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Annual Filing for Charitable OrganizationsForm CHAR500
New York State Department of Law (Office of the Attorney General)Charities Bureau - Registration Section
This form used for 120 BroadwayArticle 7-A, EPIL and dual filers New Yo, NY 10271(replaces forms CHAR 497,
MAD nm rwAD nnr, http://www.charitiesnys.com1. General Informationa. For the fiscal year beginning (mm/ddlyyyy) 01/ andb. Check if applicable for NYS: c. Name of organization
Address changeName change THE BLOOMBERG FAMILY FOUNDATION INCInitial filingFinal filing Number and street (or P.O. box if mail not delivered to street address) Room/suiteAmended filing C/O GELLER & CO, 909 THIRD AVE 116 FLNY registration pending City or town, state or country and ZIP + 4
Open to PublicInspection
d. Fed. employer ID no. (EIN)20-5602483
e. NY State registration no.40-57-41f. Telephone number212 205-0100g. EmailN/A
2. Certification - Two Signatures Required
We certify under penalties of perjury that we reviewed this report, including all attachments, and to the best of our knowledge and belief, they aretrue, correct and complete in accordance h hR laws of the State f N w York applicable to this report.
b. Chief Financial Officer orTreas. MICHAEL Nam: BLOOMBERG AUTH SIGNER
3. Annual Report Exemption Information
a. Article 7-A annual report exemption (Article 7-A registrants and dual registrants)Check *
if total contributions from NY State (including residents, foundations, corporations, government agencies, etc.) did not exceed$25,000 and the organization did not engage a professional fund raiser (PFR) or fund raising counsel (FRC) to solicitcontributions during this fiscal year.
NOTE: An organization may claim this exemption if no PFR or FRC was used and either: 1) it received an allocation from afederated fund, United Way or incorporated community appeal and contributions from other sources did not exceed$25,000 or 2) it received all or substantially all of its contributions from one government agency to which it submitted anannual report similar to that required by Article 7-A.
b. EPTL annual report exemption (EPTL registrants and dual registrants)Check *= if gross receipts did not exceed $25,000 and assets (market value) did not exceed $25,000 at anytime during this fiscal year.
For EPTL or Article 7-A registrants claiming the annual report exemption under the one law under which they are registered and for dual registrants claiming the annualreport exemptions under both laws, simply complete part 1 (General Information), part 2 (Certification) and part 3 (Annual Report Exemption Information) above.
QQ not submit a fee, Ug n complete the following schedules and do not submit any attachments to this form.
4. Article 7-A SchedulesIf you did not check the Article 7-A annual report exemption above, complete the following for this fiscal year:a. Did the organization use a professional fund raiser, fund raising counsel or commercial co-venturer for fund raising activity in NY State? .
Yes No* If "Yes", complete Schedule 4a.
b. Did the organization receive government contributions (grants)? Yes No* If "Yes", complete Schedule 4b.
5. Fee Submitted: See last page for summary of fee requirements.Indicate the filing fee(s) you are submitting along with this form:a. Article 7-A filing fee
..........................................................................................$ Submit only one check or money order for theb. EPTL filing fee ................................................................................................... $ 1,500. total fee, payable to "NYS Department of Law'c. Total fee ......................................................................................................... $1,500.
6. Attachments - For organizations that are not claiming annual report exemptions under both laws, see last page for required attachments 0, 0 0
2684511 01-21-13 1019 CHAR500-2012
215141028 737725 BLOOMFAMFND 2012.04040 THE BLOOMBERG FAMILY FOUNDA BLOOMFA1
THE BLOOMBERG FAMILY JNDATION INC5. Fee Instructions
The filing fee depends on the organizations Registration Type. For details on Registration Type and filing fees, see the Instructions forForm CHAR500.
Organization's Registration Type Fee Instructions
a) Article 7-A filing fee
Calculate the Article 7-A filing fee using the table in part a below. The EPTL filing fee is $0.
Calculate the EPTL filing fee using the table in part b below. The Article 7-A filing fee is $0.
Calculate both the Article 7-A and EPTL filing fees using the tables in parts a and b below. Add the Article 7-Aand EPTL filing fees together to calculate the total fee. Submit a single check or money order for the total fee.
Total Support & Revenue Article 7-A Fee l Any organization that contracted with or used the services of a professional fund raisermore than $250,000 $25 (PFR) or fund raising counsel (FRC) during the reporting period must pay an Article 7-A
up to $250,000 * $10
filing fee of $25, regardless of total support and revenue.
b) EPTL filing fee
6. Attachments - Document Attachment Check-ListCheck the boxes for the documents you are attaching.
For All Filers
Single check or money order payable to "NYS Department of Law
Copies of Internal Revenue Service Forms
IRS Form 990All required schedules (includingSchedule B)
LIII IRS Form 990-T
IRS Form 990-EZAll required schedules (includingSchedule B)IRS Form 990-T
IRS Form 990-PFL1 All required schedules (including
Schedule B)EIII IRS Form 990-T
Additional Article 7-A Document Attachment Requirement
Independent Accountant's Report
ED Audit Report (total support & revenue more than $250,000)ED Review Report (total support & revenue $100,001 to $250,000)
No Accountant's Report Required (total support & revenue not more than $100,000)
10194 288481 01-21-13 CHAR500 - 2012
310531111 737725 BLOOMFAMFND 2012.04040 THE BLOOMBERG FAMILY FOUNDA BLOOMFA2
Geller & Company
Via Certified Mail
August 8, 2013
Office of Attorney GeneralCharities Bureau Dept.120 Broadway, 3rd FloorNew York, NY 10271
Re: The Bloomberg Family Foundation Inc.E1N 20-56024832012 Char-500NYS Reg. #40-57-41
We respectfully request an additional three months extension of time to file until November15, 2013 for the above referenced foundation. A federal extension request for an additional3-month extension of time was timely filed on Form 8868. The reason for the extension isdue to all information necessary to file a complete and accurate tax return is not yetavailable.
Attached please find a copy of the Internal Revenue Service Form 8868 submitted by theBloomberg Family Foundation Inc.
Please contact us at (212) 583-6000 should you need additional information.Sincerely,
FiIes\Content.Outlook\9186426N\CHAR500 2nd extension Ietter.docx909 Third Avenue New York, NY 10022
212.583.6000 tel www.gellerco.com
Form 8868 (Rev. 1-2013) Page If you are filing for an Additional (Not Automatic) 3-Month Extension, complete only Part If 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 8668. If you are filing for an Automatic 3-Month Extension, complete only Part I (on page 1).Part Ill Additional (Not Automatic) 3 -Month Extension of Time. Only file the original (no copies needed).
Enter filer's ldentifvina number. see InstructionsType orprintFile by thedue date forfiling yourreturn. Seeinstructions.
Name of exempt organization or other filer, see instructions
BLOOMBERG FAMILY FOUNDATION INCNumber, street, and room or suite no. If a P.O. box, see instructions./0 GELLER & CO, 909 THIRD AVE. NO. 16 FLCity, town or post office, state, and ZIP code. For a foreign address, see instructions.EW YORK, NY 10022
Employer identification number (EIN) or
20-56 02483Social security number (SSN)
Enter the Return code for the return that this application is for (file a separate application for each return) I 0 I 41
Application Return I Application
or Form 990EZ02 I Form lO41-A
Form 4720 (iiForm 990-PF
05 I Form 606906 I Form 887O
STOP! Do not complete Part II if you were not already granted an automatic 3-month extension on a previously filed Form 8868.DIANE GtJBELLI, C /O GELLER & CO LLC
The books are lnthe care of 909 THIRD AVENUE, 16TH FL - NEW YORK, NY 10022TelephoneNo. 212-583-6000 FAXNo. lo. 2l2583624l
If the organization does not have an office or place of business In the United States, check this box IJJ
If this is for a Group Return, enter the organizations four digit Group Exemption Number (GEN) ________ If this Is for the whole group, check thisbox . If it is for part of the group, check this box 0, Ej 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, 2013.5 For calendar year 2012 , or other tax year beginning , and ending6 If the tax year entered In line 5 is for less than 12 months, check reason:
L..J Initial return =Final returnChange in accounting period
7 State in detail why you need the extensionAN ADDITIONAL EXTENSION OF TIME IS REQUIRED TO FILE A COMPLETE ANDACCURATE RETURN BECAUSE ALL INFORMATION IS NOT AVAILABLE.
8a If this application is for Form 990-13L, 990-PF, 990-T, 4720, or 6069, enter the tentativ