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

31-1678303
B Telephone number (see instructions)

(919) 604-0842
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$19,028,577J 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) 0
2 Check bullet
3 Interest on savings and temporary cash investments      
4 Dividends and interest from securities...... 301,219 301,219  
5a Gross rents.............. 398,489 398,489  
b Net rental income or (loss) 372,271
6a Net gain or (loss) from sale of assets not on line 10 93,421
b Gross sales price for all assets on line 6a 853,428
7 Capital gain net income (from Part IV, line 2)... 93,421
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........ 793,129 793,129  
Operating and Administrative Expenses 13 Compensation of officers, directors, trustees, etc. 136,500     136,500
14 Other employee salaries and wages......        
15 Pension plans, employee benefits.......        
16a Legal fees (attach schedule).........        
b Accounting fees (attach schedule)....... Click to see attachment 6,500 3,250 0 3,250
c Other professional fees (attach schedule).... Click to see attachment 62,598 62,598    
17 Interest...............        
18 Taxes (attach schedule) (see instructions) Click to see attachment 16,540 2,570    
19 Depreciation (attach schedule) and depletion...      
20 Occupancy..............        
21 Travel, conferences, and meetings....... 21,420     21,420
22 Printing and publications.......... 79     79
23 Other expenses (attach schedule)....... Click to see attachment 26,514 26,218   296
24 Total operating and administrative expenses.
Add lines 13 through 23.......... 270,151 94,636 0 161,545
25 Contributions, gifts, grants paid........ 742,953 742,953
26 Total expenses and disbursements. Add lines 24 and 25 1,013,104 94,636 0 904,498
27 Subtract line 26 from line 12:
a Excess of revenue over expenses and disbursements -219,975
b Net investment income (if negative, enter -0-) 698,493
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...............      
2 Savings and temporary cash investments.......... 2,078,256 406,499 406,499
3 Accounts receivable bullet  
Less: allowance for doubtful accounts bullet        
4 Pledges receivable bullet  
Less: allowance for doubtful accounts bullet        
5 Grants receivable.................      
6 Receivables due from officers, directors, trustees, and other
disqualified persons (attach schedule) (see page 15 of the
instructions)....................      
7 Other notes and loans receivable (attach schedule) bullet  
Less: allowance for doubtful accounts bullet        
8 Inventories for sale or use...............      
9 Prepaid expenses and deferred charges...........      
10a Investments—U.S. and state government obligations (attach schedule)      
b Investments—corporate stock (attach schedule)........ 8,279,519 Click to see attachment9,804,741 12,673,372
c Investments—corporate bonds (attach schedule)........ 251,045 Click to see attachment176,045 198,706
11 Investments—land, buildings, and equipment: basis bullet5,750,000
Less: accumulated depreciation (attach schedule) bullet   5,750,000 5,750,000 5,750,000
12 Investments—mortgage loans..............      
13 Investments—other (attach schedule)...........      
14 Land, buildings, and equipment: basis bullet1,789
Less: accumulated depreciation (attach schedule) bullet1,789      
15 Other assets (describe bullet)      
16 Total assets (to be completed by all filers—see the
instructions. Also, see page 1, item I) 16,358,820 16,137,285 19,028,577
Liabilities 17 Accounts payable and accrued expenses.......... 3,930 2,370
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).......... 3,930 2,370
Net Assets or Fund Balances bullet
and complete lines 24 through 26 and lines 30 and 31.
24 Unrestricted....................    
25 Temporarily restricted................    
26 Permanently restricted................    
bullet
and complete lines 27 through 31.
27 Capital stock, trust principal, or current funds......... 16,354,890 16,134,915
28 Paid-in or capital surplus, or land, bldg., and equipment fund    
29 Retained earnings, accumulated income, endowment, or other funds    
30 Total net assets or fund balances (see page 17 of the
instructions).................... 16,354,890 16,134,915
31 Total liabilities and net assets/fund balances (see page 17 of
the instructions).................. 16,358,820 16,137,285
Part III Analysis of Changes in Net Assets or Fund Balances
1 Total net assets or fund balances at beginning of year—Part II, column (a), line 30 (must agree
with end-of-year figure reported on prior year’s return)............... 1 16,354,890
2 Enter amount from Part I, line 27a..................... 2 -219,975
3 Other increases not included in line 2 (itemize) bullet 3  
4 Add lines 1, 2, and 3.......................... 4 16,134,915
5 Decreases not included in line 2 (itemize) bullet 5  
6 Total net assets or fund balances at end of year (line 4 minus line 5)—Part II, column (b), line 30. 6 16,134,915
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 PUBLICLY TRADED SECURITIES FTI LONG TERM      
b PUBLICLY TRADED SECURITIES FTI SHORT TERM      
c LITIGATION PROCEEDS      
d PUBLICLY TRADED SECURITES      
e CAPITAL GAIN DIVIDENDS FTI      
(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 733,574   671,332 62,242
b 119,854   108,279 11,575
c       840
d       -1,150
e       19,914
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       62,242
b       11,575
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 93,421
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 884,388 18,737,528 0.047199
2010 880,683 18,007,194 0.048907
2009 958,279 17,534,053 0.054652
2008 874,403 19,204,324 0.045532
2007 901,271 19,084,611 0.047225
2 Total of line 1, column (d) ...................... 2 0.243515
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 0.048703
4 Enter the net value of noncharitable-use assets for 2012 from Part X, line 5..... 4 18,742,718
5 Multiply line 4 by line 3....................... 5 912,827
6 Enter 1% of net investment income (1% of Part I, line 27b)........... 6 6,985
7 Add lines 5 and 6......................... 7 919,812
8 Enter qualifying distributions from Part XII, line 4.............. 8 904,498
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 13,970
hereBulletand enter 1% of Part I, line 27b...................
c All other domestic foundations enter 2% of line 27b. Exempt foreign organizations enter 4% of Part I, line 12, col. (b)
2 Tax under section 511 (domestic section 4947(a)(1) trusts and taxable foundations only. Others enter -0-) 2  
3 Add lines 1 and 2............................ 3 13,970
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 13,970
6 Credits/Payments:
a 2012 estimated tax payments and 2011 overpayment credited to 2012 6a 11,600
b Exempt foreign organizations—tax withheld at source....... 6b
c Tax paid with application for extension of time to file (Form 8868) 6c 7,500
d Backup withholding erroneously withheld ........... 6d  
7 Total credits and payments. Add lines 6a through 6d.............. 7 19,100
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 5,130
11 Enter the amount of line 10 to be: Credited to 2013 estimated taxBullet5,130 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)
    bullet
    b
    If the answer is “Yes” to line 7, has the foundation furnished a copy of Form 990-PF to the Attorney
    General (or designate) of each state as required by General Instruction G? If “No,” attach explanation .
    8b
    Yes
     
    9
    Is the foundation claiming status as a private operating foundation within the meaning of section 4942(j)(3)
    or 4942(j)(5) for calendar year 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 addressbullet  
    14
    The books are in care ofbulletJOHN A NORTON Telephone no.bullet (919) 604-0842
    Located atbullet1610 SKYE DRIVECHAPEL HILLNC ZIP+4bullet27516
    15
    Section 4947(a)(1) nonexempt charitable trusts filing Form 990-PF in lieu of Form 1041.........bullet
    and enter the amount of tax-exempt interest received or accrued during the year ......bullet
    15  
    16
    At any time during calendar year 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
     
    No
    .........bullet
    c
    Did the foundation engage in a prior year in any of the acts described in 1a, other than excepted acts,
    that were not corrected before the first day of the tax year beginning in 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
    JOHN A NORTON TREASURER
    10.0     		19,500    
    1610 SKYE DRIVE
    CHAPEL HILL,NC27516
    MICHAEL A NORTON SECRETARY
    10.0     		19,500    
    77 ALLEN ST
    ALLENDALE,NJ07401
    MARY N OWEN DIRECTOR
    10.0     		19,500    
    206 BROOKGREEN DR
    CHAPEL HILL,NC27516
    PAUL S NORTON PRESIDENT
    10.0     		19,500    
    39 DOLPHIN COVE QUAY
    STAMFORD,CT06902
    JAMES M NORTON DIRECTOR
    10.0     		19,500    
    4614 HARRISON ST
    CHEVY CHASE,MD20815
    LENORE TRILBY NORTON VICE PRESIDENT
    10.0     		19,500    
    28200 S L DEL EL ESCORIAL APT 130
    MADRID    
    SP
    ELAINE BOYLEN DIRECTOR
    10.0     		19,500    
    28873 BONIFACE DRIVE
    MALIBU,CA90265
    2 Compensation of five highest-paid employees (other than those included on line 1—see instructions). If none, enter “NONE.”
    (a) Name and address of each employee paid more than $50,000 (b) Title, and average
    hours per week
    devoted to position     		(c) Compensation (d) Contributions to
    employee benefit
    plans and deferred
    compensation     		(e) Expense account,
    other allowances
     
    Total number of other employees paid over $50,000...................bullet  
    3 Five highest-paid independent contractors for professional services (see instructions). If none, enter "NONE".
    (a) Name and address of each person paid more than $50,000 (b) Type of service (c) Compensation
     
    Total number of others receiving over $50,000 for professional services.............bullet  
    Part IX-A
    Summary of Direct Charitable Activities
    List the foundation’s four largest direct charitable activities during the tax year. Include relevant statistical information such as the number of organizations and other beneficiaries served, conferences convened, research papers produced, etc. Expenses
    1
     
    2  
    3  
    4  
    Form 990-PF (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
    11,662,551
    b
    Average of monthly cash balances.......................
    1b
    1,615,589
    c
    Fair market value of all other assets (see instructions)................
    1c
    5,750,000
    d
    Total (add lines 1a, b, and c).........................
    1d
    19,028,140
    e
    Reduction claimed for blockage or other factors reported on lines 1a and
    1c (attach detailed explanation) .............
    1e
     
    2
    Acquisition indebtedness applicable to line 1 assets..................
    2
    0
    3
    Subtract line 2 from line 1d.........................
    3
    19,028,140
    4
    Cash deemed held for charitable activities. Enter 1 1⁄2% of line 3 (for greater amount, see
    instructions) .............................
    4
    285,422
    5
    Net value of noncharitable-use assets. Subtract line 4 from line 3. Enter here and on Part V, line 4
    5
    18,742,718
    6
    Minimum investment return. Enter 5% of line 5..................
    6
    937,136
    Part XI
    Distributable Amount bullet and do not complete this part.)
    1
    Minimum investment return from Part X, line 6....................
    1
    937,136
    2a
    Tax on investment income for 2012 from Part VI, line 5......
    2a
    13,970
    b
    Income tax for 2012. (This does not include the tax from Part VI.)...
    2b
     
    c
    Add lines 2a and 2b............................
    2c
    13,970
    3
    Distributable amount before adjustments. Subtract line 2c from line 1............
    3
    923,166
    4
    Recoveries of amounts treated as qualifying distributions................
    4
     
    5
    Add lines 3 and 4............................
    5
    923,166
    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
    923,166
    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
    904,498
    b
    Program-related investments—total from Part IX-B..................
    1b
    0
    2
    Amounts paid to acquire assets used (or held for use) directly in carrying out charitable, etc.,
    purposes...............................
    2
    0
    3
    Amounts set aside for specific charitable projects that satisfy the:
    a
    Suitability test (prior IRS approval required)....................
    3a
    0
    b
    Cash distribution test (attach the required schedule) .................
    3b
    0
    4
    Qualifying distributions. Add lines 1a through 3b. Enter here and on Part V, line 8, and Part XIII, line 4
    4
    904,498
    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
    904,498
    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 7 923,166
    2 Undistributed income, if any, as of the end of 2012:
    a Enter amount for 2011 only....... 656,639
    b Total for prior years:2010, 2009, 2008  
    3 Excess distributions carryover, if any, to 2012:
    a From 2007.......  
    b From 2008.......  
    c From 2009.......  
    d From 2010.......  
    e From 2011....... 0
    fTotal of lines 3a through e......... 0
    4Qualifying distributions for 2012 from Part
    XII, line 4: bullet$ 904,498
    a Applied to 2011, but not more than line 2a 656,639
    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..... 247,859
    e Remaining amount distributed out of corpus 0
    5 Excess distributions carryover applied to 2012. 0 0
    (If an amount appears in column (d), the
    same amount must be shown in column (a).)
    6Enter the net total of each column as
    indicated below:
    a Corpus. Add lines 3f, 4c, and 4e. Subtract line 5 0
    b Prior years’ undistributed income. Subtract
    line 4b from line 2b ...........     		 
    c Enter the amount of prior years’ undistributed
    income for which a notice of deficiency has
    been issued, or on which the section 4942(a)
    tax has been previously assessed......     		 
    d Subtract line 6c from line 6b. Taxable amount
    —see 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 ..........     		675,307
    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 ......     		0
    10 Analysis of line 9:
    a Excess from 2008....  
    b Excess from 2009....  
    c Excess from 2010....  
    d Excess from 2011....  
    e Excess from 2012.... 0
    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).)
    NONE
    bList any managers of the foundation who own 10% or more of the stock of a corporation (or an equally large portion of the
    ownership of a partnership or other entity) of which the foundation has a 10% or greater interest.
    NONE
    2Information Regarding Contribution, Grant, Gift, Loan, Scholarship, etc., Programs:
    Check here bullet
    aThe name, address, and telephone number or e-mail of the person to whom applications should be addressed:
    MARY N OWEN
    206 BROOKGREEN
    CHAPEL HILL,NC27516
    (919) 604-0842
    bThe form in which applications should be submitted and information and materials they should include:
    LETTER
    cAny submission deadlines:
    NONE
    dAny restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other
    factors:
    NONE
    Form 990-PF (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
    AMERICAN CANCER SOCIETY
    626 NORTH SHORE RD
    ABSECON,NJ08201     		NONE PUBLIC DISCRETIONARY 1,500
    ASOCIACION CYD SANTA MARIA
    SANTA LUCIA 1-10-3
    MALAGA   29004
    SP     		NONE PUBLIC DISCRETIONARY 4,000
    BROTHER'S BROTHER FOUNDATION
    1200 GALVESTON AVENUE
    PITTSBURGH,PA15233     		NONE PUBLIC DISCRETIONARY 1,000
    CATHOLIC CHARITIES DEVELOPMENT OFFICE
    715 NAZARETH STREET
    RALEIGH,NC27606     		NONE PUBLIC DISCRETIONARY 1,000
    CHAPEL HILL CARRBORO YMCA
    980 MARTIN LUTHER KING JR BLVD
    CHAPEL HILL,NC27514     		NONE PUBLIC DISCRETIONARY 1,000
    CHRISTIAN SOCIAL SERVICE CENTER INC
    P O BOX 1111
    OWINGVILLE,KY40360     		NONE PUBLIC DISCRETIONARY ANGEL TREE 2,000
    CRESTED BUTTE LAND TRUST
    P O BOX 2224
    CRESTED BUTTE,CO81224     		NONE PUBLIC DISCRETIONARY 1,000
    DURHAM RESCUE MISSION
    507 EAST KNOX ST
    DURHAM,NC27703     		NONE PUBLIC DISCRETIONARY 2,000
    FOOD BANK OF CENTRAL & EAST NC
    3808 TARHEEL DR
    RALEIGH,NC27609     		NONE PUBLIC DISCRETIONARY 2,000
    HABITAT FOR HUMANITY
    P O BOX 883
    PITTSBORO,NC27312     		NONE NONE DISCRETIONARY 2,000
    LHASA HAPPY HOMES RESCUE INC
    1158 26TH ST SUITE 190
    SANTA MONICA,CA90403     		NONE PUBLIC DISCRETIONARY 1,000
    LIVESTRONG
    2201 E SIXTH STREET
    AUSTIN,TX78702     		NONE PUBLIC DISCRETIONARY 3,250
    LORRIMER SANCTUARY
    790 EWING AVE
    FRANKLIN LAKES,NJ07417     		NONE PUBLIC DISCRETIONARY 2,000
    MUSIC MAKER RELIEF FOUNDATION
    224 WEST CORBIN ST
    HILLSBOROUGH,NC27278     		NONE PUBLIC DISCRETIONARY 1,000
    NATIONAL MS SOCIETY
    1800 M STREET NW SUITE 750 SOUTH
    WASHINGTON,DC20036     		NONE PUBLIC DISCRETIONARY 500
    NATIONAL PARK FOUNDATION
    1201 EYE ST NW SUITE 550B
    WASHINGTON,DC20005     		NONE PUBLIC DISCRETIONARY 1,300
    OPEN DOOR DENTAL CLINIC OF ALAMANCE COUNTY
    P O BOX 1744
    BURLINGTON,NC272161744     		NONE PUBLIC DISCRETIONARY 1,000
    PEPPERDINE UNIVERSITY
    24255 PACIFIC COAST HWY
    MALIBU,CA90263     		NONE PUBLIC DISCRETIONARY 5,000
    REBUILDING TOGETHER INC
    1899 L ST NW SUITE 1000
    WASHINGTON,DC20036     		NONE PUBLIC DISCRETIONARY 1,000
    SALVATION ARMY DURHAM CHAPTER
    P O BOX 1330
    DURHAM,NC277021330     		NONE PUBLIC DISCRETIONARY 1,300
    SECU FAMILY HOUSE
    123 OLD MASON FARM ROAD
    CHAPEL HILL,NC27517     		NONE PUBLIC DISCRETIONARY 2,400
    SHARPSBURG HERITAGE FESTIVAL
    P O BOX 33
    SHARPSBURG,MD21782     		NONE PUBLIC DISCRETIONARY 1,000
    SHRINERS CIRCUS FUND
    11101 CREEDMOOR ROAD
    RALEIGH,NC27614     		NONE PUBLIC DISCRETIONARY 100
    SOCIETY OF ST ANDREW
    3383 SWEET HOLLOW ROAD
    BIG ISLAND,VA24526     		NONE PUBLIC DISCRETIONARY 500
    SPECIAL OLYMPICS ORANGE COUNTY
    200 PLANT RD
    CHAPEL HILL,NC27514     		NONE PUBLIC DISCRETIONARY 1,000
    STAMFORD SAILING FOUNDATION
    151 HARVARD AVE
    STAMFORD,CT06902     		NONE PUBLIC DISCRETIONARY 5,000
    SWIM ACROSS AMERICA
    ONE INTERNATIONAL PLACE
    SUITE 4600
    BOSTON,MA02110     		NONE PUBLIC DISCRETIONARY 1,000
    TABLE
    205 W WEAVER ST
    CARRBORO,NC27510     		NONE PUBLIC DISCRETIONARY 2,000
    UNC-TV
    P O BOX 14900
    RESEARCH TRIANGLE PARK,NC277094900     		NONE PUBLIC DISCRETIONARY 1,000
    UNIVERSITY OF RHODE ISLAND
    6 RHODY RAM WAY
    KINGSTON,RI02881     		NONE PUBLIC SAILING TEAM 2,000
    WUNC RADIO
    P O BOX 8880
    CHAPEL HILL,NC27515     		NONE PUBLIC DISCRETIONARY 500
    ACHIEVEMENT ACADEMY OF DURHAM
    400 WEST MAIN ST SUITE 103
    DURHAM,NC27701     		NONE PUBLIC MAJOR 20,000
    AMERICAN RED CROSS CONNECTICUT CHAPTER
    209 FARMINGTON AVE
    FARMINGTON,CT06032     		NONE PUBLIC MAJOR 5,000
    ASOCIACION ANIDAN AYUDA NINOS DE AFRICA
    C/JULIAN HERNADEZ 9 2 4
    MADRID   24043
    SP     		NONE PUBLIC MAJOR 40,000
    BATH COUNTY AGRICULTURAL EXTENSION FOUNDATION INC
    2914 E HWY 60
    OWINGSVILLE,KY403608815     		NONE PUBLIC MAJOR 25,000
    BIG BROTHERS BIG SISTERS OF TRIANGLE
    909 AVIATION PKWY SUITE 1500
    MORRISVILLE,NC27560     		NONE PUBLIC MAJOR 15,000
    BLUE GRASS COMMUNITY FOUNDATION
    250 WEST MAIB STREET SUITE 1220
    LEXINGTON,KY405071714     		NONE PUBLIC MAJOR MEMORIAL LIBRARY 5,000
    BOYS & GIRLS CLUB OF EASTERN PIEDMONT
    P O BOX 1788
    PITTSBORO,NC27312     		NONE PUBLIC MAJOR 10,000
    C & O CANAL TRUST INC
    1850 DUAL HIGHWAY SUITE 100
    HAGERSTOWN,MD21740     		NONE PUBLIC MAJOR 27,000
    CACAPON AND LOST RIVERS LAND TRUST
    RR1 BOX 328
    HIGH VIEW,WV26808     		NONE PUBLIC MAJOR 5,000
    CAROLINA SAILING CLUB FOUNDATION
    6004 BUNCHBERRY CT
    RALEIGH,NC27616     		NONE PUBLIC MAJOR 5,000
    CENTER FOR FOOD ACTION NJ
    192 W DEMEREST AVENUE
    ENGLEWOOD,NJ07631     		NONE PUBLIC MAJOR 10,000
    CHILDREN'S AID AND FAMILY SERVICES INC
    200 ROBIN ROAD
    PARAMUS,NJ07652     		NONE PUBLIC MAJOR 25,000
    CHRISTIAN SOCIAL SERVICE CENTER INC
    P O BOX 1111
    OWINGSVILLE,KY40360     		NONE PUBLIC MAJOR 15,000
    EQUALITY NOW INC
    250 WEST 57TH ST SUITE 1527
    NEW YORK,NY10107     		NONE PUBLIC MAJOR 15,000
    FRED HUTCHINSON CANCER RESEARCH CENTER
    P O BOX 19024 J5-200
    SEATTLE,WA981091024     		NONE PUBLIC MAJOR 15,000
    FRIENDS OF BLACKWATER
    501 ELIZABETH ST ROOM 3
    CHARLESTON,WV25311     		NONE PUBLIC MAJOR 5,000
    GOD'S LOVE WE DELIVER
    166 AVENUE OF THE AMERICAS
    NEW YORK,NY10013     		NONE PUBLIC MAJOR 10,000
    GREENWICH BOYS & GIRLS' CLUB ASSOC INC
    4 HORSENECK LANE
    GREENWICH,CT06830     		NONE PUBLIC MAJOR 5,000
    INTER-FAITH COUNCIL FOR SOCIAL SERVICE
    110 WEST NAIN ST
    CARRBORO,NC27510     		NONE PUBLIC MAJOR 15,000
    JOHN AVERY BOYS AND GIRLS CLUB
    P O BOX 446
    DURHAM,NC27702     		NONE PUBLIC MAJOR 15,000
    LEUKEMIA & LYMPHOMA SOCIETY NORTHERN NJ
    14 COMMERCE DR SUITE 301
    CRANFORD,NJ07016     		NONE PUBLIC MAJOR 30,000
    MEDICOS SIN FRONTERAS ESPANA
    72-1 A MELENDEZ VALDES
    MADRID   28015
    SP     		NONE PUBLIC MAJOR 10,000
    NEIGHBORS LINK STAMFORD CORP
    75 SELLECK STREET
    STAMFORD,CT06902     		NONE PUBLIC MAJOR 10,000
    NEW COVENANT HOUSE
    P O BOX 10883
    STAMFORD,CT06904     		NONE PUBLIC MAJOR 5,000
    NORTH CAROLINA COASTAL FEDERATION
    3609 HIGHWAY 24 OCEAN
    NEWPORT,NC28570     		NONE PUBLIC MAJOR 15,000
    ORPHANAID AFRICA
    268 BUSH STREET SUITE 3100
    SAN FRANCISCO,CA94104     		NONE PUBLIC MAJOR 10,000
    PARALYZED VETERANS OF AMERICA
    801 18TH ST NW
    WASHINGTON,DC20006     		NONE PUBLIC MAJOR 5,000
    RONALD MCDONALD HOUSE
    101 OLD MASON FARM RD
    CHAPEL HILL,NC27517     		NONE PUBLIC MAJOR 7,500
    SCHOLARSHIP FUND FOR INNER CITY CHILDREN
    P O BOX 9500
    NEWARK,NJ071049500     		NONE PUBLIC MAJOR 10,000
    SOUND WATERS
    1281 COVE ROAD
    STAMFORD,CT06902     		NONE PUBLIC MAJOR 5,000
    STAMFORD SAILING FOUNDATION
    151 HARVARD AVE
    STAMFORD,CT06902     		NONE PUBLIC MAJOR 25,000
    THE PORTABLE PLAYHOUSE INC
    425 MAIN ST
    FOREST CITY,PA18421     		NONE PUBLIC MAJOR 10,000
    THE WATERSIDE SCHOOL
    770 PACIFIC ST
    STAMFORD,CT06902     		NONE PUBLIC MAJOR 5,000
    THE WOMEN'S CENTER
    P O BOX 1057
    CHAPEL HILL,NC27514     		NONE PUBLIC MAJOR 10,000
    TOUCH FOUNDATION INC
    875 THIRD AVE 5TH FLOOR
    NEW YORK,NY10022     		NONE PUBLIC MAJOR 7,000
    TRIANGE OPTIONS FOR SUBSTANCE ABUSERS
    1820 JAMES ST
    DURHAM,NC27704     		NONE PUBLIC MAJOR 10,000
    UNC LINEBERGER COMPREHENSIVE CANCER CENTER
    SCHOOL OF MEDICINE CB 7295
    CHAPEL HILL,NC275997295     		NONE PUBLIC MAJOR 25,000
    WOMEN FOR WOMEN FOUNDATION INC
    P O BOX 50403
    COLORADO SPRINGS,CO80949     		NONE PUBLIC MAJOR 15,000
    YMCA-STAMFORD
    909 WASHINGTON BLVD
    STAMFORD,CT06901     		NONE PUBLIC MAJOR 5,000
    ANACOSTIA RIVERKEEPER INC
    515 M ST SE SUITE 218
    WASHINGTON,DC20003     		NONE PUBLIC DISCRETIONARY 1,000
    ASOCIACION PROTECTOR DE ANIMALES PATES
    P O BOX 627
    MOJACAR PLAYA,ALMERIA04638
    SP     		NONE PUBLIC DISCRETIONARY 4,000
    ASSOCIACION JAMBO VOLUNTEERS
    MARIA DE MOLINA 32 7A
    MADRID   28006
    SP     		NONE PUBLIC DISCRETIONARY 3,000
    BATH COUNTY HISTORICAL SOCIETY INC
    P O BOX 333
    OWINGSVILLE,KY40360     		NONE PUBLIC DISCRETIONARY 5,000
    C & O CANAL TRUST INC
    1850 DUAL HIGHWAY STE 100
    HAGERSTOWN,MD21740     		NONE PUBLIC DISCRETIONARY 3,000
    CHALLENGED ATHLETES INC
    P O BOX 910769
    SAN DIEGO,CA92191     		NONE PUBLIC DISCRETIONARY 1,000
    CHAPEL HILLCARRBORO PUBLIC SCHOOL FOUNDATION
    P O BOX 877
    CARRBORO,NC27510     		NONE PUBLIC DISCRETIONARY 500
    CHATHAM COUNTY OUTREACH ALLIANCE
    P O BOX 1326
    PITTSBORO,NC27312     		NONE PUBLIC DISCRETIONARY 2,000
    CLEAN JORDAN LAKE
    P O BOX 1447
    PITTSBORO,NC27312     		NONE PUBLIC DISCRETIONARY 500
    COLLEGETRACKS
    5126 MANNING DR
    BETHESDA,MD20814     		NONE PUBLIC DISCRETIONARY 1,000
    EXTRAORDINARY VENTURES
    201 S ELLIOTT RD
    CHAPEL HILL,NC27514     		NONE PUBLIC DISCRETIONARY 500
    FOOD FOR THE POOR
    6401 LYONS ROAD
    COCONUT CREEK,FL33073     		NONE PUBLIC DISCRETIONARY 1,000
    FUNDACION ANADE
    CLARA CAMPOAMOR 20
    MADRID,COLLADO VILLABA28400
    SP     		NONE PUBLIC DISCRETIONARY 3,000
    KARMA RESCUE INC
    1158 26TH STREET
    SUITE 155 PMB
    SANTA MONICA,CA90403     		NONE PUBLIC DISCRETIONARY 1,000
    LYMPHOMA RESEARCH FOUNDATION
    111 BROADWAY 19TH FLOOR
    NEW YORK CITY,NY10006     		NONE PUBLIC DISCRETIONARY 1,000
    MALTA HOUSE
    5 PROWITT STREET
    EAST NORWALK,CT06855     		NONE PUBLIC DISCRETIONARY 1,000
    MEALS ON WHEELS OF DURHAM INC
    406 RIGSBEE AVE SUITE 101
    DURHAM,NC27701     		NONE PUBLIC DISCRETIONARY 500
    MILL RIVER COLLABORATIVE
    C/O LAND USE
    888 WASHINGTON BLVD
    STAMFORD,CT06904     		NONE PUBLIC DISCRETIONARY 1,000
    MOREHEAD STATE UNIVERSITY FOUNDATION
    150 UNIVERSITY BLVD
    PALMER DEVELOPMENT H
    MOREHEAD,KY40351     		NONE PUBLIC DISCRETIONARY 1,000
    PARALYZED VETERANS OF AMERICA
    801 18TH ST NW
    WASHINGTON,DC20006     		NONE PUBLIC DISCRETIONARY 2,000
    POTOMAC RIVERKEEPER INC
    1100 15TH ST NW 11TH FLOOR
    WASHINGTON,DC20005     		NONE PUBLIC DISCRETIONARY 6,000
    ROCHESTER INSTITUTE OF TECHNOLOGY
    116 lOMB MEMORIAL DRIVE
    ROCHESTER,NY146235608     		NONE PUBLIC DISCRETIONARY 1,000
    SAMARPAN
    13645 CATAWBA DR
    POWAY,CA92064     		NONE PUBLIC DISCRETIONARY 1,500
    SANTA FE COMMUNITY FOUNDATION
    P O BOX 1827
    SANTA FE,NM87504     		NONE PUBLIC DISCRETIONARY 500
    TEAM RIVER RUNNER
    5007 STONE RD
    ROCKVILLE,MD20853     		NONE PUBLIC DISCRETIONARY 500
    THE ARC OF ORANGE COUNTY
    208 N COLUMBIA ST SUITE 100
    CHAPEL HILL,NC27514     		NONE PUBLIC DISCRETIONARY 1,000
    SILVER HILL HOSPITAL
    208 VALLEY RD
    NEW CANAAN,CT068403899     		NONE PUBLIC DISCRETIONARY 1,000
    THE LINCOLN MOTORCAR FOUNDATION
    5022 HARBORTOWN LN
    FORT MYERS,FL339194651     		NONE PUBLIC DISCRETIONARY MEMORIAL FOR PAUL WILSON 5,000
    THE SALVATION ARMY
    P O BOX 752
    PITTSBORO,NC27312     		NONE PUBLIC DISCRETIONARY 650
    WOMEN'S LINK WORLDWIDE
    120 SPRING STREET
    NORTHFIELD,VT05663     		NONE PUBLIC DISCRETIONARY 1,000
    ASSOCIACION JAMBO VOLUNTEERS
    MARIA DE MOLINA 32 7A
    MADRID   28006
    SP     		NONE PUBLIC MAJOR 32,000
    AVANTE
    RUA MIQUEL DE JULIETA/TOMBA SURRAO
    LENCOIS,BAHIA46960000
    BR     		NONE PUBLIC MAJOR 14,000
    CONNECTICUT FOOD BANK
    C/O JANET KNIFFIN
    150 BRADLEY ST
    EAST HAVEN,CT06512     		NONE PUBLIC MAJOR 5,000
    FREDERICK COUNTY CIVIL WAR ROUNDTABLE
    P O BOX 3232
    FREDERICK,MD217053232     		NONE PUBLIC MAJOR 6,000
    INSPIRICA INC
    C/O CAROLE SCHWARTZ
    141 FRANKLIN ST
    STAMFORD,CT06901     		NONE PUBLIC MAJOR 20,000
    MUSIC MAKER RELIEF FOUNDATION
    224 WEST CORBIN ST
    HILLSBOROUGH,NC27278     		NONE PUBLIC MAJOR 7,500
    POTOMAC RIVERKEEPER INC
    1100 15TH ST NW 11TH FLOOR
    WASHINGTON,DC20005     		NONE PUBLIC MAJOR 18,000
    REBUILDING TOGETHER INC
    1899 L ST NW SUITE 1000
    WASHINGTON,DC200363810     		NONE PUBLIC MJOR 25,000
    THE SALVATION ARMY
    P O BOX 752
    PITTSBORO,NC27312     		NONE PUBLIC MAJOR 5,000
    BATH COUNTY HISTORICAL SOCIETY INC
    P O BOX 333
    OWINGSVILLE,KY40360     		NONE PUBLIC GENERAL 600
    FORDHAM UNIVERSITY WFUV
    441 EAST FORDHAM BLVD
    BRONX,NY10458     		NONE PUBLIC GENERAL 103
    LHASA HAPPY HOMES RESCUE INC
    1158 26TH ST SUITE 190
    SANTA MONICA,CA90403     		NONE PUBLIC GENERAL 250
    ROCHESTER INSTITUTE OF TECHNOLOGY
    116 LOMG MEMORIAL DRIVE
    ROCHESTER,NY146235608     		NONE PUBLIC GENERAL 300
    MOREHEAD STATE UNIVERSITY
    C/O SHARON FRALEY
    150 UNIVERSITY BLVD SUITE 1887
    MOREHEAD,KY40351     		NONE PUBLIC GENERAL 200
    Total .................................bullet 3a 742,953
    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          
    4 Dividends and interest from securities....     14 301,219  
    5 Net rental income or (loss) from real estate:
    aDebt-financed property......          
    bNot debt-financed property.....     16 372,271  
    6Net rental income or (loss) from personal property          
    7 Other investment income.....          
    8Gain or (loss) from sales of assets other than inventory     18 93,421  
    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)..   766,911  
    13Total. Add line 12, columns (b), (d), and (e)..................
    13766,911
    (See worksheet in line 13 instructions to verify calculations.)
    Part XVI-B
    Relationship of Activities to the Accomplishment of Exempt Purposes
    Line No.
    DownArrow     		Explain below how each activity for which income is reported in column (e) of Part XVI-A contributed importantly to
    the accomplishment of the foundation’s exempt purposes (other than by providing funds for such purposes). (See
    instructions.)
    Form 990-PF (2012)
    Form 990-PF (2012)
    Page 12
    Part XVII
    Information Regarding Transfers To and Transactions and Relationships With Noncharitable Exempt Organizations
    1
    Did the organization directly or indirectly engage in any of the following with any other organization described in section
    Yes
    No
    501(c) of the Code (other than section 501(c)(3) organizations) or in section 527, relating to political organizations?
    a
    Transfers from the reporting foundation to a noncharitable exempt organization of:
    (1) Cash...................................
    1a(1)
     
    No
    (2) Other assets.................................
    1a(2)
     
    No
    b
    Other transactions:
    (1) Sales of assets to a noncharitable exempt organization....................
    1b(1)
     
    No
    (2) Purchases of assets from a noncharitable exempt organization..................
    1b(2)
     
    No
    (3) Rental of facilities, equipment, or other assets.......................
    1b(3)
     
    No
    (4) Reimbursement arrangements...........................
    1b(4)
     
    No
    (5) Loans or loan guarantees.............................
    1b(5)
     
    No
    (6) Performance of services or membership or fundraising solicitations................
    1b(6)
     
    No
    c
    Sharing of facilities, equipment, mailing lists, other assets, or paid employees..............
    1c
     
    No
    d
    If the answer to any of the above is “Yes,” complete the following schedule. Column (b) should always show the fair market value
    of the goods, other assets, or services given by the reporting foundation. If the foundation received less than fair market value
    in any transaction or sharing arrangement, show in column (d) the value of the goods, other assets, or services received.
    (a) Line No. (b) Amount involved (c) Name of noncharitable exempt organization (d) Description of transfers, transactions, and sharing arrangements
    2a
    Is the foundation directly or indirectly affiliated with, or related to, one or more tax-exempt organizations
    described in section 501(c) of the Code (other than section 501(c)(3)) or in section 527?...........
    b
    If “Yes,” complete the following schedule.
    (a) Name of organization (b) Type of organization (c) Description of relationship
    Sign Here
    Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than taxpayer or fiduciary) is based on all information of which preparer has any knowledge.
    Bullet Bullet
    May the IRS discuss this return
    with the preparer shown below
    (see instr.)?
    Signature of officer or trustee Date Title
    Paid Preparer Use Only Print/Type preparer's name Preparer's Signature Date PTIN
    Firm's namebullet



    Firm's addressbullet







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


    Software ID:  
    Software Version:  


    Form 990PF - Special Condition Description:
    Special Condition Description

    TY 2012 AccountingFeesSchedule
    Name:
    CARLSON FAMILY FOUNDATION INC
    C/O MARY N OWEN
    EIN: 31-1678303
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    BDO USA LLP 6,500 3,250   3,250

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

    TY 2012 DepreciationSchedule
    Name:
    CARLSON FAMILY FOUNDATION INC
    C/O MARY N OWEN
    EIN: 31-1678303
    Description of Property Date Acquired Cost or Other Basis Prior Years' Depreciation Computation Method Rate /
    Life (# of years)    		 Current Year's Depreciation Expense Net Investment Income Adjusted Net Income Cost of Goods Sold Not Included

    TY 2012 InvestmentsCorpBondsSchedule
    Name:
    CARLSON FAMILY FOUNDATION INC
    C/O MARY N OWEN
    EIN: 31-1678303
    Name of Bond End of Year Book Value End of Year Fair Market Value
    PEABODY ENERGY 4.75% 12/66 91,045 121,016
    APACHE CORP 6.00% 85,000 77,690

    TY 2012 InvestmentsCorpStockSchedule
    Name:
    CARLSON FAMILY FOUNDATION INC
    C/O MARY N OWEN
    EIN: 31-1678303
    Name of Stock End of Year Book Value End of Year Fair Market Value
    SCHLUMBERGER LTD 1500 SHS 69,708 103,935
    CHEVRON CORP 2000 SHS 64,151 216,280
    ANADARKO PTEROLEUM 2000 SHS 88,182 148,620
    CONOCOPHILLIPS 2164 SHS 45,122 125,490
    AIR PRODUCTS & CHEMICALS 2000 121,324 168,040
    BHP BILLITON LIMITED 2000 SHS 98,421 156,880
    FREEPORT-MCMORAN COPPER 3458 54,837 118,264
    JOHNSON CONTROLS INC 2500 SHS 101,518 76,750
    ROCKWELL AUTOMATION INC 2000SH 155,035 167,980
    GENERAL ELECTRIC CO 4800 SHS 80,240 100,752
    HONEYWELL INTL INC 2500 SHS 55,411 158,675
    CHICAGO BRIDGE & IRON 2500SHS 90,699 115,875
    JOY GLOBAL INC 1200 SHS 69,164 76,536
    AGCO CORP 2000 SHS 102,283 98,240
    UNITED PARCEL SVC INC 2000 SHS 136,114 147,460
    NIKE INC 3000 SHS 79,355 154,800
    MCDONALDS CORP 2000 SHS 30,980 176,420
    HOME DEPOT INC 3000 SHS 70,630 185,550
    CVS CAREMARK CORP 4000 SHS 62,429 193,400
    PEPSICO INC 2400 SHS 64,237 164,232
    NESTLE 3000 SHS 31,650 195,510
    PROCTOR & GAMBLE 1950 SHS 87,575 132,386
    EXPRESS SCRIPTS 2500 SHS 136,810 135,000
    LABORATORY CORP 1200 SHS 90,341 103,944
    CELGENE CORP 2000 SHS 103,602 157,440
    GILEAD SCIENCES INC 2500 SHS 98,893 183,625
    TEVA PHARMACEUTICAL 3000 SHS 80,910 112,020
    ABBOTT LABORATORIES 3000 SHS 121,542 196,500
    MERCK & CO INC 4000 SHS 137,398 163,760
    US BANCORP 4000 SHS 87,947 127,760
    BLACKROCK INC 1000 SHS 175,109 206,710
    VISA INC 1400 SHS 74,203 212,212
    ACE LTD 1500 SHS 114,456 119,700
    GOOGLE INC 200 SHS 127,344 141,874
    MICROSOFT CORP 3400 SHS 54,888 90,882
    NUANCE COMMUNICATIONS 5000 SHS 127,126 111,600
    EMC CORP 5800 SHS 76,581 146,740
    APPLE INC 200 SHS 116,860 106,606
    AGILENT TECHNOLOGIES 4000 SHS 86,461 163,760
    BROADCOM CORP 3000 SHS 94,891 99,630
    ANALOG DEVICES INC 4000 SHS 120,141 168,240
    AT&T INC 4500 SHS 95,415 151,695
    VERIZON COMMUNICATIONS 4000 SH 154,294 173,080
    VODAFONE GROUP 5500 SHS 132,398 138,545
    FRANKLIN INTL 34781.39 SHS 536,751 584,675
    S & P 500 DEPOSITORY 18912 UNI 2,220,522 2,693,258
    ISHARES TR S&P 7600 UNITS 300,438 301,112
    ISHARES TR CORE 15000 UNITS 1,578,610 1,666,200
    GUGGENHEIN INTL 30358 UNITS 501,218 511,229
    ISHARES MSCI 12500 UNITS 500,527 523,500

    TY 2012 LandEtcSchedule2
    Name:
    CARLSON FAMILY FOUNDATION INC
    C/O MARY N OWEN
    EIN: 31-1678303
    Category / Item Cost / Other Basis Accumulated Depreciation Book Value End of Year Fair Market Value


    TY 2012 OtherExpensesSchedule
    Name:
    CARLSON FAMILY FOUNDATION INC
    C/O MARY N OWEN
    EIN: 31-1678303
    Description Revenue and Expenses per Books Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    POSTAGE 46     46
    WIRE TRANSFER FEES 85     85
    MISCELLANEOUS 55     55
    OFFICE 110     110
    Rent and Royalty Expense 26,218      


    TY 2012 OtherProfessionalFeesSchedule
    Name:
    CARLSON FAMILY FOUNDATION INC
    C/O MARY N OWEN
    EIN: 31-1678303
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    FIDUCIARY TRUST INTERNATIONAL 62,598 62,598    


    TY 2012 TaxesSchedule
    Name:
    CARLSON FAMILY FOUNDATION INC
    C/O MARY N OWEN
    EIN: 31-1678303
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    FOREIGN TAXES 2,570 2,570    
    EXCISE TAX 13,970