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
CARLSON FAMILY FOUNDATION INC CO MARY N OWEN
 

Number and street (or P.O. box number if mail is not delivered to street address)206 BROOKGREEN DR   Room/suite
City or town, state, and ZIP code
CHAPEL HILL, NC27516
A Employer identification number

31-1678303
B Telephone number (see page 10 of the instructions)

(919) 604-0842
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$18,987,491J 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 25 25  
4 Dividends and interest from securities...... 344,718 344,718  
5a Gross rents.............. 396,067 396,067  
b Net rental income or (loss) 372,049
6a Net gain or (loss) from sale of assets not on line 10 107,923
b Gross sales price for all assets on line 6a 4,903,992
7 Capital gain net income (from Part IV, line 2)... 107,923
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........ 848,733 848,733  
Operating and Administrative Expenses 13 Compensation of officers, directors, trustees, etc. 136,500 0   136,500
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 6,500 3,250   3,250
c Other professional fees (attach schedule).... Click to see attachment 80,855 80,855   0
17 Interest...............        
18 Taxes (attach schedule) (see page 14 of the instructions) Click to see attachment 9,771 2,391   0
19 Depreciation (attach schedule) and depletion... Click to see attachment 178 178  
20 Occupancy..............        
21 Travel, conferences, and meetings....... 11,165 0   11,165
22 Printing and publications..........        
23 Other expenses (attach schedule)....... Click to see attachment 25,057 24,018   1,039
24 Total operating and administrative expenses.
Add lines 13 through 23.......... 270,026 110,692   151,954
25 Contributions, gifts, grants paid........ 736,109 736,109
26 Total expenses and disbursements. Add lines 24 and 25 1,006,135 110,692   888,063
27 Subtract line 26 from line 12:
a Excess of revenue over expenses and disbursements -157,402
b Net investment income (if negative, enter -0-) 738,041
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.......... 581,280 4,080,704 4,080,704
3 Accounts receivable bullet16
Less: allowance for doubtful accounts bullet   835 16 16
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........... 640    
10a Investments—U.S. and state government obligations (attach schedule) 689,301    
b Investments—corporate stock (attach schedule)........ 7,305,138 Click to see attachment6,759,457 8,881,309
c Investments—corporate bonds (attach schedule)........ 1,253,487 Click to see attachment176,045 275,462
11 Investments—land, buildings, and equipment: basis bullet5,750,000
Less: accumulated depreciation (attach schedule) bullet   6,300,000 Click to see attachment5,750,000 5,750,000
12 Investments—mortgage loans.............. 1,337,025    
13 Investments—other (attach schedule)...........      
14 Land, buildings, and equipment: basis bullet1,789
Less: accumulated depreciation (attach schedule) bullet1,789 178 Click to see attachment0 0
15 Other assets (describe bullet)      
16 Total assets (to be completed by all filers—see the
instructions. Also, see page 1, item I) 17,467,884 16,766,222 18,987,491
Liabilities 17 Accounts payable and accrued expenses..........   5,740
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 5,740
Net Assets or Fund Balances bullet
and complete lines 24 through 26 and lines 30 and 31.
24 Unrestricted....................    
25 Temporarily restricted................    
26 Permanently restricted................    
bullet
and complete lines 27 through 31.
27 Capital stock, trust principal, or current funds......... 18,454,523 18,454,523
28 Paid-in or capital surplus, or land, bldg., and equipment fund 0 0
29 Retained earnings, accumulated income, endowment, or other funds -986,639 -1,694,041
30 Total net assets or fund balances (see page 17 of the
instructions).................... 17,467,884 16,760,482
31 Total liabilities and net assets/fund balances (see page 17 of
the instructions).................. 17,467,884 16,766,222
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 17,467,884
2 Enter amount from Part I, line 27a...................... 2 -157,402
3 Other increases not included in line 2 (itemize) bullet 3 0
4 Add lines 1, 2, and 3.......................... 4 17,310,482
5 Decreases not included in line 2 (itemize) bulletClick to see attachment 5 550,000
6 Total net assets or fund balances at end of year (line 4 minus line 5)—Part II, column (b), line 30.. 6 16,760,482
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 PUBLICLY TRADED SECURITES P    
b PUBLICLY TRADED SECURITES P    
c CAPITAL GAINS DIVIDENDS P    
d
e
(e) Gross sales price (f) Depreciation allowed
(or allowable) 		(g) Cost or other basis
plus expense of sale 		(h) Gain or (loss)
(e) plus (f) minus (g)
a 799,485   746,463 53,022
b 4,104,433   4,049,606 54,827
c 74     74
d
e
Complete only for assets showing gain in column (h) and owned by the foundation on 12/31/69 (l) Gains (Col. (h) gain minus
col. (k), but not less than -0-) or
Losses (from col.(h))
(i) F.M.V. as of 12/31/69 (j) Adjusted basis
as of 12/31/69 		(k) Excess of col. (i)
over col. (j), if any
a       53,022
b       54,827
c       74
d
e
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 2 107,923
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 958,279 17,534,053 0.054652
2008 874,403 19,204,324 0.045532
2007 901,271 19,084,611 0.047225
2006 861,625 17,814,386 0.048367
2005 804,793 17,141,003 0.046951
2 Total of line 1, column (d) ...................... 2 0.242727
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 0.048545
4 Enter the net value of noncharitable-use assets for 2010 from Part X, line 5..... 4 18,007,194
5 Multiply line 4 by line 3....................... 5 874,159
6 Enter 1% of net investment income (1% of Part I, line 27b)........... 6 7,380
7 Add lines 5 and 6......................... 7 881,539
8 Enter qualifying distributions from Part XII, line 4.............. 8 888,063
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 7,380
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 7,380
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 7,380
6 Credits/Payments:
a 2010 estimated tax payments and 2009 overpayment credited to 2010 6a 1,633
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 1,633
8 Enter any penalty for underpayment of estimated tax. if Form 2220 is attached. 8 112
9 Tax due. If the total of lines 5 and 8 is more than line 7, enter amount owed.......Bullet 9 5,859
10 Overpayment. If line 7 is more than the total of lines 5 and 8, enter the amount overpaid...Bullet 10  
11 Enter the amount of line 10 to be: Credited to 2011 estimated taxBullet   Refunded Bullet 11  
Part VII-A
Statements Regarding Activities
1a
During the tax year, did the foundation attempt to influence any national, state, or local legislation or did
Yes
No
it participate or intervene in any political campaign? ....................
1a
 
No
b
Did it spend more than $100 during the year (either directly or indirectly) for political purposes (see page 19 of
the instructions for definition)?.............................
1b
 
No
If the answer is “Yes” to 1a or 1b, attach a detailed description of the activities and copies of any materials
published or distributed by the foundation in connection with the activities.
c
Did the foundation file Form 1120-POL for this year?.....................
1c
 
No
d
Enter the amount (if any) of tax on political expenditures (section 4955) imposed during the year:
(1) On the foundation. 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)bullet
    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 ofbulletJOHN A NORTON Telephone no.bullet (919) 604-0842
    Located atbullet1610 SKYE DRIVECHAPEL HILLNC ZIP+4bullet27516
    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
     
    No
    .........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
    JOHN A NORTON TREASURER
    10.00     		19,500 0 0
    1610 SKYE DRIVE
    CHAPEL HILL,NC27516
    MICHAEL A NORTON SECRETARY
    10.00     		19,500 0 0
    77 ALLEN ST
    ALLENDALE,NJ07401
    MARY N OWEN DIRECTOR
    10.00     		19,500 0 0
    206 BROOKGREEN DR
    CHAPEL HILL,NC27516
    PAUL S NORTON PRESIDENT
    10.00     		19,500 0 0
    39 DOLPHIN COVE QUAY
    STAMFORD,CT06902
    JAMES M NORTON DIRECTOR
    10.00     		19,500 0 0
    4614 HARRISON ST
    CHEVY CHASE,MD20815
    LENORE TRILBY NORTON VICE PRESIDENT
    10.00     		19,500 0 0
    APARTADO 130 28200 S L DE EL
    ESCORIAL
    MADRID SPAIN    
    SP
    ELAINE BOYLEN DIRECTOR
    10.00     		19,500 0 0
    28873 BONIFACE DRIVE
    MALIBU,CA90265
    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
    FIDUCIARY TRUST COMPANY INTERNATIONAL INVESTMENT SERVICES 80,855
    600 5TH STREET
    NEW YORK,NY10020
    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
    10,731,685
    b
    Average of monthly cash balances.......................
    1b
    1,799,730
    c
    Fair market value of all other assets (see page 24 of the instructions)............
    1c
    5,750,000
    d
    Total (add lines 1a, b, and c).........................
    1d
    18,281,415
    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
    18,281,415
    4
    Cash deemed held for charitable activities. Enter 1 1⁄2% of line 3 (for greater amount, see page 25
    of the instructions) ............................
    4
    274,221
    5
    Net value of noncharitable-use assets. Subtract line 4 from line 3. Enter here and on Part V, line 4
    5
    18,007,194
    6
    Minimum investment return. Enter 5% of line 5...................
    6
    900,360
    Part XI
    Distributable Amount bullet and do not complete this part.)
    1
    Minimum investment return from Part X, line 6....................
    1
    900,360
    2a
    Tax on investment income for 2010 from Part VI, line 5......
    2a
    7,380
    b
    Income tax for 2010. (This does not include the tax from Part VI.)...
    2b
     
    c
    Add lines 2a and 2b............................
    2c
    7,380
    3
    Distributable amount before adjustments. Subtract line 2c from line 1............
    3
    892,980
    4
    Recoveries of amounts treated as qualifying distributions................
    4
    0
    5
    Add lines 3 and 4.............................
    5
    892,980
    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
    892,980
    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
    888,063
    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
    888,063
    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
    7,380
    6
    Adjusted qualifying distributions. Subtract line 5 from line 4...............
    6
    880,683
    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 7 892,980
    2 Undistributed income, if any, as of the end of 2010:
    a Enter amount for 2009 only....... 610,565
    b Total for prior years:20, 20, 20 0
    3 Excess distributions carryover, if any, to 2010:
    a From 2005.......  
    b From 2006.......  
    c From 2007.......  
    d From 2008.......  
    e From 2009.......  
    fTotal of lines 3a through e......... 0
    4Qualifying distributions for 2010 from Part
    XII, line 4: bullet$ 888,063
    a Applied to 2009, but not more than line 2a 610,565
    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..... 277,498
    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).)
    6Enter 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 ..........     		615,482
    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) .............     		0
    9Excess distributions carryover to 2011.
    Subtract lines 7 and 8 from line 6a ......     		0
    10 Analysis of line 9:
    a Excess from 2006....  
    b Excess from 2007....  
    c Excess from 2008....  
    d Excess from 2009....  
    e Excess from 2010....  
    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:
    MARY N OWEN
    206 BROOKGREEN
    CHAPEL HILL,NC27516
    (919) 604-0842
    bThe form in which applications should be submitted and information and materials they should include:
    LETTER
    cAny submission deadlines:
    NONE
    dAny restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other
    factors:
    NONE
    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
    826 NATIONAL
    826 VALENCIA ST
    SAN FRANCISCO,CA94110     		NONE PUBLIC MAJOR GRANT 5,000
    ACHIEVEMENT ACADEMY OF DURHAM
    400 WEST MAIN ST SUITE 103
    DURHAM,NC27701     		NONE PUBLIC MAJOR GRANT 20,000
    ALZHEIMER'S ASSOCIATION NYC CHAPTER
    360 LEXINGTON AVE 4TH FLOOR
    NEW YORK,NY10017     		NONE PUBLIC MATCHING GRANT 100
    AMERICAN CANCER SOCIETY
    626 NORTH SHORE RD
    ABSECON,NJ08201     		NONE PUBLIC DISCRETIONARY 500
    AMERICAN CANCER SOCIETY
    626 NORTH SHORE RD
    ABSECON,NJ08201     		NONE PUBLIC MATCHING GRANT 325
    AMERICAN RED CROSS CONNECTICUT CHAPTER
    209 FARMINGTON AVENUE
    FARMINGTON,CT06032     		NONE PUBLIC MAJOR GRANT 5,000
    ANIMAL ADVOCATES ALLIANCE
    137 N LARCHMONT BLVD 708
    LOS ANGELES,CA90004     		NONE PUBLIC MATCHING GRANT 250
    ASOCIACION ANIDAN AYUDA NINOS DE AFRICA
    JULIAN HERNANDEZ 92428043
    MADRID    
    SP     		NONE 501 (C)(3) EQUIVALEN MAJOR GRANT 20,000
    ASOCIACION CYD SANTA MARIA
    SANTA LUCIA - 1-3 29004
    MALAGA    
    SP     		NONE 501 (C)(3) EQUIVALEN DISCRETIONARY 2,500
    AVANTE LENCOIS
    RUA MIGUEL DE JULETA
    TOMBA SURRAO    
    BR     		NONE 501 (C)(3) EQUIVALEN MAJOR GRANT 8,000
    BATH COUNTY 4-H COUNCIL
    2914 E HWY 60
    OWINGSVILLE,KY403608815     		NONE PUBLIC MAJOR GRANT 18,000
    BATH COUNTY AGRIC EXTENSION FOUNDATION INC
    2914 E HWY 60
    OWINGSVILLE,KY403608815     		NONE PUBLIC MAJOR GRANT 25,000
    BATH COUNTY HISTORICAL SOCIETY INC
    P O BOX 333
    OWINGSVILLE,KY40360     		NONE PUBLIC DISCRETIONARY 4,000
    BATH COUNTY HISTORICAL SOCIETY INC
    P O BOX 333
    OWINGSVILLE,KY40360     		NONE PUBLIC MAJOR GRANT 8,000
    BATH COUNTY HISTORICAL SOCIETY INC
    P O BOX 333
    OWINGSVILLE,KY40360     		NONE PUBLIC MATCHING GRANT 300
    BEST FRIENDS ANIMAL SOCIETY
    5001 ANGEL CANYON ROAD
    KANAB,UT847415000     		NONE PUBLIC MATCHING GRANT 400
    BIG BROTHERS AND SISTERS OF TRIANGLE
    1001 NAVAHO DR GL 150
    RALEIGH,NC27609     		NONE PUBLIC MAJOR GRANT 15,000
    BLUE GRASS COMMUNITY FOUNDATION
    250 WEST MAIN ST SUITE 1220
    LEXINGTON,KY405071714     		NONE PUBLIC DISCRETIONARY 4,000
    BLUE GRASS COMMUNITY FOUNDATION
    250 WEST 57TH STREET SUITE 1527
    LEXINGTON,KY405071714     		NONE PUBLIC MAJOR GRANT 26,000
    BOYS AND GIRLS CLUBS OF AMERICA
    1275 PEACHTREE STREET
    ATLANTA,GA303093506     		NONE PUBLIC DISCRETIONARY 1,500
    BRIDGEPORT RESCUE MISSION
    1088 FAIRFIELD AVE
    BRIDGEPORT,CT06605     		NONE PUBLIC MATCHING GRANT 100
    BROTHER'S BROTHER FOUNDATION
    1200 GALVESTON AVENUE
    PITTSBURGH,PA15233     		NONE PUBLIC DISCRETIONARY 1,000
    C & O CANAL TRUST INC
    7111 WOODLAND AVE
    TAKOMA PARK,MD20912     		NONE PUBLIC DISCRETIONARY 1,700
    C & O CANAL TRUST INC
    7111 WOODLAND AVE
    TAKOMA PARK,MD20912     		NONE PUBLIC DISCRETIONARY 300
    C & O CANAL TRUST INC
    7111 WOODLAND AVE
    TAKOMA PARK,MD20912     		NONE PUBLIC MAJOR GRANT 25,000
    C & O CANAL TRUST INC
    7111 WOODLAND AVE
    TAKOMA PARK,MD20912     		NONE PUBLIC MAJOR GRANT 10,000
    CACAPON AND LOST RIVERS LAND TRUST
    ROUTE 1 BOX 328
    HIGH VIEW,WV26808     		NONE PUBLIC MAJOR GRANT 5,000
    CAROLINA SAILING CLUB FOUNDATION
    P O BOX 91263
    RALEIGH,NC27675     		NONE PUBLIC MAJOR GRANT 5,000
    CATHOLIC CHARITIES
    715 NAZARETH STREET
    RALEIGH,NC27606     		NONE PUBLIC DISCRETIONARY 1,450
    CENTER FOR FOOD ACTION NJ
    192 WEST DEMAREST AVENUE
    ENGLEWOOD,NJ07631     		NONE PUBLIC MAJOR GRANT 10,000
    CENTER FOR FOOD ACTION NJ
    192 W DEMEREST AVENUE
    ENGLEWOOD,NJ07631     		NONE PUBLIC DISCRETIONARY 3,300
    CENTER FOR INTERNATIONAL REHABILITATION
    211 E ONTARIO SUITE 300
    CHICAGO,IL60611     		NONE PUBLIC MAJOR GRANT 20,000
    CENTRO ESPANOL DE WASHINGTON
    P O BOX 9485
    WASHINGTON,DC20016     		NONE PUBLIC DISCRETIONARY 1,000
    CHAPEL HILL CARRBORO YMCA
    980 MARTIN LUTHER KING JR BLVD
    CHAPEL HILL,NC27514     		NONE PUBLIC DISCRETIONARY 1,000
    CHAPEL HILLCARRBORO PUBLIC SCHOOL FOUNDATION
    P O BOX 877
    CARRBORO,NC27510     		NONE PUBLIC DISCRETIONARY 1,000
    CHILDREN OF FALLEN PATRIOTS FOUNDATION
    P O BOX 181
    OLD GREENWICH,CT06870     		NONE PUBLIC MATCHING GRANT 50
    CHILDREN'S AID AND FAMILY SERVICE
    200 ROBIN ROAD
    PARAMUS,NJ07652     		NONE PUBLIC MAJOR GRANT 6,000
    CHILDREN'S AID AND FAMILY SERVICE
    200 ROBIN ROAD
    PARAMUS,NJ07652     		NONE PUBLIC DISCRETIONARY 4,000
    CHRISTIAN SOCIAL SERVICE CENTER INC
    44 COLYE STREET
    OWINGSVILLE,KY40360     		NONE PUBLIC MAJOR GRANT 13,000
    COLLEGE TRACKS
    5126 MANNING DRIVE
    BETHESDA,MD20814     		NONE PUBLIC DISCRETIONARY 1,000
    COMMUNITIES IN SCHOOL OF ORANGE COUNTY INC
    P O BOX 9454
    CHAPEL HILL,NC27515     		NONE PUBLIC DISCRETIONARY 1,000
    CONCERNED CITIZENS OF ALLENDALE
    P O BOX 599
    ALLENDALE,NJ07401     		NONE PUBLIC MAJOR GRANT 25,000
    CONNECTICUT FUND FOR THE ENVIRONMENT
    205 WHITNEY AVE 1ST FLOOR
    NEW HAVEN,CT06511     		NONE PUBLIC MAJOR GRANT 5,000
    CRESTED BUTTE LAND TRUST
    P O BOX 2224
    CRESTED BUTTE,CO81224     		NONE PUBLIC DISCRETIONARY 1,000
    DIVINE WORD MISSIONARIES
    P O BOX 6099
    TECHNY,IL600826099     		NONE PUBLIC DISCRETIONARY 3,000
    DURHAM RESCUE MISSION
    P O BOX 11368
    DURHAM,NC27703     		NONE PUBLIC DISCRETIONARY 1,000
    ECOTONO
    RONDA DE TOLEDO 20 PORTAL B 1 A
    MADRID    
    SP     		NONE 501 (C)(3) EQUIVALEN DISCRETIONARY 5,000
    EQUALITY NOW
    250 WEST 57TH STREET SUITE 1527
    NEW YORK,NY10107     		NONE PUBLIC MAJOR GRANT 15,000
    EXTRAORDINARY VENTURES
    ELLIOT ROAD
    CHAPEL HILL,NC27514     		NONE PUBLIC DISCRETIONARY 500
    FAMILY CENTERS INC
    40 ARCH ST
    GREENWICH,CT06830     		NONE PUBLIC MAJOR GRANT 5,000
    FOOD FOR THE POOR
    6401 LYONS ROAD
    COCONUT CREEK,FL33073     		NONE PUBLIC MATCHING GRANT 200
    FRED HUTCHINSON CANCER RESEARCH CENTER
    P O BOX 19024 J5-200
    SEATTLE,WA981091024     		NONE PUBLIC MAJOR GRANT 10,000
    FRIEND FOR EARLIER BREAST CANCER TEST
    2407 DENT STREET
    GREENSBORO,NC27408     		NONE PUBLIC MAJOR GRANT 10,000
    FRIENDS OF BLACKWATER
    501 ELIZABETH STREET
    CHARLESTON,WV25311     		NONE PUBLIC MAJOR GRANT 10,000
    FRIENDS OF ROCK CREEK'S ENVIRONMENT INC
    9019 SPRING HILL LANE
    CHEVY CHASE,MD20815     		NONE PUBLIC MAJOR GRANT 5,000
    GIRLS SCOUTS OF USA TROOP 40336
    737 MIDLAND BLVD
    UNION,NJ07083     		NONE PUBLIC DISCRETIONARY 1,200
    GOD'S LOVE WE DELIVER
    166 AVENUE OF THE AMERICAS
    NEW YORK,NY10013     		NONE PUBLIC MAJOR GRANT 10,000
    HACKENSACK UNIVERSITY MEDICAL CENTER FOUNDATION
    360 ESSEX STREET SUITE 301
    HACKENSACK,NJ07601     		NONE PUBLIC DISCRETIONARY 1,500
    HOPE FOR HAITI
    1042 6TH AVE N
    NAPLES,FL34102     		NONE PUBLIC DISCRETIONARY 1,000
    INTER FAITH COUNCIL FOR SOCIAL SERVICE
    110 W MAIN STREET
    CARRBORO,NC27510     		NONE PUBLIC MAJOR GRANT 12,500
    JOHN AVERY BOYS AND GIRLS CLUB
    P O BOX 446
    DURHAM,NC27702     		NONE PUBLIC MAJOR GRANT 15,000
    KARMA RESCUE INC
    1158 26 STREET 155
    SANTA MONICA,CA90403     		NONE PUBLIC DISCRETIONARY 1,000
    LEUKEMIA & LYMPHOMA SOCIETY NORTHERN NEW JERSEY
    14 COMMERCE DR SUITE 301
    CRANFORD,NJ07016     		NONE PUBLIC MAJOR GRANT 25,000
    LEUKEMIA & LYMPHOMA SOCIETY RI CHAPTER
    1150 PONTIAC AVE SUITE 1
    CRANSTON,RI02920     		NONE PUBLIC DISCRETIONARY 9,250
    LEUKEMIA & LYMPHOMA SOCIETY
    1311 MAMARONECK AVE
    WHITE PLAINS,NY10605     		NONE PUBLIC DISCRETIONARY 1,500
    LEUKEMIA & LYMPHOMA SOCIETY
    1311 MAMARONECK AVE
    WHITE PLAINS,NY10605     		NONE PUBLIC DISCRETIONARY 50
    LITTLE FALLS WATERSHED ALLIANCE INC
    5015 WESTPORT ROAD
    CHEVY CHASE,MD20815     		NONE PUBLIC MAJOR GRANT 5,000
    LIVESTRONG CHALLENGE
    2201 E SIXTH STREET
    AUSTIN,TX78702     		NONE PUBLIC DISCRETIONARY 500
    MALIBU FOR YOUTH AND FAMILIES
    P O BOX 6393
    MALIBU,CA90264     		NONE PUBLIC DISCRETIONARY 1,000
    MARYKNOLL SISTERS
    10 PINEBRIDGE ROAD
    MARYKNOLL,NY10545     		NONE PUBLIC MATCHING GRANT 200
    MONTGOMERY COUNTY CERT
    101 MONROE STREET 112TH FLOOR
    ROCKVILLE,MD20850     		NONE PUBLIC DISCRETIONARY 1,000
    MUSIC MAKER RELIEF FOUNDATION
    224 WEST CORBIN STREET
    HILLSBOROUGH,NC27278     		NONE PUBLIC DISCRETIONARY 2,000
    NATIONAL MS SOCIETY
    1800 M STREET NEW SUITE 750 SOUTH
    WASHINGTON,DC20036     		NONE PUBLIC DISCRETIONARY 500
    NATIONAL MS SOCIETY
    1800 M STREET NEW SUITE 750 SOUTH
    WASHINGTON,DC20036     		NONE PUBLIC DISCRETIONARY 250
    NEW COVENANT HOUSE
    P O BOX 10883
    STAMFORD,CT06904     		NONE PUBLIC DISCRETIONARY 1,000
    NEW JERSEY CONVERVATION FOUNDATION
    170 LONGVIEW ROAD
    FAR HILLS,NJ07931     		NONE PUBLIC MAJOR GRANT 5,000
    NORTH CAROLINA SYMPHONY
    4350 LASSITER AT NORTH HILLS SUITE
    250
    RALEIGH,NC27609     		NONE PUBLIC MATCHING GRANT 50
    NORTH CAROLINA COASTAL FEDERATION
    3609 HIGHWAY 24 OCEAN
    NEWPORT,NC28570     		NONE PUBLIC MAJOR GRANT 15,000
    OPEN DOOR DENTAL CLINIC OF ALAMANCE COUNTY
    P O BOX 1744
    BURLINGTON,NC272161744     		NONE PUBLIC DISCRETIONARY 2,000
    ORPHANAID AFRICIA
    268 BUSH STREET SUITE 3100
    SAN FRANCISCO,CA94104     		NONE PUBLIC MAJOR GRANT 10,000
    OWINGSVILLE LION'S CLUB
    221 RIDGEWAY ROAD
    OWINGSVILLE,KY40360     		NONE PUBLIC DISCRETIONARY 4,500
    OWINGSVILLE BATH COUNTY PARKS
    P O BOX 639
    OWINGSVILLE,KY40360     		NONE PUBLIC MATCHING GRANT 634
    PLATAFORMA CIUDADANA ESCURIAIENSE
    TIMOTEO PADROS 5BL E-3-E 28200 SAN
    MADRID    
    SP     		NONE 501 (C)(3) EQUIVALEN DISCRETIONARY 3,000
    POTOMAC CONSERVANCY
    8601 GEORGIA AVENUE STE 612
    SILVER SPRING,MD20910     		NONE PUBLIC MAJOR GRANT 10,000
    POTOMAC CONSERVANCY
    8601 GEORGIA AVENUE STE 612
    SILVER SPRING,MD20910     		NONE PUBLIC DISCRETIONARY 9,850
    PROJECT REBIRTH
    163 WILLIAM STREET 4TH FLOOR
    NEW YORK,NY10038     		NONE PUBLIC MAJOR GRANT 10,000
    ROCHESTER INSTITUTE OF TECHNOLOGY
    116 LOMB MEMORIAL DRIVE
    ROCHESTER,NY146235608     		NONE PUBLIC MATCHING GRANT 100
    RONALD MCDONALD HOUSE
    101 OLD MASON FARM ROAD
    CHAPEL HILL,NC27514     		NONE PUBLIC MAJOR GRANT 7,500
    SALVATION ARMY
    P O BOX 1330
    DURHAM,NC277021330     		NONE PUBLIC DISCRETIONARY 1,000
    SCHOLARSHIP FUND FOR INNER CITY CHILDREN
    171 CLIFTON AVENUE PO BOX 9500
    NEWARK,NJ071049500     		NONE PUBLIC MAJOR GRANT 10,000
    SECU FAMILY HOUSE
    123 OLD MASON FARM ROAD
    CHAPEL HILL,NC27517     		NONE PUBLIC DISCRETIONARY 2,000
    SHARE YOUR CHRISTMAS
    300 N DUKE STREET
    DURHAM,NC27702     		NONE PUBLIC DISCRETIONARY 1,000
    SHARPSBURG HISTORICAL SOCIETY INC
    P O BOX 513
    SHARPSBURG,MD21782     		NONE PUBLIC DISCRETIONARY 1,000
    SOCIETY OF ST ANDREW
    3383 SWEET HOLLOW ROAD
    BIG ISLAND,VA24526     		NONE PUBLIC DISCRETIONARY 500
    SOUND WATERS
    1281 COVE ROAD
    STAMFORD,CT06902     		NONE PUBLIC MAJOR GRANT 5,000
    SOUND WATERS
    1281 COVE ROAD
    STAMFORD,CT06902     		NONE PUBLIC DISCRETIONARY 1,000
    SOUTHWEST INDIAN FOUNDATION INC
    P O BOX 307
    GALLUP,NM87301     		NONE PUBLIC MATCHING GRANT 400
    SPECIAL OLYMPICS CONNECTICUT INC
    2666 STATE STREET SUITE 1
    HAMDEN,CT065172232     		NONE PUBLIC MATCHING GRANT 50
    SPECIAL OLYMPICS NEW YORK
    819 GRAND BOULEVARD SUITE 3
    DEER OARK,NY11729     		NONE PUBLIC DISCRETIONARY 500
    SPECIAL OLYMPICS ORANGE COUNTY
    200 PLANT ROAD
    CHAPEL HILL,NC27514     		NONE PUBLIC DISCRETIONARY 1,000
    ST LUKE'S LIFEWORKS
    141 FRANKLIN STREET
    STAMFORD,CT06901     		NONE PUBLIC MAJOR GRANT 20,000
    STAMFORD SAILING FOUNDATION INC
    151 HARVARD AVE
    STAMFORD,CT06902     		NONE PUBLIC MAJOR GRANT 25,000
    STAMFORD SAILING FOUNDATION INC
    151 HARVARD AVE
    STAMFORD,CT06902     		NONE PUBLIC DISCRETIONARY 5,000
    STAMFORD SAILING FOUNDATION INC
    151 HARVARD AVE
    STAMFORD,CT06902     		NONE PUBLIC MATCHING GRANT 2,500
    TABLE MINISTRIES INC
    205 W WEAVER ST
    CARRBORO,NC27510     		NONE PUBLIC DISCRETIONARY 2,000
    THE ARC OF ORANGE COUNTY
    1777 FORDHAM BLVD SUITE 201
    CHAPEL HILL,NC27514     		NONE PUBLIC DISCRETIONARY 5,000
    THE BLUE GRASS SHIH TZU RESCUE INC
    P O BOX 910276
    LEXINGTON,KY40591     		NONE PUBLIC MATCHING GRANT 200
    THE PORTABLE PLAYHOUSE INC
    425 MAIN STREET
    FOREST CITY,PA18421     		NONE PUBLIC MAJOR GRANT 9,000
    THE RANGER FOUNDATION INC
    5564 PORTERSTOWN ROAD
    KEEDYSVILLE,MD21756     		NONE PUBLIC DISCRETIONARY 500
    THE WATERSIDE SCHOOL
    535 FAIRFIELD AVE
    STAMFORD,CT06902     		NONE PUBLIC DISCRETIONARY 1,000
    THE WOMEN'S CENTER
    P O BOX 1057
    CHAPEL HILL,NC27514     		NONE PUBLIC MAJOR GRANT 10,000
    TOUCH FOUNDATION INC
    P O BOX 1420
    NEW YORK,NY10150     		NONE PUBLIC MAJOR GRANT 7,000
    TRIANGLE RESIDENTIAL OPTIONS FOR SUBSTANCE ABUSERS INC
    1820 JAMES STREET
    DURHAM,NC27707     		NONE PUBLIC MAJOR GRANT 10,000
    UNC LINEBERGER COMPREHENSIVE CANCER CTR
    UNIVERSITY/NORTH CAROLINA
    CHAPEL HILL,NC27599     		NONE PUBLIC MAJOR GRANT 25,000
    UNC-TV
    P O BOX 14900
    RESEARCH TRIANGLE PARK,NC277094900     		NONE PUBLIC DISCRETIONARY 1,000
    WESTHAB INC
    85 EXECUTIVE BLVD
    ELMSFORD,NY10523     		NONE PUBLIC MAJOR GRANT 15,000
    WOLF RUN WILDLIFE REFUGE INC
    7376 OLD DANVILLE RD
    NICHOLASVILLE,KY40356     		NONE PUBLIC DISCRETIONARY 400
    WOMEN FOR WOMEN FOUNDATION INC
    2825 PROFESSIONAL PLACE SUITE 201
    COLORADO SPRINGS,CO80904     		NONE PUBLIC MAJOR GRANT 15,000
    WUNC RADIO
    120 FRDIAY CENTER DRIVE
    CHAPEL HILL,NC27517     		NONE PUBLIC DISCRETIONARY 1,000
    YERWOOD CENTER
    90 FAIRFIELD AVE
    STAMFORD,CT06902     		NONE PUBLIC MAJOR GRANT 10,000
    YOUNG SURVIVAL COALITION
    61 BROADWAY SUITE 2235
    NEW YORK,NY10006     		NONE PUBLIC DISCRETIONARY 500
    YOUTH QUEST INC
    1515 W NC HIGHWAY 54 SUISTE 220
    DURHAM,NC277075574     		NONE PUBLIC MAJOR GRANT 10,000
    Total .................................bullet 3a 736,109
    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     14 25  
    4 Dividends and interest from securities....     14 344,718  
    5 Net rental income or (loss) from real estate:
    aDebt-financed property......          
    bNot debt-financed property.....     16 372,049  
    6Net rental income or (loss) from personal property          
    7 Other investment income.....          
    8Gain or (loss) from sales of assets other than inventory     18 107,923  
    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).. 0 824,715 0
    13Total. Add line 12, columns (b), (d), and (e)...................
    13824,715
    (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.)
    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:
    CARLSON FAMILY FOUNDATION INC CO MARY N OWEN
    EIN: 31-1678303
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    CARNEIRO, CHUMNEY & COMPANY 6,500 3,250   3,250

    Note: To capture the full content of this document, please select landscape mode (11" x 8.5") when printing.

    TY 2010 DepreciationSchedule
    Name:
    CARLSON FAMILY FOUNDATION INC CO MARY N OWEN
    EIN: 31-1678303
    Description of Property Date Acquired Cost or Other Basis Prior Years' Depreciation Computation Method Rate /
    Life (# of years)    		 Current Year's Depreciation Expense Net Investment Income Adjusted Net Income Cost of Goods Sold Not Included
    LAND 2000-07-31 5,750,000   L   0 0    
    COMPUTER 2005-04-21 1,789 1,611 ADS 5.000000000000 178 119    

    TY 2010 InvestmentsCorpBondsSchedule
    Name:
    CARLSON FAMILY FOUNDATION INC CO MARY N OWEN
    EIN: 31-1678303
    Name of Bond End of Year Book Value End of Year Fair Market Value
    PEABODY ENERGY CORP 125,000 4.75% 12/15/66 91,045 162,344
    APACHE CORP 1,700 CONV PFD 6.00% 85,000 113,118

    TY 2010 InvestmentsCorpStockSchedule
    Name:
    CARLSON FAMILY FOUNDATION INC CO MARY N OWEN
    EIN: 31-1678303
    Name of Stock End of Year Book Value End of Year Fair Market Value
    SCHLUMBERGER LTD 1500 SHS 69,708 125,250
    CHEVRON CORP 2000 SHS 64,151 182,500
    ANADARKO PETROLEUM CORP 2000 SHS 88,182 152,320
    CONOCOPHILLIPS 2164 SHS 59,350 147,368
    DEVON ENERGY CORP NEW 2000 SHS 105,331 157,020
    AIR PRODUCTS & CHEMICALS INC 2000 SHS 121,324 181,900
    BHP BILLITON KIMITED SPON ADR 1500 SHS 62,370 139,380
    FREEPORT MCMORAN COPPER & GOLD INC 1729 SHS 54,836 207,636
    EMERSON ELECTRIC CO 2000 SHS 84,500 114,340
    GENERAL ELECTRIC CO 4800 SHS 80,241 87,792
    HONEYWELL INTL INC 3000 SHS 68,137 159,480
    ABB LTD 6500 SHS 142,976 145,925
    ITT CORP 2000 SHS 104,403 104,220
    UNITED PARCEL SVC INC 1500 SHS 97,729 108,870
    NIKE INC CL B 1500 SHS 79,355 128,130
    MCDONALDS CORP 3000 SHS 46,470 230,280
    HOME DEPOT INC 4000 SHS 95,680 140,240
    CVS CAREMARK CORP 4400 SHS 69,961 152,988
    PEPSICO INC 2400 SHS 64,237 156,792
    NESTLE SA SPONSORED ADR 3500 SHS 37,125 205,870
    PROCTOR & GAMBLE CO 1950 SHS 87,575 125,444
    LABORATORY CORP AMER HDLGS 1200 SHS 90,341 105,504
    CELGENE CORP 2500 SHS 132,921 147,850
    GILEAD SCIENCES INC 4500 SHS 191,165 163,080
    JOHNSON & JOHNSON CO 2000 SHS 49,800 123,700
    TEVA PHARMACEUTICALS INDS LTD ADR 3000 SHS 80,910 156,390
    ABBOTT LABORATORIES 3000 SHS 121,542 143,730
    MERCK & CO INC 4000 SHS 137,398 144,160
    US BANCORP DEL 4000 SHS 87,947 107,880
    BLACKROCK INC 700 SHS 114,562 133,406
    VISA INC 1400 SHS 74,203 98,532
    INVESCO LIMITED 4000 SHS 54,108 96,240
    REGENCY CTRS CORP 2000 SHS 116,137 84,480
    MICROSOFT CORP 3400 SHS 54,888 94,928
    NOKIA CORP ADR 5500 SHS 86,893 56,760
    QUALCOMM INC 3000 SHS 113,277 148,470
    RESEARCH IN MOTION LTD 2500 SHS 134,939 145,325
    CISCO SYSTEMS INC 5500 SHS 43,973 111,265
    EMC CORP 7800 SHS 134,034 178,620
    AGILENT TECHNOLOGIES INC 5000 SHS 109,298 207,150
    ANALOG DEVICES INC 4000 SHS 120,141 150,680
    AT&T INC 4500 SHS 95,415 132,210
    VERIZON COMMUNICATIONS 4000 SHS 154,294 143,120
    VODAFONE GROUP PLC 5500 SHS 132,398 145,365
    S & P 500 DEPOSITORY RECEIPTS 16900 UNITS 1,954,945 2,125,175
    TEMPLETON GLOBAL SMALLER COS FD 78328.11 SHS 690,287 583,544

    TY 2010 InvestmentsLandSchedule2
    Name:
    CARLSON FAMILY FOUNDATION INC CO MARY N OWEN
    EIN: 31-1678303
    Category/ Item Cost/Other Basis Accumulated Depreciation Book Value End of Year Fair Market Value
    LAND 5,750,000 0 5,750,000 0

    TY 2010 LandEtcSchedule2
    Name:
    CARLSON FAMILY FOUNDATION INC CO MARY N OWEN
    EIN: 31-1678303
    Category / Item Cost / Other Basis Accumulated Depreciation Book Value End of Year Fair Market Value
    COMPUTER 1,789 1,789   0


    TY 2010 OtherDecreasesSchedule
    Name:
    CARLSON FAMILY FOUNDATION INC CO MARY N OWEN
    EIN: 31-1678303
    Description Amount
    DECREASE IN APPRAISED FMV OF LAND 550,000


    TY 2010 OtherExpensesSchedule
    Name:
    CARLSON FAMILY FOUNDATION INC CO MARY N OWEN
    EIN: 31-1678303
    Description Revenue and Expenses per Books Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    OFFICE 306 0   306
    BANK CHARGES 124 0   124
    DUES AND SUBSCRIPTIONS 550 0   550
    POSTAGE 59 0   59
    INSURANCE 24,018 24,018   0


    TY 2010 OtherProfessionalFeesSchedule
    Name:
    CARLSON FAMILY FOUNDATION INC CO MARY N OWEN
    EIN: 31-1678303
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    INVESTMENT FEES-FIDUCIARY TRUST COMPANY 80,855 80,855   0


    TY 2010 TaxesSchedule
    Name:
    CARLSON FAMILY FOUNDATION INC CO MARY N OWEN
    EIN: 31-1678303
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    EXCISE TAX 7,380 0   0
    FOREIGN TAXES 2,391 2,391   0