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
2011
For calendar year 2011, or tax year beginning 01-01-2011 , and ending 12-31-2011
G
Check all that apply:
Name of foundation
RICHARD B MESSER FBO PENNOCK HOSPITAL
 

Number and street (or P.O. box number if mail is not delivered to street address)PO BOX 3636   Room/suite
City or town, state, and ZIP code
GRAND RAPIDS, MI495013636
A Employer identification number

38-6051680
B Telephone number (see page 10 of the instructions)

(800) 400-0439
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$1,833,105J 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      
4 Dividends and interest from securities...... 41,586 41,586  
5a Gross rents..............      
b Net rental income or (loss)  
6a Net gain or (loss) from sale of assets not on line 10 292,726
b Gross sales price for all assets on line 6a 2,403,327
7 Capital gain net income (from Part IV, line 2)... 292,726
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 3,725    
12 Total. Add lines 1 through 11........ 338,037 334,312  
Operating and Administrative Expenses 13 Compensation of officers, directors, trustees, etc.        
14 Other employee salaries and wages......   0 0 0
15 Pension plans, employee benefits.......   0 0  
16a Legal fees (attach schedule)......... Click to see attachment 1,134 566 0 566
b Accounting fees (attach schedule)....... Click to see attachment 870 435 0 435
c Other professional fees (attach schedule)....       0
17 Interest...............       0
18 Taxes (attach schedule) (see page 14 of the instructions) Click to see attachment 1,768 697   0
19 Depreciation (attach schedule) and depletion... 0 0  
20 Occupancy..............        
21 Travel, conferences, and meetings.......   0 0  
22 Printing and publications..........   0 0  
23 Other expenses (attach schedule)....... Click to see attachment 24,466 24,466    
24 Total operating and administrative expenses.
Add lines 13 through 23.......... 28,238 26,164 0 1,001
25 Contributions, gifts, grants paid........ 100,597 100,597
26 Total expenses and disbursements. Add lines 24 and 25 128,835 26,164 0 101,598
27 Subtract line 26 from line 12:
a Excess of revenue over expenses and disbursements 209,202
b Net investment income (if negative, enter -0-) 308,148
c Adjusted net income (if negative, enter -0-)... 0
For Privacy Act and Paperwork Reduction Act Notice, see page 30 of the instructions.
Cat. No. 11289X Form 990-PF (2011)
Form 990-PF (2011)
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............... 3,148 1 1
2 Savings and temporary cash investments.......... 38,488 57,013 57,013
3 Accounts receivable bullet  
Less: allowance for doubtful accounts bullet     0 0
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 bullet0      
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)........ 752    
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)........... 1,554,181 Click to see attachment1,748,756 1,776,091
14 Land, buildings, and equipment: basis bullet  
Less: accumulated depreciation (attach schedule) bullet        
15 Other assets (describe bullet) Click to see attachment1,209 Click to see attachment1,210  
16 Total assets (to be completed by all filers—see the
instructions. Also, see page 1, item I) 1,597,778 1,806,980 1,833,105
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
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......... 1,578,577 1,769,845
28 Paid-in or capital surplus, or land, bldg., and equipment fund    
29 Retained earnings, accumulated income, endowment, or other funds 19,201 37,135
30 Total net assets or fund balances (see page 17 of the
instructions).................... 1,597,778 1,806,980
31 Total liabilities and net assets/fund balances (see page 17 of
the instructions).................. 1,597,778 1,806,980
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 1,597,778
2 Enter amount from Part I, line 27a..................... 2 209,202
3 Other increases not included in line 2 (itemize) bullet 3 0
4 Add lines 1, 2, and 3.......................... 4 1,806,980
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 1,806,980
Form 990-PF (2011)
Form 990-PF (2011)
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 1. VIKING ESCROW FUNDS FINAL PAYMENT DUE 6/30/2012   1970-06-30 2011-01-21
b 47.123 COLUMBIA MID CAP VALUE FD-CL Z   2010-02-03 2011-04-21
c 904.159 COLUMBIA MID CAP VALUE FD-CL Z   2010-01-22 2011-04-21
d 904.159 COLUMBIA MID CAP VALUE FD-CL Z   2010-02-23 2011-04-21
e 1382.488 COLUMBIA MID CAP VALUE FD-CL Z   2010-02-12 2011-04-21
5287.135 COLUMBIA MID CAP VALUE FD-CL Z   2008-12-18 2011-04-21
1509.134 DODGE & COX INCOME FD COM   2008-05-15 2011-04-21
960.769 DODGE & COX INCOME FD COM   2008-04-10 2011-04-21
1609.01 DODGE & COX INCOME FD COM   2008-06-19 2011-04-21
825.083 DODGE & COX INCOME FD COM   2008-07-17 2011-04-21
834.028 DODGE & COX INCOME FD COM   2008-09-24 2011-04-21
359.195 GROWTH FD AMER INC CL F2   2010-01-05 2011-04-21
4493.319 GROWTH FD AMER INC CL F2   2005-06-09 2011-04-21
540.541 GROWTH FD AMER INC CL F2   2010-01-12 2011-04-21
374.392 GROWTH FD AMER INC CL F2   2010-02-03 2011-04-21
375.094 GROWTH FD AMER INC CL F2   2010-02-23 2011-04-21
741.854 GROWTH FD AMER INC CL F2   2009-10-23 2011-04-21
777.907 GROWTH FD AMER INC CL F2   2009-09-25 2011-04-21
500.94 GROWTH FD AMER INC CL F2   2009-03-25 2011-04-21
400. HCB FINL CORP COM   1986-02-05 2011-04-21
58. ISHARES BARCLAYS TIPS BOND FUND   2010-02-03 2011-04-21
95. ISHARES BARCLAYS TIPS BOND FUND   2010-01-22 2011-04-21
95. ISHARES BARCLAYS TIPS BOND FUND   2010-01-12 2011-04-21
70. ISHARES BARCLAYS TIPS BOND FUND   2010-01-05 2011-04-21
9812.745 PIMCO LOW DURATION FD - INSTL   2005-06-09 2011-04-21
48.235 PIMCO LOW DURATION FD - INSTL   2005-12-14 2011-04-21
1.71 PIMCO LOW DURATION FD - INSTL   2006-12-13 2011-04-21
2923.387 PIMCO LOW DURATION FD - INSTL   2007-01-08 2011-04-21
6233.85 PIMCO TOTAL RETURN FUND   2008-10-06 2011-04-21
8973.891 PIMCO TOTAL RETURN FUND   2008-11-04 2011-04-21
1096.964 T ROWE PRICE NEW ERA FUND INC COM   2010-12-03 2011-04-21
1856.654 ROYCE FD PREMIER   2009-10-23 2011-04-21
1936.733 ROYCE FD PREMIER   2009-09-25 2011-04-21
3164.59 ROYCE FD PREMIER   2005-06-09 2011-04-21
10. SPDR GOLD TRUST [WHFIT]   2010-01-12 2011-04-21
90. SPDR GOLD TRUST [WHFIT]   2010-01-05 2011-04-21
90. SPDR GOLD TRUST [WHFIT]   2010-02-03 2011-04-21
45. SPDR GOLD TRUST [WHFIT]   2010-02-23 2011-04-21
61.114 TOUCHSTONE MID CAP GROWTH A   2005-12-08 2011-04-21
127.172 TOUCHSTONE MID CAP GROWTH A   2005-12-08 2011-04-21
3604.27 TOUCHSTONE MID CAP GROWTH A   2005-06-09 2011-04-21
126.793 TOUCHSTONE MID CAP GROWTH A   2008-01-25 2011-04-21
256.148 TOUCHSTONE MID CAP GROWTH A   2010-01-12 2011-04-21
531.915 TOUCHSTONE MID CAP GROWTH A   2010-02-23 2011-04-21
279.799 TOUCHSTONE MID CAP GROWTH A   2009-09-25 2011-04-21
381.388 TOUCHSTONE MID CAP GROWTH A   2009-03-25 2011-04-21
1689.466 FIFTH THIRD DISCIPLINED LARGE VALUE FUND   2008-06-19 2011-04-22
470.501 FIFTH THIRD DISCIPLINED LARGE VALUE FUND   2003-08-11 2011-04-22
938.243 FIFTH THIRD DISCIPLINED LARGE VALUE FUND   2003-07-09 2011-04-22
13.479 FIFTH THIRD DISCIPLINED LARGE VALUE FUND   2003-06-09 2011-04-22
1838.397 FIFTH THIRD DISCIPLINED LARGE VALUE FUND   2003-01-13 2011-04-22
1952.019 FIFTH THIRD DISCIPLINED LARGE VALUE FUND   2002-08-13 2011-04-22
691.039 FIFTH THIRD DISCIPLINED LARGE VALUE FUND   2002-11-13 2011-04-22
1303.053 FIFTH THIRD DISCIPLINED LARGE VALUE FUND   2002-10-15 2011-04-22
1529.051 FIFTH THIRD DISCIPLINED LARGE VALUE FUND   2010-01-12 2011-04-22
2044.989 FIFTH THIRD DISCIPLINED LARGE VALUE FUND   2010-01-05 2011-04-22
2098.635 FIFTH THIRD DISCIPLINED LARGE VALUE FUND   2010-02-03 2011-04-22
1267.192 FIFTH THIRD DISCIPLINED LARGE VALUE FUND   2003-02-12 2011-04-22
1053.74 FIFTH THIRD DISCIPLINED LARGE VALUE FUND   2010-02-23 2011-04-22
2109.704 FIFTH THIRD DISCIPLINED LARGE VALUE FUND   2010-01-22 2011-04-22
982.25 FIFTH THIRD DISCIPLINED LARGE VALUE FUND   2003-03-10 2011-04-22
3222.341 FIFTH THIRD DISCIPLINED LARGE VALUE FUND   2010-02-12 2011-04-22
396.173 FIFTH THIRD DISCIPLINED LARGE VALUE FUND   2008-12-10 2011-04-22
4731. HCB FINL CORP COM   1986-02-05 2011-04-26
713. IPATH DOW JONES-UBS COMMDTY [ETN]   2011-04-21 2011-05-25
132.37 EUROPACIFIC GROWTH FD CL F-2   2011-04-21 2011-05-25
287.884 HARBOR CAPITAL APPRECIATION   2011-04-21 2011-05-25
50. ISHARES COHEN & STEERS REALTY ETF   2011-04-21 2011-05-25
246.161 MFS VALUE FUND CLASS I   2011-04-25 2011-05-25
80.249 OPPENHEIMER DVLPING MKTS-Y   2011-04-21 2011-05-25
3493.478 PIMCO ALL ASSET ALL AUTH FUND   2011-04-21 2011-05-25
406.869 PIMCO TOTAL RETURN FUND   2011-04-21 2011-05-25
560. IPATH DOW JONES-UBS COMMDTY [ETN]   2011-04-21 2011-07-21
159.76 BARON ASSET FD GROWTH & INCM   2011-04-21 2011-07-21
189.932 GOLDMAN SACHS M/C VALUE-INST   2011-04-21 2011-07-21
899.01 HARBOR CAPITAL APPRECIATION   2011-04-21 2011-07-21
66. ISHARES BARCLAYS TIPS BOND FUND   2011-05-25 2011-07-21
25. ISHARES BARCLAYS TIPS BOND FUND   2010-01-05 2011-07-21
40. ISHARES BARCLAYS TIPS BOND FUND   2010-02-12 2011-07-21
772.373 MFS VALUE FUND CLASS I   2011-04-25 2011-07-21
1750.456 MERGER FD SH BEN INT   2011-05-25 2011-07-21
1722.578 PIMCO ALL ASSET ALL AUTH FUND   2011-04-21 2011-07-21
18.653 PIMCO ALL ASSET ALL AUTH FUND   2010-12-08 2011-07-21
1134.781 PIMCO ALL ASSET ALL AUTH FUND   2010-01-22 2011-07-21
115.041 T ROWE PRICE MID-CAP GROWTH FUND   2011-04-21 2011-07-21
165.894 ROWE T PRICE US TREAS FDS LONG TERM FD   2011-04-21 2011-07-21
590.109 ROYCE FD TOTAL RETURN FD   2011-04-21 2011-07-21
632. IPATH DOW JONES-UBS COMMDTY [ETN]   2011-04-21 2011-07-22
317.709 BARON ASSET FD GROWTH & INCM   2011-04-21 2011-08-25
190.724 EUROPACIFIC GROWTH FD CL F-2   2011-04-21 2011-08-25
7065.775 FIFTH THIRD SHORT TERM BOND FUND   2011-04-22 2011-08-25
456.029 GOLDMAN SACHS M/C VALUE-INST   2011-04-21 2011-08-25
4039.573 MERGER FD SH BEN INT   2011-05-25 2011-08-25
297.231 OPPENHEIMER DVLPING MKTS-Y   2011-04-21 2011-08-25
177.265 PIMCO ALL ASSET ALL AUTH FUND   2010-01-22 2011-08-25
159.391 PIMCO ALL ASSET ALL AUTH FUND   2010-01-12 2011-08-25
727.967 PIMCO TOTAL RETURN FUND   2011-07-21 2011-08-25
12957.115 PIMCO TOTAL RETURN FUND   2011-04-21 2011-08-25
283.209 T ROWE PRICE MID-CAP GROWTH FUND   2011-04-21 2011-08-25
1202.194 ROWE T PRICE US TREAS FDS LONG TERM FD   2011-04-21 2011-08-25
1307.841 ROYCE FD TOTAL RETURN FD   2011-04-21 2011-08-25
55. SPDR GOLD TRUST [WHFIT]   2011-07-21 2011-08-25
438.287 HARBOR CAPITAL APPRECIATION   2011-04-21 2011-11-16
426.317 MFS VALUE FUND CLASS I   2011-04-25 2011-11-16
171.608 ROWE T PRICE US TREAS FDS LONG TERM FD   2011-04-21 2011-11-16
257.004 DODGE & COX INCOME FD COM   2011-08-25 2011-12-21
642.143 EUROPACIFIC GROWTH FD CL F-2   2011-04-21 2011-12-21
377.586 EUROPACIFIC GROWTH FD CL F-2   2011-07-21 2011-12-21
49.905 EUROPACIFIC GROWTH FD CL F-2   2009-09-25 2011-12-21
270.051 EUROPACIFIC GROWTH FD CL F-2   2010-01-22 2011-12-21
195.476 EUROPACIFIC GROWTH FD CL F-2   2011-11-16 2011-12-21
2.082 EUROPACIFIC GROWTH FD CL F-2   2010-02-23 2011-12-21
492.788 HARBOR CAPITAL APPRECIATION   2011-04-21 2011-12-21
76. ISHARES COHEN & STEERS REALTY ETF   2011-07-21 2011-12-21
1150.52 MFS VALUE FUND CLASS I   2011-04-25 2011-12-21
(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 27,211     27,211
b 688   522 166
c 13,192   10,000 3,192
d 13,192   10,000 3,192
e 20,171   15,000 5,171
77,139   43,196 33,943
20,177   19,000 1,177
12,845   12,000 845
21,512   20,000 1,512
11,031   10,000 1,031
11,151   10,000 1,151
11,631   10,000 1,631
145,494   125,050 20,444
17,503   15,000 2,503
12,123   10,000 2,123
12,146   10,000 2,146
24,021   19,756 4,265
25,189   20,000 5,189
16,220   10,000 6,220
4,984   59 4,925
6,397   6,103 294
10,478   9,991 487
10,478   9,974 504
7,721   7,321 400
103,034   99,697 3,337
506   482 24
18   17 1
30,696   29,000 1,696
68,448   64,957 3,491
98,533   92,700 5,833
62,571   56,000 6,571
42,090   29,614 12,476
43,906   30,000 13,906
71,741   46,868 24,873
1,468   1,129 339
13,209   9,849 3,360
13,209   9,798 3,411
6,605   4,867 1,738
1,547   1,351 196
3,220   2,811 409
91,260   78,501 12,759
3,210   2,649 561
6,486   5,000 1,486
13,468   10,000 3,468
7,085   5,000 2,085
9,657   5,000 4,657
19,125   20,358 -1,233
5,326   5,543 -217
10,621   11,024 -403
153   155 -2
20,811   19,744 1,067
22,097   20,516 1,581
7,823   7,111 712
14,751   13,018 1,733
17,309   15,000 2,309
23,149   20,000 3,149
23,757   20,000 3,757
14,345   12,064 2,281
11,928   10,000 1,928
23,882   20,000 3,882
11,119   9,155 1,964
36,477   30,000 6,477
4,485   3,082 1,403
56,534   694 55,840
34,871   37,549 -2,678
5,610   5,852 -242
11,210   11,346 -136
3,625   3,593 32
5,955   5,982 -27
2,803   2,956 -153
38,289   38,533 -244
4,488   4,467 21
27,796   29,486 -1,690
9,082   8,931 151
7,276   7,276  
36,787   35,430 1,357
7,365   7,309 56
2,790   2,615 175
4,464   4,167 297
18,668   18,769 -101
28,322   28,445 -123
18,811   19,000 -189
204   203 1
12,392   11,870 522
7,278   7,407 -129
1,918   1,863 55
8,291   8,279 12
31,387   33,277 -1,890
15,260   17,760 -2,500
6,994   8,432 -1,438
67,619   67,690 -71
14,374   17,470 -3,096
62,815   65,643 -2,828
9,137   10,950 -1,813
1,902   1,854 48
1,710   1,659 51
7,979   8,029 -50
142,010   142,269 -259
15,050   18,236 -3,186
15,424   13,501 1,923
15,576   18,349 -2,773
9,144   8,559 585
16,672   17,273 -601
9,481   10,360 -879
2,375   1,927 448
3,398   3,441 -43
22,719   28,389 -5,670
13,359   16,297 -2,938
1,766   1,858 -92
9,554   10,000 -446
6,916   7,088 -172
74   75 -1
18,006   19,421 -1,415
5,276   5,782 -506
25,542   27,958 -2,416
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       27,211
b       166
c       3,192
d       3,192
e       5,171
      33,943
      1,177
      845
      1,512
      1,031
      1,151
      1,631
      20,444
      2,503
      2,123
      2,146
      4,265
      5,189
      6,220
      4,925
      294
      487
      504
      400
      3,337
      24
      1
      1,696
      3,491
      5,833
      6,571
      12,476
      13,906
      24,873
      339
      3,360
      3,411
      1,738
      196
      409
      12,759
      561
      1,486
      3,468
      2,085
      4,657
      -1,233
      -217
      -403
      -2
      1,067
      1,581
      712
      1,733
      2,309
      3,149
      3,757
      2,281
      1,928
      3,882
      1,964
      6,477
      1,403
      55,840
      -2,678
      -242
      -136
      32
      -27
      -153
      -244
      21
      -1,690
      151
       
      1,357
      56
      175
      297
      -101
      -123
      -189
      1
      522
      -129
      55
      12
      -1,890
      -2,500
      -1,438
      -71
      -3,096
      -2,828
      -1,813
      48
      51
      -50
      -259
      -3,186
      1,923
      -2,773
      585
      -601
      -879
      448
      -43
      -5,670
      -2,938
      -92
      -446
      -172
      -1
      -1,415
      -506
      -2,416
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 2 292,726
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))
2010      
2009      
2008      
2007      
2006      
2 Total of line 1, column (d) ...................... 2  
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  
4 Enter the net value of noncharitable-use assets for 2011 from Part X, line 5..... 4  
5 Multiply line 4 by line 3....................... 5  
6 Enter 1% of net investment income (1% of Part I, line 27b)........... 6  
7 Add lines 5 and 6......................... 7  
8 Enter qualifying distributions from Part XII, line 4.............. 8  
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 (2011)
Form 990-PF (2011)
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 6,163
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 6,163
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 6,163
6 Credits/Payments:
a 2011 estimated tax payments and 2010 overpayment credited to 2011 6a 1,428
b Exempt foreign organizations—tax withheld at source....... 6b
c Tax paid with application for extension of time to file (Form 8868) 6c 0
d Backup withholding erroneously withheld ........... 6d  
7 Total credits and payments. Add lines 6a through 6d.............. 7 1,428
8 Enter any penalty for underpayment of estimated tax. if Form 2220 is attached. 8 0
9 Tax due. If the total of lines 5 and 8 is more than line 7, enter amount owed.......Bullet 9 4,735
10 Overpayment. If line 7 is more than the total of lines 5 and 8, enter the amount overpaid...Bullet 10  
11 Enter the amount of line 10 to be: Credited to 2012 estimated taxBullet0 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$   (2) On foundation managers.bullet$  
e
Enter the reimbursement (if any) paid by the foundation during the year for political expenditure tax imposed
on foundation managers.bullet$  
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)bulletMI
    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 2011 or the taxable year beginning in 2011 (see instructions for Part XIV on
    page 27)? If “Yes,” complete Part XIV..........................
    9
     
    No
    10
    Did any persons become substantial contributors during the tax year? If “Yes,” attach a schedule listing their names and addresses.
    10
     
    No
    11
    At any time during the year, did the foundation, directly or indirectly, own a controlled entity within the
    meaning of section 512(b)(13)? If "Yes," attach schedule. (see page 20 of the instructions) .......
    11
     
    No
    12
    Did the foundation acquire a direct or indirect interest in any applicable insurance contract before August 17, 2008?
    12
     
    No
    13
    Did the foundation comply with the public inspection requirements for its annual returns and exemption application?
    13
    Yes
     
    Website addressbulletN/A
    14
    The books are in care ofbulletFIFTH THIRD BANK Telephone no.bullet (616) 653-5826
    Located atbullet111 LYON ST NWGRAND RAPIDSMI ZIP+4bullet49503
    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 2011, 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 (2011)
    Form 990-PF (2011)
    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 2011?.............
    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 2011, did the foundation have any undistributed income (lines 6d
    and 6e, Part XIII) for tax year(s) beginning before 2011?...............
    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
     
    No
    c
    If the provisions of section 4942(a)(2) are being applied to any of the years listed in 2a, list the years here.
    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 2011 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 2011.)....................
    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 2011?
    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 (2011)
    Form 990-PF (2011)
    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
    FIFTH THIRD BANK TRUSTEE
    1     		0    
    111 LYON ST NW
    GRAND RAPIDS,MI49503
    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 (2011)
    Form 990-PF (2011)
    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 N/A  
    2  
    All other program-related investments. See page 24 of the instructions.
    3  
    Total. Add lines 1 through 3..........................bullet  
    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
    1,949,892
    b
    Average of monthly cash balances.......................
    1b
    0
    c
    Fair market value of all other assets (see page 24 of the instructions)............
    1c
    0
    d
    Total (add lines 1a, b, and c).........................
    1d
    1,949,892
    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
    1,949,892
    4
    Cash deemed held for charitable activities. Enter 1 1⁄2% of line 3 (for greater amount, see page 25
    of the instructions) ...........................
    4
    29,248
    5
    Net value of noncharitable-use assets. Subtract line 4 from line 3. Enter here and on Part V, line 4
    5
    1,920,644
    6
    Minimum investment return. Enter 5% of line 5..................
    6
    96,032
    Part XI
    Distributable Amount bullet and do not complete this part.)
    1
    Minimum investment return from Part X, line 6....................
    1
    96,032
    2a
    Tax on investment income for 2011 from Part VI, line 5......
    2a
    6,163
    b
    Income tax for 2011. (This does not include the tax from Part VI.)...
    2b
     
    c
    Add lines 2a and 2b............................
    2c
    6,163
    3
    Distributable amount before adjustments. Subtract line 2c from line 1............
    3
    89,869
    4
    Recoveries of amounts treated as qualifying distributions................
    4
    0
    5
    Add lines 3 and 4............................
    5
    89,869
    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
    89,869
    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
    101,598
    b
    Program-related investments—total from Part IX-B..................
    1b
    0
    2
    Amounts paid to acquire assets used (or held for use) directly in carrying out charitable, etc.,
    purposes...............................
    2
    0
    3
    Amounts set aside for specific charitable projects that satisfy the:
    a
    Suitability test (prior IRS approval required)....................
    3a
    0
    b
    Cash distribution test (attach the required schedule) .................
    3b
    0
    4
    Qualifying distributions. Add lines 1a through 3b. Enter here and on Part V, line 8, and Part XIII, line 4
    4
    101,598
    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
    101,598
    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 (2011)
    Form 990-PF (2011)
    Page 8
    Part XIII
    Undistributed Income (see page 26 of the instructions)
    (a)
    Corpus     		(b)
    Years prior to 2010     		(c)
    2010     		(d)
    2011
    1 Distributable amount for 2011 from Part XI, line 7 89,869
    2 Undistributed income, if any, as of the end of 2011:
    a Enter amount for 2010 only....... 4,809
    b Total for prior years:2009, 20, 20 0
    3 Excess distributions carryover, if any, to 2011:
    a From 2006....... 0
    b From 2007....... 0
    c From 2008....... 0
    d From 2009....... 0
    e From 2010....... 0
    fTotal of lines 3a through e......... 0
    4Qualifying distributions for 2011 from Part
    XII, line 4: bullet$ 101,598
    a Applied to 2010, but not more than line 2a 4,809
    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 2011 distributable amount..... 89,869
    e Remaining amount distributed out of corpus 6,920
    5 Excess distributions carryover applied to 2011. 0 0
    (If an amount appears in column (d), the
    same amount must be shown in column (a).)
    6Enter the net total of each column as
    indicated below:
    a Corpus. Add lines 3f, 4c, and 4e. Subtract line 5 6,920
    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 2010. Subtract line
    4a from line 2a. Taxable amount—see page 27
    of the instructions ...........     		0
    f Undistributed income for 2011. 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 2006 not
    applied on line 5 or line 7 (see page 27 of the
    instructions) .............     		0
    9Excess distributions carryover to 2012.
    Subtract lines 7 and 8 from line 6a ......     		6,920
    10 Analysis of line 9:
    a Excess from 2007.... 0
    b Excess from 2008.... 0
    c Excess from 2009.... 0
    d Excess from 2010.... 0
    e Excess from 2011.... 6,920
    Form 990-PF (2011)
    Form 990-PF (2011)
    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 2011, 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) 2011 (b) 2010 (c) 2009 (d) 2008
             
    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).)
    NONE
    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.
    NONE
    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 (2011)
    Form 990-PF (2011)
    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
    THORNAPPLE PLAYERS
    PO BOX 514
    HASTINGS,MI49058     		NONE 501(C) 3 GENERATING OPERATING BUDGET 3,000
    BARRY CO TRIAL COURT
    PO BOX 293
    HASTINGS,MI49058     		NONE 509(A)(1) GENERATING OPERATING BUDGET 16,097
    HASTINGS YOUTH ATHLETIC ASSN
    221 W STATEST
    HASTINGS,MI49058     		NONE 501(C)(3) GENERAL OPERATING BUDGET 2,000
    YMCA OF BARRY COUNTY
    2055 IROQUIS TRAIL
    HASTINGS,MI49058     		NONE 501(C)(3) GENERAL OPERATING BUDGET 10,000
    BOY SCOUTS OF AMERICA
    3213 WALKER AVE NW
    GRAND RAPIDS,MI49544     		NONE 501(C)(3) GENERAL OPERATING BUDGET 5,000
    PENNOCK HOSPITAL BOARD
    1009 W GREEN STREET
    HASTINGS,MI49058     		NONE 509(A)(1) GENERAL OPERATING BUDGET 10,000
    ANGEL FUND OF ST ROSE SCH
    707 S JEFFERSON ST
    HASTINGS,MI49058     		NONE 501(C)(3) NEEDS OF CHILDREN 10,000
    NOAH'S ARK PRESCHOOL
    405 NORTH HIGHWAY 37
    HASTINGS,MI49058     		NONE 501(C) 3 GENERAL OPERATING BUDGET 2,000
    BARRY COUNTY CHRISTIAN SCHOOL
    2999 MCKEOWN RD
    HASTINGS,MI49058     		NONE PUBLIC GENERAL OPERATING BUDGET 5,000
    CHILD ABUSE PREVENTION
    COUNCIL
    PO BOX 306
    HASTINGS,MI49058     		NONE 501(C)(3) GENERAL OPERATING BUDGET 4,000
    BCACS FOUNDATION
    63 NORTH 24TH ST
    BATTLE CREEK,MI49015     		NONE PUBLIC GENERAL OPERATING BUDGET 5,000
    THORNAPPLE ARTS COUNCIL
    PO BOX 36
    HASTINGS,MI49058     		NONE 501(C) 3 GENERAL OPERATING BUDGET 3,000
    HABITAT FOR HUMANITY
    BARRY COUNTY
    PO BOX 234
    HASTINGS,MI49058     		NONE 501(C)(3) GENERAL OPERATING BUDGET 1,000
    LEADERSHIP BARRY CO
    PO BOX 394
    HASTINGS,MI49058     		NONE 501(C)(3) GENERATING OPERATING BUDGET 2,000
    THE REVUE
    301 N MAIN ST
    NASHVILLE,MI49073     		NONE 501(C)3 GENERAL OPERATING BUDGET 1,000
    CASA FOR KIDS INC
    430 E BARFIELD DR
    HASTINGS,MI49058     		NONE 501(C)(3) GENERAL OPERATING BUDGET 10,000
    GREEN GABLES HAVEN
    629 W STATE ST STE 201
    HASTINGS,MI49058     		NONE 501(C)(3) GENERAL OPERATING BUDGET 4,000
    HASTINGS PUBLIC SCHOOLS
    232 WEST GRAND ST
    HASTINGS,MI49058     		NONE 501(C)3 GENERAL OPERATING BUDGET 3,500
    COMMUNITY MUSIC SCHOOL
    209 W GREEN ST
    HASTINGS,MI49058     		NONE 501(C)(3) GENERAL ACTIVITIES 4,000
    Total .................................bullet 3a 100,597
    bApproved for future payment
    Total .................................bullet 3b  
    Form 990-PF (2011)
    Form 990-PF (2011)
    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          
    4 Dividends and interest from securities....       0 41,586
    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       0 292,726
    9 Net income or (loss) from special events:          
    10 Gross profit or (loss) from sales of inventory..          
    11 Other revenue: aFED EXCISE TAX REF         3,725
    b
    c
    d
    e
    12 Subtotal. Add columns (b), (d), and (e)..   0 338,037
    13Total. Add line 12, columns (b), (d), and (e)..................
    13338,037
    (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.)
    4 INVESTMENT INCOME EARNED BY THIS TRUST IS USED TO MAKE
    8 CHARITABLE CONTRIBUTIONS.
    11 0
    Form 990-PF (2011)
    Form 990-PF (2011)
    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)
    Yes
     
    (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
    1a(1) 16,097 BARRY CO TRIAL COURT FOR THE NEEDS OF CHILDREN IN BARRY CO
    1a(1) 2,000 LEADERSHIP BARRY COUNTY FOR THE NEEDS OF CHILDREN IN BARRY CO
    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 (2011)
    Additional Data


    Software ID:  
    Software Version:  


    Form 990PF - Special Condition Description:
    Special Condition Description

    TY 2011 AccountingFeesSchedule
    Name:
    RICHARD B MESSER FBO PENNOCK HOSPITAL
    EIN: 38-6051680
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    TAX PREPARATION FEE 870 435   435

    TY 2011 InvestmentsOtherSchedule2
    Name:
    RICHARD B MESSER FBO PENNOCK HOSPITAL
    EIN: 38-6051680
    Category/ Item Listed at Cost or FMV Book Value End of Year Fair Market Value
    ROYCE FD TOTAL RETURN FD AT COST 48,964 46,512
    TOUCHSTONE MID CAP GROWTH      
    DODGE & COX INCOME FD AT COST 159,100 158,041
    PIMCO FDS MORTGBS FD P AT COST 39,563 38,402
    EUROPACIFIC GROWTH FD CL F-2 AT COST 131,504 139,735
    ISHARES BARCLAYS TIPS BD FD AT COST 18,343 20,304
    LORD ABBETT BD DEB FD AT COST 63,680 64,614
    ISHARES COHEN & STEERS REALTY AT COST 103,946 120,708
    PIMCO ALL ASSET ALL AUTH FD AT COST 96,366 92,476
    T ROWE PRICE MID-CAP GROWTH FD AT COST 60,321 55,606
    SPDR GOLD TRUST AT COST 50,770 49,549
    OPPENHEIMER INTL BD FD AT COST 42,472 39,396
    ROWE T PRICE US TREAS FDS AT COST 33,118 40,461
    TCW FDS INC EMERGING MKTS AT COST 41,774 39,812
    BARON GROWTH FD AT COST 48,557 46,307
    GOLDMAN SACHS MID-CAP VALUE FD AT COST 59,002 55,910
    HARBOR FD CAP APPRECIATION FD AT COST 238,635 225,801
    MFS VALUE FD AT COST 245,533 229,235
    OPPENHEIMER DVLPING MKTS AT COST 179,742 142,944
    HUSSMAN STRATEGIC GROWTH FD AT COST 87,366 85,458
    VIKING ESCROW FUNDS AT COST   84,820

    TY 2011 LegalFeesSchedule
    Name:
    RICHARD B MESSER FBO PENNOCK HOSPITAL
    EIN: 38-6051680
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    LEGAL FEES 567 283   283
    LEGAL FEES - INCOME (ALLOCABLE 567 283   283


    TY 2011 OtherAssetsSchedule
    Name:
    RICHARD B MESSER FBO PENNOCK HOSPITAL
    EIN: 38-6051680
    Description Beginning of Year - Book Value End of Year - Book Value End of Year - Fair Market Value
    ACCRUED INCOME 1,208 1,209 0
    VIKING ESCROW FDS 1 1 0


    TY 2011 OtherExpensesSchedule
    Name:
    RICHARD B MESSER FBO PENNOCK HOSPITAL
    EIN: 38-6051680
    Description Revenue and Expenses per Books Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    BANK SERVICE FEES 12,482 12,482   0
    BANK SERVICE FEES 11,984 11,984   0


    TY 2011 OtherIncomeSchedule2
    Name:
    RICHARD B MESSER FBO PENNOCK HOSPITAL
    EIN: 38-6051680
    Description Revenue And Expenses Per Books Net Investment Income Adjusted Net Income
    FED EXCISE TAX REFUND 3,725 0  


    TY 2011 TaxesSchedule
    Name:
    RICHARD B MESSER FBO PENNOCK HOSPITAL
    EIN: 38-6051680
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    FEDERAL EXCISE TAX ESTIMATE 1,071 0   0
    FOREIGN TAXES ON QUALIFIED FOR 606 606   0
    FOREIGN TAXES PAID - NQDI 91 91   0