Form990-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
2010
For calendar year 2010, or tax year beginning 01-01-2010 , and ending 12-31-2010
G
Check all that apply:
Name of foundation
ANNETTE J HAGENS MEMORIAL FOUNDATION
 

Number and street (or P.O. box number if mail is not delivered to street address)800 S OSPREY AVENUE   Room/suite
City or town, state, and ZIP code
SARASOTA, FL34236
A Employer identification number

65-6248208
B Telephone number (see page 10 of the instructions)

(941) 366-3600
C bullet
D 1. bullet
H Check type of organization:
2. bullet
I Fair market value of all assets at end
of year (from Part II, col. (c),
line 16)bullet$3,610,719J Accounting method:
 
(Part I, column (d) must be on cash basis.)
E bullet
F bullet
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)
Revenue 1 Contributions, gifts, grants, etc., received (attach schedule)  
2 Check bullet
3 Interest on savings and temporary cash investments 29,412 29,412  
4 Dividends and interest from securities...... 89,081 89,081  
5a Gross rents..............      
b Net rental income or (loss)  
6a Net gain or (loss) from sale of assets not on line 10 33,812
b Gross sales price for all assets on line 6a 461,925
7 Capital gain net income (from Part IV, line 2)... 33,812
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........ 152,305 152,305  
Operating and Administrative Expenses 13 Compensation of officers, directors, trustees, etc. 79,456 79,456   0
14 Other employee salaries and wages......        
15 Pension plans, employee benefits.......        
16a Legal fees (attach schedule).........        
b Accounting fees (attach schedule)....... Click to see attachment 1,900 1,900   0
c Other professional fees (attach schedule)....        
17 Interest...............        
18 Taxes (attach schedule) (see page 14 of the instructions) Click to see attachment 2,084 2,084   0
19 Depreciation (attach schedule) and depletion...      
20 Occupancy..............        
21 Travel, conferences, and meetings.......        
22 Printing and publications..........        
23 Other expenses (attach schedule).......        
24 Total operating and administrative expenses.
Add lines 13 through 23.......... 83,440 83,440   0
25 Contributions, gifts, grants paid........ 247,500 247,500
26 Total expenses and disbursements. Add lines 24 and 25 330,940 83,440   247,500
27 Subtract line 26 from line 12:
a Excess of revenue over expenses and disbursements -178,635
b Net investment income (if negative, enter -0-) 68,865
c Adjusted net income (if negative, enter -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
Assets 1 Cash—non-interest-bearing...............      
2 Savings and temporary cash investments.......... 169,713 98,186 98,186
3 Accounts receivable bullet  
Less: allowance for doubtful accounts bullet        
4 Pledges receivable bullet  
Less: allowance for doubtful accounts bullet        
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) bullet  
Less: allowance for doubtful accounts bullet        
8 Inventories for sale or use...............      
9 Prepaid expenses and deferred charges...........      
10a Investments—U.S. and state government obligations (attach schedule) 4,360 Click to see attachment1,960 1,960
b Investments—corporate stock (attach schedule)........ 2,033,855 Click to see attachment2,002,042 2,515,350
c Investments—corporate bonds (attach schedule)........ 997,032 Click to see attachment924,137 995,223
11 Investments—land, buildings, and equipment: basis bullet  
Less: accumulated depreciation (attach schedule) bullet        
12 Investments—mortgage loans..............      
13 Investments—other (attach schedule)...........      
14 Land, buildings, and equipment: basis bullet  
Less: accumulated depreciation (attach schedule) bullet        
15 Other assets (describe bullet)      
16 Total assets (to be completed by all filers—see the
instructions. Also, see page 1, item I) 3,204,960 3,026,325 3,610,719
Liabilities 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 bullet)    
23 Total liabilities (add lines 17 through 22).......... 0 0
Net Assets or Fund Balances bullet
and complete lines 24 through 26 and lines 30 and 31.
24 Unrestricted.................... 3,204,960 3,026,325
25 Temporarily restricted................    
26 Permanently restricted................    
bullet
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    
30 Total net assets or fund balances (see page 17 of the
instructions).................... 3,204,960 3,026,325
31 Total liabilities and net assets/fund balances (see page 17 of
the instructions).................. 3,204,960 3,026,325
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 3,204,960
2 Enter amount from Part I, line 27a...................... 2 -178,635
3 Other increases not included in line 2 (itemize) bullet 3 0
4 Add lines 1, 2, and 3.......................... 4 3,026,325
5 Decreases not included in line 2 (itemize) bullet 5 0
6 Total net assets or fund balances at end of year (line 4 minus line 5)—Part II, column (b), line 30.. 6 3,026,325
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 AIR PROD & CHEM INC P 2010-01-28 2010-10-26
b ETF ISHARES BARCLAYS CR BD FD P 2009-03-02 2010-01-28
c MFC ISHARES INTERMEDIATE P 2009-03-02 2010-01-28
d MFO PIMCO FDS PAC INVT MGMT P 2009-10-22 2010-05-11
e FPL GROUP INC P 2008-11-06 2010-05-11
DU PONT EI DE NEMOURS & CO P 2008-11-07 2010-04-30
FHLMC P 1997-06-30 2010-12-15
FRONTIER COMMUNICATIONS CORP P 2005-05-31 2010-10-26
MFC SECTOR SPDR TR SHS P 2008-05-16 2010-10-26
MFC VANGUARD INFORMATION TECH P 2007-10-30 2010-10-26
PHILIP MORRIS INTL P 2002-07-30 2010-10-26
PRAXAIR INC P 2005-01-25 2010-01-28
SCHLUMBERGER LTD P 2007-02-06 2010-10-26
SPDR DOW JONES REIT P 2008-09-09 2010-10-26
UB BANCORP P 2004-01-29 2010-01-28
WELLS FARGO & CO P 1999-10-13 2010-01-28
3M CO P 2001-06-05 2010-10-26
CAPITAL GAINS DIVIDENDS P    
(e) Gross sales price (f) Depreciation allowed
(or allowable) 		(g) Cost or other basis
plus expense of sale 		(h) Gain or (loss)
(e) plus (f) minus (g)
a 25,590   23,268 2,322
b 76,442   68,918 7,524
c 77,842   70,920 6,922
d 60,000   64,056 -4,056
e 26,504   21,978 4,526
50,000   50,812 -812
2,400   2,399 1
2,509   2,539 -30
18,690   18,930 -240
11,718   12,764 -1,046
11,798   4,869 6,929
22,836   12,558 10,278
13,830   13,074 756
30,384   35,758 -5,374
10,036   11,184 -1,148
2,860   2,097 763
18,066   11,989 6,077
420     420
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       2,322
b       7,524
c       6,922
d       -4,056
e       4,526
      -812
      1
      -30
      -240
      -1,046
      6,929
      10,278
      756
      -5,374
      -1,148
      763
      6,077
      420
2 Capital gain net income or (net capital loss) Bracket If gain, also enter in Part I, line 7
If (loss), enter -0- in Part I, line 7		 Bracket 2 33,812
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 . . . . . . . . . . . . . 		Bracket 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?
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 271,935 3,262,506 0.083352
2008 229,331 3,874,045 0.059197
2007 266,167 4,697,489 0.056662
2006 226,169 4,561,305 0.049584
2005 231,234 4,496,800 0.051422
2 Total of line 1, column (d) ...................... 2 0.300217
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 0.060043
4 Enter the net value of noncharitable-use assets for 2010 from Part X, line 5..... 4 3,413,395
5 Multiply line 4 by line 3....................... 5 204,950
6 Enter 1% of net investment income (1% of Part I, line 27b)........... 6 689
7 Add lines 5 and 6......................... 7 205,639
8 Enter qualifying distributions from Part XII, line 4.............. 8 247,500
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 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 Bulletand enter “N/A” on line 1. Bracket
Date of ruling or determination letter:   (attach copy of letter if necessary–see instructions)
b 1 689
hereBulletand 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............................ 3 689
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- ..... 5 689
6 Credits/Payments:
a 2010 estimated tax payments and 2009 overpayment credited to 2010 6a 810
b Exempt foreign organizations—tax 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.............. 7 810
8 Enter any penalty for underpayment of estimated tax. if Form 2220 is attached. Click to see attachment 8  
9 Tax due. If the total of lines 5 and 8 is more than line 7, enter amount owed.......Bullet 9  
10 Overpayment. If line 7 is more than the total of lines 5 and 8, enter the amount overpaid...Bullet 10 121
11 Enter the amount of line 10 to be: Credited to 2011 estimated taxBullet121 Refunded Bullet 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. bullet$ 0(2) On foundation managers.bullet$ 0
e
Enter the reimbursement (if any) paid by the foundation during the year for political expenditure tax imposed
on foundation managers.bullet$ 0
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)bulletFL
    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 addressbulletN/A
    14
    The books are in care ofbulletNORTHERN TRUST BANK OF FLORIDA NA Telephone no.bullet (941) 329-2627
    Located atbullet1515 RINGLING BLVDSARASOTAFL ZIP+4bullet34236
    15
    Section 4947(a)(1) nonexempt charitable trusts filing Form 990-PF in lieu of Form 1041.........bullet
    and enter the amount of tax-exempt interest received or accrued during the year ......bullet
    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 bullet  
    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?
    (2) Borrow money from, lend money to, or otherwise extend credit to (or accept it from)
    a disqualified person?.........................
    (3) Furnish goods, services, or facilities to (or accept them from) a disqualified person?
    (4) Pay compensation to, or pay or reimburse the expenses of, a disqualified person?
    (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)?.................
    (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.).........
    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
     
     
    .........bullet
    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?...............
    If “Yes,” list the years bullet20, 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
     
     
    c
    If the provisions of section 4942(a)(2) are being applied to any of the years listed in 2a, list the years here.
    bullet20, 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?.....................
    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))?
    (2) Influence the outcome of any specific public election (see section 4955); or to carry
    on, directly or indirectly, any voter registration drive?...............
    (3) Provide a grant to an individual for travel, study, or other similar purposes?
    (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)...
    (5) Provide for any purpose other than religious, charitable, scientific, literary, or
    educational purposes, or for the prevention of cruelty to children or animals?........
    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
     
     
    .........bullet
    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?............
    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?....................
    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?
    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
    NORMAN J SHEA III CPA TRUSTEE
    10.00     		33,403 0 0
    800 S OSPREY AVENUE
    SARASOTA,FL34236
    MATT A SPERLING TRUSTEE
    10.00     		33,403 0 0
    800 S OSPREY AVENUE
    SARASOTA,FL34236
    NORTHERN TRUST BANK OF FLORIDA NA TRUSTEE
    10.00     		12,650 0 0
    1515 RINGLING BLVD
    SARASOTA,FL34236
    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...................bullet 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.............bullet0
    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...........................bullet0
    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
    3,382,874
    b
    Average of monthly cash balances.......................
    1b
    82,502
    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
    3,465,376
    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
    3,465,376
    4
    Cash deemed held for charitable activities. Enter 1 1⁄2% of line 3 (for greater amount, see page 25
    of the instructions) ............................
    4
    51,981
    5
    Net value of noncharitable-use assets. Subtract line 4 from line 3. Enter here and on Part V, line 4
    5
    3,413,395
    6
    Minimum investment return. Enter 5% of line 5...................
    6
    170,670
    Part XI
    Distributable Amount bullet and do not complete this part.)
    1
    Minimum investment return from Part X, line 6....................
    1
    170,670
    2a
    Tax on investment income for 2010 from Part VI, line 5......
    2a
    689
    b
    Income tax for 2010. (This does not include the tax from Part VI.)...
    2b
     
    c
    Add lines 2a and 2b............................
    2c
    689
    3
    Distributable amount before adjustments. Subtract line 2c from line 1............
    3
    169,981
    4
    Recoveries of amounts treated as qualifying distributions................
    4
    0
    5
    Add lines 3 and 4.............................
    5
    169,981
    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
    169,981
    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
    247,500
    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
     
    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
    247,500
    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 page 26 of the instructions)............
    5
    689
    6
    Adjusted qualifying distributions. Subtract line 5 from line 4...............
    6
    246,811
    Note: The amount on line 6 will be used in Part V, column (b), in subsequent years when calculating whether the foundation qualifies for
    the section 4940(e) reduction of tax in those years.
    Form 990-PF (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 7 169,981
    2 Undistributed income, if any, as of the end of 2010:
    a Enter amount for 2009 only....... 0
    b Total for prior years:20, 20, 20 0
    3 Excess distributions carryover, if any, to 2010:
    a From 2005....... 9,350
    b From 2006....... 7,323
    c From 2007....... 33,247
    d From 2008....... 36,967
    e From 2009....... 110,090
    fTotal of lines 3a through e......... 196,977
    4Qualifying distributions for 2010 from Part
    XII, line 4: bullet$ 247,500
    a Applied to 2009, but not more than line 2a 0
    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..... 169,981
    e Remaining amount distributed out of corpus 77,519
    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).)
    6Enter the net total of each column as
    indicated below:
    a Corpus. Add lines 3f, 4c, and 4e. Subtract line 5 274,496
    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 ..........     		0
    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
    8Excess distributions carryover from 2005 not
    applied on line 5 or line 7 (see page 27 of the
    instructions) .............     		9,350
    9Excess distributions carryover to 2011.
    Subtract lines 7 and 8 from line 6a ......     		265,146
    10 Analysis of line 9:
    a Excess from 2006.... 7,323
    b Excess from 2007.... 33,247
    c Excess from 2008.... 36,967
    d Excess from 2009.... 110,090
    e Excess from 2010.... 77,519
    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.......bullet
     
    b Check box to indicate whether the organization is a private operating foundation described in section or
    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.)
    1Information Regarding Foundation Managers:
    aList 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).)
    bList 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.
    2Information Regarding Contribution, Grant, Gift, Loan, Scholarship, etc., Programs:
    Check here bullet
    aThe name, address, and telephone number of the person to whom applications should be addressed:
    ANNETTE J HAGENS MEMORIAL FOUNDATIO
    1515 RINGLING BLVD
    SARASOTA,FL34236
    (941) 329-2627
    bThe form in which applications should be submitted and information and materials they should include:
    DESIGNATED APPLICATION TO INCLUDE ORGANIZATION'S GENERAL INFORMATION & PURPOSE OF FUNDS REQUESTED.
    cAny submission deadlines:
    NONE
    dAny restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other
    factors:
    NO RESTRICTIONS EXCEPT FOR THE GEOGRAPHICAL AREA OF SARASOTA AND MANATEE COUNTIES.
    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)
    aPaid during the year
    BIG BROTHERS BIG SISTERS OF THE SUNCOAST INC
    101 W VENICE AVE 34
    VENICE,FL34285     		NONE 501(C)3 VOLUNTEER RECRUITMENT & OUTREACH 2,500
    BOYS & GIRLS CLUB OF MANATEE COUNTY
    6220 MANATEE AVE WEST SUITE 201
    BRADENTON,FL34209     		NONE 501(C)3 SUMMER CAMP 20,000
    BOYS & GIRLS CLUB OF SARASOTA COUNTY
    PO BOX 4068
    SARASOTA,FL34230     		NONE 501(C)3 SCHOLARSHIP PROGRAM 20,000
    BOYS & GIRLS CLUB OF SARASOTA COUNTY
    PO BOX 4068
    SARASOTA,FL34230     		NONE 501(C)3 SCHOLARSHIP PROGRAM 20,000
    RINGLING COLLEGE OF ART AND DESIGN
    2700 NORTH TAMIAMI TRAIL
    SARASOTA,FL34234     		NONE 501(C)3 SCHOLARSHIP PROGRAM 5,000
    BOYS & GIRLS CLUBS OF SARASOTA COUNTY
    PO BOX 4068
    SARASOTA,FL34230     		NONE 501(C)3 EXPAND TEEN PROGRAMING IN ALL AREA CLUBS 50,000
    BOYSCOUTS OF AMERICA-SOUTHWEST FLORIDA COUNCIL
    1801 BOY SCOUT DRIVE
    FORT MYERS,FL33907     		NONE 501(C)3 SCHOLARSHIP PROGRAM 2,500
    FIRST STEP OF SARASOTA INC
    1970 MAIN ST 5TH FLOOR
    SARASOTA,FL34236     		NONE 501(C)3 SCHOLARSHIP PROGRAM 5,000
    IN STRIDE
    PO BOX 365
    NOKOMIS,FL34274     		NONE 501(C)3 HIPPOTHERAPY SERVICES FOR PHYSICAL DISABILITIES 5,000
    MAST RESEARCH INSTITUTE
    100 SOUTH SCHOOL AVE
    SARASOTA,FL34239     		NONE 501(C)3 UNIVERSITY OF FLORIDA'S JUNIOR SCIENCE, ENGINEERING, 2,500
    MOST IMPROVED STUDENT INC
    1515 RINGLING BLVD
    SARASOTA,FL34236     		NONE 501(C)3 SCHOLARSHIP PROGRAM 10,000
    NIGHTLIFE CENTER
    6240 S TAMIAMI TRAIL
    SARASOTA,FL34231     		NONE 501(C)3 NIGHTLIFE GRILL TO HIRE KIDS 2,500
    SAMARITAN COUNSELING SERVICES
    3224 BEE RIDGE RD
    SARASOTA,FL34239     		NONE 501(C)3 CLIENT ASSISTANCE FUND 2,500
    SARASOTA CHRISTIAN SCHOOL YOUTH
    5415 BAHIA VISTA ST
    SARASOTA,FL34232     		NONE 501(C)3 SCHOLARSHIP PROGRAM 1,500
    SARASOTA COUNTY PARKS
    6700 CLARK ROAD
    SARASOTA,FL34241     		NONE 501(C)3 SCHOLARSHIP PROGRAM 7,500
    SARASOTA FAMILY YMCA
    1991 MAIN STREET SUITE 200
    SARASOTA,FL34236     		NONE 501(C)3 STRONG KIDS CAMPAIGN 10,000
    SARASOTA MANATEE ASSOCIATION FOR RIDING THERAPY INC
    4800 CR 675
    BRADENTON,FL34211     		NONE 501(C)3 SCHOLARSHIP PROGRAM 2,000
    SARASOTA HIGH SCHOOL BASKETBALL BOOSTER CLUB
    100 SOUTH SCHOOL AVE
    SARASOTA,FL34237     		NONE 501(C)3 UNIFORMS, GEAR & TRANSPORTATION COSTS 1,500
    POLICE ATHLETIC LEAGUE OF SARASOTA COUNTY
    2075 BAHIA VISTA STREET
    SARASOTA,FL34239     		NONE 501(C)3 CAMP PROGRAM 5,000
    SUNCOAST YOUTH BASKETBALL ASSOCIATION
    PO BOX 18456
    SARASOTA,FL34276     		NONE 501(C)3 SCHOLARSHIP PROGRAM 5,000
    SUNCOAST YOUTH BASKETBALL ASSOCIATION
    6503 WATERFORD CIRCLE
    SARASOTA,FL34238     		NONE 501(C)3 SCHOLARSHIP PROGRAM 1,000
    THE CHILDREN'S GUARDIAN FUND
    PO BOX 49722
    SARASOTA,FL34230     		NONE 501(C)3 GUARDIAN & LITEM PROGRAM 5,000
    THE FLORIDA CENTER FOR CHILD & FAMILY DEVELOPMENT INC
    4620 17TH ST
    SARASOTA,FL34235     		NONE 501(C)3 EARLY CHILDHOOD EDUCATION PROGRAM 5,000
    THE LINDSEY MAIBACH SCHOLARSHIP FUND
    2427 CARDWELL WAY
    SARASOTA,FL34231     		NONE 501(C)3 SCHOLARSHIP PROGRAM 5,000
    THE UPSIDE DOWN FOUNDATION INC
    PO BOX 17791
    SARASOTA,FL34276     		NONE 501(C)3 PRACTICING GOOD DECISIONS PROGRAM 5,000
    THE YMCA FOUNDATION OF SARASOTA INC
    ONE SOUTH SCHOOL AVENUE SUITE 302
    SARASOTA,FL34237     		NONE 501(C)3 Y-ACHIEVERS PROGRAM 5,000
    UNITED COMMUNITY CENTERS INC
    PO BOX 1683
    BRADENTON,FL34206     		NONE 501(C)3 SCHOLARSHIP PROGRAM 9,000
    WELLNESS COMMUNITY SW FLORIDA
    3900 CLARK ROAD
    SARASOTA,FL34233     		NONE 501(C)3 CHILDREN PROGRAMS & CONSTRUCTION COSTS FOR ART STUDIO 10,000
    RINGLING COLLEGE OF ART AND DESIGN
    2700 NORTH TAMIAMI TRAIL
    SARASOTA,FL34234     		NONE 501(C)3 SCHOLARSHIP PROGRAM 10,000
    SARASOTA AREA SPORTS AUTHORITY
    PO BOX 663
    SARASOTA,FL34230     		NONE 501(C)3 SCHOLARSHIP PROGRAM 2,500
    FAMILY NETWORK ON DISABILITIES
    6215 LORRAINE ROAD
    BRADENTON,FL34202     		NONE 501(C)3 RESPITE SERVICES PROGRAM 2,500
    SOUTHEASTERN GUIDE DOGS INC
    4210 77TH STREET EAST
    PALMETTO,FL34221     		NONE 501(C)3 PROVIDE & TRAIN DOG FOR SPECIAL NEEDS CHILDREN 2,500
    TAKE STOCK IN CHILDREN OF SARASOTA COUNTY INC
    PO BOX 48186
    SARASOTA,FL34230     		NONE 501(C)3 MENTORING PROGRAM 5,000
    Total .................................bullet 3a 247,500
    bApproved for future payment
    Total ..................................bullet 3b 0
    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.)
    1Program service revenue: (a)
    Business code     		(b)
    Amount     		(c)
    Exclusion code     		(d)
    Amount
    a
    b
    c
    d
    e
    f
    gFees and contracts from government agencies          
    2 Membership dues and assessments....          
    3Interest on savings and temporary cash investments         29,412
    4 Dividends and interest from securities....         89,081
    5 Net rental income or (loss) from real estate:
    aDebt-financed property......          
    bNot debt-financed property.....          
    6Net rental income or (loss) from personal property          
    7 Other investment income.....          
    8Gain or (loss) from sales of assets other than inventory         33,812
    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).. 0 0 152,305
    13Total. Add line 12, columns (b), (d), and (e)...................
    13152,305
    (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.
    DownArrow     		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.)
    3 THE FOUNDATION PROVIDES GRANTS TO QUALIFIED PUBLIC WELFARE CHARITIES
    4 EXCLUSIVELY TO HELP UNDERPRIVILEGED AND LOW INCOME YOUTHS AND
    8 FAMILIES WITHIN THE MEANING OF SECTION 501(C)3 OF THE INTERNAL
    11 REVENUE CODE.
    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?...........
    b
    If “Yes,” complete the following schedule.
    (a) Name of organization (b) Type of organization (c) Description of relationship
    SignHere
    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.
    Bullet Bullet
    Signature of officer or trustee Date Title
    PaidPreparersUseOnly Preparer's SignatureBullet Date PTIN
    Firm's namebullet



    Firm's addressbullet







         		Firm's EINbullet
    Phone no.
    Form 990-PF (2010)
    Additional Data


    Software ID:  
    Software Version:  


    Form 990PF - Special Condition Description:
    Special Condition Description

    TY 2010 AccountingFeesSchedule
    Name:
    ANNETTE J HAGENS MEMORIAL FOUNDATION
    EIN: 65-6248208
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    ACCOUNTING FEES 1,900 1,900   0

    TY 2010 InvestmentsCorpBondsSchedule
    Name:
    ANNETTE J HAGENS MEMORIAL FOUNDATION
    EIN: 65-6248208
    Name of Bond End of Year Book Value End of Year Fair Market Value
    GOLDMAN SACHS 50,552 53,368
    MFB NORTHERN HIGH YIELD FIXED INCOME FD 343,878 360,066
    DU PONT EI DE NEMOURS & CO 23,390 24,940
    DISNEY WALT CO NEW MEDIUM 51,602 53,250
    LOWES COS INC 49,749 53,947
    DEERE JOHN CAP CORP 50,019 53,480
    VERIZON GLOBAL FDG CORP 49,795 53,451
    ABBOTT LABS NT 49,660 53,895
    CISCO SYS INC SR NT 50,460 57,056
    HONEYWELL INTL INC 50,558 55,158
    JOHNSON & JOHNSON 51,505 58,738
    KIMBERLY-CLARK SR NT 52,985 62,648
    NATIONAL RURAL UTILS COOP 49,984 55,226
    ETF ISHARES BARCLAYS CREDIT BOND FUND 0 0
    MFC ISHARES TR BARCLAYS INTER CR BD FD 0 0

    TY 2010 InvestmentsCorpStockSchedule
    Name:
    ANNETTE J HAGENS MEMORIAL FOUNDATION
    EIN: 65-6248208
    Name of Stock End of Year Book Value End of Year Fair Market Value
    EXXON CORP 27,132 65,808
    GENERAL ELECTRIC 16,116 13,718
    INTEL CORP 35,788 42,060
    MICROSOFT CORP 24,408 41,880
    WELLS FARGO 39,838 58,881
    SYSCO 19,835 22,050
    MIDCAP SPDR TR UNIT 45,528 82,340
    CISCO SYSTEMS 47,250 40,460
    LOWES 27,431 37,620
    PEPSICO 35,096 52,264
    UNITED TECHNOLOGIES 32,223 70,848
    ISHARES TR MSCI EAFE INDEX 580,373 605,592
    ISHARES TR RUSSELL 2000 53,991 86,053
    ALTRIA GROUP 10,436 24,620
    3M COMPANY 35,967 51,780
    MCDONALDS CORP 14,000 61,408
    MEDCO HEALTH SOLUTIONS 17,891 45,953
    ISHARES TR MSCI EMERGE MKT 232,656 309,530
    U.S. BANCORP 58,716 56,637
    VERIZON COMMUNICATIONS 38,246 42,936
    PRAXAIR INC 0 0
    JOHNSON & JOHNSON 48,983 49,480
    MFC VANGUARD INFORMATION TECHNOLOGY 92,876 104,584
    SCHLUMBERGER LTD 35,954 45,925
    FPL GROUP INC 0 0
    MFC SECTOR SPDR TR SHS 22,085 22,050
    PHILIP MORRIS INTL INC 19,107 46,824
    SPECTRA ENERGY CORP 35,280 34,986
    SPDR DJ WILSHIRE REIT 0 0
    MFC SPDR GOLD TR 117,266 145,656
    MFO PIMCO FDS PAC INVT MGMT 71,327 85,791
    ABBOTT LABORATORIES 26,985 23,955
    MFC SELECT SECTOR SPDR TR FINANCIAL 21,585 23,925
    MFC SELECT SECTOR SPDR TR UTILS 27,252 28,206
    SPDR DOW JONES REIT ETF 90,421 91,530

    TY 2010 InvestmentsGovtObligationsSch
    Name:
    ANNETTE J HAGENS MEMORIAL FOUNDATION
    EIN: 65-6248208
    US Government Securities - End of Year Book Value:

    1,960
    US Government Securities - End of Year Fair Market Value:

    1,960
    State & Local Government Securities - End of Year Book Value:


    0
    State & Local Government Securities - End of Year Fair Market Value:


    0


    TY 2010 TaxesSchedule
    Name:
    ANNETTE J HAGENS MEMORIAL FOUNDATION
    EIN: 65-6248208
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    FOREIGN TAXES 2,084 2,084   0