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
CHARLES P & MARGARET E POLK FOUNDATION
 

Number and street (or P.O. box number if mail is not delivered to street address)301 NORTH STREET   Room/suite
City or town, state, and ZIP code
MILLERSBURG, PA17061
A Employer identification number

23-6296772
B Telephone number (see instructions)

(717) 692-2613
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$41,173,621J 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) 8,166
2 Check bullet
3 Interest on savings and temporary cash investments      
4 Dividends and interest from securities...... 809,373 809,373 809,373
5a Gross rents..............      
b Net rental income or (loss)  
6a Net gain or (loss) from sale of assets not on line 10 Click to see attachment 129,232
b Gross sales price for all assets on line 6a 2,996,861
7 Capital gain net income (from Part IV, line 2)... 129,232
8 Net short-term capital gain......... 5,247
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)....... Click to see attachment 2,184,039 266,420 1,917,619
12 Total. Add lines 1 through 11........ 3,130,810 1,205,025 2,732,239
Operating and Administrative Expenses 13 Compensation of officers, directors, trustees, etc. 126,593 12,659   113,934
14 Other employee salaries and wages...... 985,369 51,122   934,247
15 Pension plans, employee benefits....... 173,850 4,931   168,919
16a Legal fees (attach schedule).........        
b Accounting fees (attach schedule)....... 11,376 11,376    
c Other professional fees (attach schedule).... 31,001 27,366   3,635
17 Interest............... 30,128 30,128    
18 Taxes (attach schedule) (see instructions) Click to see attachment 292,942 135,260   157,681
19 Depreciation (attach schedule) and depletion... Click to see attachment 436,030 96,213  
20 Occupancy.............. 406,663 212,029   194,635
21 Travel, conferences, and meetings....... 4,371 530   3,841
22 Printing and publications..........        
23 Other expenses (attach schedule)....... Click to see attachment 614,336 171,564   442,772
24 Total operating and administrative expenses.
Add lines 13 through 23.......... 3,112,659 753,178   2,019,664
25 Contributions, gifts, grants paid........ 5,000 5,000
26 Total expenses and disbursements. Add lines 24 and 25 3,117,659 753,178   2,024,664
27 Subtract line 26 from line 12:
a Excess of revenue over expenses and disbursements 13,151
b Net investment income (if negative, enter -0-) 451,847
c Adjusted net income (if negative, enter -0-)... 2,732,239
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............... -28,409 -39,225 -39,225
2 Savings and temporary cash investments.......... 354,867 223,054 223,054
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........... 3,600 4,000 4,000
10a Investments—U.S. and state government obligations (attach schedule) 438,170 Click to see attachment380,466 393,050
b Investments—corporate stock (attach schedule)........ 12,476,695 Click to see attachment12,928,933 11,569,959
c Investments—corporate bonds (attach schedule)........ 1,269,262 Click to see attachment1,128,796 921,657
11 Investments—land, buildings, and equipment: basis bullet2,872,590
Less: accumulated depreciation (attach schedule) bullet332,632 2,576,644 Click to see attachment2,539,958 2,882,368
12 Investments—mortgage loans..............      
13 Investments—other (attach schedule)...........      
14 Land, buildings, and equipment: basis bullet19,768,060
Less: accumulated depreciation (attach schedule) bullet9,604,316 10,548,149 Click to see attachment10,163,744 25,118,102
15 Other assets (describe bullet) Click to see attachment0 Click to see attachment100,656 Click to see attachment100,656
16 Total assets (to be completed by all filers—see the
instructions. Also, see page 1, item I) 27,638,978 27,430,382 41,173,621
Liabilities 17 Accounts payable and accrued expenses.......... 4,170 16,060
18 Grants payable...................    
19 Deferred revenue..................    
20 Loans from officers, directors, trustees, and other disqualified persons    
21 Mortgages and other notes payable (attach schedule)...... 1,042,193 Click to see attachment808,556
22 Other liabilities (describe bullet)    
23 Total liabilities (add lines 17 through 22).......... 1,046,363 824,616
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 26,592,615 26,605,766
30 Total net assets or fund balances (see page 17 of the
instructions).................... 26,592,615 26,605,766
31 Total liabilities and net assets/fund balances (see page 17 of
the instructions).................. 27,638,978 27,430,382
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 26,592,615
2 Enter amount from Part I, line 27a..................... 2 13,151
3 Other increases not included in line 2 (itemize) bullet 3  
4 Add lines 1, 2, and 3.......................... 4 26,605,766
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 26,605,766
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.)
1 a SHORT TERM STOCK SALES P 2012-01-01 2012-12-31
b LONG TERM STOCK SALES P 2010-01-01 2012-12-31
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 286,252 0 281,005 5,247
b 2,710,609 0 2,586,624 123,985
c
d
e
Complete only for assets showing gain in column (h) and owned by the foundation on 12/31/69 (l) Gains (Col. (h) gain minus
col. (k), but not less than -0-) or
Losses (from col.(h))
(i) F.M.V. as of 12/31/69 (j) Adjusted basis
as of 12/31/69 		(k) Excess of col. (i)
over col. (j), if any
a 0 0 0 5,247
b 0 0 0 123,985
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 2 129,232
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 5,247
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 3,173,019 14,003,064 0.226595
2010 2,037,509 14,594,495 0.139608
2009 2,037,509 14,758,567 0.138056
2008 2,064,263 15,062,990 0.137042
2007 1,986,734 17,669,103 0.112441
2 Total of line 1, column (d) ...................... 2 0.753742
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 0.150748
4 Enter the net value of noncharitable-use assets for 2012 from Part X, line 5..... 4 14,530,018
5 Multiply line 4 by line 3....................... 5 2,190,371
6 Enter 1% of net investment income (1% of Part I, line 27b)........... 6 4,518
7 Add lines 5 and 6......................... 7 2,194,889
8 Enter qualifying distributions from Part XII, line 4.............. 8 2,898,437
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 4,518
hereBulletand enter 1% of Part I, line 27b...................
c All other domestic foundations enter 2% of line 27b. Exempt foreign organizations enter 4% of Part I, line 12, col. (b)
2 Tax under section 511 (domestic section 4947(a)(1) trusts and taxable foundations only. Others enter -0-) 2 0
3 Add lines 1 and 2............................ 3 4,518
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 4,518
6 Credits/Payments:
a 2012 estimated tax payments and 2011 overpayment credited to 2012 6a 4,518
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 4,518
8 Enter any penalty for underpayment of estimated tax. if Form 2220 is attached. 8  
9 Tax due. If the total of lines 5 and 8 is more than line 7, enter amount owed.......Bullet 9  
10 Overpayment. If line 7 is more than the total of lines 5 and 8, enter the amount overpaid...Bullet 10  
11 Enter the amount of line 10 to be: Credited to 2013 estimated taxBullet0 Refunded Bullet 11  
Part VII-A
Statements Regarding Activities
1a
During the tax year, did the foundation attempt to influence any national, state, or local legislation or did
Yes
No
it participate or intervene in any political campaign? ....................
1a
 
No
b
Did it spend more than $100 during the year (either directly or indirectly) for political purposes (see page 19 of
the instructions for definition)?............................
1b
 
No
If the answer is “Yes” to 1a or 1b, attach a detailed description of the activities and copies of any materials
published or distributed by the foundation in connection with the activities.
c
Did the foundation file Form 1120-POL for this year?.....................
1c
 
No
d
Enter the amount (if any) of tax on political expenditures (section 4955) imposed during the year:
(1) On the foundation. bullet$   (2) On foundation managers.bullet$  
e
Enter the reimbursement (if any) paid by the foundation during the year for political expenditure tax imposed
on foundation managers.bullet$  
2
Has the foundation engaged in any activities that have not previously been reported to the IRS?.......
2
 
No
If “Yes,” attach a detailed description of the activities.
3
Has the foundation made any changes, not previously reported to the IRS, in its governing instrument, articles
of incorporation, or bylaws, or other similar instruments? If “Yes,” attach a conformed copy of the changes....
3
 
No
4a
Did the foundation have unrelated business gross income of $1,000 or more during the year?........
4a
 
No
b
If “Yes,” has it filed a tax return on Form 990-T for this year?...................
4b
 
 
5
Was there a liquidation, termination, dissolution, or substantial contraction during the year?.........
5
 
No
If “Yes,” attach the statement required by General Instruction T.
6
Are the requirements of section 508(e) (relating to sections 4941 through 4945) satisfied either:
  • By language in the governing instrument, or
  • By state legislation that effectively amends the governing instrument so that no mandatory directions
    • that conflict with the state law remain in the governing instrument?................
    6
    Yes
     
    7
    Did the foundation have at least $5,000 in assets at any time during the year? If “Yes,” complete Part II, col. (c), and Part XV.
    7
    Yes
     
    8a
    Enter the states to which the foundation reports or with which it is registered (see instructions)
    bulletPA
    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
    Yes
     
    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 ofbulletPOLK FOUNDATION Telephone no.bullet (717) 692-2613
    Located atbullet301 NORTH STMILLERSBURGPA ZIP+4bullet17061
    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
    ROBERT RISSINGER CHAIRMAN
    2.00     		12,000 0 0
    900 MANOR DRIVE
    MILLERSBURG,PA17061
    JUDY PAUL SECRETARY/ADMINISTRA
    40.00     		66,937 6,694 0
    RD1 BOX 85
    KLINGERSTOWN,PA17941
    DAVID HAWLEY TREASURER
    2.00     		12,000 0 0
    575 UNION STREET
    MILLERSBURG,PA17061
    RICHARD IBBERSON BOARD MEMBER
    2.00     		12,000 0 0
    239 MOORE STREET
    MILLERSBURG,PA17061
    J BRUCE WALTER VICE-CHAIRMAN
    2.00     		12,000 0 0
    423 SHAFFER ROAD
    MILLERSBURG,PA17061
    CRYSTAL L ALTLAND ADMINISTRATOR DESIGN
    40.00     		59,656 0 0
    701 KENTUCKY DRIVE
    ELIZABETHVILLE,PA17023
    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
    JILL HOOVER ASST ADMINISTRATOR
    40.00     		62,094 6,209 0
    366 MOORE ST
    MILLERSBURG,PA17061
    RANDY CONFAIR PROPERTY MNG
    40.00     		51,122 5,112 0
    298 NELSON TERRACE
    MILLERSBURG,PA17061
    DANIEL SNYDER MAINT DIR
    40.00     		51,720 0 0
    83 E MAIN ST
    ELIZABETHVILLE,PA17023
    Total number of other employees paid over $50,000...................bullet 3
    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.............bullet0
    Part IX-A
    Summary of Direct Charitable Activities
    List the foundation’s four largest direct charitable activities during the tax year. Include relevant statistical information such as the number of organizations and other beneficiaries served, conferences convened, research papers produced, etc. Expenses
    1 OPERATE AND MAINTAIN LOW-INCOME APARTMENT COMPLEXES ANDAN ASSISTED LIVING PERSONAL CARE FACILITY FOR QUALIFYINGELDERLY PERSONS 2,359,482
    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 OPERATE AND MAINTAIN LOW-INCOME APARTMENT COMPLEXES ANDAN ASSISTED LIVING PERSONAL CARE FACILITY FOR QUALIFYINGELDERLY PERSONS 440,529
    2 MAINTAIN PROPERTY FOR MEDICAL CENTER 174,493
    All other program-related investments. See page 24 of the instructions.
    3 Click to see attachment 143,156
    Total. Add lines 1 through 3..........................bullet758,178
    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
    12,716,070
    b
    Average of monthly cash balances.......................
    1b
    -33,817
    c
    Fair market value of all other assets (see instructions)................
    1c
    2,877,590
    d
    Total (add lines 1a, b, and c).........................
    1d
    15,559,843
    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
    808,556
    3
    Subtract line 2 from line 1d.........................
    3
    14,751,287
    4
    Cash deemed held for charitable activities. Enter 1 1⁄2% of line 3 (for greater amount, see
    instructions) .............................
    4
    221,269
    5
    Net value of noncharitable-use assets. Subtract line 4 from line 3. Enter here and on Part V, line 4
    5
    14,530,018
    6
    Minimum investment return. Enter 5% of line 5..................
    6
    726,501
    Part XI
    Distributable Amount bullet and do not complete this part.)
    1
    Minimum investment return from Part X, line 6....................
    1
     
    2a
    Tax on investment income for 2012 from Part VI, line 5......
    2a
     
    b
    Income tax for 2012. (This does not include the tax from Part VI.)...
    2b
     
    c
    Add lines 2a and 2b............................
    2c
     
    3
    Distributable amount before adjustments. Subtract line 2c from line 1............
    3
     
    4
    Recoveries of amounts treated as qualifying distributions................
    4
     
    5
    Add lines 3 and 4............................
    5
     
    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
     
    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
    2,024,664
    b
    Program-related investments—total from Part IX-B..................
    1b
    758,178
    2
    Amounts paid to acquire assets used (or held for use) directly in carrying out charitable, etc.,
    purposes...............................
    2
    115,595
    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
    2,898,437
    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
    4,518
    6
    Adjusted qualifying distributions. Subtract line 5 from line 4..............
    6
    2,893,919
    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 0
    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....... 1,986,734
    b From 2008....... 2,064,263
    c From 2009....... 2,014,261
    d From 2010....... 2,040,802
    e From 2011....... 3,176,737
    fTotal of lines 3a through e......... 11,282,797
    4Qualifying distributions for 2012 from Part
    XII, line 4: bullet$ 2,898,437
    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.....  
    e Remaining amount distributed out of corpus 2,898,437
    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 14,181,234
    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) ...     		1,986,734
    9Excess distributions carryover to 2013.
    Subtract lines 7 and 8 from line 6a ......     		12,194,500
    10 Analysis of line 9:
    a Excess from 2008.... 2,064,263
    b Excess from 2009.... 2,014,261
    c Excess from 2010.... 2,040,802
    d Excess from 2011.... 3,176,737
    e Excess from 2012.... 2,898,437
    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
    726,501 700,153 729,725 737,928 2,894,307
    b 85% of line 2a ......... 617,526 595,130 620,266 627,239 2,460,161
    c Qualifying distributions from Part XII,
    line 4 for each year listed .....     		2,898,437 3,176,737 2,040,802 2,014,261 10,130,237
    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 ....     		2,898,437 3,176,737 2,040,802 2,014,261 10,130,237
    3 Complete 3a, b, or c for the
    alternative test relied upon:
    a “Assets” alternative test—enter:
    (1) Value of all assets ......         0
    (2) Value of assets qualifying
    under section 4942(j)(3)(B)(i)    		         0
    b “Endowment” alternative test— enter 2⁄3
    of minimum investment return shown in
    Part X, line 6 for each year listed...     		484,336 466,769 486,483 491,952 1,929,540
    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) ....     		        0
    (2) Support from general public
    and 5 or more exempt
    organizations as provided in
    section 4942(j)(3)(B)(iii)....     		        0
    (3) Largest amount of support
    from an exempt organization    		         0
    (4) Gross investment income         0
    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 of the person to whom applications should be addressed:
    bThe form in which applications should be submitted and information and materials they should include:
    cAny submission deadlines:
    dAny restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other
    factors:
    Form 990-PF (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
    MILLERSBURG FIRE CO
    325 CENTER ST PO BOX 151
    MILLERSBURG,PA17061     		  PUBLIC VOLUNTARY DONATION 5,000
    Total .................................bullet 3a 5,000
    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
    aLOW INCOME HOUSING RENTS         544,928
    bPERSONAL CARE CENTER ROOM AND BOARD         1,285,616
    cPERSONAL CARE SERVICES         86,706
    dMEDICAL CENTER RENTAL         264,816
    eMISC         1,973
    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....         809,373
    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         129,232
    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)..     3,122,644
    13Total. Add line 12, columns (b), (d), and (e)..................
    133,122,644
    (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.)
    1A PRODUCES REVENUES TO PAY FOR EXPENSES OF OPERATING LOW-RENTAL HOUSING
    1B PRODUCES REVENUES TO PAY FOR EXPENSES OF OPERATING ELDERLY CARE FACILITY
    1C PRODUCES REVENUES TO PAY FOR EXPENSES IN THE SUPPORT OF QUALITY ELDER CARE
    1D PRODUCES REVENUES TO PAY FOR EXPENSES IN THE SUPPORT OF QUALITY ELDER & MEDICAL CARE
    1E MISCELLANEOUS UNRESTRICTED INCOME RELATED TO OPERATIONS
    3 PRODUCES REVENUES FOR THE OPERATION AND FUTURE CONSTRUCTION OF NEW FACILITIES
    4 PRODUCES REVENUES FOR THE OPERATION AND FUTURE CONSTRUCTION OF NEW FACILITIES
    8 PRODUCES REVENUES FOR THE OPERATION AND FUTURE CONSTRUCTION OF NEW FACILITIES
    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
    Schedule B
    (Form 990, 990-EZ,
    or 990-PF)
    Department of the Treasury
    Internal Revenue Service
    Schedule of Contributors
    Arrow Bullet Attach to Form 990, 990-EZ, or 990-PF.
    OMB No. 1545-0047
    2012
    Name of the organization
    CHARLES P & MARGARET E POLK FOUNDATION
     
    Employer identification number

    23-6296772
    Organization type (check one):
    Filers of:
    Section:
    Form 990 or 990-EZ





    Form 990-PF




    Check if your organization is covered by the General Rule or a Special Rule.  
    Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.
    General Rule
    Special Rules
    ......................... Arrow Bullet   $    
    Caution. An organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990,
    990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2 of its Form 990; or check the box on line H of its
    Form 990-EZ or on Part I, line 2 of its Form 990-PF, to certify that it does not meet the filing requirements of Schedule B (Form 990,
    990-EZ, or 990-PF).
    For Paperwork Reduction Act Notice, see the Instructions
    for Form 990, 990-EZ, or 990-PF.
    Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2012)

    Schedule B (Form 990, 990-EZ, or 990-PF) (2012)
    Page 2
    Name of organization
    CHARLES P & MARGARET E POLK FOUNDATION
          		Employer identification number

    23-6296772
    Part I
    Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
    		     
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Total contributions    		 (d)
    Type of contribution
    1
    THE ALLEN SHAFFER ESTATE CO SUSQUEHANNA TRUST
     

         
    48 ORCHARD DR
       
    SHAMOKIN DAM, PA   17876

    		$5,066


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

         
     
       

    		$  


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

         
     
       

    		$  


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

         
     
       

    		$  


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

         
     
       

    		$  


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

         
     
       

    		$  


    (Complete Part II if there is a noncash contribution.)
    Schedule B (Form 990, 990-EZ, or 990-PF) (2012)

    Schedule B (Form 990, 990-EZ, or 990-PF) (2012)
    Page 3
    Name of organization
    CHARLES P & MARGARET E POLK FOUNDATION
          		Employer identification number

    23-6296772
    Part II
    Noncash Property (see instructions). Use duplicate copies of Part II if additional space is needed.
    		     
    (a) No.
    from
    Part I    		 (b)
    Description of noncash property given    		 (c)
    FMV (or estimate)
    (see instructions)     		(d)
    Date received
     
    		$    
    (a) No.
    from
    Part I    		 (b)
    Description of noncash property given    		 (c)
    FMV (or estimate)
    (see instructions)     		(d)
    Date received
     
    		$    
    (a) No.
    from
    Part I    		 (b)
    Description of noncash property given    		 (c)
    FMV (or estimate)
    (see instructions)     		(d)
    Date received
     
    		$    
    (a) No.
    from
    Part I    		 (b)
    Description of noncash property given    		 (c)
    FMV (or estimate)
    (see instructions)     		(d)
    Date received
     
    		$    
    (a) No.
    from
    Part I    		 (b)
    Description of noncash property given    		 (c)
    FMV (or estimate)
    (see instructions)     		(d)
    Date received
     
    		$    
    (a) No.
    from
    Part I    		 (b)
    Description of noncash property given    		 (c)
    FMV (or estimate)
    (see instructions)     		(d)
    Date received
     
    		$    
    Schedule B (Form 990, 990-EZ, or 990-PF) (2012)

    Schedule B (Form 990, 990-EZ, or 990-PF) (2012)
    Page 4
    Name of organization
    CHARLES P & MARGARET E POLK FOUNDATION
          		Employer identification number

    23-6296772
    Part III
    Exclusively religious, charitable, etc., individual contributions to section 501(c)(7), (8), or (10) organizations
    that total more than $1,000 for the year. Complete columns (a) through (e) and the following line entry.
    For organizations completing Part III, enter the total of exclusively religious, charitable, etc.,
    contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet$  
    Use duplicate copies of Part III if additional space is needed.
    (a) No.
    from
    Part I    		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
     
    (e) Transfer of gift
    Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
     
     
           
     
    (a) No.
    from
    Part I    		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
     
    (e) Transfer of gift
    Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
     
     
           
     
    (a) No.
    from
    Part I    		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
     
    (e) Transfer of gift
    Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
     
     
           
     
    (a) No.
    from
    Part I    		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
     
    (e) Transfer of gift
    Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
     
     
           
     
    Schedule B (Form 990, 990-EZ, or 990-PF) (2012)

    Additional Data


    Software ID:  
    Software Version:  

    TY 2012 AllOthProgRltdInvestmentsSch
    Name:
    CHARLES P & MARGARET E POLK FOUNDATION
    EIN: 23-6296772
    Category Amount
    ADMINISTRATION EXPENSES 143,156

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

    TY 2012 DepreciationSchedule
    Name:
    CHARLES P & MARGARET E POLK FOUNDATION
    EIN: 23-6296772
    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
    ROOF REPAIRS 2000-07-31 43,295 14,731 SL 39.00 1,037      
    LANDSCAPING 2000-10-31 7,500 7,500 200DB 5.00        
    FLOORING AND PAINTING 2000-10-31 7,980 7,980 200DB 5.00        
    LANDSCAPING 2000-10-31 7,500 7,500 200DB 5.00        
    FLOORING AND PAINTING 2000-10-31 70,655 70,655 200DB 5.00        
    ROOF REPAIRS 2000-07-31 47,700 16,234 SL 39.00 1,142      
    LANDSCAPING 2000-10-31 7,500 7,500 200DB 5.00        
    FLOORING AND PAINTING 2000-10-31 2,265 2,265 200DB 5.00        
    ROOF REPAIRS 2002-02-11 14,779 14,779 200DB 5.00        
    FLOORING AND PAINTING 2000-10-31 8,337 8,337 200DB 5.00        
    LANDSCAPING 2001-06-30 2,839 2,839 200DB 5.00        
    LIGHTING IMPROVEMENTS 2001-07-23 1,687 1,687 200DB 5.00        
    MISC EQUIPMENT 2000-06-30 13,885 13,885 200DB 5.00        
    VEHICLE 2000-06-30 10,708 10,708 200DB 5.00        
    OFFICE EQUIPMENT 2000-06-30 17,175 17,175 200DB 5.00        
    COMPUTER EQUIPMENT 2002-09-27 5,668 5,668 200DB 5.00        
    CARPETING 2001-12-21 1,256 1,256 200DB 5.00        
    APPLIANCES 2000-06-30 1,061 1,061 200DB 5.00        
    PAPERING AND PAINTING 2001-03-23 11,346 11,346 200DB 5.00        
    CARPETING 2001-05-18 2,215 2,215 200DB 5.00        
    CARPETING 2001-12-21 1,910 1,910 200DB 5.00        
    INCLINATOR 2001-05-10 4,450 4,450 200DB 5.00        
    OFFICE FURNITURE 2001-02-02 25,213 25,213 200DB 5.00        
    FURNITURE 2001-06-30 20,785 20,785 200DB 5.00        
    OUTSIDE PORCH FURNITURE 2001-06-30 16,290 16,290 200DB 5.00        
    GLASS DINING ROOM TABLES 2001-09-07 5,170 5,170 200DB 5.00        
    KITCHEN EQUIPMENT 2001-09-13 1,415 1,415 200DB 5.00        
    PORTABLE SOUND SYSTEM 2001-09-21 1,187 1,187 200DB 5.00        
    PIANO 2001-10-08 10,297 10,297 200DB 5.00        
    COMPUTER 2001-11-13 1,508 1,508 SL 3.00        
    300 MOORE ST 1983-06-30 923,080 746,068 SL 40.00 23,077      
    CARPETING AND FLOORING 1996-06-30 7,624 7,621 SL 10.00        
    LANDSCAPING 1996-06-30 6,672 6,671 SL 10.00        
    CARPETING AND FLOORING 1997-06-30 4,732 4,731 SL 10.00        
    INCLINATOR 1997-06-30 1,800 1,800 SL 10.00        
    PAINTING AND IMPROVEMENTS 1997-06-30 7,372 7,120 SL 15.00 246      
    IMPROVEMENTS AND REMODELING 1998-06-30 107,278 96,552 SL 15.00 7,152      
    CARPETING AND FLOORING 1998-06-30 12,559 12,559 SL 10.00        
    INCLINATORS AND ELEVATORS 1998-06-30 16,480 16,480 SL 10.00        
    LANDSCAPING 1998-06-30 1,909 1,909 SL 10.00        
    INCLINATORS AND ELEVATORS 1999-04-21 11,330 11,330 SL 10.00        
    401-403 MOORE ST 1985-06-30 990,472 990,472 SL 15.00        
    CARPET 1993-06-30 2,168 2,168 SL 10.00        
    GARAGE AND GAZEBO 1994-06-30 39,938 17,468 SL 40.00 998      
    FENCING 1994-06-30 2,940 2,940 SL 10.00        
    CARPETING 1994-06-30 7,959 7,959 SL 10.00        
    ROOF 1995-06-30 6,488 2,674 SL 40.00 162      
    FLOORING 1995-06-30 8,551 8,551 SL 7.00        
    FENCING 1997-06-30 680 680 SL 10.00        
    IMPROVEMENTS 1997-06-30 9,723 9,397 SL 15.00 324      
    FLOORING AND CARPETING 1998-06-30 7,206 7,206 SL 10.00        
    PLUMBING 1998-06-30 1,151 1,151 SL 10.00        
    IMPROVEMENTS 1999-07-20 35,253 29,179 SL 15.00 2,350      
    CARPETING 1999-11-04 4,476 4,476 SL 7.00        
    ROOF MAINTENANCE 1999-11-12 3,950 3,200 SL 15.00 263      
    IMPROVEMENTS 2001-06-30 4,934 1,297 SL 40.00 123      
    401 CENTER STREET 1987-06-30 379,408 379,408 SL 15.00        
    BUILDING 401 CENTER 1989-06-30 899,051 899,051 SL 15.00        
    ELEVATOR 1989-06-30 38,000 38,000 SL 10.00        
    BUILDING 401 CENTER 1990-06-30 266,675 266,675 SL 15.00        
    RENOVATIONS 1992-06-30 21,590 21,590 SL 15.00        
    RENOVATIONS/KITCHEN 1993-06-30 30,148 30,148 SL 15.00        
    ROOF 1993-06-30 16,035 16,035 SL 15.00        
    FLOORING 1998-06-30 1,445 1,445 SL 10.00        
    CARPETING 1999-01-18 4,746 4,746 SL 7.00        
    IMPROVEMENTS 2001-06-30 17,090 4,501 SL 40.00 427      
    ROOF 2001-05-30 25,020 6,651 SL 40.00 626      
    423-425 RACE AND NORTH BUILDING 1998-08-01 194,444 65,624 SL 40.00 4,861      
    FLOORING 1998-08-01 2,112 2,112 SL 10.00        
    PERSONAL CARE BUILDING 2000-04-30 5,597,139 1,565,521 SL 40.00 139,928      
    FURNITURE 1990-06-30 9,232 9,232 SL 7.00        
    TELEPHONE SYSTEM 1991-06-30 2,500 2,500 SL 7.00        
    COPIER 1991-06-30 1,833 1,833 SL 7.00        
    SNOWBLOWER 1991-06-30 1,413 1,413 SL 7.00        
    MISC EQUIPMENT 1991-06-30 2,780 2,780 SL 7.00        
    MISC EQUIPMENT 1992-06-30 4,083 4,083 SL 7.00        
    APPLIANCES 1993-06-30 6,564 6,564 SL 7.00        
    SNOWBLOWERS-3 1994-06-30 2,920 2,920 SL 7.00        
    OFFICE FURNITURE 1994-06-30 474 474 SL 7.00        
    APPLIANCES 1995-06-30 13,053 13,053 SL 7.00        
    APPLIANCES 1996-06-30 5,870 5,870 SL 7.00        
    LAWN MOWER 1996-06-30 2,150 2,150 SL 7.00        
    FIRE EXTINGUISHERS 1996-06-30 509 509 SL 7.00        
    CURB STOPS 1996-06-30 418 418 SL 7.00        
    STAIRCHAIR 1997-06-30 9,148 9,148 SL 7.00        
    MISC EQUIP 1997-06-30 851 851 SL 7.00        
    MISC EQUIP 1998-06-30 551 551 SL 7.00        
    OFFICE FURNITURE 1998-06-30 2,681 2,681 SL 7.00        
    COMPUTER SYSTEMS 1998-06-30 15,450 15,450 SL 5.00        
    APPLIANCES 1983-06-30 9,900 9,900 SL 10.00        
    GENERATOR 1983-06-30 5,000 5,000 SL 10.00        
    TABLES AND CHAIRS 1983-06-30 911 911 SL 10.00        
    APPLIANCES 1993-06-30 430 430 SL 7.00        
    WATER HEATERS/APPLIANCES 1998-06-30 5,206 5,206 SL 7.00        
    APPLIANCES 1985-06-30 24,960 24,960 SL 10.00        
    SOCIAL ROOM FURNITURE 1988-06-30 1,033 1,033 SL 10.00        
    FURNITURE 1993-06-30 2,266 2,266 SL 10.00        
    APPLIANCES 1994-06-30 4,056 4,056 SL 7.00        
    SIMPLEX TIME RECORDER CO 1999-06-18 1,983 1,982 SL 7.00        
    INCLINATORS/ELEVATORS 1999-10-22 3,980 3,980 SL 7.00        
    APPLIANCES 1987-06-30 10,004 10,004 SL 10.00        
    APPLIANCES 1989-06-30 16,500 16,500 SL 10.00        
    APPLIANCES 1993-06-30 869 869 SL 10.00        
    TABLES AND CHAIRS 1993-06-30 4,601 4,601 SL 10.00        
    APPLIANCES 1998-06-30 668 666 SL 7.00        
    FURNITURE 1998-06-30 251 251 SL 7.00        
    APPLIANCES 1998-08-01 279 279 SL 7.00        
    FURNISHINGS AND EQUIPMENT 2000-06-30 1,157,076 1,157,076 SL 7.00        
    BUILDING 365 NORTH 1999-08-01 91,531 28,409 SL 40.00 2,288      
    BUILDING 330 MOORE ST 1999-09-01 4,500 1,394 SL 40.00 113      
    CARPETING 1999-09-01 2,019 2,019 SL 5.00        
    BUILDING 336 MOORE ST 1999-10-01 143,612 43,978 SL 40.00 3,590      
    CARPETING 1999-10-01 7,823 7,823 SL 5.00        
    SHED AND GARAGE DEMO 1999-10-01 2,000 613 SL 40.00 50      
    BUILDING 338 MOORE 1999-10-01 67,101 20,555 SL 40.00 1,678      
    CARPETING 1999-10-01 4,480 4,480 SL 5.00        
    BUILDING 364 MOORE STREET 2000-06-30 56,437 16,285 SL 40.00 1,411      
    BUILDING 366 MOORE ST 2000-06-30 62,028 17,901 SL 40.00 1,551      
    BUILDING 372 MOORE ST 2000-05-23 85,497 24,843 SL 40.00 2,137      
    BUILDING 427-429 RACE STREET 2000-10-06 153,245 42,939 SL 40.00 3,831      
    BUILDING RACE ST HANDY MKT 2000-06-30 85,708 24,734 SL 40.00 2,143      
    WALKWAY 2001-05-31 7,100 1,891 SL 40.00 178      
    STORE FIXTURES AND EQUIPMENT 2000-06-30 21,426 21,426 SL 5.00        
    IMPROVEMENTS 2003-01-20 13,289 2,961 SL 40.00 332      
    TRUCK 2003-04-09 4,931 4,931 SL 7.00        
    CHAIRS 2003-05-29 3,780 3,780 SL 7.00        
    COMPUTER-MIS 2003-10-15 3,540 3,540 SL 3.00        
    358 MOORE ST 2003-12-01 94,959 19,454 SL 40.00 2,374      
    342-354 MOORE STREET 2003-12-01 210,421 43,036 SL 40.00 5,261      
    FIREPROOF SAFE 2004-12-15 1,600 1,600 SL 7.00        
    FURNITURE AND EQUIPMENT 2004-01-01 506,191 506,191 SL 7.00        
    445 CENTER STREET 2004-04-01 65,904 12,772 SL 40.00 1,648      
    FURNACE FOR 445 CENTER STREET 2004-03-18 3,950 3,948 SL 7.00        
    ROOF FOR 401-403 MOORE STREET 2004-12-22 28,228 13,174 SL 15.00 1,882      
    PPC BUILDING IMPROVEMENTS 2002-01-01 6,791,051 1,405,877 SL 40.00 169,776      
    PPC BUILDING RENOVATIONS 2004-12-31 57,060 9,989 SL 40.00 1,427      
    PPC PHASE 2 IMPROVEMENTS 2003-12-01 442,463 108,512 SL 40.00 11,062      
    LAND-MEDICAL ROAD 2000-02-01 547,548   NA 0.00        
    SNOWBLOWER 1996-06-30 1,562 1,562 SL 7.00        
    ELEVATOR 1985-06-30 42,794 42,794 SL 10.00        
    PAVING 1985-06-30 5,870 5,870 SL 10.00        
    COMPUTER - MIS 2005-01-17 4,582 4,580 SL 5.00        
    NEW VEHICLE 2005-09-13 14,414 13,040 SL 7.00 1,374      
    AIR CONDITIONER 2005-09-26 7,930 7,081 SL 7.00 849      
    NEW ROOF - 338 MOORE 2005-11-03 4,754 1,955 SL 15.00 317      
    OFFICE REMODEL 2005-04-05 27,493 4,637 SL 40.00 687      
    REPLACEMENT WINDOWS 2006-10-09 70,200 24,570 SL 15.00 4,680      
    REPLACEMENT WINDOWS 2006-10-29 67,500 23,250 SL 15.00 4,500      
    ROOF REPLACEMENT-445 CENTER ST 2007-04-04 18,535 5,562 SL 15.00 1,236      
    FREDERICK CENTER-LAND ONLY 2007-01-01 989,881   NA 0.00        
    FREDERICK CENTER IMPROVEMENTS 2007-03-19 11,704 1,391 SL 40.00 293      
    NEW VEHICLE 2008-11-13 2,258 1,023 SL 7.00 323      
    BOILER-FRED CENTER 2008-07-07 7,567 3,784 SL 7.00 1,081      
    FREDERICK REMODEL 2008-07-18 16,900 1,445 SL 40.00 423      
    FREDERICK REMODEL 2010 2010-12-01 99,170 2,686 SL 40.00 2,479      
    FREDERICK REMODEL 2011 2011-07-01 48,721 609 SL 40.00 1,218      
    FREDERICK CHILLER UNIT 2011-07-01 46,138 3,296 SL 7.00 6,591      
    GENERATOR 2011-10-12 142,659 3,566 SL 10.00 14,266      
    CARPETING 2012-10-30 3,739   SL 5.00 125      
    REPAVING 2012-06-22 5,450   SL 40.00 68      
    REPAVING 2012-06-22 5,750   SL 40.00 72      

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    TY 2012 GainLossSaleOtherAssetsSch
    Name:
    CHARLES P & MARGARET E POLK FOUNDATION
    EIN: 23-6296772
    Name Date Acquired How Acquired Date Sold Purchaser Name Gross Sales Price Basis Basis Method Sales Expenses Total (net) Accumulated Depreciation
    SHORT TERM STOCK SALES   Purchased     286,252 281,005     5,247  
    LONG TERM STOCK SALES   Purchased     2,710,609 2,586,624     123,985  

    TY 2012 InvestmentsCorpBondsSchedule
    Name:
    CHARLES P & MARGARET E POLK FOUNDATION
    EIN: 23-6296772
    Name of Bond End of Year Book Value End of Year Fair Market Value
    CORPORATE BONDS 1,128,796 921,657

    TY 2012 InvestmentsCorpStockSchedule
    Name:
    CHARLES P & MARGARET E POLK FOUNDATION
    EIN: 23-6296772
    Name of Stock End of Year Book Value End of Year Fair Market Value
    US 12,697,061 11,321,122
    FOREIGN 231,872 248,837

    TY 2012 InvestmentsGovtObligationsSch
    Name:
    CHARLES P & MARGARET E POLK FOUNDATION
    EIN: 23-6296772
    US Government Securities - End of Year Book Value:

    380,466
    US Government Securities - End of Year Fair Market Value:

    393,050
    State & Local Government Securities - End of Year Book Value:


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


     


    TY 2012 InvestmentsLandSchedule2
    Name:
    CHARLES P & MARGARET E POLK FOUNDATION
    EIN: 23-6296772
    Category/ Item Cost/Other Basis Accumulated Depreciation Book Value End of Year Fair Market Value
    LAND AND BLDS - RENTED 2,325,042 332,632 1,992,410  
    LAND AND BLDS - NOT RENTED 547,548   547,548  

    TY 2012 LandEtcSchedule2
    Name:
    CHARLES P & MARGARET E POLK FOUNDATION
    EIN: 23-6296772
    Category / Item Cost / Other Basis Accumulated Depreciation Book Value End of Year Fair Market Value
    BLDGS AND EQUIPMENT 19,768,060 9,604,316 10,163,744  


    TY 2012 MortgagesAndNotesPayableSch 
    Name:
    CHARLES P & MARGARET E POLK FOUNDATION
    EIN: 23-6296772
    Total Mortgage Amount: 808556


    TY 2012 OtherAssetsSchedule
    Name:
    CHARLES P & MARGARET E POLK FOUNDATION
    EIN: 23-6296772
    Description Beginning of Year - Book Value End of Year - Book Value End of Year - Fair Market Value
    CONSTRUCTION IN PROCESS   100,656 100,656
    CONSTRUCTION IN PROCESS   100,656 100,656
    CONSTRUCTION IN PROCESS   100,656 100,656


    TY 2012 OtherAssetsSchedule
    Name:
    CHARLES P & MARGARET E POLK FOUNDATION
    EIN: 23-6296772
    Description Beginning of Year - Book Value End of Year - Book Value End of Year - Fair Market Value
    CONSTRUCTION IN PROCESS   100,656 100,656
    CONSTRUCTION IN PROCESS   100,656 100,656
    CONSTRUCTION IN PROCESS   100,656 100,656


    TY 2012 OtherAssetsSchedule
    Name:
    CHARLES P & MARGARET E POLK FOUNDATION
    EIN: 23-6296772
    Description Beginning of Year - Book Value End of Year - Book Value End of Year - Fair Market Value
    CONSTRUCTION IN PROCESS   100,656 100,656
    CONSTRUCTION IN PROCESS   100,656 100,656
    CONSTRUCTION IN PROCESS   100,656 100,656


    TY 2012 OtherExpensesSchedule
    Name:
    CHARLES P & MARGARET E POLK FOUNDATION
    EIN: 23-6296772
    Description Revenue and Expenses per Books Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    INSURANCE 96,608 9,125   87,483
    REPAIRS AND MAINT 249,889 94,933   154,957
    SUPPLIES 24,854 3,551   21,303
    INSPECTIONS AND PERMITS 15 15    
    DIRECTOR FEES 48,000 48,000    
    OFFICE EXPENSE 11,354 1,284   10,070
    DUES AND SUBSCRIPTIONS 759 547   212
    FOOD FOR RESIDENTS 109,623     109,623
    EQUIPMENT CONTRACTS 38,589 11,941   26,648
    ADVERTISING 15,795 452   15,342
    TELEPHONE 11,613 1,716   9,897
    PERSONAL CARE SERVICES 3,943     3,943
    BUILDING DECOR 2,031     2,031
    RESIDENT ACTIVITY 1,263     1,263


    TY 2012 OtherIncomeSchedule2
    Name:
    CHARLES P & MARGARET E POLK FOUNDATION
    EIN: 23-6296772
    Description Revenue And Expenses Per Books Net Investment Income Adjusted Net Income
    PERSONAL CARE CENTER ROOM AND BOARD 1,285,616   1,285,616
    LOW INCOME HOUSING RENTS 544,928   544,928
    PERSONAL CARE SERVICES 86,706   86,706
    MEDICAL CENTER RENTAL 264,816 264,816  
    MISC 1,973 1,604 369


    TY 2012 TaxesSchedule
    Name:
    CHARLES P & MARGARET E POLK FOUNDATION
    EIN: 23-6296772
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    REAL ESTATE 195,428 126,385   69,043
    PAYROLL TAX 93,796 5,157   88,638
    INVESTMENT INCOME TAX 3,718 3,718