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
DUBOSE FAMILY FOUNDATION
 

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

20-1588677
B Telephone number (see instructions)

(817) 390-2202
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$11,084,771J 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) 1,323,558
2 Check bullet
3 Interest on savings and temporary cash investments 1,993 1,993  
4 Dividends and interest from securities...... 175,814 175,814  
5a Gross rents..............      
b Net rental income or (loss)  
6a Net gain or (loss) from sale of assets not on line 10 27,680
b Gross sales price for all assets on line 6a 27,680
7 Capital gain net income (from Part IV, line 2)... 27,680
8 Net short-term capital gain.........  
9 Income modifications...........  
10a Gross sales less returns and allowances  
b Less: Cost of goods sold....  
c Gross profit or (loss) (attach schedule).....    
11 Other income (attach schedule).......      
12 Total. Add lines 1 through 11........ 1,529,045 205,487  
Operating and Administrative Expenses 13 Compensation of officers, directors, trustees, etc. 48,000 24,000    
14 Other employee salaries and wages......        
15 Pension plans, employee benefits.......        
16a Legal fees (attach schedule).........        
b Accounting fees (attach schedule)....... Click to see attachment 750 375    
c Other professional fees (attach schedule)....        
17 Interest...............        
18 Taxes (attach schedule) (see instructions) Click to see attachment 7,304 2,308    
19 Depreciation (attach schedule) and depletion...      
20 Occupancy..............        
21 Travel, conferences, and meetings.......        
22 Printing and publications..........        
23 Other expenses (attach schedule).......        
24 Total operating and administrative expenses.
Add lines 13 through 23.......... 56,054 26,683   0
25 Contributions, gifts, grants paid........ 413,726 413,726
26 Total expenses and disbursements. Add lines 24 and 25 469,780 26,683   413,726
27 Subtract line 26 from line 12:
a Excess of revenue over expenses and disbursements 1,059,265
b Net investment income (if negative, enter -0-) 178,804
c Adjusted net income (if negative, enter -0-)...  
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............... 3,081,866 3,926,451 3,926,456
2 Savings and temporary cash investments.......... 1,837,810 938,344 938,344
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...........   11,798 11,798
10a Investments—U.S. and state government obligations (attach schedule)      
b Investments—corporate stock (attach schedule)........ 4,851,386 Click to see attachment5,953,784 6,208,173
c Investments—corporate bonds (attach schedule)........      
11 Investments—land, buildings, and equipment: basis bullet  
Less: accumulated depreciation (attach schedule) bullet        
12 Investments—mortgage loans..............      
13 Investments—other (attach schedule)...........      
14 Land, buildings, and equipment: basis bullet  
Less: accumulated depreciation (attach schedule) bullet        
15 Other assets (describe bullet) Click to see attachment50 Click to see attachment0 Click to see attachment0
16 Total assets (to be completed by all filers—see the
instructions. Also, see page 1, item I) 9,771,112 10,830,377 11,084,771
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 9,771,112 10,830,377
30 Total net assets or fund balances (see page 17 of the
instructions).................... 9,771,112 10,830,377
31 Total liabilities and net assets/fund balances (see page 17 of
the instructions).................. 9,771,112 10,830,377
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 9,771,112
2 Enter amount from Part I, line 27a..................... 2 1,059,265
3 Other increases not included in line 2 (itemize) bullet 3  
4 Add lines 1, 2, and 3.......................... 4 10,830,377
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 10,830,377
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 VANGUARD CAPITAL GAIN DISTRIBUTIONS D 2005-01-01 2012-12-31
b
c
d
e
(e) Gross sales price (f) Depreciation allowed
(or allowable) 		(g) Cost or other basis
plus expense of sale 		(h) Gain or (loss)
(e) plus (f) minus (g)
a 27,680 0 0 27,680
b
c
d
e
Complete only for assets showing gain in column (h) and owned by the foundation on 12/31/69 (l) Gains (Col. (h) gain minus
col. (k), but not less than -0-) or
Losses (from col.(h))
(i) F.M.V. as of 12/31/69 (j) Adjusted basis
as of 12/31/69 		(k) Excess of col. (i)
over col. (j), if any
a 0 0 0 27,680
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 27,680
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 346,840 8,494,474 0.040831
2010 345,410 6,410,954 0.053878
2009 502,220 5,275,999 0.095190
2008 414,486 4,778,659 0.086737
2007 261,487 3,739,798 0.069920
2 Total of line 1, column (d) ...................... 2 0.346556
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 0.069311
4 Enter the net value of noncharitable-use assets for 2012 from Part X, line 5..... 4 9,664,412
5 Multiply line 4 by line 3....................... 5 669,850
6 Enter 1% of net investment income (1% of Part I, line 27b)........... 6 1,788
7 Add lines 5 and 6......................... 7 671,638
8 Enter qualifying distributions from Part XII, line 4.............. 8 413,726
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 3,576
hereBulletand enter 1% of Part I, line 27b...................
c All other domestic foundations enter 2% of line 27b. Exempt foreign organizations enter 4% of Part I, line 12, col. (b)
2 Tax under section 511 (domestic section 4947(a)(1) trusts and taxable foundations only. Others enter -0-) 2 0
3 Add lines 1 and 2............................ 3 3,576
4 Subtitle A (income) tax (domestic section 4947(a)(1) trusts and taxable foundations only. Others enter -0-). 4  
5 Tax based on investment income. Subtract line 4 from line 3. If zero or less, enter -0- ..... 5 3,576
6 Credits/Payments:
a 2012 estimated tax payments and 2011 overpayment credited to 2012 6a 11,798
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.............. : -11798 7 11,798
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 8,222
11 Enter the amount of line 10 to be: Credited to 2013 estimated taxBullet8,222 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)
    bulletTX
    b
    If the answer is “Yes” to line 7, has the foundation furnished a copy of Form 990-PF to the Attorney
    General (or designate) of each state as required by General Instruction G? If “No,” attach explanation .
    8b
    Yes
     
    9
    Is the foundation claiming status as a private operating foundation within the meaning of section 4942(j)(3)
    or 4942(j)(5) for calendar year 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 ofbulletANNA ADAMS DUBOSE Telephone no.bullet (817) 390-2202
    Located atbullet2624 WEST FREEWAYFORT WORTHTX ZIP+4bullet76102
    15
    Section 4947(a)(1) nonexempt charitable trusts filing Form 990-PF in lieu of Form 1041.........bullet
    and enter the amount of tax-exempt interest received or accrued during the year ......bullet
    15  
    16
    At any time during calendar year 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
    JAMES S DUBOSE DIRECTOR
    1.00     		0 0 0
    2624 WEST FREEWAY
    FORT WORTH,TX76102
    JAMES E DUBOSE DIRECTOR
    1.00     		0 0 0
    2624 WEST FREEWAY
    FORT WORTH,TX76102
    CHRISTOPHER J KEYLAND DIRECTOR
    1.00     		0 0 0
    2624 WEST FREEWAY
    FORT WORTH,TX76102
    KATHRYN J ROBERTS PRESIDENT
    20.00     		48,000 0 0
    2624 WEST FREEWAY
    FORT WORTH,TX76102
    2 Compensation of five highest-paid employees (other than those included on line 1—see instructions). If none, enter “NONE.”
    (a) Name and address of each employee paid more than $50,000 (b) Title, and average
    hours per week
    devoted to position     		(c) Compensation (d) Contributions to
    employee benefit
    plans and deferred
    compensation     		(e) Expense account,
    other allowances
    NONE
    Total number of other employees paid over $50,000...................bullet 0
    3 Five highest-paid independent contractors for professional services (see instructions). If none, enter "NONE".
    (a) Name and address of each person paid more than $50,000 (b) Type of service (c) Compensation
    NONE
    Total number of others receiving over $50,000 for professional services.............bullet0
    Part IX-A
    Summary of Direct Charitable Activities
    List the foundation’s four largest direct charitable activities during the tax year. Include relevant statistical information such as the number of organizations and other beneficiaries served, conferences convened, research papers produced, etc. Expenses
    1
     
    2  
    3  
    4  
    Form 990-PF (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  
    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
    6,943,990
    b
    Average of monthly cash balances.......................
    1b
    2,867,596
    c
    Fair market value of all other assets (see instructions)................
    1c
    0
    d
    Total (add lines 1a, b, and c).........................
    1d
    9,811,586
    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
    9,811,586
    4
    Cash deemed held for charitable activities. Enter 1 1⁄2% of line 3 (for greater amount, see
    instructions) .............................
    4
    147,174
    5
    Net value of noncharitable-use assets. Subtract line 4 from line 3. Enter here and on Part V, line 4
    5
    9,664,412
    6
    Minimum investment return. Enter 5% of line 5..................
    6
    483,221
    Part XI
    Distributable Amount bullet and do not complete this part.)
    1
    Minimum investment return from Part X, line 6....................
    1
    483,221
    2a
    Tax on investment income for 2012 from Part VI, line 5......
    2a
    3,576
    b
    Income tax for 2012. (This does not include the tax from Part VI.)...
    2b
     
    c
    Add lines 2a and 2b............................
    2c
    3,576
    3
    Distributable amount before adjustments. Subtract line 2c from line 1............
    3
    479,645
    4
    Recoveries of amounts treated as qualifying distributions................
    4
     
    5
    Add lines 3 and 4............................
    5
    479,645
    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
    479,645
    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
    413,726
    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
    413,726
    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
    413,726
    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 7 479,645
    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.......  
    b From 2008....... 142,738
    c From 2009....... 239,675
    d From 2010....... 35,215
    e From 2011.......  
    fTotal of lines 3a through e......... 417,628
    4Qualifying distributions for 2012 from Part
    XII, line 4: bullet$ 413,726
    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..... 413,726
    e Remaining amount distributed out of corpus  
    5 Excess distributions carryover applied to 2012. 65,919 65,919
    (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 5 351,709
    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) ...     		 
    9Excess distributions carryover to 2013.
    Subtract lines 7 and 8 from line 6a ......     		351,709
    10 Analysis of line 9:
    a Excess from 2008.... 76,819
    b Excess from 2009.... 239,675
    c Excess from 2010.... 35,215
    d Excess from 2011....  
    e Excess from 2012....  
    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).)
    NA
    bList any managers of the foundation who own 10% or more of the stock of a corporation (or an equally large portion of the
    ownership of a partnership or other entity) of which the foundation has a 10% or greater interest.
    NA
    2Information Regarding Contribution, Grant, Gift, Loan, Scholarship, etc., Programs:
    Check here bullet
    aThe name, address, and telephone number or e-mail of the person to whom applications should be addressed:
    ANNA ADAMS DUBOSE
    2624 WEST FREEWAY
    FORT WORTH,TX76102
    (817) 390-2202
    bThe form in which applications should be submitted and information and materials they should include:
    WRITTEN REQUEST IN LETTER FORM, PURPOSE OR PROPOSED USE OF GRANT OR DONATION.
    cAny submission deadlines:
    NONE
    dAny restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other
    factors:
    NONE
    Form 990-PF (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
    ACH CHILD AND FAMILY SERVICES
    1424 SUMMIT AVENUE
    FORT WORTH,TX76102     		  PUBLIC TO SUPPORT CHARITABLE ACTIVITY 100
    AGRICULTURAL DEVELOPMENT FUND
    PO BOX 150
    FORT WORTH,TX76101     		  PUBLIC TO SUPPORT CHARITABLE ACTIVITY 100
    AIDS OUTREACH CENTER
    400 NORTH BEACH
    FORT WORTH,TX76111     		  PUBLIC TO SUPPORT CHARITABLE ACTIVITY 1,000
    ALEDO HIGH SCHOOL
    1000 BAILEY RANCH ROAD
    ALEDO,TX76008     		  PUBLIC TO SUPPORT CHARITABLE ACTIVITY 1,680
    AMERICAN CANCER SOCIETY
    2300 WEST FREEWAY
    FORT WORTH,TX76102     		  PUBLIC TO SUPPORT CHARITABLE ACTIVITY 1,000
    AMERICAN HEART ASSOCIATION
    2630 WEST FREEWAY
    FORT WORTH,TX76102     		  PUBLIC TO SUPPORT CHARITABLE ACTIVITY 10,000
    AMERICAN HEART ASSOCIATION
    10060 BUFFALO SPEEDWAY
    HOUSTON,TX77054     		  PUBLIC TO SUPPORT CHARITABLE ACTIVITY 1,000
    AMERICAN RED CROSS - CHISHOLM TRAIL
    1515 S SYLVANIA
    FORT WORTH,TX76111     		  PUBLIC TO SUPPORT CHARITABLE ACTIVITY 1,000
    AMERICAN RED CROSS
    PO BOX 4002018
    DES MOINES,IA50340     		  PUBLIC TO SUPPORT CHARITABLE ACTIVITY 4,000
    AMON CARTER MUSEUM
    3501 CAMP BOWIE BLVD
    FORT WORTH,TX76107     		  PUBLIC TO SUPPORT CHARITABLE ACTIVITY 5,000
    ANGEL FLIGHT
    2550 MIDWAY ROAD
    CARROLLTON,TX75006     		  PUBLIC TO SUPPORT CHARITABLE ACTIVITY 1,000
    ARTHRITIS FOUNDATION
    6080 S HULEN STREET 360
    FORT WORTH,TX76132     		  PUBLIC TO SUPPORT CHARITABLE ACTIVITY 500
    ARTS COUNCIL OF FT WORTH & TARRANT COUNTY
    1300 GENDY STREET
    FORT WORTH,TX76107     		  PUBLIC TO SUPPORT CHARITABLE ACTIVITY 5,250
    ASPEN ANIMAL SHELTER
    101 ANIMAL SHELTER ROAD
    ASPEN,CO81611     		  PUBLIC TO SUPPORT CHARITABLE ACTIVITY 500
    ASPEN COMMUNITY CHURCH
    200 E BLEEKER STREET
    ASPEN,CO81611     		  PUBLIC TO SUPPORT CHARITABLE ACTIVITY 25,000
    ASPEN MUSIC FESTIVAL & SCHOOL
    2 MUSIC SCHOOL ROAD
    ASPEN,CO81611     		  PUBLIC TO SUPPORT CHARITABLE ACTIVITY 3,000
    AUSTIN CHILDREN'S SHELTER
    4800 MANOR ROAD
    AUSTIN,TX78723     		  PUBLIC TO SUPPORT CHARITABLE ACTIVITY 5,000
    AUSTIN HABITAT FOR COMMUNITY
    310 COMAL 100
    AUSTIN,TX78702     		  PUBLIC TO SUPPORT CHARITABLE ACTIVITY 2,000
    AUSTIN PARKS FOUNDATION
    PO BOX 300369
    AUSTIN,TX78703     		  PUBLIC TO SUPPORT CHARITABLE ACTIVITY 1,000
    BOOKSPRING
    PO BOX 143147
    AUSTIN,TX78714     		  PUBLIC TO SUPPORT CHARITABLE ACTIVITY 1,000
    BOYS & GIRLS CLUN OF GREATER FORT WORTH
    3218 BELKNAP
    FORT WORTH,TX76111     		  PUBLIC TO SUPPORT CHARITABLE ACTIVITY 2,800
    CAMP FIRE USA
    2700 MEACHAM ROAD
    FORT WORTH,TX76137     		  PUBLIC TO SUPPORT CHARITABLE ACTIVITY 1,000
    CAPITAL AREA FOOD BANK OF TEXAS
    8201 SOUTH CONGRESS
    AUSTIN,TX78745     		  PUBLIC TO SUPPORT CHARITABLE ACTIVITY 2,000
    CARITAS OF AUSTIN
    PO BOX 1947
    AUSTIN,TX78767     		  PUBLIC TO SUPPORT CHARITABLE ACTIVITY 2,000
    CASA OF TRAVIS COUNTY
    7701 N LAMAR
    AUSTIN,TX78752     		  PUBLIC TO SUPPORT CHARITABLE ACTIVITY 2,000
    CENIKOR FOUNDATION
    2300 WEST FREEWAY
    FORT WORTH,TX76102     		  PUBLIC TO SUPPORT CHARITABLE ACTIVITY 1,000
    CHRISTMAS IN THE STOCKYARDS
    PO BOX 64203
    FORT WORTH,TX76164     		  PUBLIC TO SUPPORT CHARITABLE ACTIVITY 1,000
    CHRISTIAN WOMEN'S JOB CORPS OF GRANBURY
    1310 WEATHERFORD HIGHWAY
    GRANBURY,TX76048     		  PUBLIC TO SUPPORT CHARITABLE ACTIVITY 1,000
    COMMUNITY ENRICHMENT CENTER
    6250 NE LOOP 820
    N RICHLAND HILLS,TX76180     		  PUBLIC TO SUPPORT CHARITABLE ACTIVITY 2,000
    COMMUNITY PARTNERS OF TARRANT COUNTY
    2700 BEN AVENUE
    FORT WORTH,TX76103     		  PUBLIC TO SUPPORT CHARITABLE ACTIVITY 1,000
    DELL CHILDRENS MEDICAL CENTER
    4900 MUELLER
    AUSTIN,TX78752     		  PUBLIC TO SUPPORT CHARITABLE ACTIVITY 2,000
    EASTER SEALS - NORTH TEXAS
    1424 HEMPHILL STREET
    FORT WORTH,TX76104     		  PUBLIC TO SUPPORT CHARITABLE ACTIVITY 3,000
    FERTILE VALLEY MINISTRIES
    2418 MONTERREY STREET
    ARLINGTON,TX76015     		  PUBLIC TO SUPPORT CHARITABLE ACTIVITY 1,000
    FIRST UNITED METHODIST CHURCH
    800 WEST FIFTH STREET
    FORT WORTH,TX76102     		  PUBLIC TO SUPPORT CHARITABLE ACTIVITY 70,000
    FORTRESS YOUTH DEVELOPMENT CENTER
    PO BOX 422
    FORT WORTH,TX76101     		  PUBLIC TO SUPPORT CHARITABLE ACTIVITY 1,500
    COOK CHILDREN'S MEDICAL CENTER
    2309 MONTGOMERY
    FORT WORTH,TX76107     		  PUBLIC TO SUPPORT CHARITABLE ACTIVITY 1,000
    FORT WORTH COUNTRY DAY SCHOOL
    4200 COUNTRY DAY LANE
    FORT WORTH,TX76109     		  PUBLIC TO SUPPORT CHARITABLE ACTIVITY 11,000
    FORT WORTH INDEPENDENT SCHOOL DISTRICT
    1000 N UNIVERSITY DRIVE 260
    FORT WORTH,TX76107     		  PUBLIC TO SUPPORT CHARITABLE ACTIVITY 1,000
    FORT WORTH OPERA
    1300 GENDY STREET
    FORT WORTH,TX76107     		  PUBLIC TO SUPPORT CHARITABLE ACTIVITY 2,000
    FORT WORTH SYMPHONY ORCHESTRA
    PO BOX 2587
    FORT WORTH,TX76113     		  PUBLIC TO SUPPORT CHARITABLE ACTIVITY 3,600
    FORT WORTH ZOO BALL
    1989 COLONIAL PARKWAY
    FORT WORTH,TX76110     		  PUBLIC TO SUPPORT CHARITABLE ACTIVITY 7,500
    GREATER FORT WORTH AREA CIVIC LEADERS ASSOCIATION
    PO BOX 43029
    FORT WORTH,TX76162     		  PUBLIC TO SUPPORT CHARITABLE ACTIVITY 2,500
    HISTORIC SOUTHSIDE
    1606 MISTLETOE BLVD
    FORT WORTH,TX76104     		  PUBLIC TO SUPPORT CHARITABLE ACTIVITY 500
    HONOR COURAGE & COMMITMENT
    13607 NEUTRON ROAD
    DALLAS,TX75244     		  PUBLIC TO SUPPORT CHARITABLE ACTIVITY 1,000
    HOSPICE AUSTIN
    4107 SPICEWOOD SPRINGS ROAD 100
    AUSTIN,TX78759     		  PUBLIC TO SUPPORT CHARITABLE ACTIVITY 2,000
    HUGWORKS
    752 MARY DRIVE
    HURST,TX76053     		  PUBLIC TO SUPPORT CHARITABLE ACTIVITY 2,000
    INDEPENDENCE PASS
    PO BOX 1700
    ASPEN,CO81612     		  PUBLIC TO SUPPORT CHARITABLE ACTIVITY 750
    JUNIOR LEAGUE OF FORT WORTH
    255 BAILEY AVENUE
    FORT WORTH,TX76107     		  PUBLIC TO SUPPORT CHARITABLE ACTIVITY 1,000
    JUNIOR LEAGUE OF AUSTIN
    5416 PARKCREST SUITE 100
    AUSTIN,TX78731     		  PUBLIC TO SUPPORT CHARITABLE ACTIVITY 6,000
    KERA TV
    3000 HARRY HINES BLVD
    DALLAS,TX75201     		  PUBLIC TO SUPPORT CHARITABLE ACTIVITY 1,500
    LEUKEMIA & LYMPHOMA SOCIETY
    1200 SUMMIT AVENUE SUITE 425
    FORT WORTH,TX76102     		  PUBLIC TO SUPPORT CHARITABLE ACTIVITY 500
    LIFEGIFT - SOUTHEAST REGION
    2510 WESTRIDGE STREET
    HOUSTON,TX76107     		  PUBLIC TO SUPPORT CHARITABLE ACTIVITY 2,000
    KIMBELL ART MUSEUM
    3333 CAMP BOWIE BLVD
    FORT WORTH,TX76107     		  PUBLIC TO SUPPORT CHARITABLE ACTIVITY 775
    LONGHORN COUNCIL
    PO BOX 54190
    HURST,TX76054     		  PUBLIC TO SUPPORT CHARITABLE ACTIVITY 2,500
    MANOS DE CRISTO
    4911 HARMON AVENUE
    AUSTIN,TX78751     		  PUBLIC TO SUPPORT CHARITABLE ACTIVITY 1,000
    MARATHON KIDS
    2512 S IH 35 350
    AUSTIN,TX78704     		  PUBLIC TO SUPPORT CHARITABLE ACTIVITY 1,500
    MARCH OF DIMES
    6815 MANHATTAN BLVD SUITE 102
    FORT WORTH,TX76120     		  PUBLIC TO SUPPORT CHARITABLE ACTIVITY 2,500
    MARINE TOYS FOR TOTS
    PO BOX 4002896
    DES MOINES,IA50340     		  PUBLIC TO SUPPORT CHARITABLE ACTIVITY 500
    MEALS ON WHEELS - AUSTIN
    3227 EAST 5TH STREET
    AUSTIN,TX78752     		  PUBLIC TO SUPPORT CHARITABLE ACTIVITY 2,500
    MEALS ON WHEELS OF TARRANT COUNTY
    320 SOUTH FREEWAY
    FORT WORTH,TX76104     		  PUBLIC TO SUPPORT CHARITABLE ACTIVITY 100
    MENTAL HEALTH AMERICA OF TARRANT COUNTY
    3136 WEST 4TH STREET
    FORT WORTH,TX76107     		  PUBLIC TO SUPPORT CHARITABLE ACTIVITY 428
    MOUNTAIN RESCUE - ASPEN
    630 WEST MAIN STREET
    ASPEN,CO81611     		  PUBLIC TO SUPPORT CHARITABLE ACTIVITY 2,500
          0
    PITZER COLLEGE
    1050 N MILLS AVENUE
    CLAREMONT,CA91711     		  PUBLIC TO SUPPORT CHARITABLE ACTIVITY 14,000
    PLANNED PARENTHOOD
    7424 GREENVILLE AVENUE 206
    DALLAS,TX75231     		  PUBLIC TO SUPPORT CHARITABLE ACTIVITY 24,350
    PREGNANCY HELP 4 U
    425 KELLER PARKWAY
    KELLER,TX76248     		  PUBLIC TO SUPPORT CHARITABLE ACTIVITY 400
    RIVERBEND CHRISTIAN SCHOOL
    4214 CAPITAL OF TX HWY
    AUSTIN,TX78746     		  PUBLIC TO SUPPORT CHARITABLE ACTIVITY 1,500
    RIVERBEND CHURCH
    4214 CAPITAL OF TX HWY
    AUSTIN,TX78746     		  PUBLIC TO SUPPORT CHARITABLE ACTIVITY 1,500
    ROCKY TOP THERAPY CENTER
    2300 WEST FREEWAY
    FORT WORTH,TX76102     		  PUBLIC TO SUPPORT CHARITABLE ACTIVITY 1,000
    RONALD MCDONALD HOUSE FORT WORTH
    1004 7TH AVENUE
    FORT WORTH,TX76104     		  PUBLIC TO SUPPORT CHARITABLE ACTIVITY 500
    SAFE HAVEN OF TARRANT COUNTY
    2300 WEST FREEWAY
    FORT WORTH,TX76107     		  PUBLIC TO SUPPORT CHARITABLE ACTIVITY 1,000
    SAFE HAVEN OF TARRANT COUNTY
    8701 W BEDFORD EULESS ROAD 600
    HURST,TX76053     		  PUBLIC TO SUPPORT CHARITABLE ACTIVITY 1,000
    SAFE PLACE
    PO BOX 19454
    AUSTIN,TX78760     		  PUBLIC TO SUPPORT CHARITABLE ACTIVITY 2,000
    SALVATION ARMY
    8787 N STEMMONS FREEWAY SUITE 800
    DALLAS,TX75247     		  PUBLIC TO SUPPORT CHARITABLE ACTIVITY 5,000
    SALVATION ARMY
    PO BOX 2333
    FORT WORTH,TX76113     		  PUBLIC TO SUPPORT CHARITABLE ACTIVITY 2,250
    SALVATION ARMY AUSTIN
    5216 S CONGRESS
    AUSTIN,TX78745     		  PUBLIC TO SUPPORT CHARITABLE ACTIVITY 2,000
    SAMARITAN HOUSE
    929 HEMPHILL
    FORT WORTH,TX76104     		  PUBLIC TO SUPPORT CHARITABLE ACTIVITY 2,000
    SERVICE MEMBERS RELIEF FUND
    1510 CHENNAULT AVENUE
    FORT WORTH,TX76127     		  PUBLIC TO SUPPORT CHARITABLE ACTIVITY 2,000
    SETON FUND
    1201 W 38TH STREET
    AUSTIN,TX78705     		  PUBLIC TO SUPPORT CHARITABLE ACTIVITY 4,000
    SMITHSONIAN INSTITUTION
    PO BOX 96263
    WASHINGTON,DC20090     		  PUBLIC TO SUPPORT CHARITABLE ACTIVITY 200
    STRIPLING MIDDLE SCHOOL
    2100 CLOVER LANE
    FORT WORTH,TX76107     		  PUBLIC TO SUPPORT CHARITABLE ACTIVITY 10,000
    TARRANT AREA FOOD BANK
    PO BOX 11527
    FORT WORTH,TX76110     		  PUBLIC TO SUPPORT CHARITABLE ACTIVITY 1,000
    TEXAS BALLET THEATER
    1540 MALL CIRCLE
    FORT WORTH,TX76116     		  PUBLIC TO SUPPORT CHARITABLE ACTIVITY 5,240
    TEXAS VFW FOUNDATION
    PO BOX 25152
    FORT WORTH,TX76124     		  PUBLIC TO SUPPORT CHARITABLE ACTIVITY 100
    TEXAS ASSOCIATION FOR THE BLIND
    PO BOX 14200
    ARLINGTON,TX76094     		  PUBLIC TO SUPPORT CHARITABLE ACTIVITY 500
    TEXAS WESLEYAN UNIVERSITY
    1201 WESLEYAN
    FORT WORTH,TX76105     		  PUBLIC TO SUPPORT CHARITABLE ACTIVITY 30,000
    TOWN LAKE TRAIL FOUNDATION
    PO BOX 5195
    AUSTIN,TX78763     		  PUBLIC TO SUPPORT CHARITABLE ACTIVITY 20,000
    UNITED COMMUNITY CENTERS
    1200 E MADDOX AVENUE
    FORT WORTH,TX76104     		  PUBLIC TO SUPPORT CHARITABLE ACTIVITY 100
    UNIVERSITY HEALTH SYSTEM FOUNDATION
    4502 MEDICAL DR MS 18
    SAN ANTONIO,TX78229     		  PUBLIC TO SUPPORT CHARITABLE ACTIVITY 5,000
    UNITED WAY
    210 E NINTH STREET
    FORT WORTH,TX76102     		  PUBLIC TO SUPPORT CHARITABLE ACTIVITY 27,503
    UNIVERSITY OF TEXAS
    PO BOX 7727
    AUSTIN,TX78713     		  PUBLIC TO SUPPORT CHARITABLE ACTIVITY 1,000
    UNIVERSITY OF TEXAS
    PO BOX 7458
    AUSTIN,TX78713     		  PUBLIC TO SUPPORT CHARITABLE ACTIVITY 2,000
    VANDERBILT UNIVERSITY
    2301 VANDERBILT PLACE
    NASHVILLE,TN37203     		  PUBLIC TO SUPPORT CHARITABLE ACTIVITY 5,000
    VISITING ORPHANS
    449 METROPLEX DR
    NASHVILLE,TN37211     		  PUBLIC TO SUPPORT CHARITABLE ACTIVITY 1,000
    WARM PLACE
    809 LIPSCOMB
    FORT WORTH,TX76104     		  PUBLIC TO SUPPORT CHARITABLE ACTIVITY 2,500
    WESTAR INSTITUTE
    900 STATE STREET
    SALEM,OR97301     		  PUBLIC TO SUPPORT CHARITABLE ACTIVITY 5,000
    WHOLE KIDS FOUNDATION
    550 BOWIE STREET
    AUSTIN,TX78703     		  PUBLIC TO SUPPORT CHARITABLE ACTIVITY 7,000
    WISH WITH WINGS
    2300 WEST FREEWAY
    FORT WORTH,TX76102     		  PUBLIC TO SUPPORT CHARITABLE ACTIVITY 1,000
    WOMEN'S CENTER
    1723 HEMPHILL
    FORT WORTH,TX76110     		  PUBLIC TO SUPPORT CHARITABLE ACTIVITY 500
    YWCA FORT WORTH & TARRANT COUNTY
    512 W 4TH STREET
    FORT WORTH,TX76102     		  PUBLIC TO SUPPORT CHARITABLE ACTIVITY 1,000
    USO
    PO BOX 96860
    WASHINGTON,DC20077     		  PUBLIC TO SUPPORT CHARITABLE ACTIVITY 1,000
    Total .................................bullet 3a 413,726
    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 1,993  
    4 Dividends and interest from securities....     14 175,814  
    5 Net rental income or (loss) from real estate:
    aDebt-financed property......          
    bNot debt-financed property.....          
    6Net rental income or (loss) from personal property          
    7 Other investment income.....          
    8Gain or (loss) from sales of assets other than inventory     18 27,680  
    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)..   205,487  
    13Total. Add line 12, columns (b), (d), and (e)..................
    13205,487
    (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


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    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
    DUBOSE FAMILY FOUNDATION
     
    Employer identification number

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





    Form 990-PF




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

    Schedule B (Form 990, 990-EZ, or 990-PF) (2012)
    Page 2
    Name of organization
    DUBOSE FAMILY FOUNDATION
          		Employer identification number

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

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

    		$1,323,558


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

         
     
       

    		$  


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

         
     
       

    		$  


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

         
     
       

    		$  


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

         
     
       

    		$  


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

         
     
       

    		$  


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

    Schedule B (Form 990, 990-EZ, or 990-PF) (2012)
    Page 3
    Name of organization
    DUBOSE FAMILY FOUNDATION
          		Employer identification number

    20-1588677
    Part II
    Noncash Property (see instructions). Use duplicate copies of Part II if additional space is needed.
    		     
    (a) No.
    from
    Part I    		 (b)
    Description of noncash property given    		 (c)
    FMV (or estimate)
    (see instructions)     		(d)
    Date received
     
    		$    
    (a) No.
    from
    Part I    		 (b)
    Description of noncash property given    		 (c)
    FMV (or estimate)
    (see instructions)     		(d)
    Date received
     
    		$    
    (a) No.
    from
    Part I    		 (b)
    Description of noncash property given    		 (c)
    FMV (or estimate)
    (see instructions)     		(d)
    Date received
     
    		$    
    (a) No.
    from
    Part I    		 (b)
    Description of noncash property given    		 (c)
    FMV (or estimate)
    (see instructions)     		(d)
    Date received
     
    		$    
    (a) No.
    from
    Part I    		 (b)
    Description of noncash property given    		 (c)
    FMV (or estimate)
    (see instructions)     		(d)
    Date received
     
    		$    
    (a) No.
    from
    Part I    		 (b)
    Description of noncash property given    		 (c)
    FMV (or estimate)
    (see instructions)     		(d)
    Date received
     
    		$    
    Schedule B (Form 990, 990-EZ, or 990-PF) (2012)

    Schedule B (Form 990, 990-EZ, or 990-PF) (2012)
    Page 4
    Name of organization
    DUBOSE FAMILY FOUNDATION
          		Employer identification number

    20-1588677
    Part III
    Exclusively religious, charitable, etc., individual contributions to section 501(c)(7), (8), or (10) organizations
    that total more than $1,000 for the year. Complete columns (a) through (e) and the following line entry.
    For organizations completing Part III, enter the total of exclusively religious, charitable, etc.,
    contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet$  
    Use duplicate copies of Part III if additional space is needed.
    (a) No.
    from
    Part I    		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
     
    (e) Transfer of gift
    Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
     
     
           
     
    (a) No.
    from
    Part I    		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
     
    (e) Transfer of gift
    Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
     
     
           
     
    (a) No.
    from
    Part I    		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
     
    (e) Transfer of gift
    Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
     
     
           
     
    (a) No.
    from
    Part I    		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
     
    (e) Transfer of gift
    Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
     
     
           
     
    Schedule B (Form 990, 990-EZ, or 990-PF) (2012)

    Additional Data


    Software ID:  
    Software Version:  

    TY 2012 AccountingFeesSchedule
    Name:
    DUBOSE FAMILY FOUNDATION
    EIN: 20-1588677
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    JSD/JLD MANA. TAX PREP 750 375    

    TY 2012 AllOthProgRltdInvestmentsSch
    Name:
    DUBOSE FAMILY FOUNDATION
    EIN: 20-1588677
    Category Amount
    NONE  

    TY 2012 InvestmentsCorpStockSchedule
    Name:
    DUBOSE FAMILY FOUNDATION
    EIN: 20-1588677
    Name of Stock End of Year Book Value End of Year Fair Market Value
    VANGUARD HIGH YIELD FUND 399,674 412,309
    VANGUARD INTERMEDIATE TERM FUND 1,030,152 1,184,189
    VANGUARD MIDCAP INDEX FUND 217,289 241,660
    VANGUARD GLOBAL EQUITY FUND 689,107 611,425
    VANGUARD 500 INDEX FUND 543,450 570,457
    VANGUARD SMALL CAP INDEX FUND 218,352 253,806
    VANGUARD WINDSOR FUND 133,099 115,536
    VANGUARD INTERMEDIATE TERM TREASURY FUND ADMIRAL 274,712 292,484
    VANGUARD WINDSOR II FUND 121,584 100,503
    VANGUARD GNMA FUND 1,088,837 1,103,890
    VANGUARD HIGH DIVIDEND YIELD 1,237,528 1,321,914

    TY 2012 OtherAssetsSchedule
    Name:
    DUBOSE FAMILY FOUNDATION
    EIN: 20-1588677
    Description Beginning of Year - Book Value End of Year - Book Value End of Year - Fair Market Value
    ACCRUED INCOME 50    
    ACCRUED INCOME 50    
    ACCRUED INCOME 50    


    TY 2012 OtherAssetsSchedule
    Name:
    DUBOSE FAMILY FOUNDATION
    EIN: 20-1588677
    Description Beginning of Year - Book Value End of Year - Book Value End of Year - Fair Market Value
    ACCRUED INCOME 50    
    ACCRUED INCOME 50    
    ACCRUED INCOME 50    


    TY 2012 OtherAssetsSchedule
    Name:
    DUBOSE FAMILY FOUNDATION
    EIN: 20-1588677
    Description Beginning of Year - Book Value End of Year - Book Value End of Year - Fair Market Value
    ACCRUED INCOME 50    
    ACCRUED INCOME 50    
    ACCRUED INCOME 50    


    TY 2012 TaxesSchedule
    Name:
    DUBOSE FAMILY FOUNDATION
    EIN: 20-1588677
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    FOREIGN TAXES 564 564    
    EXCISE TAXES 3,202      
    PAYROLL TAXES 3,488 1,744    
    OTHER 50