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
KOEPLIN FAMILY FOUNDATION
 
% FOUNDATION MANAGEMENT GROUP
Number and street (or P.O. box number if mail is not delivered to street address)1000 SECOND AVENUE 34th floor   Room/suite
City or town, state, and ZIP code
SEATTLE, WA981041022
A Employer identification number

41-1268766
B Telephone number (see page 10 of the instructions)

(206) 667-0300
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$1,934,830
J 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) 0
2 Check bullet
3 Interest on savings and temporary cash investments      
4 Dividends and interest from securities...... 71,281 71,281  
5a Gross rents..............      
b Net rental income or (loss)  
6a Net gain or (loss) from sale of assets not on line 10 46,280
b Gross sales price for all assets on line 6a 653,190
7 Capital gain net income (from Part IV, line 2)... 37,759
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)....... -35,644 -197  
12 Total. Add lines 1 through 11........ 81,917 108,843  
Operating and Administrative Expenses 13 Compensation of officers, directors, trustees, etc. 0      
14 Other employee salaries and wages......        
15 Pension plans, employee benefits.......        
16a Legal fees (attach schedule).........        
b Accounting fees (attach schedule).......        
c Other professional fees (attach schedule).... 12,000 2,400   9,000
17 Interest............... 4      
18 Taxes (attach schedule) (see page 14 of the instructions) 1,359 372    
19 Depreciation (attach schedule) and depletion...      
20 Occupancy..............        
21 Travel, conferences, and meetings.......        
22 Printing and publications..........        
23 Other expenses (attach schedule)....... 7,582 7,542    
24 Total operating and administrative expenses.
Add lines 13 through 23.......... 20,945 10,314   9,000
25 Contributions, gifts, grants paid........ 300,000 150,009
26 Total expenses and disbursements. Add lines 24 and 25 320,945 10,314   159,009
27 Subtract line 26 from line 12:
a Excess of revenue over expenses and disbursements -239,028
b Net investment income (if negative, enter -0-) 98,529
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.......... 360,132 105,395 105,395
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) 0 77,118 77,118
b Investments—corporate stock (attach schedule)........ 874,175 Click to see attachment1,027,444 1,027,444
c Investments—corporate bonds (attach schedule)........ 815,971 Click to see attachment712,993 712,993
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 attachment10,738 Click to see attachment11,880 Click to see attachment11,880
16 Total assets (to be completed by all filers—see the
instructions. Also, see page 1, item I) 2,061,016 1,934,830 1,934,830
Liabilities 17 Accounts payable and accrued expenses.......... 864 0
18 Grants payable................... 350,000 500,000
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).......... 350,864 500,000
Net Assets or Fund Balances bullet
and complete lines 24 through 26 and lines 30 and 31.
24 Unrestricted.................... 1,710,152 1,434,830
25 Temporarily restricted................    
26 Permanently restricted................    
bullet
and complete lines 27 through 31.
27 Capital stock, trust principal, or current funds.........    
28 Paid-in or capital surplus, or land, bldg., and equipment fund    
29 Retained earnings, accumulated income, endowment, or other funds    
30 Total net assets or fund balances (see page 17 of the
instructions).................... 1,710,152 1,434,830
31 Total liabilities and net assets/fund balances (see page 17 of
the instructions).................. 2,061,016 1,934,830
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 1,710,152
2 Enter amount from Part I, line 27a..................... 2 -239,028
3 Other increases not included in line 2 (itemize) bullet 3  
4 Add lines 1, 2, and 3.......................... 4 1,471,124
5 Decreases not included in line 2 (itemize) bulletClick to see attachment 5 36,294
6 Total net assets or fund balances at end of year (line 4 minus line 5)—Part II, column (b), line 30. 6 1,434,830
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 51 SH IVANHOE MINES RTS 1/26/11   2011-01-04 2011-01-10
b 11 SH INVESCO LTD   2011-01-18 2011-07-01
c 20 SH IVANHOE MINES LTD   2011-02-09 2011-11-09
d 70 SH ATHEROS COMMUNICATIONS INC   2010-09-24 2011-01-13
e 55 SH ARM HOLDINGS PLC   2010-06-11 2011-03-31
90 SH ARM HOLDINGS PLC   2010-06-11 2011-05-04
90 SH NETSCOUT SYSTEMS INC   2011-01-14 2011-06-09
45 SH KENNAMETAL INC   2010-12-10 2011-08-18
35 SH COHERENT INC   2011-03-21 2011-08-29
10 SH COHERENT INC   2011-04-15 2011-08-29
25 SH ULTA SALON COS. & FRAGRANCE INC   2011-01-14 2011-09-15
25 SH GOODRICH CORPORATION   2011-06-22 2011-09-29
18 SH ARCELORMITTAL NY REG   2010-08-02 2011-01-27
35 SH ASAHI KAISEI CORP   2010-11-24 2011-02-04
19 SH FUJITSU LTD   2010-03-16 2011-02-02
5 SH FUJITSU LTD   2010-04-30 2011-02-02
12 SH ROYAL DUTCH SHELL PLC   2010-11-01 2011-02-10
12 SH SONY CORP ADR 1974   2010-10-29 2011-02-07
80 SH GRAN TIERRA ENERGY INC   2010-11-16 2011-03-23
13 SH TEVA PHARMACEUTICALS   2010-06-21 2011-03-16
29 SH CHINA INFORMAT TECHNOLOGY INC   2010-05-05 2011-04-13
24 SH ELDORADO GOLD CP LTD   2010-06-22 2011-05-17
SH KONINKLIJKE PHIL EL SP (CIL)   2011-02-04 2011-05-04
21 SH KONINKLIJKE PHIL EL SP   2011-02-04 2011-05-23
7 SH KONINKLIJKE PHIL EL SP   2011-03-01 2011-05-23
28 SH SOUFUN HOLDINGS LTD   2011-01-26 2011-05-13
12 SH TECK RESOURCES LTD   2010-12-02 2011-06-17
52 SH TNT EXPRESS NV   2011-06-01 2011-07-14
11 SH BHP BILLITON LTD   2011-05-11 2011-08-31
26 SH VALEO SPONSORED ADR   2010-10-22 2011-09-08
19 SH FORTESCUE METALS GROUP LTD   2011-01-24 2011-10-24
7 SH FORTESCUE METALS GROUP LTD   2011-05-12 2011-10-24
44 SH MICHELIN COMPAGNIE GENERALE   2010-12-08 2011-10-06
14 SH PRECISION DRILLING COR   2011-06-24 2011-10-28
7 SH NETAPP INC   2010-07-01 2011-01-26
8 SH JOHNSON & JOHNSON   2010-07-20 2011-03-10
8 SH PROCTER & GAMBLE   2010-07-20 2011-02-25
4 SH PROCTER & GAMBLE   2010-07-20 2011-03-03
20 SH SOUTHWESTERN ENERGY COMPANY   2010-04-05 2011-03-21
10 SH MERCK & CO INC   2010-07-20 2011-04-18
20 SH AMERICAN EXPRESS CO   2011-02-07 2011-05-17
9 SH AMERICAN EXPRESS CO   2011-03-25 2011-05-17
5 SH AMERICAN EXPRESS CO   2011-04-06 2011-05-17
10 SH AMGEN INC   2010-06-02 2011-05-17
6 SH AMGEN INC   2010-12-20 2011-05-17
15 SH AMPHENOL CORP   2011-03-16 2011-05-17
6 SH AMPHENOL CORP   2011-04-14 2011-05-17
15 SH AVON PRODUCTS INC   2010-11-02 2011-05-17
8 SH BED BATH & BEYOND INC   2010-06-30 2011-05-17
26 SH CISCO SYS INC   2010-09-27 2011-05-17
11 SH DEVON ENERGY CORP   2011-03-21 2011-05-17
15 SH EMERSON ELECTRIC CO   2011-04-25 2011-05-17
1 SH EQUINIX INC   2010-05-19 2011-05-17
3 SH EQUINIX INC   2010-06-09 2011-05-17
4 SH INTUIT INC   2011-05-17 2011-05-18
27 SH JOHNSON & JOHNSON   2010-07-20 2011-05-17
3 SH LOWES COMPANIES INC   2010-06-21 2011-05-17
13 SH LOWES COMPANIES INC   2010-10-06 2011-05-17
3 SH LOWES COMPANIES INC   2011-03-03 2011-05-17
1 SH MASTERCARD INC. CL A   2010-05-28 2011-05-17
2 SH MASTERCARD INC. CL A   2010-08-02 2011-05-17
1 SH MASTERCARD INC. CL A   2011-01-14 2011-05-17
13 SH MERCK & CO INC   2010-07-20 2011-05-17
3 SH MICROSOFT CORP   2010-08-02 2011-05-17
2 SH MORGAN STANLEY   2010-12-17 2011-05-17
13 SH NETAPP INC   2010-07-01 2011-05-17
18 SH NIVIDIA CORPORATION   2011-02-18 2011-05-17
1 SH PRAXAIR INC   2011-02-07 2011-05-17
5 SH PRAXAIR INC   2011-02-23 2011-05-17
14 SH PROCTER & GAMBLE   2010-07-20 2011-05-17
23 SH RAYTHEON CO   2011-04-06 2011-05-17
2 SH SOUTHWESTERN ENERGY COMPANY   2010-06-02 2011-05-17
17 SH SOUTHWESTERN ENERGY COMPANY   2010-08-20 2011-05-17
3 SH ST JUDE MEDICAL INC   2010-06-30 2011-05-17
8 SH ST JUDE MEDICAL INC   2010-12-03 2011-05-17
3 SH ST JUDE MEDICAL INC   2011-02-16 2011-05-17
6 SH STAPLES INC   2010-08-03 2011-05-17
12 SH STAPLES INC   2010-10-07 2011-05-17
19 SH STAPLES INC   2010-10-27 2011-05-17
9 SH STAPLES INC   2011-03-03 2011-05-17
7 SH TEVA PHARMACEUTICALS   2010-12-10 2011-05-17
3 SH THERMO FISHER SCIENTIFIC INC   2010-08-02 2011-05-17
3 SH THERMO FISHER SCIENTIFIC INC   2010-08-04 2011-05-17
2 SH THERMO FISHER SCIENTIFIC INC   2010-08-04 2011-05-17
5 SH THERMO FISHER SCIENTIFIC INC   2010-08-12 2011-05-17
4 SH THERMO FISHER SCIENTIFIC INC   2011-01-31 2011-05-17
14 SH URBAN OUTFITTERS INC   2011-04-29 2011-05-17
6 SH VIACOM INC CLASS B   2010-07-30 2011-05-17
12 SH XILINX INC   2010-10-21 2011-05-17
6 SH DOLLAR GEN CORP   2011-05-17 2011-06-01
20 SH DOLLAR GEN CORP   2011-05-17 2011-06-03
29 SH FORD MOTOR CO   2011-05-17 2011-06-24
6 SH JP MORGAN CHASE & CO   2011-05-17 2011-06-08
4 SH JP MORGAN CHASE & CO   2011-05-17 2011-06-24
6 SH JUNIPER NETWORKS   2011-05-17 2011-06-02
13 SH JUNIPER NETWORKS   2011-05-17 2011-06-07
37 SH MYLAN INC   2011-05-17 2011-05-26
3 SH SHIRE PLC   2011-05-17 2011-06-03
2 SH YUM BRANDS INC   2011-05-17 2011-06-21
12 SH EXPRESS SCRIPTS INC   2011-05-17 2011-07-21
33 SH FORD MOTOR CO   2011-05-17 2011-07-26
7 SH ILL TOOL WORKS INC   2011-05-17 2011-07-26
5 SH TEXAS INSTRUMENTS   2011-05-17 2011-07-13
6 SH TEXAS INSTRUMENTS   2011-05-17 2011-07-19
5 SH VMWARE INC CLASS A   2011-05-17 2011-07-07
8 SH AUTODESK INC DELAWARE   2011-05-17 2011-08-18
22 SH AUTODESK INC DELAWARE   2011-05-17 2011-08-22
1 SH CERNER CORP   2011-05-17 2011-07-27
5 SH FREEPORT MCMORAN CP GLD   2011-06-07 2011-08-05
4 SH FREEPORT MCMORAN CP GLD   2011-06-07 2011-08-08
3 SH FREEPORT MCMORAN CP GLD   2011-06-09 2011-08-08
1 SH FREEPORT MCMORAN CP GLD   2011-06-10 2011-08-08
5 SH FREEPORT MCMORAN CP GLD   2011-06-10 2011-08-09
2 SH GREEN MOUNTAIN COFFEE INC   2011-05-17 2011-08-18
8 SH SCRIPPS NETWORKS INTERAC CL A   2011-05-17 2011-08-18
5 SH TEXAS INSTRUMENTS   2011-05-17 2011-08-03
15 SH TEXAS INSTRUMENTS   2011-05-17 2011-08-05
3 SH TEXAS INSTRUMENTS   2011-05-31 2011-08-05
5 SH WALT DISNEY CO HLDG CO   2011-05-17 2011-08-03
4 SH WALT DISNEY CO HLDG CO   2011-05-17 2011-08-03
24 SH WALT DISNEY CO HLDG CO   2011-05-17 2011-08-10
5 SH ALTERA CORP   2011-05-17 2011-09-06
8 SH ALTERA CORP   2011-05-17 2011-09-07
3 SH CLIFFS NATURAL RESOURCES INC   2011-05-17 2011-09-21
13 SH EXPRESS SCRIPTS INC   2011-05-17 2011-09-14
5 SH EXPRESS SCRIPTS INC   2011-05-17 2011-09-15
4 SH GOODRICH CORPORATION   2011-05-17 2011-09-19
2 SH GOODRICH CORPORATION   2011-05-17 2011-09-20
2 SH GREEN MOUNTAIN COFFEE INC   2011-05-17 2011-09-13
3 SH IL TOOL WORKS INC   2011-05-17 2011-08-31
1 SH NETFLIX INC   2011-05-31 2011-09-20
1 SH NETFLIX INC   2011-08-15 2011-09-20
1 SH NETFLIX INC   2011-08-22 2011-09-20
2 SH O'REILLY AUTOMOTIVE INC   2011-05-17 2011-09-13
4 SH VISA INC CL A   2011-05-17 2011-09-16
2 SH WALTER ENERGY INC   2011-05-17 2011-09-06
5 SH WALTER ENERGY INC   2011-05-17 2011-09-21
1 SH AMAZON.COM INC   2011-05-17 2011-10-26
2 SH AMAZON.COM INC   2011-05-17 2011-10-31
4 SH CERNER CORP   2011-05-17 2011-10-03
5 SH GOODRICH CORPORATION   2011-05-17 2011-10-03
3 SH GOODRICH CORPORATION   2011-05-17 2011-10-04
4 SH GREEN MOUNTAIN COFFEE INC   2011-05-17 2011-10-31
3 SH O'REILLY AUTOMOTIVE INC   2011-05-17 2011-10-27
4 SH SCRIPPS NETWORKS INTERAC CL A   2011-05-17 2011-10-04
6 SH SCRIPPS NETWORKS INTERAC CL A   2011-05-17 2011-10-11
4 SH ABERCROMBIE & FITCH CO   2011-08-11 2011-11-16
1 SH ABERCROMBIE & FITCH CO   2011-08-11 2011-11-16
2 SH ABERCROMBIE & FITCH CO   2011-08-16 2011-11-16
6 SH GREEN MOUNTAIN COFFEE INC   2011-05-17 2011-11-10
2 SH PEABODY ENERGY CORP   2011-08-25 2011-11-11
4 SH PEABODY ENERGY CORP   2011-08-25 2011-11-14
8 SH FMC TECHNOLOGIES INC   2011-05-17 2011-12-06
2 SH PERRIGO CO   2011-05-17 2011-12-22
2 SH PERRIGO CO   2011-05-17 2011-12-27
3 SH RANGE RESOURCES CORP   2011-09-27 2011-12-12
3 SH RANGE RESOURCES CORP   2011-09-27 2011-12-13
0.227 SH GENERAL MOTORS CO WTS 071016   2002-11-15 2011-04-21
0.04 SH GENERAL MOTORS CO WTS 071016   2004-06-01 2011-04-21
0.227 SH GENERAL MOTORS CO WTS 071019   2002-11-15 2011-04-21
0.04 SH GENERAL MOTORS CO WTS 071019   2004-06-01 2011-04-21
0.95 SH GENERAL MOTORS CO   2002-11-15 2011-04-21
0.244 SH GENERAL MOTORS CO   2004-06-01 2011-04-21
100000 SH AURORA BANK CD   2002-11-15 2011-06-06
100000 SH M & I MARSHALL CD   2009-06-12 2011-06-27
100000 SH SALLIE MAE BANK   2009-06-12 2011-06-20
50000 SH HOUSEHOLD FINANCE 6.65%, DUE 7/15/11   2002-11-18 2011-07-15
GENERAL MOTORS CO WTS 071016 (CIL)   2002-11-15 2011-07-28
GENERAL MOTORS CO WTS 071019 (CIL)   2002-11-15 2011-07-28
GENERAL MOTORS CO (CIL)   2002-11-15 2011-07-28
40000 SH BANK OF AMERICA   2002-12-30 2011-09-15
GENERAL MOTORS CO WTS 071016 (CIL)   2002-11-15 2011-10-28
GENERAL MOTORS CO WTS 071019 (CIL)   2002-11-15 2011-10-28
GENERAL MOTORS CO (CIL)   2002-11-15 2011-10-28
100 SH CHIMERA INVESTMENT CORP   2009-05-28 2011-01-18
5 SH TIME WARNER CABLE INC   2007-07-25 2011-01-14
26 SH ALLSTATE CORP   2009-03-27 2011-02-09
17 SH AMEREN CORP   2007-07-25 2011-02-07
9 SH CON EDISON INC   2008-05-15 2011-02-11
34 SH MFA FINANCIAL INC   2009-09-02 2011-02-07
32 SH DREAMWORKS ANIMATION SKG INC   2007-07-25 2011-02-28
8 SH TIME WARNER CABLE INC   2007-07-25 2011-03-18
14 SH ALLSTATE CORP   2009-03-27 2011-04-15
17 SH COVIDIEN PLC   2007-10-11 2011-03-30
2.667 SH TIME WARNER CABLE INC   2007-07-25 2011-03-29
5.333 SH TIME WARNER CABLE INC   2008-05-21 2011-03-29
6 SH TIME WARNER CABLE INC   2010-02-22 2011-03-29
9 SH ALLSTATE CORP   2009-03-27 2011-05-06
6 SH ALLSTATE CORP   2009-05-08 2011-05-06
3 SH ALLSTATE CORP   2009-06-02 2011-05-06
32 SH GENZYME WAIVER   2007-07-25 2011-05-05
GENZYME WAIVER   2007-07-25 2011-05-05
6 SH GENZYME WAIVER   2010-03-23 2011-05-05
GENZYME WAIVER   2010-03-23 2011-05-05
24 SH HEALTH CARE REIT INC   2007-07-25 2011-05-24
18 SH MILLICOM INTL CELLULAR SA   2007-07-25 2011-05-25
17 SH AON CORP   2007-07-25 2011-06-09
AMC NETWORKS INC CL A (CIL)   2007-07-25 2011-06-30
13 SH AMC NETWORKS INC CL A   2007-07-25 2011-07-13
2 SH AMC NETWORKS INC CL A   2008-10-16 2011-07-13
7 SH CLOROX CO DE   2009-11-03 2011-07-20
10 SH ALLSTATE CORP   2009-06-02 2011-08-05
20 SH ALLSTATE CORP   2009-06-12 2011-08-05
19 SH COVIDIEN PLC   2007-10-11 2011-08-11
27 SH WEATHERFORD INTERNATIONAL LTD   2010-04-29 2011-08-11
30 SH MCGRAW HILL CO INC   2010-05-19 2011-09-23
53 SH MFA FINANCIAL INC   2009-09-02 2011-09-13
17 SH MCGRAW HILL CO INC   2010-06-04 2011-10-26
14 SH MCGRAW HILL CO INC   2010-07-06 2011-10-26
14 SH MFA FINANCIAL INC   2009-09-02 2011-10-25
54 SH MFA FINANCIAL INC   2009-09-25 2011-10-25
63 SH MFA FINANCIAL INC   2009-11-20 2011-10-25
61 SH ACTIVISION BLIZZARD INC   2010-07-16 2011-11-28
107 SH CHIMERA INVESTMENT CORP   2009-05-28 2011-11-21
111 SH CHIMERA INVESTMENT CORP   2009-06-05 2011-11-21
145 SH CHIMERA INVESTMENT CORP   2010-04-07 2011-11-21
51 SH IVANHOE MINES LTD   2007-07-25 2011-11-09
35 SH DARDEN RESTAURANTS   2009-05-06 2011-01-13
75 SH JUNIPER NETWORKS   2009-04-14 2011-01-13
15 SH FLOWSERVE CORP   2009-08-27 2011-01-27
25 SH NOBLE ENERGY INC   2007-12-28 2011-01-27
25 SH QUALITY SYSTEMS   2008-11-11 2011-02-17
60 SH AVNET INC   2010-02-11 2011-03-18
35 SH CANADIAN PACIFIC RAILWAY LTD   2007-12-28 2011-03-23
45 SH INFORMATICA CORP   2009-02-25 2011-04-15
15 SH INTERCONTINENTAL EXCHAGE INC.   2007-12-28 2011-04-13
30 SH CITRIX SYSTEMS INC   2007-12-28 2011-05-04
5 SH CITRIX SYSTEMS INC   2008-06-26 2011-05-04
4 SH INTUITIVE SURGICAL INC   2007-12-28 2011-05-04
45 SH STIFEL FINANCIAL CORPORATION   2010-03-17 2011-06-08
35 SH ALLEGHENY TECH INC   2010-01-21 2011-08-26
10 SH PERRIGO CO   2008-11-25 2011-08-23
40 SH SCRIPPS NETWORKS INTERAC CL A   2010-09-27 2011-10-07
8 SH V F CORPORATION   2007-12-28 2011-11-30
3 SH KDDI CORP   2009-06-23 2011-01-18
4 SH SMITH & NEPHEW PLC   2009-01-15 2011-01-11
3 SH SMITH & NEPHEW PLC   2009-03-02 2011-01-11
59 SH ALCATEL-LUCENT ADS   2009-09-09 2011-02-18
5 SH BEIJING ENTERPRISES H SP ADR   2010-01-27 2011-02-07
10 SH NESTLE SPONSORED ADR   2008-06-04 2011-02-15
14 SH UNILEVER NV NY   2008-06-19 2011-02-15
6 SH UNILEVER NV NY   2008-08-27 2011-02-15
65 SH ALCATEL-LUCENT   2009-09-09 2011-03-03
1 SH HSBC HOLDINGS PLC   2009-05-01 2011-03-01
3 SH HSBC HOLDINGS PLC   2009-06-11 2011-03-01
4 SH HSBC HOLDINGS PLC   2009-07-20 2011-03-01
7 SH HSBC HOLDINGS PLC   2009-08-17 2011-03-01
1 SH NOVO NORDISK A/S   2008-06-04 2011-03-23
2 SH NOVO NORDISK A/S   2008-10-15 2011-03-23
4 SH SMITH & NEPHEW PLC   2009-03-02 2011-03-18
9 SH SMITH & NEPHEW PLC   2009-03-25 2011-03-18
2 SH SMITH & NEPHEW PLC   2009-04-03 2011-03-18
16 SH SWEDBANK AB   2009-08-21 2011-03-24
35 SH SWEDBANK AB   2009-11-10 2011-03-24
TNT N.V. (CIL)   2008-06-04 2011-03-18
111 SH CHINA INFORMAT TECHNOLOGY INC   2010-04-06 2011-04-13
2 SH CNOOC LTD   2008-12-01 2011-04-26
9 SH SILVER WHEATON CORP   2010-01-12 2011-04-14
22 SH ANTOFAGOSTA HLDGS PLC   2009-08-27 2011-05-06
1 SH CNOOC LTD   2008-12-01 2011-05-20
3 SH CNOOC LTD   2010-03-22 2011-05-20
1 SH CNOOC LTD   2010-04-29 2011-05-20
23 SH ELDORADO GOLD CP LTD   2010-03-15 2011-05-17
21 SH SILVER WHEATON CORP   2010-01-12 2011-05-12
17 SH SOCIEDAD QUIMICA Y MINERA   2008-08-21 2011-05-20
20 SH CANADIAN NATURAL RESOURCES LTD   2010-04-29 2011-06-17
26 SH EXPERIAN GP LTD   2008-06-04 2011-05-26
44 SH POSTNL N.V.   2008-06-04 2011-06-24
8 SH POSTNL N.V.   2009-01-08 2011-06-24
5 SH SIEMENS AKTIENGESELLSCHAFT   2008-07-29 2011-06-27
3 SH SIEMENS AKTIENGESELLSCHAFT   2008-09-09 2011-06-27
1 SH SIEMENS AKTIENGESELLSCHAFT   2008-11-26 2011-06-27
4 SH SIEMENS AKTIENGESELLSCHAFT   2009-04-30 2011-06-27
2 SH BG GROUP PLC   2010-01-25 2011-07-12
9 SH BNP PARIBAS SP   2010-04-29 2011-07-21
7 SH CENOVUS ENERGY INC COM   2010-04-27 2011-07-12
119 SH DEUTSCHE BOERSE AG   2009-02-17 2011-07-12
43 SH DEUTSCHE BOERSE AG   2009-02-26 2011-07-12
43 SH DEUTSCHE BOERSE AG   2009-03-09 2011-07-12
27 SH DEUTSCHE BOERSE AG   2010-01-25 2011-07-12
13 SH BANCO SANTANDER BRASIL SA ADS   2009-12-11 2011-07-28
22 SH BANCO SANTANDER BRASIL SA ADS   2010-02-09 2011-07-28
18 SH BANCO SANTANDER BRASIL SA ADS   2010-03-22 2011-07-28
14 SH BANCO SANTANDER BRASIL SA ADS   2010-04-27 2011-07-28
59 SH BANK OF CHINA   2010-02-02 2011-09-27
17 SH BANK OF CHINA   2010-03-02 2011-09-27
2 SH BNO PARIBAS SP   2010-04-29 2011-09-20
25 SH BNO PARIBAS SP   2010-07-22 2011-09-20
13 SH CENOVUS ENERGY INC COM   2010-04-27 2011-10-31
8 SH BASF SE SP ADR   2009-02-23 2011-11-07
18 SH MAKITA CORPORATION LTD   2010-05-06 2011-11-11
7 SH MAKITA CORPORATION LTD   2010-05-19 2011-11-11
6 SH BAXTER INTL INC   2009-07-31 2011-01-25
9 SH HALLIBURTON CO   2009-08-12 2010-12-29
11 SH HALLIBURTON CO   2009-08-12 2011-01-25
20 SH KRAFT FOODS INC CL A   2009-08-12 2011-01-06
7 SH BAXTER INT'L INC   2009-07-31 2011-02-08
2 SH BAXTER INT'L INC   2009-08-12 2011-02-08
8 SH CISCO SYS INC   2009-07-16 2011-02-11
28 SH CISCO SYS INC   2009-07-21 2011-02-11
18 SH CISCO SYS INC   2009-08-12 2011-02-11
1 SH CME GROUP INC   2009-08-12 2011-02-15
7 SH VISA INC CL A   2009-08-12 2011-02-07
2 SH VISA INC CL A   2010-01-20 2011-02-07
5 SH BROADCOM CORP CL A   2009-09-25 2011-02-24
5 SH BROADCOM CORP CL A   2009-10-23 2011-02-24
4 SH BROADCOM CORP CL A   2009-10-23 2011-03-11
7 SH BROADCOM CORP CL A   2010-01-20 2011-03-11
2 SH MASTERCARD INC CL A   2010-02-08 2011-03-24
44 SH PEOPLE'S UNITED FINANCIAL INC.   2009-08-11 2011-03-25
7 SH TARGET CORPORATION   2009-08-12 2011-03-18
7 SH BAXTER INT'L INC   2009-08-12 2011-04-11
5 SH BIOGEN IDEC INC   2009-12-17 2011-04-21
4 SH BIOGEN IDEC INC   2010-01-20 2011-04-21
6 SH PEPSICO INC   2009-08-12 2011-04-06
10 SH ST. JUDE MEDICAL INC   2009-08-12 2011-04-14
25 SH AMERICAN TOWER CORP CLASS A   2009-08-12 2011-05-17
1 SH APPLE INC   2009-08-12 2011-05-17
28 SH AVON PRODUCTS INC   2009-08-12 2011-05-17
15 SH AVON PRODUCTS INC   2010-04-13 2011-05-17
1 SH BAXTER INT'L INC   2009-08-12 2011-05-17
4 SH BAXTER INT'L INC   2009-12-02 2011-05-17
4 SH BAXTER INT'L INC   2009-12-09 2011-05-17
7 SH BAXTER INT'L INC   2010-01-20 2011-05-17
18 SH BED BATH & BEYOND INC   2010-04-26 2011-05-17
16 SH CHARLES SCHWAB   2009-08-12 2011-05-17
44 SH CISCO SYS INC   2009-08-12 2011-05-17
8 SH CISCO SYS INC   2010-01-20 2011-05-17
3 SH CME GROUP INC   2009-08-12 2011-05-17
26 SH COSTCO WHOLESALE CORP   2009-08-12 2011-05-17
44 SH CROWN CASTLE INTL   2009-08-12 2011-05-17
4 SH ECOLAB INC   2010-02-10 2011-05-17
1 SH EQUINIX INC   2010-05-04 2011-05-17
3 SH EQUINIX INC   2010-05-06 2011-05-17
12 SH GILEAD SCIENCE   2009-08-12 2011-05-17
10 SH GILEAD SCIENCE   2009-10-28 2011-05-17
4 SH GILEAD SCIENCE   2010-01-20 2011-05-17
2 SH GOOGLE INC - CL A   2009-08-12 2011-05-17
4 SH HALLIBURTON CO   2009-08-12 2011-05-17
10 SH HALLIBURTON CO   2009-12-08 2011-05-17
55 SH LOWES COMPANIES INC   2009-08-12 2011-05-17
22 SH LOWES COMPANIES INC   2009-09-25 2011-05-17
8 SH LOWES COMPANIES INC   2010-01-20 2011-05-17
1 SH MASTERCARD INC CL A   2010-02-08 2011-05-17
2 SH MASTERCARD INC CL A   2010-05-13 2011-05-17
8 SH MCDONALDS CORP   2008-06-03 2011-05-17
6 SH MCDONALDS CORP   2009-11-13 2011-05-17
77 SH MICROSOFT CORPORATION   2009-08-12 2011-05-17
12 SH MICROSOFT CORPORATION   2010-01-20 2011-05-17
38 SH MORGAN STANLEY   2009-08-12 2011-05-17
12 SH NIKE INC B   2009-10-22 2011-05-17
3 SH NIKE INC B   2009-11-16 2011-05-17
6 SH NIKE INC B   2010-01-04 2011-05-17
3 SH NIKE INC B   2010-01-20 2011-05-17
15 SH NORTHERN TRUST CORP   2009-10-22 2011-05-17
8 SH NORTHERN TRUST CORP   2009-10-30 2011-05-17
4 SH NORTHERN TRUST CORP   2010-01-06 2011-05-17
10 SH ORACLE CORP   2009-08-12 2011-05-17
26 SH PEPSICO INC   2009-08-12 2011-05-17
5 SH PEPSICO INC   2009-10-06 2011-05-17
6 SH PEPSICO INC   2009-10-15 2011-05-17
5 SH PEPSICO INC   2009-11-25 2011-05-17
6 SH PEPSICO INC   2010-01-20 2011-05-17
15 SH PRAXAIR INC   2009-08-12 2011-05-17
26 SH QUALCOMM INC   2009-08-12 2011-05-17
21 SH SCHLUMBERGER LTD   2009-08-12 2011-05-17
7 SH SOUTHWESTERN ENERGY COMPANY   2010-04-14 2011-05-17
6 SH ST JUDE MEDICAL INC   2009-08-12 2011-05-17
13 SH ST JUDE MEDICAL INC   2009-10-22 2011-05-17
6 SH ST JUDE MEDICAL INC   2010-01-20 2011-05-17
43 SH STAPLES INC   2009-08-12 2011-05-17
17 SH STAPLES INC   2009-08-27 2011-05-17
6 SH STAPLES INC   2010-01-20 2011-05-17
18 SH TARGET CORPORATION   2009-08-12 2011-05-17
4 SH TARGET CORPORATION   2010-01-20 2011-05-17
6 SH TEVA PHARMACEUTICALS   2009-03-16 2011-05-17
4 SH TEVA PHARMACEUTICALS   2009-11-16 2011-05-17
3 SH TEVA PHARMACEUTICALS   2010-01-20 2011-05-17
18 SH THERMO FISHER SCIENTIFIC INC   2009-08-12 2011-05-17
24 SH VIACOM INC CLASS B   2009-08-12 2011-05-17
48 SH WESTERN UNION CO   2009-08-12 2011-05-17
10 SH WESTERN UNION CO   2010-01-20 2011-05-17
33 SH XILINX INC   2010-01-25 2011-05-17
22 SH XILINX INC   2010-02-25 2011-05-17
21 SH CHARLES SCHWAB   2009-08-12 2011-07-06
1 SH CHARLES SCHWAB   2009-09-17 2011-07-06
19 SH CHARLES SCHWAB   2009-09-17 2011-07-08
9 SH CHARLES SCHWAB   2010-01-20 2011-07-08
2 SH APPLE INC   2009-08-12 2011-07-28
7 SH ORACLE CORP   2009-08-12 2011-07-29
1 SH APPLE INC   2009-08-12 2011-09-27
6 SH HALLIBURTON CO   2010-01-20 2011-09-21
5 SH HALLIBURTON CO   2010-04-30 2011-09-21
9 SH HALLIBURTON CO   2010-06-02 2011-09-21
3 SH ORACLE CORP   2009-08-12 2011-09-06
3 SH SCHLUMBERGER LTD   2009-08-12 2011-12-09
700 SHS WILLIAMS PARTNERS, LP   2010-09-23 2011-07-11
657 SHS ENERGY TRANSFER EQUITY, LP   2009-12-08 2011-05-11
LESS: REPORTED AS ORDINARY INCOME   2011-01-01 2011-12-31
LESS: REPORTED AS ORDINARY INCOME   2010-01-01 2011-12-31
CAPITAL GAIN DISTRIBUTION - MORGAN STANLEY SMITH BARNEY   2010-01-01 2011-12-31
(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 76     76
b 259   274 -15
c 426   569 -143
d 3,127   1,961 1,166
e 1,547   697 850
2,574   1,141 1,433
1,783   2,285 -502
1,447   1,703 -256
1,483   1,980 -497
424   550 -126
1,750   926 824
3,028   2,327 701
675   574 101
495   421 74
595   588 7
157   177 -20
829   789 40
417   405 12
643   604 39
618   688 -70
70   174 -104
366   433 -67
1     1
562   651 -89
187   193 -6
653   562 91
544   638 -94
523   718 -195
940   1,054 -114
621   714 -93
439   620 -181
162   238 -76
521   644 -123
178   192 -14
382   259 123
479   466 13
503   495 8
249   248 1
838   853 -15
339   355 -16
1,007   896 111
453   407 46
252   231 21
594   559 35
356   345 11
818   832 -14
327   315 12
454   436 18
441   303 138
431   575 -144
897   1,018 -121
796   881 -85
99   97 2
296   249 47
217   218 -1
1,793   1,572 221
75   68 7
326   293 33
75   79 -4
280   202 78
560   408 152
280   235 45
481   461 20
73   79 -6
48   53 -5
687   482 205
313   459 -146
103   95 8
513   485 28
945   866 79
1,127   1,177 -50
83   79 4
705   572 133
155   109 46
414   322 92
155   142 13
119   122 -3
239   251 -12
378   385 -7
179   189 -10
344   371 -27
186   135 51
186   137 49
124   90 34
309   223 86
247   229 18
465   445 20
297   198 99
422   301 121
195   203 -8
629   675 -46
384   439 -55
245   262 -17
158   175 -17
205   232 -27
414   503 -89
845   873 -28
277   278 -1
111   108 3
668   716 -48
434   499 -65
373   400 -27
156   172 -16
187   207 -20
513   456 57
210   353 -143
538   970 -432
62   59 3
227   251 -24
175   201 -26
131   148 -17
44   49 -5
220   246 -26
184   150 34
320   402 -82
144   172 -28
402   517 -115
80   105 -25
184   205 -21
146   164 -18
739   986 -247
171   231 -60
277   370 -93
201   256 -55
566   775 -209
204   298 -94
416   361 55
209   180 29
220   150 70
141   171 -30
131   268 -137
131   245 -114
131   205 -74
136   120 16
362   321 41
148   241 -93
340   602 -262
201   195 6
432   390 42
270   235 35
600   451 149
360   271 89
265   300 -35
226   180 46
144   201 -57
230   301 -71
193   267 -74
47   67 -20
94   140 -46
243   450 -207
81   90 -9
160   180 -20
428   334 94
202   170 32
201   170 31
194   192 2
192   192  
5   21 -16
1   4 -3
4   16 -12
1   3 -2
29   118 -89
7   30 -23
100,000   100,000  
100,000   100,000  
100,000   100,000  
50,000   49,755 245
12     12
8     8
42     42
40,000   40,000  
28     28
19     19
27     27
412   331 81
326   516 -190
845   530 315
484   860 -376
452   373 79
282   263 19
881   989 -108
547   826 -279
441   285 156
884   703 181
187   275 -88
374   379 -5
421   283 138
303   184 119
202   153 49
101   79 22
2,368   1,923 445
75   61 14
444   343 101
14   11 3
1,248   861 387
1,890   1,521 369
864   696 168
19     19
481   463 18
74   35 39
521   410 111
262   264 -2
524   495 29
915   785 130
468   498 -30
1,284   877 407
375   409 -34
737   467 270
607   387 220
95   108 -13
366   426 -60
426   475 -49
738   680 58
283   354 -71
293   374 -81
383   569 -186
1,085   772 313
1,610   1,348 262
2,859   1,356 1,503
1,844   1,289 555
2,147   2,019 128
1,974   967 1,007
1,921   1,600 321
2,204   2,325 -121
2,361   586 1,775
1,819   2,828 -1,009
2,411   1,133 1,278
402   153 249
1,381   1,298 83
1,642   1,667 -25
1,608   1,571 37
894   331 563
1,527   1,876 -349
1,109   565 544
169   157 12
208   138 70
156   103 53
297   219 78
277   362 -85
542   494 48
413   417 -4
177   166 11
348   241 107
53   36 17
160   138 22
213   185 28
372   369 3
123   65 58
246   98 148
220   137 83
495   299 196
110   65 45
275   172 103
602   332 270
22     22
269   761 -492
508   159 349
386   153 233
860   546 314
232   80 152
697   481 216
232   176 56
351   300 51
713   357 356
980   627 353
784   775 9
325   200 125
352   1,753 -1,401
64   149 -85
662   575 87
397   294 103
132   60 72
529   267 262
220   191 29
318   304 14
256   205 51
851   581 270
307   212 95
307   167 140
193   196 -3
122   179 -57
206   255 -49
168   220 -52
131   156 -25
486   721 -235
140   219 -79
35   68 -33
435   792 -357
455   380 75
551   230 321
633   544 89
246   200 46
303   339 -36
357   210 147
441   256 185
628   572 56
343   395 -52
98   111 -13
150   159 -9
526   592 -66
338   388 -50
293   286 7
518   482 36
148   173 -25
203   144 59
203   139 64
161   111 50
282   202 80
494   451 43
553   734 -181
349   298 51
380   388 -8
512   247 265
410   218 192
395   343 52
515   385 130
1,305   813 492
334   166 168
847   914 -67
454   480 -26
60   55 5
239   224 15
239   221 18
418   424 -6
992   868 124
276   300 -24
729   949 -220
133   194 -61
887   859 28
2,151   1,282 869
1,811   1,199 612
207   176 31
99   101 -2
296   280 16
485   553 -68
404   433 -29
162   183 -21
1,046   919 127
181   93 88
453   272 181
1,379   1,265 114
552   463 89
201   182 19
280   226 54
560   472 88
650   461 189
487   380 107
1,874   1,824 50
292   365 -73
916   1,141 -225
1,018   780 238
254   196 58
509   395 114
254   191 63
729   798 -69
389   399 -10
194   210 -16
341   219 122
1,844   1,487 357
355   306 49
426   375 51
355   316 39
426   371 55
1,540   1,172 368
1,465   1,212 253
1,726   1,136 590
290   290  
311   231 80
673   444 229
311   230 81
855   971 -116
338   370 -32
119   148 -29
914   767 147
203   203  
295   271 24
196   211 -15
147   174 -27
1,114   823 291
1,189   597 592
990   874 116
206   194 12
1,159   804 355
773   564 209
336   394 -58
16   18 -2
293   341 -48
139   170 -31
781   332 449
215   154 61
406   166 240
220   199 21
184   151 33
330   212 118
78   66 12
219   162 57
37,668   26,468 11,200
27,141   14,528 12,613
      -5,132
      -3,383
188   0 188
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       76
b       -15
c       -143
d       1,166
e       850
      1,433
      -502
      -256
      -497
      -126
      824
      701
      101
      74
      7
      -20
      40
      12
      39
      -70
      -104
      -67
      1
      -89
      -6
      91
      -94
      -195
      -114
      -93
      -181
      -76
      -123
      -14
      123
      13
      8
      1
      -15
      -16
      111
      46
      21
      35
      11
      -14
      12
      18
      138
      -144
      -121
      -85
      2
      47
      -1
      221
      7
      33
      -4
      78
      152
      45
      20
      -6
      -5
      205
      -146
      8
      28
      79
      -50
      4
      133
      46
      92
      13
      -3
      -12
      -7
      -10
      -27
      51
      49
      34
      86
      18
      20
      99
      121
      -8
      -46
      -55
      -17
      -17
      -27
      -89
      -28
      -1
      3
      -48
      -65
      -27
      -16
      -20
      57
      -143
      -432
      3
      -24
      -26
      -17
      -5
      -26
      34
      -82
      -28
      -115
      -25
      -21
      -18
      -247
      -60
      -93
      -55
      -209
      -94
      55
      29
      70
      -30
      -137
      -114
      -74
      16
      41
      -93
      -262
      6
      42
      35
      149
      89
      -35
      46
      -57
      -71
      -74
      -20
      -46
      -207
      -9
      -20
      94
      32
      31
      2
       
      -16
      -3
      -12
      -2
      -89
      -23
       
       
       
      245
      12
      8
      42
       
      28
      19
      27
      81
      -190
      315
      -376
      79
      19
      -108
      -279
      156
      181
      -88
      -5
      138
      119
      49
      22
      445
      14
      101
      3
      387
      369
      168
      19
      18
      39
      111
      -2
      29
      130
      -30
      407
      -34
      270
      220
      -13
      -60
      -49
      58
      -71
      -81
      -186
      313
      262
      1,503
      555
      128
      1,007
      321
      -121
      1,775
      -1,009
      1,278
      249
      83
      -25
      37
      563
      -349
      544
      12
      70
      53
      78
      -85
      48
      -4
      11
      107
      17
      22
      28
      3
      58
      148
      83
      196
      45
      103
      270
      22
      -492
      349
      233
      314
      152
      216
      56
      51
      356
      353
      9
      125
      -1,401
      -85
      87
      103
      72
      262
      29
      14
      51
      270
      95
      140
      -3
      -57
      -49
      -52
      -25
      -235
      -79
      -33
      -357
      75
      321
      89
      46
      -36
      147
      185
      56
      -52
      -13
      -9
      -66
      -50
      7
      36
      -25
      59
      64
      50
      80
      43
      -181
      51
      -8
      265
      192
      52
      130
      492
      168
      -67
      -26
      5
      15
      18
      -6
      124
      -24
      -220
      -61
      28
      869
      612
      31
      -2
      16
      -68
      -29
      -21
      127
      88
      181
      114
      89
      19
      54
      88
      189
      107
      50
      -73
      -225
      238
      58
      114
      63
      -69
      -10
      -16
      122
      357
      49
      51
      39
      55
      368
      253
      590
       
      80
      229
      81
      -116
      -32
      -29
      147
       
      24
      -15
      -27
      291
      592
      116
      12
      355
      209
      -58
      -2
      -48
      -31
      449
      61
      240
      21
      33
      118
      12
      57
      11,200
      12,613
       
       
      188
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 37,759
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 180,780 2,020,233 0.089485
2009 136,300 1,933,982 0.070476
2008 92,632 2,033,635 0.04555
2007 90,761 2,128,949 0.042632
2006 99,961 2,075,705 0.048158
2 Total of line 1, column (d) ...................... 2 0.296301
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 0.05926
4 Enter the net value of noncharitable-use assets for 2011 from Part X, line 5..... 4 2,021,177
5 Multiply line 4 by line 3....................... 5 119,775
6 Enter 1% of net investment income (1% of Part I, line 27b)........... 6 985
7 Add lines 5 and 6......................... 7 120,760
8 Enter qualifying distributions from Part XII, line 4.............. 8 159,009
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 1 985
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............................ 3 985
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- ..... 5 985
6 Credits/Payments:
a 2011 estimated tax payments and 2010 overpayment credited to 2011 6a 1,900
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 1,900
8 Enter any penalty for underpayment of estimated tax. if Form 2220 is attached. 8  
9 Tax due. If the total of lines 5 and 8 is more than line 7, enter amount owed.......Bullet 9  
10 Overpayment. If line 7 is more than the total of lines 5 and 8, enter the amount overpaid...Bullet 10 915
11 Enter the amount of line 10 to be: Credited to 2012 estimated taxBullet915 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? Click to see list of attachments....................
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
 
 
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 changesClick to see list of attachments....
3
 
No
4a
Did the foundation have unrelated business gross income of $1,000 or more during the year?........
4a
Yes
 
b
If “Yes,” has it filed a tax return on Form 990-T for this year?...................
4b
Yes
 
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.Click to see list of attachments
6
Are the requirements of section 508(e) (relating to sections 4941 through 4945) satisfied either:
  • By language in the governing instrument, or
  • By state legislation that effectively amends the governing instrument so that no mandatory directions
  • that conflict with the state law remain in the governing instrument?................
    6
    Yes
     
    7
    Did the foundation have at least $5,000 in assets at any time during the year? If “Yes,” complete Part II, col. (c), and Part XV.
    7
    Yes
     
    8a
    Enter the states to which the foundation reports or with which it is registered (see page 19 of the
    instructions)bulletWA
    b
    If the answer is “Yes” to line 7, has the foundation furnished a copy of Form 990-PF to the Attorney
    General (or designate) of each state as required by General Instruction G? If “No,” attach explanation .
    8b
    Yes
     
    9
    Is the foundation claiming status as a private operating foundation within the meaning of section 4942(j)(3)
    or 4942(j)(5) for calendar year 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 ofbulletFOUNDATION MANAGEMENT GROUP Telephone no.bullet (206) 667-0300
    Located atbullet1000 SECOND AVENUE 34TH FLSEATTLEWA ZIP+4bullet981041022
    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
     
     
    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
    CARMELA M KOEPLIN PRESIDENT
    2.0
    0    
    1000 SECOND AVENUE 34th floor
    SEATTLE,WA981041022
    PATRICK J KOEPLIN VP/TREASURER
    2.0
    0    
    1000 SECOND AVENUE 34th floor
    SEATTLE,WA981041022
    DANIEL M ASHER SECRETARY
    2.0
    0    
    1000 SECOND AVENUE 34th floor
    SEATTLE,WA981041022
    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
     
    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
     
    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  
    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
    1,759,952
    b
    Average of monthly cash balances.......................
    1b
    280,124
    c
    Fair market value of all other assets (see page 24 of the instructions)............
    1c
    11,880
    d
    Total (add lines 1a, b, and c).........................
    1d
    2,051,956
    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
    0
    3
    Subtract line 2 from line 1d.........................
    3
    2,051,956
    4
    Cash deemed held for charitable activities. Enter 1 1⁄2% of line 3 (for greater amount, see page 25
    of the instructions) ...........................
    4
    30,779
    5
    Net value of noncharitable-use assets. Subtract line 4 from line 3. Enter here and on Part V, line 4
    5
    2,021,177
    6
    Minimum investment return. Enter 5% of line 5..................
    6
    101,059
    Part XI
    Distributable Amount bullet and do not complete this part.)
    1
    Minimum investment return from Part X, line 6....................
    1
    101,059
    2a
    Tax on investment income for 2011 from Part VI, line 5......
    2a
    985
    b
    Income tax for 2011. (This does not include the tax from Part VI.)...
    2b
     
    c
    Add lines 2a and 2b............................
    2c
    985
    3
    Distributable amount before adjustments. Subtract line 2c from line 1............
    3
    100,074
    4
    Recoveries of amounts treated as qualifying distributions................
    4
     
    5
    Add lines 3 and 4............................
    5
    100,074
    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
    100,074
    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
    159,009
    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
    159,009
    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
    985
    6
    Adjusted qualifying distributions. Subtract line 5 from line 4..............
    6
    158,024
    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 7 100,074
    2 Undistributed income, if any, as of the end of 2011:
    a Enter amount for 2010 only.......  
    b Total for prior years:2009, 2008, 2007  
    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....... 60,414
    fTotal of lines 3a through e......... 60,414
    4Qualifying distributions for 2011 from Part
    XII, line 4: bullet$ 159,009
    a Applied to 2010, but not more than line 2a  
    b Applied to undistributed income of prior years
    (Election required—see page 26 of the instructions)
     
    c Treated as distributions out of corpus (Election
    required—see page 26 of the instructions)...
     
    d Applied to 2011 distributable amount..... 100,074
    e Remaining amount distributed out of corpus 58,935
    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 5 119,349
    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 ..........
    0
    7 Amounts treated as distributions out of
    corpus to satisfy requirements imposed by
    section 170(b)(1)(F) or 4942(g)(3) (see page 27
    of the instructions) ...........
     
    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 ......
    119,349
    10 Analysis of line 9:
    a Excess from 2007.... 0
    b Excess from 2008.... 0
    c Excess from 2009.... 0
    d Excess from 2010.... 60,414
    e Excess from 2011.... 58,935
    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).)
    PATRICK CARMELA KOEPLIN
    bList any managers of the foundation who own 10% or more of the stock of a corporation (or an equally large portion of the
    ownership of a partnership or other entity) of which the foundation has a 10% or greater interest.
    NONE
    2Information Regarding Contribution, Grant, Gift, Loan, Scholarship, etc., Programs:
    Check here bullet
    aThe name, address, and telephone number of the person to whom applications should be addressed:
    bThe form in which applications should be submitted and information and materials they should include:
    cAny submission deadlines:
    dAny restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other
    factors:
    Form 990-PF (2011)
    Form 990-PF (2011)
    Page 10
    Part XV
    Supplementary Information (continued)
    3 Grants and Contributions Paid During the Year or Approved for Future Payment
    Recipient If recipient is an individual,
    show any relationship to
    any foundation manager
    or substantial contributor
    Foundation
    status of
    recipient
    Purpose of grant or
    contribution
    Amount
    Name and address (home or business)
    aPaid during the year
    BLESSED TERESA OF CALCUTTA PARISH
    PO BOX 705
    WOODINVILLE,WA98072
    NONE EXEMPT HUMAN SERVICES 110,000
    RECOVERY CAFE
    2202 BOREN AVENUE
    SEATTLE,WA98121
    NONE EXEMPT HUMAN SERVICES 5,000
    IGNATIAN SPIRITUALITY CENTER
    732 - 18TH AVENUE EAST
    SEATTLE,WA98112
    NONE EXEMPT HUMAN SERVICES 5,000
    SEATTLE UNIVERSITY
    PO BOX 222000
    SEATTLE,WA981121090
    NONE EXEMPT EDUCATION 20,000
    THE SMILE TRAIN
    41 MADISON AVENUE 28TH FL
    NEW YORK,NY10010
    NONE EXEMPT HEALTH 3,000
    LIVE OAK ADULT DAY SERVICES
    1147 MINNESOTA AVE
    SAN JOSE,CA95125
    NONE EXEMPT HUMAN SERVICES 4,000
    LIVERMORE VETERANS FOUNDATION
    1692 RUTGERS WAY
    LIVERMORE,CA94550
    NONE EXEMPT HUMAN SERVICES 1,500
    OUR MOTHER'S HOUSE
    PO BOX 2240
    VENICE,FL342842240
    NONE EXEMPT HUMAN SERVICES 1,500
    FROM BOARDWALK PIPELINE PARTNERS LP K-1
    9 GREENWAY PLAZA SUITE 2800
    HOUSTON,TX77046
    NONE EXEMPT PER K-1 3
    FROM BUCKEYE PARTNERS LP K-1
    5 TEK PARK
    9999 HAMILTON BLVD
    BREINIGSVILLE,PA18031
    NONE EXEMPT PER K-1 3
    FROM ENBRIDGE ENERGY PARTNERS LP K-1
    1100 LOUISIANA
    SUITE 3300
    HOUSTON,TX77002
    NONE EXEMPT PER K-1 2
    FROM WILLIAMS PARTNERS LP K-1
    ONE WILLIAMS CENTER
    TULSA,OK74172
    NONE EXEMPT PER K-1 1
    Total .................................bullet 3a 150,009
    bApproved for future payment
    Total .................................bullet 3b  
    Form 990-PF (2011)
    Form 990-PF (2011)
    Page 11
    Part XVI-A
    Analysis of Income-Producing Activities
    Enter gross amounts unless otherwise indicated. Unrelated business income Excluded by section 512, 513, or 514 (e)
    Related or exempt
    function income
    (See page 28 of
    the instructions.)
    1Program service revenue: (a)
    Business code
    (b)
    Amount
    (c)
    Exclusion code
    (d)
    Amount
    a
    b
    c
    d
    e
    f
    gFees and contracts from government agencies          
    2 Membership dues and assessments....          
    3Interest on savings and temporary cash investments          
    4 Dividends and interest from securities....     14 71,281  
    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 46,280  
    9 Net income or (loss) from special events:          
    10 Gross profit or (loss) from sales of inventory..          
    11 Other revenue: aINCOME FROM PARTNERSHIPS 211110 -35,447 14 -197  
    b
    c
    d
    e
    12 Subtotal. Add columns (b), (d), and (e).. -35,447 117,364  
    13Total. Add line 12, columns (b), (d), and (e)..................
    1381,917
    (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


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    Form 990PF - Special Condition Description:
    Special Condition Description

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    TY 2011 DepreciationSchedule
    Name:
    KOEPLIN FAMILY FOUNDATION
    EIN: 41-1268766
    Description of Property Date Acquired Cost or Other Basis Prior Years' Depreciation Computation Method Rate /
    Life (# of years)
    Current Year's Depreciation Expense Net Investment Income Adjusted Net Income Cost of Goods Sold Not Included

    TY 2011 InvestmentsCorpBondsSchedule
    Name:
    KOEPLIN FAMILY FOUNDATION
    EIN: 41-1268766
    Name of Bond End of Year Book Value End of Year Fair Market Value
    BONDS 712,993 712,993

    TY 2011 InvestmentsCorpStockSchedule
    Name:
    KOEPLIN FAMILY FOUNDATION
    EIN: 41-1268766
    Name of Stock End of Year Book Value End of Year Fair Market Value
    SECURITIES 1,027,444 1,027,444

    TY 2011 LandEtcSchedule2
    Name:
    KOEPLIN FAMILY FOUNDATION
    EIN: 41-1268766
    Category / Item Cost / Other Basis Accumulated Depreciation Book Value End of Year Fair Market Value


    TY 2011 OtherAssetsSchedule
    Name:
    KOEPLIN FAMILY FOUNDATION
    EIN: 41-1268766
    Description Beginning of Year - Book Value End of Year - Book Value End of Year - Fair Market Value
    ACCRUED INTEREST RECEIVABLE 10,618 10,263 10,263
    DIVIDENDS RECEIVABLE 120 304 304
    PREPAID TAXES 0 1,313 1,313


    TY 2011 OtherDecreasesSchedule
    Name:
    KOEPLIN FAMILY FOUNDATION
    EIN: 41-1268766
    Description Amount
    UNREALIZED LOSS 36,294


    TY 2011 OtherExpensesSchedule
    Name:
    KOEPLIN FAMILY FOUNDATION
    EIN: 41-1268766
    Description Revenue and Expenses per Books Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    BROKER FEES 7,542 7,542    
    LICENSES EXPENSE 35      
    PENALTIES AND FINES 5      


    TY 2011 OtherIncomeSchedule2
    Name:
    KOEPLIN FAMILY FOUNDATION
    EIN: 41-1268766
    Description Revenue And Expenses Per Books Net Investment Income Adjusted Net Income
    Net Activity from AmeriGas Partners LP -3,871 189  
    Net Activity from Buckeye Partners LP -665 223  
    NET ACTIVITY FROM ENBRIDGE TRANSFER PTRS -960 1  
    NET ACTIVITY FROM ENERGY TRANSFER EQ LP -3,433 18  
    Net Activity from Energy Transfer Prtns -5,080 70  
    Net Activity from INERGY, LP -1,268 9  
    Net Activity from Kinder Morgan Energy -5,512 102  
    Net Activity from Plains All-American -658 -58  
    NET ACTIVITY FROM REGENCY ENERGY PTRS -3,921 20  
    NET ACTIVITY FROM SUBURBAN PROPANE PTRS -2,496 -133  
    Net Activity from TC Pipelines LP -1,694 -132  
    NET ACTIVITY FROM BOARDWALK PIPELINE PTR -2,057 96  
    NET ACTIVITY FROM WILLIAMS PARTNERS LP -1,203 -6  
    NET ACTIVITY FROM DCP MIDSTREAM PTRS -2,297 -596  
    NET ACTIVITY FROM MAGELLAN MIDSTREAM PTR -529    


    TY 2011 OtherProfessionalFeesSchedule
    Name:
    KOEPLIN FAMILY FOUNDATION
    EIN: 41-1268766
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    MANAGEMENT FEES 12,000 2,400   9,000


    TY 2011 TaxesSchedule
    Name:
    KOEPLIN FAMILY FOUNDATION
    EIN: 41-1268766
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    FEDERAL EXCISE TAX EXPENSE 987      
    FOREIGN TAXES 372 372