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
TRUST UW BENJAMIN COUCH 360107015
 

Number and street (or P.O. box number if mail is not delivered to street address)PO BOX 477   Room/suite
City or town, state, and ZIP code
CONCORD, NH033020477
A Employer identification number

02-6004808
B Telephone number (see instructions)

(603) 229-5990
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$2,488,001J Accounting method:
 
(Part I, column (d) must be on cash basis.)
E bullet
F bullet
Part I Analysis of Revenue and Expenses (The total of amounts in columns (b), (c), and (d) may not necessarily equal the amounts in column (a) (see instructions).) (a) Revenue and
expenses per
books 		(b) Net investment
income 		(c) Adjusted net
income 		(d) Disbursements
for charitable
purposes
(cash basis only)
Revenue 1 Contributions, gifts, grants, etc., received (attach schedule)  
2 Check bullet
3 Interest on savings and temporary cash investments      
4 Dividends and interest from securities...... 62,655 62,655  
5a Gross rents..............      
b Net rental income or (loss)  
6a Net gain or (loss) from sale of assets not on line 10 -7,371
b Gross sales price for all assets on line 6a 769,534
7 Capital gain net income (from Part IV, line 2)... 0
8 Net short-term capital gain......... 0
9 Income modifications...........  
10a Gross sales less returns and allowances  
b Less: Cost of goods sold....  
c Gross profit or (loss) (attach schedule).....    
11 Other income (attach schedule).......      
12 Total. Add lines 1 through 11........ 55,284 62,655  
Operating and Administrative Expenses 13 Compensation of officers, directors, trustees, etc. 21,460 21,460    
14 Other employee salaries and wages......   0 0 0
15 Pension plans, employee benefits.......   0 0  
16a Legal fees (attach schedule).........       0
b Accounting fees (attach schedule)....... Click to see attachment 575 575 0 0
c Other professional fees (attach schedule)....       0
17 Interest...............       0
18 Taxes (attach schedule) (see instructions) Click to see attachment 909 625   0
19 Depreciation (attach schedule) and depletion... 0 0  
20 Occupancy..............        
21 Travel, conferences, and meetings.......   0 0  
22 Printing and publications..........   0 0  
23 Other expenses (attach schedule)....... Click to see attachment 276 276    
24 Total operating and administrative expenses.
Add lines 13 through 23.......... 23,220 22,936 0 0
25 Contributions, gifts, grants paid........ 124,255 124,255
26 Total expenses and disbursements. Add lines 24 and 25 147,475 22,936 0 124,255
27 Subtract line 26 from line 12:
a Excess of revenue over expenses and disbursements -92,191
b Net investment income (if negative, enter -0-) 39,719
c Adjusted net income (if negative, enter -0-)... 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.......... 62,761 37,645 37,645
3 Accounts receivable bullet  
Less: allowance for doubtful accounts bullet     0 0
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 bullet0      
8 Inventories for sale or use...............      
9 Prepaid expenses and deferred charges...........      
10a Investments—U.S. and state government obligations (attach schedule) 404,742 Click to see attachment459,957 464,766
b Investments—corporate stock (attach schedule)........ 1,423,118 Click to see attachment1,364,931 1,580,731
c Investments—corporate bonds (attach schedule)........ 450,608 Click to see attachment386,500 404,859
11 Investments—land, buildings, and equipment: basis bullet  
Less: accumulated depreciation (attach schedule) bullet        
12 Investments—mortgage loans..............      
13 Investments—other (attach schedule)...........     0
14 Land, buildings, and equipment: basis bullet  
Less: accumulated depreciation (attach schedule) bullet        
15 Other assets (describe bullet)      
16 Total assets (to be completed by all filers—see the
instructions. Also, see page 1, item I) 2,341,229 2,249,033 2,488,001
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......... 2,341,229 2,249,033
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).................... 2,341,229 2,249,033
31 Total liabilities and net assets/fund balances (see page 17 of
the instructions).................. 2,341,229 2,249,033
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 2,341,229
2 Enter amount from Part I, line 27a..................... 2 -92,191
3 Other increases not included in line 2 (itemize) bullet 3 0
4 Add lines 1, 2, and 3.......................... 4 2,249,038
5 Decreases not included in line 2 (itemize) bulletClick to see attachment 5 5
6 Total net assets or fund balances at end of year (line 4 minus line 5)—Part II, column (b), line 30. 6 2,249,033
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 310. EXELON CORP COM   2010-01-11 2012-01-09
b 370. TARGET CORP   2010-12-16 2012-01-09
c 160. TARGET CORP   2011-04-26 2012-01-09
d 160. UNITED TECHNOLOGIES   2008-05-12 2012-01-09
e 790. VALERO ENERGY CORP COM   2011-07-26 2012-01-09
40. DIAGEO PLC ADR   2011-06-02 2012-01-24
20. DIAGEO PLC ADR   2010-11-23 2012-01-24
110. EXELON CORP COM   2011-09-08 2012-01-24
150. EXELON CORP COM   2010-12-17 2012-01-24
30. DIAGEO PLC ADR   2010-11-23 2012-02-06
80. ECOLAB INC   2011-06-15 2012-02-06
90. ECOLAB INC   2010-05-05 2012-02-06
50. PROCTER & GAMBLE CO   2010-11-15 2012-02-06
60. ABBOTT LABORATORIES   2010-08-24 2012-02-16
30. ABBOTT LABORATORIES   2011-07-26 2012-02-16
30. CHEVRONTEXACO CORP   2011-05-09 2012-02-16
20. CHEVRONTEXACO CORP   2011-01-24 2012-02-16
30. COLGATE PALMOLIVE   2011-04-21 2012-02-16
80. JOHNSON & JOHNSON   2010-11-23 2012-02-16
40. PROCTER & GAMBLE CO   2010-11-16 2012-02-16
30000. U S TREASURY NOTE 3.125% 08/31/2013 DTD 09/02/08   2011-05-12 2012-03-16
15000. U S TREASURY BOND 2.625% 08/15/2020 DTD 08/15/10   2011-12-08 2012-03-19
220. AMERICAN TOWER CORP COM   2011-11-03 2012-03-23
290. HEWLETT PACKARD   2010-10-12 2012-03-23
170. MARATHON OIL   2011-07-26 2012-03-23
230. ORACLE CORP   2011-01-24 2012-03-23
100. HEWLETT PACKARD   2011-09-08 2012-03-26
170. HEWLETT PACKARD   2009-05-01 2012-03-26
10. ORACLE CORP   2011-06-15 2012-03-26
100. ORACLE CORP   2010-12-17 2012-03-26
90. ORACLE CORP   2011-01-24 2012-03-26
30000. PEPSICO INC 3.100% 01/15/2015 DTD 01/14/10   2011-04-25 2012-04-04
90. CAPITAL ONE FINANCIAL CORP   2011-03-29 2012-04-12
40. EXXON MOBIL CORP   2008-05-12 2012-04-12
20. 3M CO   2010-02-18 2012-04-12
80. J P MORGAN CHASE & CO   2008-05-12 2012-05-02
280. METLIFE INC   2012-02-16 2012-05-02
210. SYSCO CORP   2011-07-26 2012-05-02
210. SYSCO CORP   2011-07-26 2012-05-04
20000. U S TREASURY NOTE 3.125% 08/31/2013 DTD 09/02/08   2011-05-12 2012-05-04
280.612 FIDELITY SPARTAN HIGH INCOME   2010-11-24 2012-05-07
5000. HEWLETT PACKARD CO 4.750% 06/02/2014 DTD 02/26/09   2010-12-15 2012-05-07
5000. JPMORGAN CHASE & 6.00% 01/15/2018 DTD 12/20/07   2009-11-09 2012-05-07
430.338 VANGUARD INFLATION PROTECTED SEC 119   2010-11-24 2012-05-07
60. HOME DEPOT INC   2011-04-25 2012-05-10
200. MARATHON OIL   2011-07-26 2012-05-10
90. STARBUCKS CORP   2012-01-09 2012-05-10
200. MARATHON OIL   2011-07-26 2012-05-29
160. UNITED TECHNOLOGIES   2010-11-23 2012-05-29
540. INVESCO LTD SHS   2012-03-23 2012-05-29
180. PNC FINANCIAL CORP   2012-01-09 2012-06-15
100. STARBUCKS CORP   2012-01-09 2012-06-15
80. YUM BRANDS INC   2012-01-09 2012-06-15
15000. U S TREASURY NOTE 3.125% 08/31/2013 DTD 09/02/08   2011-05-12 2012-06-26
90. MARATHON OIL   2011-06-07 2012-07-09
370. MARATHON OIL   2012-01-09 2012-07-09
300. PROCTER & GAMBLE CO   2010-11-23 2012-07-09
140. APACHE CORP COM   2010-11-23 2012-07-13
100. APACHE CORP COM   2012-02-16 2012-07-13
340. NETAPP INC COM   2012-03-26 2012-07-13
100. STARBUCKS CORP   2011-09-08 2012-07-13
80. YUM BRANDS INC   2008-05-12 2012-07-13
28. ENGILITY HOLDINGS INC   2011-03-02 2012-08-03
70. GILEAD SCIENCES INC   2012-05-29 2012-08-03
20. GILEAD SCIENCES INC   2011-06-02 2012-08-03
20000. HEWLETT PACKARD CO 4.750% 06/02/2014 DTD 02/26/09   2010-12-15 2012-08-06
25000. U S TREASURY NOTE 3.125% 08/31/2013 DTD 09/02/08   2011-05-12 2012-08-08
20000. U S TREASURY BOND 2.625% 08/15/2020 DTD 08/15/10   2011-06-28 2012-08-20
20000. CONOCOPHILLIPS 4.750% 02/01/2014 DTD 02/03/09   2011-11-18 2012-08-21
80. DIAGEO PLC ADR   2008-09-24 2012-08-22
100. HOME DEPOT INC   2010-11-23 2012-08-22
170. L-3 COMMUNICATIONS HLDGS INC COM   2011-03-02 2012-08-22
10000. GE COMPANY 5.00% 02/01/2013 DTD 1/28/2003   2010-08-20 2012-09-06
40. ABBOTT LABORATORIES   2012-05-29 2012-09-13
60. COLGATE PALMOLIVE   2012-05-29 2012-09-13
50. ECOLAB INC   2012-05-10 2012-09-13
40. ECOLAB INC   2010-05-05 2012-09-13
60. MERCK & CO INC NEW COM   2012-04-12 2012-09-13
40. NEXTERA ENERGY INC COM   2012-05-10 2012-09-13
60. VERIZON COMMUNICATIONS   2012-06-15 2012-09-13
.334 ENGILITY HOLDINGS INC   2011-01-24 2012-09-14
200. ARCHER DANIELS MID   2011-03-03 2012-10-15
226. KRAFT FOODS GROUP INC   2012-08-22 2012-10-15
160. UNITED PARCEL SVC INC CL B   2012-01-09 2012-10-15
.667 KRAFT FOODS GROUP INC   2012-07-09 2012-10-22
30000. WAL-MART STORES 4.55% 5/1/2013 DTD 4/29/2003   2011-09-02 2012-10-25
10. ABBOTT LABORATORIES   2012-05-29 2012-11-01
10. ABBOTT LABORATORIES   2010-08-24 2012-11-01
20. AMERICAN EXPRESS CO   2009-08-26 2012-11-01
67.977 BUFFALO SMALL CAP FD #1444   2010-11-24 2012-11-01
20. CAPITAL ONE FINANCIAL CORP   2011-03-29 2012-11-01
20. CHEVRONTEXACO CORP   2011-01-24 2012-11-01
60. CISCO SYSTEMS INC   2008-09-24 2012-11-01
40. COCA COLA CO   2012-05-10 2012-11-01
10. COLGATE PALMOLIVE   2012-04-12 2012-11-01
30. COMCAST CORP NEW CL A   2012-08-22 2012-11-01
20. CONOCOPHILLIPS   2012-09-13 2012-11-01
30. DANAHER CORP   2011-04-26 2012-11-01
10. DIAGEO PLC ADR   2009-07-07 2012-11-01
30. WALT DISNEY CO   2012-01-09 2012-11-01
50. E M C CORP MASS   2010-11-23 2012-11-01
20. EXXON MOBIL CORP   2008-05-12 2012-11-01
30. FREEPORT-MCMORAN COPPER & GOCL B   2012-02-06 2012-11-01
30. GILEAD SCIENCES INC   2011-06-02 2012-11-01
30. HOME DEPOT INC   2010-11-23 2012-11-01
20. ILLINOIS TOOL WKS INC   2012-01-24 2012-11-01
10. INTERNATIONAL BUSINESS MACHINES   2011-04-26 2012-11-01
30. J P MORGAN CHASE & CO   2008-05-12 2012-11-01
10. JOHNSON & JOHNSON   2012-05-29 2012-11-01
10. JOHNSON & JOHNSON   2010-11-23 2012-11-01
30. MERCK & CO INC NEW COM   2012-05-29 2012-11-01
50. MICROSOFT CORP   2011-07-26 2012-11-01
40. MONDELEZ INTERNATIONAL INC   2012-08-22 2012-11-01
20. NEXTERA ENERGY INC COM   2012-05-10 2012-11-01
40. ORACLE CORP   2012-09-13 2012-11-01
20. QUALCOMM, INC.   2012-09-13 2012-11-01
20. 3M CO   2012-08-22 2012-11-01
40. US BANCORP DEL NEW   2008-05-12 2012-11-01
10. UNION PACIFIC CORP   2012-02-06 2012-11-01
30. VERIZON COMMUNICATIONS   2012-06-15 2012-11-01
40. WELLS FARGO & COMPANY COM NEW   2009-05-19 2012-11-01
20. ACE LTD   2011-07-14 2012-11-01
30. TRANSOCEAN LTD ZUG NAMEN AKT   2012-08-22 2012-11-01
30. CHECK POINT SOFTWARE TECHNOLOGIES LTD   2011-07-26 2012-11-01
160. ABBOTT LABORATORIES   2010-08-24 2012-12-03
50. WALT DISNEY CO   2012-01-09 2012-12-03
60. GILEAD SCIENCES INC   2011-06-02 2012-12-03
40. INTERNATIONAL BUSINESS MACHINES   2011-04-26 2012-12-03
170. MICROSOFT CORP   2011-07-26 2012-12-03
120. MICROSOFT CORP   2005-12-08 2012-12-03
(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 12,792   14,910 -2,118
b 17,980   21,798 -3,818
c 7,775   7,990 -215
d 11,848   11,909 -61
e 15,633   21,907 -6,274
3,508   3,415 93
1,754   1,476 278
4,336   4,733 -397
5,912   6,402 -490
2,788   2,189 599
4,907   4,395 512
5,521   4,376 1,145
3,164   3,216 -52
3,334   2,973 361
1,667   1,570 97
3,164   3,131 33
2,109   1,883 226
2,789   2,426 363
5,197   5,142 55
2,598   2,533 65
31,219   31,676 -457
15,703   15,597 106
13,581   12,659 922
6,807   11,061 -4,254
5,523   5,647 -124
6,587   7,449 -862
2,368   2,396 -28
4,025   6,265 -2,240
289   314 -25
2,886   3,200 -314
2,597   2,915 -318
31,851   31,299 552
4,885   4,692 193
3,324   3,568 -244
1,731   1,614 117
3,452   3,781 -329
9,989   10,750 -761
6,031   6,569 -538
5,930   6,569 -639
20,759   21,117 -358
2,554   2,506 48
5,320   5,456 -136
5,780   5,349 431
6,227   5,732 495
3,029   2,250 779
5,371   6,476 -1,105
4,909   4,192 717
5,043   6,277 -1,234
11,934   11,892 42
11,788   14,174 -2,386
10,496   10,725 -229
5,218   4,050 1,168
5,164   4,770 394
15,503   15,838 -335
2,194   2,767 -573
9,020   10,520 -1,500
18,452   17,039 1,413
11,638   14,495 -2,857
8,313   10,298 -1,985
9,725   15,543 -5,818
5,288   3,899 1,389
5,132   3,251 1,881
433   520 -87
4,067   3,564 503
1,162   827 335
21,181   21,825 -644
25,769   26,307 -538
21,729   19,551 2,178
21,165   21,720 -555
8,507   5,803 2,704
5,667   3,092 2,575
11,834   12,719 -885
10,182   10,863 -681
2,718   2,479 239
6,225   5,906 319
3,229   3,244 -15
2,583   1,945 638
2,642   2,300 342
2,705   2,600 105
2,709   2,633 76
5   6 -1
5,614   7,417 -1,803
10,675   9,401 1,274
11,605   11,719 -114
31   27 4
30,650   32,015 -1,365
656   620 36
656   496 160
1,139   703 436
1,945   1,673 272
1,226   1,035 191
2,224   1,883 341
1,052   1,369 -317
1,497   1,550 -53
1,058   972 86
1,127   1,020 107
1,168   1,132 36
1,569   1,621 -52
1,159   651 508
1,494   1,197 297
1,257   1,068 189
1,830   1,784 46
1,213   1,389 -176
2,026   1,241 785
1,867   928 939
1,244   1,030 214
1,967   1,684 283
1,285   1,418 -133
716   625 91
716   628 88
1,380   1,134 246
1,473   1,401 72
1,071   1,064 7
1,394   1,300 94
1,258   1,294 -36
1,196   1,261 -65
1,785   1,856 -71
1,347   1,367 -20
1,261   1,156 105
1,350   1,317 33
1,358   1,039 319
1,560   1,301 259
1,380   1,467 -87
1,365   1,768 -403
10,329   7,683 2,646
2,480   1,996 484
4,521   2,477 2,044
7,580   6,720 860
4,514   4,763 -249
3,187   3,330 -143
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       -2,118
b       -3,818
c       -215
d       -61
e       -6,274
      93
      278
      -397
      -490
      599
      512
      1,145
      -52
      361
      97
      33
      226
      363
      55
      65
      -457
      106
      922
      -4,254
      -124
      -862
      -28
      -2,240
      -25
      -314
      -318
      552
      193
      -244
      117
      -329
      -761
      -538
      -639
      -358
      48
      -136
      431
      495
      779
      -1,105
      717
      -1,234
      42
      -2,386
      -229
      1,168
      394
      -335
      -573
      -1,500
      1,413
      -2,857
      -1,985
      -5,818
      1,389
      1,881
      -87
      503
      335
      -644
      -538
      2,178
      -555
      2,704
      2,575
      -885
      -681
      239
      319
      -15
      638
      342
      105
      76
      -1
      -1,803
      1,274
      -114
      4
      -1,365
      36
      160
      436
      272
      191
      341
      -317
      -53
      86
      107
      36
      -52
      508
      297
      189
      46
      -176
      785
      939
      214
      283
      -133
      91
      88
      246
      72
      7
      94
      -36
      -65
      -71
      -20
      105
      33
      319
      259
      -87
      -403
      2,646
      484
      2,044
      860
      -249
      -143
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 -7,371
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 123,665 2,467,042 0.050127
2010 164,333 2,408,331 0.068235
2009 110,984 2,241,032 0.049524
2008 209,445 2,635,730 0.079464
2007 63,953 2,888,015 0.022144
2 Total of line 1, column (d) ...................... 2 0.269494
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 0.053899
4 Enter the net value of noncharitable-use assets for 2012 from Part X, line 5..... 4 2,458,925
5 Multiply line 4 by line 3....................... 5 132,534
6 Enter 1% of net investment income (1% of Part I, line 27b)........... 6 397
7 Add lines 5 and 6......................... 7 132,931
8 Enter qualifying distributions from Part XII, line 4.............. 8 124,255
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 1 794
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............................ 3 794
4 Subtitle A (income) tax (domestic section 4947(a)(1) trusts and taxable foundations only. Others enter -0-). 4 0
5 Tax based on investment income. Subtract line 4 from line 3. If zero or less, enter -0- ..... 5 794
6 Credits/Payments:
a 2012 estimated tax payments and 2011 overpayment credited to 2012 6a 996
b Exempt foreign organizations—tax withheld at source....... 6b
c Tax paid with application for extension of time to file (Form 8868) 6c 0
d Backup withholding erroneously withheld ........... 6d  
7 Total credits and payments. Add lines 6a through 6d.............. 7 996
8 Enter any penalty for underpayment of estimated tax. if Form 2220 is attached. 8 0
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 10 202
11 Enter the amount of line 10 to be: Credited to 2013 estimated taxBullet202 Refunded Bullet 11 0
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)
    bulletNH
    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 ofbulletTD Bank NA Telephone no.bullet (603) 229-5990
    Located atbullet143 NORTH MAIN STREETCONCORDNH ZIP+4bullet03301
    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
     
    No
    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
    TD Bank NA Trustee
    1     		21,460    
    PO Box 477
    Concord,NH033020477
    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
    2,460,390
    b
    Average of monthly cash balances.......................
    1b
    35,981
    c
    Fair market value of all other assets (see instructions)................
    1c
    0
    d
    Total (add lines 1a, b, and c).........................
    1d
    2,496,371
    e
    Reduction claimed for blockage or other factors reported on lines 1a and
    1c (attach detailed explanation) .............
    1e
    0
    2
    Acquisition indebtedness applicable to line 1 assets..................
    2
    0
    3
    Subtract line 2 from line 1d.........................
    3
    2,496,371
    4
    Cash deemed held for charitable activities. Enter 1 1⁄2% of line 3 (for greater amount, see
    instructions) .............................
    4
    37,446
    5
    Net value of noncharitable-use assets. Subtract line 4 from line 3. Enter here and on Part V, line 4
    5
    2,458,925
    6
    Minimum investment return. Enter 5% of line 5..................
    6
    122,946
    Part XI
    Distributable Amount bullet and do not complete this part.)
    1
    Minimum investment return from Part X, line 6....................
    1
    122,946
    2a
    Tax on investment income for 2012 from Part VI, line 5......
    2a
    794
    b
    Income tax for 2012. (This does not include the tax from Part VI.)...
    2b
     
    c
    Add lines 2a and 2b............................
    2c
    794
    3
    Distributable amount before adjustments. Subtract line 2c from line 1............
    3
    122,152
    4
    Recoveries of amounts treated as qualifying distributions................
    4
    0
    5
    Add lines 3 and 4............................
    5
    122,152
    6
    Deduction from distributable amount (see instructions).................
    6
    0
    7
    Distributable amount as adjusted. Subtract line 6 from line 5. Enter here and on Part XIII,
    line 1................................
    7
    122,152
    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
    124,255
    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
    124,255
    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
    0
    6
    Adjusted qualifying distributions. Subtract line 5 from line 4..............
    6
    124,255
    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 7 122,152
    2 Undistributed income, if any, as of the end of 2012:
    a Enter amount for 2011 only....... 0
    b Total for prior years:2010, 20, 20 0
    3 Excess distributions carryover, if any, to 2012:
    a From 2007....... 0
    b From 2008....... 0
    c From 2009....... 0
    d From 2010....... 0
    e From 2011....... 1,353
    fTotal of lines 3a through e......... 1,353
    4Qualifying distributions for 2012 from Part
    XII, line 4: bullet$ 124,255
    a Applied to 2011, but not more than line 2a 0
    b Applied to undistributed income of prior years
    (Election required—see instructions)......     		0
    c Treated as distributions out of corpus (Election
    required—see instructions).........     		0
    d Applied to 2012 distributable amount..... 122,152
    e Remaining amount distributed out of corpus 2,103
    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 3,456
    b Prior years’ undistributed income. Subtract
    line 4b from line 2b ...........     		0
    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......     		0
    d Subtract line 6c from line 6b. Taxable amount
    —see instructions ...........     		0
    e Undistributed income for 2011. Subtract line
    4a from line 2a. Taxable amount—see
    instructions .............     		0
    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) .............     		0
    8Excess distributions carryover from 2007 not
    applied on line 5 or line 7 (see instructions) ...     		0
    9Excess distributions carryover to 2013.
    Subtract lines 7 and 8 from line 6a ......     		3,456
    10 Analysis of line 9:
    a Excess from 2008.... 0
    b Excess from 2009.... 0
    c Excess from 2010.... 0
    d Excess from 2011.... 1,353
    e Excess from 2012.... 2,103
    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:
    MONIQUE BROWN
    C/O TD BANK NA
    PO BOX CONCORD,NH033020477
    (603) 229-5990
    bThe form in which applications should be submitted and information and materials they should include:
    LETTER SPECIFYING THE AMOUNT REQUESTED AND WHAT THE FUNDS WILL BE USED FOR
    cAny submission deadlines:
    NONE
    dAny restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other
    factors:
    QUALIFIED CHARITABLE ORGANIZATIONS LOCATED IN CONCORD, NEW HAMPSHIRE
    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
    NEW HAMPSHIRE HISTORICAL
    SOCIETY
    30 PARK STREET
    CONCORD,NH033016384     		NONE 501(C)(3) PURCHASE NEW PHOTOCOPIER 2,000
    CONCORD REG VISITING NURSE ASSN
    ATTN VIOLET ROUNDS
    CONCORD,NH033013502     		NONE 501(C)(3) SUPPORT VARIOUS ACTIVITIES 32,085
    NH ASSOCIATION FOR THE BLIND
    25 WALKER STREET
    CONCORD,NH03301     		NONE 501(C)(3) PROVIDE VISION 2,500
    RIVERBEND COMMUNITY MENTAL HEALTH
    GAYLE KIMBALL DIRECTOR OF DEVELOPM
    CONCORD,NH033022032     		NONE 501(C)(3) HELP FUND AESEP 2,500
    NEW HAMPSHIRE WILDLIFE
    54 PORTSMOUTH STREET
    CONCORD,NH03301     		NONE 501(C)(3) SUPPORT ONGOING 1,750
    GRANITE STATE INDEPENDENT LIVING
    21 CHENELL DRIVE
    CONCORD,NH033018539     		NONE 501(C)(3) SUPPORT LEARNING LAB 2,500
    STRATHSPEY & REEL SOCIETY
    ATTN BETSY WOODMAN
    102 LITTLE POND ROAD
    CONCORD,NH03301     		NONE 501(C)(3) SUPPORT MONTHLY EDUCATIONAL 1,750
    RED RIVER THEATRES INC
    15 PLEASANT STREET
    CONCORD,NH033014026     		NONE 501(C)(3) OPERATING SUPPORT 2,500
    MERRIMACK COUNTY CHILD ADVOCACY CTR
    4 COURT STREET SUITE 3
    CONCORD,NH03301     		NONE 501(C)(3) SUPPORT PROGRAMS 2,000
    NH AUDUBON
    84 SILK FARM ROAD
    CONCORD,NH03301     		NONE 501(C)(3) SUPPORT PHENOLOGY 2,000
    COMMUNITY LOAN FUND
    BETHANY TARBELL GRANTS MGR
    7 WALL STREET
    CONCORD,NH03301     		NONE 501(C)(3) SUPPORT TECHNICAL 3,000
    CONCORD COMMUNITY MUSIC
    24 WALL STREET
    CONCORD,NH03301     		NONE 501(C)(3) SUPPORT BACH LUNCH SERIES 2,500
    CONCORD HOSPITAL
    RICHARD FORD
    C/O ACCOUNTING DEPT
    CONCORD,NH03301     		NONE 501(C)(3) SUPPORT VARIOUS ACTIVITIES 62,170
    NH FOSTER & ADOPTIVE PARENT ASSOC
    JENNIFER GUILLEMETTE EX DIR
    PO BOX 3572
    CONCORD,NH03302     		NONE 501(C)(3) SUPPORT ASSOCIATION 2,500
    RISE AGAIN OUTREACH
    ATTN ROBERT MAGAN
    LOUDON,NH03307     		NONE 501(C)(3) HELP SECURE WAREHOUSE SPACE 2,500
    Total .................................bullet 3a 124,255
    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 62,651  
    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 -7,367  
    9 Net income or (loss) from special events:          
    10 Gross profit or (loss) from sales of inventory..          
    11 Other revenue: a
    b
    c
    d
    e
    12 Subtotal. Add columns (b), (d), and (e)..   55,284  
    13Total. Add line 12, columns (b), (d), and (e)..................
    1355,284
    (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:
    TRUST UW BENJAMIN COUCH 360107015
    EIN: 02-6004808
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    TAX PREPARATION FEE (NON-ALLOC 575 575    

    TY 2012 InvestmentsCorpBondsSchedule
    Name:
    TRUST UW BENJAMIN COUCH 360107015
    EIN: 02-6004808
    Name of Bond End of Year Book Value End of Year Fair Market Value
    10000 AT&T INC 4.45% 10,170 11,549
    15000 ANHEUSER-BUSCH 1.375% 15,164 15,158
    25000 BNK OF NOVA SCOTIA 2.375 25,567 25,475
    20000 BERKSHIRE HATHAWAY 5.40% 22,800 24,058
    15000 CATERPILLAR FINL SE 2.05 15,435 15,527
    10000 CISCO SYSTEMS INC 4.950% 10,927 11,838
    25000 COCA COLA CO 1.500% 23,891 25,602
    20000 GEN ELEC CAP CORP 5.625% 21,795 23,594
    5000 GEN ELEC CAP CORP 1.625% 5,082 5,083
    20000 JPMORGAN CHASE & CO 6.00 21,397 23,944
    30000 ONTARIO PROVINCE 2.950% 31,308 31,532
    10000 PFIZER INC NOTES 5.35% 11,201 11,013
    10000 SBC COMMUNICATIONS 5.10% 10,875 10,742
    10000 TOYOTA MOTOR CREDIT 2.00 10,338 10,368
    20000 WACHOVIA CORP 5.75% 22,708 23,961
    15000 WAL-MART SOTRES INC 1.50 15,437 15,439
    6778.018 FIDELITY HIGH INCOME 60,455 63,307
    3900.153 VANGUARD INFLATION PR 51,950 56,669

    TY 2012 InvestmentsCorpStockSchedule
    Name:
    TRUST UW BENJAMIN COUCH 360107015
    EIN: 02-6004808
    Name of Stock End of Year Book Value End of Year Fair Market Value
    310 BED BATH & BEYOND INC 19,824 17,332
    580 COMCAST CORP NEW CL A 19,213 21,669
    570 WALT DISNEY CO 18,948 28,380
    530 HOME DEPOT INC 15,653 32,781
    260 STARBUCKS CORP 10,136 13,944
    180 YUM BRANDS INC 7,315 11,952
    430 ARCHER DANIELS MIDLAND CO 14,818 11,778
    700 COCA COLA CO 26,925 25,375
    250 COLGATE PALMOLIVE CO 17,899 26,135
    145 DIAGEO PLC ADR 8,351 16,904
    640 MONDELEZ INTERNATIONAL INC 16,376 16,290
    450 WALGREEN CO 16,260 16,655
    540 TRANSOCEAN LTD ZUG 25,119 24,116
    280 CHEVRON CORPORATION 23,029 30,279
    290 CONOCOPHILLIPS 15,926 16,817
    370 EXXON MOBIL CORP 29,192 32,024
    660 SPECTRA ENERGY CORP 19,762 18,071
    270 ACE LTD 11,997 21,546
    350 AMERICAN EXPRESS CO 8,689 20,118
    200 BERKSHIRE HATHAWAY INC DEL 15,694 17,940
    310 CAPITAL ONE FINANCIAL CORP 15,115 17,958
    490 J P MORGAN CHASE & CO 22,148 21,545
    170 PNC BANK CORP 9,416 9,913
    820 US BANCORP DEL NEW 20,182 26,191
    670 WELLS FARGO & CO NEW 11,075 22,901
    280 ABBOTT LABS CO 13,306 18,340
    260 CELGENE CORP 17,181 20,402
    380 GILEAD SCIENCES INC 14,988 27,911
    350 JOHNSON & JOHNSON CO 21,353 24,535
    630 MERCK & CO INC NEW 22,768 25,792
    630 PFIZER 15,876 15,800
    150 WELLPOINT INC COM 10,600 9,138
    480 DANAHER CORP SHS BEN INT 25,408 26,832
    440 ILLINOIS TOOL WKS INC 20,710 26,756
    70 PRECISION CASTPARTS CORP 11,580 13,259
    285 3M CO 20,506 26,462
    120 UNION PACIFIC CORP 12,437 15,086
    470 CHECK POINT SOFTWARE TECH 26,277 22,391
    480 BROADCOM CORP 18,275 15,941
    1175 CISCO SYSTEMS INC 20,740 23,088
    230 COGNIZANT TECHNOLOGY SOLUT 15,620 16,993
    950 EMC CORPORATION/MASS 10,515 24,035
    120 INTL BUSINESS MACHINES COR 19,941 22,986
    760 MICROSOFT CORPORATION 20,151 20,299
    760 ORACLE CORPORATION 23,045 25,323
    440 QUALCOMM INCORPORATED 22,576 27,218
    270 ECOLAB INC 12,593 18,694
    580 FREEPORT-MCMORAN COOPER 25,508 19,836
    530 VERIZON COMMUNICATIONS 15,843 22,933
    340 NEXTERA ENERGY INC 20,680 23,525
    5131.351 INVESCO INTERNATIONAL 139,419 149,938
    1089.602 BUFFALO SMALL CAP FD 26,815 30,694
    2375.753 HARBOR INTERNATIONAL 138,887 147,582
    1248.159 HARTFORD MUT FDS INC 28,458 27,297
    1302.276 PERKINS MID CAP VALUE 28,325 27,791
    1429.537 ROYCE SPECIAL EQUITY 28,576 30,206
    710 SPDR GOLD TRUST 96,912 115,034

    TY 2012 InvestmentsGovtObligationsSch
    Name:
    TRUST UW BENJAMIN COUCH 360107015
    EIN: 02-6004808
    US Government Securities - End of Year Book Value:

    459,957
    US Government Securities - End of Year Fair Market Value:

    464,766
    State & Local Government Securities - End of Year Book Value:


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


     


    TY 2012 OtherDecreasesSchedule
    Name:
    TRUST UW BENJAMIN COUCH 360107015
    EIN: 02-6004808
    Description Amount
    ROUNDING ADJUSTMENT 5


    TY 2012 OtherExpensesSchedule
    Name:
    TRUST UW BENJAMIN COUCH 360107015
    EIN: 02-6004808
    Description Revenue and Expenses per Books Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    STATE/PROBATE FEES 208 208   0
    OTHER NON-ALLOCABLE EXPENSE - 68 68   0


    TY 2012 TaxesSchedule
    Name:
    TRUST UW BENJAMIN COUCH 360107015
    EIN: 02-6004808
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    FEDERAL ESTIMATES - INCOME 142 0   0
    FEDERAL ESTIMATES - PRINCIPAL 142 0   0
    FOREIGN TAXES ON QUALIFIED FOR 341 341   0
    FOREIGN TAXES ON NONQUALIFIED 284 284   0