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
MEMORIAL SCHOLARSHIP OF HENRY GROTH
ELSINOR GROTH AND WAYNE ELDER 329100

Number and street (or P.O. box number if mail is not delivered to street address)COLUMBIA BANK TRUST SVCS 249WINSLOW ERoom/suite
City or town, state, and ZIP code
BAINBRIDGE ISLAND, WA98110
A Employer identification number

20-7271091
B Telephone number (see page 10 of the instructions)

(206) 855-8508
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$1,598,622J 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 37 37  
4 Dividends and interest from securities...... 44,521 44,521  
5a Gross rents..............      
b Net rental income or (loss)  
6a Net gain or (loss) from sale of assets not on line 10 -175,233
b Gross sales price for all assets on line 6a 928,472
7 Capital gain net income (from Part IV, line 2)... 0
8 Net short-term capital gain.........  
9 Income modifications........... 8,483
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........ -130,675 44,558 8,483
Operating and Administrative Expenses 13 Compensation of officers, directors, trustees, etc. 15,773 14,196   1,577
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 2,539 2,285   254
c Other professional fees (attach schedule)....        
17 Interest...............        
18 Taxes (attach schedule) (see page 14 of the instructions) Click to see attachment 772 398   0
19 Depreciation (attach schedule) and depletion...      
20 Occupancy..............        
21 Travel, conferences, and meetings.......        
22 Printing and publications..........        
23 Other expenses (attach schedule)....... Click to see attachment 25 0   25
24 Total operating and administrative expenses.
Add lines 13 through 23.......... 19,109 16,879   1,856
25 Contributions, gifts, grants paid........ 70,450 70,450
26 Total expenses and disbursements. Add lines 24 and 25 89,559 16,879   72,306
27 Subtract line 26 from line 12:
a Excess of revenue over expenses and disbursements -220,234
b Net investment income (if negative, enter -0-) 27,679
c Adjusted net income (if negative, enter -0-)... 8,483
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............... -29    
2 Savings and temporary cash investments.......... 48,191 46,304 46,304
3 Accounts receivable bullet  
Less: allowance for doubtful accounts bullet        
4 Pledges receivable bullet  
Less: allowance for doubtful accounts bullet        
5 Grants receivable.................      
6 Receivables due from officers, directors, trustees, and other
disqualified persons (attach schedule) (see page 15 of the
instructions)....................      
7 Other notes and loans receivable (attach schedule) bullet  
Less: allowance for doubtful accounts bullet        
8 Inventories for sale or use...............      
9 Prepaid expenses and deferred charges...........      
10a Investments—U.S. and state government obligations (attach schedule)      
b Investments—corporate stock (attach schedule)........ 452,437 Click to see attachment934,524 1,052,333
c Investments—corporate bonds (attach schedule)........      
11 Investments—land, buildings, and equipment: basis bullet  
Less: accumulated depreciation (attach schedule) bullet        
12 Investments—mortgage loans..............      
13 Investments—other (attach schedule)........... 1,160,645 Click to see attachment468,776 499,985
14 Land, buildings, and equipment: basis bullet  
Less: accumulated depreciation (attach schedule) bullet        
15 Other assets (describe bullet) Click to see attachment111 Click to see attachment0 Click to see attachment0
16 Total assets (to be completed by all filers—see the
instructions. Also, see page 1, item I) 1,661,355 1,449,604 1,598,622
Liabilities 17 Accounts payable and accrued expenses..........    
18 Grants payable...................    
19 Deferred revenue..................    
20 Loans from officers, directors, trustees, and other disqualified persons    
21 Mortgages and other notes payable (attach schedule)......    
22 Other liabilities (describe bullet)    
23 Total liabilities (add lines 17 through 22).......... 0 0
Net Assets or Fund Balances bullet
and complete lines 24 through 26 and lines 30 and 31.
24 Unrestricted....................    
25 Temporarily restricted................    
26 Permanently restricted................    
bullet
and complete lines 27 through 31.
27 Capital stock, trust principal, or current funds......... 1,661,355 1,449,604
28 Paid-in or capital surplus, or land, bldg., and equipment fund 0 0
29 Retained earnings, accumulated income, endowment, or other funds 0 0
30 Total net assets or fund balances (see page 17 of the
instructions).................... 1,661,355 1,449,604
31 Total liabilities and net assets/fund balances (see page 17 of
the instructions).................. 1,661,355 1,449,604
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 1,661,355
2 Enter amount from Part I, line 27a...................... 2 -220,234
3 Other increases not included in line 2 (itemize) bulletClick to see attachment 3 8,483
4 Add lines 1, 2, and 3.......................... 4 1,449,604
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 1,449,604
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 465 AMERICAN EXPRESS CO   2007-08-17 2010-05-27
b 440 BP PLC P 2007-08-17 2010-05-27
c 350 BERKSHIRE HATHAWAY INC P 2007-08-17 2010-05-27
d 480 CENOVUS ENERGY INC P 2007-08-17 2010-05-27
e 890 CHICO FAS INC P 2007-08-17 2010-05-27
1,350 CISCO SYSTEMS INC P 2007-08-17 2010-05-27
390 DARDEN RESTAURANTS INC P 2007-08-17 2010-05-27
480 ENCANA CORP P 2007-08-17 2010-05-27
70 ENTERGY CORP P 2007-08-17 2010-05-27
100 EXELON CORP P 2007-08-17 2010-05-27
918.274 FORWARD FDS INVESTMENT GRADE FIXED INCOME FUND P 2007-06-05 2010-07-19
11,775.362 FORWARD FDS INVESTMENT GRADE FIXED INCOME FUND P 2007-06-05 2010-08-10
589.536 ACCESSOR INTERNATIONAL EQUITY P 2009-04-03 2010-07-19
416.320 ACCESSOR SMALL TO MID CAP P 2007-06-05 2010-02-11
4,288.165 ACCESSOR SMALL TO MID CAP P 2009-04-03 2010-05-27
2,618.268 ACCESSOR SMALL TO MID CAP P 2007-10-30 2010-05-27
467.023 ACCESSOR SMALL TO MID CAP P 2007-06-05 2010-05-27
314.762 ACCESSOR SMALL TO MID CAP P 2007-08-17 2010-05-27
3,389.831 FORWARD FDS ACC VALUE FD P 2007-10-30 2010-05-27
2,352.502 FORWARD FDS ACC VALUE FD P 2007-06-05 2010-05-27
413.052 FORWARD FDS ACC VALUE FD P 2007-08-17 2010-05-27
3,136.137 FORWARD FDS GROWTH FD P 2007-10-30 2010-05-27
2,690.337 FORWARD FDS GROWTH FD P 2007-06-05 2010-05-27
390.168 FORWARD FDS GROWTH FD P 2007-08-17 2010-05-27
19 GENERAL ELECTRIC CO P 2007-08-17 2010-07-19
390 KELLOGG CO P 2007-08-17 2010-05-27
520 LILLY ELI & CO P 2007-08-17 2010-05-27
540 MEDTRONIC INC P 2007-08-17 2010-05-27
464 MICROSOFT CORP P 2007-08-17 2010-05-27
19 MICROSOFT CORP P 2007-08-17 2010-07-19
300 PEPSICO INC P 2007-08-17 2010-05-27
950 ROBERT HALF INTL INC P 2007-08-17 2010-05-27
180 VANGUARD MATERIALS ETF P 2007-08-17 2010-05-27
200 VANGUARD TELECOMMUNICATIONS SERV ETF P 2007-08-17 2010-05-27
760 WELLS FARGO & COMPANY P 2007-08-17 2010-05-27
17 AT&T INC P 2010-05-27 2010-07-19
9 ABBOTT LABS P 2010-05-27 2010-07-19
9 AIR PRODS & CHEMS INC P 2010-05-27 2010-07-19
33 APPLIED MATLS INC P 2010-05-27 2010-07-19
9 AUTOMATIC DATA PROCESSING INC P 2010-05-27 2010-07-19
9 BANK OF NEW YORK MELLON CORP P 2010-05-27 2010-07-19
7 BECTON DICKINSON & CO P 2010-05-27 2010-07-19
10 CHEVRON CORPORATION P 2010-05-27 2010-07-19
8 CHUBB CORP P 2010-05-27 2010-07-19
7 COCA COLA CO P 2010-05-27 2010-07-19
8 CONOCOPHILLIPS P 2010-05-27 2010-07-19
10 EMERSON ELEC CO P 2010-05-27 2010-07-19
7 EXXON MOBIL CORP P 2010-05-27 2010-07-19
5 GENERAL DYNAMICS CORP P 2010-05-27 2010-07-19
24 INTEL CORP P 2010-05-27 2010-07-19
4 INTERNATIONAL BUSINESS MACHS P 2010-05-27 2010-07-19
5 JP MORGAN CHASE & CO P 2010-05-27 2010-07-19
9 JOHNSON & JOHNSON P 2010-05-27 2010-07-19
9 MCDONALDS CORP P 2010-05-27 2010-07-19
9 METLIFE INC P 2010-05-27 2010-07-19
10 MICROCHIP TECHNOLOGY INC P 2010-05-27 2010-07-19
7 MORGAN STANLEY P 2010-05-27 2010-07-19
17 NYSE EURONEXT P 2010-05-27 2010-07-19
9 NORFOLK SOUTHN CORP P 2010-05-27 2010-07-19
5 OMNICOM GROUP INC P 2010-05-27 2010-07-19
7 PPG INDS INC P 2010-05-27 2010-07-19
25 PFIZER INC P 2010-05-27 2010-07-19
8 PROCTER & GAMBLE CO P 2010-05-27 2010-07-19
10 QUALCOMM INC P 2010-05-27 2010-07-19
11 ROYAL DUTCH SHELL PLC P 2010-05-27 2010-07-19
8 STANLEY BLACK & DECKER INC P 2010-05-27 2010-07-19
17 TEXAS INSTRS INC P 2010-05-27 2010-07-19
6 3M CO P 2010-05-27 2010-07-19
16 TIME WARNER INC P 2010-05-27 2010-07-19
6 VF CORP P 2010-05-27 2010-07-19
11 WAL-MART STORES INC P 2010-05-27 2010-07-19
11 WASTE MGMT INC P 2010-05-27 2010-07-19
(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 18,530   27,295 -8,765
b 19,826   28,208 -8,382
c 25,622   26,550 -928
d 12,456   13,546 -1,090
e 10,844   15,726 -4,882
31,567   40,541 -8,974
16,824   15,150 1,674
14,584   14,384 200
5,238   6,743 -1,505
3,854   6,913 -3,059
10,000   10,773 -773
130,000   138,142 -8,142
8,000   5,954 2,046
10,000   14,846 -4,846
111,364   75,000 36,364
67,996   88,000 -20,004
12,129   16,654 -4,525
8,174   10,000 -1,826
54,373   88,000 -33,627
37,734   63,000 -25,266
6,625   10,000 -3,375
69,779   88,000 -18,221
59,860   73,500 -13,640
8,681   10,000 -1,319
277   726 -449
20,709   21,176 -467
16,946   28,656 -11,710
21,011   28,426 -7,415
12,073   12,982 -909
477   532 -55
18,687   20,690 -2,003
24,051   30,445 -6,394
11,707   13,772 -2,065
10,808   15,508 -4,700
21,948   27,854 -5,906
421   418 3
427   427 0
622   629 -7
403   430 -27
368   368 0
229   250 -21
476   501 -25
718   737 -19
414   402 12
365   355 10
413   411 2
452   468 -16
408   427 -19
292   341 -49
513   522 -9
519   502 17
195   199 -4
535   532 3
628   602 26
336   367 -31
301   278 23
173   191 -18
458   484 -26
474   504 -30
180   193 -13
433   448 -15
366   383 -17
494   486 8
367   355 12
602   582 20
410   453 -43
431   419 12
485   486 -1
479   487 -8
434   463 -29
542   555 -13
355   358 -3
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       -8,765
b       -8,382
c       -928
d       -1,090
e       -4,882
      -8,974
      1,674
      200
      -1,505
      -3,059
      -773
      -8,142
      2,046
      -4,846
      36,364
      -20,004
      -4,525
      -1,826
      -33,627
      -25,266
      -3,375
      -18,221
      -13,640
      -1,319
      -449
      -467
      -11,710
      -7,415
      -909
      -55
      -2,003
      -6,394
      -2,065
      -4,700
      -5,906
      3
      0
      -7
      -27
      0
      -21
      -25
      -19
      12
      10
      2
      -16
      -19
      -49
      -9
      17
      -4
      3
      26
      -31
      23
      -18
      -26
      -30
      -13
      -15
      -17
      8
      12
      20
      -43
      12
      -1
      -8
      -29
      -13
      -3
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 -175,233
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 61,075 1,291,006 0.047308
2008 95,812 1,592,137 0.060178
2007 61,031 1,321,658 0.046178
2006      
2005      
2 Total of line 1, column (d) ...................... 2 0.153664
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 0.051221
4 Enter the net value of noncharitable-use assets for 2010 from Part X, line 5..... 4 1,467,750
5 Multiply line 4 by line 3....................... 5 75,180
6 Enter 1% of net investment income (1% of Part I, line 27b)........... 6 277
7 Add lines 5 and 6......................... 7 75,457
8 Enter qualifying distributions from Part XII, line 4.............. 8 72,306
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 1 554
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............................ 3 554
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- ..... 5 554
6 Credits/Payments:
a 2010 estimated tax payments and 2009 overpayment credited to 2010 6a 700
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.............. 7 700
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 10 146
11 Enter the amount of line 10 to be: Credited to 2011 estimated taxBullet146 Refunded Bullet 11 0
Part VII-A
Statements Regarding Activities
1a
During the tax year, did the foundation attempt to influence any national, state, or local legislation or did
Yes
No
it participate or intervene in any political campaign? ....................
1a
 
No
b
Did it spend more than $100 during the year (either directly or indirectly) for political purposes (see page 19 of
the instructions for definition)?.............................
1b
 
No
If the answer is “Yes” to 1a or 1b, attach a detailed description of the activities and copies of any materials
published or distributed by the foundation in connection with the activities.
c
Did the foundation file Form 1120-POL for this year?.....................
1c
 
No
d
Enter the amount (if any) of tax on political expenditures (section 4955) imposed during the year:
(1) On the foundation. bullet$ 0(2) On foundation managers.bullet$ 0
e
Enter the reimbursement (if any) paid by the foundation during the year for political expenditure tax imposed
on foundation managers.bullet$ 0
2
Has the foundation engaged in any activities that have not previously been reported to the IRS?.......
2
 
No
If “Yes,” attach a detailed description of the activities.
3
Has the foundation made any changes, not previously reported to the IRS, in its governing instrument, articles
of incorporation, or bylaws, or other similar instruments? If “Yes,” attach a conformed copy of the changes....
3
 
No
4a
Did the foundation have unrelated business gross income of $1,000 or more during the year?........
4a
 
No
b
If “Yes,” has it filed a tax return on Form 990-T for this year?...................
4b
 
 
5
Was there a liquidation, termination, dissolution, or substantial contraction during the year?.........
5
 
No
If “Yes,” attach the statement required by General Instruction T.
6
Are the requirements of section 508(e) (relating to sections 4941 through 4945) satisfied either:
  • By language in the governing instrument, or
  • By state legislation that effectively amends the governing instrument so that no mandatory directions
    • that conflict with the state law remain in the governing instrument?................
    6
    Yes
     
    7
    Did the foundation have at least $5,000 in assets at any time during the year? If “Yes,” complete Part II, col. (c), and Part XV.
    7
    Yes
     
    8a
    Enter the states to which the foundation reports or with which it is registered (see page 19 of the
    instructions)bulletWA
    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 - NONE
    14
    The books are in care ofbulletCOLUMBIA BANK TRUST SERVICES Telephone no.bullet (206) 855-8508
    Located atbullet249 WINSLOW WAY EBAINBRIDGE ISLANDWA ZIP+4bullet98110
    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
     
    No
    .........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
    COLUMBIA STATE BANK TRUSTEE
    6.00     		15,773 0 0
    249 WINSLOW WAY EAST
    BAINBRIDGE ISLAND,WA98110
    2 Compensation of five highest-paid employees (other than those included on line 1—see page 23 of the instructions).
    If none, enter “NONE.”
    (a) Name and address of each employee paid more than $50,000 (b) Title, and average
    hours per week
    devoted to position     		(c) Compensation (d) Contributions to
    employee benefit
    plans and deferred
    compensation     		(e) Expense account,
    other allowances
    NONE
    Total number of other employees paid over $50,000...................bullet 0
    3 Five highest-paid independent contractors for professional services (see page 23 of the instructions). If none, enter "NONE".
    (a) Name and address of each person paid more than $50,000 (b) Type of service (c) Compensation
    NONE
    Total number of others receiving over $50,000 for professional services.............bullet0
    Part IX-A
    Summary of Direct Charitable Activities
    List the foundation’s four largest direct charitable activities during the tax year. Include relevant statistical information such as the number of organizations and other beneficiaries served, conferences convened, research papers produced, etc. Expenses
    1
     
    2  
    3  
    4  
    Form 990-PF (2010)
    Form 990-PF (2010)
    Page 7
    Part IX-B
    Summary of Program-Related Investments (see page 23 of the instructions)
    Describe the two largest program-related investments made by the foundation during the tax year on lines 1 and 2. Amount
    1  
    2  
    All other program-related investments. See page 24 of the instructions.
    3  
    Total. Add lines 1 through 3...........................bullet0
    Part X
    Minimum Investment Return (All domestic foundations must complete this part. Foreign foundations,
    see page 24 of the instructions.)
    1
    Fair market value of assets not used (or held for use) directly in carrying out charitable, etc.,
    purposes:
    a
    Average monthly fair market value of securities...................
    1a
    1,407,752
    b
    Average of monthly cash balances.......................
    1b
    82,350
    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
    1,490,102
    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
    1,490,102
    4
    Cash deemed held for charitable activities. Enter 1 1⁄2% of line 3 (for greater amount, see page 25
    of the instructions) ............................
    4
    22,352
    5
    Net value of noncharitable-use assets. Subtract line 4 from line 3. Enter here and on Part V, line 4
    5
    1,467,750
    6
    Minimum investment return. Enter 5% of line 5...................
    6
    73,388
    Part XI
    Distributable Amount bullet and do not complete this part.)
    1
    Minimum investment return from Part X, line 6....................
    1
    73,388
    2a
    Tax on investment income for 2010 from Part VI, line 5......
    2a
    554
    b
    Income tax for 2010. (This does not include the tax from Part VI.)...
    2b
     
    c
    Add lines 2a and 2b............................
    2c
    554
    3
    Distributable amount before adjustments. Subtract line 2c from line 1............
    3
    72,834
    4
    Recoveries of amounts treated as qualifying distributions................
    4
    8,483
    5
    Add lines 3 and 4.............................
    5
    81,317
    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
    81,317
    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
    72,306
    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
    72,306
    5
    Foundations that qualify under section 4940(e) for the reduced rate of tax on net investment
    income. Enter 1% of Part I, line 27b (see page 26 of the instructions)............
    5
    0
    6
    Adjusted qualifying distributions. Subtract line 5 from line 4...............
    6
    72,306
    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 81,317
    2 Undistributed income, if any, as of the end of 2010:
    a Enter amount for 2009 only....... 0
    b Total for prior years:20, 20, 20 0
    3 Excess distributions carryover, if any, to 2010:
    a From 2005.......  
    b From 2006.......  
    c From 2007.......  
    d From 2008....... 10,155
    e From 2009.......  
    fTotal of lines 3a through e......... 10,155
    4Qualifying distributions for 2010 from Part
    XII, line 4: bullet$ 72,306
    a Applied to 2009, but not more than line 2a 0
    b Applied to undistributed income of prior years
    (Election required—see page 26 of the instructions)    		 0
    c Treated as distributions out of corpus (Election
    required—see page 26 of the instructions)...     		0
    d Applied to 2010 distributable amount..... 72,306
    e Remaining amount distributed out of corpus 0
    5 Excess distributions carryover applied to 2010. 9,011 9,011
    (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 1,144
    b Prior years’ undistributed income. Subtract
    line 4b from line 2b ...........     		0
    c Enter the amount of prior years’ undistributed
    income for which a notice of deficiency has
    been issued, or on which the section 4942(a)
    tax has been previously assessed......     		0
    d Subtract line 6c from line 6b. Taxable
    amount—see page 27 of the instructions ...     		0
    e Undistributed income for 2009. Subtract line
    4a from line 2a. Taxable amount—see page 27
    of the instructions ...........     		0
    f Undistributed income for 2010. Subtract
    lines 4d and 5 from line 1. This amount must
    be distributed in 2011 ..........     		0
    7 Amounts treated as distributions out of
    corpus to satisfy requirements imposed by
    section 170(b)(1)(F) or 4942(g)(3) (see page 27
    of the instructions) ...........     		0
    8Excess distributions carryover from 2005 not
    applied on line 5 or line 7 (see page 27 of the
    instructions) .............     		0
    9Excess distributions carryover to 2011.
    Subtract lines 7 and 8 from line 6a ......     		1,144
    10 Analysis of line 9:
    a Excess from 2006....  
    b Excess from 2007....  
    c Excess from 2008.... 1,144
    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:
    GROTH MEMORIAL SCHOLARSHIP COMMITTE
    BREMERTON SCHOOL DISTRICT 134
    MARION AVENUE N
    BREMERTON,WA98312
    (360) 473-1000
    bThe form in which applications should be submitted and information and materials they should include:
    APPLICATION FORM AND MATERIAL AS SPECIFIED BY THE SCHOLARSHIP COMMITTEE.
    cAny submission deadlines:
    PRIOR TO COMMITTEE MEETINGS THAT ARE HELD DURING THE MONTHS OF MARCH, APRIL, MAY, AND JUNE.
    dAny restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other
    factors:
    APPLICANT MUST BE A GRADUATING SENIOR FROM A HIGH SCHOOL LOCATED WITHIN THE GEOGRAPHIC BOUNDARIES OF THE BREMERTON (WA) SCHOOL DISTRICT #100-C. APPLICANT MUST ATTEND AN ACADEMIC INSTITUTION OF HIGHER LEARNING, SITUATED WITHIN THE STATE OF WASHINGTON OFFERING A TWO OR FOUR YEAR ACADEMIC DEGREE. PROGRAMS FOCUSED EXCLUSIVELY ON VOCATIONAL, TRADE OR GRADUATE COURSES OF STUDY ARE EXCLUDED.
    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
    CENTRAL WASHINGTON UNIVERSITY
    400 E UNIVERSITY WAY
    ELLENSBURG,WA989267504     		NONE N/A SCHOLARSHIP FOR CHRISTOPHER MARTINDALE 2,000
    EASTERN WASHINGTON UNIVERSITY
    102 SUTTON HALL
    CHENEY,WA99004     		NONE N/A SCHOLARSHIP FOR DONOVAN ZINK 2,500
    EASTERN WASHINGTON UNIVERSITY
    102 SUTTON HALL
    CHENEY,WA99004     		NONE N/A SCHOLARSHIP FOR ALMA-MAY MAGDAY 3,500
    NORTHWEST UNIVERSITY
    PO BOX 579
    KIRKLAND,WA98033     		NONE N/A SCHOLARSHIP FOR NOAH IRISH 3,500
    NORTHWEST UNIVERSITY
    PO BOX 579
    KIRKLAND,WA98033     		NONE N/A SCHOLARSHIP FOR BRITTANY BRADFORD 1,250
    OLYMPIC COLLEGE
    1600 CHESTER AVENUE
    BREMERTON,WA98337     		NONE N/A SCHOLARSHIP FOR SHYANNE LEWIS 1,250
    OLYMPIC COLLEGE
    1600 CHESTER AVENUE
    BREMERTON,WA98337     		NONE N/A SCHOLARSHIP FOR CHRISTOPHER OLIVER 1,250
    OLYMPIC COLLEGE
    1600 CHESTER AVENUE
    BREMERTON,WA98337     		NONE N/A SCHOLARSHIP FOR SAMANTHA ARAMIAN 1,250
    OLYMPIC COLLEGE
    1600 CHESTER AVENUE
    BREMERTON,WA98337     		NONE N/A SCHOLARSHIP FOR HANNAH MCCOY 1,000
    OLYMPIC COLLEGE
    1600 CHESTER AVENUE
    BREMERTON,WA98337     		NONE N/A SCHOLARSHIP FOR SHANICE GUITY 1,250
    OLYMPIC COLLEGE
    1600 CHESTER AVENUE
    BREMERTON,WA98337     		NONE N/A SCHOLARSHIP FOR REBECCA STAVICK 500
    OLYMPIC COLLEGE
    1600 CHESTER AVENUE
    BREMERTON,WA98337     		NONE N/A SCHOLARSHIP FOR TORRIE OESER-BEATON 500
    OLYMPIC COLLEGE
    1600 CHESTER AVENUE
    BREMERTON,WA98337     		NONE N/A SCHOLARSHIP FOR NICHOLAS THOMAS 1,200
    OLYMPIC COLLEGE
    1600 CHESTER AVENUE
    BREMERTON,WA98337     		NONE N/A SCHOLARSHIP FOR NESLIE LEBITA 4,000
    OLYMPIC COLLEGE
    1600 CHESTER AVENUE
    BREMERTON,WA98337     		NONE N/A SCHOLARSHIP FOR BRANDON BRADDOCK 1,250
    PACIFIC LUTHERAN UNIVERSITY
    12180 PARK AVENUE S
    TACOMA,WA98447     		NONE N/A SCHOLARSHIP FOR HANG TA 4,000
    PACIFIC LUTHERAN UNIVERSITY
    12180 PARK AVENUE S
    TACOMA,WA98447     		NONE N/A SCHOLARSHIP FOR LINDA LUU 3,500
    SAINT MARTIN UNIVERSITY
    5300 PACIFIC AVENUE SE
    LACEY,WA985037500     		NONE N/A SCHOLARSHIP FOR MATTHEW OLSON 1,250
    SEATTLE PACIFIC UNIVERSITY
    3307 THIRD AVENUE W
    SEATTLE,WA981191997     		NONE N/A SCHOLARSHIP FOR REGINA OGAZI 2,500
    WASHINGTON STATE UNIVERSITY
    PO BOX 641069
    PULLMAN,WA991641069     		NONE N/A SCHOLARSHIP FOR JACLYN HILL 3,500
    WASHINGTON STATE UNIVERSITY
    PO BOX 641069
    PULLMAN,WA991641069     		NONE N/A SCHOLARSHIP FOR YONG HAO DENG 3,500
    WASHINGTON STATE UNIVERSITY
    PO BOX 641069
    PULLMAN,WA991641069     		NONE N/A SCHOLARSHIP FOR ASHLEY ARNOLD 3,500
    WASHINGTON STATE UNIVERSITY
    PO BOX 641069
    PULLMAN,WA991641069     		NONE N/A SCHOLARSHIP FOR KELSEY KOETS 3,500
    WASHINGTON STATE UNIVERSITY
    PO BOX 641069
    PULLMAN,WA991641069     		NONE N/A SCHOLARSHIP FOR SHERILYN BALISI 4,000
    WASHINGTON STATE UNIVERSITY
    PO BOX 641069
    PULLMAN,WA991641069     		NONE N/A SCHOLARSHIP FOR MEW BORIRATRIT 4,000
    WASHINGTON STATE UNIVERSITY
    PO BOX 641069
    PULLMAN,WA991641069     		NONE N/A SCHOLARSHIP FOR WENDYLIE ALIX 500
    WASHINGTON STATE UNIVERSITY
    PO BOX 641069
    PULLMAN,WA991641069     		NONE N/A SCHOLARSHIP FOR KANDYCE ALVEAR 4,000
    WASHINGTON STATE UNIVERSITY
    PO BOX 641069
    PULLMAN,WA991641069     		NONE N/A SCHOLARSHIP FOR MICHAEL DELA CRUZ 3,000
    WASHINGTON STATE UNIVERSITY
    PO BOX 641069
    PULLMAN,WA991641069     		NONE N/A SCHOLARSHIP FOR CAROLYN SUPIT 3,500
    Total .................................bullet 3a 70,450
    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 37  
    4 Dividends and interest from securities....     14 44,521  
    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 -175,233  
    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 -130,675 0
    13Total. Add line 12, columns (b), (d), and (e)...................
    13-130,675
    (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:
    MEMORIAL SCHOLARSHIP OF HENRY GROTH
    ELSINOR GROTH AND WAYNE ELDER 329100
    EIN: 20-7271091
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    ACCOUNTING FEES (TAX RETURN PREPARATION) - VON HARTEN & COMPANY INC PS 2,539 2,285   254

    TY 2010 InvestmentsCorpStockSchedule
    Name:
    MEMORIAL SCHOLARSHIP OF HENRY GROTH
    ELSINOR GROTH AND WAYNE ELDER 329100
    EIN: 20-7271091
    Name of Stock End of Year Book Value End of Year Fair Market Value
    3M CO 23,736 25,200
    ABBOTT LABS 22,672 22,757
    AIR PRODS & CHEMS INC 30,330 39,382
    APPLIED MATLS INC 26,837 29,842
    AT&T INC 22,411 26,618
    AUTOMATIC DATA PROCESSING INC 19,317 21,890
    BANK OF NEW YORK MELLON CORP 15,709 17,425
    BECTON DICKINSON & CO 26,098 30,850
    CHEVRON CORPORATION 40,354 49,731
    CHUBB CORP 21,944 25,943
    COCA COLA CO 17,555 22,559
    CONOCOPHILLIPS 19,584 25,810
    EMERSON ELEC CO 24,458 29,785
    EXXON MOBIL CORP 22,113 26,543
    GENERAL DYNAMICS CORP 20,425 21,643
    GENERAL ELECTRIC CO 35,064 19,845
    INTEL CORP 31,552 31,167
    INTERNATIONAL BUSINESS MACHS 23,325 27,151
    JOHNSON & JOHNSON 31,096 32,595
    JP MORGAN CHASE & CO 9,890 10,605
    MCDONALDS CORP 32,590 37,152
    METLIFE INC 18,810 20,487
    MICROSOFT CORP 32,028 32,711
    MICROCHIP TECHNOLOGY INC 13,820 17,618
    MORGAN STANLEY 10,705 10,721
    NYSE EURONEXT 26,434 27,761
    NORFOLK SOUTHN CORP 27,507 30,907
    OMNICOM GROUP INC 9,749 11,633
    PFIZER INC 20,906 23,796
    PPG INDS INC 20,814 27,239
    PROCTER & GAMBLE CO 29,332 31,071
    QUALCOMM INC 17,568 24,349
    ROYAL DUTCH SHELL PLC SPONSORED ADR 31,013 38,933
    STANLEY BLACK & DECKER INC 24,910 29,490
    TEXAS INSTRS INC 23,895 31,395
    TIME WARNER INC 26,188 27,570
    VANGUARD DIVIDEND APPRECIATION ETF 6,570 7,368
    VF CORP 25,419 28,353
    WAL-MART STORES INC 32,233 34,353
    WASTE MGMT INC 19,563 22,085

    TY 2010 InvestmentsOtherSchedule2
    Name:
    MEMORIAL SCHOLARSHIP OF HENRY GROTH
    ELSINOR GROTH AND WAYNE ELDER 329100
    EIN: 20-7271091
    Category/ Item Listed at Cost or FMV Book Value End of Year Fair Market Value
    ACCESSOR HIGH YIELD BOND FUND AT COST 145,645 135,126
    ACCESSOR INTERNATIONAL EQUITY AT COST 69,046 108,969
    FORWARD FDS INVESTMENT GRADE FIXED INCOME FUND AT COST 198,085 193,411
    FORWARD FDS MORTGAGE SECURITIES FUND AT COST 56,000 62,479

    TY 2010 OtherAssetsSchedule
    Name:
    MEMORIAL SCHOLARSHIP OF HENRY GROTH
    ELSINOR GROTH AND WAYNE ELDER 329100
    EIN: 20-7271091
    Description Beginning of Year - Book Value End of Year - Book Value End of Year - Fair Market Value
    INCOME REPORTED ON TAX RETURN NOT YET RECEIVED 111    


    TY 2010 OtherExpensesSchedule
    Name:
    MEMORIAL SCHOLARSHIP OF HENRY GROTH
    ELSINOR GROTH AND WAYNE ELDER 329100
    EIN: 20-7271091
    Description Revenue and Expenses per Books Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    STATE REGISTRATON FEES 25 0   25


    TY 2010 OtherIncreasesSchedule
    Name:
    MEMORIAL SCHOLARSHIP OF HENRY GROTH
    ELSINOR GROTH AND WAYNE ELDER 329100
    EIN: 20-7271091
    Description Amount
    RECOVERIES OF AMOUNTS TREATED AS QUALIFIED DISTRIBUTIONS 8,483


    TY 2010 TaxesSchedule
    Name:
    MEMORIAL SCHOLARSHIP OF HENRY GROTH
    ELSINOR GROTH AND WAYNE ELDER 329100
    EIN: 20-7271091
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    FOREIGN TAX PAID 398 398   0
    FEDERAL EXCISE TAX PAID - 2010 TAX YEAR 374 0   0