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
E M ICH BANE TUA 552-5019007053
 

Number and street (or P.O. box number if mail is not delivered to street address)1525 W WT HARRIS BLVD D1114-044   Room/suite
City or town, state, and ZIP code
CHARLOTTE, NC28288
A Employer identification number

54-6293471
B Telephone number (see instructions)

(336) 747-8187
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$4,036,087J 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 14 14  
4 Dividends and interest from securities...... 96,511 94,731  
5a Gross rents..............      
b Net rental income or (loss)  
6a Net gain or (loss) from sale of assets not on line 10 93,971
b Gross sales price for all assets on line 6a 953,370
7 Capital gain net income (from Part IV, line 2)... 93,971
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........ 190,496 188,716  
Operating and Administrative Expenses 13 Compensation of officers, directors, trustees, etc. 48,800 36,600   12,200
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 3,445 0 0 3,445
c Other professional fees (attach schedule)....       0
17 Interest...............       0
18 Taxes (attach schedule) (see instructions) Click to see attachment 29,115 2,477   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 5 5    
24 Total operating and administrative expenses.
Add lines 13 through 23.......... 81,365 39,082 0 15,645
25 Contributions, gifts, grants paid........ 165,000 165,000
26 Total expenses and disbursements. Add lines 24 and 25 246,365 39,082 0 180,645
27 Subtract line 26 from line 12:
a Excess of revenue over expenses and disbursements -55,869
b Net investment income (if negative, enter -0-) 149,634
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.......... 151,477 168,636 168,636
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)      
b Investments—corporate stock (attach schedule)........ 2,830,377 Click to see attachment2,713,620 2,925,700
c Investments—corporate bonds (attach schedule)........ 885,894    
11 Investments—land, buildings, and equipment: basis bullet  
Less: accumulated depreciation (attach schedule) bullet        
12 Investments—mortgage loans..............      
13 Investments—other (attach schedule)...........   Click to see attachment920,217 941,751
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) 3,867,748 3,802,473 4,036,087
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......... 3,867,748 3,802,473
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).................... 3,867,748 3,802,473
31 Total liabilities and net assets/fund balances (see page 17 of
the instructions).................. 3,867,748 3,802,473
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 3,867,748
2 Enter amount from Part I, line 27a..................... 2 -55,869
3 Other increases not included in line 2 (itemize) bulletClick to see attachment 3 3,899
4 Add lines 1, 2, and 3.......................... 4 3,815,778
5 Decreases not included in line 2 (itemize) bulletClick to see attachment 5 13,305
6 Total net assets or fund balances at end of year (line 4 minus line 5)—Part II, column (b), line 30. 6 3,802,473
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 .352 ACCO BRANDS CORP   2011-11-04 2012-05-15
b 93. ACCO BRANDS CORP   2011-11-04 2012-05-17
c 121. ABBOTT LABS W/RIGHTS ATTACHED EXP 11/10/2009   2012-08-09 2012-11-07
d 130. AMGEN INC COM W/RTS ATTACHED EXP 03/21/2007   2011-11-04 2012-08-09
e 47. ANHEUSER-BUSCH INBEV SPN ADR   2012-08-09 2012-11-16
7. APPLE COMPUTER INC COM   2011-09-13 2012-04-24
335. ASCENA RETAIL GROUP INC   2011-11-04 2012-03-28
175. BAKER HUGHES INC COM   2011-11-04 2012-03-28
63. BRISTOL-MYERS SQUIBB CO COM   2011-09-13 2012-04-24
337. BRISTOL-MYERS SQUIBB CO COM   2011-09-13 2012-08-09
42. CAPITAL ONE FINL CORP COM RTS EXP 11/29/2005   2011-09-13 2012-04-24
41. CAPITAL ONE FINL CORP COM RTS EXP 11/29/2005   2011-09-13 2012-08-09
245. CARDINAL HLTH INC COM   2011-09-13 2012-08-09
285. CENTURYTEL INC COM   2011-11-04 2012-07-16
19. CHEVRONTEXACO CORP COM   2011-11-04 2012-02-09
27. COCA-COLA CO COM   2011-09-13 2012-04-24
138. COCA-COLA CO COM   2011-11-04 2012-08-09
74. COMCAST CORP NEW CL A   2011-09-13 2012-04-24
36. COMCAST CORP NEW CL A   2012-08-09 2012-08-16
145. CONOCOPHILLIPS COM   2003-04-10 2012-08-09
23. COSTCO WHOLESALE CORP COM   2011-11-04 2012-04-24
107. COSTCO WHOLESALE CORP COM   2011-11-04 2012-08-09
729. CREDIT SUISSE COMM RET ST-I #2156   2011-09-13 2012-04-24
242. CREDIT SUISSE COMM RET ST-I #2156   2011-09-13 2012-08-09
37. DANAHER CORP COM   2011-09-13 2012-04-24
198. DANAHER CORP COM   2011-09-13 2012-08-09
476. DIAMOND HILL LONG-SHORT FD CL I #11   2011-11-08 2012-04-24
24. DISNEY (WALT) COMPANY HOLDING COMPANY COM   2012-08-09 2012-08-16
362. DREYFUS EMG MKT DEBT LOC C-I #6083   2011-09-13 2012-04-24
187. ECOLAB INC COM   2011-12-21 2012-08-09
26. EXXON MOBIL CORP COM   1999-01-05 2012-04-24
129. EXXON MOBIL CORP COM   1999-01-05 2012-08-09
740. FORD MTR CO DEL COM   2011-11-04 2012-07-16
102. GENERAL ELEC CO COM   2011-11-04 2012-04-24
488. GENERAL ELEC CO COM   2011-11-04 2012-08-09
38. GILEAD SCIENCES INC COM   2011-11-04 2012-04-24
35. GILEAD SCIENCES INC COM   2011-11-04 2012-08-09
28. GILEAD SCIENCES INC COM   2011-11-04 2012-09-25
252. HEWLETT-PACKARD CO COM   2012-08-09 2012-08-30
44. HOME DEPOT INC COM   2011-09-13 2012-04-24
50. HOME DEPOT INC COM   2011-09-13 2012-07-16
211. HOME DEPOT INC COM   2011-09-13 2012-08-09
35. HONEYWELL INTL INC COM   2011-11-04 2012-04-24
170. HONEYWELL INTL INC COM   2011-11-04 2012-08-09
5083. HUSSMAN STRATEGIC GROWTH FD   2011-09-13 2012-08-09
73. INTEL CORP COM   2011-09-13 2012-04-24
85. INTERCONTINENTALEXCHANGE INC   2011-11-04 2012-08-09
10. INTL BUSINESS MACHINES CORP COM   2002-12-24 2012-04-24
60. INTL BUSINESS MACHINES CORP COM   2002-12-24 2012-08-09
197. INTUIT COM W/RTS EXP 5/1/2008   2011-12-21 2012-08-09
63. ISHARES S&P 500 INDEX FUND   2011-11-04 2012-02-09
59. ISHARES S&P 500 INDEX FUND   2011-11-04 2012-04-24
82. ISHARES S&P 500 INDEX FUND   2011-11-04 2012-08-09
74. ISHARES MSCI EAFE INDEX FD   2011-11-04 2012-04-24
267. ISHARES MSCI EAFE INDEX FD   2011-11-04 2012-08-09
608. ISHARES MSCI EAFE INDEX FD   2011-11-04 2012-11-16
71. ISHARES TR-S&P MIDCAP 400 GROWTH IND   2011-11-04 2012-02-09
46. ISHARES TR-S&P MIDCAP 400 GROWTH IND   2012-08-09 2012-11-16
193. ISHARES S&P MIDCAP 400/BARRA VALUE   2011-11-04 2012-02-09
147. ISHARES S&P MIDCAP 400/BARRA VALUE   2011-11-04 2012-04-24
20. ISHARES S&P MIDCAP 400/BARRA VALUE   2011-11-04 2012-08-09
53. ISHARES S&P MIDCAP 400/BARRA VALUE   2011-11-04 2012-11-16
502. ISHARES S & P SMALLCAP 600 INDEX FUND   2011-11-04 2012-02-09
22. ISHARES S & P SMALLCAP 600 INDEX FUND   2011-11-04 2012-08-09
70. ISHARES S & P SMALLCAP 600 INDEX FUND   2011-11-04 2012-11-16
31. JOHNSON & JOHNSON COM   2011-09-13 2012-04-24
149. JOHNSON & JOHNSON COM   2011-09-13 2012-08-09
300. KRAFT FOODS INC-A COM   2011-11-04 2012-03-28
2427. LAUDUS MONDRIAN INTL FI-INST #2940   2011-11-08 2012-08-09
21. MCDONALDS CORP COM   2011-09-13 2012-04-24
119. MCDONALDS CORP COM   2011-09-13 2012-08-09
130. MCKESSON HBOC INC COM   2011-09-13 2012-08-09
62. MEADWESTVACO CORP COM W/RTS EXP 1/29/200   2011-11-04 2012-04-24
283. MEADWESTVACO CORP COM W/RTS EXP 1/29/200   2011-11-04 2012-08-09
61. MICROSOFT CORP COM   2011-11-04 2012-04-24
140. NATIONAL OILWELL INC COM   2011-11-04 2012-08-09
115. OCCIDENTAL PETE CORP COM   2011-11-04 2012-08-09
3084. PIMCO FOREIGN BOND FUND-INST   2011-07-01 2012-08-09
72. PHILLIPS 66   2003-04-10 2012-05-17
.5 PHILLIPS 66   2003-04-10 2012-05-22
29. PROCTER & GAMBLE CO COM   2001-07-24 2012-04-24
146. PROCTER & GAMBLE CO COM   2001-07-24 2012-08-09
310. PUBLIC SVC ENTERPRISE GRP INC COM   2011-11-04 2012-08-09
32. QUALCOMM INC COM W/RTS ATTACHED   2011-09-13 2012-04-24
173. QUALCOMM INC COM W/RTS ATTACHED   2011-09-13 2012-08-09
1089. RIDGEWORTH SEIX HY BD-I #5855   2012-08-13 2012-11-16
107. SPDR DJ WILSHIRE INTERNATIONAL REAL   2011-09-13 2012-04-24
287. SPDR DJ WILSHIRE INTERNATIONAL REAL   2011-09-13 2012-08-09
217. SPDR DJ WILSHIRE INTERNATIONAL REAL   2011-09-13 2012-11-16
61. TEXAS INSTRS INC COM   2011-09-13 2012-04-24
304. TEXAS INSTRS INC COM   2011-09-13 2012-08-09
42. TIMKEN CO COM   2011-11-04 2012-04-24
233. TIMKEN CO COM   2011-11-04 2012-08-09
25. UNITED TECHNOLOGIES CORP COM   2004-07-29 2012-04-24
130. UNITED TECHNOLOGIES CORP COM   2004-07-29 2012-08-09
33. UNITEDHEALTH GRP INC COM   2011-09-13 2012-04-24
420. UNUMPROVIDENT CORP COM   2011-11-04 2012-08-09
45. VANGUARD INTERMEDIATE TERM B   2011-11-04 2012-04-24
338. VANGUARD INTERMEDIATE TERM B   2011-11-04 2012-08-09
113. VANGUARD SHORT TERM BOND ETF   2011-11-04 2012-04-24
441. VANGARD MSCI EMERGING MARKETS EFT   2011-11-04 2012-02-09
355. VANGARD MSCI EMERGING MARKETS EFT   2012-08-09 2012-11-16
275. VANGUARD REIT VIPER   2011-11-04 2012-02-09
70. VANGUARD REIT VIPER   2011-11-04 2012-04-24
194. VANGUARD REIT VIPER   2011-11-04 2012-08-09
211. VERIZON COMMUNICATIONS COM   2012-07-16 2012-08-09
80. WYNN RESORTS LTD   2011-09-13 2012-07-16
33. ACCENTURE PLC   2004-04-05 2012-04-24
167. ACCENTURE PLC   2004-04-05 2012-08-09
115. COOPER INDUSTRIES PLC NEW IRELAND   2011-08-09 2012-12-03
.101 EATON CORP PLC   2012-11-30 2012-12-17
30. ACE LIMITED   2011-09-13 2012-04-24
170. ACE LIMITED   2011-09-13 2012-08-09
40. TYCO INTERNATIONAL LTD NEW   2011-09-13 2012-04-24
34. TYCO INTERNATIONAL LTD NEW   2011-09-13 2012-07-16
186. TYCO INTERNATIONAL LTD NEW   2011-09-13 2012-08-09
(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 4   3 1
b 918   894 24
c 7,815   7,941 -126
d 10,566   7,201 3,365
e 3,879   3,093 786
3,940   2,698 1,242
14,815   9,541 5,274
7,156   10,034 -2,878
2,139   1,862 277
10,821   9,958 863
2,273   1,801 472
2,296   1,758 538
9,700   9,998 -298
11,717   10,000 1,717
2,034   2,013 21
1,998   1,865 133
10,976   9,439 1,537
2,166   1,611 555
1,227   1,179 48
8,243   2,853 5,390
1,986   1,934 52
10,217   8,998 1,219
5,847   6,787 -940
2,018   2,253 -235
1,965   1,633 332
10,491   8,738 1,753
8,468   8,178 290
1,206   1,208 -2
5,177   5,235 -58
12,021   10,497 1,524
2,244   856 1,388
11,291   4,249 7,042
6,830   8,347 -1,517
1,993   1,671 322
10,218   7,993 2,225
1,974   1,555 419
1,982   1,432 550
1,892   1,146 746
4,223   4,896 -673
2,251   1,439 812
2,571   1,635 936
11,207   6,900 4,307
2,097   1,888 209
9,978   9,169 809
56,421   65,367 -8,946
1,991   1,517 474
11,215   10,907 308
2,002   800 1,202
11,951   4,801 7,150
11,742   10,454 1,288
8,555   7,927 628
8,121   7,424 697
11,548   10,318 1,230
3,905   3,841 64
13,806   13,857 -51
31,701   31,555 146
7,785   7,316 469
4,948   4,995 -47
16,173   14,734 1,439
12,220   11,222 998
1,663   1,527 136
4,299   4,046 253
38,028   34,011 4,017
1,635   1,491 144
5,006   4,743 263
1,971   1,975 -4
10,166   9,493 673
11,371   10,347 1,024
28,736   30,046 -1,310
1,982   1,811 171
10,433   10,265 168
11,470   9,645 1,825
1,955   1,789 166
7,809   7,270 539
1,943   1,602 341
10,683   10,019 664
10,415   11,196 -781
34,140   32,135 2,005
2,267   842 1,425
16   6 10
1,940   983 957
9,725   4,949 4,776
10,044   10,362 -318
1,965   1,670 295
10,610   9,029 1,581
10,781   10,705 76
3,941   3,742 199
11,058   10,036 1,022
8,585   7,588 997
1,918   1,623 295
8,999   8,089 910
2,136   1,854 282
9,488   10,283 -795
1,997   1,177 820
10,038   6,121 3,917
1,936   1,570 366
8,005   9,194 -1,189
3,947   3,956 -9
30,102   29,710 392
9,161   9,207 -46
19,457   18,469 988
14,334   14,758 -424
17,206   15,815 1,391
4,488   4,026 462
12,754   10,848 1,906
9,303   9,575 -272
7,724   11,997 -4,273
2,074   834 1,240
10,295   4,101 6,194
9,127   8,450 677
5   5  
2,242   1,845 397
12,395   10,455 1,940
2,185   1,646 539
1,771   1,399 372
10,471   7,655 2,816
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       1
b       24
c       -126
d       3,365
e       786
      1,242
      5,274
      -2,878
      277
      863
      472
      538
      -298
      1,717
      21
      133
      1,537
      555
      48
      5,390
      52
      1,219
      -940
      -235
      332
      1,753
      290
      -2
      -58
      1,524
      1,388
      7,042
      -1,517
      322
      2,225
      419
      550
      746
      -673
      812
      936
      4,307
      209
      809
      -8,946
      474
      308
      1,202
      7,150
      1,288
      628
      697
      1,230
      64
      -51
      146
      469
      -47
      1,439
      998
      136
      253
      4,017
      144
      263
      -4
      673
      1,024
      -1,310
      171
      168
      1,825
      166
      539
      341
      664
      -781
      2,005
      1,425
      10
      957
      4,776
      -318
      295
      1,581
      76
      199
      1,022
      997
      295
      910
      282
      -795
      820
      3,917
      366
      -1,189
      -9
      392
      -46
      988
      -424
      1,391
      462
      1,906
      -272
      -4,273
      1,240
      6,194
      677
       
      397
      1,940
      539
      372
      2,816
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 93,971
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 183,800 4,022,995 0.045687
2010 183,937 3,795,939 0.048456
2009 175,696 3,346,265 0.052505
2008 193,832 3,867,525 0.050118
2007 197,300 4,524,620 0.043606
2 Total of line 1, column (d) ...................... 2 0.240372
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 0.048074
4 Enter the net value of noncharitable-use assets for 2012 from Part X, line 5..... 4 3,884,463
5 Multiply line 4 by line 3....................... 5 186,742
6 Enter 1% of net investment income (1% of Part I, line 27b)........... 6 1,496
7 Add lines 5 and 6......................... 7 188,238
8 Enter qualifying distributions from Part XII, line 4.............. 8 180,645
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 2,993
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 2,993
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 2,993
6 Credits/Payments:
a 2012 estimated tax payments and 2011 overpayment credited to 2012 6a 13,896
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 13,896
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 10,903
11 Enter the amount of line 10 to be: Credited to 2013 estimated taxBullet2,996 Refunded Bullet 11 7,907
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)
    bulletVA
    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 ofbulletWELLS FARGO BANK NA Telephone no.bullet (336) 747-8187
    Located atbullet1 WEST 4TH ST - 2ND FLWINSTONSALEMNC ZIP+4bullet271013818
    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
     
    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
    WELLS FARGO BANK NA TRUSTEE
    40     		48,800    
    1525 W WT HARRIS BLVD D1114-044
    CHARLOTTE,NC282881161
    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
    3,802,634
    b
    Average of monthly cash balances.......................
    1b
    140,983
    c
    Fair market value of all other assets (see instructions)................
    1c
    0
    d
    Total (add lines 1a, b, and c).........................
    1d
    3,943,617
    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
    3,943,617
    4
    Cash deemed held for charitable activities. Enter 1 1⁄2% of line 3 (for greater amount, see
    instructions) .............................
    4
    59,154
    5
    Net value of noncharitable-use assets. Subtract line 4 from line 3. Enter here and on Part V, line 4
    5
    3,884,463
    6
    Minimum investment return. Enter 5% of line 5..................
    6
    194,223
    Part XI
    Distributable Amount bullet and do not complete this part.)
    1
    Minimum investment return from Part X, line 6....................
    1
    194,223
    2a
    Tax on investment income for 2012 from Part VI, line 5......
    2a
    2,993
    b
    Income tax for 2012. (This does not include the tax from Part VI.)...
    2b
     
    c
    Add lines 2a and 2b............................
    2c
    2,993
    3
    Distributable amount before adjustments. Subtract line 2c from line 1............
    3
    191,230
    4
    Recoveries of amounts treated as qualifying distributions................
    4
    0
    5
    Add lines 3 and 4............................
    5
    191,230
    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
    191,230
    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
    180,645
    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
    180,645
    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
    180,645
    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 7 191,230
    2 Undistributed income, if any, as of the end of 2012:
    a Enter amount for 2011 only....... 170,420
    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....... 0
    fTotal of lines 3a through e......... 0
    4Qualifying distributions for 2012 from Part
    XII, line 4: bullet$ 180,645
    a Applied to 2011, but not more than line 2a 170,420
    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..... 10,225
    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 ...........     		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 ..........     		181,005
    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 ......     		0
    10 Analysis of line 9:
    a Excess from 2008.... 0
    b Excess from 2009.... 0
    c Excess from 2010.... 0
    d Excess from 2011.... 0
    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).)
    bList any managers of the foundation who own 10% or more of the stock of a corporation (or an equally large portion of the
    ownership of a partnership or other entity) of which the foundation has a 10% or greater interest.
    2Information Regarding Contribution, Grant, Gift, Loan, Scholarship, etc., Programs:
    Check here bullet
    aThe name, address, and telephone number of the person to whom applications should be addressed:
    bThe form in which applications should be submitted and information and materials they should include:
    cAny submission deadlines:
    dAny restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other
    factors:
    Form 990-PF (2012)
    Form 990-PF (2012)
    Page 10
    Part XV
    Supplementary Information (continued)
    3 Grants and Contributions Paid During the Year or Approved for Future Payment
    Recipient If recipient is an individual,
    show any relationship to
    any foundation manager
    or substantial contributor
    		 Foundation
    status of
    recipient     		Purpose of grant or
    contribution     		Amount
    Name and address (home or business)
    aPaid during the year
    AMERICAN DIABETES ASSOCIATION
    VIRGINIA AFFILIATE INC
    1701 NORTH BEAUREGARD STREET
    ALEXANDRIA,VA22311     		NONE PUBLIC CHARITY CONTRIBUTION 3,300
    AMERCIAN CANCER SOCIETY
    ATTN PHILLIP R SAMRICK
    PO BOX 720366
    OKLAHOMA CITY,OK731720366     		NONE PUBLIC CHARITY CONTRIBUTION 8,250
    CYSTIC FIBROSIS FOUNDATION
    JOHN LEHR DIR MAJOR/PLAN GIFTS
    6931 ARLINGTON ROAD
    BETHESDA,MD20814     		NONE PUBLIC CHARITY CONTRIBUTION 3,300
    GRUNDY VOLUNTEER FIRE DEPARTMENT
    FOUNDATION
    MAPLE STREET
    Grundy,VA24614     		NONE PUBLIC CHARITY CONTRIBUTION 1,650
    PATTERSON RESCUE
    VIRGINIA 638
    Patterson,VA24631     		NONE PUBLIC CHARITY CONTRIBUTION 1,650
    SHRINERS HOSPITALS FOR CHILDREN
    POST OFFICE BOX 863770
    ORLANDO,FL328863770     		NONE PUBLIC CHARITY CONTRIBUTION 16,500
    AMERICAN RED CROSS BUCHANAN
    COUNTY CHAPTER
    117 W WASHINGTON ST
    Morris,IL60450     		NONE PUBLIC CHARITY CONTRIBUTION 8,250
    EMORY AND HENRY COLLEGE
    POST OFFICE BOX 950
    EMORY,VA24327     		NONE PUBLIC CHARITY CONTRIBUTION 8,250
    ROANOKE COLLEGE
    221 COLLEGE LANE
    SALEM,VA24153     		NONE PUBLIC CHARITY CONTRIBUTION 8,250
    EASTERN STAR HOME OF VA INC
    ATTN DAVID SMITH PRESIDENT
    4101 NINE MILE ROAD
    RICHMOND,VA23223     		NONE PUBLIC CHARITY CONTRIBUTION 1,650
    MASONIC HOME OF VIRGINIA
    4101 NINE MILE ROAD
    RICHMOND,VA23223     		NONE EXEMPT GENERAL 1,650
    VIRGINIA FOUNDATION FOR
    INDEPENDENT COLLEGES
    8010 RIDGE ROAD SUITE B
    Richmond,VA23229     		NONE PUBLIC CHARITY CONTIBUTION 8,250
    MOUNTAIN MISSION SCHOOL
    1760 EDGEWATER DRIVE
    GRUNDY,VA24614     		NONE PUBLIC CHARITY CONTRIBUTION 33,000
    OAKWOOD VOLUNTEER FIRE DEPT INC
    INTERSECTION US 460 STATE RT 624
    Oakwood,VA24631     		NONE PUBLIC CHARITY CONTRIBUTION 1,650
    WHITEWOOD FIRE DEPARTMENT
    1186 WIMMER GAP RD
    WHITEWOOD,VA246579456     		NONE PUBLIC CHARITY CONTRIBUTION 1,650
    ALZHEIMER DISEASE AND RELATED
    DISORDERS ASSOCIATION
    4600 COX ROAD SUITE 130
    GLEN ALLEN,VA23060     		NONE PUBLIC CHARITY CONTRIBUTION 3,300
    COUNCIL FIRE DEPARTMENT
    1/10 MILE ON RT 620 EAST OF RT 80
    Honaker,VA24260     		NONE PUBLIC CHARITY CONTRIBUTION 1,650
    SLATE CREEK VFD
    10087 SLATE CREEK RD
    GRUNDY,VA24614     		NONE PUBLIC CHARITY CONTRIBUTION 1,650
    RUSSELL PRATER FIRE
    LOVERS GAP RD RT 83
    Vansant,VA24656     		NONE PUBLIC CHARITY CONTRIBUTION 1,650
    DISMAL RIVER RESCUE
    1076 BROWN MOUNTAIN RD
    Whitewood,VA24657     		NONE PUBLIC CHARITY CONTRIBUTION 1,650
    KNOX CREEK FIRE & RESCUE
    FOUNDATION
    400 MAIN ST
    Knoxville,TN37902     		NONE PUBLIC CHARITY CONTRIBUTION 1,650
    DAVENPORT LIFE SAVING
    PO BOX 53
    DAVENPORT,VA24239     		NONE PUBLIC CHARITY GENERAL PURPSOE 1,650
    NATIONAL PARKINSON FOUNDATION
    C/O NATIONAL PARKINSON FDN INC
    1501 NW 9TH AVENUE
    MIAMI,FL331361494     		NONE PUBLIC CHARITY CONTRIBUTION 3,300
    NATIONAL RIGHT TO WORK
    LEGAL DEFENSE & EDUCATION FDN
    8001 BRADDOCK ROAD SUITE 600
    SPRINGFIELD,VA22160     		NONE PUBLIC CHARITY CONTRIBUTION 16,500
    PIKEVILLE COLLEGE
    147 SYCAMORE STREET
    PIKEVILLE,KY41501     		NONE PUBLIC CHARITY CONTRIBUTION 8,250
    BOY SCOUTS OF AMERICA SEQUOYAH
    ATTENTION DOUG MITCHELL
    129 BOONE RIDGE DRIVE
    JOHNSON CITY,TN37615     		NONE PUBLIC CHARITY CONTRIBUTION 16,500
    Total .................................bullet 3a 165,000
    bApproved for future payment
    Total .................................bullet 3b  
    Form 990-PF (2012)
    Form 990-PF (2012)
    Page 11
    Part XVI-A
    Analysis of Income-Producing Activities
    Enter gross amounts unless otherwise indicated. Unrelated business income Excluded by section 512, 513, or 514 (e)
    Related or exempt
    function income
    (See instructions.)
    1Program service revenue: (a)
    Business code     		(b)
    Amount     		(c)
    Exclusion code     		(d)
    Amount
    a
    b
    c
    d
    e
    f
    gFees and contracts from government agencies          
    2 Membership dues and assessments....          
    3Interest on savings and temporary cash investments     14 14  
    4 Dividends and interest from securities....     14 96,511  
    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 93,971  
    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)..   190,496  
    13Total. Add line 12, columns (b), (d), and (e)..................
    13190,496
    (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:
    E M ICH BANE TUA 552-5019007053
    EIN: 54-6293471
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    TAX PREPARATION FEE (NON-ALLOC 3,445     3,445

    TY 2012 InvestmentsCorpBondsSchedule
    Name:
    E M ICH BANE TUA 552-5019007053
    EIN: 54-6293471
    Name of Bond End of Year Book Value End of Year Fair Market Value
    04315J860 ARTIO GLOBAL HIGH IN    
    693390593 PIMCO MODERATE DURAT    
    693390700 PIMCO TOT. RTN    
    922031737 VANGUARD INFLATION P    
    94985D582 WELLS FARGO ADV.INTE    
    693391559 PIMCO EMERGING MKTS    
    025076209 AMERICAN CENTURY EQU    
    92934R769 CRM MID CAP VALUE    
    38142Y401 GOLDMAN SACHS GROWTH    
    411511504 HARBOR CAPITAL APPRE    
    780905451 ROYCE PREMIER FUND    
    94984B157 WELLS FARGO ADV. DIS    
    94975P751 WELLS FARGO ADV. EME    
    94985D244 WELLS FARGO ADV. TRA    
    246248306 DELAWARE POOLED TR    
    411511306 HARBOR INTERNATIONAL    
    261980494 DREYFUS EMG MKT DEBT    
    51855Q655 LAUDUS MONDRIAN INTL    
    693390882 PIMCO FOREIGN BD FD    
    76628T645 RIDGEWORTH SEIX HY B    
    921937819 VANGUARD INTERMEDIAT    
    921937827 VANGUARD SHORT TERM    

    TY 2012 InvestmentsCorpStockSchedule
    Name:
    E M ICH BANE TUA 552-5019007053
    EIN: 54-6293471
    Name of Stock End of Year Book Value End of Year Fair Market Value
    654106103 NIKE INC CL    
    126650100 CVS/CAREMARK CORPORA 10,688 11,556
    742718109 PROCTER & GAMBLE CO    
    20825C104 CONOCOPHILLIPS    
    30231G102 EXXON MOBIL CORP    
    00817Y108 AETNA INC-NEW    
    075887109 BECTON DICKINSON & C    
    913017109 UNITED TECHNOLOGIES    
    459200101 IBM CORP    
    74005P104 PRAXAIR INC COM    
    00206R102 AT & T INC    
    65339F101 NEXTERA ENERGY    
    G1151C101 ACCENTURE PLC    
    031162100 AMGEN INC    
    03524A108 ANHEUSER-BUSCH INBEV 8,494 12,587
    037833100 APPLE INC 18,972 23,948
    04351G101 ASCENA RETAIL GROUP    
    057224107 BAKER HUGHES INC COM    
    110122108 BRISTOL MYERS SQUIBB    
    14040H105 CAPITAL ONE FINANCIA 7,802 10,543
    14149Y108 CARDINAL HEALTH INC    
    156700106 CENTURYLINK, INC    
    166764100 CHEVRON CORP 15,657 16,437
    17275R102 CISCO SYSTEMS INC 13,864 15,484
    191216100 COCA COLA CO    
    20030N101 COMCAST CORP CLASS A 8,512 14,608
    22160K105 COSTCO WHOLESALE COR    
    22544R305 CREDIT SUISSE COMM R 219,582 192,666
    235851102 DANAHER CORP    
    25264S833 DIAMOND HILL LONG-SH 144,146 159,407
    278865100 ECOLAB INC    
    345370860 FORD MOTOR COMPANY    
    369604103 GENERAL ELECTRIC CO    
    375558103 GILEAD SCIENCES INC 6,301 11,311
    437076102 HOME DEPOT INC    
    438516106 HONEYWELL INTERNATIO    
    448108100 HUSSMAN STRATEGIC GR 112,226 96,519
    458140100 INTEL CORP 9,252 8,867
    45865V100 INTERCONTINENTALEXCH    
    461202103 INTUIT COM    
    464287200 ISHARES CORE S & P 5 146,089 166,186
    464287465 ISHARES MSCI EAFE 433,936 475,406
    464287606 ISHARES S&P MIDCAP 4 123,822 137,178
    464287705 ISHARES S&P MIDCAP 4 97,486 112,555
    464287804 ISHARES CORE S&P SMA 218,223 251,560
    46625H100 JPMORGAN CHASE & CO 12,003 15,565
    478160104 JOHNSON & JOHNSON    
    50075N104 KRAFT FOODS INC    
    580135101 MCDONALDS CORP    
    58155Q103 MCKESSON CORP 9,957 10,181
    583334107 MEADWESTVACO CORP    
    589509108 MERGER FD SH BEN INT 74,714 75,361
    594918104 MICROSOFT CORP 7,852 7,986
    637071101 NATIONAL OILWELL INC    
    674599105 OCCIDENTAL PETE CORP    
    68389X105 ORACLE CORPORATION 11,727 11,995
    744573106 PUBLIC SVC ENTERPRIS    
    747525103 QUALCOMM INC    
    78463X863 SPDR DJ WILSHIRE INT 134,183 158,784
    87612E106 TARGET CORP 11,762 13,077
    882508104 TEXAS INSTRUMENTS IN    
    887389104 TIMKEN CO    
    913017109 UNITED TECHNOLOGIES    
    91324P102 UNITEDHEALTH GROUP I 10,662 11,987
    91529Y106 UNUM GROUP    
    922042858 VANGUARD MSCI EMERGI 323,076 345,954
    922908553 VANGUARD REIT VIPER 134,703 159,762
    983134107 WYNN RESORTS LTD    
    H0023R105 ACE LIMITED    
    H89128104 TYCO INTERNATIONAL L    
    001055102 AFLAC INC 9,634 11,261
    008252108 AFFILIATED MANAGERS 13,444 14,967
    037411105 APACHE CORP 12,468 11,618
    084670702 BERKSHIRE HATHAWAY I 16,202 17,133
    088606108 BHP BILLITON LIMITED 7,750 8,783
    097023105 BOEING CO 9,255 9,345
    12572Q105 CME GROUP INC 11,361 10,742
    150870103 CELANESE CORP 7,580 8,372
    25243Q205 DIAGEO PLC - ADR 11,648 12,707
    254687106 WALT DISNEY CO 13,362 14,788
    268648102 E M C CORP MASS 9,799 9,209
    367829884 GATEWAY FUND - Y #19 94,726 93,792
    38141G104 GOLDMAN SACHS GROUP 6,863 8,547
    38259P508 GOOGLE INC 11,720 12,733
    478366107 JOHNSON CONTROLS INC 9,290 11,072
    641069406 NESTLE S.A. REGISTER 11,080 11,470
    66987V109 NOVARTIS AG - ADR 7,469 8,039
    806857108 SCHLUMBERGER LTD 14,017 13,236
    872540109 TJX COS INC NEW 11,004 10,400
    881624209 TEVA PHARMACEUTICAL 9,535 8,812
    883556102 THERMO FISHER SCIENT 10,245 11,417
    88579Y101 3M CO 11,383 11,513
    89151E109 TOTAL S.A. - ADR 10,057 10,714
    902973304 US BANCORP DEL NEW 11,995 12,009
    907818108 UNION PACIFIC CORP 18,499 19,109
    911312106 UNITED PARCEL SERVIC 9,386 9,143
    92857W209 VODAFONE GROUP PLC N 8,650 7,330
    G29183103 EATON CORP PLC 9,507 9,969

    TY 2012 InvestmentsOtherSchedule2
    Name:
    E M ICH BANE TUA 552-5019007053
    EIN: 54-6293471
    Category/ Item Listed at Cost or FMV Book Value End of Year Fair Market Value
    44980Q518 ING INTER      
    44981V706 ING REAL ESTATE      
    722005667 PIMCO COMMODITY REAL      
    779919109 T ROWE PRICE RE      
    261980494 DREYFUS EMG MKT DEBT AT COST 186,006 198,127
    51855Q655 LAUDUS MONDRIAN INTL AT COST 35,454 33,163
    693390882 PIMCO FOREIGN BD FD AT COST 32,021 33,158
    76628T645 RIDGEWORTH SEIX HY B AT COST 187,968 200,016
    921937819 VANGUARD INTERMEDIAT AT COST 166,185 166,528
    921937827 VANGUARD SHORT TERM AT COST 312,583 310,759

    TY 2012 OtherDecreasesSchedule
    Name:
    E M ICH BANE TUA 552-5019007053
    EIN: 54-6293471
    Description Amount
    MUTUAL FUND TAX EFFECTIVE DATE AFTER TYE 12,312
    ROC BASIS ADJUSTMENT 992
    ROUNDING 1


    TY 2012 OtherExpensesSchedule
    Name:
    E M ICH BANE TUA 552-5019007053
    EIN: 54-6293471
    Description Revenue and Expenses per Books Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    ADR FEES 5 5   0


    TY 2012 OtherIncreasesSchedule
    Name:
    E M ICH BANE TUA 552-5019007053
    EIN: 54-6293471
    Description Amount
    MUTUAL FUND TAX EFFECTIVE DATE BEFORE TYE 3,899


    TY 2012 TaxesSchedule
    Name:
    E M ICH BANE TUA 552-5019007053
    EIN: 54-6293471
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    FOREIGN TAXES 175 175   0
    FEDERAL TAX PAYMENT - PRIOR YE 12,742 0   0
    FEDERAL ESTIMATES - PRINCIPAL 13,896 0   0
    FOREIGN TAXES ON QUALIFIED FOR 1,718 1,718   0
    FOREIGN TAXES ON NONQUALIFIED 584 584   0