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
E LOUISE CARLSON FOUNDATION
 

Number and street (or P.O. box number if mail is not delivered to street address)1525 W WT HARRIS BLVD D1114-044   Room/suite
City or town, state, and ZIP code
CHARLOTTE, NC28288
A Employer identification number

43-6926676
B Telephone number (see page 10 of the instructions)

(336) 747-8163
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$1,685,778J 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 16 16  
4 Dividends and interest from securities...... 42,952 42,746  
5a Gross rents..............      
b Net rental income or (loss)  
6a Net gain or (loss) from sale of assets not on line 10 26,588
b Gross sales price for all assets on line 6a 599,496
7 Capital gain net income (from Part IV, line 2)... 26,588
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).......      
12 Total. Add lines 1 through 11........ 69,556 69,350  
Operating and Administrative Expenses 13 Compensation of officers, directors, trustees, etc. 33,550 25,162   8,387
14 Other employee salaries and wages......   0 0 0
15 Pension plans, employee benefits.......   0 0  
16a Legal fees (attach schedule).........       0
b Accounting fees (attach schedule).......        
c Other professional fees (attach schedule)....       0
17 Interest...............       0
18 Taxes (attach schedule) (see page 14 of the instructions) Click to see attachment 1,075 954   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 12 12    
24 Total operating and administrative expenses.
Add lines 13 through 23.......... 34,637 26,128 0 8,387
25 Contributions, gifts, grants paid........ 65,192 65,192
26 Total expenses and disbursements. Add lines 24 and 25 99,829 26,128 0 73,579
27 Subtract line 26 from line 12:
a Excess of revenue over expenses and disbursements -30,273
b Net investment income (if negative, enter -0-) 43,222
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...............      
2 Savings and temporary cash investments.......... 17,161 73,170 73,170
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) 181,121 Click to see attachment24,766 25,833
b Investments—corporate stock (attach schedule)........ 1,078,383 Click to see attachment1,214,809 1,399,453
c Investments—corporate bonds (attach schedule)........ 243,098 Click to see attachment176,355 187,322
11 Investments—land, buildings, and equipment: basis bullet  
Less: accumulated depreciation (attach schedule) bullet        
12 Investments—mortgage loans..............      
13 Investments—other (attach schedule)...........     0
14 Land, buildings, and equipment: basis bullet  
Less: accumulated depreciation (attach schedule) bullet        
15 Other assets (describe bullet)      
16 Total assets (to be completed by all filers—see the
instructions. Also, see page 1, item I) 1,519,763 1,489,100 1,685,778
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......... 1,519,763 1,489,100
28 Paid-in or capital surplus, or land, bldg., and equipment fund    
29 Retained earnings, accumulated income, endowment, or other funds    
30 Total net assets or fund balances (see page 17 of the
instructions).................... 1,519,763 1,489,100
31 Total liabilities and net assets/fund balances (see page 17 of
the instructions).................. 1,519,763 1,489,100
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 1,519,763
2 Enter amount from Part I, line 27a..................... 2 -30,273
3 Other increases not included in line 2 (itemize) bulletClick to see attachment 3 102
4 Add lines 1, 2, and 3.......................... 4 1,489,592
5 Decreases not included in line 2 (itemize) bulletClick to see attachment 5 492
6 Total net assets or fund balances at end of year (line 4 minus line 5)—Part II, column (b), line 30. 6 1,489,100
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 85. ALEXANDRIA REAL ESTATE EQUITIES INC COM W/RIGHTS ATTACHED EXP 2/10   2007-11-08 2011-09-27
b 1000. AUTOMATIC DATA PROCESSING INC COM   2008-04-30 2011-09-27
c 400. AVERY DENNISON CORP COM   2005-09-12 2011-05-11
d 225. AVON PRODS INC COM W/RTS ATTACHED   2005-09-12 2011-09-27
e 450. FORWARD AIR CORP COM W/ RTS ATTACHED EXP 05/18/2009   2005-06-01 2011-09-27
500. FORWARD HOOVER SM CAP EQ-I #103   2009-05-04 2011-09-27
425. FRANKLIN RES INC COM   2008-04-30 2011-09-27
310. W W GRAINGER INC COM W/RIGHTS ATTACHED EXP 5/15/2009   2007-04-20 2011-09-27
940. HENRY JACK & ASSOC INC COM   2009-05-01 2011-09-27
500. ILLINOIS TOOL WORKS INC COM   2005-02-08 2011-09-27
1600. LOWES COS INC COM W/RIGHTS ATTACHED EXPIRING 9/9/2008   2007-11-08 2011-09-27
130. NOBLE ENERGY INC COM   2009-03-18 2011-09-27
700. PATTERSON COS INC   2007-11-01 2011-05-11
1940. PFIZER INC COM W/RTS ATTACHED EXP 10/15/2007   2007-11-08 2011-09-27
165. PLUM CREEK TIMBER CO INC COM   2005-02-08 2011-09-27
865. QUEST DIAGNOSTICS INC COM   2007-11-01 2011-09-27
500. RS GLOBAL NATURAL RESOURCES-Y1674   2009-05-04 2011-09-27
210. SPDR DOW JONES REIT ETF   2007-12-18 2011-09-27
300. SEMPRA ENERGY COM   2009-03-30 2011-09-27
580. SIGMA ALDRICH CORP COM   2004-10-13 2011-09-27
600. SMITH & NEPHEW PLC SPDN ADR NEW   2007-11-08 2011-09-27
500. SOUTHERN CO COM   2006-08-02 2011-09-27
490. WAL MART STORES INC COM   2005-09-12 2011-12-05
600. WEIGHT WATCHERS INTL INC COM   2007-11-08 2011-09-27
300. NOBLE CORPORATION   2009-03-30 2011-09-27
(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 5,323   8,187 -2,864
b 48,382   47,752 630
c 16,852   21,966 -5,114
d 4,680   7,162 -2,482
e 12,519   12,530 -11
7,100   6,490 610
44,318   52,300 -7,982
49,825   25,733 24,092
27,786   21,049 6,737
22,920   22,158 762
32,703   51,357 -18,654
9,763   6,529 3,234
24,724   24,606 118
34,803   49,427 -14,624
5,918   5,771 147
43,561   47,939 -4,378
16,890   11,765 5,125
12,505   15,562 -3,057
15,387   13,344 2,043
38,221   16,260 21,961
27,758   31,598 -3,840
21,140   17,145 3,995
28,485   25,625 2,860
35,699   23,391 12,308
9,702   7,262 2,440
Complete only for assets showing gain in column (h) and owned by the foundation on 12/31/69 (l) Gains (Col. (h) gain minus
col. (k), but not less than -0-) or
Losses (from col.(h))
(i) F.M.V. as of 12/31/69 (j) Adjusted basis
as of 12/31/69 		(k) Excess of col. (i)
over col. (j), if any
a       -2,864
b       630
c       -5,114
d       -2,482
e       -11
      610
      -7,982
      24,092
      6,737
      762
      -18,654
      3,234
      118
      -14,624
      147
      -4,378
      5,125
      -3,057
      2,043
      21,961
      -3,840
      3,995
      2,860
      12,308
      2,440
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 26,588
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 83,527 1,631,839 0.051186
2009 88,305 1,519,464 0.058116
2008 79,667 1,794,546 0.044394
2007 58,638 1,951,085 0.030054
2006 33,661 1,800,350 0.018697
2 Total of line 1, column (d) ...................... 2 0.202447
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 0.040489
4 Enter the net value of noncharitable-use assets for 2011 from Part X, line 5..... 4 1,744,912
5 Multiply line 4 by line 3....................... 5 70,650
6 Enter 1% of net investment income (1% of Part I, line 27b)........... 6 432
7 Add lines 5 and 6......................... 7 71,082
8 Enter qualifying distributions from Part XII, line 4.............. 8 73,579
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 1 432
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............................ 3 432
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- ..... 5 432
6 Credits/Payments:
a 2011 estimated tax payments and 2010 overpayment credited to 2011 6a 148
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.............. 7 148
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 9 284
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 taxBullet   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)bulletMO
    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 addressbullet  
    14
    The books are in care ofbulletWELLS FARGO Telephone no.bullet (336) 747-8163
    Located atbullet1 WEST 4TH ST - 2ND FLOORWINSTON SALEMNC ZIP+4bullet271013818
    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
     
    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 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
    WELLS FARGO TRUSTEE
    40     		33,550    
    1525 W WT Harris BLVD D1114-044
    Charlotte,NC282881161
    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  
    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
    1,705,818
    b
    Average of monthly cash balances.......................
    1b
    65,666
    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
    1,771,484
    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
    1,771,484
    4
    Cash deemed held for charitable activities. Enter 1 1⁄2% of line 3 (for greater amount, see page 25
    of the instructions) ...........................
    4
    26,572
    5
    Net value of noncharitable-use assets. Subtract line 4 from line 3. Enter here and on Part V, line 4
    5
    1,744,912
    6
    Minimum investment return. Enter 5% of line 5..................
    6
    87,246
    Part XI
    Distributable Amount bullet and do not complete this part.)
    1
    Minimum investment return from Part X, line 6....................
    1
    87,246
    2a
    Tax on investment income for 2011 from Part VI, line 5......
    2a
    432
    b
    Income tax for 2011. (This does not include the tax from Part VI.)...
    2b
     
    c
    Add lines 2a and 2b............................
    2c
    432
    3
    Distributable amount before adjustments. Subtract line 2c from line 1............
    3
    86,814
    4
    Recoveries of amounts treated as qualifying distributions................
    4
    0
    5
    Add lines 3 and 4............................
    5
    86,814
    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
    86,814
    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
    73,579
    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
    73,579
    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
    432
    6
    Adjusted qualifying distributions. Subtract line 5 from line 4..............
    6
    73,147
    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 86,814
    2 Undistributed income, if any, as of the end of 2011:
    a Enter amount for 2010 only....... 73,579
    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$ 73,579
    a Applied to 2010, but not more than line 2a 73,579
    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..... 0
    e Remaining amount distributed out of corpus 0
    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 0
    b Prior years’ undistributed income. Subtract
    line 4b from line 2b ...........     		0
    c Enter the amount of prior years’ undistributed
    income for which a notice of deficiency has
    been issued, or on which the section 4942(a)
    tax has been previously assessed......     		0
    d Subtract line 6c from line 6b. Taxable
    amount—see page 27 of the instructions ...     		0
    e Undistributed income for 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 ..........     		86,814
    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 ......     		0
    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.... 0
    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).)
    bList any managers of the foundation who own 10% or more of the stock of a corporation (or an equally large portion of the
    ownership of a partnership or other entity) of which the foundation has a 10% or greater interest.
    2Information Regarding Contribution, Grant, Gift, Loan, Scholarship, etc., Programs:
    Check here bullet
    aThe name, address, and telephone number of the person to whom applications should be addressed:
    bThe form in which applications should be submitted and information and materials they should include:
    cAny submission deadlines:
    dAny restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other
    factors:
    Form 990-PF (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
    THE SALVATION ARMY
    C/O MARY HIZER - MIDLAND DIV
    1130 HAMPTON AVENUE
    ST LOUIS,MO631393147     		NONE PUBLIC CHARITY CONTRIBUTION 32,596
    FIRST PRESBYTERIAN CHURCH JOPLIN
    509 SOUTH PEARL AVENUE
    JOPLIN,MO64801     		NONE PUBLIC CHARITY CONTRIBUTION 32,596
    Total .................................bullet 3a 65,192
    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     14 16  
    4 Dividends and interest from securities....     14 42,952  
    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 26,588  
    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)..   69,556  
    13Total. Add line 12, columns (b), (d), and (e)..................
    1369,556
    (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 (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)
     
    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 (2011)
    Additional Data


    Software ID:  
    Software Version:  


    Form 990PF - Special Condition Description:
    Special Condition Description

    TY 2011 InvestmentsCorpBondsSchedule
    Name:
    E LOUISE CARLSON FOUNDATION
    EIN: 43-6926676
    Name of Bond End of Year Book Value End of Year Fair Market Value
    51855Q655 LAUDUS MONDRAIN 5,000 4,983
    76628T645 RIDGEWORTH SEIX HIGH 15,000 14,937
    349913889 FORWARD HOOVER SMALL    
    74972H648 RS GLOBAL NATURAL    
    29875E100 AMERICAN EUROPACIFIC    
    04315J837 ARTIO INTERNATIONAL    
    464287465 ISHARES MSCI    
    002824AQ3 ABBOTT LABS 24,115 27,036
    149123BM2 CATERPILLAR INC 26,173 29,337
    20825CAE4 CONOCOPHILLIPS 25,162 25,747
    291011AS3 EMERSON ELECTRIC 10,220 11,078
    369604AY9 GENERAL ELECTRIC COM 25,144 26,053
    494368AX1 KIMBERLY-CLARK CORP 10,358 10,669
    742718DA4 PROCTOR & GAMBLE CO 10,338 11,096
    931142BT9 WAL-MART STORES 24,845 26,386

    TY 2011 InvestmentsCorpStockSchedule
    Name:
    E LOUISE CARLSON FOUNDATION
    EIN: 43-6926676
    Name of Stock End of Year Book Value End of Year Fair Market Value
    548661107 LOWES COS    
    580135101 MCDONALDS CORP 21,580 40,132
    778296103 ROSS STORES INC 13,822 38,024
    948626106 WEIGHT WATCHERS    
    054303102 AVON PRODS    
    713448108 PEPSICO INC 29,424 39,810
    742718109 PROCTER & GAMBLE CO 14,100 20,013
    931142103 WAL MART STORES 11,730 15,239
    166764100 CHEVRON CORP 19,874 32,452
    30231G102 EXXON MOBIL CORP 24,951 41,532
    655044105 NOBLE ENERGY    
    674599105 OCCIDENTAL PETE 19,817 33,732
    084670702 BERKSHIRE HATHAWAY 28,165 38,150
    354613101 FRANKLIN RESOURCES    
    46625H100 JPMORGAN CHASE & CO 24,404 18,288
    857477103 STATE STREET CORP 24,087 22,372
    478160104 JOHNSON & JOHNSON 38,014 42,627
    703395103 PATTERSON CO    
    717081103 PFIZER INC    
    74834L100 QUEST DIAGNOSTIC    
    941848103 WATERS CORP 19,394 34,063
    053611109 AVERY DENNISON    
    31428X106 FEDEX CORPORATION 43,819 35,492
    349853101 FORWARD AIR CORP    
    384802104 GRAINGER W W    
    452308109 ILLINOIS TOOLS WORKS    
    88579Y101 3M CO 26,391 23,293
    053015103 AUTOMATIC DATA    
    17275R102 CKXCO SYSTEMS 21,339 16,272
    426281101 HENRY JACK & ASSOC    
    459200101 INTERNATIONAL BUS 43,487 65,277
    594918104 MICROSOFT CORP 42,080 39,589
    959802109 WESTERN UNION 37,349 34,694
    826552101 SIGMA ALDRICH CORP    
    816851109 SEMPRA ENERGY    
    842587107 SOUTHERN CO    
    25243Q205 DIAGEO PLC 19,883 32,783
    H5833N103 NOBLE CORPORATION    
    83175M205 SMITH & NEPHEW PLC    
    015271109 ALEXANDRIA RE    
    729251108 PLUM CREEK TIMBER    
    78464A607 SPDR DOW JONES    
    04315J837 ARTIO INTERNATIONAL 24,360 28,650
    088606108 BHP BILLITON LIMITED 13,967 13,773
    097023105 BOEING CO 6,210 7,335
    150870103 CELANESE CORP 13,662 14,388
    22544R305 CREDIT SUISSE COMM R 50,000 48,807
    25264S833 DIAMOND HILL LONG-SH 20,000 21,608
    268648102 E M C CORP MASS 6,423 6,462
    29875E100 AMERICAN EUROPACIFIC 94,447 98,351
    339128100 JP MORGAN MID CAP VA 30,000 32,864
    38142Y401 GOLDMAN SACHS GRTH O 30,000 31,378
    448108100 HUSSMAN STRATEGIC GR 20,000 19,079
    464287465 ISHARES MSCI EAFE 86,036 101,537
    487300808 KEELEY SMALL CAP VAL 30,000 33,122
    589509108 MERGER FD SH BEN INT 10,000 9,955
    66987V109 NOVARTIS AG - ADR 5,391 5,717
    683974505 OPPENHEIMER DEVELOPI 40,000 39,685
    78463X863 SPDR DJ WILSHIRE INT 49,334 47,904
    87234N849 TCW SMALL CAP GROWTH 30,000 31,376
    872540109 TJX COS INC NEW 14,257 15,169
    907818108 UNION PACIFIC CORP 11,693 14,832
    911312106 UNITED PARCEL SERVIC 6,336 7,319
    922042858 VANGUARD MSCI EMERGI 49,553 50,628
    922908553 VANGUARD REIT VIPER 49,430 55,680

    TY 2011 InvestmentsGovtObligationsSch
    Name:
    E LOUISE CARLSON FOUNDATION
    EIN: 43-6926676
    US Government Securities - End of Year Book Value:

    24,766
    US Government Securities - End of Year Fair Market Value:

    25,833
    State & Local Government Securities - End of Year Book Value:


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


     


    TY 2011 OtherDecreasesSchedule
    Name:
    E LOUISE CARLSON FOUNDATION
    EIN: 43-6926676
    Description Amount
    MUTUAL FUND POSTING DATE AFTER TYE 472
    ROC BASIS ADJUSTMENT 20


    TY 2011 OtherExpensesSchedule
    Name:
    E LOUISE CARLSON FOUNDATION
    EIN: 43-6926676
    Description Revenue and Expenses per Books Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    ADR FEE 12 12   0


    TY 2011 OtherIncreasesSchedule
    Name:
    E LOUISE CARLSON FOUNDATION
    EIN: 43-6926676
    Description Amount
    MUTUAL FUND TAX EFFECTIVE DATE BEFORE TYE 101
    ROUNDING 1


    TY 2011 TaxesSchedule
    Name:
    E LOUISE CARLSON FOUNDATION
    EIN: 43-6926676
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    FEDERAL ESTIMATES - PRINCIPAL 121 0   0
    FOREIGN TAXES ON QUALIFIED FOR 798 798   0
    FOREIGN TAXES ON NONQUALIFIED 156 156   0