efile Public Visual Render
Submission Date - 2014-05-07
TIN: 03-6018226
Form
990-PF
Department of the Treasury
Internal Revenue Service
Return of Private Foundation
or Section 4947(a)(1) Trust Treated as Private Foundation
Do not enter Social Security numbers on this form as it may be made public. By law, the IRS cannot redact the information on the form.
Information about Form 990-PF and its instructions is at
www.irs.gov/form990pf
.
OMB No. 1545-0052
20
13
Open to Public Inspection
For calendar year 2013, or tax year beginning
03-01-2013
, and ending
02-28-2014
Name of foundation
STEPHEN B COLLINS TRUST 430027011
Number and street (or P.O. box number if mail is not delivered to street address)
PO BOX 477
Room/suite
City or town, state or province, country, and ZIP or foreign postal code
CONCORD
,
NH
033020477
A Employer identification number
03-6018226
B
Telephone number (see instructions)
(802) 860-5523
C
If exemption application is pending, check here
G
Check all that apply:
Initial return
Initial return of a former public charity
Final return
Amended return
Address change
Name change
D 1.
Foreign organizations, check here .............
2.
Foreign organizations meeting the 85% test,
check here and attach computation ...........
E
If private foundation status was terminated
under section 507(b)(1)(A), check here .........
H
Check type of organization:
Section 501(c)(3) exempt private foundation
Section 4947(a)(1) nonexempt charitable trust
Other taxable private foundation
I
Fair market value of all assets at end
of year
(from Part II, col. (c),
line 16)
$
1,626,254
J
Accounting method:
Cash
Accrual
Other (specify)
(Part I, column (d) must be on cash basis.)
F
If the foundation is in a 60-month termination
under section 507(b)(1)(B), check here .........
Part I
Analysis of Revenue and Expenses
(The total of amounts in columns (b), (c), and (d) may not necessarily equal the amounts in column (a) (see instructions).)
(a)
Revenue and
expenses per
books
(b)
Net investment
income
(c)
Adjusted net
income
(d)
Disbursements
for charitable
purposes
(cash basis only)
1
Contributions, gifts, grants, etc., received (attach schedule)
2
Check
3
Interest on savings and temporary cash investments
4
Dividends and interest from securities
......
38,399
38,399
5a
Gross rents
..............
b
Net rental income or (loss)
6a
Net gain or (loss) from sale of assets not on line 10
196,232
b
Gross sales price for all assets on line 6a
856,021
7
Capital gain net income (from Part IV, line 2)
....
196,232
8
Net short-term capital gain
.........
0
9
Income modifications
...........
10a
Gross sales less returns and allowances
.......
b
Less: Cost of goods sold
...
c
Gross profit or (loss) (attach schedule)
......
11
Other income (attach schedule)
........
12
Total.
Add lines 1 through 11
.........
234,631
234,631
13
Compensation of officers, directors, trustees, etc.
15,419
15,419
14
Other employee salaries and wages
......
0
0
0
15
Pension plans, employee benefits
.......
0
0
16a
Legal fees (attach schedule)
.........
0
b
Accounting fees (attach schedule)
.......
c
Other professional fees (attach schedule)
....
0
17
Interest
...............
0
18
Taxes (attach schedule) (see instructions)
362
253
0
19
Depreciation (attach schedule) and depletion
...
0
0
20
Occupancy
..............
21
Travel, conferences, and meetings
.......
0
0
22
Printing and publications
..........
0
0
23
Other expenses (attach schedule)
.......
32
32
24
Total operating and administrative expenses.
Add lines 13 through 23
..........
15,813
15,704
0
0
25
Contributions, gifts, grants paid
........
130,000
130,000
26
Total expenses and disbursements.
Add lines 24 and 25
145,813
15,704
0
130,000
27
Subtract line 26 from line 12:
a
Excess of revenue over expenses and disbursements
88,818
b
Net investment income
(if negative, enter -0-)
218,927
c
Adjusted net income
(if negative, enter -0-)
...
0
For Paperwork Reduction Act Notice, see instructions.
Cat. No. 11289X
Form
990-PF
(2013)
Form 990-PF (2013)
Page
2
Part II
Balance Sheets
Attached schedules and amounts in the description column
should be for end-of-year amounts only. (See instructions.)
Beginning of year
End of year
(a)
Book Value
(b)
Book Value
(c)
Fair Market Value
1
Cashnon-interest-bearing
...............
2
Savings and temporary cash investments
..........
105,987
43,993
43,993
3
Accounts receivable
Less: allowance for doubtful accounts
0
0
4
Pledges receivable
Less: allowance for doubtful accounts
5
Grants receivable
.................
6
Receivables due from officers, directors, trustees, and other
disqualified persons (attach schedule) (see instructions)
.....
7
Other notes and loans receivable (attach schedule)
Less: allowance for doubtful accounts
0
8
Inventories for sale or use
...............
9
Prepaid expenses and deferred charges
...........
10a
InvestmentsU.S. and state government obligations (attach schedule)
303,815
328,088
322,728
b
Investmentscorporate stock (attach schedule)
........
737,714
825,201
951,663
c
Investmentscorporate bonds (attach schedule)
........
268,078
307,124
307,870
11
Investmentsland, buildings, and equipment: basis
Less: accumulated depreciation (attach schedule)
12
Investmentsmortgage loans
..............
13
Investmentsother (attach schedule)
...........
0
14
Land, buildings, and equipment: basis
Less: accumulated depreciation (attach schedule)
15
Other assets (describe
)
16
Total assets
(to be completed by all filerssee the
instructions. Also, see page 1, item I)
1,415,594
1,504,406
1,626,254
17
Accounts payable and accrued expenses
..........
18
Grants payable
..................
19
Deferred revenue
..................
20
Loans from officers, directors, trustees, and other disqualified persons
21
Mortgages and other notes payable (attach schedule)
......
22
Other liabilities (describe
)
23
Total liabilities
(add lines 17 through 22)
..........
0
Foundations that follow SFAS 117, check here
and complete lines 24 through 26 and lines 30 and 31.
24
Unrestricted
...................
25
Temporarily restricted
................
26
Permanently restricted
................
Foundations that do not follow SFAS 117, check here
and complete lines 27 through 31.
27
Capital stock, trust principal, or current funds
.........
1,415,594
1,504,406
28
Paid-in or capital surplus, or land, bldg., and equipment fund
29
Retained earnings, accumulated income, endowment, or other funds
30
Total net assets or fund balances
(see page 17 of the
instructions)
....................
1,415,594
1,504,406
31
Total liabilities and net assets/fund balances
(see page 17 of
the instructions)
..................
1,415,594
1,504,406
Part III
Analysis of Changes in Net Assets or Fund Balances
1
Total net assets or fund balances at beginning of yearPart II, column (a), line 30 (must agree
with end-of-year figure reported on prior years return)
...............
1
1,415,594
2
Enter amount from Part I, line 27a
.....................
2
88,818
3
Other increases not included in line 2 (itemize)
3
0
4
Add lines 1, 2, and 3
..........................
4
1,504,412
5
Decreases not included in line 2 (itemize)
5
6
6
Total net assets or fund balances at end of year (line 4 minus line 5)Part II, column (b), line 30
.
6
1,504,406
Form
990-PF
(2013)
Form 990-PF (2013)
Page
3
Part IV
Capital Gains and Losses for Tax on Investment Income
(a)
List and describe the kind(s) of property sold (e.g., real estate,
2-story brick warehouse; or common stock, 200 shs. MLC Co.)
(b)
How acquired
PPurchase
DDonation
(c)
Date acquired
(mo., day, yr.)
(d)
Date sold
(mo., day, yr.)
1 a
20. CELGENE CORP
2011-11-03
2013-03-19
b
50. COLGATE PALMOLIVE CO
2011-04-21
2013-03-19
c
80. GILEAD SCIENCES INC
2011-04-26
2013-03-19
d
20. HOME DEPOT INC
2008-06-06
2013-03-19
e
15000. FED HOME LN MTG 5.00% 01/30/2014 DTD 01/30/2004
2008-03-04
2013-04-02
20. ABBOTT LABS CO
2010-05-27
2013-04-30
318.796 INVESCO INTERNATIONAL GROWTH FUND INSTITUTIONAL CLASS
2010-11-30
2013-04-30
10. AMERICAN EXPRESS CO
2004-05-06
2013-04-30
10. ARCHER DANIELS MIDLAND CO
2011-03-02
2013-04-30
20. BROADCOM CORP
2012-03-26
2013-04-30
84.36 BUFFALO SMALL CAP FD #1444
2010-11-30
2013-04-30
10. CAPITAL ONE FINANCIAL CORP
2011-07-14
2013-04-30
10. CELGENE CORP
2011-11-03
2013-04-30
30. CISCO SYSTEMS INC
2009-06-23
2013-04-30
10. COCA COLA CO
2012-05-10
2013-04-30
10. COLGATE PALMOLIVE CO
2012-04-12
2013-04-30
20. COMCAST CORP CL A
2012-12-03
2013-04-30
10. CONOCOPHILLIPS
2012-09-13
2013-04-30
10. DANAHER CORP
2011-04-21
2013-04-30
10. DIAGEO PLC ADR
2009-07-07
2013-04-30
10. WALT DISNEY CO
2012-01-09
2013-04-30
30. EMC CORPORATION/MASS
2006-04-26
2013-04-30
10. ECOLAB INC COM
2011-06-15
2013-04-30
10. EXXON MOBIL CORP COM
2011-05-09
2013-04-30
10. FREEPORT-MCMORAN COPPER & GOCL B
2012-02-06
2013-04-30
10. GILEAD SCIENCES INC
2011-04-21
2013-04-30
115.326 HARBOR INTERNATIONAL FUND
2010-11-30
2013-04-30
10. HOME DEPOT INC
2008-06-06
2013-04-30
10. ILLINOIS TOOL WORKS
2012-01-24
2013-04-30
20. J P MORGAN CHASE & CO
2007-04-09
2013-04-30
10. JOHNSON & JOHNSON CO
2005-09-14
2013-04-30
20. MERCK & CO INC NEW COM
2011-12-01
2013-04-30
20. MICROSOFT CORPORATION
2008-06-06
2013-04-30
10. MONDELEZ INTERNATIONAL INC
2012-08-22
2013-04-30
10. NEXTERA ENERGY INC COM
2012-01-09
2013-04-30
20. ORACLE CORPORATION
2011-06-15
2013-04-30
10. PNC BANK CORP
2011-12-16
2013-04-30
20. PFIZER
2012-12-03
2013-04-30
10. PRECISION CASTPARTS CORP
2012-10-15
2013-04-30
10. QUALCOMM INCORPORATED
2010-11-08
2013-04-30
37.246 ROYCE SPECIAL EQUITY FD #327
2010-11-30
2013-04-30
20. SPECTRA ENERGY CORP
2012-01-09
2013-04-30
10. STARBUCKS CORP
2011-09-08
2013-04-30
10. TJX COMPANIES INC.
2013-02-04
2013-04-30
20. US BANCORP DEL NEW
2008-08-25
2013-04-30
20. VERIZON COMMUNICATIONS
2008-09-30
2013-04-30
10. WALGREEN CO
2013-03-19
2013-04-30
20. WELLS FARGO & CO NEW
2009-05-20
2013-04-30
10. TRANSOCEAN LTD ZUG NAMEN AKT
2012-08-22
2013-04-30
10. CHECK POINT SOFTWARE TECH LTD
2011-07-26
2013-04-30
320. MONDELEZ INTERNATIONAL INC
2012-08-22
2013-05-20
70. WELLPOINT INC COM
2012-06-15
2013-05-20
10. ABBOTT LABS CO
2012-05-29
2013-06-21
198.767 INVESCO INTERNATIONAL GROWTH FUND INSTITUTIONAL CLASS
2010-11-30
2013-06-21
10. AMERICAN EXPRESS CO
2009-08-26
2013-06-21
10. ARCHER DANIELS MIDLAND CO
2011-03-02
2013-06-21
10. BED BATH & BEYOND INC
2012-06-15
2013-06-21
10. BERKSHIRE HATHAWAY INC DEL CL B NEW
2012-05-29
2013-06-21
10. BROADCOM CORP
2012-03-26
2013-06-21
10. CHEVRONTEXACO CORP
2011-05-09
2013-06-21
20. CISCO SYSTEMS INC
2009-06-23
2013-06-21
20. COCA COLA CO
2012-05-10
2013-06-21
10. COGNIZANT TECHNLGY SLTNS COR
2012-12-03
2013-06-21
10. COMCAST CORP CL A
2012-12-03
2013-06-21
10. DANAHER CORP
2011-04-21
2013-06-21
10. WALT DISNEY CO
2012-01-09
2013-06-21
20. EMC CORPORATION/MASS
2006-04-26
2013-06-21
4767.87 FIDELITY SPARTAN HIGH INCOME
2011-10-27
2013-06-21
20. FREEPORT-MCMORAN COPPER & GOCL B
2012-02-06
2013-06-21
20. GILEAD SCIENCES INC
2012-05-29
2013-06-21
87.639 HARBOR INTERNATIONAL FUND
2010-11-30
2013-06-21
10. HOME DEPOT INC
2008-06-06
2013-06-21
10. ILLINOIS TOOL WORKS
2012-01-24
2013-06-21
10. J P MORGAN CHASE & CO
2007-04-09
2013-06-21
10. MERCK & CO INC NEW COM
2012-05-29
2013-06-21
20. MICROSOFT CORPORATION
2011-09-08
2013-06-21
10. NEXTERA ENERGY INC COM
2012-05-10
2013-06-21
20. ORACLE CORPORATION
2011-06-15
2013-06-21
10. PFIZER
2012-12-03
2013-06-21
10. QUALCOMM INCORPORATED
2010-11-08
2013-06-21
420. SPDR GOLD TRUST
2011-10-04
2013-06-21
10. SPECTRA ENERGY CORP
2012-01-09
2013-06-21
10. 3M CO
2006-04-26
2013-06-21
10. US BANCORP DEL NEW
2008-08-25
2013-06-21
10. VERIZON COMMUNICATIONS
2012-06-15
2013-06-21
20. WALGREEN CO
2013-03-19
2013-06-21
10. WELLS FARGO & CO NEW
2009-05-20
2013-06-21
10. YUM BRANDS INC
2012-01-09
2013-06-21
10. ACE LTD
2011-05-23
2013-06-21
10. TRANSOCEAN LTD ZUG NAMEN AKT
2012-08-22
2013-06-21
10. CHECK POINT SOFTWARE TECH LTD
2011-07-26
2013-06-21
170. BROADCOM CORP
2012-03-26
2013-06-27
40. BROADCOM CORP
2012-09-13
2013-06-27
70. DIAGEO PLC ADR
2009-07-07
2013-06-27
2901.487 VANGUARD SHORT-TERM FED-ADM #549
2013-06-21
2013-07-29
5000. FED HOME LN MTG 5.00% 01/30/2014 DTD 01/30/2004
2008-03-04
2013-08-06
15000. FED HOME LN MTG 4.75% 11/17/2015 DTD 10/21/2005
2008-02-28
2013-08-06
30. CELGENE CORP
2011-11-03
2013-08-16
30. ECOLAB INC COM
2012-05-10
2013-08-16
70. GILEAD SCIENCES INC
2012-05-29
2013-08-16
30. HOME DEPOT INC
2008-06-06
2013-08-16
20000. U S TREAS. BONDS 4.25% 11/15/2014 DTD 11/15/2004
2009-11-16
2013-11-13
80. AMERICAN EXPRESS CO
2009-08-26
2013-12-03
90. ARCHER DANIELS MIDLAND CO
2013-03-19
2013-12-03
190. ARCHER DANIELS MIDLAND CO
2012-02-16
2013-12-03
140. BED BATH & BEYOND INC
2012-06-15
2013-12-03
30. BERKSHIRE HATHAWAY INC DEL CL B NEW
2013-03-19
2013-12-03
90. BERKSHIRE HATHAWAY INC DEL CL B NEW
2012-05-29
2013-12-03
10. CAPITAL ONE FINANCIAL CORP
2011-07-14
2013-12-03
70. CELGENE CORP
2011-11-03
2013-12-03
135. CHEVRONTEXACO CORP
2010-11-29
2013-12-03
560. CISCO SYSTEMS INC
2009-03-06
2013-12-03
330. COCA COLA CO
2012-05-29
2013-12-03
110. COGNIZANT TECHNLGY SLTNS COR
2012-12-03
2013-12-03
20. COLGATE PALMOLIVE CO
2012-05-29
2013-12-03
10. COMCAST CORP CL A
2012-12-03
2013-12-03
260. COMCAST CORP CL A
2012-08-22
2013-12-03
140. CONOCOPHILLIPS
2012-09-13
2013-12-03
20. DANAHER CORP
2011-04-21
2013-12-03
220. WALT DISNEY CO
2010-11-29
2013-12-03
450. EMC CORPORATION/MASS
2006-04-26
2013-12-03
70. ECOLAB INC COM
2010-05-14
2013-12-03
20. EXXON MOBIL CORP COM
2011-05-09
2013-12-03
270. FREEPORT-MCMORAN COPPER & GOCL B
2012-09-13
2013-12-03
220. GILEAD SCIENCES INC
2011-04-25
2013-12-03
160. HOME DEPOT INC
2009-04-08
2013-12-03
210. ILLINOIS TOOL WORKS
2012-01-24
2013-12-03
60. INTL BUSINESS MACHINES CORP
2011-09-08
2013-12-03
230. J P MORGAN CHASE & CO
2010-11-29
2013-12-03
170. JOHNSON & JOHNSON CO
2012-05-29
2013-12-03
300. MERCK & CO INC NEW COM
2012-05-29
2013-12-03
160. NEXTERA ENERGY INC COM
2012-05-10
2013-12-03
80. PNC BANK CORP
2011-12-16
2013-12-03
300. PFIZER
2012-12-03
2013-12-03
30. PRECISION CASTPARTS CORP
2012-10-15
2013-12-03
210. QUALCOMM INCORPORATED
2012-09-13
2013-12-03
300. SPECTRA ENERGY CORP
2012-01-09
2013-12-03
120. STARBUCKS CORP
2011-09-08
2013-12-03
135. 3M CO
2012-08-22
2013-12-03
390. US BANCORP DEL NEW
2010-11-29
2013-12-03
60. UNION PACIFIC CORP
2011-11-03
2013-12-03
250. VERIZON COMMUNICATIONS
2012-06-15
2013-12-03
80. WALGREEN CO
2013-03-19
2013-12-03
220. WALGREEN CO
2012-10-15
2013-12-03
320. WELLS FARGO & CO NEW
2009-05-20
2013-12-03
20. YUM BRANDS INC
2013-03-19
2013-12-03
80. YUM BRANDS INC
2012-01-09
2013-12-03
130. ACE LTD
2011-07-14
2013-12-03
260. TRANSOCEAN LTD ZUG NAMEN AKT
2012-08-03
2013-12-03
120. CHECK POINT SOFTWARE TECH LTD
2011-07-26
2013-12-03
50. VENTAS INC COM REIT
2013-12-03
2013-12-05
15000. BNK OF NOVA SCOTIA 2.375% 12/17/2013 DTD 06/17/10
2011-05-13
2013-12-17
110. THERMO ELECTRON CORPORATION
2013-12-03
2014-02-04
754.536 FIDELITY SPARTAN HIGH INCOME
2013-07-29
2014-02-19
80. COMCAST CORP SPECIAL CL A
2013-12-03
2014-02-20
40. DAVITA INC
2013-12-03
2014-02-20
40. DAVITA INC
2013-12-03
2014-02-24
CAPITAL GAIN DIVIDENDS
P
(e)
Gross sales price
(f)
Depreciation allowed
(or allowable)
(g)
Cost or other basis
plus expense of sale
(h)
Gain or (loss)
(e) plus (f) minus (g)
a
2,234
1,288
946
b
5,617
3,155
2,462
c
3,579
1,578
2,001
d
1,391
549
842
e
15,597
16,050
-453
738
457
281
9,816
8,432
1,384
684
429
255
339
369
-30
717
773
-56
2,632
2,047
585
576
493
83
1,180
644
536
628
561
67
422
388
34
1,192
972
220
826
747
79
603
566
37
608
533
75
1,220
576
644
626
399
227
671
411
260
841
549
292
887
834
53
302
463
-161
507
197
310
7,569
6,506
1,063
732
274
458
645
515
130
979
978
1
850
644
206
942
719
223
657
556
101
314
266
48
818
588
230
655
628
27
678
554
124
583
504
79
1,907
1,654
253
614
477
137
850
739
111
629
609
20
606
390
216
486
455
31
664
607
57
1,080
601
479
492
451
41
759
502
257
514
489
25
465
589
-124
9,864
8,188
1,676
5,441
4,947
494
357
297
60
5,832
5,257
575
736
380
356
332
369
-37
701
733
-32
1,125
794
331
333
386
-53
1,192
1,044
148
490
374
116
797
775
22
622
679
-57
397
374
23
622
533
89
630
399
231
487
274
213
43,864
42,415
1,449
564
926
-362
983
509
474
5,436
4,944
492
741
274
467
691
515
176
522
489
33
472
375
97
666
533
133
784
650
134
603
628
-25
286
252
34
607
477
130
52,495
57,059
-4,564
337
305
32
1,097
854
243
356
303
53
496
439
57
975
902
73
411
251
160
691
596
95
865
682
183
481
489
-8
493
589
-96
5,722
6,490
-768
1,346
1,434
-88
8,057
4,032
4,025
31,046
30,959
87
5,117
5,350
-233
16,467
15,614
853
3,986
1,932
2,054
2,745
1,784
961
3,997
1,725
2,272
2,269
823
1,446
20,820
21,967
-1,147
6,755
2,027
4,728
3,696
2,957
739
7,803
6,398
1,405
10,914
8,804
2,110
3,432
3,070
362
10,295
7,060
3,235
715
493
222
11,202
4,508
6,694
16,491
10,416
6,075
11,808
9,158
2,650
13,281
12,712
569
10,336
7,470
2,866
1,306
990
316
486
374
112
12,641
8,464
4,177
10,120
7,692
2,428
1,474
1,065
409
15,346
6,686
8,660
10,583
6,165
4,418
7,228
3,385
3,843
1,884
1,436
448
9,213
11,778
-2,565
15,979
4,304
11,675
12,595
4,187
8,408
16,381
8,796
7,585
10,563
9,936
627
13,007
11,034
1,973
15,922
10,836
5,086
14,847
10,796
4,051
13,449
9,727
3,722
6,046
4,431
1,615
9,352
7,560
1,792
7,695
4,963
2,732
15,368
11,047
4,321
10,072
8,941
1,131
9,645
4,678
4,967
17,042
11,617
5,425
14,942
10,096
4,846
9,735
6,074
3,661
12,340
8,059
4,281
4,689
3,608
1,081
12,894
7,949
4,945
13,956
4,988
8,968
1,504
1,390
114
6,018
3,657
2,361
13,174
7,194
5,980
12,941
12,082
859
7,440
6,815
625
2,837
2,805
32
15,000
15,405
-405
12,421
11,092
1,329
7,123
7,025
98
4,005
3,783
222
2,622
2,341
281
2,723
2,341
382
9,318
Complete only for assets showing gain in column (h) and owned by the foundation on 12/31/69
(l)
Gains (Col. (h) gain minus
col. (k), but not less than -0-)
or
Losses (from col.(h))
(i)
F.M.V. as of 12/31/69
(j)
Adjusted basis
as of 12/31/69
(k)
Excess of col. (i)
over col. (j), if any
a
946
b
2,462
c
2,001
d
842
e
-453
281
1,384
255
-30
-56
585
83
536
67
34
220
79
37
75
644
227
260
292
53
-161
310
1,063
458
130
1
206
223
101
48
230
27
124
79
253
137
111
20
216
31
57
479
41
257
25
-124
1,676
494
60
575
356
-37
-32
331
-53
148
116
22
-57
23
89
231
213
1,449
-362
474
492
467
176
33
97
133
134
-25
34
130
-4,564
32
243
53
57
73
160
95
183
-8
-96
-768
-88
4,025
87
-233
853
2,054
961
2,272
1,446
-1,147
4,728
739
1,405
2,110
362
3,235
222
6,694
6,075
2,650
569
2,866
316
112
4,177
2,428
409
8,660
4,418
3,843
448
-2,565
11,675
8,408
7,585
627
1,973
5,086
4,051
3,722
1,615
1,792
2,732
4,321
1,131
4,967
5,425
4,846
3,661
4,281
1,081
4,945
8,968
114
2,361
5,980
859
625
32
-405
1,329
98
222
281
382
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
196,232
3
Net short-term capital gain or (loss) as defined in sections 1222(5) and (6):
If gain, also enter in Part I, line 8, column (c) (see instructions). If (loss), enter -0-
in Part I, line 8
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
3
Part V
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?
Yes
No
If "Yes," the foundation does not qualify under section 4940(e). Do not complete this part.
1
Enter the appropriate amount in each column for each year; see page 18 of the instructions before making any entries.
(a)
Base period years Calendar
year (or tax year beginning in)
(b)
Adjusted qualifying distributions
(c)
Net value of noncharitable-use assets
(d)
Distribution ratio
(col. (b) divided by col. (c))
2012
75,147
1,512,852
0.049672
2011
76,945
1,508,884
0.050995
2010
47,218
1,479,339
0.031918
2009
77,994
1,353,579
0.057621
2008
25,105
1,385,570
0.018119
2
Total
of line 1, column (d)
......................
2
0.208325
3
Average distribution ratio for the 5-year base perioddivide the total on line 2 by 5, or by
the number of years the foundation has been in existence if less than 5 years
.
.
.
3
0.041665
4
Enter the net value of noncharitable-use assets for 2013 from Part X, line 5
.....
4
1,558,391
5
Multiply line 4 by line 3
.......................
5
64,930
6
Enter 1% of net investment income (1% of Part I, line 27b)
...........
6
2,189
7
Add lines 5 and 6
.........................
7
67,119
8
Enter qualifying distributions from Part XII, line 4
..............
8
130,000
If line 8 is 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 Part VI instructions.
Form
990-PF
(2013)
Form 990-PF (2013)
Page
4
Part VI
Excise Tax Based on Investment Income (Section 4940(a), 4940(b), 4940(e), or 4948see page 18 of the instructions)
1a
Exempt operating foundations described in section 4940(d)(2), check here
and enter N/A" on line 1.
Date of ruling or determination letter:
(attach copy of letter if necessarysee instructions)
b
Domestic foundations that meet the section 4940(e) requirements in Part V, check
1
2,189
here
and enter 1% of Part I, line 27b
...................
c
All other domestic foundations enter 2% of line 27b. Exempt foreign organizations enter 4% of Part I, line 12, col. (b)
2
Tax under section 511 (domestic section 4947(a)(1) trusts and taxable foundations only. Others enter -0-)
2
0
3
Add lines 1 and 2
............................
3
2,189
4
Subtitle A (income) tax (domestic section 4947(a)(1) trusts and taxable foundations only. Others enter -0-).
4
0
5
Tax based on investment income.
Subtract line 4 from line 3. If zero or less, enter -0-
.....
5
2,189
6
Credits/Payments:
a
2013 estimated tax payments and 2012 overpayment credited to 2013
6a
440
b
Exempt foreign organizationstax withheld at source
.......
6b
c
Tax paid with application for extension of time to file (Form 8868)
6c
0
d
Backup withholding erroneously withheld
..........
6d
7
Total credits and payments. Add lines 6a through 6d
..............
7
440
8
Enter any
penalty
for underpayment of estimated tax.
Check here
if Form 2220 is attached.
8
0
9
Tax due.
If the total of lines 5 and 8 is more than line 7, enter
amount owed
.......
9
1,749
10
Overpayment.
If line 7 is more than the total of lines 5 and 8, enter the
amount overpaid
...
10
11
Enter the amount of line 10 to be:
Credited to 2014 estimated tax
0
Refunded
11
0
Part VII-A
Statements Regarding Activities
1a
During the tax year, did the foundation attempt to influence any national, state, or local legislation or did
Yes
No
it participate or intervene in any political campaign?
....................
1a
No
b
Did it spend more than $100 during the year (either directly or indirectly) for political purposes (see page 19 of
the instructions for definition)?
............................
1b
No
If the answer is "Yes" to
1a
or
1b,
attach a detailed description of the activities and copies of any materials
published or distributed by the foundation in connection with the activities.
c
Did the foundation file
Form 1120-POL
for this year?
.....................
1c
No
d
Enter the amount (if any) of tax on political expenditures (section 4955) imposed during the year:
(1)
On the foundation.
$
(2)
On foundation managers.
$
e
Enter the reimbursement (if any) paid by the foundation during the year for political expenditure tax imposed
on foundation managers.
$
2
Has the foundation engaged in any activities that have not previously been reported to the IRS?
.......
2
No
If "Yes," attach a detailed description of the activities.
3
Has the foundation made any changes, not previously reported to the IRS, in its governing instrument, articles
of incorporation, or bylaws, or other similar instruments?
If "Yes," attach a conformed copy of the changes
....
3
No
4a
Did the foundation have unrelated business gross income of $1,000 or more during the year?
........
4a
No
b
If "Yes," has it filed a tax return on
Form 990-T
for this year?
...................
4b
5
Was there a liquidation, termination, dissolution, or substantial contraction during the year?
.........
5
No
If "Yes," attach the statement required by General Instruction T.
6
Are the requirements of section 508(e) (relating to sections 4941 through 4945) satisfied either:
By language in the governing instrument, or
By state legislation that effectively amends the governing instrument so that no mandatory directions
that conflict with the state law remain in the governing instrument?
................
6
Yes
7
Did the foundation have at least $5,000 in assets at any time during the year?
If "Yes," complete Part II, col. (c), and Part XV.
7
Yes
8a
Enter the states to which the foundation reports or with which it is registered (see instructions)
VT
b
If the answer is "Yes" to line 7, has the foundation furnished a copy of Form 990-PF to the Attorney
General (or designate) of each state as required by General Instruction G?
If "No," attach explanation
.
8b
Yes
9
Is the foundation claiming status as a private operating foundation within the meaning of section 4942(j)(3)
or 4942(j)(5) for calendar year 2013 or the taxable year beginning in 2013 (see instructions for Part XIV)?
If "Yes," complete Part XIV
.............................
9
No
10
Did any persons become substantial contributors during the tax year?
If "Yes," attach a schedule listing their names and addresses.
10
No
11
At any time during the year, did the foundation, directly or indirectly, own a controlled entity within the
meaning of section 512(b)(13)? If "Yes," attach schedule. (see instructions)
.............
11
No
12
Did the foundation make a distribution to a donor advised fund over which the foundation or a disqualified person had
advisory privileges? If "Yes," attach statement (see instructions)
.................
12
No
13
Did the foundation comply with the public inspection requirements for its annual returns and exemption application?
13
Yes
Website address
14
The books are in care of
TD Bank NA
Telephone no.
(802) 860-5523
Located at
111 MAIN STREET
BURLINGTON
VT
ZIP+4
05401
15
Section 4947(a)(1) nonexempt charitable trusts filing Form 990-PF in lieu of
Form 1041
Check here
.........
and enter the amount of tax-exempt interest received or accrued during the year
......
15
16
At any time during calendar year 2013, did the foundation have an interest in or a signature or other authority over
Yes
No
a bank, securities, or other financial account in a foreign country?
16
No
See instructions for exceptions and filing requirements for Form TD F 90-22.1. If "Yes", enter the name of the
foreign country
Form
990-PF
(2013)
Form 990-PF (2013)
Page
5
Part VII-B
Statements Regarding Activities for Which Form 4720 May Be Required
File Form 4720 if any item is checked in the "Yes" column, unless an exception applies.
Yes
No
1a
During the year did the foundation (either directly or indirectly):
(1)
Engage in the sale or exchange, or leasing of property with a disqualified person?
Yes
No
(2)
Borrow money from, lend money to, or otherwise extend credit to (or accept it from)
a disqualified person?
.........................
Yes
No
(3)
Furnish goods, services, or facilities to (or accept them from) a disqualified person?
Yes
No
(4)
Pay compensation to, or pay or reimburse the expenses of, a disqualified person?
Yes
No
(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)?
.................
Yes
No
(6)
Agree to pay money or property to a government official? (
Exception.
Check "No"
if the foundation agreed to make a grant to or to employ the official for a period
after termination of government service, if terminating within 90 days.)
.........
Yes
No
b
If any answer is "Yes" to 1a(1)(6), did
any
of the acts fail to qualify under the exceptions described in Regulations
section 53.4941(d)-3 or in a current notice regarding disaster assistance (see page 20 of the instructions)?
...
1b
Organizations relying on a current notice regarding disaster assistance check here
.........
c
Did the foundation engage in a prior year in any of the acts described in 1a, other than excepted acts,
that were not corrected before the first day of the tax year beginning in 2013?
.............
1c
No
2
Taxes on failure to distribute income (section 4942) (does not apply for years the foundation was a private
operating foundation defined in section 4942(j)(3) or 4942(j)(5)):
a
At the end of tax year 2013, did the foundation have any undistributed income (lines 6d
and 6e, Part XIII) for tax year(s) beginning before 2013?
...............
Yes
No
If "Yes," list the years
20
,
20
,
20
,
20
b
Are there any years listed in 2a for which the foundation is
not
applying the provisions of section 4942(a)(2)
(relating to incorrect valuation of assets) to the years undistributed income? (If applying section 4942(a)(2)
to
all
years listed, answer "No" and attach statementsee instructions.)
..............
2b
No
c
If the provisions of section 4942(a)(2) are being applied to
any
of the years listed in 2a, list the years here.
20
,
20
,
20
,
20
3a
Did the foundation hold more than a 2% direct or indirect interest in any business enterprise at
any time during the year?
.........................
Yes
No
b
If "Yes," did it have excess business holdings in 2013 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 Commissioner under section 4943(c)(7)) to dispose of holdings acquired by gift or bequest; or
(3)
the lapse of the 10-, 15-, or 20-year first phase holding period?
(Use Schedule C, Form 4720, to determine
if the foundation had excess business holdings in 2013.)
....................
3b
4a
Did the foundation invest during the year any amount in a manner that would jeopardize its charitable purposes?
4a
No
b
Did the foundation make any investment in a prior year (but after December 31, 1969) that could jeopardize its
charitable purpose that had not been removed from jeopardy before the first day of the tax year beginning in 2013?
4b
No
5a
During the year did the foundation pay or incur any amount to:
(1)
Carry on propaganda, or otherwise attempt to influence legislation (section 4945(e))?
Yes
No
(2)
Influence the outcome of any specific public election (see section 4955); or to carry
on, directly or indirectly, any voter registration drive?
...............
Yes
No
(3)
Provide a grant to an individual for travel, study, or other similar purposes?
Yes
No
(4)
Provide a grant to an organization other than a charitable, etc., organization described
in section 509(a)(1), (2), or (3), or section 4940(d)(2)? (see instructions)
........
Yes
No
(5)
Provide for any purpose other than religious, charitable, scientific, literary, or
educational purposes, or for the prevention of cruelty to children or animals?
........
Yes
No
b
If any answer is "Yes" to 5a(1)(5), did
any
of the transactions fail to qualify under the exceptions described in
Regulations section 53.4945 or in a current notice regarding disaster assistance (see instructions)?
......
5b
Organizations relying on a current notice regarding disaster assistance check here
.........
c
If the answer is "Yes" to question 5a(4), does the foundation claim exemption from the
tax because it maintained expenditure responsibility for the grant?
............
Yes
No
If "Yes," attach the statement required by Regulations section 53.49455(d).
6a
Did the foundation, during the year, receive any funds, directly or indirectly, to pay premiums on
a personal benefit contract?
........................
Yes
No
b
Did the foundation, during the year, pay premiums, directly or indirectly, on a personal benefit contract?
....
6b
No
If "Yes" to 6b, file Form 8870.
7a
At any time during the tax year, was the foundation a party to a prohibited tax shelter transaction?
Yes
No
b
If yes, did the foundation receive any proceeds or have any net income attributable to the transaction?
....
7b
Form
990-PF
(2013)
Form 990-PF (2013)
Page
6
Part VIII
Information About Officers, Directors, Trustees, Foundation Managers, Highly Paid Employees,
and Contractors
1
List all officers, directors, trustees, foundation managers and their compensation (see instructions).
(a)
Name and address
(b)
Title, and average
hours per week
devoted to position
(c)
Compensation
(If not paid, enter
-0-)
(d)
Contributions to
employee benefit plans
and deferred compensation
(e)
Expense account,
other allowances
TD Bank NA
TRUSTEE
1
15,419
111 Main Sreet
Burlington
,
VT
05403
2
Compensation of five highest-paid employees (other than those included on line 1see instructions). If none, enter NONE."
(a)
Name and address of each employee paid more than $50,000
(b)
Title, and average
hours per week
devoted to position
(c)
Compensation
(d)
Contributions to
employee benefit
plans and deferred
compensation
(e)
Expense account,
other allowances
NONE
Total
number of other employees paid over $50,000
...................
0
3
Five highest-paid independent contractors for professional services (see instructions). If none, enter "NONE".
(a)
Name and address of each person paid more than $50,000
(b)
Type of service
(c)
Compensation
NONE
Total
number of others receiving over $50,000 for professional services
.............
0
Part IX-A
Summary of Direct Charitable Activities
List the foundations four largest direct charitable activities during the tax year. Include relevant statistical information such as the number of organizations and other beneficiaries served, conferences convened, research papers produced, etc.
Expenses
1
2
3
4
Form
990-PF
(2013)
Form 990-PF (2013)
Page
7
Part IX-B
Summary of Program-Related Investments
(see instructions)
Describe the two largest program-related investments made by the foundation during the tax year on lines 1 and 2.
Amount
1
2
All other program-related investments. See page 24 of the instructions.
3
Total.
Add lines 1 through 3
.........................
Part X
Minimum Investment Return
(All domestic foundations must complete this part. Foreign foundations,
see instructions.)
1
Fair market value of assets not used (or held for use) directly in carrying out charitable, etc.,
purposes:
a
Average monthly fair market value of securities
...................
1a
1,512,504
b
Average of monthly cash balances
.......................
1b
69,619
c
Fair market value of all other assets (see instructions)
................
1c
0
d
Total
(add lines 1a, b, and c)
.........................
1d
1,582,123
e
Reduction claimed for blockage or other factors reported on lines 1a and
1c (attach detailed explanation)
.............
1e
0
2
Acquisition indebtedness applicable to line 1 assets
..................
2
0
3
Subtract line 2 from line 1d
.........................
3
1,582,123
4
Cash deemed held for charitable activities. Enter 1 1/2% of line 3 (for greater amount, see
instructions)
.............................
4
23,732
5
Net value of noncharitable-use assets.
Subtract line 4 from line 3. Enter here and on Part V, line 4
5
1,558,391
6
Minimum investment return.
Enter 5% of line 5
..................
6
77,920
Part XI
Distributable Amount
(see instructions) (Section 4942(j)(3) and (j)(5) private operating foundations and certain foreign organizations check here
and do not complete this part.)
1
Minimum investment return from Part X, line 6
....................
1
77,920
2a
Tax on investment income for 2013 from Part VI, line 5
......
2a
2,189
b
Income tax for 2013. (This does not include the tax from Part VI.)
...
2b
c
Add lines 2a and 2b
............................
2c
2,189
3
Distributable amount before adjustments. Subtract line 2c from line 1
............
3
75,731
4
Recoveries of amounts treated as qualifying distributions
................
4
0
5
Add lines 3 and 4
............................
5
75,731
6
Deduction from distributable amount (see instructions)
.................
6
0
7
Distributable amount
as adjusted. Subtract line 6 from line 5. Enter here and on Part XIII,
line 1
................................
7
75,731
Part XII
Qualifying Distributions
(see instructions)
1
Amounts paid (including administrative expenses) to accomplish charitable, etc., purposes:
a
Expenses, contributions, gifts, etc.total from Part I, column (d), line 26
..........
1a
130,000
b
Program-related investmentstotal from Part IX-B
..................
1b
0
2
Amounts paid to acquire assets used (or held for use) directly in carrying out charitable, etc.,
purposes
...............................
2
0
3
Amounts set aside for specific charitable projects that satisfy the:
a
Suitability test (prior IRS approval required)
....................
3a
0
b
Cash distribution test (attach the required schedule)
.................
3b
0
4
Qualifying distributions.
Add lines 1a through 3b. Enter here and on Part V, line 8, and Part XIII, line 4
4
5
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 instructions)
.................
5
2,189
6
Adjusted qualifying distributions.
Subtract line 5 from line 4
..............
6
127,811
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 in those years.
Form
990-PF
(2013)
Form 990-PF (2013)
Page
8
Part XIII
Undistributed Income
(see instructions)
(a)
Corpus
(b)
Years prior to 2012
(c)
2012
(d)
2013
1
Distributable amount for 2013 from Part XI, line 7
75,731
2
Undistributed income, if any, as of the end of 2013:
a
Enter amount for 2012 only
.......
53,195
b
Total for prior years:
2011
,
20
,
20
0
3
Excess distributions carryover, if any, to 2013:
a
From 2008
......
0
b
From 2009
......
0
c
From 2010
......
0
d
From 2011
......
0
e
From 2012
......
0
f
Total
of lines 3a through e
........
0
4
Qualifying distributions for 2013 from Part
XII, line 4:
$
130,000
a
Applied to 2012, but not more than line 2a
53,195
b
Applied to undistributed income of prior years
(Election requiredsee instructions)
.....
0
c
Treated as distributions out of corpus (Election
requiredsee instructions)
........
0
d
Applied to 2013 distributable amount
.....
75,731
e
Remaining amount distributed out of corpus
1,074
5
Excess distributions carryover applied to 2013.
0
0
(If an amount appears in column (d), the
same amount must be shown in column (a).)
6
Enter the net total of each column as
indicated below:
a
Corpus. Add lines 3f, 4c, and 4e. Subtract line 5
1,074
b
Prior years undistributed income. Subtract
line 4b from line 2b
..........
0
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
......
0
d
Subtract line 6c from line 6b. Taxable amount
see instructions
...........
0
e
Undistributed income for 2012. Subtract line
4a from line 2a. Taxable amountsee
instructions
.............
0
f
Undistributed income for 2013. Subtract
lines 4d and 5 from line 1. This amount must
be distributed in 2014
..........
0
7
Amounts treated as distributions out of
corpus to satisfy requirements imposed by
section 170(b)(1)(F) or 4942(g)(3) (see
instructions)
.............
0
8
Excess distributions carryover from 2008 not
applied on line 5 or line 7 (see instructions)
...
0
9
Excess distributions carryover to 2014.
Subtract lines 7 and 8 from line 6a
......
1,074
10
Analysis of line 9:
a
Excess from 2009
....
0
b
Excess from 2010
....
0
c
Excess from 2011
....
0
d
Excess from 2012
....
0
e
Excess from 2013
....
1,074
Form
990-PF
(2013)
Form 990-PF (2013)
Page
9
Part XIV
Private Operating Foundations
(see instructions and Part VII-A, question 9)
1a
If the foundation has received a ruling or determination letter that it is a private operating
foundation, and the ruling is effective for 2013, enter the date of the ruling
.......
b
Check box to indicate whether the organization is a private operating foundation described in section
4942(j)(3)
or
4942(j)(5)
2a
Enter the lesser of the adjusted net
income from Part I or the minimum
investment return from Part X for each
year listed
..........
Tax year
Prior 3 years
(e) Total
(a)
2013
(b)
2012
(c)
2011
(d)
2010
b
85% of line 2a
.........
c
Qualifying distributions from Part XII,
line 4 for each year listed
.....
d
Amounts included in line 2c not used
directly for active conduct of exempt
activities
..........
e
Qualifying distributions made directly
for active conduct of exempt activities.
Subtract line 2d from line 2c
....
3
Complete 3a, b, or c for the
alternative test relied upon:
a
Assets" alternative testenter:
(1)
Value of all assets
......
(2)
Value of assets qualifying
under section 4942(j)(3)(B)(i)
b
Endowment" alternative test enter 2/3
of minimum investment return shown in
Part X, line 6 for each year listed
...
c
Support" alternative testenter:
(1)
Total support other than gross
investment income (interest,
dividends, rents, payments
on securities loans (section
512(a)(5)), or royalties)
....
(2)
Support from general public
and 5 or more exempt
organizations as provided in
section 4942(j)(3)(B)(iii)
....
(3)
Largest amount of support
from an exempt organization
(4)
Gross investment income
Part XV
Supplementary Information (Complete this part only if the organization had $5,000 or more in
assets at any time during the yearsee instructions.)
1
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 if they have contributed more than $5,000). (See section 507(d)(2).)
NONE
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.
NONE
2
Information Regarding Contribution, Grant, Gift, Loan, Scholarship, etc., Programs:
Check here
if the foundation only makes contributions to preselected charitable organizations and does not accept
unsolicited requests for funds. If the foundation makes gifts, grants, etc. (see instructions) to individuals or organizations under
other conditions, complete items 2a, b, c, and d.
a
The name, address, and telephone number of the person to whom applications should be addressed:
b
The form in which applications should be submitted and information and materials they should include:
c
Any submission deadlines:
d
Any restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other factors:
Form
990-PF
(2013)
Form 990-PF (2013)
Page
10
Part XV
Supplementary Information
(continued)
3 Grants and Contributions Paid During the Year or Approved for Future Payment
Recipient
If recipient is an individual,
show any relationship to
any foundation manager
or substantial contributor
Foundation
status of
recipient
Purpose of grant or
contribution
Amount
Name and address (home or business)
a
Paid during the year
BELLOWS FREE ACADEMY
UNION HIGH SCHOOL DISTRICT 48
ST ALBANS
,
VT
05478
NONE
SCHOOL
MAINTENANCE OF ATHLETIC
130,000
Total
.................................
3a
130,000
b
Approved for future payment
Total
.................................
3b
Form
990-PF
(2013)
Form 990-PF (2013)
Page
11
Part XVI-A
Analysis of Income-Producing Activities
Enter gross amounts unless otherwise indicated.
Unrelated business income
Excluded by section 512, 513, or 514
(e)
Related or exempt
function income
(See instructions.)
1
Program service revenue:
(a)
Business code
(b)
Amount
(c)
Exclusion code
(d)
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
Dividends and interest from securities
....
14
38,395
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
Gain or (loss) from sales of assets other than
inventory
.............
18
196,236
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)
..
234,631
13
Total.
Add line 12, columns (b), (d), and (e)
..................
13
234,631
(See worksheet in line 13 instructions to verify calculations.)
Part XVI-B
Relationship of Activities to the Accomplishment of Exempt Purposes
Line No.
Explain below how each activity for which income is reported in column (e) of Part XVI-A contributed importantly to
the accomplishment of the foundations exempt purposes (other than by providing funds for such purposes). (See
instructions.)
Form
990-PF
(2013)
Form 990-PF (2013)
Page
12
Part XVII
Information Regarding Transfers To and Transactions and Relationships With Noncharitable Exempt Organizations
1
Did the organization directly or indirectly engage in any of the following with any other organization described in section 501(c) of the Code (other than section 501(c)(3) organizations) or in section 527, relating to political organizations?
Yes
No
a
Transfers from the reporting foundation to a noncharitable exempt organization of:
(1)
Cash
...................................
1a(1)
No
(2)
Other assets
.................................
1a(2)
No
b
Other transactions:
(1)
Sales of assets to a noncharitable exempt organization
....................
1b(1)
No
(2)
Purchases of assets from a noncharitable exempt organization
..................
1b(2)
No
(3)
Rental of facilities, equipment, or other assets
.......................
1b(3)
No
(4)
Reimbursement arrangements
...........................
1b(4)
No
(5)
Loans or loan guarantees
.............................
1b(5)
No
(6)
Performance of services or membership or fundraising solicitations
................
1b(6)
No
c
Sharing of facilities, equipment, mailing lists, other assets, or paid employees
..............
1c
No
d
If the answer to any of the above is "Yes," complete the following schedule. Column
(b)
should always show the fair market value
of the goods, other assets, or services given by the reporting foundation. If the foundation received less than fair market value
in any transaction or sharing arrangement, show in column
(d)
the value of the goods, other assets, or services received.
(a)
Line No.
(b)
Amount involved
(c)
Name of noncharitable exempt organization
(d)
Description of transfers, transactions, and sharing arrangements
2a
Is the foundation directly or indirectly affiliated with, or related to, one or more tax-exempt organizations
described in section 501(c) of the Code (other than section 501(c)(3)) or in section 527?
...........
Yes
No
b
If "Yes," complete the following schedule.
(a)
Name of organization
(b)
Type of organization
(c)
Description of relationship
Sign Here
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than taxpayer or fiduciary) is based on all information of which preparer has any knowledge.
2014-04-25
May the IRS discuss this return
with the preparer shown below
(see instr.)?
Yes
No
Signature of officer or trustee
Date
Title
Paid Preparer Use Only
Print/Type preparer's name
Preparer's Signature
Date
Check if self-
employed
PTIN
Firm's name
Firm's address
Firm's EIN
Phone no.
Form
990-PF
(2013)
Additional Data
Software ID:
Software Version:
Form 990PF - Special Condition Description:
Special Condition Description