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
JOHN W PLANSOEN TRUST 485-2513843626
 

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

22-6020281
B Telephone number (see instructions)

(336) 747-8203
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$4,138,854J 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...... 110,530 109,116  
5a Gross rents..............      
b Net rental income or (loss)  
6a Net gain or (loss) from sale of assets not on line 10 -4,164
b Gross sales price for all assets on line 6a 307,599
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........ 106,366 109,116  
Operating and Administrative Expenses 13 Compensation of officers, directors, trustees, etc. 14,082 7,027   7,054
14 Other employee salaries and wages......   0 0 0
15 Pension plans, employee benefits.......   0 0  
16a Legal fees (attach schedule)......... Click to see attachment 650 0 0 650
b Accounting fees (attach schedule)....... Click to see attachment 250 0 0 250
c Other professional fees (attach schedule).... Click to see attachment 9,056 6,792   2,264
17 Interest...............       0
18 Taxes (attach schedule) (see instructions) Click to see attachment 16,171     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).......        
24 Total operating and administrative expenses.
Add lines 13 through 23.......... 40,209 13,819 0 10,218
25 Contributions, gifts, grants paid........ 173,476 173,476
26 Total expenses and disbursements. Add lines 24 and 25 213,685 13,819 0 183,694
27 Subtract line 26 from line 12:
a Excess of revenue over expenses and disbursements -107,319
b Net investment income (if negative, enter -0-) 95,297
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............... 138    
2 Savings and temporary cash investments.......... 705,632 908,990 908,990
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) 665,574 Click to see attachment454,196 531,457
b Investments—corporate stock (attach schedule)........ 1,406,023 Click to see attachment1,406,023 2,583,088
c Investments—corporate bonds (attach schedule)........ 199,213 Click to see attachment24,975 31,299
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 attachment75,000 84,020
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) 2,976,580 2,869,184 4,138,854
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......... 2,976,580 2,869,184
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).................... 2,976,580 2,869,184
31 Total liabilities and net assets/fund balances (see page 17 of
the instructions).................. 2,976,580 2,869,184
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 2,976,580
2 Enter amount from Part I, line 27a..................... 2 -107,319
3 Other increases not included in line 2 (itemize) bulletClick to see attachment 3 698
4 Add lines 1, 2, and 3.......................... 4 2,869,959
5 Decreases not included in line 2 (itemize) bulletClick to see attachment 5 775
6 Total net assets or fund balances at end of year (line 4 minus line 5)—Part II, column (b), line 30. 6 2,869,184
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 50000. BOTTLING GROUP LLC 4.625% 11/15/12   2004-10-01 2012-11-15
b 42.79 GNMA POOL #607809 5.000% 3/15/33   2003-03-25 2012-01-15
c 43.24 GNMA POOL #607809 5.000% 3/15/33   2003-03-25 2012-02-15
d 42.66 GNMA POOL #607809 5.000% 3/15/33   2003-03-25 2012-03-15
e 47.03 GNMA POOL #607809 5.000% 3/15/33   2003-03-25 2012-04-15
44.11 GNMA POOL #607809 5.000% 3/15/33   2003-03-25 2012-05-15
6518.49 GNMA POOL #607809 5.000% 3/15/33   2003-03-25 2012-06-15
30.35 GNMA POOL #607809 5.000% 3/15/33   2003-03-25 2012-07-15
29.45 GNMA POOL #607809 5.000% 3/15/33   2003-03-25 2012-08-15
33.25 GNMA POOL #607809 5.000% 3/15/33   2003-03-25 2012-09-15
29.72 GNMA POOL #607809 5.000% 3/15/33   2003-03-25 2012-10-15
33.8 GNMA POOL #607809 5.000% 3/15/33   2003-03-25 2012-11-15
33.17 GNMA POOL #607809 5.000% 3/15/33   2003-03-25 2012-12-15
200000. US TREASURY NOTES 4.000% 11/15/12   2007-12-28 2012-11-15
50000. VERIZON VIRGINIA INC 4.625% 3/15/13   2005-01-06 2012-12-10
(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 50,000   50,503 -503
b 43   43  
c 43   43  
d 43   42 1
e 47   47  
44   44  
6,518   6,493 25
30   30  
29   29  
33   33  
30   30  
34   34  
33   33  
200,000   204,477 -4,477
50,565   49,882 683
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       -503
b        
c        
d       1
e        
       
      25
       
       
       
       
       
       
      -4,477
      683
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 -4,164
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 185,936 4,042,289 0.045998
2010 149,419 3,805,167 0.039267
2009 204,870 3,751,854 0.054605
2008 237,010 4,606,946 0.051446
2007 218,200 5,167,604 0.042225
2 Total of line 1, column (d) ...................... 2 0.233541
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 0.046708
4 Enter the net value of noncharitable-use assets for 2012 from Part X, line 5..... 4 4,165,612
5 Multiply line 4 by line 3....................... 5 194,567
6 Enter 1% of net investment income (1% of Part I, line 27b)........... 6 953
7 Add lines 5 and 6......................... 7 195,520
8 Enter qualifying distributions from Part XII, line 4.............. 8 183,694
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 1,906
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 1,906
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 1,906
6 Credits/Payments:
a 2012 estimated tax payments and 2011 overpayment credited to 2012 6a 10,056
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 10,056
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 8,150
11 Enter the amount of line 10 to be: Credited to 2013 estimated taxBullet1,908 Refunded Bullet 11 6,242
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)
    bulletNJ
    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) 747-8203
    Located atbullet1 W 4TH ST - 2ND FLOORWINSTONSALEMNC 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 CO-TRUSTEE
    40     		9,370    
    1525 WEST WT HARRIS BLVD
    CHARLOTTE,NC282881114
    JOHANNA YOUNG CO-TRUSTEE
    1     		2,225    
    24 ROOSEVELT AVE
    MARBLEHEAD,MA01945
    HECTOR L PLANSOEN CO-TRUSTEE
    1     		2,487    
    5521 LIBERTY ROAD SOUTH
    SALEM,OR973069504
    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
    3,487,599
    b
    Average of monthly cash balances.......................
    1b
    741,449
    c
    Fair market value of all other assets (see instructions)................
    1c
    0
    d
    Total (add lines 1a, b, and c).........................
    1d
    4,229,048
    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
    4,229,048
    4
    Cash deemed held for charitable activities. Enter 1 1⁄2% of line 3 (for greater amount, see
    instructions) .............................
    4
    63,436
    5
    Net value of noncharitable-use assets. Subtract line 4 from line 3. Enter here and on Part V, line 4
    5
    4,165,612
    6
    Minimum investment return. Enter 5% of line 5..................
    6
    208,281
    Part XI
    Distributable Amount bullet and do not complete this part.)
    1
    Minimum investment return from Part X, line 6....................
    1
    208,281
    2a
    Tax on investment income for 2012 from Part VI, line 5......
    2a
    1,906
    b
    Income tax for 2012. (This does not include the tax from Part VI.)...
    2b
     
    c
    Add lines 2a and 2b............................
    2c
    1,906
    3
    Distributable amount before adjustments. Subtract line 2c from line 1............
    3
    206,375
    4
    Recoveries of amounts treated as qualifying distributions................
    4
    0
    5
    Add lines 3 and 4............................
    5
    206,375
    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
    206,375
    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
    183,694
    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
    183,694
    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
    183,694
    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 7 206,375
    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....... 1,857
    d From 2010....... 0
    e From 2011....... 0
    fTotal of lines 3a through e......... 1,857
    4Qualifying distributions for 2012 from Part
    XII, line 4: bullet$ 183,694
    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..... 183,694
    e Remaining amount distributed out of corpus 0
    5 Excess distributions carryover applied to 2012. 1,857 1,857
    (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 ..........     		20,824
    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
    GORDON-CONWELL THEOLOGICAL SEMINARY
    130 ESSEX STREET
    SOUTH HAMILTON,MA01982     		NONE PUBLIC EXEMPT EQUIPPING MINISTERS OF THE 35,000
    CYSTIC FIBROSIS FOUNDATION
    6931 ARLINGTON ROAD
    BETHESSDA,MD20814     		NONE PUBLIC EXEMPT RESEARCH AND THERAPEUTICS 10,000
    CHAPEL OF THE GOOD SHEPARD FDN
    376 HALE STREET
    BEVERLY,MA01915     		NONE PUBLIC EXEMPT CHAPEL PROGRAM/CHRISTIAN 21,380
    PINELANDS REFORMED CHURCH
    898 ROUTE 37 WEST
    TOMS RIVER,NJ08755     		NONE PUBLIC EXEMPT SOLAR SYSTEM 15,000
    CROYA FOUNDATION INC
    PO BOX 582
    LAKE FOREST,IL60045     		NONE PUBLIC EXEMPT MUSIC EQUIPMENT AND PROGRAM 10,358
    HOPE COLLEGE
    PO BOX 9000
    HOLLAND,MO49422     		NONE PUBLIC EXEMPT GENERAL SUPPORT 6,380
    GUILFORD COLLEGE
    5800 WEST FRIENDLY AVENUE
    GREENSBORO,NC27410     		NONE PUBLIC EXEMPT CAREER DEVELOPMENT AND 4,358
    SALVATION ARMY
    PO BOX 940
    COCOA BEACH,FL32923     		NONE PUBLIC EXEMPT DOMESTIC VIOLENCE PROGRAM 5,000
    COMMUNITY CHURCH OF VERO BEACH
    BEACH
    1901 23RD STREET
    VERO BEACH,FL32960     		NONE PUBLIC EXEMPT GENERAL SUPPORT 20,000
    RIVERSIDE THEATRE FOUNDATION INC
    3250 RIVERSIDE PARK DRIVE
    VERO BEACH,FL32963     		NONE PUBLIC EXEMPT GENERAL SUPPORT 15,000
    REFUGE HOUSE
    PO BOX 20910
    TALLAHASSEE,FL32316     		NONE PUBLIC EXEMPT GENERAL SUPPORT 6,000
    INDIAN RIVER MEMORIAL HOSPITAL INC
    1000 36TH STREET
    VERO BEACH,FL32960     		NONE PUBLIC EXEMPT 2013 MAY POPS BENEFITS 5,000
    MASONIC CHARITIES OF FLORIDA
    PO BOX 1020
    JACKSONVILLE,FL32201     		NONE PUBLIC EXEMPT GENERAL SUPPORT 5,000
    SUNNYSLOPE CHRISTIAN REFORMED
    CHURCH
    197 HRUBETZ RD SE
    SALEM,OR97302     		NONE PUBLIC EXEMPT SAFETY AND FACILITIES 15,000
    Total .................................bullet 3a 173,476
    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....     14 110,530  
    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 -4,164  
    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)..   106,366  
    13Total. Add line 12, columns (b), (d), and (e)..................
    13106,366
    (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:
    JOHN W PLANSOEN TRUST 485-2513843626
    EIN: 22-6020281
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    TAX PREPARATION FEE (NON-ALLOC 250     250

    TY 2012 InvestmentsCorpBondsSchedule
    Name:
    JOHN W PLANSOEN TRUST 485-2513843626
    EIN: 22-6020281
    Name of Bond End of Year Book Value End of Year Fair Market Value
    10138MAB1 BOTTLING GROUP LLC    
    362320AZ6 GTE CORP 24,975 31,299
    92345NAA8 VERIZON VIRGINIA INC    
    931142BV4 WALMART STORES    
    72369B406 PIONEER HIGH YIELD F    

    TY 2012 InvestmentsCorpStockSchedule
    Name:
    JOHN W PLANSOEN TRUST 485-2513843626
    EIN: 22-6020281
    Name of Stock End of Year Book Value End of Year Fair Market Value
    580135101 MCDONALDS CORP 34,910 44,105
    654106103 NIKE INC CL B    
    778296103 ROSS STORES INC 24,316 67,613
    194162103 COLGATE PALMOLIVE CO 31,217 54,884
    370334104 GENERAL MILLS INC 28,398 32,336
    487836108 KELLOGG CO 29,422 30,718
    742718109 PROCTER & GAMBLE CO 44,409 40,734
    30231G102 EXXON MOBIL CORPORAT 5,171 216,375
    001055102 AFLAC INC 33,452 35,856
    037389103 AON CORP    
    171232101 CHUBB CORP 37,798 71,931
    46625H100 JPMORGAN CHASE & CO 31,410 58,479
    693475105 PNC FINANCIAL SERVIC 29,794 29,155
    857477103 STATE STREET CORP 25,079 33,847
    110122108 BRISTOL MYERS SQUIBB 30,045 48,885
    14149Y108 CARDINAL HEALTH INC 32,529 41,180
    478160104 JOHNSON & JOHNSON 32,154 42,060
    717081103 PFIZER INC    
    790849103 ST JUDE MED INC 23,902 25,659
    655844108 NORFOLK SOUTHERN COR 32,670 61,840
    740189105 PRECISION CASTPARTS 23,108 56,826
    913017109 UNITED TECHNOLOGIES 29,294 57,407
    88579Y101 3M CO 32,534 34,819
    428236103 HEWLETT PACKARD CO 87,000 57,000
    458140100 INTEL CORP 30,565 47,838
    459200101 INTERNATIONAL BUSINE 17,120 191,550
    263534109 DU PONT EI DENEMOURS    
    74005P104 PRAXAIR INC COM 34,998 63,481
    00206R102 AT & T INC 13,904 154,661
    35906A108 FRONTIER COMMUNICAT    
    92343V104 VERIZON COMMUNICATIO 37,472 159,061
    65339F101 NEXTERA ENERGY INC 6,024 69,190
    H0023R105 ACE LIMITED 27,355 47,082
    037833100 APPLE INC 52,449 66,522
    14040H105 CAPITAL ONE FINANCIA 43,001 57,930
    345370860 FORD MOTOR COMPANY 20,420 25,900
    369604103 GENERAL ELECTRIC CO 34,870 46,178
    437076102 HOME DEPOT INC 41,481 74,220
    464287499 ISHARES TR RUSSELL M 97,784 123,279
    464287655 ISHARES RUSSELL 2000 95,073 123,694
    58155Q103 MCKESSON CORP 41,971 53,328
    747525103 QUALCOMM INC 23,711 27,837
    87612E106 TARGET CORP 31,296 35,502
    91324P102 UNITEDHEALTH GROUP I 44,016 48,816
    983134107 WYNN RESORTS LTD 33,901 25,310

    TY 2012 InvestmentsGovtObligationsSch
    Name:
    JOHN W PLANSOEN TRUST 485-2513843626
    EIN: 22-6020281
    US Government Securities - End of Year Book Value:

    454,196
    US Government Securities - End of Year Fair Market Value:

    531,457
    State & Local Government Securities - End of Year Book Value:


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


     


    TY 2012 InvestmentsOtherSchedule2
    Name:
    JOHN W PLANSOEN TRUST 485-2513843626
    EIN: 22-6020281
    Category/ Item Listed at Cost or FMV Book Value End of Year Fair Market Value
    72369B406 PIONEER HIGH YIELD F AT COST 75,000 84,020

    TY 2012 LegalFeesSchedule
    Name:
    JOHN W PLANSOEN TRUST 485-2513843626
    EIN: 22-6020281
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    HEROLD LAW 650     650


    TY 2012 OtherDecreasesSchedule
    Name:
    JOHN W PLANSOEN TRUST 485-2513843626
    EIN: 22-6020281
    Description Amount
    MUTUAL FUND POSTING DATE AFTER TYE 773
    ROUNDING 2


    TY 2012 OtherIncreasesSchedule
    Name:
    JOHN W PLANSOEN TRUST 485-2513843626
    EIN: 22-6020281
    Description Amount
    MUTUAL FUND TAX EFFECTIVE DATE BEFORE TYE 698


    TY 2012 OtherProfessionalFeesSchedule
    Name:
    JOHN W PLANSOEN TRUST 485-2513843626
    EIN: 22-6020281
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    RICHARD POST - AGENT FOR TRUST 9,056 6,792   2,264


    TY 2012 TaxesSchedule
    Name:
    JOHN W PLANSOEN TRUST 485-2513843626
    EIN: 22-6020281
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    FEDERAL TAX PAYMENT - PRIOR YE 6,115 0   0
    FEDERAL ESTIMATES - PRINCIPAL 10,056 0   0