-
TIN:
Form
990-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
20
12
Open to Public Inspection
For calendar year 2012, or tax year beginning
01-01-2012
, and ending
12-31-2012
Name of foundation
Brotherhood Mutual Foundation Inc
Number and street (or P.O. box number if mail is not delivered to street address)
6400 Brotherhood Way
Room/suite
City or town, state, and ZIP code
Fort Wayne
,
IN
46825
A Employer identification number
20-3618117
B
Telephone number (see instructions)
(260) 482-8668
C
If exemption application is pending, check here
G
Check all that apply:
Initial return
Initial return of a former public charity
Final return
Amended return
Address change
Name change
D 1.
Foreign organizations, check here .............
2.
Foreign organizations meeting the 85% test,
check here and attach computation ...........
H
Check type of organization:
Section 501(c)(3) exempt private foundation
Section 4947(a)(1) nonexempt charitable trust
Other taxable private foundation
I
Fair market value of all assets at end
of year
(from Part II, col. (c),
line 16)
$
202,272
J
Accounting method:
Cash
Accrual
Other (specify)
(Part I, column (d) must be on cash basis.)
E
If private foundation status was terminated
under section 507(b)(1)(A), check here .........
F
If the foundation is in a 60-month termination
under section 507(b)(1)(B), check here .........
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)
1
Contributions, gifts, grants, etc., received (attach schedule)
570,612
2
Check
3
Interest on savings and temporary cash investments
6
6
6
4
Dividends and interest from securities
......
5a
Gross rents
..............
b
Net rental income or (loss)
6a
Net gain or (loss) from sale of assets not on line 10
5,539
b
Gross sales price for all assets on line 6a
549,442
7
Capital gain net income (from Part IV, line 2)
...
5,539
8
Net short-term capital gain
.........
5,539
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
........
576,157
5,545
5,545
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)
.......
c
Other professional fees (attach schedule)
....
17
Interest
...............
18
Taxes (attach schedule) (see instructions)
19
Depreciation (attach schedule) and depletion
...
20
Occupancy
..............
21
Travel, conferences, and meetings
.......
22
Printing and publications
..........
23
Other expenses (attach schedule)
.......
159
24
Total operating and administrative expenses.
Add lines 13 through 23
..........
159
0
0
25
Contributions, gifts, grants paid
........
458,537
458,537
26
Total expenses and disbursements.
Add lines 24 and 25
458,696
0
458,537
27
Subtract line 26 from line 12:
a
Excess of revenue over expenses and disbursements
117,461
b
Net investment income
(if negative, enter -0-)
5,545
c
Adjusted net income
(if negative, enter -0-)
...
5,545
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
1
Cash—non-interest-bearing
...............
4,043
-24,344
-24,344
2
Savings and temporary cash investments
..........
80,768
199,907
199,907
3
Accounts receivable
Less: allowance for doubtful accounts
4
Pledges receivable
Less: allowance for doubtful accounts
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)
Less: allowance for doubtful accounts
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)
........
26,709
26,709
c
Investments—corporate bonds (attach schedule)
........
11
Investments—land, buildings, and equipment: basis
Less: accumulated depreciation (attach schedule)
12
Investments—mortgage loans
..............
13
Investments—other (attach schedule)
...........
14
Land, buildings, and equipment: basis
Less: accumulated depreciation (attach schedule)
15
Other assets (describe
)
16
Total assets
(to be completed by all filers—see the
instructions. Also, see page 1, item I)
84,811
202,272
202,272
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
)
23
Total liabilities
(add lines 17 through 22)
..........
0
Foundations that follow SFAS 117, check here
and complete lines 24 through 26 and lines 30 and 31.
24
Unrestricted
....................
25
Temporarily restricted
................
26
Permanently restricted
................
Foundations that do not follow SFAS 117, check here
and complete lines 27 through 31.
27
Capital stock, trust principal, or current funds
.........
84,811
202,272
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)
....................
84,811
202,272
31
Total liabilities and net assets/fund balances
(see page 17 of
the instructions)
..................
84,811
202,272
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
84,811
2
Enter amount from Part I, line 27a
.....................
2
117,461
3
Other increases not included in line 2 (itemize)
3
4
Add lines 1, 2, and 3
..........................
4
202,272
5
Decreases not included in line 2 (itemize)
5
6
Total net assets or fund balances at end of year (line 4 minus line 5)—Part II, column (b), line 30
.
6
202,272
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.)
1a
b
c
d
e
(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
b
c
d
e
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
b
c
d
e
2
Capital gain net income or (net capital loss)
If gain, also enter in Part I, line 7
If (loss), enter -0- in Part I, line 7
2
5,539
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
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
3
5,539
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?
Yes
No
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
353,960
127,725
2.77127
2010
357,192
80,828
4.41916
2009
298,706
81,408
3.66925
2008
383,067
165,263
2.31792
2007
281,339
139,121
2.02226
2
Total
of line 1, column (d)
......................
2
15.19986
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
3.03997
4
Enter the net value of noncharitable-use assets for 2012 from Part X, line 5
.....
4
75,290
5
Multiply line 4 by line 3
.......................
5
228,879
6
Enter 1% of net investment income (1% of Part I, line 27b)
...........
6
55
7
Add lines 5 and 6
.........................
7
228,934
8
Enter qualifying distributions from Part XII, line 4
..............
8
458,537
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
Exempt operating foundations described in section 4940(d)(2), check here
and enter “N/A” on line 1.
Date of ruling or determination letter:
(attach copy of letter if necessary–see instructions)
b
Domestic foundations that meet the section 4940(e) requirements in Part V, check
1
55
here
and 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
55
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
55
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.
Check here
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
.......
9
55
10
Overpayment.
If line 7 is more than the total of lines 5 and 8, enter the
amount overpaid
...
10
11
Enter the amount of line 10 to be:
Credited to 2013 estimated tax
Refunded
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.
$
(2)
On foundation managers.
$
e
Enter the reimbursement (if any) paid by the foundation during the year for political expenditure tax imposed
on foundation managers.
$
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
No
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)
IN
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 address
N/A
14
The books are in care of
Matthew G HirschyTreasurer
Telephone no.
(260) 482-8668
Located at
6400 Brotherhood Way
Fort Wayne
IN
ZIP+4
468254235
15
Section 4947(a)(1) nonexempt charitable trusts filing Form 990-PF in lieu of
Form 1041
—Check here
.........
and enter the amount of tax-exempt interest received or accrued during the year
......
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
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?
Yes
No
(2)
Borrow money from, lend money to, or otherwise extend credit to (or accept it from)
a disqualified person?
.........................
Yes
No
(3)
Furnish goods, services, or facilities to (or accept them from) a disqualified person?
Yes
No
(4)
Pay compensation to, or pay or reimburse the expenses of, a disqualified person?
Yes
No
(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)?
.................
Yes
No
(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.)
.........
Yes
No
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
Organizations relying on a current notice regarding disaster assistance check here
.........
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?
...............
Yes
No
If “Yes,” list the years
20
,
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.
20
,
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?
.........................
Yes
No
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))?
Yes
No
(2)
Influence the outcome of any specific public election (see section 4955); or to carry
on, directly or indirectly, any voter registration drive?
...............
Yes
No
(3)
Provide a grant to an individual for travel, study, or other similar purposes?
Yes
No
(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)
........
Yes
No
(5)
Provide for any purpose other than religious, charitable, scientific, literary, or
educational purposes, or for the prevention of cruelty to children or animals?
........
Yes
No
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
Organizations relying on a current notice regarding disaster assistance check here
.........
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?
............
Yes
No
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?
........................
Yes
No
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?
Yes
No
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
Matthew G Hirschy
Treasurer
0.00
0
6400 Brotherhood Way
Fort Wayne
,
IN
46825
Hugh White
Vice President
0.00
0
6400 Brotherhood Way
Fort Wayne
,
IN
46825
Mark A Robison
President
0.00
0
6400 Brotherhood Way
Fort Wayne
,
IN
46825
James A Blum
Chairman
0.00
0
6400 Brotherhood Way
Fort Wayne
,
IN
46825
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
...................
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
.............
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
..........................
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
76,437
c
Fair market value of all other assets (see instructions)
................
1c
0
d
Total
(add lines 1a, b, and c)
.........................
1d
76,437
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
76,437
4
Cash deemed held for charitable activities. Enter 1 1⁄2% of line 3 (for greater amount, see
instructions)
.............................
4
1,147
5
Net value of noncharitable-use assets.
Subtract line 4 from line 3. Enter here and on Part V, line 4
5
75,290
6
Minimum investment return.
Enter 5% of line 5
..................
6
3,765
Part XI
Distributable Amount
(see instructions) (Section 4942(j)(3) and (j)(5) private operating foundations and certain foreign organizations check here
and do not complete this part.)
1
Minimum investment return from Part X, line 6
....................
1
3,765
2a
Tax on investment income for 2012 from Part VI, line 5
......
2a
55
b
Income tax for 2012. (This does not include the tax from Part VI.)
...
2b
c
Add lines 2a and 2b
............................
2c
55
3
Distributable amount before adjustments. Subtract line 2c from line 1
............
3
3,710
4
Recoveries of amounts treated as qualifying distributions
................
4
5
Add lines 3 and 4
............................
5
3,710
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
3,710
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
458,537
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
458,537
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
55
6
Adjusted qualifying distributions.
Subtract line 5 from line 4
..............
6
458,482
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
3,710
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
.......
274,448
b
From 2008
.......
375,000
c
From 2009
.......
294,640
d
From 2010
.......
353,151
e
From 2011
.......
347,574
f
Total
of lines 3a through e
.........
1,644,813
4
Qualifying distributions for 2012 from Part
XII, line 4:
$
458,537
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
.....
3,710
e
Remaining amount distributed out of corpus
454,827
5
Excess distributions carryover applied to 2012.
(If an amount appears in column (d), the
same amount must be shown in column (a).)
6
Enter the net total of each column as
indicated below:
a
Corpus. Add lines 3f, 4c, and 4e. Subtract line 5
2,099,640
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)
.............
8
Excess distributions carryover from 2007 not
applied on line 5 or line 7 (see instructions)
...
274,448
9
Excess distributions carryover to 2013.
Subtract lines 7 and 8 from line 6a
......
1,825,192
10
Analysis of line 9:
a
Excess from 2008
....
375,000
b
Excess from 2009
....
294,640
c
Excess from 2010
....
353,151
d
Excess from 2011
....
347,574
e
Excess from 2012
....
454,827
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
.......
b
Check box to indicate whether the organization is a private operating foundation described in section
4942(j)(3)
or
4942(j)(5)
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.)
1
Information Regarding Foundation Managers:
a
List 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).)
b
List 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.
2
Information Regarding Contribution, Grant, Gift, Loan, Scholarship, etc., Programs:
Check here
if the foundation only makes contributions to preselected charitable organizations and does not accept
unsolicited requests for funds. If the foundation makes gifts, grants, etc. (see instructions) to individuals or organizations under
other conditions, complete items 2a, b, c, and d.
a
The name, address, and telephone number of the person to whom applications should be addressed:
b
The form in which applications should be submitted and information and materials they should include:
c
Any submission deadlines:
d
Any restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other
factors:
Form
990-PF
(2012)
Form 990-PF (2012)
Page
10
Part XV
Supplementary Information
(continued)
3 Grants and Contributions Paid During the Year or Approved for Future Payment
Recipient
If recipient is an individual,
show any relationship to
any foundation manager
or substantial contributor
Foundation
status of
recipient
Purpose of grant or
contribution
Amount
Name and address (home or business)
a
Paid during the year
Youth for Christ
6427 Oakbrook Parkway
Fort Wayne
,
IN
46825
Exempt
Donation
47,489
YMCA of Greater Fort Wayne
347 W Berry St STE 500
Fort Wayne
,
IN
46802
Exempt
Donation
2,000
YFC Vitality Care
6427 Oakbrook Parkway
Fort Wayne
,
IN
46825
Exempt
Donation
22,880
Wycliffe Bible Translators
PO Box 628200
Orlando
,
FL
32862
Exempt
Donation
5,000
World Ventures Serbia Now
23526 Dawkins Rd
Woodburn
,
IN
46797
Exempt
Donation
12,500
World Relief
7 E Baltimore
Baltimore
,
MD
21202
Exempt
Donation
1,000
WBCL Radio
1025 W Rudisill Blvd
Fort Wayne
,
IN
46807
Exempt
Sharathon
5,000
Vitality Care Institute YFC
6427 Oakbrook Parkway
Fort Wayne
,
IN
46825
Exempt
Donation
2,080
Vera Bradley Foundation
PO Box 80201
Fort Wayne
,
IN
46898
Exempt
Donation
5,000
University of St Francis
2701 Spring St
Fort Wayne
,
IN
46808
Exempt
Donation
6,000
United Way of Allen County
PO Box 11784
Fort Wayne
,
IN
46860
Exempt
Donation
10,000
True Vine Ministries
11910 Shearwater Run
Fort Wayne
,
IN
46845
Exempt
Donation-Walkathon
1,500
Training Leaders International
PO Box 15292
Minneapolis
,
MN
55415
Exempt
Donation-Mission Work
750
The Studio Christian Youth Center
111 W Jefferson St
Albion
,
IN
46701
Exempt
Donation
300
The Salvation Army
2901 N Clinton St
Fort Wayne
,
IN
46805
Exempt
Donation
750
The Reclamation Project
2614 S Calhoun St
Fort Wayne
,
IN
46807
Exempt
Donation
1,500
The Hub Mission Ministry
11120 SW 41st Place
Mustang
,
OK
73064
Exempt
Donation
500
Taylor World Outreach
236 W Reade Ave
Upland
,
IN
46989
Exempt
Donation
250
Taylor University
1025 Rudisill Blvd
Fort Wayne
,
IN
46807
Exempt
Donation
30,000
Star 883
8 Martin Luther Dr
Fort Wayne
,
IN
46825
Exempt
Donation-Sharathon
12,065
St Simon Catholic Church
8155 Oaklandon Rd
Indianapolis
,
IN
46236
Exempt
Memorial Contribution
250
South Side Opportunity Service
4001 S Anthony Blvd
Fort Wayne
,
IN
46806
Exempt
Donation
2,000
Soles4Souls
319 Martingdale Dr
Old Hickory
,
TN
37138
Exempt
Donation
200
Saint Joe Methodist Church
6004 Reed Rd
Fort Wayne
,
IN
46835
Exempt
Donation
200
Rescue Ministries
301 W Superior St PO Box 1116
Fort Wayne
,
IN
46802
Exempt
Donation
41,444
Remedy LiveFM
6429 Oakbrook Parkway
Fort Wayne
,
IN
46825
Exempt
Donation
14,292
Rebel Ministries
6365 County Rd 45
St Joe
,
IN
46785
Exempt
Donation- Mission Trips
2,050
Questa Foundation
3468 Stellhorn Rd
Fort Wayne
,
IN
46815
Exempt
Donation
5,000
Pathway Community Church
10315 Dawsons Creek Blvd STE C
Fort Wayne
,
IN
46825
Exempt
Donation
750
New Beginnings
2266 Wakefield Mound Rd
Piketon
,
OH
45661
Exempt
Donation
21,000
Neighborhood Christian Legal Clinic
2826 S Calhoun St
Fort Wayne
,
IN
46807
Exempt
Donation
500
Neighborhood Center
PO Box 6337
Fort Wayne
,
IN
46896
Exempt
Donation
500
National Alliance of Research Academy
3630 N Hills Dr
Austin
,
TX
78731
Exempt
Donation
1,000
Mustard Seed
3636 Illinois Rd
Fort Wayne
,
IN
46804
Exempt
Donation
1,000
Matthew 25
413 E Jefferson Blvd
Fort Wayne
,
IN
46802
Exempt
Donation
5,000
Manchester College
604 E College Ave
North Manchester
,
IN
46962
Exempt
Donation
5,000
Loving Shepherd Ministries
PO Box 375-A
Bluffton
,
IN
46714
Exempt
Donation
650
Ligonier United Methodist Church
PO Box 66
Ligonier
,
IN
46767
Exempt
Donation
200
Lifeline YouthFamily Services
PO Box 80487
Fort Wayne
,
IN
46898
Exempt
Donation
5,000
Life Bridge Church
12719 Corbin Rd
Fort Wayne
,
IN
46845
Exempt
Donation
1,750
Level 13 Church
8840 St Joe Rd
Fort Wayne
,
IN
46835
Exempt
Donation
750
Lakewood Park Christian School
5555 Cr 29 S
Auburn
,
IN
46706
Exempt
Sponsorship of Golf Marathon
1,000
Knights of Columbus
1502 E Wallen Rd
Fort Wayne
,
IN
46825
Exempt
Hope Center Fund Raiser
1,000
Kates Kart
429 E Dupont Rd 119
Fort Wayne
,
IN
46825
Exempt
Donation
1,000
Junior Achievement
601 Noble Dr
Fort Wayne
,
IN
46825
Exempt
Donation
1,000
Josiah Venture
PO Box 4317
Wheaton
,
IL
60189
Exempt
Donation
1,000
International Teams
411 W River Rd
Elgin
,
IL
60123
Exempt
Donation
1,000
Interfaith Hospitality Network
2925 E State Blvd
Fort Wayne
,
IN
46805
Exempt
Donation
2,500
IIHS
1005 N Glebe Rd STE 800
Arlington
,
VA
22201
Exempt
Donation
1,000
Huntertown Elementary
15330 Lima Rd
Huntertown
,
IN
46748
Exempt
Donation
250
Heartland Church
1025 Vance Avenue
Fort Wayne
,
IN
46805
Exempt
Donation
1,000
Grace Point Church of the Nazarene
8611 Mayhew Rd
Fort Wayne
,
IN
46845
Exempt
Donation
1,600
Girl Scouts of N Indiana-Michiana
10008 Dupont Circle Dr E
Fort Wayne
,
IN
46825
Exempt
Donation
1,500
FW Childrens Zoo
3411 Sherman Blvd
Fort Wayne
,
IN
46808
Exempt
Donation
7,500
FW Alumni & Friends Resource Center
915 W Rudisill Blvd
Fort Wayne
,
IN
46807
Exempt
Donation
250
Fort Wayne Habitat for Humanity
629 E Washington Blvd
Fort Wayne
,
IN
46802
Exempt
Donation
60,857
Financial Fortress Initiative
3282 mallard Cove
Fort Wayne
,
IN
46804
Exempt
Donation
1,000
Fellowship of Evangelical Churches
1420 Kerrway Court
Fort Wayne
,
IN
46805
Exempt
Donation
8,297
Fellowship of Christian Athletes
576 Geiger Dr STE B
Roanoke
,
IN
46783
Exempt
Golf Outing Sponsorship
5,000
Euell A Wilson Center Inc
1512 Oxford St
Fort Wayne
,
IN
46806
Exempt
Donation
2,500
Erins House
3811 Illinois Rd S
Fort Wayne
,
IN
46804
Exempt
Donation
500
Encourage One Another
9827 Chesapeake Point
Fort Wayne
,
IN
46819
Exempt
Donation
500
Embassy Theatre Foundation
125 W Berry St
Fort Wayne
,
IN
46802
Exempt
Donation
1,000
Crossbridge Community Church
3409 Hursh Rd
Fort Wayne
,
IN
46845
Exempt
Donation
100
Community Harvest Food Bank
999 E Tillman Rd
Fort Wayne
,
IN
46816
Exempt
Donation
1,000
CLHS
1601 St Joe River Rd
Fort Wayne
,
IN
46805
Exempt
Season Sponsor for Concordia HS Band
500
City of Fort Wayne Solid Waste Dept
200 E Berry St STE 210
Fort Wayne
,
IN
46802
Exempt
Donation to Great American Clean Up
450
Christian Legal Society
8001 Braddock Rd STE 300
Springfield
,
VA
22151
Exempt
Donation
500
Child Evangelism
4646 W Jefferson STE 280
Fort Wayne
,
IN
46804
Exempt
Donation
2,000
Central District Missionary Church
3282 Mallard Cove
Fort Wayne
,
IN
46804
Exempt
Monthly Donation
2,000
Central Christian School
5801 Schwartz Rd
Fort Wayne
,
IN
46835
Exempt
Donation to Computer Lab
8,333
CCCA co Bob Baylor
PO Box 62189
Colorado Springs
,
CO
80962
Exempt
Donation (Corners of the Field)
1,250
Campus Crusade Jesus Film Project
100 lake Hart Dr 3100
Orlando
,
FL
32832
Exempt
Donation
1,500
California Baptist University Choir
8432 Magnolia Avenue
Riverside
,
CA
92504
Exempt
Donation to College for Choir event
750
Boy Scouts of America
8315 W Jefferson Blvd
Fort Wayne
,
IN
46804
Exempt
Donation
2,500
BMIC co Juventud Con Una Mision Mazatla
15 Las Palmas Los Pinos
Mazatlan
,
Sinaloa
MX
Exempt
Donation for Kelly Minich's Mission Trip
750
Bethel College
1001 W McKinley Avenue
Fort Wayne
,
IN
46545
Exempt
Donation to Graduate Dinner
2,000
Associated Churches of Fort Wayne
602 E Wayne St
Fort Wayne
,
IN
46802
Exempt
Event Sponsor Donation
5,500
ARC - Easter Seals
4919 Coldwater Rd
Fort Wayne
,
IN
46825
Exempt
Donation-Dancing with Easter Seals ARC Stars
750
Anthony Wayne Rotary Club
1637 Traders Crossing
Fort Wayne
,
IN
46845
Exempt
Donation (Run to Help Eradicate Polio)
300
American Family Association of IN
PO Box 40307
Indianapolis
,
IN
46240
Exempt
Donation
11,000
American Bible Society
1865 Broadway
New York
,
NY
10023
Exempt
Donation
25,000
Allen County Jail Chaplaincy
417 S Calhoun St
Fort Wayne
,
IN
46802
Exempt
Donation
1,000
Advance America
101 W Ohio Street Suite 660
Indianapolis
,
IN
46204
Exempt
Donation
7,500
A Hope Center
3630 Hobson Road
Fort Wayne
,
IN
46815
Exempt
Banquet & Strides for Hope
7,500
Total
.................................
3a
458,537
b
Approved for future payment
Trinity Communications
PO Box 5021
Fort Wayne
,
IN
46895
Exempt
Pledge
6,000
Questa Foundation for Education
PO Box 5224
Fort Wayne
,
IN
46895
Exempt
Pledge
10,000
Central Christian School
5801 Schwartz Rd
Fort Wayne
,
IN
46835
Exempt
Pledge
8,333
Rescue Mission
PO Box 1116 301 W Superior St
Fort Wayne
,
IN
46802
Exempt
Pledge
35,000
Total
.................................
3b
59,333
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.)
1
Program service revenue:
(a)
Business code
(b)
Amount
(c)
Exclusion code
(d)
Amount
a
b
c
d
e
f
g
Fees and contracts from government agencies
2
Membership dues and assessments
....
3
Interest on savings and temporary cash investments
14
6
4
Dividends and interest from securities
....
5
Net rental income or (loss) from real estate:
a
Debt-financed property
......
b
Not debt-financed property
.....
6
Net rental income or (loss) from personal property
7
Other investment income
.....
8
Gain or (loss) from sales of assets other than inventory
5,539
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)
..
6
5,539
13
Total.
Add line 12, columns (b), (d), and (e)
..................
13
5,545
(See worksheet in line 13 instructions to verify calculations.)
Part XVI-B
Relationship of Activities to the Accomplishment of Exempt Purposes
Line No.
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.)
8
Gain on securities between time donated and time sold
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?
...........
Yes
No
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.
May the IRS discuss this return
with the preparer shown below
(see instr.)?
Yes
No
Signature of officer or trustee
Date
Title
Paid Preparer Use Only
Print/Type preparer's name
Preparer's Signature
Date
Check if self-
employed
PTIN
Firm's name
Firm's address
Firm's EIN
Phone no.
Form
990-PF
(2012)
Additional Data
Software ID:
12000229
Software Version:
2012v2.0
Form 990PF - Special Condition Description:
Special Condition Description
-
TIN:
Schedule B
(Form 990, 990-EZ,
or 990-PF)
Department of the Treasury
Internal Revenue Service
Schedule of Contributors
Attach to Form 990, 990-EZ, or 990-PF.
OMB No. 1545-0047
20
12
Name of the organization
Brotherhood Mutual Foundation Inc
Employer identification number
20-3618117
Organization type
(check one):
Filers of:
Section:
Form 990 or 990-EZ
501(c)( ) (enter number) organization
4947(a)(1) nonexempt charitable trust
not
treated as a private foundation
527 political organization
Form 990-PF
501(c)(3) exempt private foundation
4947(a)(1) nonexempt charitable trust treated as a private foundation
501(c)(3) taxable private foundation
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
For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, $5,000 or more (in money or
property) from any one contributor. Complete Parts I and II.
Special Rules
For a section 501(c)(3) organization filing Form 990 or 990-EZ that met the 33
1
/3
% support test of the regulations
under sections 509(a)(1) and 170(b)(1)(A)(vi) and received from any one contributor, during the year, a contribution of the
greater of
(1)
$5,000 or
(2)
2% of the amount on (i) Form 990, Part VIII, line 1h, or (ii) Form 990-EZ, line 1. Complete Parts I and II.
For a section 501(c)(7), (8), or (10) organization filing Form 990 or 990-EZ that received from any one contributor,
during the year, total contributions of more than $1,000 for use
exclusively
for religious, charitable,
scientific, literary, or educational purposes, or the prevention of cruelty to children or animals. Complete Parts I, II, and
III.
For a section 501(c)(7), (8), or (10) organization filing Form 990 or 990-EZ that received from any one contributor,
during the year, contributions for use
exclusively
for religious, charitable, etc., purposes, but these contributions did
not total to more than $1,000. If this box is checked, enter here the total contributions that were received during
the year for an
exclusively
religious, charitable, etc., purpose. Do not complete any of the parts unless the
General Rule
applies to this organization because it received nonexclusively religious, charitable, etc., contributions of $5,000 or more
during the year
.........................
$
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. 30613X
Schedule B (Form 990, 990-EZ, or 990-PF) (2012)
Schedule B (Form 990, 990-EZ, or 990-PF) (2012)
Page
2
Name of organization
Brotherhood Mutual Foundation Inc
Employer identification number
20-3618117
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
5
Brotherhood Mutual Insurance
6400 Brotherhood Way
Fort Wayne
,
IN
46825
$
177,895
Person
Payroll
Noncash
(Complete Part II if there is a noncash contribution.)
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
4
Brotherhood Mutual Insurance
6400 Brotherhood Way
Fort Wayne
,
IN
46825
$
26,709
Person
Payroll
Noncash
(Complete Part II if there is a noncash contribution.)
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
3
Brotherhood Mutual Insurance
6400 Brotherhood Way
Fort Wayne
,
IN
46825
$
173,910
Person
Payroll
Noncash
(Complete Part II if there is a noncash contribution.)
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
2
Brotherhood Mutual Insurance
6400 Brotherhood Way
Fort Wayne
,
IN
46825
$
97,346
Person
Payroll
Noncash
(Complete Part II if there is a noncash contribution.)
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
1
Brotherhood Mutual Insurance
6400 Brotherhod Way
Fort Wayne
,
IN
46825
$
94,752
Person
Payroll
Noncash
(Complete Part II if there is a noncash contribution.)
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
$
Person
Payroll
Noncash
(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
Brotherhood Mutual Foundation Inc
Employer identification number
20-3618117
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
5
2,650 shares of Medco
$
177,895
2012-02-27
(a) No.
from
Part I
(b)
Description of noncash property given
(c)
FMV (or estimate)
(see instructions)
(d)
Date received
4
425 Shares Qualcomm Inc.
$
26,709
2012-12-20
(a) No.
from
Part I
(b)
Description of noncash property given
(c)
FMV (or estimate)
(see instructions)
(d)
Date received
3
2,000 Shares of McDonalds
$
173,910
2012-10-31
(a) No.
from
Part I
(b)
Description of noncash property given
(c)
FMV (or estimate)
(see instructions)
(d)
Date received
2
160 Shares of Apple
$
97,346
2012-04-26
(a) No.
from
Part I
(b)
Description of noncash property given
(c)
FMV (or estimate)
(see instructions)
(d)
Date received
1
130 Shares of Priceline
$
94,752
2012-04-26
(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
Brotherhood Mutual Foundation Inc
Employer identification number
20-3618117
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.)
$
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
-
TIN:
TY 2012 OtherExpensesSchedule
Name:
Brotherhood Mutual Foundation Inc
EIN:
20-3618117
Software ID:
12000229
Software Version:
2012v2.0
Description
Revenue and Expenses per Books
Net Investment Income
Adjusted Net Income
Disbursements for Charitable Purposes
Bank Fees
159