efile Public Visual Render
Submission Date - 2017-11-10
TIN: 03-0317962
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.
Information about Form 990-PF and its instructions is at
www.irs.gov/form990pf
.
OMB No. 1545-0052
20
16
Open to Public Inspection
For calendar year 2016, or tax year beginning
07-01-2016
, and ending
06-30-2017
Name of foundation
The Robert Fleming & Jane Howe Patrick
Foundation Inc
Number and street (or P.O. box number if mail is not delivered to street address)
PO Box 234
Room/suite
City or town, state or province, country, and ZIP or foreign postal code
Charlotte
,
VT
05445
A Employer identification number
03-0317962
B
Telephone number (see instructions)
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
F
If the foundation is in a 60-month termination
under section 507(b)(1)(B), check here .......
I
Fair market value of all assets at end
of year
(from Part II, col. (c),
line 16)
$
1,748,887
J
Accounting method:
Cash
Accrual
Other (specify)
(Part I, column (d) must be on cash basis.)
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
Sch. B
.............
3
Interest on savings and temporary cash investments
8
8
4
Dividends and interest from securities
...
27,466
27,466
5a
Gross rents
............
b
Net rental income or (loss)
6a
Net gain or (loss) from sale of assets not on line 10
122,997
b
Gross sales price for all assets on line 6a
448,858
7
Capital gain net income (from Part IV, line 2)
...
122,997
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)
.......
12
Total.
Add lines 1 through 11
........
150,471
150,471
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)
.......
c
Other professional fees (attach schedule)
....
25,123
25,123
17
Interest
...............
18
Taxes (attach schedule) (see instructions)
...
3,172
3,172
19
Depreciation (attach schedule) and depletion
...
20
Occupancy
..............
21
Travel, conferences, and meetings
.......
22
Printing and publications
..........
23
Other expenses (attach schedule)
.......
173
173
24
Total operating and administrative expenses.
Add lines 13 through 23
..........
28,468
28,468
0
25
Contributions, gifts, grants paid
.......
94,500
94,500
26
Total expenses and disbursements.
Add lines 24 and 25
122,968
28,468
94,500
27
Subtract line 26 from line 12:
a
Excess of revenue over expenses and disbursements
27,503
b
Net investment income
(if negative, enter -0-)
122,003
c
Adjusted net income
(if negative, enter -0-)
...
For Paperwork Reduction Act Notice, see instructions.
Cat. No. 11289X
Form
990-PF
(2016)
Form 990-PF (2016)
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
.............
16,844
11,659
11,659
2
Savings and temporary cash investments
.........
80,777
86,657
86,657
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 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)
b
Investmentscorporate stock (attach schedule)
.......
1,104,539
1,125,012
1,637,997
c
Investmentscorporate bonds (attach schedule)
.......
11
Investmentsland, buildings, and equipment: basis
Less: accumulated depreciation (attach schedule)
12
Investmentsmortgage loans
.............
13
Investmentsother (attach schedule)
..........
14
Land, buildings, and equipment: basis
Less: accumulated depreciation (attach schedule)
15
Other assets (describe
)
8,539
12,574
12,574
16
Total assets
(to be completed by all filerssee the
instructions. Also, see page 1, item I)
1,210,699
1,235,902
1,748,887
17
Accounts payable and accrued expenses
..........
18
Grants payable
..................
19
Deferred revenue
.................
20
Loans from officers, directors, trustees, and other disqualified persons
4,365
2,065
21
Mortgages and other notes payable (attach schedule)
......
22
Other liabilities (describe
)
23
Total liabilities
(add lines 17 through 22)
.........
4,365
2,065
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
........
28
Paid-in or capital surplus, or land, bldg., and equipment fund
29
Retained earnings, accumulated income, endowment, or other funds
1,206,334
1,233,837
30
Total net assets or fund balances
(see instructions)
.....
1,206,334
1,233,837
31
Total liabilities and net assets/fund balances
(see instructions)
.
1,210,699
1,235,902
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
1,206,334
2
Enter amount from Part I, line 27a
.....................
2
27,503
3
Other increases not included in line 2 (itemize)
3
4
Add lines 1, 2, and 3
..........................
4
1,233,837
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
1,233,837
Form
990-PF
(2016)
Form 990-PF (2016)
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
51 HELMERICH & PAYNE
P
2016-02-18
2017-01-04
b
51 HELMERICH & PAYNE
P
2016-02-18
2017-01-04
c
23 ZOETIS INC CLASS-A
P
2013-08-26
2017-01-05
d
82 KOHLS CORPORATION WISC
P
2015-11-12
2017-01-11
e
77 MACY'S INC
P
2016-01-05
2017-01-11
82 MICHAEL KORS HOLDINGS LTD
P
2016-07-11
2017-01-11
90 MICHAEL KORS HOLDINGS LTD
P
2015-05-28
2017-01-11
80 MICHAEL KORS HOLDINGS LTD
P
2015-07-08
2017-01-11
1 DILLARDS INC CL A
P
2015-08-26
2017-01-12
47 DILLARDS INC CL A
P
2015-10-02
2017-01-12
23 CATERPILLAR INC
P
2013-12-05
2017-01-19
17 CATERPILLAR INC
P
2015-09-24
2017-01-19
12 HOME DEPOT INC
P
2009-07-02
2017-01-23
4 AETNA INC (NEW)(CT)
P
2015-11-23
2017-01-24
14 AETNA INC (NEW)(CT)
P
2015-12-04
2017-01-24
4 AETNA INC (NEW)(CT)
P
2015-12-04
2017-01-25
7 AETNA INC (NEW)(CT)
P
2015-12-11
2017-01-25
19 AETNA INC (NEW)(CT)
P
2015-12-11
2017-01-26
7 AETNA INC (NEW)(CT)
P
2015-12-11
2017-01-27
14 AETNA INC (NEW)(CT)
P
2015-12-11
2017-01-30
6 AETNA INC (NEW)(CT)
P
2016-02-12
2017-01-31
13 AETNA INC (NEW)(CT)
P
2015-12-11
2017-01-31
0.685 LOGMEIN INC COM
P
2013-12-04
2017-01-31
0.5 BIOVERATIV INC
P
2016-12-08
2017-02-01
1 BIOVERATIV INC
P
2009-07-16
2017-02-06
1 BIOVERATIV INC
P
2009-07-16
2017-02-06
1 BIOVERATIV INC
P
2009-10-21
2017-02-06
9 BIOVERATIV INC
P
2009-10-21
2017-02-06
3 BIOVERATIV INC
P
2009-10-21
2017-02-06
7 BIOVERATIV INC
P
2009-10-21
2017-02-06
20 CATERPILLAR INC
P
2016-07-11
2017-02-09
30 CATERPILLAR INC
P
2015-09-24
2017-02-09
68 SCRIPPS NETWORKS INTERAC CL A
P
2016-06-17
2017-02-09
148 TEREX CP NEW DEL
P
2015-03-10
2017-02-22
61 BE AEROSPACE INC
P
2016-03-03
2017-02-24
61 BE AEROSPACE INC
P
2016-02-23
2017-02-24
21 SIGNET JEWELERS LIMITED
P
2016-07-21
2017-02-28
99 SIGNET JEWELERS LIMITED
P
2016-09-29
2017-02-28
52 GENERAL ELECTRIC CO
P
2012-02-09
2017-03-08
9 ADOBE SYSTEMS
P
2015-08-26
2017-03-09
16 GENERAL ELECTRIC CO
P
2012-02-09
2017-03-09
37 GENERAL ELECTRIC CO
P
2012-02-09
2017-03-09
25 GENERAL ELECTRIC CO
P
2012-02-09
2017-03-10
17 GENERAL ELECTRIC CO
P
2014-02-05
2017-03-10
11 GENERAL ELECTRIC CO
P
2014-02-05
2017-03-10
12 GENERAL ELECTRIC CO
P
2014-02-05
2017-03-13
7 GENERAL ELECTRIC CO
P
2014-03-07
2017-03-13
31 GENERAL ELECTRIC CO
P
2014-03-07
2017-03-13
4 GENERAL ELECTRIC CO
P
2014-03-17
2017-03-13
2 GENERAL ELECTRIC CO
P
2014-10-09
2017-03-13
69 METLIFE INCORPORATED
P
2011-03-15
2017-03-14
51 METLIFE INCORPORATED
P
2012-08-24
2017-03-14
152 METLIFE INCORPORATED
P
2013-01-04
2017-03-14
51 GENERAL ELECTRIC CO
P
2014-10-09
2017-03-15
19 GENERAL ELECTRIC CO
P
2014-10-09
2017-03-16
36 GENERAL ELECTRIC CO
P
2015-03-09
2017-03-16
67 CHINA MOBILE LTD
P
2016-06-20
2017-03-24
57 CHINA MOBILE LTD
P
2014-03-18
2017-03-24
40 CHINA MOBILE LTD
P
2014-10-27
2017-03-24
102 TEREX CP NEW DEL
P
2015-03-10
2017-03-24
15 WALT DISNEY CO HLDG CO
P
2009-07-02
2017-03-24
58 METLIFE INCORPORATED
P
2013-01-04
2017-03-28
75 METLIFE INCORPORATED
P
2014-08-25
2017-03-28
105 METLIFE INCORPORATED
P
2015-02-12
2017-03-28
19 SCRIPPS NETWORKS INTERAC CL A
P
2016-06-17
2017-03-28
23 SCRIPPS NETWORKS INTERAC CL A
P
2016-06-21
2017-03-28
182 SANTANDER CONSUMER USA HDG INC
P
2014-07-10
2017-04-03
28 COCA COLA CO
P
2006-02-13
2017-04-07
21 COCA COLA CO
P
2009-07-02
2017-04-07
18 FORTINET INC
P
2016-04-01
2017-04-10
18 FORTINET INC
P
2016-04-05
2017-04-10
8 FORTINET INC
P
2016-04-07
2017-04-10
54 CBS CORP NEW CL B SHRS
P
2016-09-29
2017-04-20
47 CBS CORP NEW CL B SHRS
P
2016-11-08
2017-04-20
8 FLUOR CORP NEW
P
2008-11-19
2017-04-20
30 FLUOR CORP NEW
P
2008-11-20
2017-04-20
35 FLUOR CORP NEW
P
2009-07-02
2017-04-20
3 FLUOR CORP NEW
P
2009-07-06
2017-04-20
17 FLUOR CORP NEW
P
2009-10-28
2017-04-20
5 FLUOR CORP NEW
P
2011-10-04
2017-04-20
148 AKORN INC
P
2017-01-19
2017-04-25
24 COCA COLA CO
P
2009-07-02
2017-04-25
69 ABBVIE INC COM
P
2014-09-05
2017-04-27
55 PAYPAL HLDGS INC COM
P
2007-03-14
2017-04-28
5 PAYPAL HLDGS INC COM
P
2008-08-06
2017-04-28
51 CVS HEALTH CORP COM
P
2009-07-02
2017-05-02
24 CVS HEALTH CORP COM
P
2009-11-19
2017-05-02
22 ZOETIS INC CLASS-A
P
2013-08-26
2017-05-05
14 ZOETIS INC CLASS-A
P
2013-08-27
2017-05-05
23 ZOETIS INC CLASS-A
P
2013-08-27
2017-05-08
4 AMAZON COM INC
P
2008-09-29
2017-05-11
9 YUM CHINA HLDNGS
P
2012-12-21
2017-05-11
22 YUM CHINA HLDNGS
P
2013-02-07
2017-05-11
11 YUM CHINA HLDNGS
P
2013-03-13
2017-05-11
19 YUM CHINA HLDNGS
P
2013-06-21
2017-05-11
11 YUM CHINA HLDNGS
P
2013-10-09
2017-05-11
36 APPLE INC
P
2013-06-20
2017-05-12
25 IPG PHOTONICS CORP
P
2016-10-13
2017-05-16
30 MICRON TECH INC
P
2014-09-16
2017-05-16
85 MICRON TECH INC
P
2014-10-28
2017-05-16
30 MICRON TECH INC
P
2015-01-20
2017-05-16
180 MICRON TECH INC
P
2015-04-02
2017-05-16
69 MICRON TECH INC
P
2015-07-08
2017-05-16
11 FORTINET INC
P
2016-04-07
2017-05-22
13 FORTINET INC
P
2016-05-04
2017-05-22
2 APACHE CORP
P
2012-07-11
2017-05-30
4 APACHE CORP
P
2012-07-17
2017-05-30
65 APACHE CORP
P
2012-07-17
2017-05-30
2 APACHE CORP
P
2013-05-07
2017-05-30
1 APACHE CORP
P
2012-07-11
2017-05-30
7 APACHE CORP
P
2013-05-07
2017-05-30
65 APACHE CORP
P
2016-01-20
2017-05-30
60 APACHE CORP
P
2016-02-12
2017-05-30
2 FORTINET INC
P
2016-05-04
2017-05-30
11 FORTINET INC
P
2016-05-06
2017-05-30
6 FORTINET INC
P
2016-05-06
2017-06-01
11 FORTINET INC
P
2016-05-13
2017-06-01
6 FORTINET INC
P
2016-05-13
2017-06-02
9 FORTINET INC
P
2016-05-19
2017-06-02
2 FORTINET INC
P
2016-10-12
2017-06-06
7 FORTINET INC
P
2016-05-19
2017-06-06
16 FORTINET INC
P
2016-05-31
2017-06-06
17 FORTINET INC
P
2016-10-12
2017-06-07
25 FORTINET INC
P
2016-10-12
2017-06-08
93 MICRON TECH INC
P
2015-07-08
2017-06-09
54 MICRON TECH INC
P
2016-07-11
2017-06-16
108 MICRON TECH INC
P
2015-07-08
2017-06-16
20 PAYPAL HLDGS INC COM
P
2008-08-06
2017-06-16
3 PAYPAL HLDGS INC COM
P
2009-07-02
2017-06-16
1 REGENERON PHARM
P
2014-07-18
2017-06-16
2 ALPHABET INC CL A
P
2008-09-23
2017-06-22
5 ALPHABET INC CL A
P
2008-10-23
2017-06-22
74 AUTODESK INC DELAWARE
P
2009-07-02
2017-06-22
54 COMCAST CORP (NEW) CLASS A
P
2009-10-05
2017-06-22
74 COMCAST CORP (NEW) CLASS A
P
2009-10-05
2017-06-22
38 COMCAST CORP (NEW) CLASS A
P
2009-10-05
2017-06-22
17 FACEBOOK INC CL-A
P
2013-04-10
2017-06-22
23 FACEBOOK INC CL-A
P
2013-04-23
2017-06-22
3 JPMORGAN CHASE & CO
P
2009-07-02
2017-06-22
74 TE CONNECTIVITY LTD NEW
P
2006-02-13
2017-06-22
5 UNITEDHEALTH GP INC
P
2012-05-09
2017-06-28
1 UNITEDHEALTH GP INC
P
2012-05-09
2017-06-28
4 UNITEDHEALTH GP INC
P
2012-07-10
2017-06-28
4 THERMO FISHER SCIENTIFIC
P
2009-05-14
2017-06-29
20 THERMO FISHER SCIENTIFIC
P
2009-07-02
2017-06-29
24 JOHNSON & JOHNSON
P
2010-12-14
2017-06-28
5 THERMO FISHER SCIENTIFIC
P
2011-05-12
2017-06-29
11 UNITEDHEALTH GP INC
P
2012-07-10
2017-06-28
12 IPG PHOTOONICS CORP
P
2016-10-13
2017-06-29
0.5 ADIENT PLC COM
P
2016-10-28
2016-10-28
20 ADIENT PLC COM
P
2016-10-28
2016-11-01
13 AKAMAI TECHNOLOGIES INC
P
2011-03-17
2016-11-08
7 AKAMAI TECHNOLOGIES INC
P
2011-05-12
2016-11-08
8 AKAMAI TECHNOLOGIES INC
P
2011-05-12
2016-11-09
15 AMERICAN AIRLS GROUP INC
P
2014-10-03
2016-09-15
32 APPLIED MATERIALS INC
P
2013-08-15
2016-07-28
110 APPLIED MATERIALS INC
P
2013-08-19
2016-07-28
63 APPLIED MATERIALS INC
P
2013-08-19
2016-08-31
7 APPLIED MATERIALS INC
P
2014-08-25
2016-08-31
440 BANK OF AMERICA CORP
P
2012-08-10
2016-12-09
80 BANK OF AMERICA CORP
P
2012-08-10
2016-12-12
190 BANK OF AMERICA CORP
P
2014-05-14
2016-12-12
39 BANK OF AMERICA CORP
P
2014-06-16
2016-12-12
4 BLACKROCK INC
P
2009-03-30
2016-08-09
7 BLACKROCK INC
P
2009-07-02
2016-08-09
23 BRISTOL MYERS SQUIBB CO
P
2013-09-18
2016-12-02
8 BRISTOL MYERS SQUIBB CO
P
2013-09-18
2016-12-05
18 BRISTOL MYERS SQUIBB CO
P
2014-01-13
2016-12-05
8 BRISTOL MYERS SQUIBB CO
P
2014-01-28
2016-12-05
26 BRISTOL MYERS SQUIBB CO
P
2014-01-28
2016-12-09
24 BRISTOL MYERS SQUIBB CO
P
2014-03-24
2016-12-09
4 BRISTOL MYERS SQUIBB CO
P
2014-04-16
2016-12-09
12 BRISTOL MYERS SQUIBB CO
P
2014-04-16
2016-12-12
46 BRISTOL MYERS SQUIBB CO
P
2014-07-02
2016-12-12
11 BROADCOM LTD SHS
P
2013-07-23
2016-12-12
39 BROADCOM LTD SHS
P
2013-07-23
2016-12-12
2 BROADCOM LTD SHS
P
2013-08-12
2016-12-12
198 CALPINE CORP NEW
P
2016-03-29
2016-12-13
182 CALPINE CORP NEW
P
2016-04-04
2016-12-13
36 CATERPILLAR INC
P
2013-12-05
2016-08-31
25 CHARLES SCHWAB NEW
P
2011-11-03
2016-11-14
38 CHARLES SCHWAB NEW
P
2011-11-03
2016-11-14
8 CHINA MOBILE LTD
P
2013-11-04
2016-11-10
72 CHINA MOBILE LTD
P
2014-01-13
2016-11-10
60 CHINA MOBILE LTD
P
2014-02-07
2016-11-10
1 CHINA MOBILE LTD
P
2014-03-18
2016-11-10
147 CITIGROUP INC NEW
P
2013-01-10
2016-12-12
14 COMCAST CORP (NEW) CLASS A
P
2009-10-05
2016-11-16
10 COMCAST CORP (NEW) CLASS A
P
2009-10-05
2016-11-16
0.4 COMMERCEHUB INC-SERIES A
P
2007-09-06
2016-07-22
3 COMMERCEHUB INC-SERIES A
P
2007-09-06
2016-08-04
0.8 COMMERCEHUB INC-SERIES C
P
2007-09-06
2016-07-22
1 COMMERCEHUB INC-SERIES C
P
2006-02-13
2016-08-04
5 COMMERCEHUB INC-SERIES C
P
2007-09-06
2016-08-04
75 DEVON ENERGY CORP NEW
P
2015-04-29
2016-08-26
108 DEVON ENERGY CORP NEW
P
2016-01-20
2016-10-10
21 DEVON ENERGY CORP NEW
P
2015-04-29
2016-10-10
45 EATON CORP PLC SHS
P
2012-12-03
2016-09-13
22 EATON CORP PLC SHS
P
2012-12-03
2016-09-14
22 EATON CORP PLC SHS
P
2012-12-03
2016-09-15
26 EATON CORP PLC SHS
P
2012-12-03
2016-09-16
5 EATON CORP PLC SHS
P
2012-12-03
2016-09-20
2 EATON CORP PLC SHS
P
2012-12-03
2016-09-20
4 EATON CORP PLC SHS
P
2014-03-27
2016-09-20
4 EATON CORP PLC SHS
P
2014-10-01
2016-09-20
8 EATON CORP PLC SHS
P
2012-12-03
2016-09-20
1 EATON CORP PLC SHS
P
2012-12-03
2016-09-20
14 EATON CORP PLC SHS
P
2014-10-01
2016-09-22
1 EATON CORP PLC SHS
P
2012-12-03
2016-09-22
8 EATON CORP PLC SHS
P
2012-12-03
2016-09-22
95 HORIZON PHARMA PLC SHS
P
2016-08-08
2016-12-13
320 HORIZON PHARMA PLC SHS
P
2015-11-06
2016-12-13
20 JOHNSON & JOHNSON
P
2009-07-02
2016-11-16
5 JOHNSON & JOHNSON
P
2010-12-14
2016-11-16
0.325 JOHNSON CTLS INTL PLC
P
2009-07-02
2016-09-06
20 L-3 COMMUNICATIONS HOLDING INC
P
2006-02-13
2016-12-12
22 L-3 COMMUNICATIONS HOLDING INC
P
2007-01-11
2016-12-12
87 LAM RESEARCH CORPORATION
P
2014-09-16
2016-08-11
0.6 LIBERTY EXPEDIA HOLD SER A
P
2007-09-06
2016-11-07
1.147 LIBERTY EXPEDIA HOLD SER A
P
2006-02-13
2016-11-14
11.853 LIBERTY EXPEDIA HOLD SER A
P
2007-09-06
2016-11-14
0.4 LIBERTY INTERACTIVE CORP
P
2007-09-06
2016-11-07
0.241 LIONS GATE ENTMNT CORP CL B
P
2016-12-12
2016-12-12
85 LOUISIANA PACIFIC CORP
P
2014-06-18
2016-08-16
145 LOUISIANA PACIFIC CORP
P
2014-10-06
2016-08-16
36 MICHAEL KORS HOLDINGS LTD
P
2015-04-01
2016-09-29
42 MICHAEL KORS HOLDINGS LTD
P
2015-05-28
2016-09-29
260 MICRON TECH INC
P
2014-09-16
2016-08-31
18 MORGAN STANLEY
P
2016-02-12
2016-12-12
50 MORGAN STANLEY
P
2013-11-15
2016-12-12
100 MORGAN STANLEY
P
2014-01-03
2016-12-12
100 MORGAN STANLEY
P
2014-06-18
2016-12-12
178 PFIZER INC
P
2011-11-17
2016-07-21
7 PRAIRIESKY RTY LTD
P
2016-06-06
2016-10-18
18 RELIANCE STEEL & ALUM CO
P
2013-10-23
2016-07-11
49 STARZ SERIES A
P
2008-06-23
2016-12-12
44 TUPPERWARE BRANDS CORP
P
2016-07-11
2016-11-23
53 TUPPERWARE BRANDS CORP
P
2015-07-30
2016-11-23
4 UNITED PARCEL SER INC CL-B
P
2011-03-24
2016-12-16
78 VIACOM INC NEW CLASS B
P
2016-09-29
2016-11-08
10 VMWARE INC CLASS A
P
2015-01-30
2016-09-01
18 WESTERN DIGITAL CORPORATION
P
2016-05-04
2016-12-12
22 WESTERN DIGITAL CORPORATION
P
2015-11-03
2016-12-12
23 WESTERN DIGITAL CORPORATION
P
2015-11-04
2016-12-12
26 WESTERN DIGITAL CORPORATION
P
2015-12-03
2016-12-12
43 YUM BRANDS INC
P
2012-12-21
2016-08-10
9 YUM BRANDS INC
P
2012-12-21
2016-11-08
4 YUM BRANDS INC
P
2013-02-07
2016-11-08
18 YUM BRANDS INC
P
2013-02-07
2016-11-09
11 YUM BRANDS INC
P
2013-03-13
2016-11-09
19 YUM BRANDS INC
P
2013-06-21
2016-11-10
8 YUM BRANDS INC
P
2013-10-09
2016-11-10
4 YUM BRANDS INC
P
2013-10-09
2016-11-11
6 YUM BRANDS INC
P
2014-02-25
2016-11-11
20 YUM BRANDS INC
P
2014-02-27
2016-11-11
(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
4,013
2,622
1,391
b
4,013
2,620
1,393
c
1,238
687
551
d
3,349
3,785
-436
e
2,304
2,849
-545
3,514
4,225
-711
3,857
4,177
-320
3,429
3,345
84
56
92
-36
2,651
4,134
-1,483
2,154
1,943
211
1,592
1,118
474
1,649
275
1,374
470
425
45
1,647
1,439
208
476
411
65
833
728
105
2,247
1,976
271
824
728
96
1,631
1,456
175
707
591
116
1,531
1,352
179
69
47
22
22
22
43
11
32
43
7
36
43
11
32
386
68
318
129
23
106
301
42
259
1,859
1,557
302
2,789
1,973
816
5,142
4,369
773
4,667
3,773
894
3,834
2,751
1,083
3,834
2,616
1,218
1,386
1,863
-477
6,535
7,426
-891
1,552
997
555
1,078
685
393
475
307
168
1,099
709
390
751
479
272
511
415
96
331
269
62
359
293
66
209
182
27
928
808
120
120
102
18
60
50
10
3,701
2,937
764
2,736
1,776
960
8,154
5,441
2,713
1,513
1,273
240
564
474
90
1,069
920
149
3,750
3,729
21
3,191
2,588
603
2,239
2,300
-61
3,059
2,600
459
1,683
344
1,339
3,034
2,076
958
3,923
4,072
-149
5,493
5,270
223
1,489
1,221
268
1,802
1,452
350
2,363
3,527
-1,164
1,194
569
625
895
515
380
669
554
115
669
555
114
298
243
55
3,682
2,950
732
3,205
2,716
489
404
266
138
1,517
914
603
1,770
1,698
72
152
141
11
859
799
60
253
231
22
4,870
3,087
1,783
1,036
589
447
4,608
3,812
796
2,606
1,023
1,583
237
77
160
4,079
1,598
2,481
1,920
743
1,177
1,300
658
642
827
412
415
1,350
677
673
3,782
261
3,521
309
173
136
755
423
332
378
230
148
652
399
253
378
217
161
5,620
2,162
3,458
3,569
2,044
1,525
863
919
-56
2,445
2,761
-316
863
890
-27
5,177
4,913
264
1,984
1,212
772
443
334
109
524
417
107
96
169
-73
192
335
-143
3,113
5,448
-2,335
96
154
-58
48
80
-32
335
538
-203
3,113
2,259
854
2,874
2,191
683
78
64
14
431
349
82
235
190
45
431
357
74
234
195
39
352
299
53
78
61
17
273
233
40
625
546
79
662
515
147
980
757
223
2,853
1,634
1,219
1,649
686
963
3,299
1,897
1,402
1,038
307
731
156
30
126
460
300
160
1,957
437
1,520
4,892
875
4,017
7,885
1,349
6,536
2,169
399
1,770
2,973
539
2,434
1,526
281
1,245
2,618
469
2,149
3,541
604
2,937
261
99
162
5,843
2,177
3,666
928
278
650
186
56
130
742
222
520
696
143
553
3,482
794
2,688
3,214
1,504
1,710
871
309
562
2,042
611
1,431
1,725
981
744
22
23
-1
900
932
-32
862
476
386
464
240
224
531
274
257
540
540
858
495
363
2,951
1,694
1,257
1,880
970
910
209
155
54
10,179
3,392
6,787
1,818
617
1,201
4,317
2,828
1,489
886
596
290
1,478
504
974
2,587
1,189
1,398
1,284
1,062
222
445
369
76
1,000
1,018
-18
445
407
38
1,478
1,323
155
1,364
1,226
138
227
196
31
679
587
92
2,604
2,217
387
1,950
810
1,140
6,913
2,769
4,144
355
125
230
2,283
2,811
-528
2,099
2,709
-610
2,951
3,041
-90
923
319
604
1,402
486
916
443
417
26
3,988
3,636
352
3,323
2,834
489
55
45
10
8,775
6,267
2,508
939
207
732
671
146
525
6
2
4
41
15
26
11
5
6
14
3
11
68
29
39
3,349
5,093
-1,744
4,782
2,332
2,450
930
1,426
-496
2,851
2,031
820
1,388
993
395
1,388
993
395
1,620
1,174
446
315
226
89
126
90
36
252
271
-19
252
234
18
504
361
143
63
45
18
898
818
80
64
45
19
513
361
152
1,401
2,030
-629
4,719
6,056
-1,337
2,325
1,125
1,200
581
313
268
15
4
11
3,150
1,569
1,581
3,465
1,732
1,733
7,753
6,268
1,485
24
10
14
46
16
30
475
189
286
16
6
10
6
6
1,624
1,246
378
2,771
1,964
807
1,690
2,324
-634
1,972
1,949
23
4,283
7,963
-3,680
774
416
358
2,151
1,522
629
4,301
3,142
1,159
4,301
3,264
1,037
6,538
3,474
3,064
156
135
21
1,459
1,350
109
882
38
844
2,582
2,556
26
3,110
3,088
22
464
288
176
2,915
2,935
-20
740
769
-29
1,184
709
475
1,447
1,505
-58
1,513
1,559
-46
1,710
1,639
71
3,819
2,742
1,077
557
401
156
248
178
70
1,112
801
311
680
532
148
1,171
924
247
493
366
127
243
183
60
365
309
56
1,217
1,031
186
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
1,391
b
1,393
c
551
d
-436
e
-545
-711
-320
84
-36
-1,483
211
474
1,374
45
208
65
105
271
96
175
116
179
22
32
36
32
318
106
259
302
816
773
894
1,083
1,218
-477
-891
555
393
168
390
272
96
62
66
27
120
18
10
764
960
2,713
240
90
149
21
603
-61
459
1,339
958
-149
223
268
350
-1,164
625
380
115
114
55
732
489
138
603
72
11
60
22
1,783
447
796
1,583
160
2,481
1,177
642
415
673
3,521
136
332
148
253
161
3,458
1,525
-56
-316
-27
264
772
109
107
-73
-143
-2,335
-58
-32
-203
854
683
14
82
45
74
39
53
17
40
79
147
223
1,219
963
1,402
731
126
160
1,520
4,017
6,536
1,770
2,434
1,245
2,149
2,937
162
3,666
650
130
520
553
2,688
1,710
562
1,431
744
-1
-32
386
224
257
363
1,257
910
54
6,787
1,201
1,489
290
974
1,398
222
76
-18
38
155
138
31
92
387
1,140
4,144
230
-528
-610
-90
604
916
26
352
489
10
2,508
732
525
4
26
6
11
39
-1,744
2,450
-496
820
395
395
446
89
36
-19
18
143
18
80
19
152
-629
-1,337
1,200
268
11
1,581
1,733
1,485
14
30
286
10
378
807
-634
23
-3,680
358
629
1,159
1,037
3,064
21
109
844
26
22
176
-20
-29
475
-58
-46
71
1,077
156
70
311
148
247
127
60
56
186
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
122,997
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 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))
2015
79,000
1,567,890
0.05039
2014
86,900
1,667,815
0.05210
2013
80,913
1,534,625
0.05273
2012
91,217
1,265,670
0.07207
2011
82,227
1,153,386
0.07129
2
Total
of line 1, column (d)
.....................
2
0.298577
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
0.059715
4
Enter the net value of noncharitable-use assets for 2016 from Part X, line 5
......
4
1,650,325
5
Multiply line 4 by line 3
......................
5
98,549
6
Enter 1% of net investment income (1% of Part I, line 27b)
...........
6
1,220
7
Add lines 5 and 6
........................
7
99,769
8
Enter qualifying distributions from Part XII, line 4
,.............
8
94,500
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
(2016)
Form 990-PF (2016)
Page
4
Part VI
Excise Tax Based on Investment Income (Section 4940(a), 4940(b), 4940(e), or 4948see 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
2,440
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
3
Add lines 1 and 2
...........................
3
2,440
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
2,440
6
Credits/Payments:
a
2016 estimated tax payments and 2015 overpayment credited to 2016
6a
1,280
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
1,280
8
Enter any
penalty
for underpayment of estimated tax.
Check here
if Form 2220 is attached.
8
1
9
Tax due.
If the total of lines 5 and 8 is more than line 7, enter
amount owed
.......
9
1,161
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 2017 estimated tax
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 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
No
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 2016 or the taxable year beginning in 2016 (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
Form
990-PF
(2016)
Form 990-PF (2016)
Page
5
Part VII-A
Statements Regarding Activities
(continued)
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
Harriet S Patrick
Telephone no.
(802) 425-2508
Located at
2952 Greenbush Road
Charlotte
VT
ZIP+4
05445
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 2016, 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 FinCEN Form 114, Report of Foreign Bank and Financial Accounts (FBAR). If "Yes", enter the name of the foreign country
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 instructions)?
........
1b
No
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 2016?
.............
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 2016, did the foundation have any undistributed income (lines 6d
and 6e, Part XIII) for tax year(s) beginning before 2016?
.............
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 2016 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 2016.)
..................
3b
No
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 2016?
4b
No
Form
990-PF
(2016)
Form 990-PF (2016)
Page
6
Part VII-B
Statements Regarding Activities for Which Form 4720 May Be Required
(Continued)
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 4945(d)(4)(A)? (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
No
Form
990-PF
(2016)
Form 990-PF (2016)
Page
7
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
Harriet S Patrick
President
0.00
0
2952 Greenbush Road
Charlotte
,
VT
05445
Richard Cunningham
Vice President
0.00
0
2952 Greenbush Road
Charlotte
,
VT
05445
C Dennis Hill
Director
0.00
0
121 Conner Way
Williston
,
VT
05495
Glen A Wright
Director
0.00
0
8291 NW 120th Street
Reddick
,
FL
32686
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
...................
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
.............
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
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 instructions.
3
Total.
Add lines 1 through 3
.........................
Form
990-PF
(2016)
Form 990-PF (2016)
Page
8
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
1,567,155
b
Average of monthly cash balances
.......................
1b
108,302
c
Fair market value of all other assets (see instructions)
................
1c
0
d
Total
(add lines 1a, b, and c)
.........................
1d
1,675,457
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
3
Subtract line 2 from line 1d
.........................
3
1,675,457
4
Cash deemed held for charitable activities. Enter 1 1/2% of line 3 (for greater amount, see
instructions)
.............................
4
25,132
5
Net value of noncharitable-use assets.
Subtract line 4 from line 3. Enter here and on Part V, line 4
5
1,650,325
6
Minimum investment return.
Enter 5% of line 5
..................
6
82,516
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
82,516
2a
Tax on investment income for 2016 from Part VI, line 5
......
2a
2,440
b
Income tax for 2016. (This does not include the tax from Part VI.)
...
2b
c
Add lines 2a and 2b
............................
2c
2,440
3
Distributable amount before adjustments. Subtract line 2c from line 1
............
3
80,076
4
Recoveries of amounts treated as qualifying distributions
................
4
5
Add lines 3 and 4
............................
5
80,076
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
80,076
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
94,500
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
94,500
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
6
Adjusted qualifying distributions.
Subtract line 5 from line 4
..............
6
94,500
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
(2016)
Form 990-PF (2016)
Page
9
Part XIII
Undistributed Income
(see instructions)
(a)
Corpus
(b)
Years prior to 2015
(c)
2015
(d)
2016
1
Distributable amount for 2016 from Part XI, line 7
80,076
2
Undistributed income, if any, as of the end of 2016:
a
Enter amount for 2015 only
.......
b
Total for prior years:
20
,
20
,
20
3
Excess distributions carryover, if any, to 2016:
a
From 2011
......
25,104
b
From 2012
......
29,499
c
From 2013
......
7,356
d
From 2014
......
7,174
e
From 2015
......
1,850
f
Total
of lines 3a through e
........
70,983
4
Qualifying distributions for 2016 from Part
XII, line 4:
$
94,500
a
Applied to 2015, 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)
........
0
d
Applied to 2016 distributable amount
.....
80,076
e
Remaining amount distributed out of corpus
14,424
5
Excess distributions carryover applied to 2016.
(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
85,407
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 2015. Subtract line
4a from line 2a. Taxable amountsee
instructions
.............
f
Undistributed income for 2016. Subtract
lines 4d and 5 from line 1. This amount must
be distributed in 2017
..........
0
7
Amounts treated as distributions out of
corpus to satisfy requirements imposed by
section 170(b)(1)(F) or 4942(g)(3) (Election may
be required - see instructions)
.......
8
Excess distributions carryover from 2011 not
applied on line 5 or line 7 (see instructions)
...
25,104
9
Excess distributions carryover to 2017.
Subtract lines 7 and 8 from line 6a
......
60,303
10
Analysis of line 9:
a
Excess from 2012
....
29,499
b
Excess from 2013
....
7,356
c
Excess from 2014
....
7,174
d
Excess from 2015
....
1,850
e
Excess from 2016
....
14,424
Form
990-PF
(2016)
Form 990-PF (2016)
Page
10
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 2016, 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)
2016
(b)
2015
(c)
2014
(d)
2013
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).)
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.
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 address of the person to whom applications should be addressed:
The Robert Fleming Jane Patrick Fou
PO Box 234
Charlotte
,
VT
05445
(802) 425-2508
b
The form in which applications should be submitted and information and materials they should include:
Written request for support to include description of charitable organization, detailed description of program/project requested grant to support and copy of requesting organization's federal tax exemption as a Sec501(c)(3) organization.
c
Any submission deadlines:
None
d
Any restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other
factors:
All awards limited to organizations serving Vermont activities.
Form
990-PF
(2016)
Form 990-PF (2016)
Page
11
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
Rokeby Museum
4334 Route 7
Ferrisburgh
,
VT
05456
None
PC
Program Support
10,000
Vermont Foodbank
33 Parker Road
Barre
,
VT
05641
None
PC
Program Support
10,500
Champlain Valley Office of Economic
PO Box 1603
Burlington
,
VT
05402
None
PC
Warmth Program
1,000
Faith in Action Northern Comm
3339 Main Street
Cabot
,
VT
05647
None
PC
Program Support
1,500
Hope
PO Box 165
Middlebury
,
VT
05753
None
501(c)(3)
Operating Activities
12,000
The Charlotte Congregational Church
403 Church Hill Road
Charlotte
,
VT
05445
None
501(c)(3)
Operating Activities
1,000
NEKCA - Northeast Kingdom Com Actio
PO Box 346
Newport
,
VT
05855
None
PC
Warmth Program
1,000
Southern Vermont Community Action
91 Buck Drive
Westminister
,
VT
05158
None
PC
Warmth Program
1,000
Home Share Now
105 N Main Street Ste 3
Barre
,
VT
05461
None
501(c)(3)
Program Support
1,000
Hinesburg Artist Series Inc
PO Box 286
Hinesburg
,
VT
05461
None
PC
Program Support
1,000
CVABE
46 Washington Street Suite 100
Barre
,
VT
05641
None
PC
Literacy Program
1,000
Vermont Historical Society
60 Washingon Street
Barre
,
VT
05461
None
501(c)(3)
Workshops
2,500
Vermont Youth Orchestra Assoc
223 Ethan Allen Ave
Colchester
,
VT
05446
None
501(c)(3)
Program Support
3,500
Kid Safe Collaborative
45 Kilburn Street
Burlington
,
VT
05401
None
PC
Program Support
1,000
Barre Historical Society
46 Granite Street
Barre
,
VT
05641
None
PC
Program Support
2,500
Brattleboro Memorial Hospital
13 Belmont Avenue
Brattleboro
,
VT
05301
None
PC
Program Support
2,000
John Graham Housing And Services
69 Main Street
Vergennes
,
VT
05491
None
PC
Program Support
6,000
Partners in Adventure
PO Box 867
Shelburne
,
VT
05481
None
PC
Program Support
1,000
Community Action of Southwestern VT
45 Union Street
Rutland
,
VT
05701
None
PC
Program Support
1,000
Capstone Community Action
20 Gable Place
Barre
,
VT
05641
None
PC
Program Support
1,000
Vergennes Area Seniors Assoc
PO Box 212
Vergennes
,
VT
05491
None
PC
Program Support
500
Hinesburg Artist Series
PO Box 286
Hinesburg
,
VT
05461
None
PC
Program Support
500
New England Youth Theatre
100 Flat Street
Brattleboro
,
VT
05301
None
PC
Program Support
500
Age Well
93 Court Street
Middlebury
,
VT
05753
None
PC
Program Support
1,000
ACTR
297 Creek road
Middlebury
,
VT
05753
None
PC
New Bus
4,500
Resources
266 Pine Street
Burlington
,
VT
05401
None
PC
Program Funding
1,000
Sara Holbrook Community Center
60 North Avenue
Burlington
,
VT
05401
None
PC
Program Support
2,500
The Springfield Players
PO Box 113
Springfield
,
VT
05150
None
PC
Program Support
1,000
Turning Point
191 Bank Street
Burlington
,
VT
05401
None
PC
Program Support
2,000
State of Vermont
100 Mineral Street Suite 304
Springfield
,
VT
05156
None
GOV
Program Support
500
VT Commission on Native American Af
1 National Life Drive Davis Bldg
Montpelier
,
VT
05620
None
GOV
Program Support
5,000
Women's Freedom Center
PO Box 933
Brattleboro
,
VT
05302
None
PC
Program Support
1,000
Helen Day Art Center
Box 441
Stowe
,
VT
05672
None
PC
Program Support
1,000
Vergennes Congregational Church
30 S Water Street
Vergennes
,
VT
05491
None
PC
Program Support
1,000
Have a Heart Community Food Shelf
11 School Street
Bristol
,
VT
05443
None
PC
Program Support
1,000
First Congregational Church of Esse
One Church Street
Essex Jct
,
VT
05452
None
PC
Program Support
1,000
Shelburne food Shelf
3420 Shelburne Road
Shelburne
,
VT
05482
None
PC
Program Support
1,000
Williston Community Food Shelf
400 Cornerstone Drive Suite 130
Williston
,
VT
05495
None
PC
Program Support
1,000
Brandon Area Food Shelf
Route 7 Union Street
Brandon
,
VT
05733
None
PC
Program Support
1,000
North End Food Pantry
1416 North Avenue
Burlington
,
VT
05408
None
PC
Program Support
1,000
Colchester Community Food Shelf
245 Main Street
Colchester
,
VT
05446
None
PC
Program Support
1,000
Starksboro Food Shelf
3056 VT Rte 116
Starksboro
,
VT
05487
None
PC
Program Support
1,000
Hinesburg Community Resource Center
51 Ballard Corner Road
Hinesburg
,
VT
05461
None
PC
Program Support
1,000
Randolph Area Food Shelf
Prince Street 3
Randolph
,
VT
05060
None
PC
Program Support
1,000
Bethel Area Food Shelf
Church Street
Bethel
,
VT
05032
None
PC
Program Support
1,000
Total
.................................
3a
94,500
b
Approved for future payment
Total
.................................
3b
Form
990-PF
(2016)
Form 990-PF (2016)
Page
12
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
8
4
Dividends and interest from securities
....
14
27,466
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
122,997
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)
..
150,471
13
Total.
Add line 12, columns (b), (d), and (e)
..................
13
150,471
(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
(2016)
Form 990-PF (2016)
Page
13
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) is based on all information of which preparer has any knowledge.
2017-11-10
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
Glen A Wright CPA
Preparer's Signature
Date
Check if self-
employed
PTIN
P00673819
Firm's name
GLEN A WRIGHT CPA
Firm's EIN
Firm's address
8291 NW 120th Street
Reddick
,
FL
326864514
Phone no.
(352) 591-1119
Form
990-PF
(2016)
Additional Data
Software ID:
16000303
Software Version:
2016v3.0
Form 990PF - Special Condition Description:
Special Condition Description