATTACHMENT 5

.

DAVID H. KOCH CHARITABLE FOUNDATION

FORM 990PF, PART II - PREPAID EXPENSES AND DEFERRED CHARGES

DESCRIPTION

PREPAID EXPENSES

TOTALS

14352G K932 11/11/2010 4:33:09 PM V 09-8.5 85652

ENDING BOOK VALUE

ATTACHMENT 6

33.

33.

ENDING FMV

48-0926946

33.

3_3 __ .

ATTACHMENT 6

DAVID H. KOCH CHARITABLE FOUNDATION

FORM 990PF, PART VIII - LIST OF OFFICERS, DIRECTORS, AND TRUSTEES

NAME AND ADDRESS

DAVID H. KOCH 667 MADISON AVE NEW YORK, NY 10021

RUTHE. WILLIAMS PO BOX 2256 WICHITA, KS 67201

VONDA HOLLIMAN PO BOX 2256 WICHITA, KS 67201

TITLE AND AVERAGE HOURS PER WEEK DEVOTED TO POSITION

PRESIDENT/DIRECTOR 1. 00

SECRETARY 1. 00

TREASURER 1. 00

GRAND TOTALS

14352G K932 11/11/2010 4:33:09 PM V 09-8.5 85652

COMPENSATION

0.

0.

0.

0.

48-0926946

ATTACHMENT 7

CONTRIBUTIONS EXPENSE ACCT TO EMPLOYEE BENEFIT PLANS

0.

0.

0.

0.

AND OTHER ALLOWANCES

0.

0.

0.

__Q.

ATTACHMENT 7

Form 8868 (Rev 4-2009)

• If you are filin!J for an Additional (Not Automatic) 3-Month Extension, complete only Part II and check this box , , . Note. Only complete Part II if you have already been granted an automatic 3-month extension on a previously filed Form 8868. • If you are fihnQ for an Automatic 3-Month Extension, complete only Part I (on DaQe 1). ·~u-·-Additional {Not Automatic) 3-Month Extension of Time. Onlv file the oriainal {no copies needed).

Type or Name of Exempt Organization

print DAVID H. KOCH CHARITABLE FOUNDATION File by the Number. street, and room or suite no. If a P.O. box, see instructions. extended 4111 EAST 37TH STREET NORTH due dete for filing the City, town or post office, state, and ZIP code For a foreign address, see instructions return. See WICHITA, KS 67220-3203 inatrucbona

Check type of return to be filed (File a separate application for each return)· Form 990 X Form 990-PF Form 990-BL Form 990- T (sec. 401 (a) or 408(a) trust) Form 990-EZ Form 990- T trust other than above

Employer Identification number

48-0926946 For IRS use ally

Form 1041-A Form 4720

Form 5227

O Form 6069

D Form 8870

STOPI Do not complete Part II if you were not already granted an automatic 3-month extension on a previously flled Form 8868.

• The books are in the care of .,. _v_o_N_D_A_H_O_L_L_I_MA_N _____________________ _ Telephone No .,. 316 828-5552 FAX No . .,.

• If the organization does not have an office or place of business m the United States, check this box . . • • • • . . . • • . . • . .,. D • If this 1s for a Group Return, enter the organization's four digit Group Exemption Number (GEN) If this 1s for the whole group, check this box ..• .,. D. If 1t 1s for part of the group, check this box . • .,. D and attach a list with the names and EINs of all members the extension is for.

4 I request an additional 3-month extension of time until NOVEMBER 15, 201 O

5 For calendar year 2 O O 9 , or other tax year beginning -r--.------~- and ending -r-~----------6 If this tax year is for less than 12 months, check reason: D Initial return D F

0

mal return D Change 1n accounting period

7 State in detail why you need the extension ------------------------------THE TAXPAYER REQUESTS ADDITIONAL TIME IN ORDER TO GATHER THE NECESSARY INFORMATION FOR A COMPLETE AND ACCURATE RETURN.

Sa If this application is for Form 990-BL, 990-PF. 990-T, 4 720, or 6069, enter the tentative tax. less any nonrefundable credits. See instructions Ba $

b If this application 1s 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 -previouslv with Form 8868. Sb $

c Balance Due. Subtract llne Sb from line Sa Include your payment with this form, or, 1f required, deposit with FTD coupon or, 1f required, by using EFTPS (Electronic Federal Tax Pavment Svstem) See instructions. Be $ 0

Signature and Verification Under penalties of perjury, I declare that I hllll8 examined this form, including accompanying schedules end statements, end to the best of my knowledge and belief, 1t is true, correct, and complete, and that I am eulhonzed to prepare this form.

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nt1e ... C.P.A. Form 8868 (Rev 4·2009)