Form990-PF
Click to see list of attachments

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
HAYSWOOD FOUNDATION INC
 

Number and street (or P.O. box number if mail is not delivered to street address)1 WEST MCDONALD PARKWAY   Room/suite
City or town, state, and ZIP code
MAYSVILLE, KY41056
A Employer identification number

23-7345996
B Telephone number (see instructions)

(606) 563-9333
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$7,961,583J 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) 14,706
2 Check bullet
3 Interest on savings and temporary cash investments 28,459 28,459 28,459
4 Dividends and interest from securities...... 160,091 160,091 160,091
5a Gross rents..............      
b Net rental income or (loss)  
6a Net gain or (loss) from sale of assets not on line 10 126,280
b Gross sales price for all assets on line 6a 3,669,150
7 Capital gain net income (from Part IV, line 2)... 126,280
8 Net short-term capital gain......... 6,121
9 Income modifications...........  
10a Gross sales less returns and allowances  
b Less: Cost of goods sold....  
c Gross profit or (loss) (attach schedule).....    
11 Other income (attach schedule)....... Click to see attachment 1,047 1,047  
12 Total. Add lines 1 through 11........ 330,583 315,877 194,671
Operating and Administrative Expenses 13 Compensation of officers, directors, trustees, etc. 22,620   4,524 18,096
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 4,420   4,420  
c Other professional fees (attach schedule).... Click to see attachment 47,956 47,956    
17 Interest...............        
18 Taxes (attach schedule) (see instructions) Click to see attachment 9,830   8,328 1,502
19 Depreciation (attach schedule) and depletion...      
20 Occupancy.............. 11,625   2,325 9,300
21 Travel, conferences, and meetings.......        
22 Printing and publications..........        
23 Other expenses (attach schedule)....... Click to see list of attachments 9,238   1,848 7,390
24 Total operating and administrative expenses.
Add lines 13 through 23.......... 105,689 47,956 21,445 36,288
25 Contributions, gifts, grants paid........ 318,723 318,723
26 Total expenses and disbursements. Add lines 24 and 25 424,412 47,956 21,445 355,011
27 Subtract line 26 from line 12:
a Excess of revenue over expenses and disbursements -93,829
b Net investment income (if negative, enter -0-) 267,921
c Adjusted net income (if negative, enter -0-)... 173,226
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 Savings and temporary cash investments.......... 125,928 286,659 286,659
3 Accounts receivable bullet  
Less: allowance for doubtful accounts bullet        
4 Pledges receivable bullet  
Less: allowance for doubtful accounts bullet        
5 Grants receivable.................      
6 Receivables due from officers, directors, trustees, and other
disqualified persons (attach schedule) (see page 15 of the
instructions)....................      
7 Other notes and loans receivable (attach schedule) bullet  
Less: allowance for doubtful accounts bullet        
8 Inventories for sale or use...............      
9 Prepaid expenses and deferred charges...........      
10a Investments—U.S. and state government obligations (attach schedule) 437,462 286,166 302,240
b Investments—corporate stock (attach schedule)........ 5,159,025 4,895,609 5,617,237
c Investments—corporate bonds (attach schedule)........ 1,520,005 1,680,201 1,755,447
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 bullet21,189
Less: accumulated depreciation (attach schedule) bullet21,189 19,921    
15 Other assets (describe bullet)      
16 Total assets (to be completed by all filers—see the
instructions. Also, see page 1, item I) 7,262,341 7,148,635 7,961,583
Liabilities 17 Accounts payable and accrued expenses.......... 1,551 1,597
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).......... 1,551 1,597
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 7,260,790 7,147,038
30 Total net assets or fund balances (see page 17 of the
instructions).................... 7,260,790 7,147,038
31 Total liabilities and net assets/fund balances (see page 17 of
the instructions).................. 7,262,341 7,148,635
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 7,260,790
2 Enter amount from Part I, line 27a..................... 2 -93,829
3 Other increases not included in line 2 (itemize) bullet 3  
4 Add lines 1, 2, and 3.......................... 4 7,166,961
5 Decreases not included in line 2 (itemize) bulletClick to see attachment 5 19,923
6 Total net assets or fund balances at end of year (line 4 minus line 5)—Part II, column (b), line 30. 6 7,147,038
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        
b Capital Gain Dividends      
c T ROWE PRICE EQUITY P 2001-01-01 2012-01-11
d SPDR DJ WILSHIRE P 2001-01-01 2012-01-13
e SCOUT INTL FUND P 2001-01-01 2012-01-11
PIONEER FUND P 2001-01-01 2012-01-11
NUVEEN REAL ESTATE P 2001-01-01 2012-11-21
ISHARES MSCI P 2001-01-01 2012-01-13
IPATH DOW JONES P 2001-01-01 2012-11-26
ISHARES MSCI P 2001-01-01 2012-05-22
ISHARES MSCI P 2001-01-01 2012-01-13
AMERICAN GRW FD P 2001-01-01 2012-01-11
AMERICAN EUROPACIFIC P 2001-01-01 2012-04-05
NUVEEN HIGH INCOME P 2001-01-01 2012-11-21
NUVEEN HIGH INCOME P 2001-01-01 2012-01-11
FHLMC MTN P 2001-01-01 2012-01-11
CREDIT SUISSE COMM P 2001-01-01 2012-01-11
AMERICAN CENTY INTL BOND FD P 2001-01-01 2012-01-11
1247 TYCO P 2007-10-01 2012-08-17
300 WATERS CORP COM P 2005-06-21 2012-04-09
400 US BANCORP P 2008-05-07 2012-07-16
200 TJX COS INC P 2010-12-28 2012-07-16
25000 PEPSICO P 2008-04-28 2012-05-15
425 PEPSICO P 2005-06-21 2012-07-31
25000 IBM P 2005-11-02 2012-11-29
495 HOME DEPOT P 2005-06-21 2012-07-16
25000 GENERAL ELECTRIC P 2005-06-27 2012-06-15
50000 FEDERAL NATL MTG ASSN P 2005-06-22 2012-09-15
663.122 AMERICAN EUROPACIFIC P 2010-10-26 2012-11-26
200 CVS P 2009-02-02 2012-07-16
350 3M CO COM P 2011-10-06 2012-07-31
(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       72,550
b        
c 379,965   325,940 54,025
d 179,395   215,223 -35,828
e 396,464   409,338 -12,874
472,230   495,523 -23,293
44,355   39,053 5,302
30,138   26,657 3,481
39,526   40,519 -993
242,391   271,910 -29,519
131,732   154,750 -23,018
647,369   566,094 81,275
103,277   95,025 8,252
11,221   11,141 80
3,078   3,289 -211
102,566   100,415 2,151
287,048   321,860 -34,812
155,989   155,547 442
71,253   56,475 14,778
27,016   11,862 15,154
13,092   13,528 -436
8,966   4,444 4,522
25,000   26,195 -1,195
30,901   21,797 9,104
25,000   24,699 301
25,373   19,647 5,726
25,000   24,801 199
50,000   50,881 -881
26,691   25,000 1,691
9,536   5,350 4,186
32,028   25,907 6,121
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       54,025
d       -35,828
e       -12,874
      -23,293
      5,302
      3,481
      -993
      -29,519
      -23,018
      81,275
      8,252
      80
      -211
      2,151
      -34,812
      442
      14,778
      15,154
      -436
      4,522
      -1,195
      9,104
      301
      5,726
      199
      -881
      1,691
      4,186
      6,121
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 2 126,280
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 6,121
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      
2010      
2009      
2008      
2007      
2 Total of line 1, column (d) ...................... 2  
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  
4 Enter the net value of noncharitable-use assets for 2012 from Part X, line 5..... 4  
5 Multiply line 4 by line 3....................... 5  
6 Enter 1% of net investment income (1% of Part I, line 27b)........... 6  
7 Add lines 5 and 6......................... 7  
8 Enter qualifying distributions from Part XII, line 4.............. 8  
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 5,358
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 5,358
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 5,358
6 Credits/Payments:
a 2012 estimated tax payments and 2011 overpayment credited to 2012 6a 6,400
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 6,400
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  
10 Overpayment. If line 7 is more than the total of lines 5 and 8, enter the amount overpaid...Bullet 10 1,042
11 Enter the amount of line 10 to be: Credited to 2013 estimated taxBullet1,042 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)
    bulletKY
    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 ofbulletANDERSON JONES CPAs PSC Telephone no.bullet (606) 564-6260
    Located atbullet1 WEST MCDONALD PKWY MAYSVILLE KYMAYSVILLEKY ZIP+4bullet41056
    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
    C J HUNTER IV Director
    0.00     		0    
    PO BOX 203
    WASHINGTON,KY41096
    LLOYD SCHILTZ Executive Direc
    25.00     		0    
    ONE W MCDONALD PKWY
    MAYSVILLE,KY41056
    RONALD RICE Vice President
    0.00     		0    
    8020 MARSHALL DRIVE
    MAYSVILLE,KY41056
    ROBERT ROSS Director
    0.00     		0    
    660 BUFFALO TRACE
    MAYSVILLE,KY41056
    JOHN R HUTCHINGS Director
    0.00     		0    
    PO BOX 86
    MAYSLICK,KY41055
    DEBRA WALLINGFORD Director
    0.00     		0    
    2 RIVER RIDGE
    MAYSVILLE,KY41056
    DAVE WALLINGFORD President
    0.00     		0    
    938 JERSEY RIDGE ROAD
    MAYSVILLE,KY41056
    DOUGLAS HENDRICKSON Director
    0.00     		0    
    180 EDGEMONT ROAD
    MAYSVILLE,KY41056
    ANN TOMLIN Director
    0.00     		0    
    289 SHANNON LANE
    MAYSVILLE,KY41056
    KIRK TOLLE Director
    0.00     		0    
    658 HILLCREST ROAD
    MAYSVILLE,KY41056
    WARREN MARKWELL Treasurer
    0.00     		0    
    220 EDGEMONT ROAD
    MAYSVILLE,KY41056
    JOHN G PARKER Director
    0.00     		0    
    41 HACKETT RIDGE
    BROOKSVILLE,KY41004
    WILLIAM C MCNEILL Director
    0.00     		0    
    140 W MAPLE LEAF
    MAYSVILLE,KY41056
    MICHAEL CLARKE Secretary
    0.00     		0    
    119 SUTTON STREET
    MAYSVILLE,KY41056
    DAVID CLARKE Director
    0.00     		0    
    309 WADSWORTH DRIVE
    MAYSVILLE,KY41056
    JOHN MCDOWELL Director
    0.00     		0    
    377 EDGEMONT ROAD
    MAYSVILLE,KY41056
    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 DONATIONS TO LOCAL CHARITIES 194,613
    2 SCHOLARSHIPS 124,110
    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
    7,737,824
    b
    Average of monthly cash balances.......................
    1b
    187,081
    c
    Fair market value of all other assets (see instructions)................
    1c
    0
    d
    Total (add lines 1a, b, and c).........................
    1d
    7,924,905
    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
    7,924,905
    4
    Cash deemed held for charitable activities. Enter 1 1⁄2% of line 3 (for greater amount, see
    instructions) .............................
    4
    118,874
    5
    Net value of noncharitable-use assets. Subtract line 4 from line 3. Enter here and on Part V, line 4
    5
    7,806,031
    6
    Minimum investment return. Enter 5% of line 5..................
    6
    390,302
    Part XI
    Distributable Amount bullet and do not complete this part.)
    1
    Minimum investment return from Part X, line 6....................
    1
    390,302
    2a
    Tax on investment income for 2012 from Part VI, line 5......
    2a
    5,358
    b
    Income tax for 2012. (This does not include the tax from Part VI.)...
    2b
     
    c
    Add lines 2a and 2b............................
    2c
    5,358
    3
    Distributable amount before adjustments. Subtract line 2c from line 1............
    3
    384,944
    4
    Recoveries of amounts treated as qualifying distributions................
    4
     
    5
    Add lines 3 and 4............................
    5
    384,944
    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
    384,944
    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
    355,011
    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
    355,011
    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
     
    6
    Adjusted qualifying distributions. Subtract line 5 from line 4..............
    6
    355,011
    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 7 384,944
    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....... 12,095
    b From 2008....... 145,103
    c From 2009....... 26,526
    d From 2010.......  
    e From 2011.......  
    fTotal of lines 3a through e......... 183,724
    4Qualifying distributions for 2012 from Part
    XII, line 4: bullet$ 355,011
    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..... 355,011
    e Remaining amount distributed out of corpus  
    5 Excess distributions carryover applied to 2012. 29,933 29,933
    (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 5 153,791
    b Prior years’ undistributed income. Subtract
    line 4b from line 2b ...........     		 
    c Enter the amount of prior years’ undistributed
    income for which a notice of deficiency has
    been issued, or on which the section 4942(a)
    tax has been previously assessed......     		 
    d Subtract line 6c from line 6b. Taxable amount
    —see instructions ...........     		 
    e Undistributed income for 2011. Subtract line
    4a from line 2a. Taxable amount—see
    instructions .............     		 
    f Undistributed income for 2012. Subtract
    lines 4d and 5 from line 1. This amount must
    be distributed in 2013 ..........     		0
    7 Amounts treated as distributions out of
    corpus to satisfy requirements imposed by
    section 170(b)(1)(F) or 4942(g)(3) (see
    instructions) .............     		 
    8Excess distributions carryover from 2007 not
    applied on line 5 or line 7 (see instructions) ...     		 
    9Excess distributions carryover to 2013.
    Subtract lines 7 and 8 from line 6a ......     		153,791
    10 Analysis of line 9:
    a Excess from 2008.... 127,265
    b Excess from 2009.... 26,526
    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:
    HAYSWOOD FOUNDTION INC
    ONE W MCDONALD PKWY SUITE 3A
    MAYSVILLE,KY41056
    (606) 563-9333
    bThe form in which applications should be submitted and information and materials they should include:
    REQUEST BY CALLING THE OFFICE AT (606) 563-9333.
    cAny submission deadlines:
    APRIL 25TH
    dAny restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other
    factors:
    APPLICANT MUST BE A CURRENT OR PAST MEMBER OF THE GRADUATING CLASS OF BRACKEN COUNTY HIGH SCHOOL. FIRST-TIME RECIPIENTS WILL BE SELECTED FROM THE CURRENT HIGH SCHOOL GRADUATING CLASS. APPLICANT MUST BE PLANNING TO ATTEND UNDERGRADUATE COLLEGE OR UNIVERSITY WITHIN KY. THE SELECTION PROCESS IS BASED ON FINANCIAL NEED, ACADEMICS AND EXTRA-CURRICULAR ACTIVITIES.
    aThe name, address, and telephone number or e-mail of the person to whom applications should be addressed:
    HAYSWOOD FOUNDATION INC
    ONE W MCDONALD PKWY SUITE 3A
    MAYSVILLE,KY41056
    (606) 563-9333
    bThe form in which applications should be submitted and information and materials they should include:
    REQUEST BY CALLING THE OFFICE AT (606) 563-9333.
    cAny submission deadlines:
    APRIL 26TH
    dAny restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other
    factors:
    TO BE ELIGIBLE, APPLICANTS MUST HAVE GRADUATED FROM ST PATRICK'S OR MASON COUNTY HIGH SCHOOL. THE SELECTION PROCESS IS BASED ON FINANCIAL NEED, ACADEMICS AND EXTRA-CURRICULAR ACTIVITIES. HIGH SCHOOL APPLICANTS MUST HAVE A 2.5 CUMULATIVE GRADE POINT AVERAGE OR BETTER TO BE CONSIDERED.
    aThe name, address, and telephone number or e-mail of the person to whom applications should be addressed:
    HAYSWOOD FOUNDATION INC
    ONE W MCDONALD PKWY SUITE 3A
    MAYSVILLE,KY41056
    (606) 563-9333
    bThe form in which applications should be submitted and information and materials they should include:
    REQUEST BY CALLING THE OFFICE AT (606) 563-9333.
    cAny submission deadlines:
    APRIL 26TH
    dAny restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other
    factors:
    APPLICANTS MUST HAVE GRADUATED FROM AN ACCREDITED HIGH SCHOOL IN MASON COUNTY, KY. THE SELECTION PROCESS IS BASED ON FINANCIAL NEED, ACADEMICS AND EXTRA-CURRICULAR ACTIVITIES. HIGH SCHOOL APPLICANTS MUST HAVE A 3.0 GRADE POINT AVERAGE OR BETTER.
    aThe name, address, and telephone number or e-mail of the person to whom applications should be addressed:
    HAYSWOOD FOUNDATION INC
    ONE W MCDONALD PKWY SUITE 3A
    MAYSVILLE,KY41056
    (606) 563-9333
    bThe form in which applications should be submitted and information and materials they should include:
    REQUEST BY CALLING THE OFFICE AT (606) 563-9333.
    cAny submission deadlines:
    APRIL 26TH
    dAny restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other
    factors:
    APPLICANT OR APPLICANT'S PARENTS MUST HAVE A PRINCIPAL RESIDENCE IN MASON COUNTY. THE SELECTION PROCESS IS BASED ON FINANCIAL NEED, ACADEMICS AND EXTRA-CURRICULAR ACTIVITIES. TO BE CONSIDERED, HIGH SCHOOL STUDENTS MUST HAVE A 3.0 CUMULATIVE GRADE POINT AVERAGE OR BETTER; COLLEGE APPLICANTS MUST HAVE A 2.50 CUMULATIVE GRADE POINT AVERAGE OR BETTER.
    aThe name, address, and telephone number or e-mail of the person to whom applications should be addressed:
    HAYSWOOD FOUNDATION INC
    ONE W MCDONALD PKWY SUITE 3A
    MAYSVILLE,KY41056
    (606) 563-9333
    bThe form in which applications should be submitted and information and materials they should include:
    REQUEST BY CALLING THE OFFICE AT (606) 563-9333.
    cAny submission deadlines:
    APRIL 26TH
    dAny restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other
    factors:
    YOU MUST BE UNDER AGE 25 AT THE TIME OF THE INITIAL APPLICATION. SCHOLARSHIPS ARE NOT AWARDED FOR POST-GRADUATE STUDIES. MUST BE A MEMBER OF THE CURRENT GRADUATING CLASS AT MASON COUNTY HIGH SCHOOL. SCHOLARSHIP MAY BE RENEWED FOR UP TO THREE ADDITIONAL YEARS. APPLICANTS MUST BE PLANNING TO ATTEND AN ACCREDITED US COLLEGE OR UNIVERSITY AS A FULL-TIME STUDENT. SELECTION IS BASED ON ACADEMICS, EXTRA-CURRICULAR ACTIVITIES AND COMMUNITY INVOLVEMENT. APPLICANTS MUST HAVE A WEIGHTED CUMMULATIVE GRADE POINT AVERAGE OF 3.5 OR HIGHER AND AN ACT SCORE OF 25 OR HIGHER TO BE CONSIDERED. RECIPIENTS IN COLLEGE MUST MAINTAIN A GRADE POINT AVERAGE OF 3.0 OR HIGHER TO RETAIN.
    aThe name, address, and telephone number or e-mail of the person to whom applications should be addressed:
    HAYSWOOD FOUNDATION INC
    ONE W MCDONALD PKWY SUITE 3A
    MAYSVILLE,KY41056
    (606) 563-9333
    bThe form in which applications should be submitted and information and materials they should include:
    AVAILABLE BY CONTACTING THE OFFICE AT (606) 563-9333.
    cAny submission deadlines:
    APRIL 26TH
    dAny restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other
    factors:
    THE SELECTION PROCESS IS BASED ON FINANCIAL NEED, ACADEMICS AND EXTRA-CURRICULAR ACTIVITIES. TO BE CONSIDERED, A 2.50 CUMULATIVE GRADE POINT AVERAGE OR BETTER IS REQUIRED.
    aThe name, address, and telephone number or e-mail of the person to whom applications should be addressed:
    HAYSWOOD FOUNDATION
    ONE W MCDONALD PKWY
    MAYSVILLE,KY41056
    (606) 563-9333
    bThe form in which applications should be submitted and information and materials they should include:
    REQUEST BY CALLING THE OFFICE AT (606) 563-9333.
    cAny submission deadlines:
    AUGUST 1ST
    dAny restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other
    factors:
    GRANTS ARE ONLY AWARDED TO ORGANIZATIONS RECOGNIZED BY THE IRS AS ABLE TO RECEIVE TAX-DEDUCTIBLE CONTRIBUTIONS FROM INDIVIDUALS. PREFERENCE IS GIVEN TO THOSE QUALIFYING UNDER SECTION 501(C)(3). GRANTS MAY BE MADE TO NON-PROFIT ORGANIZATIONS IN A SEVEN COUNTY AREA INCLUDING BRACKEN, FLEMING, LEWIS, MASON & ROBERTSON COUNTIES IN KENTUCKY AND ADAMS AND BROWN COUNTIES IN OHIO.
    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
    BOYS AND GIRLS CLUB OF CINCINNATI
    3504 WASHINGTON AVE
    CINCINNATI,OH45203     		NONE 501C3 YOUTH RECREATION - PHYSICAL HEALTH 8,000
    DOWNING PERFORMING ARTS ACADEMY
    116 SUTTON STREET
    MAYSVILLE,KY41056     		NONE 501C3 EDUCATION 2,500
    AMERICAN RED CROSS
    103 E 2ND STREET
    MAYSVILLE,KY41056     		NONE 501C3 COMMUNITY HEALTH/WELFARE 5,000
    KY GATEWAY MUSEUM CENTER
    SUTTON STREET
    MAYSVILLE,KY41056     		NONE 501C3 EDUCATION 10,000
    WOMENS CRISIS CENTER
    111 E 3RD STREET
    MAYSVILLE,KY41056     		NONE 501C3 COMMUNITY HEALTH/WELFARE 8,000
    ST PATRICK SCHOOL
    318 LIMESTONE STREET
    MAYSVILLE,KY41056     		NONE 501C3 EDUCATION 10,000
    BUFFALO TRACE CHILDRENS ADVOCACY
    224 LIMESTONE STREET
    MAYSVILLE,KY41056     		NONE 501C3 PROTECTION OF YOUTH 10,000
    CANCER FIGHTERS UNITED
    4209 US 62
    MAYSVILLE,KY41056     		NONE 501C3 COMMUNITY HEALTH/WELFARE 2,000
    MAYSVILLE MASON CO ARTS COMMISSION
    MAYSVILLE KY
    MAYSVILLE,KY41056     		NONE 501C3 COMMUNITY DEVELOPMENT 2,000
    MANCHESTER YOUTH CENTER
    52
    MANCHESTER,OH45144     		NONE 501C3 YOUTH RECREATION 5,000
    HOSPICE OF HOPE
    KENTON STATION DRIVE
    MAYSVILLE,KY41056     		NONE 501C3 COMMUNITY DEVELOPMENT 25,000
    LICKING VALLEY RCD COUNCIL
    US HWY 68
    MAYSVILLE,KY41056     		NONE 501 C 3 EDUCATION 1,000
    ST AUGUSTINE SCHOOL
    110 E 3RD STREET
    MAYSVILLE,KY41056     		NONE 501 C 3 EDUCATION 8,000
    LICKING VALLEY COLLEGE
    US HWY 68
    MAYSVILLE,KY41056     		NONE 501 C 3 EDUCATION 5,000
    MAYSVILLE INITIATIVES
    600 CLARK ST
    MAYSVILLE,KY41056     		NONE 501 C 3 COMMUNITY DEVELOPMENT 15,000
    CASA PROGRAM
    PO BOX 631
    MAYSVILLE,KY41056     		NONE 501 C 3 PROTECTION OF YOUTH 5,000
    TOM BROWNING BOYS AND GIRLS CLUB
    MAPLE LEAF
    MAYSVILLE,KY41056     		NONE 501 C 3 YOUTH RECREATION 20,000
    MASON CO INTERAGENCY COUNCIL
    US 68
    MAYSVILLE,KY41056     		NONE 501 C 3 COMMUNITY DEVELOPMENT 5,000
    OHIO VALLEY ARTIST GUILD
    ONE W MCDONALD PKWY
    MAYSVILLE,KY41056     		NONE 501 C 3 COMMUNITY DEVELOPMENT 2,000
    MAYSVILLE PLAYERS
    SECOND STREET
    MAYSVILLE,KY41056     		NONE 501 C 3 COMMUNITY ACTIVITIES 26,113
    LIMESTONE FAMILY YMCA
    US 68
    MAYSVILLE,KY41056     		NONE 501 C 3 COMMUNITY DEVELOPMENT 20,000
    DOWNING VARIOUS SCHOLARSHIP PROGRAM
    VARIOUS
    MAYSVILLE,KY41056     		NONE STUDENT EDUCATION 124,110
    Total .................................bullet 3a 318,723
    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         28,459
    4 Dividends and interest from securities....         160,091
    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.....         1,047
    8Gain or (loss) from sales of assets other than inventory         126,280
    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)..     315,877
    13Total. Add line 12, columns (b), (d), and (e)..................
    13315,877
    (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
    HAYSWOOD FOUNDATION INC
     
    Employer identification number

    23-7345996
    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
    HAYSWOOD FOUNDATION INC
          		Employer identification number

    23-7345996
    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
     
     

    KY GATEWAY MUSEUM CENTER    
    215 SUTTON STREET
       
    MAYSVILLE, KY   41056

    		$5,000


    (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
    HAYSWOOD FOUNDATION INC
          		Employer identification number

    23-7345996
    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
    HAYSWOOD FOUNDATION INC
          		Employer identification number

    23-7345996
    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:
    HAYSWOOD FOUNDATION INC
    EIN: 23-7345996
    Software ID:12000229
    Software Version:2012v2.0
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    PROFESSIONAL SERVICES 4,420 0 4,420 0

    TY 2012 LandEtcSchedule2
    Name:
    HAYSWOOD FOUNDATION INC
    EIN: 23-7345996
    Software ID:12000229
    Software Version:2012v2.0
    Category / Item Cost / Other Basis Accumulated Depreciation Book Value End of Year Fair Market Value
    Machinery and Equipment 21,189 21,189    


    TY 2012 OtherDecreasesSchedule
    Name:
    HAYSWOOD FOUNDATION INC
    EIN: 23-7345996
    Software ID:12000229
    Software Version:2012v2.0
    Description Amount
    ROUNDING 1
    PRIOR YEAR DEPR ADJ 19,922


    TY 2012 OtherExpensesSchedule
    Name:
    HAYSWOOD FOUNDATION INC
    EIN: 23-7345996
    Software ID:12000229
    Software Version:2012v2.0
    Description Revenue and Expenses per Books Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    WORKERS COMP INSURANCE 438   88 350
    SUPPLIES 552   110 442
    POSTAGE 200   40 160
    MEETING EXPENSE 883   177 706
    INTERNET ACCESS 263   53 210
    INSURANCE 2,211   442 1,769
    EMPLOYEE HEALTH 4,479   896 3,583
    COPIER MAINTENANCE 212   42 170


    TY 2012 OtherIncomeSchedule2
    Name:
    HAYSWOOD FOUNDATION INC
    EIN: 23-7345996
    Software ID:12000229
    Software Version:2012v2.0
    Description Revenue And Expenses Per Books Net Investment Income Adjusted Net Income
    Other Investment Income 1,047 1,047  


    TY 2012 OtherProfessionalFeesSchedule
    Name:
    HAYSWOOD FOUNDATION INC
    EIN: 23-7345996
    Software ID:12000229
    Software Version:2012v2.0
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    INVESTMENT FEES-US BANK 27,108 27,108 0 0
    INVESTMENT FEE-HILLIARD LYONS 20,848 20,848 0 0


    TY 2012 TaxesSchedule
    Name:
    HAYSWOOD FOUNDATION INC
    EIN: 23-7345996
    Software ID:12000229
    Software Version:2012v2.0
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    TAX AND LICENSE 15   3 12
    PAYROLL TAXES 1,862   372 1,490
    FEDERAL INCOME TAX 7,953   7,953