-
TIN:
Form
990-PF
Department of the Treasury
Internal Revenue Service
Return of Private Foundation
or Section 4947(a)(1) Nonexempt Charitable Trust
Treated as a Private Foundation
Note.
The foundation may be able to use a copy of this return to satisfy state reporting requirements.
OMB No. 1545-0052
20
10
For calendar year 2010, or tax year beginning
01-01-2010
, and ending
12-31-2010
G
Check all that apply:
Initial return
Initial return of a former public charity
Final return
Amended return
Address change
Name change
Name of foundation
MARLBORO COUNTY GENERAL HOSPITAL CHARITY
Number and street (or P.O. box number if mail is not delivered to street address)
PO BOX 2907 - TRUST TAX DEPT
Room/suite
City or town, state, and ZIP code
WILSON
,
NC
278942907
A Employer identification number
57-0737029
B
Telephone number (see page 10 of the instructions)
(803) 251-1377
C
If exemption application is pending, check here
D 1.
Foreign organizations, 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
2.
Foreign organizations meeting the 85% test,
check here and attach computation
I
Fair market value of all assets at end
of year
(from Part II, col. (c),
line 16)
$
6,385,518
J
Accounting method:
Cash
Accrual
Other (specify)
(Part I, column (d) must be on cash basis.)
E
If private foundation status was terminated
under section 507(b)(1)(A), check here
F
If the foundation is in a 60-month termination
under section 507(b)(1)(B), check here
Part I
Analysis of Revenue and Expenses
(The total of amounts in columns (b), (c), and (d) may not necessarily equal the amounts in column (a) (see page 11 of the instructions).)
(a)
Revenue and
expenses per
books
(b)
Net investment
income
(c)
Adjusted net
income
(d)
Disbursements
for charitable
purposes
(cash basis only)
1
Contributions, gifts, grants, etc., received (attach schedule)
2
Check
3
Interest on savings and temporary cash investments
13,438
13,438
4
Dividends and interest from securities
......
150,082
150,082
5a
Gross rents
..............
b
Net rental income or (loss)
6a
Net gain or (loss) from sale of assets not on line 10
244,086
b
Gross sales price for all assets on line 6a
2,909,838
7
Capital gain net income (from Part IV, line 2)
...
244,086
8
Net short-term capital gain
.........
0
9
Income modifications
...........
10a
Gross sales less returns and allowances
b
Less: Cost of goods sold
....
c
Gross profit or (loss) (attach schedule)
.....
11
Other income (attach schedule)
.......
154
154
12
Total.
Add lines 1 through 11
........
407,760
407,760
13
Compensation of officers, directors, trustees, etc.
56,511
33,907
22,605
14
Other employee salaries and wages
......
0
0
0
15
Pension plans, employee benefits
.......
0
0
16a
Legal fees (attach schedule)
.........
0
b
Accounting fees (attach schedule)
.......
c
Other professional fees (attach schedule)
....
245
245
17
Interest
...............
0
18
Taxes (attach schedule) (see page 14 of the instructions)
1,416
0
19
Depreciation (attach schedule) and depletion
...
0
0
20
Occupancy
..............
21
Travel, conferences, and meetings
.......
0
0
22
Printing and publications
..........
0
0
23
Other expenses (attach schedule)
.......
40
40
24
Total operating and administrative expenses.
Add lines 13 through 23
..........
58,212
33,947
0
22,850
25
Contributions, gifts, grants paid
........
261,018
261,018
26
Total expenses and disbursements.
Add lines 24 and 25
319,230
33,947
0
283,868
27
Subtract line 26 from line 12:
a
Excess of revenue over expenses and disbursements
88,530
b
Net investment income
(if negative, enter -0-)
373,813
c
Adjusted net income
(if negative, enter -0-)
...
0
For Privacy Act and Paperwork Reduction Act Notice, see page 30 of the instructions.
Cat. No. 11289X
Form
990-PF
(2010)
Form 990-PF (2010)
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
Cash—non-interest-bearing
...............
2
Savings and temporary cash investments
..........
164,711
35,281
35,281
3
Accounts receivable
Less: allowance for doubtful accounts
0
0
4
Pledges receivable
Less: allowance for doubtful accounts
5
Grants receivable
.................
6
Receivables due from officers, directors, trustees, and other
disqualified persons (attach schedule) (see page 15 of the
instructions)
....................
7
Other notes and loans receivable (attach schedule)
Less: allowance for doubtful accounts
0
8
Inventories for sale or use
...............
9
Prepaid expenses and deferred charges
...........
10a
Investments—U.S. and state government obligations (attach schedule)
255,443
255,443
256,828
b
Investments—corporate stock (attach schedule)
........
4,472,145
4,846,172
5,259,186
c
Investments—corporate bonds (attach schedule)
........
954,162
797,619
834,223
11
Investments—land, buildings, and equipment: basis
Less: accumulated depreciation (attach schedule)
12
Investments—mortgage loans
..............
13
Investments—other (attach schedule)
...........
0
14
Land, buildings, and equipment: basis
Less: accumulated depreciation (attach schedule)
15
Other assets (describe
)
16
Total assets
(to be completed by all filers—see the
instructions. Also, see page 1, item I)
5,846,461
5,934,515
6,385,518
17
Accounts payable and accrued expenses
..........
18
Grants payable
...................
19
Deferred revenue
..................
20
Loans from officers, directors, trustees, and other disqualified persons
21
Mortgages and other notes payable (attach schedule)
......
22
Other liabilities (describe
)
23
Total liabilities
(add lines 17 through 22)
..........
0
Foundations that follow SFAS 117, check here
and complete lines 24 through 26 and lines 30 and 31.
24
Unrestricted
....................
25
Temporarily restricted
................
26
Permanently restricted
................
Foundations that do not follow SFAS 117, check here
and complete lines 27 through 31.
27
Capital stock, trust principal, or current funds
.........
5,846,461
5,934,515
28
Paid-in or capital surplus, or land, bldg., and equipment fund
29
Retained earnings, accumulated income, endowment, or other funds
30
Total net assets or fund balances
(see page 17 of the
instructions)
....................
5,846,461
5,934,515
31
Total liabilities and net assets/fund balances
(see page 17 of
the instructions)
..................
5,846,461
5,934,515
Part III
Analysis of Changes in Net Assets or Fund Balances
1
Total net assets or fund balances at beginning of year—Part II, column (a), line 30 (must agree
with end-of-year figure reported on prior year’s return)
...............
1
5,846,461
2
Enter amount from Part I, line 27a
......................
2
88,530
3
Other increases not included in line 2 (itemize)
3
0
4
Add lines 1, 2, and 3
..........................
4
5,934,991
5
Decreases not included in line 2 (itemize)
5
476
6
Total net assets or fund balances at end of year (line 4 minus line 5)—Part II, column (b), line 30
..
6
5,934,515
Form
990-PF
(2010)
Form 990-PF (2010)
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
P—Purchase
D—Donation
(c)
Date acquired
(mo., day, yr.)
(d)
Date sold
(mo., day, yr.)
1 a
1000. ABB LTD SPONSORED ADR
2008-12-04
2010-04-01
b
760. AKAMAI TECHNOLOGIES COMMON
2010-01-07
2010-06-17
c
670. AKAMAI TECHNOLOGIES COMMON
2010-01-07
2010-09-23
d
750. AMGEN INCORPORATED
2007-04-05
2010-01-07
e
630. ANADARKO PETE CORP.
2009-04-22
2010-06-17
2510. APPLIED MATERIALS
2009-11-23
2010-06-17
1000. AVERY DENNISON CORP. COMMON
2008-12-04
2010-11-24
3205.33 BB&T SHORT INTER US GOVT INCOME FUND
2009-10-27
2010-06-17
1250. BANK OF NEW YORK MELLON CORP
2010-06-17
2010-11-24
700. BARRICK GOLD CORP. EFF. 1-18-95
2010-06-17
2010-09-23
710. BAXTER INTERNATIONAL INCORPORATED
2010-06-17
2010-11-24
1220. BAXTER INTERNATIONAL INCORPORATED
2010-11-24
10. BERKSHIRE HATHAWAY INC DEL CLASS B
2008-10-23
2010-01-07
250. BERKSHIRE HATHAWAY INC DEL CL B COMMON
2008-12-04
2010-04-01
500. BERKSHIRE HATHAWAY INC DEL CL B COMMON
2009-10-27
2010-11-24
1580. CAMPBELL SOUP COMPANY
2009-11-23
2010-06-17
450. CHEVRON TEXACO CORP COMMON
2003-11-14
2010-01-07
400. COCA COLA COMPANY
2005-04-15
2010-04-01
730. CONOCOPHILLIPS COM
2003-06-24
2010-09-23
1500. CORNING INCORPORATED
2009-01-08
2010-01-07
780. DISNEY WALT COMPANY
2007-08-10
2010-09-23
800. DU PONT E I DE NEMOURS & COMPANY
2003-11-14
2010-04-01
3000. DUKE ENERGY CORP
2010-09-23
1010. EBAY INC
2010-01-07
2010-09-23
200. EMERSON ELECTRIC COMPANY
2003-12-19
2010-01-07
1800. EMERSON ELECTRIC COMPANY
2010-04-01
250000. FED HOME LOAN MTG CORP DTD 02/09/07 4.87
2007-02-28
2010-02-09
228.495 FEDERATED HIGH YIELD BOND INST CL FUND #
2009-11-23
2010-01-07
1020.107 FEDERATED HIGH YIELD BOND INST CL FUND #
2009-10-27
2010-06-17
3217.707 FEDERATED MORTGAGE INSTITUTIONAL CLASS FUND #835
2009-10-27
2010-04-01
2904.716 FEDERATED MORTGAGE INSTITUTIONAL CLASS FUND #835
2009-10-27
2010-06-17
1204.293 FIDELITY ADVISOR HIGH INCOME FD #377 CL
2009-10-27
2010-01-07
.079 FRONTIER COMMUNICATIONS CORP COMMON
2007-11-27
2010-07-23
1040. GENUINE PARTS COMPANY
2009-11-23
2010-06-17
100. GOLDMAN SACHS GROUP COMMON
2007-08-16
2010-01-07
50. GOOGLE INC CL A
2009-01-08
2010-09-23
640. HEWLETT PACKARD COMPANY
2009-10-27
2010-04-01
500. HONEYWELL INTERNATIONAL INC
2008-05-29
2010-01-07
1000. INTEL CORPORATION
2003-11-14
2010-01-07
2000. INTEL CORPORATION
2007-08-16
2010-09-23
220. INTERNATIONAL BUSINESS MACHINES CORP
2004-08-11
2010-09-23
40. ISHARES BARCLAYS TIPS BOND FUND
2010-04-01
2010-06-17
1700. ISHARES RUSSELL 1000 INDEX FUND
2009-04-22
2010-01-07
300. CEF ISHARES TR S&P
2008-05-07
2010-06-17
3630. ISHARES SILVER TRUST
2009-10-27
2010-04-01
800. KRAFT FOODS INC-A COMMON
2007-08-10
2010-09-23
2050. KROGER COMPANY COMMON
2010-04-01
2010-09-23
500. ELI LILLY & CO
2007-11-27
2010-01-07
500. MARATHON OIL CORPORATION COMMON
2008-12-04
2010-01-07
2000. S & P 400 MID-CAP DEP RECPT COMMON
2010-01-07
340. MONSANTO CO COMMON
2009-04-22
2010-06-17
770. NUCOR CORPORATION
2010-04-01
2010-06-17
1100. PROCTOR AND GAMBLE COMPANY
2010-04-01
1000. PROGRESS ENERGY, INC
2004-03-04
2010-09-23
1000. QUALCOMM INC COMMON
2007-03-12
2010-11-24
500. RALCORP HLDGS INC NEW
2010-01-07
2010-09-23
400. SPDR GOLD TRUST
2008-12-04
2010-11-24
3230. AMEX FINANCIAL SELECT SPDR
2009-11-23
2010-01-07
1050. SUNCOR ENERGY, INC
2009-10-27
2010-09-23
3380. SYMANTEC CORP COMMON
2010-11-24
1000. SYSCO CORPORATION
2008-12-04
2010-04-01
1140. SYSCO CORPORATION
2009-11-23
2010-09-23
470. THE TRAVELERS COMPANIES INC.
2009-11-23
2010-11-24
1000. US BANCORP
2008-12-04
2010-04-01
200. UNITED TECHNOLOGIES CORPORATION
2008-05-29
2010-01-07
1322.579 VANGUARD GNMA FUND FUND 36
2009-04-09
2010-04-01
2824.744 VANGUARD GNMA FUND FUND 36
2009-10-27
2010-06-17
170.844 VANGUARD GNMA FUND FUND 36
2009-04-09
2010-06-17
1000. VERIZON COMMUNICATIONS INC
2010-09-23
3446.765 VIRTUS QUALITY SMALL CAP FUND CL I FUND
2009-10-27
2010-09-23
1390. VODAFONE GROUP PLC NEW SP ADR
2009-10-27
2010-09-23
1120. VODAFONE GROUP PLC NEW SP ADR
2009-10-27
2010-11-24
890. WELLPOINT INC
2009-04-22
2010-06-17
1580. WEATHERFORD INTL LTD
2010-01-07
2010-09-23
500. TRANSOCEAN LTD
2008-12-04
2010-06-17
(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
22,173
11,938
10,235
b
34,484
20,012
14,472
c
34,561
17,642
16,919
d
41,759
43,777
-2,018
e
26,979
26,403
576
33,559
31,195
2,364
38,340
28,010
10,330
30,803
30,963
-160
34,062
32,688
1,374
33,026
31,269
1,757
35,431
30,164
5,267
60,882
67,037
-6,155
33,128
38,394
-5,266
20,349
16,415
3,934
39,989
32,913
7,076
58,997
54,598
4,399
35,734
16,754
18,980
22,068
16,528
5,540
40,682
19,172
21,510
29,144
16,800
12,344
26,028
25,997
31
30,287
32,240
-1,953
53,641
46,581
7,060
24,583
23,565
1,018
8,708
6,492
2,216
91,388
54,189
37,199
250,000
250,508
-508
2,200
2,141
59
9,701
9,538
163
31,791
31,823
-32
29,134
28,728
406
9,741
9,538
203
1
1
42,921
38,259
4,662
17,664
16,846
818
25,849
16,224
9,625
34,140
30,511
3,629
20,315
29,723
-9,408
20,340
32,900
-12,560
38,340
46,300
-7,960
29,147
18,456
10,691
4,258
4,134
124
106,417
79,808
26,609
17,535
18,828
-1,293
63,633
60,134
3,499
25,192
25,495
-303
44,690
44,772
-82
17,630
25,399
-7,769
16,300
11,153
5,147
270,073
273,326
-3,253
16,993
27,210
-10,217
31,906
35,419
-3,513
69,805
54,243
15,562
44,029
47,080
-3,051
47,749
39,995
7,754
28,806
30,565
-1,759
53,629
30,297
23,332
48,966
47,933
1,033
33,022
37,093
-4,071
58,237
56,283
1,954
29,532
22,583
6,949
33,732
31,326
2,406
25,817
24,916
901
26,070
28,055
-1,985
14,072
14,054
18
14,138
14,152
-14
30,959
30,366
593
1,872
1,828
44
32,490
35,357
-2,867
33,399
30,366
3,033
35,486
31,608
3,878
29,053
25,468
3,585
48,544
37,306
11,238
26,797
30,984
-4,187
24,700
24,984
-284
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
10,235
b
14,472
c
16,919
d
-2,018
e
576
2,364
10,330
-160
1,374
1,757
5,267
-6,155
-5,266
3,934
7,076
4,399
18,980
5,540
21,510
12,344
31
-1,953
7,060
1,018
2,216
37,199
-508
59
163
-32
406
203
4,662
818
9,625
3,629
-9,408
-12,560
-7,960
10,691
124
26,609
-1,293
3,499
-303
-82
-7,769
5,147
-3,253
-10,217
-3,513
15,562
-3,051
7,754
-1,759
23,332
1,033
-4,071
1,954
6,949
2,406
901
-1,985
18
-14
593
44
-2,867
3,033
3,878
3,585
11,238
-4,187
-284
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
244,086
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 pages 13 and 17 of the instructions).
If (loss), enter -0- in Part I, line 8
.
.
.
.
.
.
.
.
.
.
.
.
.
3
Part V
Qualification Under Section 4940(e) for Reduced Tax on Net Investment Income
(For optional use by domestic private foundations subject to the section 4940(a) tax on net investment income.)
If section 4940(d)(2) applies, leave this part blank.
Was the foundation liable for the section 4942 tax on the distributable amount of any year in the base period?
Yes
No
If “Yes,” the foundation does not qualify under section 4940(e). Do not complete this part.
1
Enter the appropriate amount in each column for each year; see page 18 of the instructions before making any entries.
(a)
Base period years Calendar
year (or tax year beginning in)
(b)
Adjusted qualifying distributions
(c)
Net value of noncharitable-use assets
(d)
Distribution ratio
(col. (b) divided by col. (c))
2009
327,088
5,616,580
0.058236
2008
364,000
6,446,435
0.056465
2007
353,700
7,453,686
0.047453
2006
336,961
7,094,274
0.047498
2005
354,830
7,097,688
0.049992
2
Total
of line 1, column (d)
......................
2
0.259644
3
Average distribution ratio for the 5-year base period—divide 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
0.051929
4
Enter the net value of noncharitable-use assets for 2010 from Part X, line 5
.....
4
6,006,313
5
Multiply line 4 by line 3
.......................
5
311,901
6
Enter 1% of net investment income (1% of Part I, line 27b)
...........
6
3,738
7
Add lines 5 and 6
.........................
7
315,639
8
Enter qualifying distributions from Part XII, line 4
..............
8
283,868
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 on page 18.
Form
990-PF
(2010)
Form 990-PF (2010)
Page
4
Part VI
Excise Tax Based on Investment Income (Section 4940(a), 4940(b), 4940(e), or 4948—see page 18 of the instructions)
1a
Exempt operating foundations described in section 4940(d)(2), check here
and enter “N/A” on line 1.
Date of ruling or determination letter:
(attach copy of letter if necessary–see instructions)
b
Domestic foundations that meet the section 4940(e) requirements in Part V, check
1
7,476
here
and enter 1% of Part I, line 27b
...................
c
All other domestic foundations enter 2% of line 27b. Exempt foreign organizations enter 4% of Part I, line 12, col. (b)
2
Tax under section 511 (domestic section 4947(a)(1) trusts and taxable foundations only. Others enter -0-)
2
0
3
Add lines 1 and 2
............................
3
7,476
4
Subtitle A (income) tax (domestic section 4947(a)(1) trusts and taxable foundations only. Others enter -0-).
4
0
5
Tax based on investment income.
Subtract line 4 from line 3. If zero or less, enter -0-
.....
5
7,476
6
Credits/Payments:
a
2010 estimated tax payments and 2009 overpayment credited to 2010
6a
1,604
b
Exempt foreign organizations—tax withheld at source
.......
6b
c
Tax paid with application for extension of time to file (Form 8868)
6c
0
d
Backup withholding erroneously withheld
...........
6d
7
Total credits and payments. Add lines 6a through 6d
..............
7
1,604
8
Enter any
penalty
for underpayment of estimated tax.
Check here
if Form 2220 is attached.
8
0
9
Tax due.
If the total of lines 5 and 8 is more than line 7, enter
amount owed
.......
9
5,872
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 2011 estimated tax
Refunded
11
0
Part VII-A
Statements Regarding Activities
1a
During the tax year, did the foundation attempt to influence any national, state, or local legislation or did
Yes
No
it participate or intervene in any political campaign?
....................
1a
No
b
Did it spend more than $100 during the year (either directly or indirectly) for political purposes (see page 19 of
the instructions for definition)?
.............................
1b
No
If the answer is “Yes” to
1a
or
1b,
attach a detailed description of the activities and copies of any materials
published or distributed by the foundation in connection with the activities.
c
Did the foundation file
Form 1120-POL
for this year?
.....................
1c
No
d
Enter the amount (if any) of tax on political expenditures (section 4955) imposed during the year:
(1)
On the foundation.
$
(2)
On foundation managers.
$
e
Enter the reimbursement (if any) paid by the foundation during the year for political expenditure tax imposed
on foundation managers.
$
2
Has the foundation engaged in any activities that have not previously been reported to the IRS?
.......
2
No
If “Yes,” attach a detailed description of the activities.
3
Has the foundation made any changes, not previously reported to the IRS, in its governing instrument, articles
of incorporation, or bylaws, or other similar instruments?
If “Yes,” attach a conformed copy of the changes
....
3
No
4a
Did the foundation have unrelated business gross income of $1,000 or more during the year?
........
4a
No
b
If “Yes,” has it filed a tax return on
Form 990-T
for this year?
...................
4b
5
Was there a liquidation, termination, dissolution, or substantial contraction during the year?
.........
5
No
If “Yes,” attach the statement required by General Instruction T.
6
Are the requirements of section 508(e) (relating to sections 4941 through 4945) satisfied either:
By language in the governing instrument, or
By state legislation that effectively amends the governing instrument so that no mandatory directions
that conflict with the state law remain in the governing instrument?
................
6
Yes
7
Did the foundation have at least $5,000 in assets at any time during the year?
If “Yes,” complete Part II, col. (c), and Part XV.
7
Yes
8a
Enter the states to which the foundation reports or with which it is registered (see page 19 of the
instructions)
SC
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 2010 or the taxable year beginning in 2010 (see instructions for Part XIV on
page 27)?
If “Yes,” complete Part XIV
...........................
9
No
10
Did any persons become substantial contributors during the tax year?
If “Yes,” attach a schedule listing their names and addresses.
10
No
11
At any time during the year, did the foundation, directly or indirectly, own a controlled entity within the
meaning of section 512(b)(13)? If "Yes," attach schedule. (see page 20 of the instructions)
.......
11
No
12
Did the foundation acquire a direct or indirect interest in any applicable insurance contract before August 17, 2008?
12
No
13
Did the foundation comply with the public inspection requirements for its annual returns and exemption application?
13
Yes
Website address
14
The books are in care of
BRANCH BANKING & TRUST COMPANY
Telephone no.
(803) 251-1377
Located at
1901 ASSEMBLY ST 2ND FL
COLUMBIA
SC
ZIP+4
29201
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 2010, did the foundation have an interest in or a signature or other authority over
a bank, securities, or other financial account in a foreign country?
.................
16
No
See page 20 of the instructions for exceptions and filing requirements for Form TD F 90-22.1. If "Yes", enter the name of the foreign country
Form
990-PF
(2010)
Form 990-PF (2010)
Page
5
Part VII-B
Statements Regarding Activities for Which Form 4720 May Be Required
File Form 4720 if any item is checked in the “Yes” column, unless an exception applies.
Yes
No
1a
During the year did the foundation (either directly or indirectly):
(1)
Engage in the sale or exchange, or leasing of property with a disqualified person?
Yes
No
(2)
Borrow money from, lend money to, or otherwise extend credit to (or accept it from)
a disqualified person?
.........................
Yes
No
(3)
Furnish goods, services, or facilities to (or accept them from) a disqualified person?
Yes
No
(4)
Pay compensation to, or pay or reimburse the expenses of, a disqualified person?
Yes
No
(5)
Transfer any income or assets to a disqualified person (or make any of either available
for the benefit or use of a disqualified person)?
.................
Yes
No
(6)
Agree to pay money or property to a government official? (
Exception.
Check “No”
if the foundation agreed to make a grant to or to employ the official for a period
after termination of government service, if terminating within 90 days.)
.........
Yes
No
b
If any answer is “Yes” to 1a(1)–(6), did
any
of the acts fail to qualify under the exceptions described in Regulations
section 53.4941(d)-3 or in a current notice regarding disaster assistance (see page 20 of the instructions)?
...
1b
Organizations relying on a current notice regarding disaster assistance check here
.........
c
Did the foundation engage in a prior year in any of the acts described in 1a, other than excepted acts,
that were not corrected before the first day of the tax year beginning in 2010?
.............
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 2010, did the foundation have any undistributed income (lines 6d
and 6e, Part XIII) for tax year(s) beginning before 2010?
...............
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 year’s undistributed income? (If applying section 4942(a)(2)
to
all
years listed, answer “No” and attach statement—see page 20 of the 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 2010 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 2010.)
....................
3b
4a
Did the foundation invest during the year any amount in a manner that would jeopardize its charitable purposes?
4a
No
b
Did the foundation make any investment in a prior year (but after December 31, 1969) that could jeopardize its
charitable purpose that had not been removed from jeopardy before the first day of the tax year beginning in 2010?
4b
No
5a
During the year did the foundation pay or incur any amount to:
(1)
Carry on propaganda, or otherwise attempt to influence legislation (section 4945(e))?
Yes
No
(2)
Influence the outcome of any specific public election (see section 4955); or to carry
on, directly or indirectly, any voter registration drive?
...............
Yes
No
(3)
Provide a grant to an individual for travel, study, or other similar purposes?
Yes
No
(4)
Provide a grant to an organization other than a charitable, etc., organization described
in section 509(a)(1), (2), or (3), or section 4940(d)(2)? (see page 22 of the 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 page 22 of the instructions)?
5b
Organizations relying on a current notice regarding disaster assistance check here
.........
c
If the answer is “Yes” to question 5a(4), does the foundation claim exemption from the
tax because it maintained expenditure responsibility for the grant?
............
Yes
No
If “Yes,” attach the statement required by Regulations section 53.4945–5(d).
6a
Did the foundation, during the year, receive any funds, directly or indirectly, to pay
premiums on a personal benefit contract?
....................
Yes
No
b
Did the foundation, during the year, pay premiums, directly or indirectly, on a personal benefit contract?
....
6b
No
If “Yes” to 6b, file Form 8870.
7a
At any time during the tax year, was the foundation a party to a prohibited tax shelter transaction?
Yes
No
b
If yes, did the foundation receive any proceeds or have any net income attributable to the transaction?
....
7b
Form
990-PF
(2010)
Form 990-PF (2010)
Page
6
Part VIII
Information About Officers, Directors, Trustees, Foundation Managers, Highly Paid Employees,
and Contractors
1
List all officers, directors, trustees, foundation managers and their compensation (see page 22 of the 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
BRANCH BANKING & TRUST COMPANY
TRUSTEE
1
56,511
1901 ASSEMBLY ST
COLUMBIA
,
SC
29201
2
Compensation of five highest-paid employees (other than those included on line 1—see page 23 of the instructions).
If none, enter “NONE.”
(a)
Name and address of each employee paid more than $50,000
(b)
Title, and average
hours per week
devoted to position
(c)
Compensation
(d)
Contributions to
employee benefit
plans and deferred
compensation
(e)
Expense account,
other allowances
NONE
Total
number of other employees paid over $50,000
...................
0
3
Five highest-paid independent contractors for professional services (see page 23 of the instructions). If none, enter "NONE".
(a)
Name and address of each person paid more than $50,000
(b)
Type of service
(c)
Compensation
NONE
Total
number of others receiving over $50,000 for professional services
.............
0
Part IX-A
Summary of Direct Charitable Activities
List the foundation’s four largest direct charitable activities during the tax year. Include relevant statistical information such as the number of organizations and other beneficiaries served, conferences convened, research papers produced, etc.
Expenses
1
2
3
4
Form
990-PF
(2010)
Form 990-PF (2010)
Page
7
Part IX-B
Summary of Program-Related Investments
(see page 23 of the instructions)
Describe the two largest program-related investments made by the foundation during the tax year on lines 1 and 2.
Amount
1
2
All other program-related investments. See page 24 of the instructions.
3
Total.
Add lines 1 through 3
...........................
Part X
Minimum Investment Return
(All domestic foundations must complete this part. Foreign foundations,
see page 24 of the 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
6,097,780
b
Average of monthly cash balances
.......................
1b
0
c
Fair market value of all other assets (see page 24 of the instructions)
............
1c
0
d
Total
(add lines 1a, b, and c)
.........................
1d
6,097,780
e
Reduction claimed for blockage or other factors reported on lines 1a and
1c (attach detailed explanation)
..............
1e
0
2
Acquisition indebtedness applicable to line 1 assets
..................
2
0
3
Subtract line 2 from line 1d
..........................
3
6,097,780
4
Cash deemed held for charitable activities. Enter 1 1⁄2% of line 3 (for greater amount, see page 25
of the instructions)
............................
4
91,467
5
Net value of noncharitable-use assets.
Subtract line 4 from line 3. Enter here and on Part V, line 4
5
6,006,313
6
Minimum investment return.
Enter 5% of line 5
...................
6
300,316
Part XI
Distributable Amount
(see page 25 of the 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
300,316
2a
Tax on investment income for 2010 from Part VI, line 5
......
2a
7,476
b
Income tax for 2010. (This does not include the tax from Part VI.)
...
2b
c
Add lines 2a and 2b
............................
2c
7,476
3
Distributable amount before adjustments. Subtract line 2c from line 1
............
3
292,840
4
Recoveries of amounts treated as qualifying distributions
................
4
0
5
Add lines 3 and 4
.............................
5
292,840
6
Deduction from distributable amount (see page 25 of the instructions)
...........
6
0
7
Distributable amount
as adjusted. Subtract line 6 from line 5. Enter here and on Part XIII,
line 1
.................................
7
292,840
Part XII
Qualifying Distributions
(see page 25 of the 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
283,868
b
Program-related investments—total from Part IX-B
..................
1b
0
2
Amounts paid to acquire assets used (or held for use) directly in carrying out charitable, etc.,
purposes
................................
2
0
3
Amounts set aside for specific charitable projects that satisfy the:
a
Suitability test (prior IRS approval required)
....................
3a
0
b
Cash distribution test (attach the required schedule)
.................
3b
0
4
Qualifying distributions.
Add lines 1a through 3b. Enter here and on Part V, line 8, and Part XIII, line 4
4
283,868
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 page 26 of the instructions)
............
5
0
6
Adjusted qualifying distributions.
Subtract line 5 from line 4
...............
6
283,868
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
(2010)
Form 990-PF (2010)
Page
8
Part XIII
Undistributed Income
(see page 26 of the instructions)
(a)
Corpus
(b)
Years prior to 2009
(c)
2009
(d)
2010
1
Distributable amount for 2010 from Part XI, line 7
292,840
2
Undistributed income, if any, as of the end of 2010:
a
Enter amount for 2009 only
.......
261,798
b
Total for prior years:
2008
,
20
,
20
0
3
Excess distributions carryover, if any, to 2010:
a
From 2005
.......
0
b
From 2006
.......
0
c
From 2007
.......
0
d
From 2008
.......
0
e
From 2009
.......
0
f
Total
of lines 3a through e
.........
0
4
Qualifying distributions for 2010 from Part
XII, line 4:
$
283,868
a
Applied to 2009, but not more than line 2a
261,798
b
Applied to undistributed income of prior years
(Election required—see page 26 of the instructions)
0
c
Treated as distributions out of corpus (Election
required—see page 26 of the instructions)
...
0
d
Applied to 2010 distributable amount
.....
22,070
e
Remaining amount distributed out of corpus
0
5
Excess distributions carryover applied to 2010.
0
0
(If an amount appears in column (d), the
same amount must be shown in column (a).)
6
Enter the net total of each column as
indicated below:
a
Corpus. Add lines 3f, 4c, and 4e. Subtract line 5
0
b
Prior years’ undistributed income. Subtract
line 4b from line 2b
...........
0
c
Enter the amount of prior years’ undistributed
income for which a notice of deficiency has
been issued, or on which the section 4942(a)
tax has been previously assessed
......
0
d
Subtract line 6c from line 6b. Taxable
amount—see page 27 of the instructions
...
0
e
Undistributed income for 2009. Subtract line
4a from line 2a. Taxable amount—see page 27
of the instructions
...........
0
f
Undistributed income for 2010. Subtract
lines 4d and 5 from line 1. This amount must
be distributed in 2011
..........
270,770
7
Amounts treated as distributions out of
corpus to satisfy requirements imposed by
section 170(b)(1)(F) or 4942(g)(3) (see page 27
of the instructions)
...........
0
8
Excess distributions carryover from 2005 not
applied on line 5 or line 7 (see page 27 of the
instructions)
.............
0
9
Excess distributions carryover to 2011.
Subtract lines 7 and 8 from line 6a
......
0
10
Analysis of line 9:
a
Excess from 2006
....
0
b
Excess from 2007
....
0
c
Excess from 2008
....
0
d
Excess from 2009
....
0
e
Excess from 2010
....
0
Form
990-PF
(2010)
Form 990-PF (2010)
Page
9
Part XIV
Private Operating Foundations
(see page 27 of the 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 2010, 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)
2010
(b)
2009
(c)
2008
(d)
2007
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 test—enter:
(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 test—enter:
(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 year—see page 27 of the instructions.)
1
Information Regarding Foundation Managers:
a
List any managers of the foundation who have contributed more than 2% of the total contributions received by the foundation
before the close of any tax year (but only if they have contributed more than $5,000). (See section 507(d)(2).)
NONE
b
List any managers of the foundation who own 10% or more of the stock of a corporation (or an equally large portion of the
ownership of a partnership or other entity) of which the foundation has a 10% or greater interest.
NONE
2
Information Regarding Contribution, Grant, Gift, Loan, Scholarship, etc., Programs:
Check here
if the foundation only makes contributions to preselected charitable organizations and does not accept
unsolicited requests for funds. If the foundation makes gifts, grants, etc. (see page 28 of the instructions) to individuals or organizations
under other conditions, complete items 2a, b, c, and d.
a
The name, address, and telephone number of the person to whom applications should be addressed:
b
The form in which applications should be submitted and information and materials they should include:
c
Any submission deadlines:
d
Any restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other
factors:
Form
990-PF
(2010)
Form 990-PF (2010)
Page
10
Part XV
Supplementary Information
(continued)
3 Grants and Contributions Paid During the Year or Approved for Future Payment
Recipient
If recipient is an individual,
show any relationship to
any foundation manager
or substantial contributor
Foundation
status of
recipient
Purpose of grant or
contribution
Amount
Name and address (home or business)
a
Paid during the year
MARLBORO COUNTY GENERAL
HOSPITAL INC
P O BOX 677
BENNETTSVILLE
,
SC
29512
NONE
EXEMPT
GENERAL
204,551
MARLBORO PARK HOSPITAL
PO BOX 738
BENNETTEVILLE
,
SC
29512
NONE
EXEMPT
GENERAL
27,467
FRANCES MARION UNIVERSITY
NURSES SCHOLARSHIPS
PO BOX 100547
FLORENCE
,
SC
29501
NONE
EXEMPT
EDUCATIONAL
29,000
Total
.................................
3a
261,018
b
Approved for future payment
Total
..................................
3b
Form
990-PF
(2010)
Form 990-PF (2010)
Page
11
Part XVI-A
Analysis of Income-Producing Activities
Enter gross amounts unless otherwise indicated.
Unrelated business income
Excluded by section 512, 513, or 514
(e)
Related or exempt
function income
(See page 28 of
the 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
13,438
4
Dividends and interest from securities
....
14
150,082
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
244,086
9
Net income or (loss) from special events:
10
Gross profit or (loss) from sales of inventory
..
11
Other revenue:
a
LITIGATION SETTLE
01
154
b
c
d
e
12
Subtotal. Add columns (b), (d), and (e)
..
407,760
13
Total.
Add line 12, columns (b), (d), and (e)
...................
13
407,760
(See worksheet in line 13 instructions on page 28 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 organization’s exempt purposes (other than by providing funds for such purposes). (See
page 28 of the instructions.)
Form
990-PF
(2010)
Form 990-PF (2010)
Page
12
Part XVII
Information Regarding Transfers To and Transactions and Relationships With Noncharitable Exempt Organizations
1
Did the organization directly or indirectly engage in any of the following with any other organization described in section
Yes
No
501(c) of the Code (other than section 501(c)(3) organizations) or in section 527, relating to political organizations?
a
Transfers from the reporting foundation to a noncharitable exempt organization of:
(1)
Cash
....................................
1a(1)
No
(2)
Other assets
.................................
1a(2)
No
b
Other transactions:
(1)
Sales of assets to a noncharitable exempt organization
....................
1b(1)
No
(2)
Purchases of assets from a noncharitable exempt organization
..................
1b(2)
No
(3)
Rental of facilities, equipment, or other assets
.......................
1b(3)
No
(4)
Reimbursement arrangements
............................
1b(4)
No
(5)
Loans or loan guarantees
..............................
1b(5)
No
(6)
Performance of services or membership or fundraising solicitations
................
1b(6)
No
c
Sharing of facilities, equipment, mailing lists, other assets, or paid employees
..............
1c
No
d
If the answer to any of the above is “Yes,” complete the following schedule. Column
(b)
should always show the fair market value
of the goods, other assets, or services given by the reporting foundation. If the foundation received less than fair market value
in any transaction or sharing arrangement, show in column
(d)
the value of the goods, other assets, or services received.
(a)
Line No.
(b)
Amount involved
(c)
Name of noncharitable exempt organization
(d)
Description of transfers, transactions, and sharing arrangements
2a
Is the foundation directly or indirectly affiliated with, or related to, one or more tax-exempt organizations
described in section 501(c) of the Code (other than section 501(c)(3)) or in section 527?
...........
Yes
No
b
If “Yes,” complete the following schedule.
(a)
Name of organization
(b)
Type of organization
(c)
Description of relationship
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than taxpayer or fiduciary) is based on all information of which preparer has any knowledge.
Signature of officer or trustee
Date
Title
Preparer's Signature
Date
Check if self-
employed
PTIN
Firm's name
Firm's address
Firm's EIN
Phone no.
Form
990-PF
(2010)
Additional Data
Software ID:
Software Version:
Form 990PF - Special Condition Description:
Special Condition Description
-
TIN:
TY 2010 OtherDecreasesSchedule
Name:
MARLBORO COUNTY GENERAL HOSPITAL CHARITY
EIN:
57-0737029
Description
Amount
DIFF IN MUTUAL FDS REC/REPORTED
472
ADJUSTMENT FOR ROUNDING
4