efile Public Visual Render
Submission Date - 2014-02-26
TIN: 03-0368595
Form
990-PF
Department of the Treasury
Internal Revenue Service
Return of Private Foundation
or Section 4947(a)(1) Nonexempt Charitable Trust
Treated as a Private Foundation
Note.
The foundation may be able to use a copy of this return to satisfy state reporting requirements.
OMB No. 1545-0052
20
12
Open to Public Inspection
For calendar year 2012, or tax year beginning
11-01-2012
, and ending
10-31-2013
Name of foundation
BEN COHEN CHARITABLE TRUST
Number and street (or P.O. box number if mail is not delivered to street address)
C/O GHP ADVISORS PC PO BOX 5550
Room/suite
City or town, state, and ZIP code
BURLINGTON
,
VT
054025550
A Employer identification number
03-0368595
B
Telephone number (see instructions)
(802) 863-5099
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 ...........
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)
$
4,882,285
J
Accounting method:
Cash
Accrual
Other (specify)
(Part I, column (d) must be on cash basis.)
E
If private foundation status was terminated
under section 507(b)(1)(A), check here .........
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)
1,346,717
2
Check
3
Interest on savings and temporary cash investments
5,593
5,593
4
Dividends and interest from securities
......
46,645
46,645
5a
Gross rents
..............
b
Net rental income or (loss)
6a
Net gain or (loss) from sale of assets not on line 10
92,755
b
Gross sales price for all assets on line 6a
1,610,555
7
Capital gain net income (from Part IV, line 2)
...
998,594
8
Net short-term capital gain
.........
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)
.......
481
481
12
Total.
Add lines 1 through 11
........
1,492,191
1,051,313
13
Compensation of officers, directors, trustees, etc.
14
Other employee salaries and wages
......
15
Pension plans, employee benefits
.......
16a
Legal fees (attach schedule)
.........
b
Accounting fees (attach schedule)
.......
14,072
12,075
2,000
c
Other professional fees (attach schedule)
....
17
Interest
...............
18
Taxes (attach schedule) (see instructions)
4,323
323
19
Depreciation (attach schedule) and depletion
...
20
Occupancy
..............
21
Travel, conferences, and meetings
.......
22
Printing and publications
..........
2,379
2,379
23
Other expenses (attach schedule)
.......
20,135
17,579
24
Total operating and administrative expenses.
Add lines 13 through 23
..........
40,909
12,398
21,958
25
Contributions, gifts, grants paid
........
349,802
349,802
26
Total expenses and disbursements.
Add lines 24 and 25
390,711
12,398
371,760
27
Subtract line 26 from line 12:
a
Excess of revenue over expenses and disbursements
1,101,480
b
Net investment income
(if negative, enter -0-)
1,038,915
c
Adjusted net income
(if negative, enter -0-)
...
For Paperwork Reduction Act Notice, see instructions.
Cat. No. 11289X
Form
990-PF
(2012)
Form 990-PF (2012)
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
...............
225,931
96,711
96,711
2
Savings and temporary cash investments
..........
135,222
344,033
343,486
3
Accounts receivable
Less: allowance for doubtful accounts
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 page 15 of the
instructions)
....................
7
Other notes and loans receivable (attach schedule)
Less: allowance for doubtful accounts
8
Inventories for sale or use
...............
9
Prepaid expenses and deferred charges
...........
10a
InvestmentsU.S. and state government obligations (attach schedule)
440,792
618,966
603,894
b
Investmentscorporate stock (attach schedule)
........
1,897,058
2,534,261
3,284,575
c
Investmentscorporate bonds (attach schedule)
........
51,561
258,208
253,754
11
Investmentsland, buildings, and equipment: basis
Less: accumulated depreciation (attach schedule)
12
Investmentsmortgage loans
..............
13
Investmentsother (attach schedule)
...........
300,000
299,865
299,865
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)
3,050,564
4,152,044
4,882,285
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
.........
1,829,357
1,829,357
28
Paid-in or capital surplus, or land, bldg., and equipment fund
29
Retained earnings, accumulated income, endowment, or other funds
1,221,207
2,322,687
30
Total net assets or fund balances
(see page 17 of the
instructions)
....................
3,050,564
4,152,044
31
Total liabilities and net assets/fund balances
(see page 17 of
the instructions)
..................
3,050,564
4,152,044
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
3,050,564
2
Enter amount from Part I, line 27a
.....................
2
1,101,480
3
Other increases not included in line 2 (itemize)
3
4
Add lines 1, 2, and 3
..........................
4
4,152,044
5
Decreases not included in line 2 (itemize)
5
6
Total net assets or fund balances at end of year (line 4 minus line 5)Part II, column (b), line 30
.
6
4,152,044
Form
990-PF
(2012)
Form 990-PF (2012)
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
PUBLICLY TRADED SECURITIES (ST ACCT MC 2698)
D
1988-08-08
2013-02-28
b
PUBLICLY TRADED SECURITIES (ST ACCT MC 2698)
P
2001-08-17
2013-05-31
c
PUBLICLY TRADED SECURITIES (ST ACCT MC 4691)
P
d
e
(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
1,286,677
0
308,813
977,864
b
95,000
0
71,262
23,738
c
228,878
0
231,886
-3,008
d
e
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
0
0
0
977,864
b
0
0
0
23,738
c
0
0
0
-3,008
d
e
2
Capital gain net income or (net capital loss)
If gain, also enter in Part I, line 7
If (loss), enter -0- in Part I, line 7
2
998,594
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
-3,008
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))
2011
355,525
3,142,445
0.113136
2010
189,953
3,472,559
0.054701
2009
96,000
2,977,266
0.032244
2008
210,000
2,682,717
0.078279
2007
230,643
3,655,364
0.063097
2
Total
of line 1, column (d)
......................
2
0.341457
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
0.068291
4
Enter the net value of noncharitable-use assets for 2012 from Part X, line 5
.....
4
4,395,376
5
Multiply line 4 by line 3
.......................
5
300,165
6
Enter 1% of net investment income (1% of Part I, line 27b)
...........
6
10,389
7
Add lines 5 and 6
.........................
7
310,554
8
Enter qualifying distributions from Part XII, line 4
..............
8
371,760
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
(2012)
Form 990-PF (2012)
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
10,389
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
10,389
4
Subtitle A (income) tax (domestic section 4947(a)(1) trusts and taxable foundations only. Others enter -0-).
4
5
Tax based on investment income.
Subtract line 4 from line 3. If zero or less, enter -0-
.....
5
10,389
6
Credits/Payments:
a
2012 estimated tax payments and 2011 overpayment credited to 2012
6a
2,991
b
Exempt foreign organizationstax withheld at source
.......
6b
c
Tax paid with application for extension of time to file (Form 8868)
6c
d
Backup withholding erroneously withheld
...........
6d
7
Total credits and payments. Add lines 6a through 6d
..............
7
2,991
8
Enter any
penalty
for underpayment of estimated tax.
Check here
if Form 2220 is attached.
8
7
9
Tax due.
If the total of lines 5 and 8 is more than line 7, enter
amount owed
.......
9
7,405
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 2013 estimated tax
0
Refunded
11
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 2012 or the taxable year beginning in 2012 (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
N/A
14
The books are in care of
GHP ADVISORS PC
Telephone no.
(802) 863-5099
Located at
131 MAIN STREET 8TH FLOOR
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 2012, did the foundation have an interest in or a signature or other authority over
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
(2012)
Form 990-PF (2012)
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 2012?
.............
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 2012, did the foundation have any undistributed income (lines 6d
and 6e, Part XIII) for tax year(s) beginning before 2012?
...............
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
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 2012 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 2012.)
....................
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 2012?
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
No
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
(2012)
Form 990-PF (2012)
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
BENNETT R COHEN CO GHP ADVISORS PC
TRUSTEE
2.50
0
0
0
PO BOX 5550
BURLINGTON
,
VT
05402
CHARLES LACY
ADMIN TRUSTEE
2.50
0
0
0
324 BROWNS TRACE ROAD
JERICHO
,
VT
05465
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
CAMPAIGN TO EDUCATE AND PUBLICIZE ISSUES PERTAINING TOFINANCIAL INFLUENCES OVER THE AMERICAN POLITICAL SYSTEM
21,958
2
3
4
Form
990-PF
(2012)
Form 990-PF (2012)
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
3,808,722
b
Average of monthly cash balances
.......................
1b
653,589
c
Fair market value of all other assets (see instructions)
................
1c
0
d
Total
(add lines 1a, b, and c)
.........................
1d
4,462,311
e
Reduction claimed for blockage or other factors reported on lines 1a and
1c (attach detailed explanation)
.............
1e
2
Acquisition indebtedness applicable to line 1 assets
..................
2
3
Subtract line 2 from line 1d
.........................
3
4,462,311
4
Cash deemed held for charitable activities. Enter 1 12% of line 3 (for greater amount, see
instructions)
.............................
4
66,935
5
Net value of noncharitable-use assets.
Subtract line 4 from line 3. Enter here and on Part V, line 4
5
4,395,376
6
Minimum investment return.
Enter 5% of line 5
..................
6
219,769
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
219,769
2a
Tax on investment income for 2012 from Part VI, line 5
......
2a
10,389
b
Income tax for 2012. (This does not include the tax from Part VI.)
...
2b
c
Add lines 2a and 2b
............................
2c
10,389
3
Distributable amount before adjustments. Subtract line 2c from line 1
............
3
209,380
4
Recoveries of amounts treated as qualifying distributions
................
4
5
Add lines 3 and 4
............................
5
209,380
6
Deduction from distributable amount (see instructions)
.................
6
7
Distributable amount
as adjusted. Subtract line 6 from line 5. Enter here and on Part XIII,
line 1
................................
7
209,380
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
371,760
b
Program-related investmentstotal from Part IX-B
..................
1b
2
Amounts paid to acquire assets used (or held for use) directly in carrying out charitable, etc.,
purposes
...............................
2
3
Amounts set aside for specific charitable projects that satisfy the:
a
Suitability test (prior IRS approval required)
....................
3a
b
Cash distribution test (attach the required schedule)
.................
3b
4
Qualifying distributions.
Add lines 1a through 3b. Enter here and on Part V, line 8, and Part XIII, line 4
4
371,760
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
10,389
6
Adjusted qualifying distributions.
Subtract line 5 from line 4
..............
6
361,371
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
(2012)
Form 990-PF (2012)
Page
8
Part XIII
Undistributed Income
(see instructions)
(a)
Corpus
(b)
Years prior to 2011
(c)
2011
(d)
2012
1
Distributable amount for 2012 from Part XI, line 7
209,380
2
Undistributed income, if any, as of the end of 2012:
a
Enter amount for 2011 only
.......
b
Total for prior years:
20
,
20
,
20
3
Excess distributions carryover, if any, to 2012:
a
From 2007
.......
b
From 2008
.......
45,924
c
From 2009
.......
96,000
d
From 2010
.......
190,500
e
From 2011
.......
202,021
f
Total
of lines 3a through e
.........
534,445
4
Qualifying distributions for 2012 from Part
XII, line 4:
$
371,760
a
Applied to 2011, but not more than line 2a
b
Applied to undistributed income of prior years
(Election requiredsee instructions)
......
c
Treated as distributions out of corpus (Election
requiredsee instructions)
.........
d
Applied to 2012 distributable amount
.....
209,380
e
Remaining amount distributed out of corpus
162,380
5
Excess distributions carryover applied to 2012.
(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
696,825
b
Prior years undistributed income. Subtract
line 4b from line 2b
...........
c
Enter the amount of prior years undistributed
income for which a notice of deficiency has
been issued, or on which the section 4942(a)
tax has been previously assessed
......
d
Subtract line 6c from line 6b. Taxable amount
see instructions
...........
e
Undistributed income for 2011. Subtract line
4a from line 2a. Taxable amountsee
instructions
.............
f
Undistributed income for 2012. Subtract
lines 4d and 5 from line 1. This amount must
be distributed in 2013
..........
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)
.............
8
Excess distributions carryover from 2007 not
applied on line 5 or line 7 (see instructions)
...
9
Excess distributions carryover to 2013.
Subtract lines 7 and 8 from line 6a
......
696,825
10
Analysis of line 9:
a
Excess from 2008
....
45,924
b
Excess from 2009
....
96,000
c
Excess from 2010
....
190,500
d
Excess from 2011
....
202,021
e
Excess from 2012
....
162,380
Form
990-PF
(2012)
Form 990-PF (2012)
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 2012, 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)
2012
(b)
2011
(c)
2010
(d)
2009
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 23
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).)
BEN COHEN
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 or e-mail of the person to whom applications should be addressed:
BEN COHEN
C/O GHP ADVISORS PC PO BOX 5550
BURLINGTON
,
VT
05402
(802) 863-5099
b
The form in which applications should be submitted and information and materials they should include:
SEE ATTACHED
c
Any submission deadlines:
SEE ATTACHED
d
Any restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other
factors:
SEE ATTACHED
Form
990-PF
(2012)
Form 990-PF (2012)
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
CENTER FOR INTERNATIONAL POLICY
2000 M STREET NW SUITE 720
WASHINGTON
,
DC
20036
PUBLIC
UNRESTRICTED
10,000
CENTER FOR RESPONSIVE POLITICS
1101 14TH ST NW SUITE 1030
WASHINGTON
,
DC
20005
PUBLIC
UNRESTRICTED
1,000
COMMUNITY SOLUTIONS INC
4 GRIFFIN ROAD NORTH SUITE 100B
WINDSOR
,
CT
06095
PUBLIC
UNRESTRICTED
5,000
GROUNDS FOR HEALTH
92 SOUTH MAIN STREET 2
WATERBURY
,
VT
05676
PUBLIC
UNRESTRICTED
1,000
HEIFER INTERNATIONAL
1 WORLD AVENUE
LITTLE ROCK
,
AR
72202
PUBLIC
UNRESTRICTED
1,000
INTERNATIONAL FORUM GLOBALIZATION
1009 GENERAL KENNEDY AVENUE 2
SAN FRANCISCO
,
CA
94129
PUBLIC
UNRESTRICTED
176,752
KIDS FOR PEACE
3303 JAMES DRIVE
CARLSBAD
,
CA
92008
PUBLIC
UNRESTRICTED
100
MUSIC IN SCHOOLS TODAY
582 MARKET STREET SUITE 213
SAN FRANCISCO
,
CA
94104
PUBLIC
UNRESTRICTED
1,000
NATIONAL WILDLIFE FEDERATION NORTHEAST REGIONAL CENTER
PO BOX 1583
MERRIFIELD
,
VA
22116
PUBLIC
UNRESTRICTED
100
NATIONAL PRIORITIES PROJECT
243 KING STREET SUITE 109
NORTHAMPTON
,
MA
01060
PUBLIC
UNRESTRICTED
3,500
NE COALITION AGAINST NUCLEAR POLLUTION
139 MAIN STREET SUITE 701
BRATTLEBORO
,
VT
05301
PUBLIC
UNRESTRICTED
500
PEACE & JUSTICE CENTER
60 LAKE STREET 1C
BURLINGTON
,
VT
05401
PUBLIC
UNRESTRICTED
5,000
PERI SUPPORT FUND
418 N PLEASANT STREET
AMHERST
,
MA
01002
PUBLIC
UNRESTRICTED
15,000
PROJECT ON GOVERNMENT OVERSIGHT
1100 G STREET NW SUITE 500
WASHINGTON
,
DC
20005
PUBLIC
UNRESTRICTED
5,000
RESOURCE
266 PINE STREET
BURLINGTON
,
VT
05401
PUBLIC
UNRESTRICTED
2,000
SOCIAL VENTURES INC
124 WESTFIELD DRIVE
ITHACA
,
NY
14850
PUBLIC
UNRESTRICTED
50,000
THE JEWISH MUSEUM
1109 5TH AVE AT 92ND ST
NEW YORK
,
NY
10128
PUBLIC
UNRESTRICTED
5,000
THE RECTORY SCHOOL
528 POMFRET ST
POMFRET
,
CT
06258
PUBLIC
UNRESTRICTED
50,000
UNITED FOR A FAIR ECONOMY
1 MILK STREET 5TH FLOOR
BOSTON
,
MA
02109
PUBLIC
UNRESTRICTED
750
VERMONT FOOD BANK
33 PARKER ROAD WILSON INDUSTRIAL PA
BARRE
,
VT
05641
PUBLIC
UNRESTRICTED
100
VNRC
9 BAILEY AVENUE
MONTPELIER
,
VT
05602
PUBLIC
UNRESTRICTED
5,000
VT DISASTER RELIEF FUND
PO BOX 843
MONTPELIER
,
VT
05601
PUBLIC
UNRESTRICTED
11,000
WOMEN'S ACTION FOR NEW DIRECTIONS
691 MASSACHUSETTS AVENUE
ARLINGTON
,
MA
02476
PUBLIC
UNRESTRICTED
1,000
Total
.................................
3a
349,802
b
Approved for future payment
Total
.................................
3b
Form
990-PF
(2012)
Form 990-PF (2012)
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
14
5,593
4
Dividends and interest from securities
....
14
46,645
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
92,755
9
Net income or (loss) from special events:
10
Gross profit or (loss) from sales of inventory
..
11
Other revenue:
a
Investment in LLC
14
-155
b
Securities litigation
14
636
c
d
e
12
Subtotal. Add columns (b), (d), and (e)
..
145,474
13
Total.
Add line 12, columns (b), (d), and (e)
..................
13
145,474
(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
(2012)
Form 990-PF (2012)
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
Yes
No
501(c) of the Code (other than section 501(c)(3) organizations) or in section 527, relating to political organizations?
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.
2014-02-26
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
GEORGE H PHILIBERT CPA
Preparer's Signature
GEORGE H PHILIBERT CPA
Date
Check if self-
employed
PTIN
Firm's name
Firm's address
GHP ADVISORS PC
131 MAIN STREET 8TH FLOOR
BURLINGTON
,
VT
05401
Firm's EIN
Phone no.
(802) 863-5099
Form
990-PF
(2012)
Additional Data
Software ID:
Software Version:
Part VI Line 7 - Tax Paid Original Return:
2991
Form 990PF - Special Condition Description:
Special Condition Description