0 w U Form 990 -PF Return of Private Foundation 0+B No 1545-0052 or Section 4947(a)(1) Nonexempt Charitable Trust ®i 2 Department ottheTreasury Treated as a Private Foundation Internal Revenue Service Note . The foundation may be able to use a cops' of the return to satisfy state Ieport ing requirements • For calendar veer 2012 or tax year beainnfna - 2012 and ending on Name of foundation ou r, i_ it-7 '07 L ' r'/I^ T ( A f k r^^ " H A Employe r derrtrfication number Z 3 ^- ,6 Number and street ( or P 16. box n r if Dell of delivered to street address) Room"suite B Telephone Ixurbei tree instructions) 1,1741 bfl ^ - ------ z - 4z 5 -- Zf 7c 7 City or tov state and ZIP coda C If exenXtlun application is pending check q /W G Check all that apply : q Initial return q Initial return of a former public chanty D 1. Foreign olganlza tuon-s check here ► q q Final return q Amended return q Address chan e q Narre chan e 2 Foreign orgarizations meeting the 85'16 test, g g check here and attach computation ► q H Check type of organization : q Section 501 (c)(3) exempt private foundation E If private foalndatlon status was tennnated under r-,^ q Section 4947 (( 1 ) nonexem pt charitable trust L^ Other taxable p rivate foundation sactron clock here I. 5071bikl ) .A^ chock here I. q Fair market value of all assets at J Accounting method : q Cash q Accrual end of year ( from Part!! , col (c), [''Other (specify) '. - 'es 41*-'' F if the foundation is Ina 60-rncnth term nation undersCctlon507{brr11 ( B) heckh re line 16) ► $ (Part ! column (d) must be on cash basis 1 Analysis of Revenue and Expenses n7Te totalof ( a) Revenue and Disbursements M amounts in columns ). (C). and (d) may not necessmr! {b y y equd expenses per tnpnt (b) Net (c) Adjust ed not for charitable the amounts in column lal )see rnstnrcbonsl 1 books nxom cons e Income purposes ^,^sh basis is onlvl 1 Contributions . gifts. grants. etc . received {attach schedul e) Y? ''`' : fir; 4 r . ^+ :• 2 Check ► q it the foundation is not re uired to attach Sch B q 3 Interest on savings and temporary cash investmerls 4 Dividends and interest from securities . . . . Z3 __ 7i 1 - - P RO?; 'Mil 5a Gross rents . . . . . . . . . . . . x b Net rental income or (loss) m 6a Net gain or (loss) from sale of assets not on fine 10 b Gross sales price for all assets on line 6a _ _ c^,^^, :t•, ^• ; •„^..• . .''>,- :^•^ ,.:; ',. `;^,'.. 1^,,•.;^^„r^.^, : ^,^^,^:;^,r:^,,,;; -,^;_^^ 7 Capital gain net income ( from Part IV . line 2) 3;' >',- "_+•^ / 1 ^,: ? r, r'' -? ;, = :` 5 OC 8 Net short - term capital gain . . . . . . . .f, 9 Income modifications . . . . . ' _`',. s: .:, - -;.' a. - - i . $ ,•ip rl- ay:" R r 10Gross sales less returns and allowances I b Less: Cost of goods sold L------ 'tom, ; ,.; . ,•. F ,;' :^,°<° a.`^; ' '_^^ .. ^•- _"^.r _„ ^•.f c Gross profit or doss) (attach schedule ) . . . 11 Other income (attach schedule) . . . . . y 12 Total . Add lines 1 throu g h 11 . 1 / C yF' U) 13 Corrpensation of officers. directors, trustees, etc . 14 Other employee salaries and wages . . . . . --- 15 Pension pl on ^^` - x 16a Legal fees ttach I ll LU b Accounting f (attach schedule ) c Other prof nal f t h sa ul p u I - -- R 17 Interest LIJ N 4.1 y 18 Taxes (attac h sc e.(seelnstructot -. . . 70 a 19 Deprecatlo 1177 ^arl^i pletlo i F^ tt^ W. ` 20 Occupancy . . . . . . . . . . . . -- --- - 21 Travel , conferences , and meetings . . . . . -' -- - -- -- - = 22 Printing and publications - t 23 Other expenses (attach schedule) . . . . . 24 Total operating and administrative expenses. sy Add lines 13 through 23 r 700 25 Contributions, gifts, grants paid . . . . . b 26 Total ex penses and disbursements . Add lines 24 and 25 Z OZ O 27 Subtract line 26 from line 12: _, ;,"':,ir . Y ",-. ," ; Ir '^^' .;;i ' : ",,;v; • „ ` •,s` ^ ^ :t, •1 '" a Excess of revenue over expenses and disbursements O _ ' 3' • ,' ,, "rt. b Net Investment Income ( if negative, enter -0-) ,a " `'4<>',;• :;:g ^,,^y` ' •:,;•• Y ; y^ c Ad usted net Income ( if ne gative, enter -0 -) „yam ,,•^ ;Ott ^^. For Paperwork Reduction Act Notice, see instructions. Cat N. 112 ,4X Foln,99O-PF t'o,2. 0 lLf
Transcript
0
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Form 990-PF Return of Private Foundation 0+B No 1545-0052or Section 4947(a)(1) Nonexempt Charitable Trust ®i 2
Department ottheTreasury Treated as a Private FoundationInternal Revenue Service Note . The foundation may be able to use a cops' of the return to satisfy state Ieport ing requirements •
For calendar veer 2012 or tax year beainnfna - 2012 and ending onName of foundation
our,
i_it-7'07
L' r'/I^ T
(
A f k r^^
"
H
A Employe r derrtrfication number
Z 3 ^- ,6Number and street ( or P 16. box n r if Dell of delivered to street address) Room"suite B Telephone Ixurbei tree instructions)
1,1741 bfl ^- ------ z - 4z 5 -- Zf 7c 7City or tov state and ZIP coda C If exenXtlun application is pending check q/W
G Check all that apply: q Initial return q Initial return of a former public chanty D 1. Foreign olganlza tuon-s check here ► q
q Final return q Amended return
q Address chan e q Narre chan e2 Foreign orgarizations meeting the 85'16 test,
g g check here and attach computation ► q
H Check type of organization : q Section 501 (c)(3) exempt private foundation E If private foalndatlon status was tennnated underr-,^
q Section 4947(( 1 ) nonexempt charitable trust L^ Other taxable p rivate foundationsactron clock here I.5071bikl ) .A^ chock here I. q
Fair market value of all assets at J Accounting method : q Cash q Accrualend of year (from Part!!, col (c), [''Other (specify)
'. - 'es 41*-''F if the foundation is Ina 60-rncnth term nation
undersCctlon507{brr11 ( B) heckh re
line 16) ► $ (Part ! column (d) must be on cash basis 1
Analysis of Revenue and Expenses n7Te totalof(a) Revenue and DisbursementsM
amounts in columns ). (C). and (d) may not necessmr!{b y y equd expenses per tnpnt(b) Net (c) Adjust ed not for charitable
the amounts in column lal )see rnstnrcbonsl 1 books nxomcons
e Income purposes^,^sh basisis onlvl
1 Contributions . gifts. grants. etc . received {attach schedul e) Y? ''`' : fir; 4 r . ^+ :•
2 Check ► q it the foundation is not re uired to attach Sch Bq3 Interest on savings and temporary cash investmerls
m 6a Net gain or (loss) from sale of assets not on fine 10b Gross sales price for all assets on line 6a _ _ c^,^^, :t•, ^• ; •„^..• . .''>,- :^•^ ,.:; ',. `;^,'.. 1^,,•.;^^„r^.^, : ^,^^,^:;^,r:^,,,;; -,^;_^^
7 Capital gain net income (from Part IV . line 2) 3;' >',- "_+•^ / 1 ^,: ? r, r'' -? ;, = :` 5OC 8 Net short -term capital gain . . . . . . . .f,
9 Income modifications . . . . . ' _`',. s: .:, - -;.' a. - - i . $ ,•iprl- ay:"R r
10Gross sales less returns and allowances I
b Less: Cost of goods soldL------ 'tom, ; ,.; . ,•. F ,;' :^,°<° a.`^; ' '_^^ .. ^•- _"^.r _„ ^•.f
c Gross profit or doss) (attach schedule) . . .11 Other income (attach schedule) . . . . . y
12 Total . Add lines 1 throug h 11 . 1 / C yF'
U) 13 Corrpensation of officers. directors, trustees, etc .14 Other employee salaries and wages . . . . .
---15 Pension pl on ^^` -x 16a Legal fees ttach I llLU b Accounting f (attach schedule)
14 Land . buildm9s, and equipment basis III --------•-- ° ' ,. :ra's :r?Y T11:7̀•.L ., «^a_ • ,:pt1 Er -
Less: accumulated depreciation (attach schedule) ►15 Other assets (describe III -- -•---•---•-••- ------- - - --•-•--- f --- --- -- -16 Total assets ( to be completed by all filers-see the
instructions Also. see page 1. item I) 441 fr u < 44
L6Foundations that do not follow SFAS 117 , check here ► qand complete lines 27 through 31.
;' ate
27 Capital stock , trust pnncipal , or current funds . . . . .
28 Paid- in or capital surplus. or lanc.t bldg.. and equipment fund
rA29 Retained earning s . accumulated income . endowment or other funds0 Total net assets or fund balances (see instructions) . . . 1 J
„^ t'qy- ^ r ^4j+^ qt _•^ Y^v^TSI ••;
` +tx;3Z 31 Total liabilities and net assets/fund balances (see
5t}^''sr 'a
instructions)
• Analysis of Changes in Net Assets or Fund BalancesI Total net assets or fund balances at beginning of year - Part 11. colurm (a). line 30 (must agree with
__
end-of-year figure reported on prior year's return) 1 )t 1
. . . . . . . . . .2 Enter amount from Part I. line 27a . . . . . . . 2
_
v.3 Other increases not included in line 2 (itemize ) ► /q^ e(S t std G j f ^cYEr^
5 Decreases not included in line 2 (iterrrze) ► ----- ---'' --
•--- 5
6 Total net assets or fund balances at end of year (line 4 minus line 5) -Part II, column (b), line 30 . 6
Fomi9W-PF %2012t
15
Form 990-PF (20121 Page 3
• Capital Gains and Losses for Tax on Investment Incomele) List and describe the kind(st of property sold (e g real estate .
2-story brick warehouse or conimn stock. 200st,s MLCCo I
(1) How acquiredP-PhaseD-Donation
(c) Date acquired111 day yr)
(d) Date sold
nno day yrf
Ia 4747 -' rX S ^G• -y 6 / z
b G ^P' lCGk(z. 17 ti 4 8D ^! f zcd
e
(e) Gross sales pica (I) Depreciation allowed
.or allowable)
(g) Cost or other basisplus expense of sale
(hj Gain of doss)ref plus '1)mrnrs (g)
a 6 12 _Z z oG^b /Cde
Complete only for assets showing gain in column (h) and owned by the foundation on 12/31/69 (I) Gains (Col (ht gain nanus
(i) F M V as of 12/31 i 9U) Adjusted basisas of 12131/69
(k) Excsss of col .j,
over cot ()l it any
col Ou but not less than -0-I orLosses ifroin col (h))
ab - ------c
c
-- -
d-----
e
2 Capital gain net Income or (net capital loss) t If gain. also enter in Part I, line 7( If pons), enter -0- in Part I. line 7 f 2 3z^ r
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- inPart 1. line 8 3
li uuanttcanon unaer Section 4y4ute) Tor rseaucea tax on N et investment i ncome _
(For optional use by domestic private foundations subject to the section 4940(a) tax on net investment income.)
It 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 penod? q Yes' No
If "Yes," the foundation does not qualify under section 4940(e). Do not complete this part.
I Enter the appropriate amount in each column for each year: sep the instructions before making any entries.
(a) (b) (c) td)Base period years
distnhidions Net :.rlne M n rid aidahlr-rise ac, et;Distnlxdion ratio
Calendar year.oi tax year beginning inn Adjusted qualifying .cc i b. do ided by •:•:I 'c m-- y-- 3 ff^ _-;0 4 Z 7-2011 r -7 1-f "2010 Ib z 579, z f4 __,o ?gam -2009 0 $f^2008 ^aa 4r602007 5vv z wcf 3: r (a 6 a z
2 Total of line 1 . column (d) . . . . . . . . . . . . . . . . . . . . . 2 , -• t -7 -7
3 Average distribution ratio for the 5-year base period -dlvlcia the total on line 2 by 5. or by the
nun-ber of years the foundation has been in existence if less than 5 years 3
4 Enter the net value of noncharitable-use assets for 2012 from Part X. line 5 . . . . . . 4 2..Z. 1 2. I
5 Multiply line 4 by line 3 . . . . . . . . . . . . . . . . . . . . . 5 t C7
6 Enter 1 % of net investment income (1'/ of Part I. line 27b) . . . . . . . . . . 6 r D ( 6
8 Enter qualifying distributions from Part XII, line 4 . . . . . . . . . . . . . . .
If line 8 is equal to or greater than line 7. check the box in Part VI. line 1b. and conplete that part using a 1% tax rate See the
Part VI instructions.
Foon990-113F 12012i
Form 990-PF (2012) Page 4
Excise Tax Based on Investment Income (Section 4940(a), 4940(b), 4940(e), or 4948- see instructions)1a
b
Exempt operating foundations described in section 4940(d)(2j. check q and enter "N/A" on line 1.Date of ruling or determination letter ------------------- (attach copy of letter If necessary-see Instructions )Domestic foundations that meet the section 4940(e) requirements in Part V. check
p
1
.y.. •y,A.uS ,y,...,.
•I A-x a =```NINONFO f
c
2
here ► ($ and enter 1 % of Part I, line 27bAll other domestic foundations enter 2% of line 27b Exempt foreign organizations enter 4% ofPart 1. line 12, col (b).
Tax under section 511 (do)mestic section 4947(a)(1) trusts and taxable foundations only. Others enter -0-)
;r
fir
2
# •^' k . !. #
O
M
3 Add lines 1 and 2 . . . . . . . . . . . . . . . . . . . . . . . . . . 3 l 64 Subtitle A (income) tax (domestic section 4947(a)(1) trusts and taxable foundations only. Others enter -0-) 45 Tax based on Investment Income . Subtract line 4 from line 3. If zero or less, enter -0- . . . . 5 1 D6a
Credits&Payments:2012 estimated tax payments and 2011 overpayment credited to 2012 6a .10
+` ^)+
b Exempt foreign organizations-tax withheld at source . . . . . 6bc
d
Tax pad with application for extension of time to file (Form 8868) .
7 Total credits and payments. Add lines 6a through 6d . . . . . . . . . . . . . . . 7 p8 Enter any penalty for underpayment of estimated tax. Check here q if Form 2220 is attached 89 Tax due. If the total of lines 5 and 8 is more than line 7, enter amount owed . . . . . . ► 9 p / ^f10 Overpayment . If line 7 is more than the total of lines 5 and 8. enter the amount overpaid . . ► 1011 Enter the amount of line 10 to be: Credited to 2013 estimated tax ► Refunded ► 11
a
b
cd
e
4ab
5
6
During the tax year, did the foundation attempt to influence any national, state, or local legislation or did itparticipate or intervene in any political campaign? .
Did it spend more than $100 dunng the year (either directly or indirectly) for political purposes (seeInstructions for the definition)?
If the answer is "Yes" to 1a or 1b, attach a detailed description of the activities and copies of any materialspublished or distributed by the foundation in connection with the activities
Did the foundation file Form 1120-POL for this year? . . . . . . . . . . . . . . . . . .
Enter the amount (if any) of tax on political expenditures (section 4955) imposed during the year:(1) On the foundation. ► $ (2) On foundation mk-inagers. ► $Enter the reimbursement (if any) paid by the foundation during the year for political expenditure tax ir-lposedon foundation managers. ► $
Has the foundation engaged in any activities that have not previously been reported to the IRS? . . . .
If 'Yes, "attach a detailed description of the activities.
Has the foundation made any changes, not previously reported to the IRS, in its governing instrument. articles ofIncorporation, or bylaws. or other similar instruments? If "Yes •' attach a confonned copy of the changes
Did the foundation have unrelated business gross income of $1,000 or more during the year? . . . . .If "Yes." has it filed a tax return on Form 990-T for this year? . . . . . . . . . . . . . . .Was there a liquidation. termination. dissolution, or substantial contraction during the year?If 'Yes, "attach the statement required by General Instruction T
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 miarxiatory directions thatconflict with the state law remain in the governing instrument? .
7 Did the foundation have at least $5,000 in assets at any time during the year? If Yes." cornolete Par N. col. rci, and Par! XV
8a Enter the states to which the foundation reports or with which it is registered (see instructions) ►
- ---- -- --- ---- -- ----- ---• -- -•----- • ._.._ ._._.... ---•--• -b It the answer rs "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 Instn,ction G? If "No, " attach explanation
9 is the foundation claiming status as a pnvate operating foundation within the maanuxg of section 4942(()(3) or
4942U)(5) for calendar year 2012 or the taxable year beginning in 2012 (see instructions for Part XIV)? If "Yes. "complete Part XIV . . . . . .
10 Did any persons become substantial contributors during the tax year? I f "Yes " attach a schedule listing their
names and addresses . . . . .
lb
2
4a4b
8b X
9
10
For„ 990-PF ,2012,
Form 990-PF (20121 Page 5
111111101MIMM 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 X
12 Did the foundation make a distribution to a donor advised fund over which the foundation or a disqualified xperson had advisory privileges? If "Yes." attach statement (see instructions) - - 12
13 Did the foundation comply with the public inspection requirements for its annual returns and exemption application? 13 ^CWebsite address ►
14 The books are in care of ( 6-1S: t Q ,. -r 15 Telephone no. ► ZS3 ^ ^^ fZLocated at ► W , z1P+4 ► B `.
15 Section 4947(a)(1) nonexerrpt c ritable trusfs filing Form 990-PF rn lieu of Form 1041 -Check here. . . . . ► qand 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 Yes [1oover a bank, securities, or other financial account in a foreign country? - 16
See the instructions for exceptions and filing requirements for Form TD F 90-22 1 If "Yes." enter the nacre of ,the foreign country ►
File Form 4720 If any Item is checked In the "Yes" column, unless an exception applies. "b Yes Nola During the year did the foundation (either directly or indirectly):
P(1) Engage in the sale or exchange. or leasing of property with adisqulified person? q Yes No '+l'r,.(2) Borrow money from, lend money to, or otherwise extend credit to (or accept it from) a
disqualified person? q Yes gNo ," 4(3) Furnish goods, services, or facilities to (or accept them from) a disqualified person? . . El Yes 'No }' ° r• }(4) Pay compensation to, or pay or reimburse the expenses of, a disqualified person? Yes LN No
r; • f ,r(5) Transfer any income or assets to a cfisqualrfied person (or make any of either available for r'^•^^^ ^f
the benefit or use of a disqualified person)? q Yes No ,w +
(6) Agree to pay money or property to a government official? (Exception. Check "No" if thefoundation agreed to make a grant to or to employ the official for a period after stermination of government service, if ternirkating within 90 days) q Yes INo
b If any answer is "Yes" to 1 a(r1'(6) . did any of the acts fail to qualify under the exceptions described in Regulationssection 53.4941(d)-3 or in a current notice regarding disaster assistance (see instructions)? ibOrganizations relying on a current notice regarding disaster assistance check here . . . . . . '{^7. "
c Did the foundation engage in a prior year in any of the acts described in 1a other than excepted arts, that
.^
were not corrected before the first day of the tax year beginning in 2012? - 1c2 Taxes on failure to distribute income (section 4942) (does not apply for years the foundation was a private
operating foundation defined in section 49420)(3) or 49420)(5)):
a At the end of tax year 2012. did the foundation have any undistributed income (lines 6d and6e, Part XIII) for tax year(s) beginning before 2012? . . q Yes No
If "Yes." list the years ► 20 . 20 , 20 . 20 (' t
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 year's undistributed income? (If applying section 4942(a)(2) toall years listed, answer "No" and attach statement-see 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. t^► 20 .20 .20 .20 ^'+y
3a Did the foundation hold more than a2% direct or indirect interest in any business enterpriseat any time during the year? . . - - - q Yes 0 No it-5
b If "Yes." did it have excess business holdings in 2012 as a result of (1) any purchase by the foundation or lay l&U.disqualified persons after May 26. 1969: (2) the lapse of the 5-year period (or longer period approved by theCommissioner under section 4943(c)(7)) to dispose of holdings acquired by gift or bequest: or (3) the lapse ofthe 10 -. 15-, or 20-year first phase holding period? (Use Schedule C• Foam 4720, to determine if thefoundation had excess business holdings in 2012) 3b
4a Did the foundation invest during the year any amount in a manner that would jeopardize its chartable purposes? 4a Xb Old the foundation make any Investment in a prior year (but after December 31 1969) that could jeopardize its
chartable purpose that had not been removed from jeopardy before the first day of the tax year beginning in 2012? 4b x
Foi1»990-PF (2012,
Form 990-PF (2012) 6iee^ Statements Regarding Activities for Which Form 4720 May Be Required (continued)
5a During the year did the foundation pay or incur any arr cunt to: ;'";(1) Carry on propaganda. or otherwise attempt to influence legislation (section 4945(e))? q Yes WNo(2} Influence the outcome of any specific public election (see section 4955): or to carry on ^^'
directly or indirectly, any voter registration drive?E
- r,l Yes f No
¶-ICa r.. Y ^+.^`'
'
(3) Provide agrant to an individual for travel . study, or other slmllar purposes? . . . . . El Yes No^
ZfrNS^^ „(4) Provide a grant to an organization other than a charitable, etc .• organization described in v *n,- CH
section 509 (a)( 1 ) . (2) , or (3), or section 4940(d)(2)? (see instructions) q Yes 12 Nor
J,N(5) Provide for any purpose other than religious, charitable. scientific . literary or educational *rtt ;,r, z -^
purposes, or for the prevention of cruelty to children or animals? q Yes [XNob If any answer is " Yes" to 5a ( 1 )-(5) did any of the transactions fall to q uali fy under the exc eptions described in
;^als
Regulations section 53 4945 or in a current notice regarding disaster assistance (see instructions)? . 5bOrganizations relying on a current notice regarding disaster assistance check here . . . . . ► q 'r (t {^ q t t
c If the answer is "Yes" to question Sa(4), does the foundation claim exemption from the taxbecause it maintained expenditure responsibility for the grant? ^. [] Yes No
3
II MIf 'Yes , " attach the statemen t required by Regulations section 53 4945-5(d). M ^.$
h * y
11"
"6a Did the foundation . during the year , receive any funds, directly or indirectly. to pay premiumson a personal benefit contrac t? ^No
b Did the foundation , during the year , pay premiums, directly or indirectly , on a personal benefit contract? . 6bIf "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? q Yes No ^ x ^ ;b It "Yes. " did the foundation receive any proceeds or have any net income attributable to the transaction? . 7b
in ormatlon Aaout omcers, urrectors, Trustees, Foundation Managers, Highly Paid Employees,and Contractors
1 Ust all officers, directors, trustees, foundation managers and their compensation ( see Instructions).
(a) Narne and address(b) Title and average
hours pet v, eek(c) Corrq,ensation
Of not paid,(d) Contnbutions to
enyployee benefit plans^) Expense account
other allowancesdevoted to position enter 0 and deferred compensa tion
oyth e r ^ 6 e P ^. - y -- " - !s7W, 4k<t' 141VwooQ -'r.? aY5 _
-Gy D
'r-kr& e e u d4 f !G' e Vi c e /
ir°iE^ C1 ^L•E flf/°^arl^ G% ^r^ U
- t;P I O O2 Conapensation of five highest-paid employees (other than those Included on line 1-see Instructions). If none, enter
*INONE."
----------(a) Name and address of each employee paid imre than $50000
(b) Title and a •. rrajehours per week
devoted to position
----`---(c) C : n-gwnsatiou
(d) Contributions toe"'00yee benefitplans and deferred
compensation
(e) Expense accountother allowances
Q'. .......... ......• . ......... ...........
Total number of other employees paid over $50 . 000 . ►Fistn,990-PF 12012,
Form 990 -PF (2012) Page 7
Information About Officers , Directors , Trustees, Foundation Managers , Highly Paid Employees,and Contractors (continued) _
3 Five hlahest-Daid Independent contractors for professional services (see instruction s ). If none , enter "N ONE."
(a) Name and address of each person paid more th an $50 000 (b) Type of servi ce )c) Cormensation
Summary of Program -Related Investments (see instructions)Describe the two largest pi og ram-related investments made by th e foundation dui nrg the tax year on In yes 1 a i id 2 Anuutrt
~--- - - -^All otlxi program-related investments See instructica is
3
Total . Add Vries 1 through 3 . . . . ►Fon i9W-PF r2012i
Form 990-PF (2012) Page 8
' Minimum Investment Return (All domestic foundations must complete this part. Foreign foundations,see instructions.)
1 Far market value of assets not used (or held for use) directly in carrying out charitable, etcpurposes:
a Average monthly fair market value of securities . . . . . . . . . . . . . . . . . Ia Z 5z'p 9b Average of monthly cash balances . . . . . . . . . . . . . . . . . . . lb I z q z v
c Fair market value of all other assets (see instructions) . . . . . . . . . . . . . . . is
d Total (add lines 1a. b, and c) . . . . . . . . . . . . . . . . . . . . . . . Id Z /e Reduction claimed for blockage or other factors reported on lines 1 3 and
3 Subtract line 2 from line id . . . . . . . . . . . . . . . . . . . . . . . . 34 Cash deemed held for chantable activities Enter 1 vz % of line 3 (for greater amount, see
instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 -30177015 Net value of noneharitable-use assets . Subtract line 4 from line 3. Enter here and on Part V. line 4 5 z.6 f ?„6 Minimum Investment return . Enter 51/c, of line 5 . . . . . . . . . . . . . . 6 t 5,0 S. aic
' Distributable Amount (see instructions) (Section 49420)(3) and (I)(5) private operatingfoundations and certai n foreign organizations check here ► [] and do not conpletc this part)
1 Minimum investment return from Part X, line 6 . . . . . . . . . . . 1 / 3 6 d2a Tax on investment income for 2012 from Part VI, line 5 . . . . . . . 2a p ( t;:
b Income tax for 2012. (This does not include the tax from Part VI.) . . . 2bc Add tins 2a and 2b . . . . . . . . . . . . . . . . . . . . . . . . . . 2c
3 Distributable amount before adustments. Subtract line 2c from line 1 . . . . . . . . . 3 i z '5 g o4 Recoveries of amounts treated as qualifying distributions . . . . . . . . . . . . . 4
5 Add lines 3 and 4 . . . . . . . . . . . . . . . . . . . . . . . . 5 j 2 O6 Deduction from distributable amount (see instructions) . . . . . . . . . . . . . 67 Distributable amount as adjusted Subtract line 6 from line 5 Enter here and on Part XIII, ! x^ ^a^p
7Vline 1 . . . . . . 7
Qualifying Distributions (see instructions)
1 Amounts paid (including administrative expenses) to accomplish charitable, etc.. purposes: W
a Expenses, contributions, gifts. etc. -total from Part I, column (ca, line 26 . . . . . . . . . is /J rjp0b Program-related investments-total from Part IX-B . . . . . . . . . . . . . . . . 1 b
2 Amounts pad 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*
b Cash distribution test (attach the required schedule) . 3b4 Qualifying distributions . Add lines 1 a through 3b Enter here and on Part V. line 8. and Part XIII. line 4 45 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) . . . . . . . . . . . . . . . . 56 Adjusted qualifying distributions . Subtract line 5 from line 4 . . . . . . . . .
Note . The amount on line 6 will be used in Part V, column (h), in subsequent years when calculating whether the foundationqualifies for the section 4940(e) reduction of tax in those years.
Foim 990-PF ,7o12)
Form 990-PF (2012 9unclistrtbuted income (see instructions)
(a) (b)(c1 (Co
1 Ustnbutable amount for 2012 from Part XI. C•,tpuss Y,,a,s p„o[ t.: 2011 2011 2012
line?
t^ II4.' !9FC"."•^^-,^.r`.,
, _^e^ :F • ,^n ,Y,• itN.: < :M1 r,:[^ •n. •• `^'t'^ (err P2 Undistributed income. if any. as of the end of 2012'
c'^L{•'fm-,u Y'-+ M
a Enter amount for 2011 only . . . . . f..(Z4 7
b Total for prior years: 20 20 20`°3 Excess distributions carryover, if any, to 2012: ^' ^ '^^,.X_ - 'x: , •.}rtd.::^`^ ., ^Fj ^^^ y'^JQw, ^fa From 2007b From 2008 . . . . .c From 2009 . . .d From 2010 ^` ', . , ^,
d Applied to 2012 distributable amount '>:'4'=;frN1?;l4;,;":.-; :•;'i'u j', ti'r ,' [T' a"i''r< •: a4 ', 1 If 4e Remaining amount distributed out of corpus ti•L" 3 r ; `zffl, xi `, £ S+ .Y -;+'e ,'",,,;g zFC:;` °,-, ti's 6;{yl,t v
5 Excess distributions carryover applied to 2012Of an amount appears in column (d), the sameamount must be shown in column (a)1 '' ' 9s'Gn,"•F'1'"k
:7sa;ytwP •n r,`` f n EYi, ;r" ca'; ''ms 1`x^^'sm 5 >^47.'154'+-•'i
6 Enter the net total of each column as
Indicated below r., f.ik{:^Y,^ `k•', `rid Yfl,i7.L" (s;]' c 4 P flNyy^`^; }'a Corpus. Add lines 3f, 4c, and 4e. Subtract line 5
b Prior years' undistributed Income. Subtract " 'k' ^y='f:`';'', 'fi•, ', i'i Y ':.< +- rr ^r''t• a-", ;t^ r a ^"^ r; t+?^ P,^` ^` ' 4 i^ sp
y :line 4b from line 2b - 34 ^:>:.:_,^zz ^s _ __________ ,r,, a ':r':^` N^^u> ,^^;^..^r-^-^„• e'')^^^.^kM^t"' :r v.
c Enter the amount of prior years' undistributedincome for which a notice of deficiency hasbeen Issued. or on which the section 4942(a)
rZ,tax has been previously assessed 6s'^t^,' x^ `•,;^{; ^;^
d Subtract line 6c from line 6b Taxableamount-see instructions
e Undistributed Income for 2011 Subtract line ^c', `;t",' ` `„•;,r^, c-: ; ', w: ` ` ;".; ^^^F +N;. ;'•_^ s q.;q .r J l,r^ ,r r 'i(if`r .t. ,'0 ti el• b` _,"
., [^"^^' ,:hin 1.'^`. ^
4a from line 2a Taxable amount-see hr<^^M^}r 4: ' •^ .^J'. .'v ; ^,°}+^,cfJGk"'•i',S.",rr ^mr ,, r^.yl.'tc;;^' • ^",
instructions
It Undistributed income for 2012. Subtract lines ". ,'r+ t J{I^• .;'' ,rt ^'+''+'''''^' 'i^^^,r "vim ^P'J', r ,y1̂4d and 5 from line 1 This arrount must be
n,adistributed in 2013.
7 Amounts treated as distributions out of corpus "1" •`^'^.,^^ ? ^^^ ,.t^ ' 1 ° +';: ° ^'^)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) 17 t^,
9 Excess distributions carryover to 2013. _r-g,-^ fi ^_^4u' '=" '•"^ " "- s>' - ^'.:-.' '>;^t rSubtract lines 7 and 8 from line 6a
10 Analysis of line 9:
a Excess from 2008 . . . 4y s„ Y, ,; rr, ...,- " «, it r s;^ t+' 'z ?r r• f{ib Excess from 2009. . .
c Excess from 2010 .
d Excess from 2011 . . .Excess from 2012. . .@ °'9L a^..F"., {•:^..J::'. ,'c.., .,. .... .,,e,t*, f ^r ',^,:^•n'"r^':}" ,lti^JS •.^.,k%Ju_ .•,^t _ ^..'^^ .. `l
Fo[mtF_W-11t(2012)
Form 990-PF (2012) Page 10
is 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 Ctieck box to Indicate whether the foundation is a private operating foundation described in section q 49420)(3) or q 49420)(5)
2a Enter the lesser of the adjusted net Tax year Prior 3 yearsincome from Part I or the minimum (a) 2012 (b) 2011 (c) 2010 (d) 2009
(e) Tatar
investment return from Part X foreach year listed . . . . . .
b a5% of line 2aC 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 test- enter:
(1) Value of all assets . .
(2) Value of assets qualifying under
section 4942O)(3)(B)(i)b "Endowment" alternative test-enter 2/3
of minimum investment return shown inPart X, line 6 for each year listed
c "Support" alternative test-enter.
(1) Total support other than grossinvestment income (interest.dividends, rents. payments onsecunties loans (section512(a)(5)). or royalties) . .
(2) Support from general publicand 5 or more exemptorganizations as provided insection 49420)(3)(B)(ui) . . . .
(3) Largest amount of support from
an exempt organization . . .
4 Gross Investment Income
• Supplementary information (Complete this part only if the foundation had $5,000 or more in assets at
any time during the year-see instructions.)
I Infon lon Regarding Foundation Managers:a List any managers of the foundation who have contnbuted 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
Check here ► q 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 a-mad of the person to whore applications should be addressed:
-'c-86-- ?Z-e*(xed^e ^a^r r^^ W rfRlaP ;t Aek )-Gbgfe, PA Z gwormin which app i ations should be subr ed and information and materials they should include:
,& t'Ot, ac Any submission dea;1lines:
d Any restrictions or(limitations on awards. such as by geographical areas, charitable fields. kinds of Institutions. or other
factors:
Foon„ 990-PF X012)
Form 990-PF (2012) Page 1 i
• -Supplementary Information (continued)3 Grants and Contributions Paid During the Year or Approved for Future Payment
Recipient If reopent tis an individualshow any relationship to
Foindationstatus of
Purpose of grant or A unt
Name and address (home or business)airy foudation nslnagerof sutsfantial contributor recrpent
contribution
a Paid during the year
solebury friends meeting N General purposes 2000.00
Solebury PA 18966
haverford college N General purposes 1000.00
Haverford PA
westtown school N Class gift 1000.00
Westtown, PA
Philadelphia yearly meeting N General purposes 500.00
1515 Cherry St, Phila PA 19102
Rotary International N Hurricane Relief 1000.00
York PA
New Jersey Health Foundation Y School of Public Health 30000.00
New Brunswick, NJ
Howard Univ College of Medicine N General purposes 2000.00
Washington, DC
Trustees of the University of Pennsylvania N Mackie lectureship 10000.00
Philadelphia Pa
College of Physicians of Philadelphia N General purposes 2000.00
Philadelphia PA
American Trauma Society N General purposes 2000.00
Falls Church, VA
saint peter's foundation Y Peds Resident Teaching 1000.00
New Brunswick, NJ
saint peter's foundation Y Reach Out and Read 5000.00
New Brunswick, NJ
westtown school N Scholarship Fund 20000.00
Westtown, PA
westtown school N Science Building 21000.00
Westtown, PA
York hospital foundation Y Rhoads lecutreship 10000.00
York PA
Amer Philosophical soc N General purposes 2000.00
Philadelphia PA
United Negro College Fund(UNCF) Y General purposes 2000.00
Philadelphia PA
Meharry Medical College N General purposes 2000.00
• Analysis of Income. Producing ActivitiesEnter gross amounts unless otherwise indicated. Unrelated business income Excluded by section 512 513, or 514
(e)
am service revenue:
(a)Business code
(b)Amount
(c)Exclusion code
(d)Amount
Related or exemptfunction income(See instructions)
Fees and contracts from government agenciesrrbership dues and assessments . . . .
rest on savings and temporary cash investmentsdends and interest from securities . . . .
rental income or (loss) from real estate: _ ,, a^-._. ,Y s•^ Fr^` 9Y;11 ^f^',"; ;^___ ^m
Not debt-financed property . . . . . .rental income or (loss) from personal propertyer investment income . . . . . . . .or Qoss) from sales of assets other than inventory
Income or (loss) from special events . . .
ss profit or (loss) from sales of inventoryer revenue: a
)total. Add columns (b), (d), and (e) . . . 7
B
h
o
h
13 Total . Add line 12, columns (b), (d), and (e) . . . . . . . . . . . . . . . . . . 13See worksheet in line 13 instructions to verify calculations.)
1 Progabcdef
92 Me3 Int4 DIvi5 NeNot
ab
6NeNot7 Ot8 Gab9 NeNot
10 Gr
11 Ot
bcde
12 Su
Line No. Explain below how each activity for which income is reported in column le) of Part XVI-A contributed importantly to they accomplishment of the foundation s exempt purposes (other than by providing funds for such purposes) (See instructions)
Foim -1"t {2012)
Form 990-PF (2012) Page 13
- Information Regarding Transfers To and Transactions and Relationships With NoncharitableExem pt Organizations
1 Did the organization directly or indirectly engage in any of the following with any other organization described Yes Noin section 501 (c) of the Code (other than section 501(c)(3) organizations) or in section 527. relating to political
00t, corganizations? ` :^4' V
r4
a Transfers from the reporting foundation to a nonchantable exempt organization of ` . ^ .,(1) Cash . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 a 1 X(2) Other assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . la(2)
b Other transactions: „ M. ''(1) Sales of assets to a noncharitable exerTpt organization . . . . . . . . . . . . . . . .
,1b 1) x
(2) Purchases of assets from a nonchantable exempt organization . . . . . . . . . . . . . . lb 2)(3) Rental of facilities, equipment , or other assets . . . . . . . . . . . . . . . . . . . 1b(3
(6) Performance of services or rrembership or fundraising solicitations . . . . . . . . . . . 1 b 6)
c Sharing of facilities , equipment , mailing lists, other assets, or paid employees . . . . . . . . . . 1cd If the answer to any of the above is "Yes." complete the following schedule Colurm (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 marketvalue in any transaction or shanng arrangement, show in colurm (d) the value of the goods, other assets. or services recei ved
(a) Line no (b) Amount involved ( c) Name of nonthantable exempt organization (d) Description of transfers transactions and sharing arrangements
2a Is the foundation cfirectly or Indirectly affiliated with, or related to. one or rrore tax-exempt organizationsdescribed in section 501(c) of the Code (other than section 501(c)(3)) or in section 527? q Yes ®' No
b If "Yes," complete the following schedule.
(a) Name of organ iz ation (b) Type of organization (c) Description of relationship
Under penalties of perjury I declare that I have e ermined this return uw hiding s c npanyuy sc heduk-s and statc+nents an, I the best of my knovvlacje and betel it is true
Si ncorrect . and complete De-Iara ofpreparerutheithintarpa;eriisba%~IondIIinfonr tKrrofnhr_t . Tier has n krr^vrledge
