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
DUBOSE FAMILY FOUNDATION
 

Number and street (or P.O. box number if mail is not delivered to street address)PO BOX 2990   Room/suite
City or town, state, and ZIP code
FORT WORTH, TX76113
A Employer identification number

20-1588677
B Telephone number (see page 10 of the instructions)

(817) 390-2202
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$9,682,681J 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) 1,323,558
2 Check bullet
3 Interest on savings and temporary cash investments 2,113 2,113  
4 Dividends and interest from securities...... 159,231 159,231  
5a Gross rents..............      
b Net rental income or (loss)  
6a Net gain or (loss) from sale of assets not on line 10 26,028
b Gross sales price for all assets on line 6a 26,028
7 Capital gain net income (from Part IV, line 2)... 26,028
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........ 1,510,930 187,372  
Operating and Administrative Expenses 13 Compensation of officers, directors, trustees, etc. 48,000 24,000    
14 Other employee salaries and wages......        
15 Pension plans, employee benefits.......        
16a Legal fees (attach schedule)......... Click to see attachment 463 231    
b Accounting fees (attach schedule)....... Click to see attachment 750 375    
c Other professional fees (attach schedule)....        
17 Interest...............        
18 Taxes (attach schedule) (see page 14 of the instructions) Click to see attachment 11,394 2,674    
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.......... 60,607 27,280   0
25 Contributions, gifts, grants paid........ 346,840 346,840
26 Total expenses and disbursements. Add lines 24 and 25 407,447 27,280   346,840
27 Subtract line 26 from line 12:
a Excess of revenue over expenses and disbursements 1,103,483
b Net investment income (if negative, enter -0-) 160,092
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............... 3,663,058 3,081,866 3,081,868
2 Savings and temporary cash investments.......... 2,033,875 1,837,810 1,837,810
3 Accounts receivable bullet  
Less: allowance for doubtful accounts bullet        
4 Pledges receivable bullet  
Less: allowance for doubtful accounts bullet        
5 Grants receivable.................      
6 Receivables due from officers, directors, trustees, and other
disqualified persons (attach schedule) (see page 15 of the
instructions)....................      
7 Other notes and loans receivable (attach schedule) bullet  
Less: allowance for doubtful accounts bullet        
8 Inventories for sale or use...............      
9 Prepaid expenses and deferred charges...........      
10a Investments—U.S. and state government obligations (attach schedule)      
b Investments—corporate stock (attach schedule)........ 2,970,646 Click to see attachment4,851,386 4,762,953
c Investments—corporate bonds (attach schedule)........      
11 Investments—land, buildings, and equipment: basis bullet  
Less: accumulated depreciation (attach schedule) bullet        
12 Investments—mortgage loans..............      
13 Investments—other (attach schedule)...........      
14 Land, buildings, and equipment: basis bullet  
Less: accumulated depreciation (attach schedule) bullet        
15 Other assets (describe bullet) Click to see attachment50 Click to see attachment50 Click to see attachment50
16 Total assets (to be completed by all filers—see the
instructions. Also, see page 1, item I) 8,667,629 9,771,112 9,682,681
Liabilities 17 Accounts payable and accrued expenses..........    
18 Grants payable...................    
19 Deferred revenue..................    
20 Loans from officers, directors, trustees, and other disqualified persons    
21 Mortgages and other notes payable (attach schedule)......    
22 Other liabilities (describe bullet)    
23 Total liabilities (add lines 17 through 22)..........   0
Net Assets or Fund Balances bullet
and complete lines 24 through 26 and lines 30 and 31.
24 Unrestricted....................    
25 Temporarily restricted................    
26 Permanently restricted................    
bullet
and complete lines 27 through 31.
27 Capital stock, trust principal, or current funds.........    
28 Paid-in or capital surplus, or land, bldg., and equipment fund    
29 Retained earnings, accumulated income, endowment, or other funds 8,667,629 9,771,112
30 Total net assets or fund balances (see page 17 of the
instructions).................... 8,667,629 9,771,112
31 Total liabilities and net assets/fund balances (see page 17 of
the instructions).................. 8,667,629 9,771,112
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 8,667,629
2 Enter amount from Part I, line 27a..................... 2 1,103,483
3 Other increases not included in line 2 (itemize) bullet 3  
4 Add lines 1, 2, and 3.......................... 4 9,771,112
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 9,771,112
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 VANGUARD - CAPITAL GAIN DISTRIBUTIONS D 2005-01-01 2011-12-31
b
c
d
e
(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 26,028 0 0 26,028
b
c
d
e
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 0 0 0 26,028
b
c
d
e
2 Capital gain net income or (net capital loss) Bracket If gain, also enter in Part I, line 7
If (loss), enter -0- in Part I, line 7		 Bracket 2 26,028
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 345,410 6,410,954 0.053878
2009 502,220 5,275,999 0.095190
2008 414,486 4,778,659 0.086737
2007 261,487 3,739,798 0.069920
2006 48,099 2,404,879 0.020001
2 Total of line 1, column (d) ...................... 2 0.325726
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 0.065145
4 Enter the net value of noncharitable-use assets for 2011 from Part X, line 5..... 4 8,494,474
5 Multiply line 4 by line 3....................... 5 553,373
6 Enter 1% of net investment income (1% of Part I, line 27b)........... 6 1,601
7 Add lines 5 and 6......................... 7 554,974
8 Enter qualifying distributions from Part XII, line 4.............. 8 346,840
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 3,202
hereBulletand enter 1% of Part I, line 27b...................
c All other domestic foundations enter 2% of line 27b. Exempt foreign organizations enter 4% of Part I, line 12, col. (b)
2 Tax under section 511 (domestic section 4947(a)(1) trusts and taxable foundations only. Others enter -0-) 2 0
3 Add lines 1 and 2............................ 3 3,202
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 3,202
6 Credits/Payments:
a 2011 estimated tax payments and 2010 overpayment credited to 2011 6a 15,000
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.............. : -15000 7 15,000
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 11,798
11 Enter the amount of line 10 to be: Credited to 2012 estimated taxBullet11,798 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)bulletTX
    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 ofbulletKATHRYN J ROBERTS Telephone no.bullet (817) 390-2202
    Located atbullet2624 WEST FREEWAYFORT WORTHTX ZIP+4bullet76102
    15
    Section 4947(a)(1) nonexempt charitable trusts filing Form 990-PF in lieu of Form 1041.........bullet
    and enter the amount of tax-exempt interest received or accrued during the year ......bullet
    15  
    16
    At any time during calendar year 2011, did the foundation have an interest in or a signature or other authority over
    a bank, securities, or other financial account in a foreign country? .................
    16
     
    No
    See page 20 of the instructions for exceptions and filing requirements for Form TD F 90-22.1. If "Yes", enter the name of the foreign country bullet  
    Form 990-PF (2011)
    Form 990-PF (2011)
    Page 5
    Part VII-B
    Statements Regarding Activities for Which Form 4720 May Be Required
    File Form 4720 if any item is checked in the “Yes” column, unless an exception applies.
    Yes
    No
    1a
    During the year did the foundation (either directly or indirectly):
    (1) Engage in the sale or exchange, or leasing of property with a disqualified person?
    (2) Borrow money from, lend money to, or otherwise extend credit to (or accept it from)
    a disqualified person?.........................
    (3) Furnish goods, services, or facilities to (or accept them from) a disqualified person?
    (4) Pay compensation to, or pay or reimburse the expenses of, a disqualified person?
    (5) Transfer any income or assets to a disqualified person (or make any of either available
    for the benefit or use of a disqualified person)?.................
    (6) Agree to pay money or property to a government official? (Exception. Check “No”
    if the foundation agreed to make a grant to or to employ the official for a period
    after termination of government service, if terminating within 90 days.).........
    b
    If any answer is “Yes” to 1a(1)–(6), did any of the acts fail to qualify under the exceptions described in Regulations
    section 53.4941(d)-3 or in a current notice regarding disaster assistance (see page 20 of the instructions)?...
    1b
     
     
    .........bullet
    c
    Did the foundation engage in a prior year in any of the acts described in 1a, other than excepted acts,
    that were not corrected before the first day of the tax year beginning in 2011?.............
    1c
     
    No
    2
    Taxes on failure to distribute income (section 4942) (does not apply for years the foundation was a private
    operating foundation defined in section 4942(j)(3) or 4942(j)(5)):
    a
    At the end of tax year 2011, did the foundation have any undistributed income (lines 6d
    and 6e, Part XIII) for tax year(s) beginning before 2011?...............
    If “Yes,” list the years bullet20, 20, 20, 20
    b
    Are there any years listed in 2a for which the foundation is not applying the provisions of section 4942(a)(2)
    (relating to incorrect valuation of assets) to the year’s undistributed income? (If applying section 4942(a)(2)
    to all years listed, answer “No” and attach statement—see page 20 of the instructions.) .........
    2b
     
     
    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
    JAMES S DUBOSE DIRECTOR
    1.00     		0 0 0
    2624 WEST FREEWAY
    FORT WORTH,TX76102
    JAMES E DUBOSE DIRECTOR
    1.00     		0 0 0
    2624 WEST FREEWAY
    FORT WORTH,TX76102
    CHRISTOPHER J KEYLAND DIRECTOR
    1.00     		0 0 0
    2624 WEST FREEWAY
    FORT WORTH,TX76102
    KATHRYN J ROBERTS PRESIDENT
    20.00     		48,000 0 0
    2624 WEST FREEWAY
    FORT WORTH,TX76102
    2 Compensation of five highest-paid employees (other than those included on line 1—see page 23 of the instructions).
    If none, enter “NONE.”
    (a) Name and address of each employee paid more than $50,000 (b) Title, and average
    hours per week
    devoted to position     		(c) Compensation (d) Contributions to
    employee benefit
    plans and deferred
    compensation     		(e) Expense account,
    other allowances
    NONE
    Total number of other employees paid over $50,000...................bullet 0
    3 Five highest-paid independent contractors for professional services (see page 23 of the instructions). If none, enter "NONE".
    (a) Name and address of each person paid more than $50,000 (b) Type of service (c) Compensation
    NONE
    Total number of others receiving over $50,000 for professional services.............bullet0
    Part IX-A
    Summary of Direct Charitable Activities
    List the foundation’s four largest direct charitable activities during the tax year. Include relevant statistical information such as the number of organizations and other beneficiaries served, conferences convened, research papers produced, etc. Expenses
    1
     
    2  
    3  
    4  
    Form 990-PF (2011)
    Form 990-PF (2011)
    Page 7
    Part IX-B
    Summary of Program-Related Investments (see page 23 of the instructions)
    Describe the two largest program-related investments made by the foundation during the tax year on lines 1 and 2. Amount
    1  
    2  
    All other program-related investments. See page 24 of the instructions.
    3  
    Total. Add lines 1 through 3..........................bullet  
    Part X
    Minimum Investment Return (All domestic foundations must complete this part. Foreign foundations,
    see page 24 of the instructions.)
    1
    Fair market value of assets not used (or held for use) directly in carrying out charitable, etc.,
    purposes:
    a
    Average monthly fair market value of securities...................
    1a
    6,542,626
    b
    Average of monthly cash balances.......................
    1b
    2,081,205
    c
    Fair market value of all other assets (see page 24 of the instructions)............
    1c
    0
    d
    Total (add lines 1a, b, and c).........................
    1d
    8,623,831
    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
    8,623,831
    4
    Cash deemed held for charitable activities. Enter 1 1⁄2% of line 3 (for greater amount, see page 25
    of the instructions) ...........................
    4
    129,357
    5
    Net value of noncharitable-use assets. Subtract line 4 from line 3. Enter here and on Part V, line 4
    5
    8,494,474
    6
    Minimum investment return. Enter 5% of line 5..................
    6
    424,724
    Part XI
    Distributable Amount bullet and do not complete this part.)
    1
    Minimum investment return from Part X, line 6....................
    1
    424,724
    2a
    Tax on investment income for 2011 from Part VI, line 5......
    2a
    3,202
    b
    Income tax for 2011. (This does not include the tax from Part VI.)...
    2b
     
    c
    Add lines 2a and 2b............................
    2c
    3,202
    3
    Distributable amount before adjustments. Subtract line 2c from line 1............
    3
    421,522
    4
    Recoveries of amounts treated as qualifying distributions................
    4
     
    5
    Add lines 3 and 4............................
    5
    421,522
    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
    421,522
    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
    346,840
    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
    346,840
    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
     
    6
    Adjusted qualifying distributions. Subtract line 5 from line 4..............
    6
    346,840
    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 7 421,522
    2 Undistributed income, if any, as of the end of 2011:
    a Enter amount for 2010 only.......  
    b Total for prior years:20, 20, 20  
    3 Excess distributions carryover, if any, to 2011:
    a From 2006.......  
    b From 2007....... 37,753
    c From 2008....... 179,667
    d From 2009....... 239,675
    e From 2010....... 35,215
    fTotal of lines 3a through e......... 492,310
    4Qualifying distributions for 2011 from Part
    XII, line 4: bullet$ 346,840
    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..... 346,840
    e Remaining amount distributed out of corpus  
    5 Excess distributions carryover applied to 2011. 74,682 74,682
    (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 5 417,628
    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) .............     		 
    9Excess distributions carryover to 2012.
    Subtract lines 7 and 8 from line 6a ......     		417,628
    10 Analysis of line 9:
    a Excess from 2007....  
    b Excess from 2008.... 142,738
    c Excess from 2009.... 239,675
    d Excess from 2010.... 35,215
    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).)
    NA
    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.
    NA
    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:
    KATHRYN J ROBERTS
    2624 WEST FREEWAY
    FORT WORTH,TX76102
    (817) 390-2202
    bThe form in which applications should be submitted and information and materials they should include:
    WRITTEN REQUEST IN LETTER FORM, PURPOSE OR PROPOSED USE OF GRANT OR DONATION.
    cAny submission deadlines:
    NONE
    dAny restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other
    factors:
    NONE
    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
    ALZHEIMER'S ASSOCIATION
    4329 EXECUTIVE CENTER DR 100
    AUSTIN,TX78731     		  PUBLIC SUPPORT CHARITABLE ACTIVITY 3,000
    ASPEN COMMUNITY CHURCH
    N ASPEN E BLEEKER STREETS
    ASPEN,CO81611     		  PUBLIC SUPPORT CHARITABLE ACTIVITY 25,000
    AMERICAN HEART ASSOCIATION
    2630 WEST FREEWAY
    FORT WORTH,TX76102     		  PUBLIC SUPPORT CHARITABLE ACTIVITY 10,000
    AMERICAN RED CROSS
    1515 S SYLVANIA AVENUE
    FORT WORTH,TX76111     		  PUBLIC SUPPORT CHARITABLE ACTIVITY 5,000
    ARTHRITIS FOUNDATION
    6080 S HULEN ST
    FORT WORTH,TX76132     		  PUBLIC SUPPORT CHARITABLE ACTIVITY 500
    ARTS COUNCIL OF FORT WORTH AND TARRANT COUNTY
    1300 GENDY ST
    FORT WORTH,TX76107     		  PUBLIC SUPPORT CHARITABLE ACTIVITY 3,000
    BOY SCOUTS OF AMERICA
    PO BOX 54190
    HURST,TX76054     		  PUBLIC SUPPORT CHARITABLE ACTIVITY 2,010
    ALEDO HIGH SCHOOL
    1000 BAILEY RANCH ROAD
    ALEDO,TX76008     		  PUBLIC SUPPORT CHARITABLE ACTIVITY 1,300
    CAMP FIRE USA
    2700 MEACHAM BLVD
    FORT WORTH,TX76137     		  PUBLIC SUPPORT CHARITABLE ACTIVITY 500
    BEN HOGAN FOUNDATION
    PO BOX 121518
    FORT WORTH,TX76121     		  PUBLIC SUPPORT CHARITABLE ACTIVITY 100
    AMERICAN CANCER SOCIETY
    8900 CARPENTER FREEWAY
    DALLAS,TX75247     		  PUBLIC SUPPORT CHARITABLE ACTIVITY 500
    CAMPAIGN FOR TOBACCO FREE KIDS
    1400 EYE STREET NW 1200
    WASHINGTON,DC20005     		  PUBLIC SUPPORT CHARITABLE ACTIVITY 2,500
    AMERICAN LUNG FOUNDAITON
    1301 PENNSYLVANIA AVENUE NW 800
    WASHINGTON,DC20004     		  PUBLIC SUPPORT CHARITABLE ACTIVITY 5,000
    COMMUNITY ENRICHMENT CENTER
    6250 NE LOOP 820
    NORTH RICHLAND HILLS,TX76180     		  PUBLIC SUPPORT CHARITABLE ACTIVITY 1,500
    ASPEN MUSIC FESTIVAL & SCHOOL
    2 MUSIC SCHOOL ROAD
    ASPEN,CO81611     		  PUBLIC SUPPORT CHARITABLE ACTIVITY 1,000
    COMMUNITY PARTNERS OF TARRANT COUNTY
    2700 BEN AVENUE
    FORT WORTH,TX76103     		  PUBLIC SUPPORT CHARITABLE ACTIVITY 1,000
    BREAKTHROUGH AT COUNTRY DAY SCHOOL
    4200 COUNTRY DAY LANE
    FORT WORTH,TX76109     		  PUBLIC SCHOLARSHIP 1,000
    COUNTRY DAY SCHOOL
    4200 COUNTRY DAY LANE
    FORT WORTH,TX76109     		  PUBLIC SCHOLARSHIP 10,000
    CHRISTMAS IN THE STOCKYARDS
    PO BOX 64203
    FORT WORTH,TX76102     		  PUBLIC SUPPORT CHARITABLE ACTIVITY 1,000
    FIRST UNITED METHODIST CHURCH
    800 WEST FIFTH STREET
    FORT WORTH,TX76102     		  PUBLIC SUPPORT CHARITABLE ACTIVITY 60,000
    FEEDING AMERICA
    PO BOX 96749
    WASHINGTON,DC20090     		  PUBLIC SUPPORT CHARITABLE ACTIVITY 3,000
    FWISD
    1000 N UNIVERSITY DR 260
    FORT WORTH,TX76107     		  PUBLIC SUPPORT CHARITABLE ACTIVITY 1,000
    FORT WORTH MUSEUM OF SCIENCEHISTORY
    1501 MONTGOMERY
    FORT WORTH,TX76107     		  PUBLIC SUPPORT CHARITABLE ACTIVITY 5,820
    FORT WORTH OPERA
    1300 GENDY STREET
    FORT WORTH,TX76107     		  PUBLIC SUPPORT CHARITABLE ACTIVITY 2,000
    AUSTIN CHILDRENS SHELTER
    4800 MANOR ROAD
    AUSTIN,TX78723     		  PUBLIC SUPPORT CHARITABLE ACTIVITY 3,000
    FORT WORTH SYMPHONY AND ORCHESTRA
    PO BOX 2587
    FORT WORTH,TX76113     		  PUBLIC SUPPORT CHARITABLE ACTIVITY 4,250
    CANCER RESEARCH INSTITUTE
    55 BROADWAY 1802
    NEW YORK,NY10006     		  PUBLIC SUPPORT CHARITABLE ACTIVITY 5,000
    CANINES FOR DISABLED KIDS
    299 REDEMPTION ROCK TRAIL SOUTH
    PRINCETON,MA01541     		  PUBLIC SUPPORT CHARITABLE ACTIVITY 2,500
    CHILD STUDY CENTER
    1300 WEST LANCASTER
    FORT WORTH,TX76102     		  PUBLIC SUPPORT CHARITABLE ACTIVITY 2,000
    CHRISTIAN WOMEN'S JOB CORPS OF GRANBURY
    1310 WEATHERFORD HIGHWAY BUILDING C
    GRANBURY,TX76048     		  PUBLIC SUPPORT CHARITABLE ACTIVITY 1,000
    HISTORIC SOUTHSIDE
    1000 THROCKMORTON
    FORT WORTH,TX76102     		  PUBLIC SUPPORT CHARITABLE ACTIVITY 500
    HUGWORKS
    752 MARY DRIVE
    HURST,TX76053     		  PUBLIC SUPPORT CHARITABLE ACTIVITY 2,000
    CLARK EDUCATIONAL SERVICES
    2300 WEST MAGNOLIA
    FORT WORTH,TX76110     		  PUBLIC SUPPORT CHARITABLE ACTIVITY 1,000
    COMMUNITY HOSPICE OF TEXAS
    6100 WESTERN PLACE
    FORT WORTH,TX76107     		  PUBLIC SUPPORT CHARITABLE ACTIVITY 100
    MANOS DE CRISTO
    4911 HARMON AVENUE
    AUSTIN,TX78751     		  PUBLIC SUPPORT CHARITABLE ACTIVITY 1,000
    CUISINE FOR HEALING
    4150 INTERNATIONAL PLAZA STE 600
    FORT WORTH,TX76109     		  PUBLIC SUPPORT CHARITABLE ACTIVITY 1,000
    FORT WORTH ZOO
    1989 COLONIAL PARKWAY
    FORT WORTH,TX76110     		  PUBLIC SUPPORT CHARITABLE ACTIVITY 5,000
    EASTER SEALS OF NORTH TEXAS
    1424 HEMPHILL STREET
    FORT WORTH,TX76104     		  PUBLIC SUPPORT CHARITABLE ACTIVITY 10,500
    PLANNED PARENTHOOD
    7424 GREENVILLE AVE STE 206
    DALLAS,TX75231     		  PUBLIC SUPPORT CHARITABLE ACTIVITY 20,437
    GREATER FW AREA CIVIC LEADERS ASSOCIATION
    PO BOX 34029
    FORT WORTH,TX76162     		  PUBLIC SUPPORT CHARITABLE ACTIVITY 2,500
    EDNA ADAN UNIVERSITY HOSPITAL
    PO BOX 49146
    BLAINE,MN55449     		  PUBLIC SUPPORT CHARITABLE ACTIVITY 100
    FIRST TEE OF FORT WORTH
    PO BOX 4767
    FORT WORTH,TX76164     		  PUBLIC SUPPORT CHARITABLE ACTIVITY 1,179
    SALVATION ARMY
    PO BOX 36006
    DALLAS,TX75235     		  PUBLIC SUPPORT CHARITABLE ACTIVITY 1,000
    HOPE FARMS
    865 ATLANTA ST
    FORT WORTH,TX76104     		  PUBLIC SUPPORT CHARITABLE ACTIVITY 1,000
    LENA POPE HOME
    3131 SANQUINET STREET
    FORT WORTH,TX76107     		  PUBLIC SUPPORT CHARITABLE ACTIVITY 750
    FORTRESS YDC
    PO BOX 422
    FORT WORTH,TX76101     		  PUBLIC SUPPORT CHARITABLE ACTIVITY 1,000
    HOSPICE AUSTIN
    4107 SPICEWOOD SPRINGS RD 100
    AUSTIN,TX78759     		  PUBLIC SUPPORT CHARITABLE ACTIVITY 2,000
    TARRANT AREA FOOD BANK
    2600 CULLEN ST
    FORT WORTH,TX76107     		  PUBLIC SUPPORT CHARITABLE ACTIVITY 2,000
    TARRANT COUNTY ACCESS
    PO BOX 1461
    FORT WORTH,TX76101     		  PUBLIC SUPPORT CHARITABLE ACTIVITY 1,500
    TEXAS ASSOCIATION FOR BLIND
    PO BOX 14200
    ARLINGTON,TX76094     		  PUBLIC SUPPORT CHARITABLE ACTIVITY 500
    INDEPENDANCE PASS FOUNDATION
    PO BOX 1700
    ASPEN,CO81612     		  PUBLIC SUPPORT CHARITABLE ACTIVITY 250
    MENTAL HEALTH ASSOCIATION
    3136 W 4TH
    FORT WORTH,TX76107     		  PUBLIC SUPPORT CHARITABLE ACTIVITY 3,428
    FORT WORTH OFFICERS AWARD FOUNDATION
    PO BOX 17659
    FORT WORTH,TX73102     		  PUBLIC SUPPORT CHARITABLE ACTIVITY 1,000
    UNITED WAY
    210 E NINTH
    FORT WORTH,TX76102     		  PUBLIC SUPPORT CHARITABLE ACTIVITY 26,357
    UNIVERSITY OF TEXAS
    PO BOX 7727
    AUSTIN,TX78713     		  PUBLIC SUPPORT CHARITABLE ACTIVITY 2,000
    GOOD SAMARITAN HOME CARE
    121 CORTEZ ROAD
    HOT SPRINGS VILLAGE,AR71909     		  PUBLIC SUPPORT CHARITABLE ACTIVITY 2,500
    KERAKXT
    3000 HARRY HINES BLVD
    DALLAS,TX75201     		  PUBLIC SUPPORT CHARITABLE ACTIVITY 3,500
    KIMBELL ART MUSEUM
    3333 CAMP BOWIE BLVD
    FORT WORTH,TX76107     		  PUBLIC SUPPORT CHARITABLE ACTIVITY 775
    WARM PLACE
    809 LIPSCOMB
    FORT WORTH,TX76104     		  PUBLIC SUPPORT CHARITABLE ACTIVITY 2,500
    WESTAR INSTITUTE
    PO BOX 7628
    SANTA ROSA,CA95407     		  PUBLIC SUPPORT CHARITABLE ACTIVITY 5,000
    LONE STAR FILM SOCIETY
    2501 N FOREST PARK BLVD
    FORT WORTH,TX76110     		  PUBLIC SUPPORT CHARITABLE ACTIVITY 4,500
    MARINE TOYS FOR TOTS FOUNDATION
    PO BOX 4002896
    DES MOINES,IA50340     		  PUBLIC SUPPORT CHARITABLE ACTIVITY 500
    MUSCULAR DYSTOPHY ASSOCIATION
    101 SUMMIT AVENUE 204
    FORT WORTH,TX76102     		  PUBLIC SUPPORT CHARITABLE ACTIVITY 1,000
    MODERN ART MUSEUM
    3200 DARNELL
    FORT WORTH,TX76107     		  PUBLIC SUPPORT CHARITABLE ACTIVITY 834
    NATIONAL BRAIN TUMOR SOCIETY
    124 WATERTOWN STREET SUITE 2D
    WATERTOWN,MA02472     		  PUBLIC SUPPORT CHARITABLE ACTIVITY 250
    NATIONAL CASA
    100 W HARRISON
    SEATTLE,WA98119     		  PUBLIC SUPPORT CHARITABLE ACTIVITY 2,500
    PARKINSONS DISEASE FOUNDATION
    1359 BROADWAY 1509
    NEW YORK,NY10018     		  PUBLIC SUPPORT CHARITABLE ACTIVITY 5,500
    CENTER FOR MISSING AND EXPLOITED CHILDREN
    699 PRINCE ST
    ALEXANDRIA,VA22314     		  PUBLIC SUPPORT CHARITABLE ACTIVITY 2,500
    PITZER COLLEGE
    1050 NORTH MILLS AVE
    CLAREMONT,CA91711     		  PUBLIC SUPPORT CHARITABLE ACTIVITY 9,000
    READING IS FUNDAMENTAL
    1255 23RD STREET NW 300
    WASHINGTON,DC20037     		  PUBLIC SUPPORT CHARITABLE ACTIVITY 2,000
    TEXAS BALLET THEATER
    16005 GREEN OAKS RD
    FORT WORTH,TX76116     		  PUBLIC SUPPORT CHARITABLE ACTIVITY 3,500
    PRESBYTERIAN NIGHT SHELTER
    PO BOX 2645
    FORT WORTH,TX76113     		  PUBLIC SUPPORT CHARITABLE ACTIVITY 1,000
    TEXAS WESLEYAN UNIVERSITY
    1201 WESLEYAN
    FORT WORTH,TX76105     		  PUBLIC SCHOLARSHIP 6,000
    SERVICE MEMBERS RELIEF FUND
    1510 CHEENAULT
    FORT WORTH,TX76127     		  PUBLIC SUPPORT CHARITABLE ACTIVITY 1,000
    USO
    PO BOX 96860
    WASHINGTON,DC20077     		  PUBLIC SUPPORT CHARITABLE ACTIVITY 2,000
    VANDERBILT UNIVERSITY
    2301 VANDERBILT PLACE
    NASHVILLE,TN37203     		  PUBLIC SCHOLARSHIP 6,000
    SMITHSONIAN INSTITUTE
    PO BOX 96263
    WASHINGTON,DC20090     		  PUBLIC SUPPORT CHARITABLE ACTIVITY 100
    SOUTHWEST TRANSPLANT LIFE
    5489 BLAIR RD
    DALLAS,TX75231     		  PUBLIC SUPPORT CHARITABLE ACTIVITY 2,500
    STRIPLING MIDDLE SCHOOL
    2100 CLOVER LANE
    FORT WORTH,TX76107     		  PUBLIC SUPPORT CHARITABLE ACTIVITY 10,000
    TOWN LAKE TRAIL FOUNDATION
    PO BOX 5195
    AUSTIN,TX78763     		  PUBLIC SUPPORT CHARITABLE ACTIVITY 5,000
    ST JUDES CHILDREN'S RESEARCH HOSPITAL
    PO BOX 167
    MEMPHIS,TN38101     		  PUBLIC SUPPORT CHARITABLE ACTIVITY 2,500
    TCC FOUNDATION
    1500 HOUSTON ST
    FORT WORTH,TX76102     		  PUBLIC SUPPORT CHARITABLE ACTIVITY 100
    TEXAS HEALTH - HARRIS METHODIST FOUNDATION
    6100 WESTERN PLACE SUITE 1001
    FORT WORTH,TX76107     		  PUBLIC SUPPORT CHARITABLE ACTIVITY 10,000
    UNITED COMMUNITY CENTERS
    1200 E MADDOX AVENUE
    FORT WORTH,TX76104     		  PUBLIC SUPPORT CHARITABLE ACTIVITY 100
    UT LAB SCHOOL
    1 UNIVERSITY STATION
    AUSTIN,TX78712     		  PUBLIC SUPPORT CHARITABLE ACTIVITY 2,500
    VFW POST 1798
    300 SE 2ND
    TULIA,TX79088     		  PUBLIC SUPPORT CHARITABLE ACTIVITY 100
    Total .................................bullet 3a 346,840
    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 2,113  
    4 Dividends and interest from securities....     14 159,231  
    5 Net rental income or (loss) from real estate:
    aDebt-financed property......          
    bNot debt-financed property.....          
    6Net rental income or (loss) from personal property          
    7 Other investment income.....          
    8Gain or (loss) from sales of assets other than inventory     18 26,028  
    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)..   187,372  
    13Total. Add line 12, columns (b), (d), and (e)..................
    13187,372
    (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
    Schedule B
    (Form 990, 990-EZ,
    or 990-PF)
    Department of the Treasury
    Internal Revenue Service
    Schedule of Contributors
    Arrow Bullet Attach to Form 990, 990-EZ, or 990-PF.
    OMB No. 1545-0047
    2011
    Name of organization
    DUBOSE FAMILY FOUNDATION
     
    Employer identification number

    20-1588677
    Organization type (check one):
    Filers of:
    Section:
    Form 990 or 990-EZ





    Form 990-PF




    Check if your organization is covered by the General Rule or a Special Rule.  
    Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.
    General Rule
    Special Rules
    ......................... Arrow Bullet   $    
    Caution. An Organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990,
    990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its
    Form 990-EZ or on Part I, line 2, of its Form 990-PF, to certify that it does not meet the filing requirements of Schedule B (Form 990,
    990-EZ, or 990-PF).
    For Paperwork Reduction Act Notice, see the Instructions
    for Form 990, 990-EZ, or 990-PF.
    Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2011)

    Page 2
    Schedule B (Form 990, 990-EZ, or 990-PF) (2011)
    Name of organization
    DUBOSE FAMILY FOUNDATION
          		Employer identification number

    20-1588677
    Part I
    Contributors (see Instructions). Use duplicate copies of Part I if additional space is needed.
    		     
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Total contributions    		 (d)
    Type of contribution
    1
     
     

    JS JL DUBOSE 2005 CHARITABLE LEAD A    
    PO BOX 2990
       
    FORT WORTH, TX   76113

    		$1,323,558




    (Complete Part II if there is a noncash contribution.)
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Total contributions    		 (d)
    Type of contribution
     
     
     

         
     
       

    		$  




    (Complete Part II if there is a noncash contribution.)
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Total contributions    		 (d)
    Type of contribution
     
     
     

         
     
       

    		$  




    (Complete Part II if there is a noncash contribution.)
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Total contributions    		 (d)
    Type of contribution
     
     
     

         
     
       

    		$  




    (Complete Part II if there is a noncash contribution.)
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Total contributions    		 (d)
    Type of contribution
     
     
     

         
     
       

    		$  




    (Complete Part II if there is a noncash contribution.)
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Total contributions    		 (d)
    Type of contribution
     
     
     

         
     
       

    		$  




    (Complete Part II if there is a noncash contribution.)
    Schedule B (Form 990, 990-EZ, or 990-PF) (2011)

    Page 3
    Schedule B (Form 990, 990-EZ, or 990-PF) (2011)
    Name of organization
    DUBOSE FAMILY FOUNDATION
          		Employer identification number

    20-1588677
    Part II
    Noncash Property (see Instructions). Use duplicate copies of Part II if additional space is needed.
    		     
    (a) No.
    from
    Part I    		 (b)
    Description of noncash property given    		 (c)
    FMV (or estimate)
    (see instructions).     		(d)
    Date received
     
    		$    
    (a) No.
    from
    Part I    		 (b)
    Description of noncash property given    		 (c)
    FMV (or estimate)
    (see instructions).     		(d)
    Date received
     
    		$    
    (a) No.
    from
    Part I    		 (b)
    Description of noncash property given    		 (c)
    FMV (or estimate)
    (see instructions).     		(d)
    Date received
     
    		$    
    (a) No.
    from
    Part I    		 (b)
    Description of noncash property given    		 (c)
    FMV (or estimate)
    (see instructions).     		(d)
    Date received
     
    		$    
    (a) No.
    from
    Part I    		 (b)
    Description of noncash property given    		 (c)
    FMV (or estimate)
    (see instructions).     		(d)
    Date received
     
    		$    
    (a) No.
    from
    Part I    		 (b)
    Description of noncash property given    		 (c)
    FMV (or estimate)
    (see instructions).     		(d)
    Date received
     
    		$    
    Schedule B (Form 990, 990-EZ, or 990-PF) (2011)

    Page 4
    Schedule B (Form 990, 990-EZ, or 990-PF) (2011)
    Name of organization
    DUBOSE FAMILY FOUNDATION
          		Employer identification number

    20-1588677
    Part III
    Exclusively religious, charitable, etc., individual contributions to section 501(c)(7), (8), or (10) organizations
    that total more than $1,000 for the year. Complete columns (a) through (e) and the following line entry.
    For organizations completing Part III, enter the total of exclusively religious, charitable, etc.,
    contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet $  
    Use duplicate copies of Part III if additional space is needed
    (a) No.
    from
    Part I    		 (b)
    Purpose of gift    		 (c)
    Use of gift    		 (d)
    Description of how gift is held
     
    (e)
    Transfer of gift
    Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
     
     
           
     
    (a) No.
    from
    Part I    		 (b)
    Purpose of gift    		 (c)
    Use of gift    		 (d)
    Description of how gift is held
     
    (e)
    Transfer of gift
    Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
     
     
           
     
    (a) No.
    from
    Part I    		 (b)
    Purpose of gift    		 (c)
    Use of gift    		 (d)
    Description of how gift is held
     
    (e)
    Transfer of gift
    Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
     
     
           
     
    (a) No.
    from
    Part I    		 (b)
    Purpose of gift    		 (c)
    Use of gift    		 (d)
    Description of how gift is held
     
    (e)
    Transfer of gift
    Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
     
     
           
     
    Schedule B (Form 990, 990-EZ, or 990-PF) (2011)

    Additional Data


    Software ID:  
    Software Version:  

    TY 2011 AccountingFeesSchedule
    Name:
    DUBOSE FAMILY FOUNDATION
    EIN: 20-1588677
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    JSD/JLD MANA. TAX PREP 750 375    

    TY 2011 AllOthProgRltdInvestmentsSch
    Name:
    DUBOSE FAMILY FOUNDATION
    EIN: 20-1588677
    Category Amount
    NONE  

    TY 2011 InvestmentsCorpStockSchedule
    Name:
    DUBOSE FAMILY FOUNDATION
    EIN: 20-1588677
    Name of Stock End of Year Book Value End of Year Fair Market Value
    VANGUARD HIGH YIELD FUND 374,876 360,199
    VANGUARD INTERMEDIATE TERM FUND 970,260 1,106,551
    VANGUARD MIDCAP INDEX FUND 213,928 208,340
    VANGUARD GLOBAL EQUITY FUND 678,111 511,555
    VANGUARD 500 INDEX FUND 531,217 491,924
    VANGUARD SMALL CAP INDEX FUND 213,729 214,652
    VANGUARD WINDSOR FUND 130,685 95,535
    VANGUARD INTERMEDIATE TERM TREASURY FUND ADMIRAL 266,821 284,586
    VANGUARD WINDSOR II FUND 119,217 86,047
    VANGUARD GNMA FUND 1,046,482 1,077,528
    VANGUARD HIGH DIVIDEND YIELD 306,060 326,036

    TY 2011 LegalFeesSchedule
    Name:
    DUBOSE FAMILY FOUNDATION
    EIN: 20-1588677
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    BWW LEGAL 463 231    


    TY 2011 OtherAssetsSchedule
    Name:
    DUBOSE FAMILY FOUNDATION
    EIN: 20-1588677
    Description Beginning of Year - Book Value End of Year - Book Value End of Year - Fair Market Value
    ACCRUED INCOME 50 50 50
    ACCRUED INCOME 50 50 50
    ACCRUED INCOME 50 50 50


    TY 2011 OtherAssetsSchedule
    Name:
    DUBOSE FAMILY FOUNDATION
    EIN: 20-1588677
    Description Beginning of Year - Book Value End of Year - Book Value End of Year - Fair Market Value
    ACCRUED INCOME 50 50 50
    ACCRUED INCOME 50 50 50
    ACCRUED INCOME 50 50 50


    TY 2011 OtherAssetsSchedule
    Name:
    DUBOSE FAMILY FOUNDATION
    EIN: 20-1588677
    Description Beginning of Year - Book Value End of Year - Book Value End of Year - Fair Market Value
    ACCRUED INCOME 50 50 50
    ACCRUED INCOME 50 50 50
    ACCRUED INCOME 50 50 50


    TY 2011 TaxesSchedule
    Name:
    DUBOSE FAMILY FOUNDATION
    EIN: 20-1588677
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    FOREIGN TAXES 585 585    
    EXCISE TAXES 6,630      
    PAYROLL TAXES 4,179 2,089