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 11-01-2011 , and ending 10-31-2012
G
Check all that apply:
Name of foundation
HARRY & THELMA SURRENA MEMORIAL
 

Number and street (or P.O. box number if mail is not delivered to street address)P O BOX 603   Room/suite
City or town, state, and ZIP code
SHERIDAN, WY82801
A Employer identification number

23-7435554
B Telephone number (see page 10 of the instructions)

(307) 672-6494
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$4,923,426J 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 33,737 32,174  
4 Dividends and interest from securities...... 112,826 112,826  
5a Gross rents..............      
b Net rental income or (loss)  
6a Net gain or (loss) from sale of assets not on line 10 155,662
b Gross sales price for all assets on line 6a 1,191,861
7 Capital gain net income (from Part IV, line 2)... 155,662
8 Net short-term capital gain.........  
9 Income modifications...........  
10a Gross sales less returns and allowances  
b Less: Cost of goods sold....  
c Gross profit or (loss) (attach schedule).....    
11 Other income (attach schedule).......      
12 Total. Add lines 1 through 11........ 302,225 300,662  
Operating and Administrative Expenses 13 Compensation of officers, directors, trustees, etc. 25,437 12,719   12,718
14 Other employee salaries and wages......        
15 Pension plans, employee benefits.......        
16a Legal fees (attach schedule).........        
b Accounting fees (attach schedule)....... Click to see attachment 2,000 1,500   500
c Other professional fees (attach schedule).... Click to see attachment 12,000 12,000    
17 Interest...............        
18 Taxes (attach schedule) (see page 14 of the instructions) Click to see attachment 4,913 1,208   973
19 Depreciation (attach schedule) and depletion...      
20 Occupancy..............        
21 Travel, conferences, and meetings.......        
22 Printing and publications..........        
23 Other expenses (attach schedule).......        
24 Total operating and administrative expenses.
Add lines 13 through 23.......... 44,350 27,427   14,191
25 Contributions, gifts, grants paid........ 233,500 233,500
26 Total expenses and disbursements. Add lines 24 and 25 277,850 27,427   247,691
27 Subtract line 26 from line 12:
a Excess of revenue over expenses and disbursements 24,375
b Net investment income (if negative, enter -0-) 273,235
c Adjusted net income (if negative, enter -0-)...  
For Privacy Act and Paperwork Reduction Act Notice, see page 30 of the instructions.
Cat. No. 11289X Form 990-PF (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.......... 70,494 77,828 77,828
3 Accounts receivable bullet  
Less: allowance for doubtful accounts bullet        
4 Pledges receivable bullet  
Less: allowance for doubtful accounts bullet        
5 Grants receivable.................      
6 Receivables due from officers, directors, trustees, and other
disqualified persons (attach schedule) (see page 15 of the
instructions)....................      
7 Other notes and loans receivable (attach schedule) bullet  
Less: allowance for doubtful accounts bullet        
8 Inventories for sale or use...............      
9 Prepaid expenses and deferred charges...........      
10a Investments—U.S. and state government obligations (attach schedule) 387,933 Click to see attachment360,168 379,552
b Investments—corporate stock (attach schedule)........ 2,455,252 Click to see attachment2,794,416 3,473,825
c Investments—corporate bonds (attach schedule)........ 1,206,624 Click to see attachment912,289 969,239
11 Investments—land, buildings, and equipment: basis bullet  
Less: accumulated depreciation (attach schedule) bullet        
12 Investments—mortgage loans..............      
13 Investments—other (attach schedule)...........      
14 Land, buildings, and equipment: basis bullet  
Less: accumulated depreciation (attach schedule) bullet        
15 Other assets (describe bullet) Click to see attachment22,993 Click to see attachment22,982 Click to see attachment22,982
16 Total assets (to be completed by all filers—see the
instructions. Also, see page 1, item I) 4,143,296 4,167,683 4,923,426
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)   Click to see attachment12
23 Total liabilities (add lines 17 through 22)..........   12
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......... 2,443,594 2,443,594
28 Paid-in or capital surplus, or land, bldg., and equipment fund    
29 Retained earnings, accumulated income, endowment, or other funds 1,699,702 1,724,077
30 Total net assets or fund balances (see page 17 of the
instructions).................... 4,143,296 4,167,671
31 Total liabilities and net assets/fund balances (see page 17 of
the instructions).................. 4,143,296 4,167,683
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 4,143,296
2 Enter amount from Part I, line 27a..................... 2 24,375
3 Other increases not included in line 2 (itemize) bullet 3  
4 Add lines 1, 2, and 3.......................... 4 4,167,671
5 Decreases not included in line 2 (itemize) bullet 5  
6 Total net assets or fund balances at end of year (line 4 minus line 5)—Part II, column (b), line 30. 6 4,167,671
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 ABBOTT LABORATORIES P 2010-02-12 2012-05-25
b COSTCO WHOLESALE CORPORATION P 2009-10-22 2011-11-23
c GNMA POOL 2009-61 5.500% P 2010-06-08 2012-05-20
d PEABODY ENERGY CORPORATION P 2010-03-12 2012-03-05
e WASHINGTON MUTUAL BANKRUPTCY PROCEED P 2006-07-18 2012-09-26
ABBOTT LABORATORIES P 2010-03-12 2012-05-25
COSTCO WHOLESALE CORPORATION P 2009-10-22 2012-08-03
GNMA POOL 2009-61 5.500% P 2010-06-08 2012-06-20
PEABODY ENERGY CORPORATION P 2010-05-14 2012-03-05
ABBOTT LABORATORIES P 2010-10-26 2012-05-25
DISNEY WALT CO HOLDINGS P 2009-01-15 2012-07-05
GNMA POOL 2009-61 5.500% P 2010-06-08 2012-07-20
PEABODY ENERGY CORPORATION P 2010-06-02 2012-03-05
ABBOTT LABORATORIES P 2011-04-06 2012-05-25
EXXON MOBIL CORPORATION P 1983-06-24 2011-11-23
GNMA POOL 2009-61 5.500% P 2010-06-08 2012-08-20
PHILLIPS 66 P 2002-01-08 2012-05-09
AIR PRODUCTS & CHEMICALS P 2009-09-17 2012-02-28
FED HOME LOAN BANK NOTES 1.250% P 2012-05-23 2012-08-03
GNMA POOL 2009-61 5.500% P 2010-06-08 2012-09-20
TARGET CORPORATION P 2004-04-19 2012-08-03
AIR PRODUCTS & CHEMICALS P 2010-10-26 2012-02-28
FED HOME LOAN BANK NOTES 3.125% P 2011-08-18 2012-02-23
GNMA POOL 2009-61 5.500% P 2010-06-08 2012-10-20
TIFFANY & CO P 2011-12-23 2012-07-05
APPLE COMPUTER INC P 2009-10-05 2012-03-22
FED HOME LOAN BANK NOTES STR 1.250% P 2012-04-17 2012-06-28
GOOGLE INC P 2012-03-22 2012-10-01
VANGUARD GNMA FUND 36 P 2007-12-20 2011-11-23
BARCLAYS BANK PLC STR 5.000% P 2010-06-14 2012-06-29
GENERAL ELECTRIC CAPITAL CORP 5.000% P 2007-12-20 2012-04-10
GOOGLE INC P 2010-06-09 2012-10-01
VANGUARD SHORT-TERM INVESTMENT GRADE P 2004-03-11 2012-10-17
BB&T CORPORATION 3.850% P 2010-05-12 2012-07-27
GENERAL MOTORS CO P 2007-12-31 2011-11-04
GOOGLE INC P 2010-08-06 2012-10-01
VERIZON COMMUNICATIONS P 2011-11-23 2012-05-04
CATERPILLAR INC P 2010-02-12 2012-02-08
GNMA POOL 2009-61 5.500% P 2010-06-08 2011-11-20
INTEL CORPORATION P 1993-06-28 2012-09-13
VERIZON COMMUNICATIONS P 2010-12-07 2012-05-04
CITIGROUP INC P 2011-01-06 2011-11-23
GNMA POOL 2009-61 5.500% P 2010-06-08 2011-12-20
JOHNSON & JOHNSON P 1996-07-30 2012-09-13
WASHINGTON MUTUAL DEFAULTED 4.00% P 2006-07-18 2012-03-23
CITIGROUP INC P 2010-04-09 2011-11-23
GNMA POOL 2009-61 5.500% P 2010-06-08 2012-01-20
JOHNSON & JOHNSON P 2011-05-23 2012-09-13
WASTE MANAGEMENT INC P 2011-11-04 2012-09-27
CITIGROUP INC P 2010-05-13 2011-11-23
GNMA POOL 2009-61 5.500% P 2010-06-08 2012-02-20
PEABODY ENERGY CORPORATION P 2011-10-25 2012-03-05
WASTE MANAGEMENT INC P 2011-11-23 2012-09-27
CITIGROUP INC P 2010-06-02 2011-11-23
GNMA POOL 2009-61 5.500% P 2010-06-08 2012-03-20
PEABODY ENERGY CORPORATION P 2011-11-23 2012-03-05
WASTE MANAGEMENT INC P 2011-08-26 2012-09-27
CONOCOPHILLIPS P 2002-01-08 2012-08-17
GNMA POOL 2009-61 5.500% P 2010-06-08 2012-04-20
PEABODY ENERGY CORPORATION P 2010-02-12 2012-03-05
GENERAL MOTORS LITIGATION PROCCEDS P 2009-11-23 2012-04-06
(e) Gross sales price (f) Depreciation allowed
(or allowable) 		(g) Cost or other basis
plus expense of sale 		(h) Gain or (loss)
(e) plus (f) minus (g)
a 18,738   16,116 2,622
b 10,064   7,267 2,797
c 204   223 -19
d 6,271   9,764 -3,493
e 2,870     2,870
18,738   16,214 2,524
15,618   9,360 6,258
205   224 -19
6,271   8,301 -2,030
12,492   10,515 1,977
16,858   7,015 9,843
206   225 -19
6,271   7,764 -1,493
4,247   3,449 798
11,259   649 10,610
207   226 -19
11,030   4,783 6,247
27,296   23,795 3,501
50,000   50,000  
208   227 -19
19,324   13,621 5,703
9,099   8,568 531
20,625   20,623 2
209   228 -19
21,694   25,780 -4,086
12,638   3,923 8,715
50,000   50,000  
31,828   27,231 4,597
59,000   54,922 4,078
100,000   100,000  
100,000   102,344 -2,344
37,890   24,208 13,682
30,000   30,000  
50,000   52,250 -2,250
155     155
18,945   12,495 6,450
10,075   8,896 1,179
11,391   5,576 5,815
199   217 -18
28,316   4,284 24,032
40,298   33,110 7,188
8,207   17,428 -9,221
200   218 -18
41,362   14,318 27,044
111,624   96,741 14,883
5,862   11,450 -5,588
200   219 -19
20,681   19,716 965
8,020   7,894 126
14,069   24,900 -10,831
201   220 -19
9,406   12,023 -2,617
8,020   7,652 368
2,345   3,970 -1,625
202   221 -19
4,703   5,039 -336
25,663   26,095 -432
40,118   16,097 24,021
203   222 -19
12,542   17,383 -4,841
23     23
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       2,622
b       2,797
c       -19
d       -3,493
e       2,870
      2,524
      6,258
      -19
      -2,030
      1,977
      9,843
      -19
      -1,493
      798
      10,610
      -19
      6,247
      3,501
       
      -19
      5,703
      531
      2
      -19
      -4,086
      8,715
       
      4,597
      4,078
       
      -2,344
      13,682
       
      -2,250
      155
      6,450
      1,179
      5,815
      -18
      24,032
      7,188
      -9,221
      -18
      27,044
      14,883
      -5,588
      -19
      965
      126
      -10,831
      -19
      -2,617
      368
      -1,625
      -19
      -336
      -432
      24,021
      -19
      -4,841
      23
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 2 155,662
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 -9,988
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 234,756 4,609,464 0.050929
2009 207,821 4,402,615 0.047204
2008 186,524 3,996,482 0.046672
2007 176,828 5,058,764 0.034955
2006 269,988 5,384,174 0.050145
2 Total of line 1, column (d) ...................... 2 0.229905
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 0.045981
4 Enter the net value of noncharitable-use assets for 2011 from Part X, line 5..... 4 4,807,448
5 Multiply line 4 by line 3....................... 5 221,051
6 Enter 1% of net investment income (1% of Part I, line 27b)........... 6 2,732
7 Add lines 5 and 6......................... 7 223,783
8 Enter qualifying distributions from Part XII, line 4.............. 8 247,691
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 2,732
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  
3 Add lines 1 and 2............................ 3 2,732
4 Subtitle A (income) tax (domestic section 4947(a)(1) trusts and taxable foundations only. Others enter -0-). 4  
5 Tax based on investment income. Subtract line 4 from line 3. If zero or less, enter -0- ..... 5 2,732
6 Credits/Payments:
a 2011 estimated tax payments and 2010 overpayment credited to 2011 6a 2,720
b Exempt foreign organizations—tax withheld at source....... 6b
c Tax paid with application for extension of time to file (Form 8868) 6c  
d Backup withholding erroneously withheld ........... 6d  
7 Total credits and payments. Add lines 6a through 6d.............. 7 2,720
8 Enter any penalty for underpayment of estimated tax. if Form 2220 is attached. 8  
9 Tax due. If the total of lines 5 and 8 is more than line 7, enter amount owed.......Bullet 9 12
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  
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)bulletWY
    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 ofbulletPRADERE MOHATT RINALDO Telephone no.bullet (307) 672-6494
    Located atbulletPO BOX 603SHERIDANWY ZIP+4bullet82801
    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
     
     
    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
     
     
    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
     
     
    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
    RALPH C ROBINSONClick to see attachment TRUSTEE
    2.00     		12,719 0 0
    PO BOX 27
    BUFFALO,WY82834
    JOHN PRADEREClick to see attachment TRUSTEE
    2.00     		12,718 0 0
    PO BOX 603
    SHERIDAN,WY82801
    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  
    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.............bullet  
    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
    4,726,592
    b
    Average of monthly cash balances.......................
    1b
    131,084
    c
    Fair market value of all other assets (see page 24 of the instructions)............
    1c
    22,982
    d
    Total (add lines 1a, b, and c).........................
    1d
    4,880,658
    e
    Reduction claimed for blockage or other factors reported on lines 1a and
    1c (attach detailed explanation) .............
    1e
     
    2
    Acquisition indebtedness applicable to line 1 assets..................
    2
     
    3
    Subtract line 2 from line 1d.........................
    3
    4,880,658
    4
    Cash deemed held for charitable activities. Enter 1 1⁄2% of line 3 (for greater amount, see page 25
    of the instructions) ...........................
    4
    73,210
    5
    Net value of noncharitable-use assets. Subtract line 4 from line 3. Enter here and on Part V, line 4
    5
    4,807,448
    6
    Minimum investment return. Enter 5% of line 5..................
    6
    240,372
    Part XI
    Distributable Amount bullet and do not complete this part.)
    1
    Minimum investment return from Part X, line 6....................
    1
    240,372
    2a
    Tax on investment income for 2011 from Part VI, line 5......
    2a
    2,732
    b
    Income tax for 2011. (This does not include the tax from Part VI.)...
    2b
     
    c
    Add lines 2a and 2b............................
    2c
    2,732
    3
    Distributable amount before adjustments. Subtract line 2c from line 1............
    3
    237,640
    4
    Recoveries of amounts treated as qualifying distributions................
    4
     
    5
    Add lines 3 and 4............................
    5
    237,640
    6
    Deduction from distributable amount (see page 25 of the instructions)...........
    6
     
    7
    Distributable amount as adjusted. Subtract line 6 from line 5. Enter here and on Part XIII,
    line 1................................
    7
    237,640
    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
    247,691
    b
    Program-related investments—total from Part IX-B..................
    1b
     
    2
    Amounts paid to acquire assets used (or held for use) directly in carrying out charitable, etc.,
    purposes...............................
    2
     
    3
    Amounts set aside for specific charitable projects that satisfy the:
    a
    Suitability test (prior IRS approval required)....................
    3a
     
    b
    Cash distribution test (attach the required schedule) .................
    3b
     
    4
    Qualifying distributions. Add lines 1a through 3b. Enter here and on Part V, line 8, and Part XIII, line 4
    4
    247,691
    5
    Foundations that qualify under section 4940(e) for the reduced rate of tax on net investment
    income. Enter 1% of Part I, line 27b (see page 26 of the instructions)............
    5
    2,732
    6
    Adjusted qualifying distributions. Subtract line 5 from line 4..............
    6
    244,959
    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 7 237,640
    2 Undistributed income, if any, as of the end of 2011:
    a Enter amount for 2010 only....... 71,231
    b Total for prior years:20, 20, 20  
    3 Excess distributions carryover, if any, to 2011:
    a From 2006.......  
    b From 2007.......  
    c From 2008.......  
    d From 2009.......  
    e From 2010.......  
    fTotal of lines 3a through e.........  
    4Qualifying distributions for 2011 from Part
    XII, line 4: bullet$ 247,691
    a Applied to 2010, but not more than line 2a 71,231
    b Applied to undistributed income of prior years
    (Election required—see page 26 of the instructions)    		  
    c Treated as distributions out of corpus (Election
    required—see page 26 of the instructions)...     		 
    d Applied to 2011 distributable amount..... 176,460
    e Remaining amount distributed out of corpus  
    5 Excess distributions carryover applied to 2011.    
    (If an amount appears in column (d), the
    same amount must be shown in column (a).)
    6Enter the net total of each column as
    indicated below:
    a Corpus. Add lines 3f, 4c, and 4e. Subtract line 5  
    b Prior years’ undistributed income. Subtract
    line 4b from line 2b ...........     		 
    c Enter the amount of prior years’ undistributed
    income for which a notice of deficiency has
    been issued, or on which the section 4942(a)
    tax has been previously assessed......     		 
    d Subtract line 6c from line 6b. Taxable
    amount—see page 27 of the instructions ...     		 
    e Undistributed income for 2010. Subtract line
    4a from line 2a. Taxable amount—see page 27
    of the instructions ...........     		 
    f Undistributed income for 2011. Subtract
    lines 4d and 5 from line 1. This amount must
    be distributed in 2011 ..........     		61,180
    7 Amounts treated as distributions out of
    corpus to satisfy requirements imposed by
    section 170(b)(1)(F) or 4942(g)(3) (see page 27
    of the instructions) ...........     		 
    8Excess distributions carryover from 2006 not
    applied on line 5 or line 7 (see page 27 of the
    instructions) .............     		 
    9Excess distributions carryover to 2012.
    Subtract lines 7 and 8 from line 6a ......     		 
    10 Analysis of line 9:
    a Excess from 2007....  
    b Excess from 2008....  
    c Excess from 2009....  
    d Excess from 2010....  
    e Excess from 2011....  
    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:
    SURRENA MEMORIAL FUND
    BOX 27
    BUFFALO,WY82834
    (307) 684-5574
    bThe form in which applications should be submitted and information and materials they should include:
    WRITTEN APPLICATION
    cAny submission deadlines:
    NONE
    dAny restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other
    factors:
    CHARITABLE, RELIGIOUS, SCIENTIFIC, & EDUCATIONAL PURPOSES IN THE U.S.
    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
    CHILDREN'S CENTER - BUFFA
    151 KLONDIKE
    BUFFALO,WY82834     		NONE 501C3 GENERAL OPERATIONS 45,000
    CHILDREN'S CENTER
    863 HIGHLAND AVE
    SHERIDAN,WY82801     		NONE 501C3 GENERAL OPERATIONS 30,000
    GENESIS FOUNDATION
    444 CRESCENT DR
    SHERIDAN,WY82801     		NONE 501C3 GENERAL OPERATIONS 25,000
    HABITAT FOR HUMANITY OF
    THE EASTERN BIGHORNS INC
    PO BOX 6196
    SHERIDAN,WY82801     		NONE 501C3 GENERAL OPERATIONS 10,000
    JOHNSON COUNTY LIBRARY
    FOUNDATION
    171 N ADAMS
    BUFFALO,WY82834     		NONE 501C3 GENERAL OPERATIONS 10,000
    SENIOR CITIZENS COUNCIL
    211 SMITH STREET
    SHERIDAN,WY82801     		NONE 501C3 GENERAL OPERATIONS 5,000
    METHODIST CHURCH
    OF BUFFALO WYOMING
    132 N ADAMS AVE
    BUFFALO,WY82834     		NONE 501C3 GENERAL OPERATIONS 5,000
    METHODIST CHURCH
    OF SHERIDAN WYOMING
    215 W WORKS
    SHERIDAN,WY82801     		NONE 501C3 GENERAL OPERATIONS 5,000
    MOUNTAIN PLAINS HERITAGE
    PO BOX 27
    BUFFALO,WY82834     		NONE 501C3 GENERAL OPERATIONS 3,000
    SHERIDAN COUNTY LIBRARY
    FOUNDATION INC
    335 W ALGER
    SHERIDAN,WY82801     		NONE 501C3 GENERAL OPERATIONS 5,000
    SHERIDAN COLLEGE
    FOUNDATION
    3059 COFFEEN AVE
    SHERIDAN,WY82801     		NONE 501C3 GENERAL OPERATIONS 10,000
    STORY BRANCH LIBRARY
    PO BOX 188
    STORY,WY82842     		NONE 501C3 GENERAL OPERATIONS 5,000
    STORY COMMUNITY CHURCH
    PO BOX 415
    STORY,WY82842     		NONE 501C3 GENERAL OPERATIONS 5,000
    VOLUNTEERS OF AMERICA OF
    WYOMING AND MONTANA
    PO BOX 6291
    SHERIDAN,WY82801     		NONE 501C3 HOMELESS SHELTER 5,000
    JOHNSON COUNTY YMCA
    101 SOUTH KLONDIKE
    BUFFALO,WY82834     		NONE 501C3 GENERAL OPERATIONS 20,000
    SHERIDAN COUNTY YMCA
    417 NORTH JEFFERSON
    SHERIDAN,WY82801     		NONE 501C3 GENERAL OPERATIONS 20,000
    SCOTTISH RITE CHILDHOOD
    LANGUAGE CLINIC C/O TOM NEIGHBORS
    8 RIVERBEND COURT
    SHERIDAN,WY82801     		NONE 501C3 GENERAL OPERATIONS 5,000
    BREAD OF LIFE
    PO BOX 909
    BUFFALO,WY82834     		NONE 501C3 GENERAL OPERATIONS 5,000
    BUFFALO SENIOR CENTER
    671 W FETTERMAN
    BUFFALO,WY82834     		NONE 501C3 GENERAL OPERATIONS 500
    CLEARMONT COMMUNITY LIBRA
    PO BOX 26
    CLEARMONT,WY82835     		NONE 501C3 GENERAL OPERATIONS 5,000
    TONGUE RIVER BRANCH
    LIBRARY
    PO BOX 909
    RANCHESTER,WY82839     		NONE 501C3 GENERAL OPERATIONS 5,000
    TONGUE RIVER CHILD'S
    PLACE
    84 DAYTON STREET
    RANCHESTER,WY82839     		NONE 501C3 GENERAL OPERATIONS 5,000
    Total .................................bullet 3a 233,500
    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 33,737  
    4 Dividends and interest from securities....     14 112,826  
    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     18 155,662  
    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)..   302,225  
    13Total. Add line 12, columns (b), (d), and (e)..................
    13302,225
    (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 AccountingFeesSchedule
    Name:
    HARRY & THELMA SURRENA MEMORIAL
    EIN: 23-7435554
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    ACCOUNTING FEES 2,000 1,500   500

    TY 2011 CompensationExplanation
    Name:
    HARRY & THELMA SURRENA MEMORIAL
    EIN: 23-7435554
    Person Name Explanation
    RALPH C ROBINSON  
    JOHN PRADERE  

    TY 2011 InvestmentsCorpBondsSchedule
    Name:
    HARRY & THELMA SURRENA MEMORIAL
    EIN: 23-7435554
    Name of Bond End of Year Book Value End of Year Fair Market Value
    BARCLAYS BANK PLC    
    BB&T CORPORATION    
    BLACKROCK INC 50,000 59,347
    CSX CORP 6.25% 50,920 61,566
    DODGE & COX INCOME FUND 75,000 79,045
    GENERAL ELECTRIC CAP 5.1% 100,000 111,085
    GENERAL ELECTRIC CAPITAL 5.0%    
    LILLY ELI & CO 26,963 29,429
    MORGAN STANLEY STR 24,000 25,927
    OPPENHEIMER INTERNATIONAL BOND FUND 73,000 72,982
    PRUDENTIAL FINANCIAL INC 5.75% 100,000 99,999
    ROYAL BANK OF SCOTLAND PLC 3.40% 25,280 25,452
    TEMPLETON GLOBAL BOND FUND 76,000 75,233
    US BANCORP 15,725 15,847
    VANGUARD HIGH YIELD CORPORATE PORT 125,000 136,115
    VANGUARD INTERMEDIATE-TERM INVEST 98,000 104,733
    VANGUARD SHORT TERM CORP FUND 72,401 72,479
    WASHINGTON MUTUAL INC    

    TY 2011 InvestmentsCorpStockSchedule
    Name:
    HARRY & THELMA SURRENA MEMORIAL
    EIN: 23-7435554
    Name of Stock End of Year Book Value End of Year Fair Market Value
    GENERAL ELECTRIC CAPITAL CORP 49,987 50,277
    PUBLIC STORAGE 6.50% PFD 25,000 28,270
    TENN VALLEY AUTH 6/1/28 49,980 53,155
    ABBOTT LABORATORIES 6,694 8,646
    AIR PRODUCTS & CHEMICALS    
    AMGEN INC 53,284 77,841
    APACHE CORPORATION 43,804 40,532
    APPLE COMPUTER INC 52,793 121,445
    BAKER HUGHES INC 66,625 60,856
    BB&T CORPORATION 35,117 32,685
    BERKSHIRE HATHAWAY INC - CL B 46,352 51,810
    BOEING CO 42,930 52,830
    CATERPILLAR INC 50,699 60,385
    CHEVRON CORP 32,432 79,925
    CISCO SYSTEMS 60,417 41,148
    CITIGROUP INC    
    COCA COLA COMPANY 32,015 37,180
    CONOCOPHILLIPS    
    CONSOLIDATED EDISON INC 16,915 36,228
    COSTCO WHOLESALE CORPORATION 23,705 40,750
    DEERE & COMPANY 59,013 64,080
    DISNEY WALT CO HOLDINGS 36,314 56,537
    DU PONT E I DE NEMOURS & COMPANY 49,615 46,746
    EMC CORPORATION 32,330 43,956
    EMERSON ELECTRIC CO 32,434 48,430
    EXELON CORPORATION 76,664 69,950
    EXXON MOBIL CORP 16,499 91,170
    FLUOR CORPORATION 45,724 39,095
    FORD MOTOR COMPANY 70,325 82,606
    GENERAL ELECTRIC CO 50,559 63,180
    GENERAL MILLS 21,057 40,080
    GILEAD SCIENCES INC. 35,513 47,023
    GOOGLE INC    
    HUNTINGTON BANCSHARES INC 33,055 35,173
    ILLINOIS TOOL WORKS INC 24,598 27,599
    INTEL CORP 42,095 41,962
    INTERNATIONAL BUSINESS MACHINES CORP 65,091 80,730
    JOHNSON & JOHNSON    
    JOHNSON CONTROLS INC 42,641 32,188
    J.P. MORGAN CHASE & CO 124,552 127,124
    KRAFT FOODS INC 16,513 22,730
    MCDONALDS CORPORATION 67,935 80,984
    MCKESSON CORPORATION 58,560 62,144
    MDU RESOURCES GROUP 27,086 39,114
    MERCK & CO INC 44,834 54,756
    MICROSOFT CORPORATION 41,449 39,956
    MONDELEZ INTERNATIONAL INC 30,547 39,825
    NEXTERA ENERGY INC 54,412 70,060
    NORTHERN TRUST CORPORATION 54,945 47,800
    ORACLE CORPORATION 44,415 62,160
    PEABODY ENERGY CORPORATION    
    PEPSICO 24,613 55,392
    PFIZER INC 3,983 52,227
    PHILIP MORRIS INTERNATIONAL 45,035 61,992
    PROCTOR & GAMBLE CO 37,000 55,392
    QUALCOMM INC 37,584 58,610
    SCHLUMBERGER LIMITED 45,606 46,933
    SOUTHERN CO 6,839 46,840
    TARGET CORP 39,071 53,486
    UNITEDHEALTH GROUP INC 66,056 69,888
    VERIZON COMMUNICATIONS    
    WASTE MANAGEMENT INC    
    BHP BILLITON LIMITED ADR 35,212 35,370
    TEVA PHARMACEUTICAL INDUSTRIES LIMIT 62,804 44,462
    OPPENHEIMER MAIN ST SMALL CAP 40,000 44,746
    T ROWE PRICE MID CAP FUND 50,000 57,327
    T ROWE PRICE MID CAP VALUE FUND 50,000 57,226
    AMERICAN EUROPACIFIC GROWTH FUND 73,447 82,510
    HARBOR INTERNATIONAL FUND 58,089 81,497
    EATON VANCE TAX-MANAGED EMERGING 55,000 54,314
    VANGUARD EMERGIN MARKETS ETF 26,553 24,897
    HARBOR COMMODITY REAL RETURN STRATEG 50,000 49,716
    GENERAL MOTORS CO WARRANTS EXP 07/10   6,087
    GENERAL MOTORS CO WARRANTS EXP 07/10   3,792

    TY 2011 InvestmentsGovtObligationsSch
    Name:
    HARRY & THELMA SURRENA MEMORIAL
    EIN: 23-7435554
    US Government Securities - End of Year Book Value:

    309,649
    US Government Securities - End of Year Fair Market Value:

    326,968
    State & Local Government Securities - End of Year Book Value:


    50,519
    State & Local Government Securities - End of Year Fair Market Value:


    52,584


    TY 2011 OtherAssetsSchedule
    Name:
    HARRY & THELMA SURRENA MEMORIAL
    EIN: 23-7435554
    Description Beginning of Year - Book Value End of Year - Book Value End of Year - Fair Market Value
    MINERAL RIGHTS 22,982 22,982 22,982
    PREPAID FEDERAL EXCISE TAX 11    


    TY 2011 OtherLiabilitiesSchedule
    Name:
    HARRY & THELMA SURRENA MEMORIAL
    EIN: 23-7435554
    Description Beginning of Year - Book Value End of Year - Book Value
    FEDERAL TAXES PAYABLE   12


    TY 2011 OtherProfessionalFeesSchedule
    Name:
    HARRY & THELMA SURRENA MEMORIAL
    EIN: 23-7435554
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    INVESTMENT MANAGEMENT FEES 12,000 12,000    


    TY 2011 TaxesSchedule
    Name:
    HARRY & THELMA SURRENA MEMORIAL
    EIN: 23-7435554
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    PAYROLL TAXES 1,946 973   973
    2011 990-PF EXCISE TAXES 2,732      
    FOREIGN TAXES 235 235