44-34-`d0

Registration Statement for Charitable Organizations

Farm CHAR410 New York State Department of Law (Office of the Attorney General)
Charities Bureau - Registration Section Open to Public
For new registrants only 120 Broadway Inspection
(Amending use CHAR410-A. New York, NY 10271
Re-registering use CHAR410-R) www. ch a riti es nys . co m/

Part A - Ideation of Registrant

1. Full name of organization (exactly as it appears in your organizing document) 5. Fed. employer ID no. (EIN)
THE BARACK OBAMA FOUNDATION
4 6. 4 9 5 0 7 5 1
2. Go Name (if applicable) 6. Organization's website
N/A obamapresidentialfoundation.org
3. Mailing address (Number and street) Room/suite 7. Primary contact
300 E. RANDOLPH ST. 4030 JOHN KEVIN POORMAN
City or town, state or country and ZIP+4 Title

CHICAGO, IL 60601 DIRECTOR/ PRESIDENT

4. Principal NYS address (Number and street) Room/suite Phone Fax
N/A (312) 626-1133
City or town, state or country and ZIP+4 Email

N/A info@obamapresidentialfoundation.org

Part B - Certification

We certify under penalties for perjury that w reviewed this Registration Statement, including all schedules and attachments, and to the best of our
knowledge and belief, they are true, correct 4r d qff IFtpletgfrAcsordance with the laws of the State of New York applicable to this statement.
JOHN KEVIN POORMAN, DIREC T OR/ PRESIDENT
1. President or Authorizes CNfioer]Tnistee /
Printed Name Title Date

2. Chief-Finanaat Otf:br Treat:uaar

ROBBIN COHEN, ACTING EXEC. DIR./ VP/TREASURER
7 9-/Z
Printed Name Title Date

Part ,C - Fee SubmiNd

If registering to solicit contributions, fee is $25. Check if you are submitting $25 fee to Submit check or money order,
If not registering to solicit contributions, no fee is owed. register to solicit contributions. payable to "NYS Department of Law."

Pact D - Attachments - All DocuMaft Reid

Attach all of the following documents to this Registration Statement, even if you are claiming an exemption from registration:
Certificate of incorporation, trust agreement or other organizing document, and any amendments; and ATTACHED
Bylaws or other organizational rules, and any amendments; and ATTACHED
IRS Form 1023 or 1024 Application for Recognition of Exemption (if applicable); and ATTACHED
IRS tax exemption determination letter (if applicable) PENDING EXEMPTION

Part E - Request fW'Re etlon

Is the organization requesting exemption from registration under either or both Article 7-A or the EPTL? ......................... Yes* q No
* If "Yes", complete Schedule E.

Page 1 of 3 Form CHAR410 (2010)

Part F - Organlzattan Structure
1. Incorporation / formation
a. Type of organization: b. Type of corporation if New York not-for-profit corporation
Corporation
A[] Bq C q Dq
Limited liability company (LLC) ......................... q
Partnership ........................................ q c. Date incorporated if a corporation or formed if other than a corporation
Sole proprietorship .................................. q
0 1 3 1 2 0 1 4
Trust ............................................. -- -- ----
Unincorporated association ............................ q d. State in which incorporated or formed
Other` ............................................ q
" If Other, describe: WASHINGTON, D.C.

2. List all chapters, branches and affiliates of your organization (attach additional sheets if necessary)
NIA Mailing address (number and street, room/suite,
Name Relationship City or town, state or country and zip+4)

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3. List all officers, directors, trustees and key employees

Mailing address (number and street, room/suite, End of term
Name Title city or town, state or country and zip+4) (if applicable)
REFER TO ATTACHED BOARD LIST

----------------------------------------

----------------------------------------

---------------------------------------- --

------------ ---------------------------- I I

----------------------------------------

----------------------------------------

---------------------------------------- / /

4. Other Names and Registration Numbers

a. List all other names used by your organization, including any prior names
N/A
b. List all prior New York State charities registration numbers for the organization, including those from the New York State Attorney General's
Charities Bureau or the New York State Department of State's Office of Charities Registration
N/A

Page 2 of 3 Form CHAR410 (2010)

Part G - OrlipmW tlon Activities . ^.' 777777,
1. Month the annual accounting period ends (01-12) 2. NTEE code
12 Q

3. Date organization began doing each of following in New York State:

a. UPO APPROVAL
conducting activity ....................................................................... ..... - Y- / - - - -
b. maintaining assets ....................................................................... ..... N/A / --1
- /
c. soliciting contributions (including from residents, foundations, corporations, government agencies, etc.) UPO J APPPOVAL
4. Describe the purposes of your organization
REFER TO ATTACHED PURPOSE STATEMENT

5. Has your organization or any of your officers, directors, trustees or key employees been:
a. enjoined or otherwise prohibited by a government agency or court from soliciting contributions? .......... ............... q Yes* No
* If "Yes", describe:

b. found to have engaged in unlawful practices in connection with the solicitation or administration of charitable assets? ........ q Yes* No
* If "Yes", describe:

6. Has your organization's registration or license been suspended by any government agency? ............... ............... q Yes* No
* If "Yes", describe:

7. Does your organization solicit or intend to solicit contributions (including from residents, foundations, corporations, government
agencies, etc.) in New York State? ............................................................. ............... Yes* q No
* If "Yes", describe the purposes for which contributions are or will be solicited:
REFER TO ATTACHED PURPOSE STATEMENT

8. List all fund raising professionals (FRP) that your organization has engaged for fund raising activity in NY State (attach additional sheets if
necessary)
Type of FRP Mailing address (number and street, room/suite,
Name (see instructions for definitions) city or town, state or country and zip+4) Dates of contract
SMOOT TEWES GROUP Start date: 06/27/2014
PFR ................ 818 CONNECTICUT AVE., N.W. STE 200 - - - - - - - -
q ----------------------------------- 1 2/31 / 2020
CCV ................ q WASHINGTON, D.C. 20006 End date:
- - - - - - - -

PFR ................ q Start date: _

-------------------------------
End date: _ /
CCV ................ q

PFR ................ q
Start date: _ -1_ _ _ _
FRC ................ 0 r -----------------------------------
CCV ................ q End date: _ -/- -/
- - - -

Part H - FetAW -Vat Exwspt

1. If applicable, list the date your organization:
a. applied for tax exempt status ....................................................................
b. was granted tax exempt status PEN9ING /

c. was denied tax exempt status ................................................................... N/A / /

d. had its tax exempt status revoked ................................................................ N/A / /

2. Provide Internal Revenue Code provision: 501(c)(_)

Page 3 of 3 Form CHAR410 (2010)

 THE BARACK OBAMA FOUNDATION

The Barack Obama Foundation Purpose Statement

The Barack Obama Foundation will both plan and develop a Presidential Center for future
activities, including the Presidential Library, a museum and a broader campus, and engage in
activities reflecting President Obama's values and priorities throughout his career in public
service: expanding economic opportunity, inspiring an ethic of American citizenship, and
promoting peace, justice and dignity throughout the world. The Foundation envisions a
Presidential Center that, through its mission, initiatives, and physical and virtual presence,
advances and interprets the themes of civic engagement, global perspective, health and wellness,
environmental stewardship, public education, a spirit of innovation, and will become an anchor
for economic development and cultivate a strong relationship with the library's surrounding
community.

The Foundation will serve as the vehicle by which the Presidential Library is constructed, and, in
accordance with the statutory requirements outlined in the Presidential Libraries Act, by which
the endowment necessary for the National Archives and Records Administration (NARA) to
operate the Presidential Library is created and funded. The Foundation anticipates negotiating a
joint use agreement with NARA in the future which will outline the responsibilities of both the
Foundation and the government and will likely require the Foundation to provide ongoing
support for the activities of the Presidential Library.

300 East Randolph Street, Suite 4030 obamapresidentialfoundation.org

Chicago, IL 60601
 THE BARACK OBAMA FOUNDATION

The Barack Obama Foundation List of Directors and Officers

1. Martin H. Nesbitt, Director/Chairman

300 East Randolph St, Suite 4030

Chicago, IL 60601
Phone number: 312.626.1122

2. J. Kevin Poorman, Director/President

300 N. Lasalle St., Ste 1500

Chicago, IL 60654
Phone number: 312.873.4812

3. David Plouffe, Director/Vice President/Secretary

3612 Macomb St NW
Washington, DC 20016
Phone number: 202.329.6790

4. Maya Soetoro-Ng, Director

1949 Naniu Place, Apt. p2201

Honolulu, HI 96822
Phone number: 808.365.9470

5. Robbin Cohen, Vice President/Treasurer

300 East Randolph St, Suite 4030

Chicago, IL 60601
Phone number: 312.626.1123

30(O East Randolph Street, SLHte 4030 obamapresidentialfoundation.org

Chicago, IL 60601