MESSNER REEVES LLP DENVER | LAS VEGAS. LOS ANGELES | NEW YORK Aux Bure Daecr Dist athltamessner com (603) 454.5443 October 5, 2016 VIA CERTIFIED MAIL - RETURN RECEIPT REQUESTED Internal Revenue Service P.O. Box 12192 Covington, KY 41012-0192 RE: Requesting Approval of Scholarship or Educational Grant Procedures To Whom It May Concern: This firm represents the Messner Foundation (EIN 26-4038964) (the “Foundation”) and, on behalf of the Foundation, respectfully submits this request for advance approval of individual grant- ‘making procedures under LR.C. § 4945(g)(1), In connection with the above request, please find enclosed the following documents: ‘+ Form 8940 — Request for Miscellaneous Determination and remittance of $1,000.00 payment. for the User Fee. ‘* Form 1023, Schedule H ~ Organizations Providing Scholarships, Fellowships, Educational Loan, or Other Educational Grants to Individuals and Private Foundations Requesting Advance Approval of Individual Grant Procedures; Form 1023, Schedule H Attachment Form 2848 ~ Power of Attorney and Declaration of Representative 1 appreciate your consideration of this request and look forward to hearing from you. Please feel free contact me directly by telephone at 303-454-5443 or by email abeltz@messner.com should you have any questions or requests for additional information. Very truly yours, Alex M. Beltz Enclosures 4020817023) 1430 Wynkoop Street | Suite 300 | Denver CO 80202 | 303 623 1800 tel | 303 623 0552 fax3195167 1 Attach this card to the back ofthe mailiece, fr onthe front f space permits. x fe Fesaived by Printed Name) ] 1D Agent 1 ascreseon ]E Osteo Cevery tie Aested to Infeenal Levyrue Revie PD Box 12/92 lovingior, LY Aivi2-0142 ADU AUE 9590 9401 0131 S225 9528 7 Zo toe Numer (anstor om seniceiabey | 2015 LbbO 0000 2086 1302 PS Form 3811, July 2015 PaN 7=30-02-200-0055, 3 7015 lbb0 0000 2086 1302 7015 Lbb0 OOOO 20a 1302 1 vey adress citar rom ten 7? CO YeS IVES. omer dolvery address below: NoPAY TO THE ORDER OF k MEMO MESSNER REEVES LLP PROFESSIONAL ACCOUNT +490 WYNKOOP Sr. SUITE 300 DENVER, co dazoa United States Treasury One Thousand & No/100 Dollars United States Treasury mo3a532 Qeter t 224052200 38440005 aun" 38532" 9/30/2016 $1,000.00Request for Miscellaneous os r vo 8940 Determination cao. 1stsca1 (ov dne2011) Depart of he Tesi Under Section 507, 509(a), 4940, 4942, 4945, and isk Rovone Sos (6055 of the Intomal Revenue Code Use the instructions to complete this form. A User Fee must be attached to this form, if required. For user fee iaformation or ‘additional help, Visit our wobsite at wavy is govreo or call RS Exempt Organizations Customer Account Services toll-free at 4-877-829-5500. if the required information and documents are not submitted with payment ofthe appropriate user fee, the for may be returned to you. Identification of Organization Ja FullName of Organization Messner Foundation 1b Address (number, suet and roomvaute) a P.O. Box, see instructions] © Olly State | e Zip Code +4 1430 Wynkoop Street, Suite 400 Denver co 202.6172 2 Employer \dentifcation Number [3 Month Tax Year [4 Person to Contact f More Information is Needed Ends (MM) 25.4028964 Alex Beltz 2 3 _ Contact Telephone Number Fax Number (optional) 7 User Fee Submitted 302622-1000 302.692.0552 1000.00 Type of Request ‘8 Please salect tho Rema) bolow thal boat doscibe your requost_Using an attachment, provide @ detaod explana To include the organizations name and EIN on each adtlonal sheet a. 1 Advance approval of certain set-asides described in saction 4942(a)2) n your request. Be sure C1 Advance approval of voter registration activities described in section 49454) ‘Advance approval of scholarship procedures described in section 4845(a) 4. Exemption from Form 990 filing requirements e (1 Advance approval that a potential grant or contribution constitutes an “unusual grant” © Change in Type (or inital determination of Type) of a section 509(a)(3) organization 9 CZ Reclassification of foundation status, including a voluntary request from a public charity for private foundation status bh L1Termination of private foundation status under section 507(0)(1)(8)—advance ruling request Gi Termination of private foundation status under section 507(0(1)(2)60-month period ended ‘Unser perio of pay vane is aplcaion, Waiting accompanying ealarars ad ached, rd be beat ty towadge and bet Please Sign Sa DRE, Te RAR aff Hore Bryant S. Messner Diceckor Tipeer era ope pen rary oe For Paperwork Reduction Act Notice, se separate netuctons. cat. 8784 Fam BO Ra FT LINOfom eo 12013) _(€0) nan: Messner Foundation fu 26- 4038964 rap 25 Schedule H. Organizations Providing Scholarships, Felowships, Educational Loans, or Other Educational Grants to Individuals and Private Foundations Requesting Advance Approval of individual Grant Procedures ‘Names of individual recipionts are not required fo be listed in Schedule Public charities and private foundations complete lines ta through 7 of this section. See the instructions to Part Xif you are not sure whether you are a public charity ora private foundation. Describe the types of educational grants you provide to individuals, such as scholarships, fellowships, loans, tc. Describe the purpose and amount of your scholarships, fellowships, and other educational grants and loans that you award, It you award educational loans, explain the terms of the loans (Interest rato, length, forgiveness, etc). ‘Specify how your program is publicized. Provide copies of any solicitation or announcement materia. Provide a sample copy of the application used. 2 Do you maintain case histories showing recipients of your scholarships, felowships, educational res Ono loans, oF other educational grants, including names, addresses, purposes of awards, amount of each grant, manner of selection, and relationship (f any) to officers, trustees, or donors of funds to you? If No." refer to the instructions. 3 Describe the specific criteria you use to determine who is eligible for your program. (For example, eligibility selection criteria could consist of graduating high school students from a particular high school who wil attend collage, writers of scholarly works about American history, etc.) 44a. Describe the specific criteria you use to select recipients. (For example, specific selection criteria could consist of prior academic performance, financial need, etc) bb Describe how you determine the number of grants that wil be made annually Describe how you determine the amount of each of your grants. Describe any requirement or condition that you impose on recipients to obtain, maintain, or qualify for renewal of a grant (For example, specific requirements or conaitions could consist of attendance at a four-year College, maintaining a certain {grade point average, teaching in public school after graduation from college, etc) '5 Describe your procedures for supervising the scholarships, fellowships, educational loans, or other educational grants. Desoribe whether you obtain reports and grade transcripts from recipionts, or you pay grants directly to a schoo! under ‘an arrangement whereby the school wll apply the grant funds only for enralld students who are in good standing. Also, describe your procedures for taking action ifthe terms of the award are violated. ‘6 Who is on the selection committee for the awards made under your program, including names of current committee members, criteria for committee membership, and the method of replacing committee members? 7 Are relatives of members of the selection committee, or of your officers, directors, or substantial C1 Yes. No contributors eigible for awards made under your program? If "Yes," what measures are taken to fensure unbiased selections? Note. you area private foundation, you are not permitted to provide educational grants to disqualified persone, Diqualled persone nctde your substantial contiviors and foundation managers and Esra family members of decualfied persons. SEEM Private roundations complete lines Ya through of this section. Public charities do not complete this section. 1a if we determine that you rea private foundation, do you want this application tobe «Wl Yes. (02089140 /3)The Messner Foundation x Qo eA esi MESSNER FOUNDATION a ay ABOUT MESSNER FOUNDATION s ‘The Masener Foundation identfes uncerprisieged high school students who have demoristvated ieaderebp tats and gies those suderts the resources and connections they oe=d fo eurish. The goal ofthe Messrer Foundalion te cutvate the nevt generation of eushese and communty leaders Potential leaders besin emerging in Ngh schol \itue some students are aicking respensibity and trying to get by deing the bare minum, thers are demonstrating leadership tats: tating shathe, stung to ieprove, seeking obigatons. Some students may start a school cub ct compete fee ft chain the orchestra: others may accept responsibil as captan of an athiei eam or seek executhe postions within youth ‘crgancatons The Viesiner Foundation secks out poteiial future eaders, focusing on mabvated. unsetprivdeged high schoct students who ‘embrace chatenges. ‘The Messner Fourdation not ony helps ts Scholrs financial, but also proves them unptalleled formalive Me experiences. Assistance bagins ‘the form ofcolege scholarships Along the way, Scholars receive personal ano professional guidance from the Messner Foundate and business and communty waders. ‘hte Mesoner Scholars are incoflege, the Messner Foundaton arranges or them to have meanlegh! nlrnships and Jobs win Denver businesses, Aer Messner Scholars graduate from colege, the Messner Foundation prowjdee ebuccks and connections to support Scholars goals ard arbtions. (Ofcourse, every leader demands resuts fom themselves and cthers. The Messner Foundation val felow its Scholars to ensure they are working ‘nad talang iniisine. and hong thersselies tothe highest cf standards. The Messner Feundation wl rot que students a blank check for 2 Tour year education. On the contrary the Hlesenes Foundation jl continue proving scholarship finds ana assetance on to Scholars uno coniinue to aczepl responsbit, seek cppertunty, and eve for achieversent “The Messner Foundation takes fessors fom Mesaner Resves'clents and apples them to ts phianthropic gig, Messner Reeves has been honeres to work ccsely wah young companies wth cteat petental and has seen how investment n these futre corporate Kesders can pay huge Ahidends. Gne excelent exaripe is Monty Morar's frets voc wth a small stl up restaurant hat came to Monty and hfessner Reeves n the Inte (2806 for egal counsel -Chipotie Mesican Grit. Chipotie ie nov a pubic waded mniemational company anc a leader m the festaurantindusty “The Messner Foundation beleves that siiarptental for orowth and evcelence evstsn cur high schools just waking lobe ciovered. The Messner Foundation sincerely hopes that you vil fale advanlage of Messner Reeves’ expertise by malirg a donation to the Wesener Foundatin: 2 donation thst wi help deveiop tommorrow’ business anc cormmenty leaders | MESSNER REEVES LLP Be inven tas undaton Seho'sen ©2008-2016 Mascnar Reeves LLP.ee a PM ena Cu ea eis eens el) MESSNER FOUNDATION any Messner Foundation Scholarship PURPOSE ‘The Messner Foundtion Scholarship & avalabe to high-achieving high school seniors with financial need who have demonstrated leadership tras 06 abd gtaduate ftom a four-year colege or universiy. The students the Messner Foundation aims to help have wotked hard in school and have gotien involved in their communay. bul have nancial concems that mate the idea of cofege overwhelming. SELECTION CRITERIA 1. Applcants must be at east 3 senlocin igh school er equivalent i homeschooled when applying. 2. Applicant must be accepted and decides upon which colegefunhersty he/she is attending no later than (TED). 2. The appicant must be a ubtime student {minimum of 12 cred hours a semester, 4. Applcants ard recpents can re-apply annual a long as the above crteria are met ‘The scholarship is avatable to any appicant regardless of age, sex, race, creed, calor enc origin, religion, personal belief, or any other protested ciasstication, APPLICATION PROCEDURE Im order to app; applicant needs to complete the attached application form and return @ etter by uploading a POF or Word Doc inthe form below ‘of mal 6 the address below, postmarked no later than (TED) ‘Messner Foundation Scholarship 1430 nkoop Street Suite 300 Denver. CO 020: {Incomplete applcations wil not Be considered, Ilo submitted materials can be retumed SCHOLARSHIPS AWARDED (ne student wl be selected fiom the foo! of applicants and wil have access to funding for up o feur years for undergraduate studies. Please note ‘that this application is fr funding ofthe 2017-2018 academe year only Awards fer subsequent years will be avarded based on reapplcation ‘The amount of allied scholarships is fo be determined annually tis at the schools discretion cn how to disburse the award. SUBMIT YOUR APPLICATION. Please submit your completed appicaion by (TED DOWMLOAD APPLICATION = © 2008-2016 Messner Reeves LLP aeme MESSNER FOUNDATION SCHOLARSHIP APPLICATIONMESSNER FOUNDATION Dear Applicant: ‘Attached is the application for the Messner Foundation Scholarship. If after reading the enclosed material you feel you meet the basic criteria, please complete the application and attach all supporting documents. Ifyou have any questions or concerns, please contact Jodi Kinnen at jkinnen@messner.com or 303-623- 1800. We will be happy to assist you. ‘Thank you for your interest in the Messner Foundation Scholarship program. | wish you the best in your ‘educational pursuits. Sincerely, ryant 5. “Corky” Messner fe afd Founder - Messner Reeves LLPMESSNER FOUNDATION SCHOLARSHIP APPLICATION FORM PURPOSE The Messner Foundation Scholarship is available to high-achieving high school seniors with financial need who have demonstrated leadership traits and seek to attend and graduate from a four- year college or university. The students the Messner Foundation aims to help have worked hard in school and have gotten involved in their community, but have financial concerns that make the idea of college overwhelming. SELECTION CRITERIA 1. Applicants must be at least a senior in high school, or equivalent if homeschooled when applying. 2. Applicant must be accepted and decided upon which college/university he/she is attending no later than (TBD), 3. The applicant must be a full-time student (minimum of 12 credit hours a semester) 4. Applicants and recipients can re-apply annually as long as the above criteria are met. The scholarship is available to any applicant regardless of age, sex, race, ereed, color, ethnic origin, ion, personal beliefs, or any other protected classification. APPLICATION PROCEDURE In order to apply, applicant needs to complete the attached application form and return it either by uploading a PDF or Word Doc online at Messnerfoundation.orgimessner-foundation-scholarship or mail to the address below, postmarked no later than (TBD): Messner Foundation Scholarship Attention: Jodi Kinnen 1430 Wynkoop Street Suite 300 Denver, CO 80202 Incomplete applications will not be considered. No submitted materials can be returned, SCHOLARSHIPS AWARDED One student will be selected from the pool of applicants and will have access to funding for up to four years for undergraduate studies. Please note that this application is for funding of the 2017- 2018 academic year only. Awards for subsequent years will be awarded based on reapplication, The amount of allotted scholarships is to be determined annually. It is at the school’s discretion on how to disburse the award.MESSNER FOUNDATION SCHOLARSHIP APPLICATION FORM PART I: INFORMATION PROFILE Name: Student ID#: Last First Middle Home Address: City: State: Zip: Home Phone: Cell Phone: Email: Name of College/University Attending: Financial Aid Address: City: State: Zip: ‘Name of Current School (if different from above): Anticipated Course of Study: Current Cumulative GPA:MESSNER FOUNDATION SCHOLARSHIP APPLICATION FORM PART II: LEADERSHIP/EXTRACURRICULAR EXPERIENCE List all extracurricular activities in which you have been actively involved: List all leadership experiences and roles you've had: PART III: ESSAY The applicant must answer two of the three following questions in essay format with a maximum of 300 words per question. 1, What does leadership mean to you? What makes a good leader and why? 2. How has your education contributed to who you are today? Why is education important to you? 3. If you could change three things in your communi and why? or the world, what would you change PART IV: TRANSCRIPTS ‘Forward your high school transcripts if you are a senior in high school or a freshman in college + Forward your college or post-secondary transcrip of your continuing education ‘© ALL transcripts must have the school’s official seal affixed. jou are in your second year or higher Note: Ask for transcripts immediately, as schools may take weeks to process your request. We request that you submit a current photograph for possible use in future publications. Your signature gives both Messner Foundation and Messner Reeves LLP permission to use your photograph and to interview you for a possible story in Messner publications. This is not mandatory and will not affect judging Signature: Date:MESSNER FOUNDATION SCHOLARSHIP APPLICATION FORM RE PART V: FINANCIAL AID INFORMATION SHEET ‘Must be completed by Financial Aid Please submit the following form to an officer in the financial aid office where the scholarship would be applied. This application cannot be processed without this information, Dear Financial Aid Officer: ‘The Messner Foundation was established to provide financial assistance to selected students. This award, while based on merit, is also based on financial need. Please complete the form below to help us better evaluate the student applying for the Messner Foundation Scholarship. Should the student receive an award, we will contact your office with more information, Applicant’s Name: ast First Middle Name of College/University Insti Financial Aid Office Address: City: State: Zip: Financial Aid Office Phone Number: School’s Estimated Cost for Student's 20___Academie Year (Including tuition, books, fees, and room and board, if applicable): $ Student’s Family Contribution Index (as determined by C’ Total Need: $ S, or other agency): $ ‘Name and Title of Person Completing Form: Signature: Date:rn 2848 fev, Dec. 2015) and Declaration Deptt Teas tena ewe Senos > Information about Form 2848 and its Power of Attorney ‘Caution: A separate Form 2648 must be completed foreach taxpayer. Form 2848 will not be honored {or any purpose other than representation before the IRS, Taxpayer information. Texpayer must sgn and date this fom on ‘Texpayer name and address Messner Foundation 11430 Wynkoop Street, Suite 400 Power of Attorney owe No. 1545-0150, For IS Use Only Peooved Teloghon of Representative vifom2e%a. instructions is at www ire paged, Ine, Taxpayer iontiication numbore) 26-4038064 ‘Dame telephone number | Pian rumnbar Gi applicable) Denver, cO 80202 303-623-1800 Fereby apponts the folowing repressive) as Saree Tack 2 Representatives) must sign and date this frm on page 2, Par Name and address CAF No. PrN Alex M, Belz, E59, 11430 Wynkoop Steet, Suite 400 Telephone No. 308 828-1800, Denver, Colorado 80202 FaxNo. ea.g2s. Check ito be sent copies of notices and communications _[]__|_Chockitnow Address -]Teiophone No. LT Name and adress ‘OAF No. 0311-36568. FTN Pige K. Justus, Esq, : = : 1430 Wynkoop Street, Suite 400 Telephone Noo 308-828-4800) Denver, Colorado 80202 Fax No. Check itt be sent copies of notices and communications []__|_Checkit new: Adress Name and adress ‘CAF Ne. Pm “eleptone No, FaxNo. (Note: IS sends notices and communications tony wo presertaties) | Check new: Adress CT Name and adress CAF No. PTW “Telephone No, Fax No. (Note: I sends notices and cemmanioston to ony to representatives to represent the taxpayer betore the Internal Revenue Serves and perform a ‘Check if new: Address the following acts: ‘Acts authorized (jou are requed to complet this ne 3) Wh te exception ofthe acts desrbad in ne Sb, | ateriz my represeiavels) to rasive and lnspet ry cofintistaxinfomaton and to pram acs hat can parm wth respect ote tx mates desorbed belo. Fo example my epresatsves) halve the auboty sgn ay sgroments, consents, sina documets se trues ene a for authoring arepredetati o gn a rete) Desciptn ater cara, Erpoymer Pal Ein Estate, GA, Wstsbews, “Tax oem Number Year(s) er Period) ff appicable) raster sip, PL, FOIA, Col Pray, Sec 5000 Shaved Feepensbity ee riod aaa ou: isan eesesnenratae ‘rece | (1040, 981,720, te) append) (Gee instructors) Request for Miscellaneous Determination 940 2016 “Specific use not recorded on Gentralized Authorization File (CAF). I the power of allomey Is fora specific use nat recorded on GAR, check this box. Seo the instructions for Line 4 Specific Use Not Recorded on CAF »o ‘5a Additional acts authorized. in adtion tothe act sta online 2 above, | authorize my representative) to perform the folowing acts (2 instructions for ine Sa for mor information} Dauthorize cisciosure to tid partes; Cssubstiute or add representatvets; sign aretuns Clother acts euthorze For Privacy Act and Paperwork Reduction Act Notice, see the instruct ons. ‘anes 888 Fem 2848 fari22019Fm 2848 lev. 12-2015) Page 'b_Spocific acts not authorized. My representatives (are) not authorized to endorse or otherwise negotate any check nouding drecing accepting payment by ary means, electronic or otherwise, into an account owned or controled by the representative) or any fm or ether entity with whom the representatives is (are) associated issued by the government in respect ofa federal tax laity ist any otter specific dations to the acts ahnise authorized inthis power of attomey (se Instructions for line Sb) 6 Retention/revocation of prior power(s) of attomey. The fling ofthis power of attomey automatically revokes all eater powers) of atoeyon le wh he tral Reus See othe sane mtr ard yas ped covered by is doce. yu do nt art te rovoko a prior power of attomey, check here ‘YOU MUST ATTACH A COPY OF ANY POWER OF ATTORNEY YOU WANT TO REMAIN IN EFFECT. 7. Signature of taxpayer. tax matter concems a yearn which aint return was fled, each spouse must le a separate power of atoney even if ey are appointing the same representatives. If signed by a corporate ocr, pater, quad, tax matters partner, executor, racer, ‘administator, or tustoe on bona of the taxpayer, cory tha | have the legal author to ext thi form on behalf ofthe taxpayer IGNED, AND DATED, THE IRS WILL RETURN THIS POWER OF ATTORNEY TO THE TAXPAYER. Walle Date Tie fappicabig “Pini ae Print aaa lnpayer om inti an nial [2MII_Deciaration of Representative Und: ponies ofp by my signatr belw ceca hae + lam ot curenty suspended or dbared om pracice,oineligble for practice, befor the neal Revenue Sec; + am astjocto oglatonscotaned in Gra 201 FR, Suite A, Pat 10, as amended, govoringpracca forth ama Revrua Seni; ‘am authorized to represen! th taxpayer onan Pa or the mato) spect tee; and ‘Tamone fhe folowing: 2 Atom a mabe ood standing ofthe bar ofthe highest court ofthe jrisicion shown blo. ' Conted Puc Accountan—tomsed to pracce a a otied puble accountants active inte sition show blo. © Envoled Agent~enoted as an agent by the Internal Revenue Sence pa th requirement of Crear 220, 4 Offer bon fie oleae taxpayer gait « FulLTneEpoyee—aul-ime employee of he tnepaye. {Fay Marbac~arembar ofthe taxpayers nat fay poe, ae, ci gacpares, ranch, stepparent sahil ote. ess). 19 Enroled Actuary —enroled 2s an actuary by the Joint Boar forthe Enrollment of Actuaries under 29 U.S.C. 1242 (he autho to practice before the intemal Revenue Senice is limited by section 10.36) of Crear 23) 'n Unenroled Return Preparer— Author to practice beore the IRS mite. An unerralied retum preparer may represent, provided the prepare) repared and signed the return or caim for refund or prepared i hares no sgnature space onthe frm) 2 was eligible to sign the return or lim fr ffund; (9 has a valid PTIN; and (8) possesses the requed Anna Fling Season Program Recor of Completions), See Special Rules ‘and Requirements for Unanroled Return Preparers Inthe Instructions for addtional information. Studont Attomey or CPA —recaivs permission o represent taxpayer before the IRS by vitue of his/her statu asa law, business, o accounting ‘student working in an LITC or STGP, Soe instructions for Par ifr adctional information and quirements. + Enrolled Retirement Plan Agent aneolled asa rotrement plan agont under the requremonts of Circular 230 tho authority to practice before the Internal Revere Serie is ited by section 10.36). > IF THIS DECLARATION OF REPRESENTATIVE IS NOT COMPLETED, SIGNED, AND DATED, THE IRS WILL RETURN THE POWER OF ATTORNEY. REPRESENTATIVES MUST SIGN IN THE ORDER LISTED IN PART |, LINE 2. Note: For dasignations dt, enter your ttle, poston, or raltionship tothe taxpayer nthe ‘Licensing jection" column, Licensing jurisdiction Designtion— inset {Gtate)orcther | rgistatin, cr enrolment Wesertabove | Geensing authority | number applctle. Signature as oa (f applicable, : S Ate We elt FZ Nn co 44096 Fom 2848 fv 22015)Complete tems 1, 2, and 3 1 Print your name and addrass onthe reverse 50 that we ean rat the card 0 you. 1 Attach this card to the back ofthe malpiece, fron the front I space permits. “1 re Aeeneced to Indeeral Revenue Secuite | PO Box 12142 re AAU AAA 9550 3401 03h 5225 9518 7% | 2. tie Nomar (ransfar rom service abe 2015 Lbb0 OOOO 2086 1302 PS Form 3811, July 2016 PSN 7590-02-000-9055 ‘Domes etiam Recapt