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
GROFFMARY S
 

Number and street (or P.O. box number if mail is not delivered to street address)1 WEST 4TH STREET D4000-041   Room/suite
City or town, state, and ZIP code
WINSTON SALEM, NC27101
A Employer identification number

23-6479982
B Telephone number (see instructions)

(336) 747-8176
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$200,829J 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...... 4,626 4,548  
5a Gross rents..............      
b Net rental income or (loss)  
6a Net gain or (loss) from sale of assets not on line 10 7,658
b Gross sales price for all assets on line 6a 104,437
7 Capital gain net income (from Part IV, line 2)... 7,658
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........ 12,284 12,206  
Operating and Administrative Expenses 13 Compensation of officers, directors, trustees, etc. 1,006 754   252
14 Other employee salaries and wages......   0 0 0
15 Pension plans, employee benefits.......   0 0  
16a Legal fees (attach schedule).........       0
b Accounting fees (attach schedule).......        
c Other professional fees (attach schedule).... Click to see attachment 630     630
17 Interest...............       0
18 Taxes (attach schedule) (see instructions) Click to see attachment 148 50   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.......... 1,784 804 0 882
25 Contributions, gifts, grants paid........ 9,000 9,000
26 Total expenses and disbursements. Add lines 24 and 25 10,784 804 0 9,882
27 Subtract line 26 from line 12:
a Excess of revenue over expenses and disbursements 1,500
b Net investment income (if negative, enter -0-) 11,402
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............... 765 371 371
2 Savings and temporary cash investments.......... 11,335 9,755 9,755
3 Accounts receivable bullet  
Less: allowance for doubtful accounts bullet     0 0
4 Pledges receivable bullet  
Less: allowance for doubtful accounts bullet        
5 Grants receivable.................      
6 Receivables due from officers, directors, trustees, and other
disqualified persons (attach schedule) (see page 15 of the
instructions)....................      
7 Other notes and loans receivable (attach schedule) bullet  
Less: allowance for doubtful accounts bullet0      
8 Inventories for sale or use...............      
9 Prepaid expenses and deferred charges...........      
10a Investments—U.S. and state government obligations (attach schedule)      
b Investments—corporate stock (attach schedule)........ 96,961 Click to see attachment110,474 119,377
c Investments—corporate bonds (attach schedule)........ 75,842    
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 attachment68,199 71,326
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) 184,903 188,799 200,829
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......... 184,903 188,799
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).................... 184,903 188,799
31 Total liabilities and net assets/fund balances (see page 17 of
the instructions).................. 184,903 188,799
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)............... 1 184,903
2 Enter amount from Part I, line 27a..................... 2 1,500
3 Other increases not included in line 2 (itemize) bulletClick to see attachment 3 2,849
4 Add lines 1, 2, and 3.......................... 4 189,252
5 Decreases not included in line 2 (itemize) bulletClick to see attachment 5 453
6 Total net assets or fund balances at end of year (line 4 minus line 5)—Part II, column (b), line 30. 6 188,799
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 60. ARTISAN FDS INC INTL FD INVESTOR CLASS   2011-08-26 2012-08-08
b 23. ARTISAN FDS INC INTL FD INVESTOR CLASS   2011-08-26 2012-09-19
c 12. ARTISAN MID CAP FUND-INS #1333   2012-04-11 2012-09-19
d 257.052 ARTIO TOTAL RETURN BD FD CL I #1524   2008-10-31 2012-04-09
e 170.363 ARTIO INTERNATIONAL EQ FD 3# 1529   2010-02-01 2012-04-09
19. CREDIT SUISSE COMM RET ST-I #2156   2011-08-26 2012-08-08
64. CREDIT SUISSE COMM RET ST-I #2156   2011-08-26 2012-09-19
17. DIAMOND HILL LONG-SHORT FD CL I #11   2012-08-10 2012-09-19
40. DODGE & COX INT'L STOCK FD # 1048   2007-05-01 2012-08-08
24. DODGE & COX INT'L STOCK FD # 1048   2007-05-01 2012-09-19
141.873 DODGE & COX INCOME FD COM   2011-02-04 2012-04-09
557.127 DODGE & COX INCOME FD COM   2011-08-26 2012-04-09
40. DODGE & COX INCOME FD COM   2012-08-10 2012-09-19
380.609 DODGE & COX INCOME FD COM   2012-08-10 2012-11-19
210.391 DODGE & COX INCOME FD COM   2007-05-01 2012-11-19
24. DREYFUS EMG MKT DEBT LOC C-I #6083   2011-08-26 2012-09-19
42. FLEMING CAP MUTUAL FUND GROUP J P MORGAN MID CAP VALUE FUND   2010-12-17 2012-04-09
11. FLEMING CAP MUTUAL FUND GROUP J P MORGAN MID CAP VALUE FUND   2010-12-17 2012-08-08
11. FLEMING CAP MUTUAL FUND GROUP J P MORGAN MID CAP VALUE FUND   2010-12-17 2012-09-19
472.139 GOLDEN LARGE CAP CORE FUND-I   2009-02-27 2012-04-09
8. GATEWAY FUND - Y #1986   2012-08-10 2012-09-19
219.189 GOLDMAN SACHS GROWTH OPPORTUNITIES INSTITUTIONAL SHARES   2009-01-30 2012-04-09
181.507 GOLDMAN SACHS LARGE CAP VALUE FUND INSTITUTIONAL SHARES   2009-02-27 2012-04-09
30. HARBOR FD CAP APPRECIATION   2011-08-26 2012-04-09
15.036 HARBOR FD CAP APPRECIATION   2011-08-26 2012-09-19
5.964 HARBOR FD CAP APPRECIATION   2012-08-10 2012-09-19
317.57 HUSSMAN STRATEGIC GROWTH FD   2012-04-11 2012-08-08
3. ISHARES S&P 500 INDEX FUND   2012-08-08 2012-09-19
21. KEELEY SMALL CAP VAL FD CL I #2251   2010-12-17 2012-04-09
6. KEELEY SMALL CAP VAL FD CL I #2251   2010-12-17 2012-08-08
18. KEELEY SMALL CAP VAL FD CL I #2251   2010-12-17 2012-09-19
170. LAUDUS MONDRIAN INTL FI-INST #2940   2012-04-11 2012-08-08
17. LAUDUS MONDRIAN INTL FI-INST #2940   2012-04-11 2012-09-19
70. MFS VALUE FUND-CLASS I #893   2011-05-26 2012-04-09
14. MFS VALUE FUND-CLASS I #893   2011-05-26 2012-08-08
22. MFS VALUE FUND-CLASS I #893   2011-05-26 2012-09-19
199.734 MAINSTAY EP US EQ YLD-IS #1204   2012-04-11 2012-08-08
65. MERGER FD SH BEN INT   2012-04-11 2012-08-08
12. OPPENHEIMER DEVELOPING MKT-Y #788   2011-08-26 2012-09-19
859. PIMCO FDS PAC INVT MGMT SER TOTAL RETURN FD INSTL CL   2011-08-26 2012-04-09
48. PIMCO FDS PAC INVT MGMT SER TOTAL RETURN FD INSTL CL   2012-08-10 2012-09-19
69.87 PIMCO FOREIGN BOND FUND-INST   2012-04-11 2012-08-08
47.822 PIMCO FOREIGN BOND FUND-INST   2011-08-26 2012-08-08
67.308 PIMCO FOREIGN BOND FUND-INST   2011-02-04 2012-08-08
18. PIMCO FOREIGN BOND FUND-INST   2011-08-26 2012-09-19
498.442 PIMCO COMMODITY REAL RET STRAT-I#45   2009-02-27 2012-04-09
48. RIDGEWORTH SEIX HY BD-I #5855   2012-04-11 2012-08-08
46. RIDGEWORTH SEIX HY BD-I #5855   2011-08-26 2012-09-19
32. RIDGEWORTH SEIX HY BD-I #5855   2011-08-26 2012-11-19
922. ROWE T PRICE SHORT TERM BD FD INC   2011-08-29 2012-05-07
928. ROWE T PRICE SHORT TERM BD FD INC   2011-08-29 2012-08-08
561. ROWE T PRICE SHORT TERM BD FD INC   2012-04-11 2012-08-08
554. ROWE T PRICE SHORT TERM BD FD INC   2012-04-11 2012-11-19
15. SPDR DJ WILSHIRE INTERNATIONAL REAL   2011-08-24 2012-08-08
9. SPDR DJ WILSHIRE INTERNATIONAL REAL   2011-08-24 2012-09-19
7. TCW GALILEO FDS INC SMALL CAP GROWTH FD   2010-12-17 2012-08-08
22. TCW GALILEO FDS INC SMALL CAP GROWTH FD   2010-12-17 2012-09-19
64. TCW GALILEO FDS INC SMALL CAP GROWTH FD   2010-12-17 2012-11-19
95. TCW GALILEO FDS INC SMALL CAP GROWTH FD   2010-12-17 2012-12-19
9. VANGARD MSCI EMERGING MARKETS EFT   2010-12-17 2012-09-19
10. VANGUARD REIT VIPER   2010-12-17 2012-04-09
8. VANGUARD REIT VIPER   2010-12-17 2012-08-08
3. VANGUARD REIT VIPER   2010-12-17 2012-09-19
287.094 WELLS FARGO ADV INTL BOND-IS #4705   2011-02-04 2012-04-09
(e) Gross sales price (f) Depreciation allowed
(or allowable) 		(g) Cost or other basis
plus expense of sale 		(h) Gain or (loss)
(e) plus (f) minus (g)
a 1,375   1,228 147
b 550   471 79
c 496   483 13
d 3,519   3,150 369
e 1,775   1,656 119
158   178 -20
543   600 -57
314   304 10
1,259   1,892 -633
808   1,135 -327
1,928   1,848 80
7,571   7,466 105
556   552 4
5,302   5,249 53
2,931   2,666 265
358   365 -7
1,093   987 106
297   259 38
309   259 50
5,415   3,491 1,924
221   219 2
5,552   3,175 2,377
2,171   1,611 560
1,312   1,077 235
662   540 122
263   248 15
3,535   3,719 -184
443   422 21
534   523 11
155   150 5
500   449 51
2,018   1,981 37
206   198 8
1,724   1,698 26
350   340 10
572   534 38
2,672   2,633 39
1,033   1,024 9
404   373 31
9,586   9,423 163
554   549 5
772   755 17
528   508 20
744   700 44
202   191 11
3,325   2,931 394
472   462 10
461   431 30
317   300 17
4,472   4,472  
4,501   4,501  
2,721   2,715 6
2,687   2,681 6
581   542 39
361   325 36
187   204 -17
649   640 9
1,636   1,862 -226
2,549   2,765 -216
385   424 -39
625   534 91
527   421 106
203   158 45
3,247   3,132 115
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       147
b       79
c       13
d       369
e       119
      -20
      -57
      10
      -633
      -327
      80
      105
      4
      53
      265
      -7
      106
      38
      50
      1,924
      2
      2,377
      560
      235
      122
      15
      -184
      21
      11
      5
      51
      37
      8
      26
      10
      38
      39
      9
      31
      163
      5
      17
      20
      44
      11
      394
      10
      30
      17
       
       
      6
      6
      39
      36
      -17
      9
      -226
      -216
      -39
      91
      106
      45
      115
2 Capital gain net income or (net capital loss) Bracket If gain, also enter in Part I, line 7
If (loss), enter -0- in Part I, line 7		 Bracket 2 7,658
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 9,342 193,718 0.048225
2010 10,687 185,946 0.057474
2009 9,977 162,836 0.06127
2008 10,022 195,846 0.051173
2007 9,550 226,287 0.042203
2 Total of line 1, column (d) ...................... 2 0.260345
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 0.052069
4 Enter the net value of noncharitable-use assets for 2012 from Part X, line 5..... 4 192,468
5 Multiply line 4 by line 3....................... 5 10,022
6 Enter 1% of net investment income (1% of Part I, line 27b)........... 6 114
7 Add lines 5 and 6......................... 7 10,136
8 Enter qualifying distributions from Part XII, line 4.............. 8 9,882
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 1 228
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............................ 3 228
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- ..... 5 228
6 Credits/Payments:
a 2012 estimated tax payments and 2011 overpayment credited to 2012 6a 108
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.............. 7 108
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 9 120
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 0
Part VII-A
Statements Regarding Activities
1a
During the tax year, did the foundation attempt to influence any national, state, or local legislation or did
Yes
No
it participate or intervene in any political campaign? ....................
1a
 
No
b
Did it spend more than $100 during the year (either directly or indirectly) for political purposes (see page 19 of
the instructions for definition)?............................
1b
 
No
If the answer is “Yes” to 1a or 1b, attach a detailed description of the activities and copies of any materials
published or distributed by the foundation in connection with the activities.
c
Did the foundation file Form 1120-POL for this year?.....................
1c
 
No
d
Enter the amount (if any) of tax on political expenditures (section 4955) imposed during the year:
(1) On the foundation. bullet$   (2) On foundation managers.bullet$  
e
Enter the reimbursement (if any) paid by the foundation during the year for political expenditure tax imposed
on foundation managers.bullet$  
2
Has the foundation engaged in any activities that have not previously been reported to the IRS?.......
2
 
No
If “Yes,” attach a detailed description of the activities.
3
Has the foundation made any changes, not previously reported to the IRS, in its governing instrument, articles
of incorporation, or bylaws, or other similar instruments? If “Yes,” attach a conformed copy of the changes....
3
 
No
4a
Did the foundation have unrelated business gross income of $1,000 or more during the year?........
4a
 
No
b
If “Yes,” has it filed a tax return on Form 990-T for this year?...................
4b
 
 
5
Was there a liquidation, termination, dissolution, or substantial contraction during the year?.........
5
 
No
If “Yes,” attach the statement required by General Instruction T.
6
Are the requirements of section 508(e) (relating to sections 4941 through 4945) satisfied either:
  • By language in the governing instrument, or
  • By state legislation that effectively amends the governing instrument so that no mandatory directions
    • that conflict with the state law remain in the governing instrument?................
    6
    Yes
     
    7
    Did the foundation have at least $5,000 in assets at any time during the year? If “Yes,” complete Part II, col. (c), and Part XV.
    7
    Yes
     
    8a
    Enter the states to which the foundation reports or with which it is registered (see instructions)
    bulletPA
    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 Telephone no.bullet (336) 747-8176
    Located atbullet1 WEST 4TH STREET 6TH FLOORWINSTONSALEMNC ZIP+4bullet27101
    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
     
    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
     
     
    Form 990-PF (2012)
    Form 990-PF (2012)
    Page 6
    Part VIII
    Information About Officers, Directors, Trustees, Foundation Managers, Highly Paid Employees,
    and Contractors
    1 List all officers, directors, trustees, foundation managers and their compensation (see instructions).
    (a) Name and address (b) Title, and average
    hours per week
    devoted to position     		(c) Compensation
     (If not paid, enter
    -0-)     		(d) Contributions to
    employee benefit plans
    and deferred compensation     		(e) Expense account,
    other allowances
    WELLS FARGO BANK TRUSTEE
    4     		1,006    
    1525 WEST WT HARRIS BLVD
    CHARLOTTE,NC28288
    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
    184,193
    b
    Average of monthly cash balances.......................
    1b
    11,206
    c
    Fair market value of all other assets (see instructions)................
    1c
    0
    d
    Total (add lines 1a, b, and c).........................
    1d
    195,399
    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
    195,399
    4
    Cash deemed held for charitable activities. Enter 1 1⁄2% of line 3 (for greater amount, see
    instructions) .............................
    4
    2,931
    5
    Net value of noncharitable-use assets. Subtract line 4 from line 3. Enter here and on Part V, line 4
    5
    192,468
    6
    Minimum investment return. Enter 5% of line 5..................
    6
    9,623
    Part XI
    Distributable Amount bullet and do not complete this part.)
    1
    Minimum investment return from Part X, line 6....................
    1
    9,623
    2a
    Tax on investment income for 2012 from Part VI, line 5......
    2a
    228
    b
    Income tax for 2012. (This does not include the tax from Part VI.)...
    2b
     
    c
    Add lines 2a and 2b............................
    2c
    228
    3
    Distributable amount before adjustments. Subtract line 2c from line 1............
    3
    9,395
    4
    Recoveries of amounts treated as qualifying distributions................
    4
    2,848
    5
    Add lines 3 and 4............................
    5
    12,243
    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
    12,243
    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
    9,882
    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
    9,882
    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
    9,882
    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 12,243
    2 Undistributed income, if any, as of the end of 2012:
    a Enter amount for 2011 only....... 8,777
    b Total for prior years:2010, 20, 20 0
    3 Excess distributions carryover, if any, to 2012:
    a From 2007....... 0
    b From 2008....... 0
    c From 2009....... 0
    d From 2010....... 0
    e From 2011....... 0
    fTotal of lines 3a through e......... 0
    4Qualifying distributions for 2012 from Part
    XII, line 4: bullet$ 9,882
    a Applied to 2011, but not more than line 2a 8,777
    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..... 1,105
    e Remaining amount distributed out of corpus 0
    5 Excess distributions carryover applied to 2012. 0 0
    (If an amount appears in column (d), the
    same amount must be shown in column (a).)
    6Enter the net total of each column as
    indicated below:
    a Corpus. Add lines 3f, 4c, and 4e. Subtract line 5 0
    b Prior years’ undistributed income. Subtract
    line 4b from line 2b ...........     		0
    c Enter the amount of prior years’ undistributed
    income for which a notice of deficiency has
    been issued, or on which the section 4942(a)
    tax has been previously assessed......     		0
    d Subtract line 6c from line 6b. Taxable amount
    —see instructions ...........     		0
    e Undistributed income for 2011. Subtract line
    4a from line 2a. Taxable amount—see
    instructions .............     		0
    f Undistributed income for 2012. Subtract
    lines 4d and 5 from line 1. This amount must
    be distributed in 2013 ..........     		11,138
    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 or e-mail of the person to whom applications should be addressed:
    COLUMBIA HIGH SCHOOL
    901 IRONVILLE PIKE STREET
    COLUMBIA,PA17512
    (717) 684-7500
    bThe form in which applications should be submitted and information and materials they should include:
    ANY
    cAny submission deadlines:
    APRIL 1ST
    dAny restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other
    factors:
    AWARDS BASED ON NEED, PERFORMANCE AND PERSONAL INTERVIEW
    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
    CENTER FOR SCHOLARSHIP
    ADMINISTRATION
    P O BOX 1465
    TAYLORS,SC29687     		NONE PUBLIC CHARITY SCHOLARSHIPS 9,000
    Total .................................bullet 3a 9,000
    bApproved for future payment
    Total .................................bullet 3b  
    Form 990-PF (2012)
    Form 990-PF (2012)
    Page 11
    Part XVI-A
    Analysis of Income-Producing Activities
    Enter gross amounts unless otherwise indicated. Unrelated business income Excluded by section 512, 513, or 514 (e)
    Related or exempt
    function income
    (See instructions.)
    1Program service revenue: (a)
    Business code     		(b)
    Amount     		(c)
    Exclusion code     		(d)
    Amount
    a
    b
    c
    d
    e
    f
    gFees and contracts from government agencies          
    2 Membership dues and assessments....          
    3Interest on savings and temporary cash investments          
    4 Dividends and interest from securities....     14 4,626  
    5 Net rental income or (loss) from real estate:
    aDebt-financed property......          
    bNot debt-financed property.....          
    6Net rental income or (loss) from personal property          
    7 Other investment income.....          
    8Gain or (loss) from sales of assets other than inventory     18 7,658  
    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)..   12,284  
    13Total. Add line 12, columns (b), (d), and (e)..................
    1312,284
    (See worksheet in line 13 instructions to verify calculations.)
    Part XVI-B
    Relationship of Activities to the Accomplishment of Exempt Purposes
    Line No.
    DownArrow     		Explain below how each activity for which income is reported in column (e) of Part XVI-A contributed importantly to
    the accomplishment of the foundation’s exempt purposes (other than by providing funds for such purposes). (See
    instructions.)
    Form 990-PF (2012)
    Form 990-PF (2012)
    Page 12
    Part XVII
    Information Regarding Transfers To and Transactions and Relationships With Noncharitable Exempt Organizations
    1
    Did the organization directly or indirectly engage in any of the following with any other organization described in section
    Yes
    No
    501(c) of the Code (other than section 501(c)(3) organizations) or in section 527, relating to political organizations?
    a
    Transfers from the reporting foundation to a noncharitable exempt organization of:
    (1) Cash...................................
    1a(1)
     
    No
    (2) Other assets.................................
    1a(2)
     
    No
    b
    Other transactions:
    (1) Sales of assets to a noncharitable exempt organization....................
    1b(1)
     
    No
    (2) Purchases of assets from a noncharitable exempt organization..................
    1b(2)
     
    No
    (3) Rental of facilities, equipment, or other assets.......................
    1b(3)
     
    No
    (4) Reimbursement arrangements...........................
    1b(4)
     
    No
    (5) Loans or loan guarantees.............................
    1b(5)
     
    No
    (6) Performance of services or membership or fundraising solicitations................
    1b(6)
     
    No
    c
    Sharing of facilities, equipment, mailing lists, other assets, or paid employees..............
    1c
     
    No
    d
    If the answer to any of the above is “Yes,” complete the following schedule. Column (b) should always show the fair market value
    of the goods, other assets, or services given by the reporting foundation. If the foundation received less than fair market value
    in any transaction or sharing arrangement, show in column (d) the value of the goods, other assets, or services received.
    (a) Line No. (b) Amount involved (c) Name of noncharitable exempt organization (d) Description of transfers, transactions, and sharing arrangements
    2a
    Is the foundation directly or indirectly affiliated with, or related to, one or more tax-exempt organizations
    described in section 501(c) of the Code (other than section 501(c)(3)) or in section 527?...........
    b
    If “Yes,” complete the following schedule.
    (a) Name of organization (b) Type of organization (c) Description of relationship
    Sign Here
    Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than taxpayer or fiduciary) is based on all information of which preparer has any knowledge.
    Bullet Bullet
    May the IRS discuss this return
    with the preparer shown below
    (see instr.)?
    Signature of officer or trustee Date Title
    Paid Preparer Use Only Print/Type preparer's name Preparer's Signature Date PTIN
    Firm's namebullet



    Firm's addressbullet







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


    Software ID:  
    Software Version:  


    Form 990PF - Special Condition Description:
    Special Condition Description

    TY 2012 InvestmentsCorpBondsSchedule
    Name:
    GROFFMARY S
    EIN: 23-6479982
    Name of Bond End of Year Book Value End of Year Fair Market Value
    04315J209 ARTIO TOTAL RTN BND    
    256210105 DODGE & COX    
    261980494 DREYFUS EMERGING MKT    
    4812C0803 JPMORGAN HIGH YIELD    
    693390700 PIMCO TOTAL RTN    
    922031869 VANGUARD INFLATION    
    94985D582 WELLS FARGO ADVTG    
    693391559 PIMCO EMERGING MKT    
    693390882 PIMCO FOREIGN BD    
    34984T881 GOLDEN LARGE CAP    
    38142Y401 GOLDMAN SACHS GRWTH    
    38142Y773 GOLDMAN SACHS LARGE    
    339128100 JP MORGAN MID CAP    
    487300808 KELLEY SMALL CAP VAL    
    784924425 SSGA EMERGING MKT    
    87234N849 TCW SMALL CAP GRWTH    
    949915565 WELLS FARGO ADVTG    
    94984B181 WELLS FARGO ADVTG    
    04315J837 ARTIO INTERNATIONAL    
    256206103 DODGE & COX INTERNAT    
    922042858 VANGUARD EMERGING MK    
    76628T645 RIDGEWORTH SEIX HY B    
    77957P105 T ROWE PRICE SHORT T    

    TY 2012 InvestmentsCorpStockSchedule
    Name:
    GROFFMARY S
    EIN: 23-6479982
    Name of Stock End of Year Book Value End of Year Fair Market Value
    44980Q518 ING INTERNATIONAL RE    
    722005667 PIMCO COMMODITY RTN    
    922908553 VANGUARD REIT VIPER 5,798 7,106
    04314H204 ARTISAN INTERNATIONA 7,777 9,272
    04315J837 ARTIO INTERNATIONAL    
    22544R305 CREDIT SUISSE COMM R 10,110 9,497
    256206103 DODGE & COX INT'L ST 8,458 9,321
    339128100 JP MORGAN MID CAP VA 3,772 4,445
    34984T881 GOLDEN LARGE CAP COR    
    38142Y401 GOLDMAN SACHS GRTH O    
    38142Y773 GOLDMAN SACHS L/C VA    
    411511504 HARBOR CAPITAL APRCT 10,424 12,147
    464287200 ISHARES CORE S & P 5 6,137 7,014
    487300808 KEELEY SMALL CAP VAL 4,577 5,261
    552983694 MFS VALUE FUND-CLASS 8,360 9,085
    683974505 OPPENHEIMER DEVELOPI 5,472 6,100
    78463X863 SPDR DJ WILSHIRE INT 6,123 6,988
    87234N849 TCW SMALL CAP GROWTH    
    922042858 VANGUARD MSCI EMERGI 6,426 6,323
    04314H600 ARTISAN MID CAP FUND 5,605 5,451
    25264S833 DIAMOND HILL LONG-SH 4,802 4,967
    367829884 GATEWAY FUND - Y #19 4,937 4,888
    448108100 HUSSMAN STRATEGIC GR 4,030 3,686
    464287648 ISHARES RUSSELL 2000 4,810 4,956
    589509108 MERGER FD SH BEN INT 2,856 2,870

    TY 2012 InvestmentsOtherSchedule2
    Name:
    GROFFMARY S
    EIN: 23-6479982
    Category/ Item Listed at Cost or FMV Book Value End of Year Fair Market Value
    256210105 DODGE & COX INCOME F AT COST 8,607 9,559
    261980494 DREYFUS EMG MKT DEBT AT COST 9,368 9,888
    262028855 DRIEHAUS ACTIVE INCO AT COST 2,883 2,955
    51855Q655 LAUDUS MONDRIAN INTL AT COST 4,256 4,226
    693390700 PIMCO TOTAL RET FD-I AT COST 28,583 29,225
    693390882 PIMCO FOREIGN BD FD AT COST 3,791 4,011
    76628T645 RIDGEWORTH SEIX HY B AT COST 9,177 9,925
    77957P105 T ROWE PRICE SHORT T AT COST 1,534 1,537

    TY 2012 OtherDecreasesSchedule
    Name:
    GROFFMARY S
    EIN: 23-6479982
    Description Amount
    MUTUAL FUND TIMING DIFFERENCE 368
    PY RETURN OF CAPITAL ADJUSTMENT 85


    TY 2012 OtherIncreasesSchedule
    Name:
    GROFFMARY S
    EIN: 23-6479982
    Description Amount
    RECOVERY OF PY GRANTS PAID 2,848
    ROUNDING 1


    TY 2012 OtherProfessionalFeesSchedule
    Name:
    GROFFMARY S
    EIN: 23-6479982
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    SCHOLARSHIP ADMINISTRATION FEE 630     630


    TY 2012 TaxesSchedule
    Name:
    GROFFMARY S
    EIN: 23-6479982
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    FEDERAL ESTIMATES - PRINCIPAL 98 0   0
    FOREIGN TAXES ON QUALIFIED FOR 35 35   0
    FOREIGN TAXES ON NONQUALIFIED 15 15   0