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
2012
Open to Public Inspection
For calendar year 2012, or tax year beginning 01-01-2012 , and ending 12-31-2012
Name of foundation
JASPER SEATING FOUNDATION INC
C/O JASPER SEATING CO INC

Number and street (or P.O. box number if mail is not delivered to street address)PO BOX 231   Room/suite
City or town, state, and ZIP code
JASPER, IN47546
A Employer identification number

35-6024534
B Telephone number (see instructions)

(812) 482-3204
C bullet
G Check all that apply:

D 1. bullet
2. bullet
H Check type of organization:
I Fair market value of all assets at end
of year (from Part II, col. (c),
line 16)bullet$43,542J 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 instructions).) (a) Revenue and
expenses per
books 		(b) Net investment
income 		(c) Adjusted net
income 		(d) Disbursements
for charitable
purposes
(cash basis only)
Revenue 1 Contributions, gifts, grants, etc., received (attach schedule)  
2 Check bullet
3 Interest on savings and temporary cash investments 55 55 55
4 Dividends and interest from securities......      
5a Gross rents..............      
b Net rental income or (loss)  
6a Net gain or (loss) from sale of assets not on line 10  
b Gross sales price for all assets on line 6a  
7 Capital gain net income (from Part IV, line 2)...  
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........ 55 55 55
Operating and Administrative Expenses 13 Compensation of officers, directors, trustees, etc.        
14 Other employee salaries and wages......        
15 Pension plans, employee benefits.......        
16a Legal fees (attach schedule).........        
b Accounting fees (attach schedule).......        
c Other professional fees (attach schedule)....        
17 Interest...............        
18 Taxes (attach schedule) (see instructions) Click to see attachment 8     8
19 Depreciation (attach schedule) and depletion...      
20 Occupancy..............        
21 Travel, conferences, and meetings.......        
22 Printing and publications..........        
23 Other expenses (attach schedule)....... Click to see attachment 26     26
24 Total operating and administrative expenses.
Add lines 13 through 23.......... 34 0   34
25 Contributions, gifts, grants paid........ 21,740 21,740
26 Total expenses and disbursements. Add lines 24 and 25 21,774 0   21,774
27 Subtract line 26 from line 12:
a Excess of revenue over expenses and disbursements -21,719
b Net investment income (if negative, enter -0-) 55
c Adjusted net income (if negative, enter -0-)... 55
For Paperwork Reduction Act Notice, see instructions.
Cat. No. 11289X Form 990-PF (2012)
Form 990-PF (2012)
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............... 872 697 697
2 Savings and temporary cash investments.......... 64,389 42,845 42,845
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)........      
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)      
16 Total assets (to be completed by all filers—see the
instructions. Also, see page 1, item I) 65,261 43,542 43,542
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 65,261 43,542
30 Total net assets or fund balances (see page 17 of the
instructions).................... 65,261 43,542
31 Total liabilities and net assets/fund balances (see page 17 of
the instructions).................. 65,261 43,542
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 65,261
2 Enter amount from Part I, line 27a..................... 2 -21,719
3 Other increases not included in line 2 (itemize) bullet 3  
4 Add lines 1, 2, and 3.......................... 4 43,542
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 43,542
Form 990-PF (2012)
Form 990-PF (2012)
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.)
1a
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
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
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  
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 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))
2011 18,862 63,378 0.297611
2010 34,639 43,351 0.799036
2009 38,209 32,893 1.161615
2008 46,198 25,232 1.830929
2007 54,011 13,171 4.100752
2 Total of line 1, column (d) ...................... 2 8.189943
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 1.637989
4 Enter the net value of noncharitable-use assets for 2012 from Part X, line 5..... 4 55,564
5 Multiply line 4 by line 3....................... 5 91,013
6 Enter 1% of net investment income (1% of Part I, line 27b)........... 6 1
7 Add lines 5 and 6......................... 7 91,014
8 Enter qualifying distributions from Part XII, line 4.............. 8 21,774
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.
Form 990-PF (2012)
Form 990-PF (2012)
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 1
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 1
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 1
6 Credits/Payments:
a 2012 estimated tax payments and 2011 overpayment credited to 2012 6a  
b Exempt foreign organizations—tax withheld at source....... 6b
c Tax paid with application for extension of time to file (Form 8868) 6c  
d Backup withholding erroneously withheld ........... 6d  
7 Total credits and payments. Add lines 6a through 6d.............. 7  
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 1
10 Overpayment. If line 7 is more than the total of lines 5 and 8, enter the amount overpaid...Bullet 10  
11 Enter the amount of line 10 to be: Credited to 2013 estimated taxBullet   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 instructions)
    bulletIN
    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 2012 or the taxable year beginning in 2012 (see instructions for Part XIV)?
    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 instructions) .............
    11
     
    No
    12
    Did the foundation make a distribution to a donor advised fund over which the foundation or a disqualified person had
    advisory privileges? If "Yes," attach statement (see instructions).................
    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 ofbulletJASPER SEATING CO INC Telephone no.bullet (812) 482-3204
    Located atbulletPO BOX 231JASPERIN ZIP+4bullet47546
    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 2012, 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 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 (2012)
    Form 990-PF (2012)
    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 2012?.............
    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 2012, did the foundation have any undistributed income (lines 6d
    and 6e, Part XIII) for tax year(s) beginning before 2012?...............
    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 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 2012 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 2012.)....................
    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 2012?
    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 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 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 (2012)
    Form 990-PF (2012)
    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 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
    MICHAEL ELLIOTTClick to see attachment PRESIDENT
    0.20     		0 0 0
    PO BOX 231
    JASPER,IN47547
    GLENN GRAMELSPACHER IIClick to see attachment SECRETARY
    0.20     		0 0 0
    PO BOX 231
    JASPER,IN47547
    WILLIAM RUBINOClick to see attachment DIRECTOR
    0.20     		0 0 0
    PO BOX 231
    JASPER,IN47547
    NICHOLAS GRAMELSPACHERClick to see attachment DIRECTOR
    0.20     		0 0 0
    PO BOX 231
    JASPER,IN47547
    RONALD BECKClick to see attachment DIRECTOR
    0.20     		0 0 0
    PO BOX 231
    JASPER,IN47547
    2 Compensation of five highest-paid employees (other than those included on line 1—see instructions). If none, enter “NONE.”
    (a) Name and address of each employee paid more than $50,000 (b) Title, and average
    hours per week
    devoted to position     		(c) Compensation (d) Contributions to
    employee benefit
    plans and deferred
    compensation     		(e) Expense account,
    other allowances
    NONE
    Total number of other employees paid over $50,000...................bullet  
    3 Five highest-paid independent contractors for professional services (see instructions). If none, enter "NONE".
    (a) Name and address of each person paid more than $50,000 (b) Type of service (c) Compensation
    NONE
    Total number of others receiving over $50,000 for professional services.............bullet  
    Part IX-A
    Summary of Direct Charitable Activities
    List the foundation’s four largest direct charitable activities during the tax year. Include relevant statistical information such as the number of organizations and other beneficiaries served, conferences convened, research papers produced, etc. Expenses
    1
     
    2  
    3  
    4  
    Form 990-PF (2012)
    Form 990-PF (2012)
    Page 7
    Part IX-B
    Summary of Program-Related Investments (see instructions)
    Describe the two largest program-related investments made by the foundation during the tax year on lines 1 and 2. Amount
    1 N/A  
    2  
    All other program-related investments. See page 24 of the instructions.
    3  
    Total. Add lines 1 through 3..........................bullet  
    Part X
    Minimum Investment Return (All domestic foundations must complete this part. Foreign foundations,
    see 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
    0
    b
    Average of monthly cash balances.......................
    1b
    56,410
    c
    Fair market value of all other assets (see instructions)................
    1c
    0
    d
    Total (add lines 1a, b, and c).........................
    1d
    56,410
    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
    56,410
    4
    Cash deemed held for charitable activities. Enter 1 1⁄2% of line 3 (for greater amount, see
    instructions) .............................
    4
    846
    5
    Net value of noncharitable-use assets. Subtract line 4 from line 3. Enter here and on Part V, line 4
    5
    55,564
    6
    Minimum investment return. Enter 5% of line 5..................
    6
    2,778
    Part XI
    Distributable Amount bullet and do not complete this part.)
    1
    Minimum investment return from Part X, line 6....................
    1
    2,778
    2a
    Tax on investment income for 2012 from Part VI, line 5......
    2a
    1
    b
    Income tax for 2012. (This does not include the tax from Part VI.)...
    2b
     
    c
    Add lines 2a and 2b............................
    2c
    1
    3
    Distributable amount before adjustments. Subtract line 2c from line 1............
    3
    2,777
    4
    Recoveries of amounts treated as qualifying distributions................
    4
     
    5
    Add lines 3 and 4............................
    5
    2,777
    6
    Deduction from distributable amount (see instructions).................
    6
     
    7
    Distributable amount as adjusted. Subtract line 6 from line 5. Enter here and on Part XIII,
    line 1................................
    7
    2,777
    Part XII
    Qualifying Distributions (see 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
    21,774
    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
    21,774
    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 instructions).................
    5
     
    6
    Adjusted qualifying distributions. Subtract line 5 from line 4..............
    6
    21,774
    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 (2012)
    Form 990-PF (2012)
    Page 8
    Part XIII
    Undistributed Income (see instructions)
    (a)
    Corpus     		(b)
    Years prior to 2011     		(c)
    2011     		(d)
    2012
    1 Distributable amount for 2012 from Part XI, line 7 2,777
    2 Undistributed income, if any, as of the end of 2012:
    a Enter amount for 2011 only.......  
    b Total for prior years:20, 20, 20  
    3 Excess distributions carryover, if any, to 2012:
    a From 2007....... 53,352
    b From 2008....... 44,937
    c From 2009....... 36,565
    d From 2010....... 32,472
    e From 2011....... 15,694
    fTotal of lines 3a through e......... 183,020
    4Qualifying distributions for 2012 from Part
    XII, line 4: bullet$ 21,774
    a Applied to 2011, but not more than line 2a  
    b Applied to undistributed income of prior years
    (Election required—see instructions)......     		 
    c Treated as distributions out of corpus (Election
    required—see instructions).........     		 
    d Applied to 2012 distributable amount..... 2,777
    e Remaining amount distributed out of corpus 18,997
    5 Excess distributions carryover applied to 2012.    
    (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 5 202,017
    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 instructions ...........     		 
    e Undistributed income for 2011. Subtract line
    4a from line 2a. Taxable amount—see
    instructions .............     		 
    f Undistributed income for 2012. Subtract
    lines 4d and 5 from line 1. This amount must
    be distributed in 2013 ..........     		0
    7 Amounts treated as distributions out of
    corpus to satisfy requirements imposed by
    section 170(b)(1)(F) or 4942(g)(3) (see
    instructions) .............     		 
    8Excess distributions carryover from 2007 not
    applied on line 5 or line 7 (see instructions) ...     		53,352
    9Excess distributions carryover to 2013.
    Subtract lines 7 and 8 from line 6a ......     		148,665
    10 Analysis of line 9:
    a Excess from 2008.... 44,937
    b Excess from 2009.... 36,565
    c Excess from 2010.... 32,472
    d Excess from 2011.... 15,694
    e Excess from 2012.... 18,997
    Form 990-PF (2012)
    Form 990-PF (2012)
    Page 9
    Part XIV
    Private Operating Foundations (see 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 2012, 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) 2012 (b) 2011 (c) 2010 (d) 2009
             
    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 instructions.)
    1Information Regarding Foundation Managers:
    aList any managers of the foundation who have contributed more than 2% of the total contributions received by the foundation
    before the close of any tax year (but only if they have contributed more than $5,000). (See section 507(d)(2).)
    bList any managers of the foundation who own 10% or more of the stock of a corporation (or an equally large portion of the
    ownership of a partnership or other entity) of which the foundation has a 10% or greater interest.
    2Information Regarding Contribution, Grant, Gift, Loan, Scholarship, etc., Programs:
    Check here bullet
    aThe name, address, and telephone number or e-mail of the person to whom applications should be addressed:
    JASPER GROUP
    PO BOX 231
    JASPER,IN47547
    (812) 771-4591
    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 (2012)
    Form 990-PF (2012)
    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
    408 NURSES PROGRAM
    1642 W 5TH AVE
    JASPER,IN47546     		  501(C)(3) EDUCATIONAL 100
    ACTORS COMMUNITY THEATRE
    PO BOX 603
    JASPER,IN47547     		  501(C)(3) CHARITABLE 50
    ANDERSON WOOD -RIVERWALK
    PO BOX 650
    JASPER,IN47547     		  501(C)(3) CHARITABLE 150
    ARTHUR GENERAL BAPTIST CH
    5130 SOUTH STATE ROAD 61
    WINSLOW,IN47598     		  501(C)(3) RELIGIOUS 100
    BUFFALO TRACE COUNCIL
    3501 E LLOYD EXPRESSWAY
    EVANSVILLE,IN47715     		  501(C)(3) CHARITABLE 100
    CALVARY BAPTIST CHURCH
    PO BOX 118
    HUNTINGBURG,IN47542     		  501(C)(3) RELIGIOUS 100
    CAMP CARE
    PO BOX 514
    JASPER,IN475470514     		  501(C)(3) CHARITABLE 25
    CELESTINE ELEMENTARY PTO
    PO BOX 54
    CELESTINE,IN47521     		  501(C)(3) EDUCATIONAL 25
    CHRISTIAN CHURCH OF JASPER
    1450 ENERGY DRIVE
    JASPER,IN47546     		  501(C)(3) RELIGIOUS 100
    CRISIS CONNECTION
    PO BOX 903
    JASPER,IN47547     		  501(C)(3) CHARITABLE 50
    DISABLED AMERICAN VETERAN
    1181 W 100 S
    JASPER,IN47546     		  501(C)(3) CHARITABLE 25
    DUBOIS COUNTY 4-H COUNCIL
    1482 EXECUTIVE BLVD
    JASPER,IN47546     		  501(C)(3) CHARITABLE 250
    DUBOIS COUNTY FOOD BANK
    1404 MERIDIAN RD
    JASPER,IN47546     		  501(C)(3) CHARITABLE 500
    DUBOIS COUNTY MUSEUM
    2704 N NEWTON ST STE A
    JASPER,IN47546     		  501(C)(3) CHARITABLE 150
    DUBOIS COUNTY SPECIAL OLYMPICS
    PO BOX 355
    JASPER,IN475470355     		  501(C)(3) CHARITABLE 100
    FERDINAND FIRE DEPARTMENT
    221 EAST 4TH ST PO BOX 31
    FERDINAND,IN47532     		  501(C)(3) CHARITABLE 500
    FERDINAND HEIMATFEST
    PO BOX 133
    FERDINAND,IN47532     		  501(C)(3) CHARITABLE 250
    FIRST BAPTIST CHURCH
    3556 N PORTERSVILLE RD
    JASPER,IN47546     		  501(C)(3) RELIGIOUS 100
    FIRST PRESBYTERIAN CHURCH
    3240 ST CHARLES ST
    JASPER,IN47546     		  501(C)(3) RELIGIOUS 100
    FOREST PARK POST PROM COM
    1440 MICHIGAN ST
    FERDINAND,IN47532     		  501(C)(3) CHARITABLE 100
    FOREST PARK YOUTH SPORTS
    1640 EAST MAPLE DRIVE
    HUNTINGBURG,IN47542     		  501(C)(3) EDUCATIONAL 50
    GIBAULT INC
    PO BOX 2316
    TERRE HAUTE,IN47802     		  501(C)(3) RELIGIOUS 50
    HADI SHRINE CIRCUS
    1545 E ST RD 164
    JASPER,IN47546     		  501(C)(3) CHARITABLE 30
    HOLY FAMILY CATHOLIC SCHOOL FOUNDAT
    950 CHURCH ST
    JASPER,IN47546     		  501(C)(3) RELIGIOUS 100
    HOLY FAMILY CHURCH
    950 CHURCH ST
    JASPER,IN47546     		  501(C)(3) RELIGIOUS 100
    IFWDA-BRADFORD WOODSCAMP
    2500 WERNLE ROAD
    RICHMOND,IN47374     		  501(C)(3) CHARITABLE 200
    INDIANA BASEBALL HALL OF FAME
    1436 LEOPOLD ST
    JASPER,IN47546     		  501(C)(3) CHARITABLE 50
    INDIANA ELITE
    1813 DAISY ST SE
    DEMOTTE,IN46310     		  501(C)(3) CHARITABLE 100
    INDIANA NETWORK FOR HIGHER EDUC
    1100 W 42ND ST SUITE 228
    INDIANAPOLIS,IN46208     		  501(C)(3) RELIGIOUS 25
    JASPER 3V3 SOCCER TOURNAM
    PO BOX 52
    JASPER,IN47547     		  501(C)(3) CHARITABLE 50
    JASPER AMERICAN LEGION 147
    1220 NEWTON STREET
    JASPER,IN47546     		  501(C)(3) CHARTIABLE 25
    JASPER HIGH SCHOOL POST PROM
    3109 VIRGINIA AVE
    JASPER,IN47546     		  501(C)(3) CHARITABLE 300
    JASPER JUNIOR ACHIEVEMENT
    PO BOX 561
    JASPER,IN47547     		  501(C)(3) EDUCATIONAL 100
    JASPER VOLUNTEER FIRE DEPARTMENT
    932 MILL ST
    JASPER,IN47546     		  501(C)(3) CHARITABLE 2,500
    JASPER YOUTH SOCCER LEAGUE
    PO BOX 673
    JASPER,IN47547     		  501(C)(3) CHARITABLE 50
    MEMORIAL SLOAN-KETTERING
    PO BOX 7247-0260
    PHILADELPHIA,PA19170     		  501(C)(3) SCIENTIFIC 100
    NORTHEAST DUBOIS POST PROM COMMITTE
    4711 N DUBOIS RD NE
    DUBOIS,IN47527     		  501(C)(3) CHARITABLE 100
    NU VISION USA MINISTRY
    PO BOX 146
    OTWELL,IN47564     		  501(C)(3) CHARITABLE 50
    ORANGE COUNTY SPECIAL OLYMPICS
    1640 E CR 100 N
    PAOLI,IN47454     		  501(C)(3) CHARITABLE 50
    PARALYZED VETERANS OF AMERICA
    7 MILL BROOK RD
    WILTON,NH03086     		  501(C)(3) SCIENTIFIC 25
    PIKE CENTRAL POST PROM
    10595 E CO RD 325 N
    OTWELL,IN47564     		  501(C)(3) CHARITABLE 100
    PRECIOUS BLOOD CHURCH
    1385 W 6TH ST
    JASPER,IN47546     		  501(C)(3) RELIGIOUS 100
    PROVIDENCE HOME HEALTH CARE CENTER
    520 W 9TH ST
    JASPER,IN47546     		  501(C)(3) CHARITABLE 100
    RAINTREE COUNCIL GIRL SCOUTS
    PO BOX 1350
    EVANSVILLE,IN47706     		  501(C)(3) CHARITABLE 300
    REDEEMER LUTHERAN CHURCH
    140 E 32ND ST
    JASPER,IN47546     		  501(C)(3) RELIGIOUS 100
    SCHNELLVILLE COMMUNITY CLUB
    7855 EAST MARKET STREET
    SCHNELLVILLE,IN47580     		  501(C)(3) CHARITABLE 50
    SHILOH UNITED METHODIST CHURCH
    1971 W ST RD 56
    JASPER,IN47546     		  501(C)(3) RELIGIOUS 100
    SISTERS OF PROVIDENCE
    1 SISTERS OF PROVIDENCE
    SAINT MARY OF THE WOOD,IN47876     		  501(C)(3) RELIGIOUS 100
    SOUTHERN INDIANA LEATHERNECKS
    PO BOX 184
    JASPER,IN475470184     		  501(C)(3) CHARITABLE 160
    SOUTHERN INDIANA LEATHERNECKS
    PO BOX 184
    JASPER,IN475470184     		  501(C)(3) CHARITABLE 100
    SOUTHRIDGE POST PROM
    1265 TIMBER RIDGE DR
    HUNTINGBURG,IN47542     		  501(C)(3) CHARITABLE 100
    SPRINGS VALLEY AFTER-SCHOOL PROGRAM
    498 S LARRY BIRD BLVD
    FRENCH LICK,IN47432     		  501(C)(3) CHARITABLE 50
    ST ANTHONY AMERICAN LEGION
    PO BOX 153
    ST ANTHONY,IN47575     		  501(C)(3) CHARITABLE 100
    ST ANTHONY CATHOLIC CHURCH
    442 S OHIO ST
    ST ANTHONY,IN47575     		  501(C)(3) RELIGIOUS 100
    ST ANTHONY COMMUNITY CENTER
    PO BOX 34
    ST ANTHONY,IN47575     		  501(C)(3) CHARITABLE 100
    ST ANTHONY OF PADUA CHURCH
    PO BOX 98
    ST ANTHONY,IN47575     		  501(C)(3) RELIGIOUS 100
    ST CELESTINE CHURCH
    PO BOX 1
    CELESTINE,IN47521     		  501(C)(3) RELIGIOUS 100
    ST FERDINAND CHURCH
    PO BOX 156
    FERDINAND,IN47532     		  501(C)(3) RELIGIOUS 100
    ST FERDINAND CHURCH RAFFLE COMM
    PO BOX 156
    FERDINAND,IN47532     		  501(C)(3) RELIGIOUS 100
    ST JOHN'S LUTHERAN CHURCH
    7367 E ST RD 356
    OTWELL,IN47564     		  501(C)(3) RELIGIOUS 100
    ST JOSEPH CATHOLIC CHURCH
    1020 KUNDEK ST
    JASPER,IN47546     		  501(C)(3) RELIGIOUS 100
    ST JUDE CHILDREN'S RESEARCH HOSP
    PO BOX 50
    MEMPHIS,TN38101     		  501(C)(3) CHARITABLE 100
    ST MARY'S CHURCH
    313 N WASHINGTON ST
    HUNTINGTBURG,IN47542     		  501(C)(3) RELIGIOUS 100
    ST MARY'S CHURCH
    PO BOX 67
    IRELAND,IN47545     		  501(C)(3) RELIGIOUS 100
    THROOP ELEMENTARY SCHOOL PTO
    301 ELM STREET
    PAOLI,IN474541199     		  501(C)(3) CHARITABLE 50
    TRI-CAP ADOLESCENT PROGRAM
    PO BOX 729 607 THIRD AVE
    JASPER,IN475470729     		  501(C)(3) EDUCATIONAL 100
    TRINITY UNITED CHURCH OF CHRIST
    310 W 8TH ST
    JASPER,IN47546     		  501(C)(3) RELIGIOUS 100
    VETERANS OF FOREIGN WARS
    1907 NEWTON ST
    JASPER,IN47546     		  501(C)(3) CHARITABLE 25
    WNIN 883 FM
    PO BOX 777
    EVANSVILLE,IN47705     		  501(C)(3) CHARITABLE 125
    ST ANTHONY OF PADUA CHURCH
    5K RUN/WALK ATTN CINDY KLEM
    PO BOX 98
    ST ANTHONY,IN47575     		  501(C)(3) RELIGIOUS 25
    AMERICAN CANCER SOCIETY
    5K-RYAN BETZ
    225 S CLAY STREET
    JASPER,IN47546     		  501(C)(3) SCIENTIFIC 25
    AMERICAN LEGION
    BOYS STATE PROGRAM
    1220 NEWTON
    JASPER,IN47546     		  501(C)(3) SCIENTIFIC 100
    DELTA SIGMA WOMEN'S LITTLE 500
    C/O ANDREA SCHROERING
    4219 S SANTINE ROAD
    ST ANTHONY,IN47575     		  501(C)(3) SCHOLASTIC 25
    MARGOLIN HEBREW ACADEMY
    C/O COOPER HOTELS
    1661 AARON BRENNER DR
    MEMPHIS,TN38120     		  501(C)(3) RELIGIOUS 1,800
    PULMONARY FIBROSIS FOUNDATION
    C/O CRUISIN' TOWARD A CURE C/O PARTENHEIMER FAMILY
    805 SOUTH WOODRIDGE ROAD
    HOLLAND,IN47541     		  501(C)(3) CHARITABLE 25
    HEARTLAND HALF MARATHON
    C/O DC MULTISPORTS
    2704 NEWTON STREET
    JASPER,IN47546     		  501(C)(3) CHARITABLE 25
    AMERICAN LEGION AUXILIARY
    C/O DOROTHY HAUTSCH
    1220 NEWTON
    JASPER,IN47546     		  501(C)(3) SCIENTIFIC 25
    TOWN OF BIRDSEYE COMMUNITY FOUND
    C/O DUBOIS COUNTY COMMUNITY FOUNDATION
    600 MCCRILLUS STREET
    JASPER,IN47546     		  501(C)(3) CHARITABLE 100
    DUBOIS RURITAN CLUB
    C/O ERIN KALB
    4149 N 4TH STREET
    DUBOIS,IN47527     		  501(C)(3) CHARITABLE 50
    SCENIC HILLS CARE CENTER
    C/O INDEPENDENCE FROM HUNGER
    311 EAST 1ST STREET
    FERDINAND,IN47532     		  501(C)(3) CHARITABLE 50
    NATIONAL CHILD SAFETY COUNCIL
    C/O JASPER POLICE DEPT
    309 EAST 6TH STREET
    JASPER,IN47546     		  501(C)(3) CHARITABLE 50
    JASPER STRASSENFEST BBQ CONTEST
    C/O JOHN PATTON
    932 MILL STREET
    JASPER,IN47546     		  501(C)(3) CHARITABLE 200
    ADVENTURE CREW 185
    C/O JOHN SENG
    983 W 19TH ST
    JASPER,IN47546     		  501(C)(3) CHARITABLE 50
    FRIENDS OF THE POOR
    C/O KAYLA DOOLEY
    225 CLAY STREET
    JASPER,IN47546     		  501(C)(3) CHARITABLE 25
    FRIENDS OF THE NRA
    C/O KENT PFAU
    1347 E JASPER-DUBOIS ROAD
    JASPER,IN47546     		  501(C)(3) CHARITABLE 25
    COMMUNITY CLUB OF DUBOIS
    C/O NEIL RASCHE
    5101 N DUBOIS ROAD NE
    DUBOIS,IN47527     		  501(C)(3) CHARITABLE 50
    IRELAND ELEMENTARY SCHOOL PTO
    C/O RAY MEHLING
    PO BOX 95
    IRELAND,IN47545     		  501(C)(3) EDUCATIONAL 100
    PSI IOTA XI ORGANIZATION
    C/O SARA PARKS
    1308 HIGHWAY 150 EAST
    PAOLI,IN47454     		  501(C)(3) CHARITABLE 25
    SOUTHWESTERN INDIANA OFFICIALS ASSO
    C/O STAN VOLLMER AND/OR MIKE ZEHR
    3718 EAST STATE ROAD 56
    DUBOIS,IN47527     		  501(C)(3) CHARITABLE 50
    INDIANA HUNTER EDUCATION ASSOCIATIO
    C/O TIM LUEKEN
    PO BOX 231
    JASPER,IN47546     		  501(C)(3) CHARITABLE 50
    AMERICAN CANCER SOCIETY
    C/O TRISHA BOEHM
    858 N MESSMER DRIVE
    CELESTINE,IN47521     		  501(C)(3) SCIENTIFIC 25
    VUJC
    CENTER FOR ADV MANUFACTURING AND TECHNOLOGY
    85 COLLEGE AVE
    JASPER,IN47546     		  501(C)(3) EDUCATIONAL 2,500
    BUFFALO TRACE COUNCIL -DI
    DISTINGUISHED CITIZEN BANQUET
    PO BOX 565
    JASPER,IN47547     		  501(C)(3) CHARITABLE 500
    SALVATION ARMY
    DUBOIS COUNTY UNIT
    PO BOX 984
    INDIANAPOLIS,IN46206     		  501(C)(3) CHARITABLE 50
    BUFFALO TRACE COUNCIL
    EQUIPMENT CAMPAIGN C/O KENNETH STELTERNPOHL
    1128 EISENHOWER AVE
    JASPER,IN47546     		  501(C)(3) CHARITABLE 200
    BIG BROTHERS BIG SISTERS
    GOLF SCRAMBLE
    PO BOX 86
    JASPER,IN47547     		  501(C)(3) CHARITABLE 100
    ALZHEIMER'S ASSOCIATION
    GREATER KENTUCKY AND SOUTHERN INDIANA CHAPTER
    PO BOX 20038
    LOUISVILLE,KY40250     		  501(C)(3) SCIENTIFIC 50
    CHRISTIAN CHURCH OF JASPER
    HAITI MISSION TRIP C/O BRIAN SELF
    1450 ENERGY DRIVE
    JASPER,IN47546     		  501(C)(3) CHARITABLE 100
    DUBOIS COUNTY SPORTSMEN'S
    HUNTERS FOR THE HUNGRY
    PO BOX 304
    JASPER,IN47547     		  501(C)(3) CHARITABLE 50
    GENERATIONS
    MEALS ON WHEELS
    1019 N 4TH ST
    PO BOX 314
    VINCENNES,IN47591     		  501(C)(3) CHARITABLE 100
    CUMBERLAND COLLEGE
    OFFICE OF THE PRESIDENT
    816 WALNUT ST
    WILLIAMSBURG,KY40769     		  501(C)(3) EDUCATIONAL 100
    ORANGE COUNTY 4-H COUNCIL
    ORANGE COUNTY EXTENSION SERVICE
    205 E MAIN ST STE 4
    PAOLI,IN47454     		  501(C)(3) CHARITABLE 100
    AMERICAN CANCER SOCIETY
    RELAY FOR LIFE -JOYCE SCHERLE
    6993 W 1025 S
    HOLLAND,IN47541     		  501(C)(3) SCIENTIFIC 50
    INDIANA UNIVERSITY
    RILEY'S DANCE MARATHON C/O JONATHAN KLEM
    225 CLAY STREET
    JASPER,IN47546     		  501(C)(3) CHARITABLE 50
    RAC
    RIVERSIDE CHALLENGE SWIM
    225 CLAY STREET
    JASPER,IN47546     		  501(C)(3) CHARITABLE 50
    SISTER CITIES OF JASPER
    STUDENT EXCHANGE PROGRAM GOLF SCRAMBLE
    1600 ST CHARLES STREET
    JASPER,IN47546     		  501(C)(3) CHARITABLE 100
    MEMORIAL HOSPITAL FOUNDATION
    SULTAN'S RUN CHARITY CLASSIC
    800 WEST 9TH STREET
    JASPER,IN47546     		  501(C)(3) CHARITABLE 750
    DESTINATION IMAGINATION G
    TENTH STREET ELEMENTARY
    328 W TENTH STREET
    JASPER,IN47546     		  501(C)(3) EDUCATIONAL 100
    ST MEINRAD ARCHABBEY
    THE APPEAL OF SAINT BEDE HALL
    200 HILL DRIVE
    ST MEINRAD,IN47544     		  501(C)(3) RELIGIOUS 4,000
    Total .................................bullet 3a 21,740
    bApproved for future payment
    Total .................................bullet 3b  
    Form 990-PF (2012)
    Form 990-PF (2012)
    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 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 55  
    4 Dividends and interest from securities....          
    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          
    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)..   55  
    13Total. Add line 12, columns (b), (d), and (e)..................
    1355
    (See worksheet in line 13 instructions 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 foundation’s exempt purposes (other than by providing funds for such purposes). (See
    instructions.)
    Form 990-PF (2012)
    Form 990-PF (2012)
    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
    Sign Here
    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
    May the IRS discuss this return
    with the preparer shown below
    (see instr.)?
    Signature of officer or trustee Date Title
    Paid Preparer Use Only Print/Type preparer's name Preparer's Signature Date PTIN
    Firm's namebullet



    Firm's addressbullet







         		Firm's EINbullet
    Phone no.
    Form 990-PF (2012)
    Additional Data


    Software ID:  
    Software Version:  


    Form 990PF - Special Condition Description:
    Special Condition Description

    TY 2012 CompensationExplanation
    Name:
    JASPER SEATING FOUNDATION INC
    C/O JASPER SEATING CO INC
    EIN: 35-6024534
    Person Name Explanation
    MICHAEL ELLIOTT  
    GLENN GRAMELSPACHER II  
    WILLIAM RUBINO  
    NICHOLAS GRAMELSPACHER  
    RONALD BECK  

    TY 2012 OtherExpensesSchedule
    Name:
    JASPER SEATING FOUNDATION INC
    C/O JASPER SEATING CO INC
    EIN: 35-6024534
    Description Revenue and Expenses per Books Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    EXPENSES        
    CHECKS 26     26


    TY 2012 TaxesSchedule
    Name:
    JASPER SEATING FOUNDATION INC
    C/O JASPER SEATING CO INC
    EIN: 35-6024534
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    STATE TAXES 7     7
    IRS TAXES 1     1