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
CARLSON FAMILY FOUNDATION INC
C/O MARY N OWEN
% JOHN A NORTON
Number and street (or P.O. box number if mail is not delivered to street address)206 BROOKGREEN DR   Room/suite
City or town, state, and ZIP code
CHAPEL HILL, NC27516
A Employer identification number

31-1678303
B Telephone number (see page 10 of the instructions)

(919) 604-0842
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$18,288,919J 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...... 268,337 268,337  
5a Gross rents.............. 399,822 399,822  
b Net rental income or (loss) 374,791
6a Net gain or (loss) from sale of assets not on line 10 -76,413
b Gross sales price for all assets on line 6a 1,458,925
7 Capital gain net income (from Part IV, line 2)... 0
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........ 591,746 668,159  
Operating and Administrative Expenses 13 Compensation of officers, directors, trustees, etc. 136,500     136,500
14 Other employee salaries and wages......        
15 Pension plans, employee benefits.......        
16a Legal fees (attach schedule).........        
b Accounting fees (attach schedule)....... Click to see attachment 6,500 3,250 0 3,250
c Other professional fees (attach schedule).... Click to see attachment 71,400 71,400    
17 Interest...............        
18 Taxes (attach schedule) (see page 14 of the instructions) Click to see attachment 13,269 1,939    
19 Depreciation (attach schedule) and depletion...      
20 Occupancy..............        
21 Travel, conferences, and meetings....... 16,846     16,846
22 Printing and publications..........        
23 Other expenses (attach schedule)....... Click to see attachment 25,323 25,031   292
24 Total operating and administrative expenses.
Add lines 13 through 23.......... 269,838 101,620 0 156,888
25 Contributions, gifts, grants paid........ 727,500 727,500
26 Total expenses and disbursements. Add lines 24 and 25 997,338 101,620 0 884,388
27 Subtract line 26 from line 12:
a Excess of revenue over expenses and disbursements -405,592
b Net investment income (if negative, enter -0-) 566,539
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.......... 4,080,704 2,078,256 2,078,256
3 Accounts receivable bullet  
Less: allowance for doubtful accounts bullet   16    
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)........ 6,759,457 Click to see attachment8,279,519 10,172,950
c Investments—corporate bonds (attach schedule)........ 176,045 Click to see attachment251,045 287,713
11 Investments—land, buildings, and equipment: basis bullet5,750,000
Less: accumulated depreciation (attach schedule) bullet   5,750,000 5,750,000 5,750,000
12 Investments—mortgage loans..............      
13 Investments—other (attach schedule)...........      
14 Land, buildings, and equipment: basis bullet1,789
Less: accumulated depreciation (attach schedule) bullet1,789      
15 Other assets (describe bullet)      
16 Total assets (to be completed by all filers—see the
instructions. Also, see page 1, item I) 16,766,222 16,358,820 18,288,919
Liabilities 17 Accounts payable and accrued expenses.......... 5,740 3,930
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).......... 5,740 3,930
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......... 16,760,482 16,354,890
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).................... 16,760,482 16,354,890
31 Total liabilities and net assets/fund balances (see page 17 of
the instructions).................. 16,766,222 16,358,820
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 16,760,482
2 Enter amount from Part I, line 27a..................... 2 -405,592
3 Other increases not included in line 2 (itemize) bullet 3  
4 Add lines 1, 2, and 3.......................... 4 16,354,890
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 16,354,890
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 PUBLICLY TRADED SECURITIES      
b PUBLICLY TRADED SECURITIES      
c LITIGATION PROCEEDS      
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 67,057   84,671 -17,614
b 1,381,812   1,450,667 -68,855
c 98     98
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       -17,614
b       -68,855
c       98
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 -76,413
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 880,683 18,007,194 0.048907
2009 958,279 17,534,053 0.054652
2008 874,403 19,204,324 0.045532
2007 901,271 19,084,611 0.047225
2006 861,625 17,814,386 0.048367
2 Total of line 1, column (d) ...................... 2 0.244683
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 0.048937
4 Enter the net value of noncharitable-use assets for 2011 from Part X, line 5..... 4 18,737,528
5 Multiply line 4 by line 3....................... 5 916,958
6 Enter 1% of net investment income (1% of Part I, line 27b)........... 6 5,665
7 Add lines 5 and 6......................... 7 922,623
8 Enter qualifying distributions from Part XII, line 4.............. 8 884,388
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 11,331
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 11,331
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 11,331
6 Credits/Payments:
a 2011 estimated tax payments and 2010 overpayment credited to 2011 6a 7,400
b Exempt foreign organizations—tax withheld at source....... 6b
c Tax paid with application for extension of time to file (Form 8868) 6c 7,500
d Backup withholding erroneously withheld ........... 6d  
7 Total credits and payments. Add lines 6a through 6d.............. 7 14,900
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 3,569
11 Enter the amount of line 10 to be: Credited to 2012 estimated taxBullet3,569 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)bullet
    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 ofbulletJOHN A NORTON Telephone no.bullet (919) 604-0842
    Located atbullet1610 SKYE DRIVECHAPEL HILLNC ZIP+4bullet27516
    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
    JOHN A NORTON TREASURER
    10.0     		19,500    
    1610 SKYE DRIVE
    CHAPEL HILL,NC27516
    MICHAEL A NORTON SECRETARY
    10.0     		19,500    
    77 ALLEN ST
    ALLENDALE,NJ07401
    MARY N OWEN DIRECTOR
    10.0     		19,500    
    206 BROOKGREEN DR
    CHAPEL HILL,NC27516
    PAUL S NORTON PRESIDENT
    10.0     		19,500    
    39 DOLPHIN COVE QUAY
    STAMFORD,CT06902
    JAMES M NORTON DIRECTOR
    10.0     		19,500    
    4614 HARRISON ST
    CHEVY CHASE,MD20815
    LENORE TRILBY NORTON VICE PRESIDENT
    10.0     		19,500    
    28200 S L DEL EL ESCORIAL APT 130
    MADRID    
    SP
    ELAINE BOYLEN DIRECTOR
    10.0     		19,500    
    28873 BONIFACE DRIVE
    MALIBU,CA90265
    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
    10,840,128
    b
    Average of monthly cash balances.......................
    1b
    2,432,743
    c
    Fair market value of all other assets (see page 24 of the instructions)............
    1c
    5,750,000
    d
    Total (add lines 1a, b, and c).........................
    1d
    19,022,871
    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
    19,022,871
    4
    Cash deemed held for charitable activities. Enter 1 1⁄2% of line 3 (for greater amount, see page 25
    of the instructions) ...........................
    4
    285,343
    5
    Net value of noncharitable-use assets. Subtract line 4 from line 3. Enter here and on Part V, line 4
    5
    18,737,528
    6
    Minimum investment return. Enter 5% of line 5..................
    6
    936,876
    Part XI
    Distributable Amount bullet and do not complete this part.)
    1
    Minimum investment return from Part X, line 6....................
    1
    936,876
    2a
    Tax on investment income for 2011 from Part VI, line 5......
    2a
    11,331
    b
    Income tax for 2011. (This does not include the tax from Part VI.)...
    2b
     
    c
    Add lines 2a and 2b............................
    2c
    11,331
    3
    Distributable amount before adjustments. Subtract line 2c from line 1............
    3
    925,545
    4
    Recoveries of amounts treated as qualifying distributions................
    4
     
    5
    Add lines 3 and 4............................
    5
    925,545
    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
    925,545
    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
    884,388
    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
    884,388
    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
    884,388
    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 7 925,545
    2 Undistributed income, if any, as of the end of 2011:
    a Enter amount for 2010 only....... 615,482
    b Total for prior years:2009, 2008, 2007  
    3 Excess distributions carryover, if any, to 2011:
    a From 2006.......  
    b From 2007.......  
    c From 2008.......  
    d From 2009.......  
    e From 2010.......  
    fTotal of lines 3a through e.........  
    4Qualifying distributions for 2011 from Part
    XII, line 4: bullet$ 884,388
    a Applied to 2010, but not more than line 2a 615,482
    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..... 268,906
    e Remaining amount distributed out of corpus 0
    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 0
    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 ..........     		656,639
    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 ......     		0
    10 Analysis of line 9:
    a Excess from 2007....  
    b Excess from 2008....  
    c Excess from 2009....  
    d Excess from 2010....  
    e Excess from 2011.... 0
    Form 990-PF (2011)
    Form 990-PF (2011)
    Page 9
    Part XIV
    Private Operating Foundations (see page 27 of the instructions and Part VII-A, question 9)
    1a If the foundation has received a ruling or determination letter that it is a private operating
    foundation, and the ruling is effective for 2011, enter the date of the ruling.......bullet
     
    b Check box to indicate whether the organization is a private operating foundation described in section or
    2a Enter the lesser of the adjusted net
    income from Part I or the minimum
    investment return from Part X for each
    year listed ..........     		Tax year Prior 3 years (e) Total
    (a) 2011 (b) 2010 (c) 2009 (d) 2008
             
    b 85% of line 2a .........          
    c Qualifying distributions from Part XII,
    line 4 for each year listed .....     		         
    d Amounts included in line 2c not used directly
    for active conduct of exempt activities ....     		         
    e Qualifying distributions made directly
    for active conduct of exempt activities.
    Subtract line 2d from line 2c ....     		         
    3 Complete 3a, b, or c for the
    alternative test relied upon:
    a “Assets” alternative test—enter:
    (1) Value of all assets ......          
    (2) Value of assets qualifying
    under section 4942(j)(3)(B)(i)    		          
    b “Endowment” alternative test— enter 2⁄3
    of minimum investment return shown in
    Part X, line 6 for each year listed...     		         
    c “Support” alternative test—enter:
    (1) Total support other than gross
    investment income (interest,
    dividends, rents, payments
    on securities loans (section
    512(a)(5)), or royalties) ....     		         
    (2) Support from general public
    and 5 or more exempt
    organizations as provided in
    section 4942(j)(3)(B)(iii)....     		         
    (3) Largest amount of support
    from an exempt organization    		          
    (4) Gross investment income          
    Part XV
    Supplementary Information (Complete this part only if the organization had $5,000 or more in
    assets at any time during the year—see page 27 of the instructions.)
    1Information Regarding Foundation Managers:
    aList any managers of the foundation who have contributed more than 2% of the total contributions received by the foundation
    before the close of any tax year (but only if they have contributed more than $5,000). (See section 507(d)(2).)
    NONE
    bList any managers of the foundation who own 10% or more of the stock of a corporation (or an equally large portion of the
    ownership of a partnership or other entity) of which the foundation has a 10% or greater interest.
    NONE
    2Information Regarding Contribution, Grant, Gift, Loan, Scholarship, etc., Programs:
    Check here bullet
    aThe name, address, and telephone number of the person to whom applications should be addressed:
    MARY N OWEN
    206 BROOKGREEN
    CHAPEL HILL,NC27516
    (919) 604-0842
    bThe form in which applications should be submitted and information and materials they should include:
    LETTER
    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
    ACHILLES INTERNATIONAL
    42 WEST 38TH STREET SUITE 400
    NEW YORK,NY10018     		NONE PUBLIC DISCRETIONARY 500
    AMERICAN CANCER SOCIETY
    626 NORTH SHORE RD
    ABSECON,NJ08201     		NONE PUBLIC DISCRETIONARY 500
    ANIMAL ADVOCATES ALLIANCE
    137 N LARCHMONT BLVD SUITE 708
    LOS ANGELES,CA90004     		NONE PUBLIC DISCRETIONARY 500
    ASOCIACION CYD SANTA MARIA
    SANTA LUCIA 1-10-3
    MALAGA   29004
    SP     		NONE PUBLIC DISCRETIONARY 4,500
    BEACON PROGRAM
    141 MACNIDER HALL
    CAMPUS BOX 7550
    CHAPEL HILL,NC27599     		NONE PUBLIC DISCRETIONARY 100
    BERGEN COUNTY SOCIETY
    666 GODWIND AVE SUITE 210
    MIDLAND PARK,NJ07432     		NONE PUBLIC DISCRETIONARY 1,500
    BLUE GRASS COMMUNITY FOUNDATION
    250 WEST MAIN ST SUITE 1220
    LEXINGTON,KY405071714     		NONE PUBLIC DISCRETIONARY 2,000
    BOYS AND GIRLS CLUBS OF AMERICA
    1275 PEACHTREE ST
    ATLANTA,GA303093506     		NONE PUBLIC DISCRETIONARY 600
    BROTHER'S BROTHER FOUNDATION
    1200 GALVESTON AVENUE
    PITTSBURGH,PA15233     		NONE PUBLIC DISCRETIONARY 2,000
    CATHOLIC CHARITIES DEVELOPMENT OFFICE
    715 NAZARETH STREET
    RALEIGH,NC27606     		NONE PUBLIC DISCRETIONARY 1,000
    CHAPEL HILL CARRBORO YMCA
    980 MARTIN LUTHER KING JR BLVD
    CHAPEL HILL,NC27514     		NONE PUBLIC DISCRETIONARY 650
    CHRISTIAN SOCIAL SERVICE CENTER INC
    P O BOX 1111
    OWINGVILLE,KY40360     		NONE PUBLIC DISCRETIONARY 2,300
    CRESTED BUTTE LAND TRUST
    P O BOX 2224
    CRESTED BUTTE,CO81224     		NONE PUBLIC DISCRETIONARY 1,000
    DURHAM RESCUE MISSION
    P O BOX 11868
    DURHAM,NC27703     		NONE PUBLIC DISCRETIONARY 1,000
    FOOD BANK OF CENTRAL & EAST NC
    3808 TARHEEL DR
    RALEIGH,NC27609     		NONE PUBLIC DISCRETIONARY 900
    FUNDACION JUAN BONAL
    DOCTOR FLEMING 15 BAJOS
    ZARAGOZA,50004SPAIN
    SP     		NONE PUBLIC DISCRETIONARY 7,000
    HABITAT FOR HUMANITY BERGEN COUNTY
    10 BANTA PL
    HACKENSACK,NJ07601     		NONE NONE DISCRETIONARY 3,000
    HARRIS TEMPLE MISSIONARY BAPTIST CHURCH
    11611 HWY 365 S
    LITTLE ROCK,AR72206     		NONE NONE DISCRETIONARY 500
    JERICHO ROAD HOMELESS SHELTER
    167 NORTH 9TH STREET
    PATERSON,NJ07522     		NONE PUBLIC DISCRETIONARY 1,000
    KIN TU NIDITO CHILDREN
    3922 N MOUNTAIN AVE
    TUCSON,AZ85719     		NONE PUBLIC DISCRETIONARY 200
    LHASA HAPPY HOMES RESCUE INC
    1158 26TH ST SUITE 190
    SANTA MONICA,CA90403     		NONE PUBLIC DISCRETIONARY 500
    LIVESTRONG
    2201 E SIXTH STREET
    AUSTIN,TX78702     		NONE PUBLIC DISCRETIONARY 3,500
    LORRIMER SANCTUARY
    790 EWING AVE
    FRANKLIN LAKES,NJ07417     		NONE PUBLIC DISCRETIONARY 1,500
    LOUISVILLE MANDOLIN ORCHESTRA INC
    2643 PARK AVE
    LOUISVILLE,KY40205     		NONE PUBLIC DISCRETIONARY 1,500
    MALIBU COMMUNITY LABOR EXCHANGE
    23595 CIVIC CENTER WAY
    MALIBU,CA90265     		NONE PUBLIC DISCRETIONARY 1,000
    MUSIC MAKER RELIEF FOUNDATION
    224 WEST CORBIN ST
    HILLSBOROUGH,NC27278     		NONE PUBLIC DISCRETIONARY 2,000
    NATIONAL MS SOCIETY
    1800 M STREET NW SUITE 750 SOUTH
    WASHINGTON,DC20036     		NONE PUBLIC DISCRETIONARY 1,000
    NATIONAL PARK SERVICE
    1850 DUAL HIGHWAY SUITE 100
    HAGERSTOWN,MD21740     		NONE PUBLIC DISCRETIONARY 10,900
    NEW YORK CITY RELIEF
    295 WALNUT ST
    ELIZABETH,NJ07021     		NONE PUBLIC DISCRETIONARY 2,200
    NORTH CAROLINA NETWORK OF GRANTMAKERS
    1720 EAST FRANKLIN STREET
    CHAPEL HILL,NC27514     		NONE PUBLIC YOUTH SERVICES PROJECT 3,500
    NORTHERN HIGHLANDS HIGH SCHOOL
    298 HILLSIDE AVENUE
    ALLENDALE,NJ07401     		NONE PUBLIC DISCRETIONARY 1,000
    OPEN DOOR DENTAL CLINIC OF ALAMANCE COUNTY
    P O BOX 1744
    BURLINGTON,NC272161744     		NONE PUBLIC DISCRETIONARY 500
    OWINGSVILLE FIRST CHURCH OF GOD INC
    P O BOX 100
    OWINGSVILLE,KY40360     		NONE PUBLIC DISCRETIONARY 1,000
    PEPPERDINE UNIVERSITY
    24255 PACIFIC COAST HWY
    MALIBU,CA90263     		NONE PUBLIC DISCRETIONARY 5,000
    PLATAFORMA CIUDADANA ESCURIALENSE
    TIMOTEO PADROS 5BL E-3 D
    MADRD,SAN LORENZA DE EL ESCORIAL28200
    SP     		NONE PUBLIC DISCRETIONARY 2,000
    PROJECT GRADUATION CHAPEL
    P O BOX 17043
    CHAPEL HILL,NC27516     		NONE PUBLIC DISCRETIONARY 250
    PTA THRIFT SHOP BUILDING CAMPAIGN
    115 WEST MAIN STREET
    CARRBORO,NC27510     		NONE PUBLIC DISCRETIONARY 1,500
    REBUILDING TOGETHER BERGEN COUNTY
    P O BOX 1389
    RIDGEWOOD,NJ07450     		NONE PUBLIC DISCRETIONARY 1,200
    REBUILDING TOGETHER INC
    1899 L ST NW SUITE 1000
    WASHINGTON,DC20036     		NONE PUBLIC DISCRETIONARY 1,000
    SALVATION ARMY DURHAM CHAPTER
    P O BOX 1330
    DURHAM,NC277021330     		NONE PUBLIC DISCRETIONARY 1,000
    SCHOOL ON WHEELS INC
    P O BOX 23371
    VENTURA,CA93002     		NONE PUBLIC DISCRETIONARY 1,000
    SECU FAMILY HOUSE
    123 OLD MASON FARM ROAD
    CHAPEL HILL,NC27517     		NONE PUBLIC DISCRETIONARY 2,000
    SHARPSBURG HERITAGE FESTIVAL
    100 E MAIN ST
    SHARPSBURG,MD21782     		NONE PUBLIC DISCRETIONARY 1,000
    SHRINERS CIRCUS FUND
    11101 CREEDMOOR ROAD
    RALEIGH,NC27614     		NONE PUBLIC DISCRETIONARY 100
    SOCIETY OF ST ANDREW
    3383 SWEET HOLLOW ROAD
    BIG ISLAND,VA24526     		NONE PUBLIC DISCRETIONARY 500
    SPECIAL OLYMPICS ORANGE COUNTY
    200 PLANT RD
    CHAPEL HILL,NC27514     		NONE PUBLIC DISCRETIONARY 1,000
    STAMFORD SAILING FOUNDATION
    151 HARVARD AVE
    STAMFORD,CT06902     		NONE PUBLIC DISCRETIONARY 10,000
    SWIM ACROSS AMERICA
    ONE INTERNATIONAL PLACE
    SUITE 4600
    BOSTON,MA02110     		NONE PUBLIC DISCRETIONARY 500
    TABLE
    205 W WEAVER ST
    CARRBORO,NC27510     		NONE PUBLIC DISCRETIONARY 2,000
    THE LEUKEMIA & LYMPHOMA SOCIETY OF NC CHAPTER
    401 HARRISON OAKS BLVD SUITE 200
    CARY,NC27513     		NONE PUBLIC DISCRETIONARY 500
    THE LEUKEMIA & LYMPHOMA SOCIETY OF RI CHAPTER
    1150 PONTIAC AVE SUITE 1
    CRANSTON,RI02920     		NONE PUBLIC DISCRETIONARY 6,000
    THE ROSE FOUNDATION
    637 WYCKOFF AVE PMB 320
    WYCKOFF,NJ07481     		NONE PUBLIC DISCRETIONARY 1,000
    UNC-TV
    P O BOX 14900
    RESEARCH TRIANGLE PARK,NC277094900     		NONE PUBLIC DISCRETIONARY 4,000
    UNIVERSITY OF RHODE ISLAND
    6 RHODY RAM WAY
    KINGSTON,RI02881     		NONE PUBLIC SAILING TEAM 1,000
    WOMEN OF VISION
    P O BOX 4303
    GREENWICH,CT08831     		NONE PUBLIC DISCRETIONARY 1,000
    WUNC RADIO
    P O BOX 8880
    CHAPEL HILL,NC27515     		NONE PUBLIC DISCRETIONARY 500
    826 NATIONAL
    44 GOUGH STREET SUITE 206
    SAN FRANCISCO,CA94103     		NONE PUBLIC MAJOR 5,000
    ACHIEVEMENT ACADEMY OF DURHAM
    400 WEST MAIN ST SUITE 103
    DURHAM,NC27701     		NONE PUBLIC MAJOR 25,000
    AMERICAN RED CROSS CONNECTICUT CHAPTER
    209 FARMINGTON AVE
    FARMINGTON,CT06032     		NONE PUBLIC MAJOR 5,000
    ARTS GUILD NEW JERSEY INC
    1670 IRVING STREET
    RAHWAY,NJ07065     		NONE PUBLIC MAJOR 18,325
    ASOCIACION ANIDAN AYUDA NINOS DE AFRICA
    C/JULIAN HERNADEZ 9 2 4
    MADRID   24043
    SP     		NONE PUBLIC MAJOR 20,000
    BATH COUNTY AGRICULTURAL EXTENSION FOUNDATION INC
    2914 E HWY 60
    OWINGSVILLE,KY403608815     		NONE PUBLIC MAJOR 25,000
    BIG BROTHERS BIG SISTERS OF TRIANGLE
    909 AVIATION PKWY SUITE 1500
    MORRISVILLE,NC27560     		NONE PUBLIC MAJOR 15,000
    BLUE GRASS COMMUNITY FOUNDATION
    250 WEST MAIB STREET SUITE 1220
    LEXINGTON,KY405071714     		NONE PUBLIC MAJOR 20,000
    BOYS & GIRLS CLUB OF EASTERN PIEDMONT
    P O BOX 1788
    PITTSBORO,NC27312     		NONE PUBLIC MAJOR 10,000
    C & O CANAL TRUST INC
    1850 DUAL HIGHWAY SUITE 100
    HAGERSTOWN,MD21740     		NONE PUBLIC MAJOR 31,675
    CACAPON AND LOST RIVERS LAND TRUST
    RR1 BOX 328
    HIGH VIEW,WV26808     		NONE PUBLIC MAJOR 5,000
    CAROLINA SAILING CLUB FOUNDATION
    6004 BUNCHBERRY CT
    RALEIGH,NC27616     		NONE PUBLIC MAJOR 5,000
    CENTER FOR FOOD ACTION NJ
    192 W DEMEREST AVENUE
    ENGLEWOOD,NJ07631     		NONE PUBLIC MAJOR 15,000
    CHILDREN'S AID AND FAMILY SERVICES INC
    200 ROBIN ROAD
    PARAMUS,NJ07652     		NONE PUBLIC MAJOR 25,000
    CHRISTIAN SOCIAL SERVICE CENTER INC
    P O BOX 1111
    OWINGSVILLE,KY40360     		NONE PUBLIC MAJOR 25,000
    EQUALITY NOW INC
    250 WEST 57TH ST SUITE 1527
    NEW YORK,NY10107     		NONE PUBLIC MAJOR 15,000
    FAMILY CENTERS INC
    40 ARCH ST
    GREENWICH,CT06830     		NONE PUBLIC MAJOR 5,000
    FRED HUTCHINSON CANCER RESEARCH CENTER
    P O BOX 19024 J5-200
    SEATTLE,WA981091024     		NONE PUBLIC MAJOR 10,000
    FRIENDS OF BLACKWATER
    501 ELIZABETH ST ROOM 3
    CHARLESTON,WV25311     		NONE PUBLIC MAJOR 5,000
    FRIENDS OF ROCK CREEK'S ENVIRONMENT INC
    P O BOX 42680
    WASHINGTON,DC20015     		NONE PUBLIC MAJOR 5,000
    GATEWAY HOMELESS COALITION INC
    P O BOC 326
    MOREHEAD,KY40351     		NONE PUBLIC MAJOR 15,000
    GOD'S LOVE WE DELIVER
    166 AVENUE OF THE AMERICAS
    NEW YORK,NY10013     		NONE PUBLIC MAJOR 10,000
    GREENWICH BOYS & GIRLS' CLUB ASSOC INC
    4 HORSENECK LANE
    GREENWICH,CT06830     		NONE PUBLIC MAJOR 10,000
    INTER-FAITH COUNCIL FOR SOCIAL SERVICE
    110 WEST NAIN ST
    CARRBORO,NC27510     		NONE PUBLIC MAJOR 15,000
    JOHN AVERY BOYS AND GIRLS CLUB
    P O BOX 446
    DURHAM,NC27702     		NONE PUBLIC MAJOR 12,500
    LEUKEMIA & LYMPHOMA SOCIETY NORTHERN NJ
    14 COMMERCE DR SUITE 301
    CRANFORD,NJ07016     		NONE PUBLIC MAJOR 25,000
    LITTLE FALLS WATERSHED ALLIANCE INC
    4920 DORSET AVE
    CHEVY CHASE,MD20815     		NONE PUBLIC MAJOR 5,000
    MEDICOS SIN FRONTERAS ESPANA
    72-1 A MELENDEZ VALDES
    MADRID   28015
    SP     		NONE PUBLIC MAJOR 10,000
    NEIGHBORS LINK STAMFORD CORP
    75 SELLECK STREET
    STAMFORD,CT06902     		NONE PUBLIC MAJOR 10,000
    NEW COVENANT HOUSE
    P O BOX 10883
    STAMFORD,CT06904     		NONE PUBLIC MAJOR 5,000
    NEW JERSEY CONSERVATION FOUNDATION
    170 LONGVIEW ROAD
    FAR HILLS,NJ07931     		NONE PUBLIC BAMBOO BROOK - MAJOR 5,000
    NORTH CAROLINA COASTAL FEDERATION
    3609 HIGHWAY 24 OCEAN
    NEWPORT,NC28570     		NONE PUBLIC MAJOR 15,000
    ORPHANAID AFRICA
    268 BUSH STREET SUITE 3100
    SAN FRANCISCO,CA94104     		NONE PUBLIC MAJOR 10,000
    PARALYZED VETERANS OF AMERICA
    801 18TH ST NW
    WASHINGTON,DC20006     		NONE PUBLIC MAJOR 10,000
    PROJECT REBIRTH
    163 WILLIAM STREET 4TH FLOOR
    NEW YORK,NY10038     		NONE PUBLIC MAJOR 10,000
    RONALD MCDONALD HOUSE
    101 OLD MASON FARM RD
    CHAPEL HILL,NC27517     		NONE PUBLIC MAJOR 7,500
    SCHOLARSHIP FUND FOR INNER CITY CHILDREN
    P O BOX 9500
    NEWARK,NJ071049500     		NONE PUBLIC MAJOR 10,000
    SCHOOL ON WHEELS INC
    P O BOX 23371
    VENTURA,CA93002     		NONE PULIC MAJOR 4,000
    SOUND WATERS
    1281 COVE ROAD
    STAMFORD,CT06902     		NONE PUBLIC MAJOR 5,000
    ST LUKES LIFEWORKS
    141 FRANKLIN STREET
    STAMFORD,CT06901     		NONE PUBLIC MAJOR 15,000
    STAMFORD SAILING FOUNDATION
    151 HARVARD AVE
    STAMFORD,CT06902     		NONE PUBLIC MAJOR 25,000
    THE PORTABLE PLAYHOUSE INC
    425 MAIN ST
    FOREST CITY,PA18421     		NONE PUBLIC MAJOR 10,000
    THE WATERSIDE SCHOOL
    770 PACIFIC ST
    STAMFORD,CT06902     		NONE PUBLIC MAJOR 5,000
    THE WOMEN'S CENTER
    P O BOX 1057
    CHAPEL HILL,NC27514     		NONE PUBLIC MAJOR 10,000
    TOUCH FOUNDATION INC
    875 THIRD AVE 5TH FLOOR
    NEW YORK,NY10022     		NONE PUBLIC MAJOR 7,000
    TRIANGE OPTIONS FOR SUBSTANCE ABUSERS
    1820 JAMES ST
    DURHAM,NC27704     		NONE PUBLIC MAJOR 10,000
    UNC LINEBERGER COMPREHENSIVE CANCER CENTER
    SCHOOL OF MEDICINE CB 7295
    CHAPEL HILL,NC275997295     		NONE PUBLIC MAJOR 25,000
    WOMEN FOR WOMEN FOUNDATION INC
    P O BOX 50403
    COLORADO SPRINGS,CO80949     		NONE PUBLIC MAJOR 15,000
    YMCA-STAMFORD
    909 WASHINGTON BLVD
    STAMFORD,CT06901     		NONE PUBLIC MAJOR 10,000
    ALZHEIMER'S ASSOCIATION
    225 N MICHIGAN AVE 17TH FLOOR
    CHICAGO,IL606017633     		NONE PUBLIC GENERAL 100
    ALZHEIMER'S ASSOCIATION CT CHAPTER
    2075 SILAS DEANE HWY
    ROCKY HILL,CT06067     		NONE PUBLIC GENERAL 50
    AMERICAN LIVER FOUNDATION
    127 WASHINGTON AVE
    NORTH HAVEN,CT06473     		NONE PUBLIC GENERAL 50
    BIG BROTHERS BIG SISTERS GREATER CHARLOTTE
    3801 E INDEPENDENCE BLVD SUITE 101
    CHARLOTTE,NC28205     		NONE PUBLIC GENERAL 50
    FOOD FOR THE POOR
    6401 LYONS ROAD
    COCONUT CREEK,FL33073     		NONE PUBLIC GENERAL 100
    MARYKNOLL SISTERS OF ST DOMINIC
    10 PINEBRIDGE RD
    MAYKNOLL,NY10545     		NONE PUBLIC GENERAL 100
    MONTGOMERY COUNTY COUNCIL OF THE ARTS
    P O BOX 128
    MT STERLING,KY40353     		NONE PUBLIC GENERAL 50
    MUSIC MAKER RELIEF FOUNDATION
    224 WEST CORBIN ST
    HILLSBOROUGH,NC27278     		NONE PUBLIC GENERAL 50
    NATIONAL MS SOCIETY CT CHAPTER
    659 TOWER AVENUE
    HARTFORD,CT06112     		NONE PUBLIC GENERAL 50
    NATIONAL MS SOCIETY NYC CHAPTER
    733 THIRD AVENUE 3RD FLOOR
    NEW YORK,NY100173288     		NONE PUBLIC GENERAL 50
    NEW YORK UNIVERSITY
    OFFICE OF GIFT ADMINISTRATION
    726 BROADWAY 2ND FLOOR
    NEW YORK,NY100039580     		NONE PUBLIC GENERAL 300
    ROCHESTER INSTITUTE OF TECHNOLOGY
    116 LOMB MEMEORIAL DRIVE
    ROCHESTER,NY146235608     		NONE PUBLIC GENERAL 100
    SCHOOL ON WHEELS INC
    P O BOX 23371
    VENTURA,CA93002     		NONE PUBLIC GENERAL 100
    SOUTHWEST INDIAN FOUNDATION INC
    P O BOX 86
    GALLUP,NM87305     		NONE PUBLIC GENERAL 200
    SPECIAL OLYMPICS CONNECTICUT INC
    2666 STATE STREET SUITE 1
    HAMDEN,CT065172232     		NONE PUBLIC GENERAL 50
    ST STEPHENS INDIAN MISSION FOUNDATION
    33 ST STEPHENS ROAD
    SAINT STEPHENS,WV825249989     		NONE PUBLIC GENERAL 100
    STAMFORD SAILING FOUNDATION
    151 HARVARD AVE
    STAMFORD,CT06902     		NONE PUBLIC GENERAL 5,000
    UNIVERSITY OF RHODE ISLAND
    6 RHODY RAM WAY
    KINGSTON,RI02881     		NONE PUBLIC SAILING TEAM 100
    Total .................................bullet 3a 727,500
    bApproved for future payment
    Total .................................bullet 3b  
    Form 990-PF (2011)
    Form 990-PF (2011)
    Page 11
    Part XVI-A
    Analysis of Income-Producing Activities
    Enter gross amounts unless otherwise indicated. Unrelated business income Excluded by section 512, 513, or 514 (e)
    Related or exempt
    function income
    (See page 28 of
    the instructions.)
    1Program service revenue: (a)
    Business code     		(b)
    Amount     		(c)
    Exclusion code     		(d)
    Amount
    a
    b
    c
    d
    e
    f
    gFees and contracts from government agencies          
    2 Membership dues and assessments....          
    3Interest on savings and temporary cash investments          
    4 Dividends and interest from securities....     14 268,337  
    5 Net rental income or (loss) from real estate:
    aDebt-financed property......          
    bNot debt-financed property.....     16 399,822  
    6Net rental income or (loss) from personal property          
    7 Other investment income.....          
    8Gain or (loss) from sales of assets other than inventory     18 -76,413  
    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)..   591,746  
    13Total. Add line 12, columns (b), (d), and (e)..................
    13591,746
    (See worksheet in line 13 instructions on page 28 to verify calculations.)
    Part XVI-B
    Relationship of Activities to the Accomplishment of Exempt Purposes
    Line No.
    DownArrow     		Explain below how each activity for which income is reported in column (e) of Part XVI-A contributed importantly to
    the accomplishment of the organization’s exempt purposes (other than by providing funds for such purposes). (See
    page 28 of the instructions.)
    Form 990-PF (2011)
    Form 990-PF (2011)
    Page 12
    Part XVII
    Information Regarding Transfers To and Transactions and Relationships With Noncharitable Exempt Organizations
    1
    Did the organization directly or indirectly engage in any of the following with any other organization described in section
    Yes
    No
    501(c) of the Code (other than section 501(c)(3) organizations) or in section 527, relating to political organizations?
    a
    Transfers from the reporting foundation to a noncharitable exempt organization of:
    (1) Cash...................................
    1a(1)
     
    No
    (2) Other assets.................................
    1a(2)
     
    No
    b
    Other transactions:
    (1) Sales of assets to a noncharitable exempt organization....................
    1b(1)
     
    No
    (2) Purchases of assets from a noncharitable exempt organization..................
    1b(2)
     
    No
    (3) Rental of facilities, equipment, or other assets.......................
    1b(3)
     
    No
    (4) Reimbursement arrangements...........................
    1b(4)
     
    No
    (5) Loans or loan guarantees.............................
    1b(5)
     
    No
    (6) Performance of services or membership or fundraising solicitations................
    1b(6)
     
    No
    c
    Sharing of facilities, equipment, mailing lists, other assets, or paid employees..............
    1c
     
    No
    d
    If the answer to any of the above is “Yes,” complete the following schedule. Column (b) should always show the fair market value
    of the goods, other assets, or services given by the reporting foundation. If the foundation received less than fair market value
    in any transaction or sharing arrangement, show in column (d) the value of the goods, other assets, or services received.
    (a) Line No. (b) Amount involved (c) Name of noncharitable exempt organization (d) Description of transfers, transactions, and sharing arrangements
    2a
    Is the foundation directly or indirectly affiliated with, or related to, one or more tax-exempt organizations
    described in section 501(c) of the Code (other than section 501(c)(3)) or in section 527?...........
    b
    If “Yes,” complete the following schedule.
    (a) Name of organization (b) Type of organization (c) Description of relationship
    SignHere
    Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than taxpayer or fiduciary) is based on all information of which preparer has any knowledge.
    Bullet Bullet
    Signature of officer or trustee Date Title
    PaidPreparersUseOnly Preparer's SignatureBullet Date PTIN
    Firm's namebullet



    Firm's addressbullet







         		Firm's EINbullet
    Phone no.
    Form 990-PF (2011)
    Additional Data


    Software ID:  
    Software Version:  


    Form 990PF - Special Condition Description:
    Special Condition Description

    TY 2011 AccountingFeesSchedule
    Name:
    CARLSON FAMILY FOUNDATION INC
    C/O MARY N OWEN
    EIN: 31-1678303
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    CARNEIRO CHUMNEY & CO 6,500 3,250   3,250

    Note: To capture the full content of this document, please select landscape mode (11" x 8.5") when printing.

    TY 2011 DepreciationSchedule
    Name:
    CARLSON FAMILY FOUNDATION INC
    C/O MARY N OWEN
    EIN: 31-1678303
    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:
    CARLSON FAMILY FOUNDATION INC
    C/O MARY N OWEN
    EIN: 31-1678303
    Name of Bond End of Year Book Value End of Year Fair Market Value
    HUMAN GENOME SCIENCES 3% 11/18 75,000 67,312
    PEABODY ENERGY 4.75% 12/66 91,045 128,125
    APACHE CORP 6.00% 85,000 92,276

    TY 2011 InvestmentsCorpStockSchedule
    Name:
    CARLSON FAMILY FOUNDATION INC
    C/O MARY N OWEN
    EIN: 31-1678303
    Name of Stock End of Year Book Value End of Year Fair Market Value
    SCHLUMBERGER LTD 1500 SHS 69,709 102,465
    CHEVRON CORP 2000 SHS 64,151 212,800
    ANADARKO PTEROLEUM 2000 SHS 88,182 152,660
    CONOCOPHILLIPS 2164 SHS 59,350 157,691
    DEVON ENERGY CORP 2000 SHS 105,331 124,000
    AIR PRODUCTS & CHEMICALS 2000 121,324 170,380
    BHP BILLITON LIMITED 1500 SHS 62,370 105,945
    FREEPORT-MCMORAN COPPER 3458 54,837 127,220
    JOHNSON CONTROLS INC 3500 SHS 142,126 109,410
    GENERAL ELECTRIC CO 4800 SHS 80,240 85,968
    HONEYWELL INTL INC 3000 SHS 68,137 163,050
    ABB LTD 6500 SHS 142,976 122,395
    UNITED PARCEL SVC INC 1500 SHS 97,729 109,785
    NIKE INC 1500 SHS 79,355 144,555
    MCDONALDS CORP 3000 SHS 46,470 300,990
    HOME DEPOT INC 4000 SHS 95,680 168,160
    CVS CAREMARK CORP 4400 SHS 69,961 179,432
    PEPSICO INC 2400 SHS 64,237 159,240
    NESTLE 3000 SHS 31,650 173,130
    PROCTOR & GAMBLE 1950 SHS 87,575 130,084
    ST JUDE MEDICAL INC 3000 SHS 157,667 102,900
    LABORATORY CORP 1200 SHS 90,341 103,164
    CELGENE CORP 2000 SHS 103,602 135,200
    GILEAD SCIENCES INC 4500 SHS 191,165 184,185
    TEVA PHARMACEUTICAL 3000 SHS 80,910 121,080
    ABBOTT LABORATORIES 3000 SHS 121,542 168,690
    MERCK & CO INC 4000 SHS 137,398 150,800
    US BANCORP 4000 SHS 87,947 108,200
    BLACKROCK INC 700 SHS 114,562 124,768
    VISA INC 1400 SHS 74,203 142,142
    MICROSOFT CORP 3400 SHS 54,888 88,264
    EMC CORP 7800 SHS 134,034 168,012
    AGILENT TECHNOLOGIES 4000 SHS 86,461 139,720
    BROADCOM CORP 3000 SHS 95,431 88,080
    ANALOG DEVICES INC 4000 SHS 120,141 143,120
    AT&T INC 4500 SHS 95,415 136,080
    VERIZON COMMUNICATIONS 4000 SH 154,294 160,480
    VODAFONE GROUP 5500 SHS 132,398 154,165
    FRANKLIN INTL 33525.81 SHS 516,160 456,622
    S & P 500 DEPOSITORY 18912 UNT 2,220,522 2,373,456
    ISHARES TR S & P 7600 SHS 300,438 270,712
    ISHARES TR BARCLAYS 15000 SHS 1,578,610 1,653,750

    TY 2011 LandEtcSchedule2
    Name:
    CARLSON FAMILY FOUNDATION INC
    C/O MARY N OWEN
    EIN: 31-1678303
    Category / Item Cost / Other Basis Accumulated Depreciation Book Value End of Year Fair Market Value


    TY 2011 OtherExpensesSchedule
    Name:
    CARLSON FAMILY FOUNDATION INC
    C/O MARY N OWEN
    EIN: 31-1678303
    Description Revenue and Expenses per Books Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    POSTAGE 77     77
    WIRE TRANSFER FEES 80     80
    MISCELLANEOUS 135     135
    Rent and Royalty Expense 25,031      


    TY 2011 OtherProfessionalFeesSchedule
    Name:
    CARLSON FAMILY FOUNDATION INC
    C/O MARY N OWEN
    EIN: 31-1678303
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    WELSH CHESTER GALINEY MALONE 5,000 5,000    
    FIDUCIARY TRUST INTERNATIONAL 66,305 66,305    
    MERRILL LYNCH 95 95    


    TY 2011 TaxesSchedule
    Name:
    CARLSON FAMILY FOUNDATION INC
    C/O MARY N OWEN
    EIN: 31-1678303
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    FOREIGN TAXES 1,939 1,939    
    EXCISE TAX 11,330