Form990-PF
Click to see attachment

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
SIEGFRIED AND MARJORIE CLAUSSNER
FOUNDATION

Number and street (or P.O. box number if mail is not delivered to street address)20 PRESIDENTAL DRIVE   Room/suite
City or town, state, and ZIP code
ROSELLE, IL60172
A Employer identification number

36-3774034
B Telephone number (see instructions)

(630) 980-5100
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$1,035,765J 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) 52,200
2 Check bullet
3 Interest on savings and temporary cash investments 213 213 213
4 Dividends and interest from securities...... 12,171 12,171 12,171
5a Gross rents..............      
b Net rental income or (loss)  
6a Net gain or (loss) from sale of assets not on line 10 34,803
b Gross sales price for all assets on line 6a 902,790
7 Capital gain net income (from Part IV, line 2)... 36,468
8 Net short-term capital gain......... 26,309
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)....... Click to see attachment 3,214    
12 Total. Add lines 1 through 11........ 102,601 48,852 38,693
Operating and Administrative Expenses 13 Compensation of officers, directors, trustees, etc.        
14 Other employee salaries and wages......        
15 Pension plans, employee benefits.......        
16a Legal fees (attach schedule).........        
b Accounting fees (attach schedule)....... Click to see attachment 350 350 350 350
c Other professional fees (attach schedule).... Click to see attachment 1,577 1,577 1,577 1,577
17 Interest...............        
18 Taxes (attach schedule) (see instructions) Click to see attachment 17 17 17 17
19 Depreciation (attach schedule) and depletion...      
20 Occupancy..............        
21 Travel, conferences, and meetings.......        
22 Printing and publications.......... 196 196 196 196
23 Other expenses (attach schedule)....... Click to see list of attachments 7,109 7,109 7,109 7,109
24 Total operating and administrative expenses.
Add lines 13 through 23.......... 9,249 9,249 9,249 9,249
25 Contributions, gifts, grants paid........ 45,700 45,700
26 Total expenses and disbursements. Add lines 24 and 25 54,949 9,249 9,249 54,949
27 Subtract line 26 from line 12:
a Excess of revenue over expenses and disbursements 47,652
b Net investment income (if negative, enter -0-) 39,603
c Adjusted net income (if negative, enter -0-)... 29,444
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............... 40,887 49,251 49,251
2 Savings and temporary cash investments..........      
3 Accounts receivable bullet  
Less: allowance for doubtful accounts bullet        
4 Pledges receivable bullet  
Less: allowance for doubtful accounts bullet        
5 Grants receivable.................      
6 Receivables due from officers, directors, trustees, and other
disqualified persons (attach schedule) (see page 15 of the
instructions)....................      
7 Other notes and loans receivable (attach schedule) bullet  
Less: allowance for doubtful accounts bullet        
8 Inventories for sale or use...............      
9 Prepaid expenses and deferred charges...........      
10a Investments—U.S. and state government obligations (attach schedule)      
b Investments—corporate stock (attach schedule)........ 912,338 951,626 986,514
c Investments—corporate bonds (attach schedule)........      
11 Investments—land, buildings, and equipment: basis bullet  
Less: accumulated depreciation (attach schedule) bullet        
12 Investments—mortgage loans..............      
13 Investments—other (attach schedule)...........      
14 Land, buildings, and equipment: basis bullet  
Less: accumulated depreciation (attach schedule) bullet        
15 Other assets (describe bullet)      
16 Total assets (to be completed by all filers—see the
instructions. Also, see page 1, item I) 953,225 1,000,877 1,035,765
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.................... 953,225 1,000,877
25 Temporarily restricted................    
26 Permanently restricted................    
bullet
and complete lines 27 through 31.
27 Capital stock, trust principal, or current funds.........    
28 Paid-in or capital surplus, or land, bldg., and equipment fund    
29 Retained earnings, accumulated income, endowment, or other funds    
30 Total net assets or fund balances (see page 17 of the
instructions).................... 953,225 1,000,877
31 Total liabilities and net assets/fund balances (see page 17 of
the instructions).................. 953,225 1,000,877
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)............... 1 953,225
2 Enter amount from Part I, line 27a..................... 2 47,652
3 Other increases not included in line 2 (itemize) bullet 3  
4 Add lines 1, 2, and 3.......................... 4 1,000,877
5 Decreases not included in line 2 (itemize) bullet 5  
6 Total net assets or fund balances at end of year (line 4 minus line 5)—Part II, column (b), line 30. 6 1,000,877
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 F/S SPDR GOLD TRUST P 2012-01-01 2012-09-12
b 200 SHS UNITED ST OIL FD PARTNERSHIP P 2012-09-07 2012-10-03
c 750 SHS united states natl gas fund P 2012-05-21 2012-05-31
d 50 SHS TERRA NITROGEN P 2012-01-06 2012-02-15
e 50 SHS SPDR GOLD TRUST P 2012-07-25 2012-10-12
100 SHS PROSHARES TR II ULTRA SHORT P 2012-05-22 2012-06-14
100 SHS ENERGY TRANSFER P 2012-07-05 2012-10-19
300 SHS IPATH GS CRUDE P 2012-03-16 2012-04-10
100 SHS ASML HOLDING P 2012-06-29 2012-08-28
1,000 SHS ZYNGA INC P 2012-06-18 2012-07-26
100 SHS VISA INC P 2011-12-07 2012-04-10
100 SHS UNITEDHEALTH GROUP P 2012-10-10 2012-10-16
200 SHS ULTRATECH STEPPER P 2012-06-18 2012-07-16
200 SHS TRINITY INDUSTRIES P 2012-09-05 2012-11-08
100 SHS TRACTOR SUPPLY P 2011-11-14 2012-01-03
100 SHS TOYOTA MOTORS P 2011-12-07 2012-03-02
200 SHS TOWERS WATSON CO P 2012-02-15 2012-04-10
350 SHS SYNCOR ADDL P 2012-05-31 2012-06-22
100 SHS STARBUCKS P 2011-11-18 2012-04-23
300 SHS STAMPS .COM P 2012-01-27 2012-02-10
500 SHS STAGE STORES INC P 2012-05-17 2012-11-15
500 SHS STARR SURGICAL P 2012-01-27 2012-02-10
400 SHS SPECTRUM PHARMACEUTICALS P 2012-06-15 2012-07-30
150 SHS SECTOR SPDR TR SHS BEN INTENRY P 2012-07-17 2012-08-30
100 SHS SECTOR SPDR TR SHS BEN INT P 2012-07-05 2012-10-23
400 SHS HEALTH CARE SELECT SECTOR P 2012-04-25 2012-10-23
250 SHS ST JOE CORP P 2012-09-05 2012-12-17
300 SHS SPDR SERIES TRUST S&P HOME BU P 2012-08-06 2012-11-09
200 SHS SPDR SERIES TRUST S&P HOME BU P 2012-07-05 2012-08-22
100 SHS SPDR SERIES TRUST S&P P 2012-03-01 2012-04-10
200 SHS RIVERBED TECHNOLOGY P 2011-11-18 2012-01-27
150 SHS RAILAMERICA P 2012-07-16 2012-07-25
1,000 SHS PROTEOMIX INC P 2012-09-05 2012-09-07
250 SHS PROSHARES TR ULTRASHT DOW30 P 2012-05-04 2012-05-21
300 shs PROSHS UL S&P 500 P 2012-05-21 2012-08-22
100 SHS POST PROPERTIES INC P 2011-12-27 2012-02-16
250 SHS PETROLEO BRASILERO P 2012-10-16 2012-11-08
150 SHS PAY CHEX P 2012-06-14 2012-11-09
500 SHS PANDORA MEDIA INC P 2012-05-31 2012-07-26
200 SHS ORACLE P 2012-03-01 2012-04-10
1,000 SHS NORTHSTAR RLTY FN P 2012-01-06 2012-03-22
25 SHS NEWMARKET CORP P 2012-09-05 2012-10-08
150 SHS NETGEAR INC P 2012-01-19 2012-02-08
100 SHS MOSAIC CO P 2012-07-27 2012-10-03
200 SHS MICROSOFT P 2012-06-27 2012-10-19
50 SHS MCDONALDS P 2011-11-10 2012-01-24
200 SHS MARKET VECTORS ETF TR COAL P 2012-10-11 2012-11-07
150 SHS MARKET VECTORS ETF TR AGRIBUS P 2012-09-12 2012-11-07
100 SHS MANHATTEN ASSOC P 2012-03-08 2012-04-10
50 shs LINKDEN CORP P 2012-03-08 2012-05-04
250 SHS KYTHERA BIOPHARMAceuticals P 2012-10-11 2012-11-08
750 SHS JANUS CAPITAL P 2012-10-03 2012-10-12
50 SHS ISHARES TRANS DJ AVG P 2012-01-10 2012-01-31
300 SHS INTERLINE BRANDS P 2012-01-19 2012-03-21
200 SHS INTEL P 2011-01-27 2012-04-10
1,000 SHS INCONTACT INC P 2012-10-10 2012-10-19
10 SHS GOGGLE INC P 2012-09-05 2012-10-15
50 SHS GOLDMAN SACHS P 2012-10-10 2012-11-08
500 SHS FORD MOTOR CO P 2012-09-05 2012-11-16
300 SHS FIRST TR EXCHANGE TRADED P 2012-08-17 2012-10-19
50 SHS F5 NETWORK P 2012-05-22 2012-05-24
550 SHS FACEBOOK P 2012-09-14 2012-10-10
200 SHS EXPRESS SCRIPTS HOLDING P 2012-04-17 2012-10-23
400 SHS EXPRESS INC P 2012-02-23 2012-03-06
150 SHS EXELON CORP P 2012-04-26 2012-05-17
300 SHS ELLIE MAE INC P 2012-05-31 2012-08-21
300 SHS ELECTRONICS FOR IMAGING P 2012-10-11 2012-11-07
400 SHS DYCOM IND P 2011-12-29 2012-02-29
150 SHS DISCOVER P 2012-06-18 2012-09-25
100 SHS WALT DISNEY P 2011-11-11 2012-04-10
100 SHS DIREXON DLY ENERGY P 2012-10-03 2012-10-12
175 SHS DIGTAL REALTY TR P 2012-03-01 2012-03-07
1,000 SHS DAYSTAR TECH P 2012-09-05 2012-09-07
150 SHS CYBERONICS P 2012-03-08 2012-04-10
200 SHS COPPER TIRE & RUBBER P 2012-07-06 2012-07-25
75 SHS COMPASS MINRLS P 2012-04-26 2012-05-18
400 SHS COLUMBIA BKG P 2012-02-08 2012-04-09
300 SHS CISCO P 2012-08-21 2012-10-24
700 SHS CEMEX SA P 2012-07-16 2012-08-31
150 SHS CABOT P 2012-06-29 2012-08-01
150 SHS BRINKER INTL P 2012-06-19 2012-07-25
70 SHS APPLE P 2012-05-21 2012-10-19
150 SHS AMERICAN INTL GRP P 2012-05-31 2012-11-02
50 SHS AMAZON P 2012-05-11 2012-05-18
150 SHS AMAZON P 2012-04-10 2012-05-18
.986 SHS PENTAIR LTD P 1999-11-01 2012-10-12
1,000 SHS QUAKER CHEMICAL P 2010-05-05 2012-07-20
1,120 SHS GRAMERCY CAP CORP P 2008-04-02 2012-01-30
1,062 SHS FIRST OPPORTUNITY FD P 1991-08-21 2012-03-29
500 SHS EXXON MOBIL P 2008-10-06 2012-09-14
500 SHS CIMAREX P 2005-10-06 2012-04-09
15,000 SHS BMO BANK OF MONTREAL P 2005-02-01 2012-12-26
75 SHS ARLINGTON ASSET INV P 2005-04-05 2012-01-30
600SHS ALLIANCE BERNSTEIN HOLDING LP P 2003-11-14 2012-10-18
300 SHS WALGREENS P 2012-06-19 2012-07-20
600 SHS SIEMENS AG P 2012-04-19 2012-12-11
1000 SHS JPMORGAN CHASE P 2011-08-08 2012-04-23
(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 8     8
b 6,579   6,785 -206
c 13,983   16,409 -2,426
d 11,005   9,199 1,806
e 8,489   7,792 697
4,279   4,395 -116
4,440   4,063 377
7,568   8,122 -554
5,681   5,079 602
3,133   5,717 -2,584
11,701   9,710 1,991
5,639   5,713 -74
5,828   6,349 -521
6,083   5,631 452
6,962   7,467 -505
8,111   6,841 1,270
12,659   13,059 -400
4,077   5,096 -1,019
5,782   4,250 1,532
8,719   9,703 -984
11,004   7,942 3,062
5,193   5,672 -479
6,065   4,986 1,079
10,632   10,121 511
4,581   4,411 170
15,440   15,256 184
5,332   4,779 553
7,628   6,725 903
4,109   4,368 -259
5,949   5,984 -35
4,785   5,371 -586
4,085   3,727 358
2,333   2,437 -104
14,088   13,076 1,012
16,611   15,967 644
4,455   4,485 -30
5,236   5,827 -591
4,806   4,747 59
4,628   5,207 -579
5,687   5,953 -266
5,183   5,087 96
5,956   6,347 -391
5,633   6,040 -407
5,509   5,884 -375
5,731   6,043 -312
4,916   4,633 283
4,867   5,019 -152
7,590   7,707 -117
4,631   4,814 -183
11,633   9,047 2,586
5,368   4,887 481
6,713   6,980 -267
4,690   4,615 75
6,428   5,239 1,189
5,487   5,458 29
5,823   6,227 -404
7,337   6,815 522
5,829   6,011 -182
5,188   4,801 387
5,618   5,791 -173
5,339   5,850 -511
10,460   11,637 -1,177
11,454   11,562 -108
9,455   9,376 79
5,738   5,782 -44
7,154   4,913 2,241
5,024   5,071 -47
8,101   8,439 -338
5,612   4,942 670
4,175   3,706 469
5,056   5,259 -203
12,737   12,996 -259
1,523   1,737 -214
5,532   5,659 -127
3,158   3,597 -439
5,604   5,634 -30
8,753   8,773 -20
5,372   5,757 -385
5,194   4,739 455
5,462   6,039 -577
4,629   4,784 -155
40,427   35,930 4,497
4,980   5,335 -355
10,881   11,495 -614
30,856   29,710 1,146
43   41 2
42,900   30,060 12,840
3,000   25,945 -22,945
7,569   1,428 6,141
46,149   24,520 21,629
34,857   20,244 14,613
16,498   15,417 1,081
1,674   24,024 -22,350
9,981   10,862 -881
10,281   9,044 1,237
61,820   55,399 6,421
41,839   36,415 5,424
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       8
b       -206
c       -2,426
d       1,806
e       697
      -116
      377
      -554
      602
      -2,584
      1,991
      -74
      -521
      452
      -505
      1,270
      -400
      -1,019
      1,532
      -984
      3,062
      -479
      1,079
      511
      170
      184
      553
      903
      -259
      -35
      -586
      358
      -104
      1,012
      644
      -30
      -591
      59
      -579
      -266
      96
      -391
      -407
      -375
      -312
      283
      -152
      -117
      -183
      2,586
      481
      -267
      75
      1,189
      29
      -404
      522
      -182
      387
      -173
      -511
      -1,177
      -108
      79
      -44
      2,241
      -47
      -338
      670
      469
      -203
      -259
      -214
      -127
      -439
      -30
      -20
      -385
      455
      -577
      -155
      4,497
      -355
      -614
      1,146
      2
      12,840
      -22,945
      6,141
      21,629
      14,613
      1,081
      -22,350
      -881
      1,237
      6,421
      5,424
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 36,468
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 26,309
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 46,613    
2010 49,116 919,765 0.05340
2009 41,325 889,318 0.04647
2008 44,505 865,760 0.05141
2007 54,674 824,080 0.06635
2 Total of line 1, column (d) ...................... 2 0.21762
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 0.04352
4 Enter the net value of noncharitable-use assets for 2012 from Part X, line 5..... 4  
5 Multiply line 4 by line 3....................... 5  
6 Enter 1% of net investment income (1% of Part I, line 27b)........... 6 396
7 Add lines 5 and 6......................... 7 396
8 Enter qualifying distributions from Part XII, line 4.............. 8 54,949
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 1 396
hereBulletand enter 1% of Part I, line 27b...................
c All other domestic foundations enter 2% of line 27b. Exempt foreign organizations enter 4% of Part I, line 12, col. (b)
2 Tax under section 511 (domestic section 4947(a)(1) trusts and taxable foundations only. Others enter -0-) 2  
3 Add lines 1 and 2............................ 3 396
4 Subtitle A (income) tax (domestic section 4947(a)(1) trusts and taxable foundations only. Others enter -0-). 4  
5 Tax based on investment income. Subtract line 4 from line 3. If zero or less, enter -0- ..... 5 396
6 Credits/Payments:
a 2012 estimated tax payments and 2011 overpayment credited to 2012 6a  
b Exempt foreign organizations—tax withheld at source....... 6b
c Tax paid with application for extension of time to file (Form 8868) 6c  
d Backup withholding erroneously withheld ........... 6d  
7 Total credits and payments. Add lines 6a through 6d.............. 7  
8 Enter any penalty for underpayment of estimated tax. if Form 2220 is attached. 8  
9 Tax due. If the total of lines 5 and 8 is more than line 7, enter amount owed.......Bullet 9 396
10 Overpayment. If line 7 is more than the total of lines 5 and 8, enter the amount overpaid...Bullet 10  
11 Enter the amount of line 10 to be: Credited to 2013 estimated taxBullet   Refunded Bullet 11  
Part VII-A
Statements Regarding Activities
1a
During the tax year, did the foundation attempt to influence any national, state, or local legislation or did
Yes
No
it participate or intervene in any political campaign? ....................
1a
 
No
b
Did it spend more than $100 during the year (either directly or indirectly) for political purposes (see page 19 of
the instructions for definition)?............................
1b
 
No
If the answer is “Yes” to 1a or 1b, attach a detailed description of the activities and copies of any materials
published or distributed by the foundation in connection with the activities.
c
Did the foundation file Form 1120-POL for this year?.....................
1c
 
No
d
Enter the amount (if any) of tax on political expenditures (section 4955) imposed during the year:
(1) On the foundation. bullet$   (2) On foundation managers.bullet$  
e
Enter the reimbursement (if any) paid by the foundation during the year for political expenditure tax imposed
on foundation managers.bullet$  
2
Has the foundation engaged in any activities that have not previously been reported to the IRS?.......
2
 
No
If “Yes,” attach a detailed description of the activities.
3
Has the foundation made any changes, not previously reported to the IRS, in its governing instrument, articles
of incorporation, or bylaws, or other similar instruments? If “Yes,” attach a conformed copy of the changes....
3
 
No
4a
Did the foundation have unrelated business gross income of $1,000 or more during the year?........
4a
Yes
 
b
If “Yes,” has it filed a tax return on Form 990-T for this year?...................
4b
Yes
 
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
     
    No
    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)
    bulletIL
    b
    If the answer is “Yes” to line 7, has the foundation furnished a copy of Form 990-PF to the Attorney
    General (or designate) of each state as required by General Instruction G? If “No,” attach explanation .
    8b
    Yes
     
    9
    Is the foundation claiming status as a private operating foundation within the meaning of section 4942(j)(3)
    or 4942(j)(5) for calendar year 2012 or the taxable year beginning in 2012 (see instructions for Part XIV)?
    If “Yes,” complete Part XIV.............................
    9
     
    No
    10
    Did any persons become substantial contributors during the tax year? If “Yes,” attach a schedule listing their names and addresses.
    10
     
    No
    11
    At any time during the year, did the foundation, directly or indirectly, own a controlled entity within the
    meaning of section 512(b)(13)? If "Yes," attach schedule. (see instructions) .............
    11
     
    No
    12
    Did the foundation make a distribution to a donor advised fund over which the foundation or a disqualified person had
    advisory privileges? If "Yes," attach statement (see instructions).................
    12
     
    No
    13
    Did the foundation comply with the public inspection requirements for its annual returns and exemption application?
    13
    Yes
     
    Website addressbulletN/A
    14
    The books are in care ofbulletSIEGFRIED CLAUSSNER Telephone no.bullet (630) 980-5100
    Located atbullet20 PRESIDENTAL DRIVEROSELLEIL ZIP+4bullet60172
    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
     
    No
    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
     
    No
    .........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
     
    No
    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
    HEIDI KOHUTH Trustee
    2.00     		0    
    124 NORTH SHORE DRIVE
    MOORESVILLE,NC28117
    GRETCHEN KROLL Trustee
    2.00     		0    
    4805 JUNEAU LANE
    PLYMOUTH,MN55446
    MARTA DUFFY Trustee
    2.00     		0    
    9N773 OLD MILL COURT
    ELGIN,IL60124
    MARK CLAUSSNER Trustee
    2.00     		0    
    17010 YAWL ROAD
    CORNELIUS,NC28031
    MARJORIE CLAUSSNER Trustee
    10.00     		0    
    130 CASTLE ROCK LANE
    BLOOMINGDALE,IL60108
    SIEGFRIED J CLAUSSNER Trustee
    10.00     		0    
    130 CASTLE ROCK LANE
    BLOOMINGDALE,IL60108
    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  
    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.............bullet  
    Part IX-A
    Summary of Direct Charitable Activities
    List the foundation’s four largest direct charitable activities during the tax year. Include relevant statistical information such as the number of organizations and other beneficiaries served, conferences convened, research papers produced, etc. Expenses
    1 N/A 0
    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
    0
    b
    Average of monthly cash balances.......................
    1b
    0
    c
    Fair market value of all other assets (see instructions)................
    1c
    0
    d
    Total (add lines 1a, b, and c).........................
    1d
    0
    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
     
    3
    Subtract line 2 from line 1d.........................
    3
    0
    4
    Cash deemed held for charitable activities. Enter 1 1⁄2% of line 3 (for greater amount, see
    instructions) .............................
    4
    0
    5
    Net value of noncharitable-use assets. Subtract line 4 from line 3. Enter here and on Part V, line 4
    5
    0
    6
    Minimum investment return. Enter 5% of line 5..................
    6
    0
    Part XI
    Distributable Amount bullet and do not complete this part.)
    1
    Minimum investment return from Part X, line 6....................
    1
     
    2a
    Tax on investment income for 2012 from Part VI, line 5......
    2a
    396
    b
    Income tax for 2012. (This does not include the tax from Part VI.)...
    2b
     
    c
    Add lines 2a and 2b............................
    2c
    396
    3
    Distributable amount before adjustments. Subtract line 2c from line 1............
    3
    396
    4
    Recoveries of amounts treated as qualifying distributions................
    4
     
    5
    Add lines 3 and 4............................
    5
    396
    6
    Deduction from distributable amount (see instructions).................
    6
     
    7
    Distributable amount as adjusted. Subtract line 6 from line 5. Enter here and on Part XIII,
    line 1................................
    7
    0
    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
    54,949
    b
    Program-related investments—total from Part IX-B..................
    1b
     
    2
    Amounts paid to acquire assets used (or held for use) directly in carrying out charitable, etc.,
    purposes...............................
    2
     
    3
    Amounts set aside for specific charitable projects that satisfy the:
    a
    Suitability test (prior IRS approval required)....................
    3a
     
    b
    Cash distribution test (attach the required schedule) .................
    3b
     
    4
    Qualifying distributions. Add lines 1a through 3b. Enter here and on Part V, line 8, and Part XIII, line 4
    4
    54,949
    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
    396
    6
    Adjusted qualifying distributions. Subtract line 5 from line 4..............
    6
    54,553
    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 0
    2 Undistributed income, if any, as of the end of 2012:
    a Enter amount for 2011 only.......  
    b Total for prior years:20, 20, 20  
    3 Excess distributions carryover, if any, to 2012:
    a From 2007....... 55,113
    b From 2008....... 44,735
    c From 2009....... 41,397
    d From 2010....... 49,597
    e From 2011....... 46,630
    fTotal of lines 3a through e......... 237,472
    4Qualifying distributions for 2012 from Part
    XII, line 4: bullet$ 54,949
    a Applied to 2011, but not more than line 2a  
    b Applied to undistributed income of prior years
    (Election required—see instructions)......     		 
    c Treated as distributions out of corpus (Election
    required—see instructions).........     		0
    d Applied to 2012 distributable amount.....  
    e Remaining amount distributed out of corpus 54,949
    5 Excess distributions carryover applied to 2012.    
    (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 5 292,421
    b Prior years’ undistributed income. Subtract
    line 4b from line 2b ...........     		 
    c Enter the amount of prior years’ undistributed
    income for which a notice of deficiency has
    been issued, or on which the section 4942(a)
    tax has been previously assessed......     		 
    d Subtract line 6c from line 6b. Taxable amount
    —see instructions ...........     		 
    e Undistributed income for 2011. Subtract line
    4a from line 2a. Taxable amount—see
    instructions .............     		 
    f Undistributed income for 2012. Subtract
    lines 4d and 5 from line 1. This amount must
    be distributed in 2013 ..........     		0
    7 Amounts treated as distributions out of
    corpus to satisfy requirements imposed by
    section 170(b)(1)(F) or 4942(g)(3) (see
    instructions) .............     		 
    8Excess distributions carryover from 2007 not
    applied on line 5 or line 7 (see instructions) ...     		55,113
    9Excess distributions carryover to 2013.
    Subtract lines 7 and 8 from line 6a ......     		237,308
    10 Analysis of line 9:
    a Excess from 2008.... 44,735
    b Excess from 2009.... 41,397
    c Excess from 2010.... 49,597
    d Excess from 2011.... 46,630
    e Excess from 2012.... 54,949
    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 or e-mail of the person to whom applications should be addressed:
    SIEGFRIED J CLAUSSNER
    20 PRESIDENTAL DRIVE
    ROSELLE,IL60172
    (630) 980-5100
    bThe form in which applications should be submitted and information and materials they should include:
    WRITTEN REQUEST
    cAny submission deadlines:
    NONE
    dAny restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other
    factors:
    NONE
    Form 990-PF (2012)
    Form 990-PF (2012)
    Page 10
    Part XV
    Supplementary Information (continued)
    3 Grants and Contributions Paid During the Year or Approved for Future Payment
    Recipient If recipient is an individual,
    show any relationship to
    any foundation manager
    or substantial contributor
    		 Foundation
    status of
    recipient     		Purpose of grant or
    contribution     		Amount
    Name and address (home or business)
    aPaid during the year
    FOOD FOR THE POOR INC
    6401 LYONS RD
    COCONUT CREEK,FL33073     		NONE   TO ASSIST IN BUILDING A HOME FOR A DESTITUTE FAMILY IN HONDURAS 3,200
    MAYO CLINIC DEVELOPMENT DEPARTMENT
    200 FIRST STREET SW
    ROCHESTER,MN55905     		NONE ACTIVE GENERAL SUPPORT 2,000
    THE LUTHERAN CHURCH-MISSOURI SYNOD
    PO BOX 66861
    ST LOUIS,MO63166     		NONE ACTIVE JAPAN EARTHQUAKE HELP 2,000
    MINISTRY INITATIVE OF WESTFIELD INC
    PO BOX 412
    WESTFIELD,WI53964     		NONE ACTIVE RESSURECTION LUTHERAN HIGH SCHOOL 1,000
    ST EDWARDS CENTRAL CATHOLIC HIGH SCHOOL
    335 LOCUST ST
    ELGIN,IL60123     		NONE ACTIVE TUTION ASSISTANCE 2,000
    GRACE LUTHERAN CHURCH
    422 VALHI BLVD
    HOUMA,LA70360     		NONE ACTIVE AS NEEDED 1,000
    AMAZING GRACE LUTHERAN CHURCH
    PO BOX 104
    OXFORD,FL34484     		NONE ACTIVE OUTREACH 1,000
    ST MARYS CATHOLIC SCHOOL
    103 N GIFFORD ST
    ELGIN,IL60120     		NONE ACTIVE TUTION ASSISTANCE 1,000
    CONCORDIA UNIVERSITY WISCONSIN
    12800 NORTH LAKE SHORE DR
    MEQUON,WI53097     		NONE ACTIVE TUTION ASSISTANCE 1,000
    HOPE LUTHERAN CHURCH
    25999 OLD 41 ROAD
    BONITA SPRINGS,FL34135     		NONE ACTIVE PRESCHOOL 3,500
    BEAUTIFUL SAVIOR LUTHERAN CHURCH
    5005 NORTHWEST BOULEVARD
    PLYMOUTH,MN55442     		NONE ACTIVE BUILDING FUND 2,000
    TRINITYHOPE LUTHERAN CHURCH
    2366 CARIO BEND ROAD
    LEBANON,TN37087     		NONE ACTIVE HAITI FEEDING PROGRAM 2,000
    THE GIDEONS INTERNATIONAL
    PO BOX O8336
    FORT MYERS,FL33908     		NONE ACTIVE BIBLE PURCHASE 1,500
    ST PAUL LUTHERAN CHURCH
    846 N MENARD AVENUE
    CHICAGO,IL60651     		NONE ACTIVE GENERAL SUPPORT 1,000
    THE LIFE CENTER
    825 DUNDEE AVE
    ELGIN,IL60121     		NONE ACTIVE GENERAL FUND 1,000
    ST JOHNS LUTHERAN CHURCH
    2823 COUNTY HIGHWAY Z
    ADAMS,WI53910     		NONE ACTIVE GENERAL SUPPORT 1,000
    PUBLIC ACTION TO DELIVER SHELTER
    1730 BERKLEY ST
    ELGIN,IL60123     		NONE ACTIVE GENERAL SUPPORT 1,000
    OUR SAVIOR LUTHERAN CHURCH
    5110 FRANKLIN RD
    NASHVILLE,TN37220     		NONE ACTIVE MISSIONS 4,000
    MT CALVARY LUTHERAN CHURCH
    PO BOX 250
    KANNAPOLIS,NC28082     		NONE ACTIVE GENERAL SUPPORT 1,000
    MARYS PLACE SHARING CARING
    525 NORTH 7TH STREET
    MINNEAPOLIS,MN55405     		NONE ACTIVE GENERAL SUPPORT 1,000
    AMEGOS EN CRISTO HOPE LUTHERAN CHUR
    25999 OLD 41 ROAD
    BONITA SPRINGS,FL34135     		NONE ACTIVE HISPANIC OUTREACH 5,500
    CHRIST LUTHERAN CHURCH
    PO BOX 4118
    BRECKENRIDGE,CO80424     		NONE ACTIVE GENERAL SUPPORT 1,000
    CHICAGO UPTOWN MINISTRY
    4720 NORTH SHERIDAN ROAD
    CHICAGO,IL60640     		NONE ACTIVE GENERAL SUPPORT 1,000
    TRINITY LUTHERAN CHURCH
    728 CHURCH ST
    WISCONSIN DELLS,WI53965     		NONE ACTIVE GENERAL FUND 1,000
    ST MATTHEW LUTHERAN CHURCH
    2108 W 21ST STREET
    CHICAGO,IL60608     		NONE ACTIVE GENERAL SUPPORT 1,000
    ST VINCENT DePAUL
    397 FULTON ST
    ELGIN,IL60120     		NONE ACTIVE GENERAL SUPPORT 1,000
    TRINITY LUTHERAN CHURCH FOUNDATION
    405 RUSH ST
    ROSELLE,IL60172     		NONE ACTIVE SCHOOL ENDOWMENT 2,000
    Total .................................bullet 3a 45,700
    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   213      
    4 Dividends and interest from securities....   12,171      
    5 Net rental income or (loss) from real estate:
    aDebt-financed property......         493
    bNot debt-financed property.....          
    6Net rental income or (loss) from personal property          
    7 Other investment income.....   2,622      
    8Gain or (loss) from sales of assets other than inventory         34,803
    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).. 15,006   35,296
    13Total. Add line 12, columns (b), (d), and (e)..................
    1350,302
    (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: 12000229
    Software Version: 2012v2.0


    Form 990PF - Special Condition Description:
    Special Condition Description
    Schedule B
    (Form 990, 990-EZ,
    or 990-PF)
    Department of the Treasury
    Internal Revenue Service
    Schedule of Contributors
    Arrow Bullet Attach to Form 990, 990-EZ, or 990-PF.
    OMB No. 1545-0047
    2012
    Name of the organization
    SIEGFRIED AND MARJORIE CLAUSSNER
    FOUNDATION
    Employer identification number

    36-3774034
    Organization type (check one):
    Filers of:
    Section:
    Form 990 or 990-EZ





    Form 990-PF




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

    Schedule B (Form 990, 990-EZ, or 990-PF) (2012)
    Page 2
    Name of organization
    SIEGFRIED AND MARJORIE CLAUSSNER
    FOUNDATION         		Employer identification number

    36-3774034
    Part I
    Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
    		     
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Total contributions    		 (d)
    Type of contribution
    1
     
     

    SIEGFRIED MARJORIE CLAUSSNER    
    130 CASTLE ROCK LANE
       
    BLOOMINGDALE, IL   60108

    		$50,500


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

         
     
       

    		$  


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

         
     
       

    		$  


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

         
     
       

    		$  


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

         
     
       

    		$  


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

         
     
       

    		$  


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

    Schedule B (Form 990, 990-EZ, or 990-PF) (2012)
    Page 3
    Name of organization
    SIEGFRIED AND MARJORIE CLAUSSNER
    FOUNDATION         		Employer identification number

    36-3774034
    Part II
    Noncash Property (see instructions). Use duplicate copies of Part II if additional space is needed.
    		     
    (a) No.
    from
    Part I    		 (b)
    Description of noncash property given    		 (c)
    FMV (or estimate)
    (see instructions)     		(d)
    Date received
     
    		$    
    (a) No.
    from
    Part I    		 (b)
    Description of noncash property given    		 (c)
    FMV (or estimate)
    (see instructions)     		(d)
    Date received
     
    		$    
    (a) No.
    from
    Part I    		 (b)
    Description of noncash property given    		 (c)
    FMV (or estimate)
    (see instructions)     		(d)
    Date received
     
    		$    
    (a) No.
    from
    Part I    		 (b)
    Description of noncash property given    		 (c)
    FMV (or estimate)
    (see instructions)     		(d)
    Date received
     
    		$    
    (a) No.
    from
    Part I    		 (b)
    Description of noncash property given    		 (c)
    FMV (or estimate)
    (see instructions)     		(d)
    Date received
     
    		$    
    (a) No.
    from
    Part I    		 (b)
    Description of noncash property given    		 (c)
    FMV (or estimate)
    (see instructions)     		(d)
    Date received
     
    		$    
    Schedule B (Form 990, 990-EZ, or 990-PF) (2012)

    Schedule B (Form 990, 990-EZ, or 990-PF) (2012)
    Page 4
    Name of organization
    SIEGFRIED AND MARJORIE CLAUSSNER
    FOUNDATION         		Employer identification number

    36-3774034
    Part III
    Exclusively religious, charitable, etc., individual contributions to section 501(c)(7), (8), or (10) organizations
    that total more than $1,000 for the year. Complete columns (a) through (e) and the following line entry.
    For organizations completing Part III, enter the total of exclusively religious, charitable, etc.,
    contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet$  
    Use duplicate copies of Part III if additional space is needed.
    (a) No.
    from
    Part I    		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
     
    (e) Transfer of gift
    Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
     
     
           
     
    (a) No.
    from
    Part I    		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
     
    (e) Transfer of gift
    Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
     
     
           
     
    (a) No.
    from
    Part I    		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
     
    (e) Transfer of gift
    Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
     
     
           
     
    (a) No.
    from
    Part I    		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
     
    (e) Transfer of gift
    Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
     
     
           
     
    Schedule B (Form 990, 990-EZ, or 990-PF) (2012)

    Additional Data


    Software ID: 12000229
    Software Version: 2012v2.0

    TY 2012 AccountingFeesSchedule
    Name:
    SIEGFRIED AND MARJORIE CLAUSSNER
    FOUNDATION
    EIN: 36-3774034
    Software ID:12000229
    Software Version:2012v2.0
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    50 350 350 350 350

    TY 2012 OtherExpensesSchedule
    Name:
    SIEGFRIED AND MARJORIE CLAUSSNER
    FOUNDATION
    EIN: 36-3774034
    Software ID:12000229
    Software Version:2012v2.0
    Description Revenue and Expenses per Books Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    Rental Expenses 99 99 99 99
    RAYMOND JAMES 6,973 6,973 6,973 6,973
    ILLINOIS FILING FEE 15 15 15 15
    BROKER FEE 22 22 22 22


    TY 2012 OtherIncomeSchedule2
    Name:
    SIEGFRIED AND MARJORIE CLAUSSNER
    FOUNDATION
    EIN: 36-3774034
    Software ID:12000229
    Software Version:2012v2.0
    Description Revenue And Expenses Per Books Net Investment Income Adjusted Net Income
    Rental Income - Noninvestment Property 592    
    Other Investment Income 2,622    


    TY 2012 OtherProfessionalFeesSchedule
    Name:
    SIEGFRIED AND MARJORIE CLAUSSNER
    FOUNDATION
    EIN: 36-3774034
    Software ID:12000229
    Software Version:2012v2.0
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    CONSULTING FEE 1,577 1,577 1,577 1,577


    TY 2012 TaxesSchedule
    Name:
    SIEGFRIED AND MARJORIE CLAUSSNER
    FOUNDATION
    EIN: 36-3774034
    Software ID:12000229
    Software Version:2012v2.0
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    FEDERAL TAX PAID 17 17 17 17