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
SAMARITAN FOUNDATION FOR CHURCH AND
FAMILY WELLNESS INC

Number and street (or P.O. box number if mail is not delivered to street address)500 W SILVER SPRING DRIVE NO K270   Room/suite
City or town, state, and ZIP code
GLENDALE, WI53217
A Employer identification number

26-1596247
B Telephone number (see page 10 of the instructions)

(414) 964-4357
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$13,459,359J 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) 34,016
2 Check bullet
3 Interest on savings and temporary cash investments 1,844 1,844 1,844
4 Dividends and interest from securities...... 238,405 238,405 238,405
5a Gross rents..............      
b Net rental income or (loss)  
6a Net gain or (loss) from sale of assets not on line 10 -194,695
b Gross sales price for all assets on line 6a 3,125,472
7 Capital gain net income (from Part IV, line 2)... 0
8 Net short-term capital gain......... 0
9 Income modifications...........  
10a Gross sales less returns and allowances  
b Less: Cost of goods sold....  
c Gross profit or (loss) (attach schedule).....    
11 Other income (attach schedule)....... Click to see attachment 106,256 0 106,256
12 Total. Add lines 1 through 11........ 185,826 240,249 346,505
Operating and Administrative Expenses 13 Compensation of officers, directors, trustees, etc. 195,000 0 48,750 146,250
14 Other employee salaries and wages...... 134,836 0 50,851 83,985
15 Pension plans, employee benefits....... 110,860 0 28,628 82,232
16a Legal fees (attach schedule)......... Click to see attachment 1,996 0 0 1,996
b Accounting fees (attach schedule)....... Click to see attachment 18,420 0 17,420 1,000
c Other professional fees (attach schedule).... Click to see attachment 450 0 0 450
17 Interest............... 138 0 0 138
18 Taxes (attach schedule) (see page 14 of the instructions) Click to see attachment 38,199 0 38,199 0
19 Depreciation (attach schedule) and depletion... Click to see attachment 9,393 0 9,393
20 Occupancy.............. 45,349 0 9,070 36,279
21 Travel, conferences, and meetings.......        
22 Printing and publications.......... 8,230 0 0 8,230
23 Other expenses (attach schedule)....... Click to see attachment 80,425 0 3,276 77,149
24 Total operating and administrative expenses.
Add lines 13 through 23.......... 643,296 0 205,587 437,709
25 Contributions, gifts, grants paid........ 0 0
26 Total expenses and disbursements. Add lines 24 and 25 643,296 0 205,587 437,709
27 Subtract line 26 from line 12:
a Excess of revenue over expenses and disbursements -457,470
b Net investment income (if negative, enter -0-) 240,249
c Adjusted net income (if negative, enter -0-)... 140,918
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............... 90,185 119,732 119,732
2 Savings and temporary cash investments..........      
3 Accounts receivable bullet30,102
Less: allowance for doubtful accounts bullet     30,102 30,102
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...........   25,651 25,651
10a Investments—U.S. and state government obligations (attach schedule)      
b Investments—corporate stock (attach schedule)........ 11,186,337 Click to see attachment13,233,229 13,233,229
c Investments—corporate bonds (attach schedule)........      
11 Investments—land, buildings, and equipment: basis bullet  
Less: accumulated depreciation (attach schedule) bullet   59,133    
12 Investments—mortgage loans..............      
13 Investments—other (attach schedule)...........      
14 Land, buildings, and equipment: basis bullet67,480
Less: accumulated depreciation (attach schedule) bullet16,873 0 Click to see attachment50,607 50,607
15 Other assets (describe bullet) Click to see attachment0 Click to see attachment38 Click to see attachment38
16 Total assets (to be completed by all filers—see the
instructions. Also, see page 1, item I) 11,335,655 13,459,359 13,459,359
Liabilities 17 Accounts payable and accrued expenses.......... 561 2,130
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) Click to see attachment12,171 Click to see attachment42,253
23 Total liabilities (add lines 17 through 22).......... 12,732 44,383
Net Assets or Fund Balances bullet
and complete lines 24 through 26 and lines 30 and 31.
24 Unrestricted.................... 11,322,923 3,414,976
25 Temporarily restricted................    
26 Permanently restricted................ 0 10,000,000
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).................... 11,322,923 13,414,976
31 Total liabilities and net assets/fund balances (see page 17 of
the instructions).................. 11,335,655 13,459,359
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 11,322,923
2 Enter amount from Part I, line 27a...................... 2 -457,470
3 Other increases not included in line 2 (itemize) bulletClick to see attachment 3 2,549,523
4 Add lines 1, 2, and 3.......................... 4 13,414,976
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 13,414,976
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 3600 SHS MERCURY GENERAL CORP D 2007-12-31 2010-04-21
b 16400 SHS MERCURY GENERAL CORP D 2007-12-31 2010-04-23
c 25000 SHS MERCURY GENERAL CORP D 2007-12-31 2010-11-04
d 77339.52 SHS DODGE & COX INCOME FUND P 2009-10-07 2010-12-20
e 41666.66 SHS NICHOLAS MONEY MKT FUND P 2008-10-01 2010-01-28
35307.710 SHS NICHOLAS MONEY MARKET FUND P 2008-10-01 2010-03-30
1692.29 SHS NICHOLAS MONEY MARKET FUND P 2008-11-04 2010-03-30
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 164,452   179,316 -14,864
b 743,928   816,884 -72,956
c 1,105,001   1,245,250 -140,249
d 1,031,659   1,000,050 31,609
e 41,667   41,667 0
35,308   35,308 0
1,692   1,692 0
1,765     1,765
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       -14,864
b       -72,956
c       -140,249
d       31,609
e       0
      0
      0
      1,765
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 -194,695
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 0
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 410,479 9,751,341 0.042095
2008 288,146 9,672,648 0.029790
2007      
2006      
2005      
2 Total of line 1, column (d) ...................... 2 0.071885
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 0.035943
4 Enter the net value of noncharitable-use assets for 2010 from Part X, line 5..... 4 11,956,876
5 Multiply line 4 by line 3....................... 5 429,766
6 Enter 1% of net investment income (1% of Part I, line 27b)........... 6 2,402
7 Add lines 5 and 6......................... 7 432,168
8 Enter qualifying distributions from Part XII, line 4.............. 8 438,576
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 2,402
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 2,402
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 2,402
6 Credits/Payments:
a 2010 estimated tax payments and 2009 overpayment credited to 2010 6a 2,440
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 2,440
8 Enter any penalty for underpayment of estimated tax. if Form 2220 is attached. 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 38
11 Enter the amount of line 10 to be: Credited to 2011 estimated taxBullet38 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
     
    No
    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)bulletWI
    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
    Yes
     
    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 addressbulletWWW.SAMARITANFAMILTWELLNESS.ORG
    14
    The books are in care ofbulletSCOTT STONER Telephone no.bullet (414) 964-4357
    Located atbullet500 W SILVER SPRING DR STE K270GLENDALEWI ZIP+4bullet53217
    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
    SCOTT STONER PRESIDENT/EXECUTIVE DIRECT
    60.00     		195,000 31,125 59,315
    500 W SILVER SPRING K720
    GLENDALE,WI53217
    AB NICHOLAS VICE PRESIDENT
    0.00     		0 0 0
    500 W SILVER SPRING K720
    GLENDALE,WI53217
    JAMES WIGDALE SECRETARY
    0.00     		0 0 0
    500 W SILVER SPRING K720
    GLENDALE,WI53217
    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
    HOLLY STONER COUNSELOR
    40.00     		75,000 0 0
    2017 E OLIVE STREET
    SHOREWOOD,WI53211
    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 APPROXIMATELY 5,000 PEOPLE WERE SERVED BY OUR FAMILY WELLNESS PROGRAM THROUGH COUNSELING, CONSULTING AND EDUCATION 437,709
    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
    12,080,878
    b
    Average of monthly cash balances.......................
    1b
    58,082
    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
    12,138,960
    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
    12,138,960
    4
    Cash deemed held for charitable activities. Enter 1 1⁄2% of line 3 (for greater amount, see page 25
    of the instructions) ............................
    4
    182,084
    5
    Net value of noncharitable-use assets. Subtract line 4 from line 3. Enter here and on Part V, line 4
    5
    11,956,876
    6
    Minimum investment return. Enter 5% of line 5...................
    6
    597,844
    Part XI
    Distributable Amount bullet and do not complete this part.)
    1
    Minimum investment return from Part X, line 6....................
    1
     
    2a
    Tax on investment income for 2010 from Part VI, line 5......
    2a
     
    b
    Income tax for 2010. (This does not include the tax from Part VI.)...
    2b
     
    c
    Add lines 2a and 2b............................
    2c
     
    3
    Distributable amount before adjustments. Subtract line 2c from line 1............
    3
     
    4
    Recoveries of amounts treated as qualifying distributions................
    4
     
    5
    Add lines 3 and 4.............................
    5
     
    6
    Deduction from distributable amount (see page 25 of the instructions)...........
    6
     
    7
    Distributable amount as adjusted. Subtract line 6 from line 5. Enter here and on Part XIII,
    line 1.................................
    7
     
    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
    437,709
    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
    867
    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
    438,576
    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
    2,402
    6
    Adjusted qualifying distributions. Subtract line 5 from line 4...............
    6
    436,174
    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  
    2 Undistributed income, if any, as of the end of 2010:
    a Enter amount for 2009 only.......  
    b Total for prior years:20, 20, 20  
    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.........  
    4Qualifying distributions for 2010 from Part
    XII, line 4: bullet$  
    a Applied to 2009, but not more than line 2a  
    b Applied to undistributed income of prior years
    (Election required—see page 26 of the instructions)    		  
    c Treated as distributions out of corpus (Election
    required—see page 26 of the instructions)...     		 
    d Applied to 2010 distributable amount.....  
    e Remaining amount distributed out of corpus  
    5 Excess distributions carryover applied to 2010.    
    (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  
    b Prior years’ undistributed income. Subtract
    line 4b from line 2b ...........     		 
    c Enter the amount of prior years’ undistributed
    income for which a notice of deficiency has
    been issued, or on which the section 4942(a)
    tax has been previously assessed......     		 
    d Subtract line 6c from line 6b. Taxable
    amount—see page 27 of the instructions ...     		 
    e Undistributed income for 2009. Subtract line
    4a from line 2a. Taxable amount—see page 27
    of the instructions ...........     		 
    f Undistributed income for 2010. Subtract
    lines 4d and 5 from line 1. This amount must
    be distributed in 2011 ..........     		 
    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) ...........     		 
    8Excess distributions carryover from 2005 not
    applied on line 5 or line 7 (see page 27 of the
    instructions) .............     		 
    9Excess distributions carryover to 2011.
    Subtract lines 7 and 8 from line 6a ......     		 
    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
    2008-09-17
    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
    140,918 67,427 325,804 0 534,149
    b 85% of line 2a ......... 119,780 57,313 276,933 0 454,027
    c Qualifying distributions from Part XII,
    line 4 for each year listed .....     		438,576 412,911 288,146 0 1,139,633
    d Amounts included in line 2c not used directly
    for active conduct of exempt activities ....     		0 0 0 0 0
    e Qualifying distributions made directly
    for active conduct of exempt activities.
    Subtract line 2d from line 2c ....     		438,576 412,911 288,146 0 1,139,633
    3 Complete 3a, b, or c for the
    alternative test relied upon:
    a “Assets” alternative test—enter:
    (1) Value of all assets ...... 13,461,761 11,335,655 9,703,907   34,501,323
    (2) Value of assets qualifying
    under section 4942(j)(3)(B)(i)    		 13,431,761 11,335,655 9,703,907   34,471,323
    b “Endowment” alternative test— enter 2⁄3
    of minimum investment return shown in
    Part X, line 6 for each year listed...     		        0
    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) ....     		        0
    (2) Support from general public
    and 5 or more exempt
    organizations as provided in
    section 4942(j)(3)(B)(iii)....     		        0
    (3) Largest amount of support
    from an exempt organization    		         0
    (4) Gross investment income         0
    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:
    bThe form in which applications should be submitted and information and materials they should include:
    cAny submission deadlines:
    dAny restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other
    factors:
    Form 990-PF (2010)
    Form 990-PF (2010)
    Page 10
    Part XV
    Supplementary Information (continued)
    3 Grants and Contributions Paid During the Year or Approved for Future Payment
    Recipient If recipient is an individual,
    show any relationship to
    any foundation manager
    or substantial contributor
    		 Foundation
    status of
    recipient     		Purpose of grant or
    contribution     		Amount
    Name and address (home or business)
    aPaid during the year
    Total .................................bullet 3a 0
    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
    aCOUNSELING/COACHING INCOME         106,256
    b
    c
    d
    e
    f
    gFees and contracts from government agencies          
    2 Membership dues and assessments....          
    3Interest on savings and temporary cash investments     14 1,844  
    4 Dividends and interest from securities....     14 238,405  
    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     18 -194,695  
    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 45,554 106,256
    13Total. Add line 12, columns (b), (d), and (e)...................
    13151,810
    (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.)
    1 COUNSELING AND COACHING INCOME IS USED IS USED TO ACCOMPLISH THE ORGANIZATIONS EDUCATIONAL PURPOSES
    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
    Schedule B
    (Form 990, 990-EZ,
    or 990-PF)
    Department of the Treasury
    Internal Revenue Service
    Schedule of Contributors
    Arrow Bullet Attach to Form 990, 990-EZ, or 990-PF.
    OMB No. 1545-0047
    2010
    Name of organization
    SAMARITAN FOUNDATION FOR CHURCH AND
    FAMILY WELLNESS INC
    Employer identification number

    26-1596247
    Organization type (check one):
    Filers of:
    Section:
    Form 990 or 990-EZ





    Form 990-PF




    Check if your organization is covered by the General Rule or a Special Rule.  
    Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.
    General Rule—
    Special Rules
    ......................... Arrow Bullet   $    
    Caution. An Organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990,
    990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2 of its Form 990, or check the box in the heading of its
    Form 990-EZ, or on line 2 of its Form 990-PF, to certify that it does not meet the filing requirements of Schedule B (Form 990,
    990-EZ, or 990-PF).
    For Paperwork Reduction Act Notice, see the Instructions
    for Form 990, 990-EZ, or 990-PF.
    Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2010)

    Schedule B (Form 990, 990-EZ, or 990-PF) (2010)
    Page 1 of 1 of Part I
    Name of organization
    SAMARITAN FOUNDATION FOR CHURCH AND
    FAMILY WELLNESS INC         		Employer identification number

    26-1596247
    Part I
    Contributors (see Instructions)
    		     
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Aggregate contributions    		 (d)
    Type of contribution
    1
     
     

    JOHAN SEGERDAHL    
    601 E LAKE TERRACE
       
    MILWAUKEE, WI   53217

    		$10,000




    (Complete Part II if there is
    a noncash contribution.)
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Aggregate contributions    		 (d)
    Type of contribution
    2
     
     

    KAY CAMPELL    
    9016 N BAYSIDE DRIVE
       
    BAYSIDE, WI   53217

    		$7,500




    (Complete Part II if there is
    a noncash contribution.)
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Aggregate contributions    		 (d)
    Type of contribution
     
     
     

         
     
       

    		$  




    (Complete Part II if there is
    a noncash contribution.)
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Aggregate contributions    		 (d)
    Type of contribution
     
     
     

         
     
       

    		$  




    (Complete Part II if there is
    a noncash contribution.)
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Aggregate contributions    		 (d)
    Type of contribution
     
     
     

         
     
       

    		$  




    (Complete Part II if there is
    a noncash contribution.)
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Aggregate contributions    		 (d)
    Type of contribution
     
     
     

         
     
       

    		$  




    (Complete Part II if there is
    a noncash contribution.)
    Schedule B (Form 990, 990-EZ, or 990-PF) (2010)

    Schedule B (Form 990, 990-EZ, or 990-PF) (2010)
    Page 1 of 1 of Part II
    Name of organization
    SAMARITAN FOUNDATION FOR CHURCH AND
    FAMILY WELLNESS INC         		Employer identification number

    26-1596247
    Part II
    Noncash Property (see Instructions)
    		     
    (a) No.
    from
    Part I    		 (b)
    Description of noncash property given    		 (c)
    FMV (or estimate)
    (see instructions)     		(d)
    Date received
     
    		$    
    (a) No.
    from
    Part I    		 (b)
    Description of noncash property given    		 (c)
    FMV (or estimate)
    (see instructions)     		(d)
    Date received
     
    		$    
    (a) No.
    from
    Part I    		 (b)
    Description of noncash property given    		 (c)
    FMV (or estimate)
    (see instructions)     		(d)
    Date received
     
    		$    
    (a) No.
    from
    Part I    		 (b)
    Description of noncash property given    		 (c)
    FMV (or estimate)
    (see instructions)     		(d)
    Date received
     
    		$    
    (a) No.
    from
    Part I    		 (b)
    Description of noncash property given    		 (c)
    FMV (or estimate)
    (see instructions)     		(d)
    Date received
     
    		$    
    (a) No.
    from
    Part I    		 (b)
    Description of noncash property given    		 (c)
    FMV (or estimate)
    (see instructions)     		(d)
    Date received
     
    		$    
    Schedule B (Form 990, 990-EZ, or 990-PF) (2010)

    Schedule B (Form 990, 990-EZ, or 990-PF) (2010)
    Page 1 of 1 of Part III
    Name of organization
    SAMARITAN FOUNDATION FOR CHURCH AND
    FAMILY WELLNESS INC         		Employer identification number

    26-1596247
    Part III
    Exclusively religious, charitable, etc., individual contributions to section 501(c)(7), (8), or (10) organizations
    aggregating more than $1,000 for the year. (Complete columns (a) through (e) and the following line entry.)
    For organizations completing Part III, enter the total of exclusively religious, charitable, etc.,
    contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet $  
    (a) No.
    from
    Part I    		 (b)
    Purpose of gift    		 (c)
    Use of gift    		 (d)
    Description of how gift is held
     
    (e)
    Transfer of gift
    Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
     
     
           
     
    (a) No.
    from
    Part I    		 (b)
    Purpose of gift    		 (c)
    Use of gift    		 (d)
    Description of how gift is held
     
    (e)
    Transfer of gift
    Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
     
     
           
     
    (a) No.
    from
    Part I    		 (b)
    Purpose of gift    		 (c)
    Use of gift    		 (d)
    Description of how gift is held
     
    (e)
    Transfer of gift
    Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
     
     
           
     
    (a) No.
    from
    Part I    		 (b)
    Purpose of gift    		 (c)
    Use of gift    		 (d)
    Description of how gift is held
     
    (e)
    Transfer of gift
    Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
     
     
           
     
    Schedule B (Form 990, 990-EZ, or 990-PF) (2010)

    Additional Data


    Software ID:  
    Software Version:  

    TY 2010 AccountingFeesSchedule
    Name:
    SAMARITAN FOUNDATION FOR CHURCH AND
    FAMILY WELLNESS INC
    EIN: 26-1596247
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    ACCOUNTING FEES 18,420 0 17,420 1,000

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

    TY 2010 DepreciationSchedule
    Name:
    SAMARITAN FOUNDATION FOR CHURCH AND
    FAMILY WELLNESS INC
    EIN: 26-1596247
    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
    DESK 2008-11-01 1,313 153 SL 10.000000000000 131 0 131  
    CABINET 2008-11-01 415 48 SL 10.000000000000 42 0 42  
    CAMCORDER 2008-11-01 1,590 186 SL 10.000000000000 159 0 159  
    PRINTER 2008-12-31 800 160 SL 5.000000000000 160 0 160  
    LAPTOP PRO 2 2008-12-31 2,600 520 SL 5.000000000000 520 0 520  
    LAPTOP PRO 3 2008-12-31 1,500 300 SL 5.000000000000 300 0 300  
    MACPRACTICE SOFTWARE 2009-03-26 2,930 733 SL 3.000000000000 977 0 977  
    IMAC 2008-12-31 1,499 300 SL 5.000000000000 300 0 300  
    LAPTOP 2008-12-31 1,800 360 SL 5.000000000000 360 0 360  
    RUG 2008-12-31 2,000 200 SL 10.000000000000 200 0 200  
    LAPTOP PRO 1 2008-12-31 2,600 520 SL 5.000000000000 520 0 520  
    COUCH 2009-08-12 1,234 51 SL 10.000000000000 123 0 123  
    SOFTWARE 2009-06-02 4,019 782 SL 3.000000000000 1,340 0 1,340  
    DESKS 2009-04-01 6,000 450 SL 10.000000000000 600 0 600  
    OFFICE CHAIRS 2009-04-01 1,400 105 SL 10.000000000000 140 0 140  
    SCREEN 2009-04-01 337 25 SL 10.000000000000 34 0 34  
    TABLES 2009-04-01 1,200 90 SL 10.000000000000 120 0 120  
    CHAIRS 2009-04-01 950 71 SL 10.000000000000 95 0 95  
    WHITEBOARD 2009-04-01 507 38 SL 10.000000000000 51 0 51  
    CHAIRS 2009-04-01 2,057 154 SL 10.000000000000 206 0 206  
    TABLES 2009-04-01 800 60 SL 10.000000000000 80 0 80  
    DESK 2009-04-01 2,000 150 SL 10.000000000000 200 0 200  
    CHAIRS 2009-04-01 934 70 SL 10.000000000000 93 0 93  
    CREDENZA / DESK 2009-04-01 1,859 140 SL 10.000000000000 186 0 186  
    CHAIRS 2009-04-01 1,944 146 SL 10.000000000000 194 0 194  
    TABLES 2009-04-01 603 45 SL 10.000000000000 60 0 60  
    TABLES 2009-04-01 1,224 92 SL 10.000000000000 122 0 122  
    CHAIRS 2009-04-01 1,568 118 SL 10.000000000000 157 0 157  
    COFFEE MAKER 2009-04-01 150 11 SL 10.000000000000 15 0 15  
    WHITEBOARD 2009-04-01 507 38 SL 10.000000000000 51 0 51  
    DISPLAY BOARD 2009-04-01 1,789 134 SL 10.000000000000 179 0 179  
    MICROWAVE 2009-04-01 190 14 SL 10.000000000000 19 0 19  
    CREDENZA 2009-04-01 5,800 435 SL 10.000000000000 580 0 580  
    ART WORK 2009-04-01 800 60 SL 10.000000000000 80 0 80  
    LAPTOP 4 2009-04-01 2,000 300 SL 5.000000000000 400 0 400  
    PHONES 2009-04-01 1,452 109 SL 10.000000000000 145 0 145  
    LEASE BUILD-OUT 2009-04-01 4,319 216 SL 15.000000000000 288 0 288  
    NEW DOOR 2009-04-01 1,923 96 SL 15.000000000000 128 0 128  
    PHONES 2010-09-06 536   SL 10.000000000000 18 0 18  
    LIGHTING EQUIPMENT 2010-08-25 211   SL 10.000000000000 7 0 7  
    SOFTWARE - TIME MANAGEMENT 2010-08-19 120   SL 3.000000000000 13 0 13  

    TY 2010 InvestmentsCorpStockSchedule
    Name:
    SAMARITAN FOUNDATION FOR CHURCH AND
    FAMILY WELLNESS INC
    EIN: 26-1596247
    Name of Stock End of Year Book Value End of Year Fair Market Value
    RBC INVESTMENT ACCOUNT 13,233,229 13,233,229

    TY 2010 LandEtcSchedule2
    Name:
    SAMARITAN FOUNDATION FOR CHURCH AND
    FAMILY WELLNESS INC
    EIN: 26-1596247
    Category / Item Cost / Other Basis Accumulated Depreciation Book Value End of Year Fair Market Value
    DESK 1,313 284 1,029 0
    CABINET 415 90 325 0
    CAMCORDER 1,590 345 1,245 0
    PRINTER 800 320 480 0
    LAPTOP PRO 2 2,600 1,040 1,560 0
    LAPTOP PRO 3 1,500 600 900 0
    MACPRACTICE SOFTWARE 2,930 1,710 1,220 0
    IMAC 1,499 600 899 0
    LAPTOP 1,800 720 1,080 0
    RUG 2,000 400 1,600 0
    LAPTOP PRO 1 2,600 1,040 1,560 0
    COUCH 1,234 174 1,060 0
    SOFTWARE 4,019 2,122 1,897 0
    DESKS 6,000 1,050 4,950 0
    OFFICE CHAIRS 1,400 245 1,155 0
    SCREEN 337 59 278 0
    TABLES 1,200 210 990 0
    CHAIRS 950 166 784 0
    WHITEBOARD 507 89 418 0
    CHAIRS 2,057 360 1,697 0
    TABLES 800 140 660 0
    DESK 2,000 350 1,650 0
    CHAIRS 934 163 771 0
    CREDENZA / DESK 1,859 326 1,533 0
    CHAIRS 1,944 340 1,604 0
    TABLES 603 105 498 0
    TABLES 1,224 214 1,010 0
    CHAIRS 1,568 275 1,293 0
    COFFEE MAKER 150 26 124 0
    WHITEBOARD 507 89 418 0
    DISPLAY BOARD 1,789 313 1,476 0
    MICROWAVE 190 33 157 0
    CREDENZA 5,800 1,015 4,785 0
    ART WORK 800 140 660 0
    LAPTOP 4 2,000 700 1,300 0
    PHONES 1,452 254 1,198 0
    LEASE BUILD-OUT 4,319 504 3,815 0
    NEW DOOR 1,923 224 1,699 0
    PHONES 536 18 518 0
    LIGHTING EQUIPMENT 211 7 204 0
    SOFTWARE - TIME MANAGEMENT 120 13 107 0


    TY 2010 LegalFeesSchedule
    Name:
    SAMARITAN FOUNDATION FOR CHURCH AND
    FAMILY WELLNESS INC
    EIN: 26-1596247
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    LEGAL FEES 1,996 0 0 1,996


    TY 2010 OtherAssetsSchedule
    Name:
    SAMARITAN FOUNDATION FOR CHURCH AND
    FAMILY WELLNESS INC
    EIN: 26-1596247
    Description Beginning of Year - Book Value End of Year - Book Value End of Year - Fair Market Value
    PREPAID TAXES 0 38 38


    TY 2010 OtherExpensesSchedule
    Name:
    SAMARITAN FOUNDATION FOR CHURCH AND
    FAMILY WELLNESS INC
    EIN: 26-1596247
    Description Revenue and Expenses per Books Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    AUTO EXPENSE 674 0 168 506
    REPAIRS AND MAINTENANCE 1,050 0 210 840
    BANK CHARGES 874 0 0 874
    INSURANCE 2,213 0 443 1,770
    INTERNET & CABLE 90 0 0 90
    MEALS 913 0 0 913
    PAYROLL COSTS 2,191 0 661 1,530
    OFFICE EXPENSE 4,781 0 104 4,677
    POSTAGE 831 0 0 831
    TELEPHONE 7,549 0 1,510 6,039
    LICENSES 633 0 127 506
    TRAINING & EDUCATION 10,621 0 0 10,621
    PROGRAM COSTS 22,974 0 0 22,974
    PROMOTION & ADVERTISING 20,755 0 0 20,755
    TRAVEL 1,075 0 0 1,075
    OTHER EXPENSE 434 0 24 410
    UNDERPAYMENT PENALTY 452 0 0 452
    DUES & SUBSCRIPTIONS 2,315 0 29 2,286


    TY 2010 OtherIncomeSchedule2
    Name:
    SAMARITAN FOUNDATION FOR CHURCH AND
    FAMILY WELLNESS INC
    EIN: 26-1596247
    Description Revenue And Expenses Per Books Net Investment Income Adjusted Net Income
    COUNSELING/COACHING INCOME 106,256   106,256


    TY 2010 OtherIncreasesSchedule
    Name:
    SAMARITAN FOUNDATION FOR CHURCH AND
    FAMILY WELLNESS INC
    EIN: 26-1596247
    Description Amount
    UNREALIZED GAIN ON INVESTMENTS 2,549,523


    TY 2010 OtherLiabilitiesSchedule
    Name:
    SAMARITAN FOUNDATION FOR CHURCH AND
    FAMILY WELLNESS INC
    EIN: 26-1596247
    Description Beginning of Year - Book Value End of Year - Book Value
    ACCRUED WAGES 7,058 5,826
    PAYROLL TAXES 2,609 630
    EXCISE TAX PAYABLE 2,504 0
    DEFERRED FEDERAL EXCISE TAX 0 35,797


    TY 2010 OtherProfessionalFeesSchedule
    Name:
    SAMARITAN FOUNDATION FOR CHURCH AND
    FAMILY WELLNESS INC
    EIN: 26-1596247
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    OTHER 450 0 0 450


    TY 2010 TaxesSchedule
    Name:
    SAMARITAN FOUNDATION FOR CHURCH AND
    FAMILY WELLNESS INC
    EIN: 26-1596247
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    EXCISE TAXES 2,402 0 2,402 0
    DEFERRED EXCISE TAX 35,797 0 35,797 0