Form990-PF
Click to see attachment

Department of the Treasury
Internal Revenue Service
Return of Private Foundation
or Section 4947(a)(1) Nonexempt Charitable Trust
Treated as a Private Foundation
Note. The foundation may be able to use a copy of this return to satisfy state reporting requirements.
OMB No. 1545-0052
2012
Open to Public Inspection
For calendar year 2012, or tax year beginning 01-01-2012 , and ending 12-31-2012
Name of foundation
Van Sloun Foundation
 

Number and street (or P.O. box number if mail is not delivered to street address)PO Box 1161787E Scotch Pine Lane   Room/suite
City or town, state, and ZIP code
Westport, MA02791
A Employer identification number

04-6691809
B Telephone number (see instructions)

(508) 748-1665
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$8,091,632J 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) 200,000
2 Check bullet
3 Interest on savings and temporary cash investments      
4 Dividends and interest from securities...... 177,345 177,345 177,345
5a Gross rents..............      
b Net rental income or (loss)  
6a Net gain or (loss) from sale of assets not on line 10 221,349
b Gross sales price for all assets on line 6a 1,100,334
7 Capital gain net income (from Part IV, line 2)... 313,919
8 Net short-term capital gain.........  
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........ 598,694 491,264 177,345
Operating and Administrative Expenses 13 Compensation of officers, directors, trustees, etc. 27,500     27,500
14 Other employee salaries and wages......        
15 Pension plans, employee benefits.......        
16a Legal fees (attach schedule).........        
b Accounting fees (attach schedule)....... Click to see attachment 2,550 2,550 2,550  
c Other professional fees (attach schedule).... Click to see attachment 33,805 33,805 33,805  
17 Interest...............        
18 Taxes (attach schedule) (see instructions) Click to see attachment 9,936 5,820   125
19 Depreciation (attach schedule) and depletion...      
20 Occupancy..............        
21 Travel, conferences, and meetings....... 4,849      
22 Printing and publications..........        
23 Other expenses (attach schedule)....... Click to see list of attachments 1,445      
24 Total operating and administrative expenses.
Add lines 13 through 23.......... 80,085 42,175 36,355 27,625
25 Contributions, gifts, grants paid........ 368,031 368,031
26 Total expenses and disbursements. Add lines 24 and 25 448,116 42,175 36,355 395,656
27 Subtract line 26 from line 12:
a Excess of revenue over expenses and disbursements 150,578
b Net investment income (if negative, enter -0-) 449,089
c Adjusted net income (if negative, enter -0-)... 140,990
For Paperwork Reduction Act Notice, see instructions.
Cat. No. 11289X Form 990-PF (2012)
Form 990-PF (2012)
Page 2
Part II Balance Sheets Attached schedules and amounts in the description column
should be for end-of-year amounts only. (See instructions.)		 Beginning of year End of year
(a) Book Value (b) Book Value (c) Fair Market Value
Assets 1 Cash—non-interest-bearing............... 2,376    
2 Savings and temporary cash investments.......... 1,414,851 771,904 771,904
3 Accounts receivable bullet  
Less: allowance for doubtful accounts bullet        
4 Pledges receivable bullet  
Less: allowance for doubtful accounts bullet        
5 Grants receivable.................      
6 Receivables due from officers, directors, trustees, and other
disqualified persons (attach schedule) (see page 15 of the
instructions)....................      
7 Other notes and loans receivable (attach schedule) bullet  
Less: allowance for doubtful accounts bullet        
8 Inventories for sale or use...............      
9 Prepaid expenses and deferred charges...........   2,579  
10a Investments—U.S. and state government obligations (attach schedule) 507,795 Click to see attachment253,042 253,042
b Investments—corporate stock (attach schedule)........ 5,628,117 Click to see attachment7,066,686 7,066,686
c Investments—corporate bonds (attach schedule)........ 214,754    
11 Investments—land, buildings, and equipment: basis bullet  
Less: accumulated depreciation (attach schedule) bullet        
12 Investments—mortgage loans..............      
13 Investments—other (attach schedule)...........      
14 Land, buildings, and equipment: basis bullet  
Less: accumulated depreciation (attach schedule) bullet        
15 Other assets (describe bullet)      
16 Total assets (to be completed by all filers—see the
instructions. Also, see page 1, item I) 7,767,893 8,094,211 8,091,632
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.........    
28 Paid-in or capital surplus, or land, bldg., and equipment fund    
29 Retained earnings, accumulated income, endowment, or other funds 7,767,893 8,094,211
30 Total net assets or fund balances (see page 17 of the
instructions).................... 7,767,893 8,094,211
31 Total liabilities and net assets/fund balances (see page 17 of
the instructions).................. 7,767,893 8,094,211
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 7,767,893
2 Enter amount from Part I, line 27a..................... 2 150,578
3 Other increases not included in line 2 (itemize) bulletClick to see attachment 3 175,740
4 Add lines 1, 2, and 3.......................... 4 8,094,211
5 Decreases not included in line 2 (itemize) bullet 5  
6 Total net assets or fund balances at end of year (line 4 minus line 5)—Part II, column (b), line 30. 6 8,094,211
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 Capital Gain Distribution P 2000-01-01 2012-12-31
b 500 Shs Exxon Mobil D 2003-10-30 2012-04-26
c 300 Shs Water Corp D 2005-06-28 2012-01-11
d 500 Shs Vertex Pharmaceuticals P 2012-03-30 2012-05-16
e 4000 Shs USB Capital VIII P 2009-04-22 2012-02-16
300 Shs Stryker Corp P 2009-05-12 2012-01-11
1750 Shs Potash Corp P 2011-08-05 2012-10-19
700 Shs Philip Morris Intl Inc D 2009-04-22 2012-11-30
600 Shs Procter & Gamble D 1992-05-14 2012-11-30
300 Shs PepsiCo P 2004-11-12 2012-03-30
200 Shs Occidental Pete P 2006-10-11 2012-04-26
450 Shs Novartis AG P 2005-06-28 2012-04-26
400 Shs Merck P 1994-10-24 2012-01-11
1500 Shs Mosaic Co P 2011-08-05 2012-10-19
600 Shs Altria Group P 2009-10-19 2012-11-30
1100 Shs Altria Group D 2009-04-22 2012-04-26
200 Shs John Wiley P 2006-03-27 2012-01-11
200 Shs Johnson & Johnson P 1992-10-22 2012-01-11
300 shs Imperial Oil P 2009-04-22 2012-01-11
6000 Shs Gentex P 2012-04-04 2012-10-19
900 Shs Fiserv Incorporated P 2000-12-04 2012-04-26
800 Shs Expeditors Intl Wash P 2007-03-28 2012-10-19
500 Shs Dover D 1994-10-24 2012-11-30
200 Shs Chevron Texaco P 2006-10-11 2012-04-26
900 Shs Cenovus Energy D 2002-07-18 2012-04-26
400 Shs Church & Dwight P 2009-12-18 2012-11-30
1120 Shs Church & Dwight D 2004-11-12 2012-04-26
200 Shs Automatic Data Processing P 2004-08-09 2012-04-26
100 Shs Automatic Data Processing P 2004-08-09 2012-03-30
200 Shs Automatic Data Processing D 2003-12-12 2012-03-30
300 Shs Analog Devices P 1999-01-04 2012-11-30
400 Shs Analog Devices P 1992-01-10 2012-04-26
300 Shs Analog Devices P 1992-01-10 2012-03-30
700 Shs Analog Devices P 1992-01-10 2012-01-11
500 Shs Adobe Systems P 2006-07-25 2012-03-30
(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 10,404     10,404
b 42,605   18,304 24,301
c 22,089   11,453 10,636
d 31,404   20,619 10,785
e 100,000   81,801 18,199
15,609   12,010 3,599
70,921   96,764 -25,843
61,861   27,880 33,981
40,169   11,187 28,982
19,829   15,580 4,249
17,809   8,952 8,857
24,907   21,324 3,583
15,289   6,772 8,517
80,842   98,899 -18,057
20,218   11,047 9,171
33,377   19,030 14,347
8,916   7,631 1,285
12,982   2,500 10,482
13,732   10,551 3,181
101,592   138,857 -37,265
58,386   32,659 25,727
30,322   37,331 -7,009
30,362   9,559 20,803
21,057   12,644 8,413
30,741   6,134 24,607
21,572   11,580 9,992
53,398   17,290 36,108
11,013   7,034 3,979
5,547   3,517 2,030
11,095   6,966 4,129
12,198   4,728 7,470
15,209   660 14,549
12,100   495 11,605
25,603   1,154 24,449
17,176   13,503 3,673
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       10,404
b       24,301
c       10,636
d       10,785
e       18,199
      3,599
      -25,843
      33,981
      28,982
      4,249
      8,857
      3,583
      8,517
      -18,057
      9,171
      14,347
      1,285
      10,482
      3,181
      -37,265
      25,727
      -7,009
      20,803
      8,413
      24,607
      9,992
      36,108
      3,979
      2,030
      4,129
      7,470
      14,549
      11,605
      24,449
      3,673
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 2 313,919
3 Net short-term capital gain or (loss) as defined in sections 1222(5) and (6):
If gain, also enter in Part I, line 8, column (c) (see instructions). If (loss), enter -0-
in Part I, line 8 . . . . . . . . . . . . . . . . 		Bracket 3 -26,480
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 396,034 7,844,210 0.05049
2010 361,951 7,290,580 0.04965
2009 298,125 6,422,213 0.04642
2008 304,070 7,143,468 0.04257
2007 330,250 7,641,744 0.04322
2 Total of line 1, column (d) ...................... 2 0.23234
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 0.04647
4 Enter the net value of noncharitable-use assets for 2012 from Part X, line 5..... 4 7,956,955
5 Multiply line 4 by line 3....................... 5 369,736
6 Enter 1% of net investment income (1% of Part I, line 27b)........... 6 4,491
7 Add lines 5 and 6......................... 7 374,227
8 Enter qualifying distributions from Part XII, line 4.............. 8 395,656
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 4,491
hereBulletand enter 1% of Part I, line 27b...................
c All other domestic foundations enter 2% of line 27b. Exempt foreign organizations enter 4% of Part I, line 12, col. (b)
2 Tax under section 511 (domestic section 4947(a)(1) trusts and taxable foundations only. Others enter -0-) 2  
3 Add lines 1 and 2............................ 3 4,491
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 4,491
6 Credits/Payments:
a 2012 estimated tax payments and 2011 overpayment credited to 2012 6a 3,200
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 3,200
8 Enter any penalty for underpayment of estimated tax. if Form 2220 is attached. 8  
9 Tax due. If the total of lines 5 and 8 is more than line 7, enter amount owed.......Bullet 9 1,291
10 Overpayment. If line 7 is more than the total of lines 5 and 8, enter the amount overpaid...Bullet 10  
11 Enter the amount of line 10 to be: Credited to 2013 estimated taxBullet   Refunded Bullet 11  
Part VII-A
Statements Regarding Activities
1a
During the tax year, did the foundation attempt to influence any national, state, or local legislation or did
Yes
No
it participate or intervene in any political campaign? ....................
1a
 
No
b
Did it spend more than $100 during the year (either directly or indirectly) for political purposes (see page 19 of
the instructions for definition)?............................
1b
 
No
If the answer is “Yes” to 1a or 1b, attach a detailed description of the activities and copies of any materials
published or distributed by the foundation in connection with the activities.
c
Did the foundation file Form 1120-POL for this year?.....................
1c
 
No
d
Enter the amount (if any) of tax on political expenditures (section 4955) imposed during the year:
(1) On the foundation. bullet$   (2) On foundation managers.bullet$  
e
Enter the reimbursement (if any) paid by the foundation during the year for political expenditure tax imposed
on foundation managers.bullet$  
2
Has the foundation engaged in any activities that have not previously been reported to the IRS?.......
2
 
No
If “Yes,” attach a detailed description of the activities.
3
Has the foundation made any changes, not previously reported to the IRS, in its governing instrument, articles
of incorporation, or bylaws, or other similar instruments? If “Yes,” attach a conformed copy of the changes....
3
 
No
4a
Did the foundation have unrelated business gross income of $1,000 or more during the year?........
4a
 
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)
    bulletMA
    b
    If the answer is “Yes” to line 7, has the foundation furnished a copy of Form 990-PF to the Attorney
    General (or designate) of each state as required by General Instruction G? If “No,” attach explanation .
    8b
    Yes
     
    9
    Is the foundation claiming status as a private operating foundation within the meaning of section 4942(j)(3)
    or 4942(j)(5) for calendar year 2012 or the taxable year beginning in 2012 (see instructions for Part XIV)?
    If “Yes,” complete Part XIV.............................
    9
     
    No
    10
    Did any persons become substantial contributors during the tax year? If “Yes,” attach a schedule listing their names and addresses.
    10
     
    No
    11
    At any time during the year, did the foundation, directly or indirectly, own a controlled entity within the
    meaning of section 512(b)(13)? If "Yes," attach schedule. (see instructions) .............
    11
     
    No
    12
    Did the foundation make a distribution to a donor advised fund over which the foundation or a disqualified person had
    advisory privileges? If "Yes," attach statement (see instructions).................
    12
     
    No
    13
    Did the foundation comply with the public inspection requirements for its annual returns and exemption application?
    13
    Yes
     
    Website addressbulletN/A
    14
    The books are in care ofbulletAmerican Research & Management Telephone no.bullet (508) 748-1611
    Located atbullet145 Front StreetMarionMA ZIP+4bullet02738
    15
    Section 4947(a)(1) nonexempt charitable trusts filing Form 990-PF in lieu of Form 1041.........bullet
    and enter the amount of tax-exempt interest received or accrued during the year ......bullet
    15  
    16
    At any time during calendar year 2012, did the foundation have an interest in or a signature or other authority over
    a bank, securities, or other financial account in a foreign country? .................
    16
     
    No
    See instructions for exceptions and filing requirements for Form TD F 90-22.1. If "Yes", enter the name of the foreign country bullet  
    Form 990-PF (2012)
    Form 990-PF (2012)
    Page 5
    Part VII-B
    Statements Regarding Activities for Which Form 4720 May Be Required
    File Form 4720 if any item is checked in the “Yes” column, unless an exception applies.
    Yes
    No
    1a
    During the year did the foundation (either directly or indirectly):
    (1) Engage in the sale or exchange, or leasing of property with a disqualified person?
    (2) Borrow money from, lend money to, or otherwise extend credit to (or accept it from)
    a disqualified person?.........................
    (3) Furnish goods, services, or facilities to (or accept them from) a disqualified person?
    (4) Pay compensation to, or pay or reimburse the expenses of, a disqualified person?
    (5) Transfer any income or assets to a disqualified person (or make any of either available
    for the benefit or use of a disqualified person)?.................
    (6) Agree to pay money or property to a government official? (Exception. Check “No”
    if the foundation agreed to make a grant to or to employ the official for a period
    after termination of government service, if terminating within 90 days.).........
    b
    If any answer is “Yes” to 1a(1)–(6), did any of the acts fail to qualify under the exceptions described in Regulations
    section 53.4941(d)-3 or in a current notice regarding disaster assistance (see page 20 of the instructions)?...
    1b
     
    No
    .........bullet
    c
    Did the foundation engage in a prior year in any of the acts described in 1a, other than excepted acts,
    that were not corrected before the first day of the tax year beginning in 2012?.............
    1c
     
    No
    2
    Taxes on failure to distribute income (section 4942) (does not apply for years the foundation was a private
    operating foundation defined in section 4942(j)(3) or 4942(j)(5)):
    a
    At the end of tax year 2012, did the foundation have any undistributed income (lines 6d
    and 6e, Part XIII) for tax year(s) beginning before 2012?...............
    If “Yes,” list the years bullet20, 20, 20, 20
    b
    Are there any years listed in 2a for which the foundation is not applying the provisions of section 4942(a)(2)
    (relating to incorrect valuation of assets) to the year’s undistributed income? (If applying section 4942(a)(2)
    to all years listed, answer “No” and attach statement—see instructions.) ..............
    2b
     
    No
    c
    If the provisions of section 4942(a)(2) are being applied to any of the years listed in 2a, list the years here.
    bullet20, 20, 20, 20
    3a
    Did the foundation hold more than a 2% direct or indirect interest in any business enterprise at
    any time during the year?.........................
    b
    If “Yes,” did it have excess business holdings in 2012 as a result of (1) any purchase by the foundation
    or disqualified persons after May 26, 1969; (2) the lapse of the 5-year period (or longer period approved
    by the Commissioner under section 4943(c)(7)) to dispose of holdings acquired by gift or bequest; or (3)
    the lapse of the 10-, 15-, or 20-year first phase holding period? (Use Schedule C, Form 4720, to determine
    if the foundation had excess business holdings in 2012.)....................
    3b
     
    No
    4a
    Did the foundation invest during the year any amount in a manner that would jeopardize its charitable purposes?
    4a
     
    No
    b
    Did the foundation make any investment in a prior year (but after December 31, 1969) that could jeopardize its
    charitable purpose that had not been removed from jeopardy before the first day of the tax year beginning in 2012?
    4b
     
    No
    5a
    During the year did the foundation pay or incur any amount to:
    (1) Carry on propaganda, or otherwise attempt to influence legislation (section 4945(e))?
    (2) Influence the outcome of any specific public election (see section 4955); or to carry
    on, directly or indirectly, any voter registration drive?...............
    (3) Provide a grant to an individual for travel, study, or other similar purposes?
    (4) Provide a grant to an organization other than a charitable, etc., organization described
    in section 509(a)(1), (2), or (3), or section 4940(d)(2)? (see instructions)........
    (5) Provide for any purpose other than religious, charitable, scientific, literary, or
    educational purposes, or for the prevention of cruelty to children or animals?........
    b
    If any answer is “Yes” to 5a(1)–(5), did any of the transactions fail to qualify under the exceptions described in
    Regulations section 53.4945 or in a current notice regarding disaster assistance (see instructions)? ......
    5b
     
    No
    .........bullet
    c
    If the answer is “Yes” to question 5a(4), does the foundation claim exemption from the
    tax because it maintained expenditure responsibility for the grant?............
    If “Yes,” attach the statement required by Regulations section 53.4945–5(d).
    6a
    Did the foundation, during the year, receive any funds, directly or indirectly, to pay premiums on
    a personal benefit contract?........................
    b
    Did the foundation, during the year, pay premiums, directly or indirectly, on a personal benefit contract?....
    6b
     
    No
    If “Yes” to 6b, file Form 8870.
    7a
    At any time during the tax year, was the foundation a party to a prohibited tax shelter transaction?
    b
    If yes, did the foundation receive any proceeds or have any net income attributable to the transaction? ....
    7b
     
    No
    Form 990-PF (2012)
    Form 990-PF (2012)
    Page 6
    Part VIII
    Information About Officers, Directors, Trustees, Foundation Managers, Highly Paid Employees,
    and Contractors
    1 List all officers, directors, trustees, foundation managers and their compensation (see instructions).
    (a) Name and address (b) Title, and average
    hours per week
    devoted to position     		(c) Compensation
     (If not paid, enter
    -0-)     		(d) Contributions to
    employee benefit plans
    and deferred compensation     		(e) Expense account,
    other allowances
    NANCY VAN SLOUN Director
    0.00     		0    
    30 WEST POINT DRIVE
    TONKA BAY,MN55331
    EVERETT M DAVIS Director
    0.00     		0    
    43 COVE CIRCLE
    MARION,MA02738
    DAVID B TITUS Trustee
    0.00     		0    
    PO Box 1219
    MARION,MA02738
    JOSEPH VAN SLOUN Executive Direc
    10.00     		27,500    
    3527 JIDANA LANE
    MINNETONKA,MN55345
    DENNIS VAN SLOUN Trustee
    0.00     		0    
    17230 CLEAR SPRING LANE
    MINNETONKA,MN55345
    SYLVIA VAN SLOUN Trustee
    0.00     		0    
    SCOTCH PINE LANE
    WESTPORT,MA02791
    NEIL VAN SLOUN Trustee
    0.00     		0    
    SCOTCH PINE LANE
    WESTPORT,MA02791
    2 Compensation of five highest-paid employees (other than those included on line 1—see instructions). If none, enter “NONE.”
    (a) Name and address of each employee paid more than $50,000 (b) Title, and average
    hours per week
    devoted to position     		(c) Compensation (d) Contributions to
    employee benefit
    plans and deferred
    compensation     		(e) Expense account,
    other allowances
    NONE
    Total number of other employees paid over $50,000...................bullet  
    3 Five highest-paid independent contractors for professional services (see instructions). If none, enter "NONE".
    (a) Name and address of each person paid more than $50,000 (b) Type of service (c) Compensation
    NONE
    Total number of others receiving over $50,000 for professional services.............bullet  
    Part IX-A
    Summary of Direct Charitable Activities
    List the foundation’s four largest direct charitable activities during the tax year. Include relevant statistical information such as the number of organizations and other beneficiaries served, conferences convened, research papers produced, etc. Expenses
    1
     
    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
    6,395,008
    b
    Average of monthly cash balances.......................
    1b
    1,683,119
    c
    Fair market value of all other assets (see instructions)................
    1c
    0
    d
    Total (add lines 1a, b, and c).........................
    1d
    8,078,127
    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
    8,078,127
    4
    Cash deemed held for charitable activities. Enter 1 1⁄2% of line 3 (for greater amount, see
    instructions) .............................
    4
    121,172
    5
    Net value of noncharitable-use assets. Subtract line 4 from line 3. Enter here and on Part V, line 4
    5
    7,956,955
    6
    Minimum investment return. Enter 5% of line 5..................
    6
    397,848
    Part XI
    Distributable Amount bullet and do not complete this part.)
    1
    Minimum investment return from Part X, line 6....................
    1
    397,848
    2a
    Tax on investment income for 2012 from Part VI, line 5......
    2a
    4,491
    b
    Income tax for 2012. (This does not include the tax from Part VI.)...
    2b
     
    c
    Add lines 2a and 2b............................
    2c
    4,491
    3
    Distributable amount before adjustments. Subtract line 2c from line 1............
    3
    393,357
    4
    Recoveries of amounts treated as qualifying distributions................
    4
     
    5
    Add lines 3 and 4............................
    5
    393,357
    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
    393,357
    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
    395,656
    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
    395,656
    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
    4,491
    6
    Adjusted qualifying distributions. Subtract line 5 from line 4..............
    6
    391,165
    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 7 393,357
    2 Undistributed income, if any, as of the end of 2012:
    a Enter amount for 2011 only....... 10,894
    b Total for prior years:20, 20, 20  
    3 Excess distributions carryover, if any, to 2012:
    a From 2007.......  
    b From 2008.......  
    c From 2009.......  
    d From 2010.......  
    e From 2011.......  
    fTotal of lines 3a through e.........  
    4Qualifying distributions for 2012 from Part
    XII, line 4: bullet$ 395,656
    a Applied to 2011, but not more than line 2a 10,894
    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..... 384,762
    e Remaining amount distributed out of corpus  
    5 Excess distributions carryover applied to 2012.    
    (If an amount appears in column (d), the
    same amount must be shown in column (a).)
    6Enter the net total of each column as
    indicated below:
    a Corpus. Add lines 3f, 4c, and 4e. Subtract line 5  
    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 ..........     		8,595
    7 Amounts treated as distributions out of
    corpus to satisfy requirements imposed by
    section 170(b)(1)(F) or 4942(g)(3) (see
    instructions) .............     		 
    8Excess distributions carryover from 2007 not
    applied on line 5 or line 7 (see instructions) ...     		 
    9Excess distributions carryover to 2013.
    Subtract lines 7 and 8 from line 6a ......     		 
    10 Analysis of line 9:
    a Excess from 2008....  
    b Excess from 2009....  
    c Excess from 2010....  
    d Excess from 2011....  
    e Excess from 2012....  
    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:
    Neil Van Sloun
    Scotch Pine Lane PO Box 116
    Westport,MA02791
    (508) 636-4573
    bThe form in which applications should be submitted and information and materials they should include:
    Letter requesting funds
    cAny submission deadlines:
    None
    dAny restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other
    factors:
    None
    Form 990-PF (2012)
    Form 990-PF (2012)
    Page 10
    Part XV
    Supplementary Information (continued)
    3 Grants and Contributions Paid During the Year or Approved for Future Payment
    Recipient If recipient is an individual,
    show any relationship to
    any foundation manager
    or substantial contributor
    		 Foundation
    status of
    recipient     		Purpose of grant or
    contribution     		Amount
    Name and address (home or business)
    aPaid during the year
    Faith's Lodge
    4080 West Broadway Suite 212
    Minneapolis,MN55422     		None Public Unrestricted 4,000
    Angela Gildea
    1200 Observatory Drive
    Madison,WI53706     		None PRVT Scholarship 1,000
    Loren Arena
    998 Faunce Corner Road
    North Dartmouth,MA02747     		None PRVT Scholarship 1,000
    Joshua C Conway
    3622 Therese Street
    Wayzata,MN55391     		None PRVT Scholarship 1,000
    Ian Penman
    121 Kennebec
    Orono,ME04469     		None PRVT Scholarship 2,000
    Danielle B Rageotte
    Paul Smiths College PO Box 265
    Paul Smiths,NY12970     		None PRVT Scholarship 1,000
    Watoto Trust
    Schadualistri
    Lenk,SchadaulistriLenk 3775
    SZ     		None PRVT Unrestricted 250
    America's Vet Dogs
    371 East Jericho Turnpike
    Smithtown,NY11787     		None Public Unrestricted 14,000
    Westport Youth Athletic Association
    PO Box 1567
    Westport,MA02790     		None Public Unrestricted 3,000
    The Shwartz Center for Children
    1 Posa Place
    Dartmouth,MA02747     		None Public Unrestricted 4,000
    Camp Sunshine
    35 Acadia Road
    Casco,ME04015     		None Public Unrestricted 9,000
    Guide Dog Foundation for the Blind
    70 Audubon Street
    New Haven,CT06510     		None Public Unrestricted 4,000
    Guiding Eyes for the Blind
    611 Granite Springs Road
    Yorktown Heights,NY10598     		None Public Unrestricted 5,000
    Bentley College
    175 Forest Street
    Waltham,MA02452     		None PRVT Unrestricted 750
    BLITHEWOLD INC
    101 Ferry Road
    Bristol,RI02809     		None Public Unrestricted 10,000
    Dorcas Widows Fund
    574 Prairie Center Drive 135-109
    Eden Prairie,MN55344     		None Public Unrestricted 2,300
    Univ of Minnesota Masonic Cancer Ct
    425 E River Pkwy
    Minneapolis,MN55455     		None Public Unrestricted 8,100
    Star Kids of New Bedford
    PO Box 79198
    Dartmouth,MA02747     		None Public Unrestricted 2,000
    REDWOOD CITY HERITAGE ASSOCIATION
    627 Hamilton Street
    Redwood City,CA94063     		None Public Unrestricted 1,000
    Massachusetts Audubon Society
    208 S Great Road
    Lincoln,MA01773     		None Public Unrestricted 10,000
    Vested Interest in K-9's
    PO Box 9
    East Taunton,MA02718     		None Public Purchase bullet proof vest for police dog 1,031
    Pamela Katten Foundation
    525 W Monroe
    Chicago,IL60661     		None PRVT Unrestricted 500
    Minnesota Landscape Arboretum Found
    3675 Arboretum Drive
    Chaska,MN55318     		None Public Unrestricted 13,500
    The Raptor Center
    1920 Fitch Avenue
    St Paul,MN55108     		None Public Unrestricted 9,000
    Cummings School of VetMedicin
    200 Westboro Road
    North Grafton,MA01536     		NONE Public Unrestricted 10,000
    Trustees University of Pennsylvania
    3451 Walnut Street
    Philadelphia,PA19104     		NONE Public UNRESTRICTED 30,000
    Animal Rescue League of Greater Fal
    474 Durfee Street
    Fall River,MA02720     		NONE Public UNRESTRICTED 35,000
    Westport Land Conservation Trust
    PO Box 3975 830 Drift Rd
    Westport,MA02790     		NONE Public UNRESTRICTED 1,000
    TABOR ACADEMY
    Front Street
    Marion,MA02738     		NONE PRVT UNRESTRICTED 1,250
    BOWDOIN COLLEGE
    5000 South St
    Brunswick,ME04011     		NONE PRVT UNRESTRICTED 1,750
    Student Conservation Association
    689 River Road
    Charlestown,NH03603     		NONE Public UNRESTRICTED 8,000
    Demarest Lloyd Center
    430 Potomska Road
    Dartmouth,MA02748     		NONE Public UNRESTRICTED 5,000
    Fred Hutchinson Cancer Research Cen
    1100 Fairview Ave N
    Seattle,WA98109     		NONE Public UNRESTRICTED 20,000
    Alice Lloyd College
    100 Purpose Road
    Pippa Passes,KY41844     		NONE PRVT UNRESTRICTED 30,600
    Perkins School for the Blind
    175 N Beacon St
    Watertown,MA02472     		NONE Public UNRESTRICTED 8,000
    FRIENDS ACADEMY
    1088 Tucker Road
    North Dartmouth,MA02747     		NONE Public Remedial Reading Program 7,000
    NEADS
    305 Redemption Rock Trail
    Princeton,MA01541     		NONE Public UNRESTRICTED 5,000
    Friends Academy Girls Sports Progra
    1088 Tucker Road
    North Dartmouth,MA02747     		NONE Public UNRESTRICTED 7,000
    FRONTIER NURSING
    195 School Street
    Hyden,KY41749     		NONE PRVT UNRESTRICTED 10,000
    Westport River Watershed Alliance
    1151 Main Road
    Westport,MA02790     		NONE Public UNRESTRICTED 10,000
    BEREA COLLEGE
    101 Chestnut Street
    Berea,KY40403     		NONE PRVT UNRESTRICTED 10,000
    CONNECTICUT COLLEGE
    270 Mohegan Ave
    New London,CT06320     		NONE Public Ann C Wheeler Endowment 1,000
    MONTANA STATE UNIVERSITY FND
    PO Box 173150
    Bozeman,MT59717     		NONE PRVT Horticultural Department 4,000
    Rails To Trails Conservancy
    2121 Ward Court NW 5th Floor
    Washington,DC20037     		NONE Public UNRESTRICTED 1,000
    MORRIS ANIMAL FOUNDATION
    10200 East Girard Suite B 430
    Denver,CO80231     		NONE Public UNRESTRICTED 30,000
    DUCKS UNLIMITED
    One Waterfowl Way
    Memphis,TN38120     		NONE Public UNRESTRICTED 15,000
    Westport Fishermen's Association
    PO Box 83
    Westport Point,MA02791     		NONE PRVT UNRESTRICTED 5,000
    Alyssa Fuhrman
    106 Pleasant ST SE
    Minneapolis,MN55455     		NONE PRVT Scholarship 1,000
    Jennifer Renauld
    10 Gray Oaks Drive
    East Freetown,MA02717     		NONE PRVT Scholarship 1,000
    Nathaniel Hitt
    115 Wentz Hall 1515 Pine St
    La Crosse,WI54601     		NONE PRVT Scholarship 1,000
    Benjamin Williams
    UMC PO Box 1466
    Crookston,MN56716     		NONE PRVT Scholarship 1,000
    Kathryn Narem
    638 State St Apt 303
    Madison,WI53703     		NONE PRVT Scholarship 1,000
    Total .................................bullet 3a 368,031
    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....     14 177,345  
    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     18 221,349  
    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)..   398,694  
    13Total. Add line 12, columns (b), (d), and (e)..................
    13398,694
    (See worksheet in line 13 instructions to verify calculations.)
    Part XVI-B
    Relationship of Activities to the Accomplishment of Exempt Purposes
    Line No.
    DownArrow     		Explain below how each activity for which income is reported in column (e) of Part XVI-A contributed importantly to
    the accomplishment of the foundation’s exempt purposes (other than by providing funds for such purposes). (See
    instructions.)
    Form 990-PF (2012)
    Form 990-PF (2012)
    Page 12
    Part XVII
    Information Regarding Transfers To and Transactions and Relationships With Noncharitable Exempt Organizations
    1
    Did the organization directly or indirectly engage in any of the following with any other organization described in section
    Yes
    No
    501(c) of the Code (other than section 501(c)(3) organizations) or in section 527, relating to political organizations?
    a
    Transfers from the reporting foundation to a noncharitable exempt organization of:
    (1) Cash...................................
    1a(1)
     
    No
    (2) Other assets.................................
    1a(2)
     
    No
    b
    Other transactions:
    (1) Sales of assets to a noncharitable exempt organization....................
    1b(1)
     
    No
    (2) Purchases of assets from a noncharitable exempt organization..................
    1b(2)
     
    No
    (3) Rental of facilities, equipment, or other assets.......................
    1b(3)
     
    No
    (4) Reimbursement arrangements...........................
    1b(4)
     
    No
    (5) Loans or loan guarantees.............................
    1b(5)
     
    No
    (6) Performance of services or membership or fundraising solicitations................
    1b(6)
     
    No
    c
    Sharing of facilities, equipment, mailing lists, other assets, or paid employees..............
    1c
     
    No
    d
    If the answer to any of the above is “Yes,” complete the following schedule. Column (b) should always show the fair market value
    of the goods, other assets, or services given by the reporting foundation. If the foundation received less than fair market value
    in any transaction or sharing arrangement, show in column (d) the value of the goods, other assets, or services received.
    (a) Line No. (b) Amount involved (c) Name of noncharitable exempt organization (d) Description of transfers, transactions, and sharing arrangements
    2a
    Is the foundation directly or indirectly affiliated with, or related to, one or more tax-exempt organizations
    described in section 501(c) of the Code (other than section 501(c)(3)) or in section 527?...........
    b
    If “Yes,” complete the following schedule.
    (a) Name of organization (b) Type of organization (c) Description of relationship
    Sign Here
    Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than taxpayer or fiduciary) is based on all information of which preparer has any knowledge.
    Bullet Bullet
    May the IRS discuss this return
    with the preparer shown below
    (see instr.)?
    Signature of officer or trustee Date Title
    Paid Preparer Use Only Print/Type preparer's name Preparer's Signature Date PTIN
    Firm's namebullet



    Firm's addressbullet







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


    Software ID: 12000229
    Software Version: 2012v2.0


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

    04-6691809
    Organization type (check one):
    Filers of:
    Section:
    Form 990 or 990-EZ





    Form 990-PF




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

    Schedule B (Form 990, 990-EZ, or 990-PF) (2012)
    Page 2
    Name of organization
    Van Sloun Foundation
          		Employer identification number

    04-6691809
    Part I
    Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
    		     
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Total contributions    		 (d)
    Type of contribution
    1
     
     

    Mr Mrs Neil J Van Sloun    
    SCOTCH PINE LANE
       
    WESTPORT, MA   02791

    		$200,000


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

         
     
       

    		$  


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

         
     
       

    		$  


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

         
     
       

    		$  


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

         
     
       

    		$  


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

         
     
       

    		$  


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

    Schedule B (Form 990, 990-EZ, or 990-PF) (2012)
    Page 3
    Name of organization
    Van Sloun Foundation
          		Employer identification number

    04-6691809
    Part II
    Noncash Property (see instructions). Use duplicate copies of Part II if additional space is needed.
    		     
    (a) No.
    from
    Part I    		 (b)
    Description of noncash property given    		 (c)
    FMV (or estimate)
    (see instructions)     		(d)
    Date received
     
    		$    
    (a) No.
    from
    Part I    		 (b)
    Description of noncash property given    		 (c)
    FMV (or estimate)
    (see instructions)     		(d)
    Date received
     
    		$    
    (a) No.
    from
    Part I    		 (b)
    Description of noncash property given    		 (c)
    FMV (or estimate)
    (see instructions)     		(d)
    Date received
     
    		$    
    (a) No.
    from
    Part I    		 (b)
    Description of noncash property given    		 (c)
    FMV (or estimate)
    (see instructions)     		(d)
    Date received
     
    		$    
    (a) No.
    from
    Part I    		 (b)
    Description of noncash property given    		 (c)
    FMV (or estimate)
    (see instructions)     		(d)
    Date received
     
    		$    
    (a) No.
    from
    Part I    		 (b)
    Description of noncash property given    		 (c)
    FMV (or estimate)
    (see instructions)     		(d)
    Date received
     
    		$    
    Schedule B (Form 990, 990-EZ, or 990-PF) (2012)

    Schedule B (Form 990, 990-EZ, or 990-PF) (2012)
    Page 4
    Name of organization
    Van Sloun Foundation
          		Employer identification number

    04-6691809
    Part III
    Exclusively religious, charitable, etc., individual contributions to section 501(c)(7), (8), or (10) organizations
    that total more than $1,000 for the year. Complete columns (a) through (e) and the following line entry.
    For organizations completing Part III, enter the total of exclusively religious, charitable, etc.,
    contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet$  
    Use duplicate copies of Part III if additional space is needed.
    (a) No.
    from
    Part I    		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
     
    (e) Transfer of gift
    Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
     
     
           
     
    (a) No.
    from
    Part I    		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
     
    (e) Transfer of gift
    Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
     
     
           
     
    (a) No.
    from
    Part I    		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
     
    (e) Transfer of gift
    Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
     
     
           
     
    (a) No.
    from
    Part I    		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
     
    (e) Transfer of gift
    Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
     
     
           
     
    Schedule B (Form 990, 990-EZ, or 990-PF) (2012)

    Additional Data


    Software ID: 12000229
    Software Version: 2012v2.0

    TY 2012 AccountingFeesSchedule
    Name:
    Van Sloun Foundation
    EIN: 04-6691809
    Software ID:12000229
    Software Version:2012v2.0
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    Benoit & McArdle 2,550 2,550 2,550 0

    TY 2012 InvestmentsCorpStockSchedule
    Name:
    Van Sloun Foundation
    EIN: 04-6691809
    Software ID:12000229
    Software Version:2012v2.0
    Name of Stock End of Year Book Value End of Year Fair Market Value
    Vanguard St Inv Grade Investor 497,702 497,702
    Vanguard Interm-Ter Inv-Grade 491,429 491,429
    Dodge & Cox Income Fund 497,131 497,131
    Wells Fargo Pref Stock 134,940 134,940
    The Charles Schwab Corp 57,440 57,440
    Portfolio Recovery Associates 106,860 106,860
    Mosaic Co    
    E I du Pont de Nemours 89,957 89,957
    Deere and Company 129,630 129,630
    Royal Dutch Shell 106,335 106,335
    Northern Oil and Gas 50,460 50,460
    US Bancorp 36,348 36,348
    Leucadia National 118,950 118,950
    Jeffries Group 55,710 55,710
    Expeditors Intl Wash 75,145 75,145
    Private Bancorp 50,700 50,700
    Nestle S A ADR 97,755 97,755
    Safeguard Scientifics 73,750 73,750
    EMC 75,900 75,900
    Potash Corp of Saskatchewan    
    Imperial Oil 116,100 116,100
    Cenovus Energy 204,594 204,594
    USB Capital VII    
    Philip Morris International 167,280 167,280
    JP Morgan Chase 102,080 102,080
    Goldman Sachs 100,600 100,600
    First Potomac Realty 74,160 74,160
    Altria Corp 172,920 172,920
    Stryker Corp 93,194 93,194
    KEWEENAU LAND ASSN LTD 45,042 45,042
    REALTY INCOME CORP. 120,630 120,630
    J G BOSWELL 183,825 183,825
    WATERS CORPORATION 148,104 148,104
    Occidental Pete 80,441 80,441
    Illinois Toolworks 121,620 121,620
    Chevron Texaco 194,652 194,652
    John Wiley Class A 89,539 89,539
    Glacier Bancorp 117,680 117,680
    Adobe Systems 75,360 75,360
    EXXON MOBIL 155,790 155,790
    NOVARTIS AG SPONSORED ADR 113,940 113,940
    TransCanada 165,620 165,620
    Church & Dwight 267,850 267,850
    Automatic Data Processing 96,781 96,781
    PLUM CREEK TIMBER CO 88,740 88,740
    ENCANA 142,272 142,272
    PEPSICO 136,860 136,860
    GENERAL ELECTRIC 146,930 146,930
    DOVER 197,130 197,130
    PROCTER & GAMBLE 101,835 101,835
    FISERV 150,157 150,157
    MERCK 61,410 61,410
    JOHNSON & JOHNSON 140,200 140,200
    ANALOG DEVICES 147,208 147,208

    TY 2012 InvestmentsGovtObligationsSch
    Name:
    Van Sloun Foundation
    EIN: 04-6691809
    Software ID:12000229
    Software Version:2012v2.0
    US Government Securities - End of Year Book Value:

    253,042
    US Government Securities - End of Year Fair Market Value:

    253,042
    State & Local Government Securities - End of Year Book Value:


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


     


    TY 2012 OtherExpensesSchedule
    Name:
    Van Sloun Foundation
    EIN: 04-6691809
    Software ID:12000229
    Software Version:2012v2.0
    Description Revenue and Expenses per Books Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    Insurance 750      
    Dues 695      


    TY 2012 OtherProfessionalFeesSchedule
    Name:
    Van Sloun Foundation
    EIN: 04-6691809
    Software ID:12000229
    Software Version:2012v2.0
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    American Research & Management 33,805 33,805 33,805 0


    TY 2012 TaxesSchedule
    Name:
    Van Sloun Foundation
    EIN: 04-6691809
    Software ID:12000229
    Software Version:2012v2.0
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    Foreign taxes 5,820 5,820    
    Federal excise taxes 3,991      
    Commonwealth of Massachusetts 125     125