Form990-PF

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

Number and street (or P.O. box number if mail is not delivered to street address)Foundation Source 501 Silverside Rd   Room/suite
City or town, state, and ZIP code
Wilmington, DE198091377
A Employer identification number

94-3276752
B Telephone number (see instructions)

(800) 839-1754
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$4,634,249J Accounting method:
 
(Part I, column (d) must be on cash basis.)
E bullet
F bullet
Part I Analysis of Revenue and Expenses (The total of amounts in columns (b), (c), and (d) may not necessarily equal the amounts in column (a) (see instructions).) (a) Revenue and
expenses per
books 		(b) Net investment
income 		(c) Adjusted net
income 		(d) Disbursements
for charitable
purposes
(cash basis only)
Revenue 1 Contributions, gifts, grants, etc., received (attach schedule)  
2 Check bullet
3 Interest on savings and temporary cash investments 16 16  
4 Dividends and interest from securities...... 8,360 8,360  
5a Gross rents..............      
b Net rental income or (loss)  
6a Net gain or (loss) from sale of assets not on line 10 Click to see attachment 341,448
b Gross sales price for all assets on line 6a  
7 Capital gain net income (from Part IV, line 2)... 341,448
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)....... Click to see attachment 129,570 129,523  
12 Total. Add lines 1 through 11........ 479,394 479,347  
Operating and Administrative Expenses 13 Compensation of officers, directors, trustees, etc. 24,000     24,000
14 Other employee salaries and wages......        
15 Pension plans, employee benefits.......        
16a Legal fees (attach schedule).........        
b Accounting fees (attach schedule).......        
c Other professional fees (attach schedule).... Click to see attachment 22,844 22,844    
17 Interest...............        
18 Taxes (attach schedule) (see instructions) Click to see attachment 6,544      
19 Depreciation (attach schedule) and depletion...      
20 Occupancy..............        
21 Travel, conferences, and meetings.......        
22 Printing and publications..........        
23 Other expenses (attach schedule)....... Click to see attachment 46,390 12,417   33,973
24 Total operating and administrative expenses.
Add lines 13 through 23.......... 99,778 35,261   57,973
25 Contributions, gifts, grants paid........ 153,500 153,500
26 Total expenses and disbursements. Add lines 24 and 25 253,278 35,261   211,473
27 Subtract line 26 from line 12:
a Excess of revenue over expenses and disbursements 226,116
b Net investment income (if negative, enter -0-) 444,086
c Adjusted net income (if negative, enter -0-)...  
For Paperwork Reduction Act Notice, see instructions.
Cat. No. 11289X Form 990-PF (2012)
Form 990-PF (2012)
Page 2
Part II Balance Sheets Attached schedules and amounts in the description column
should be for end-of-year amounts only. (See instructions.)		 Beginning of year End of year
(a) Book Value (b) Book Value (c) Fair Market Value
Assets 1 Cash—non-interest-bearing...............      
2 Savings and temporary cash investments.......... 111,651 204,059 204,059
3 Accounts receivable bullet  
Less: allowance for doubtful accounts bullet        
4 Pledges receivable bullet  
Less: allowance for doubtful accounts bullet        
5 Grants receivable.................      
6 Receivables due from officers, directors, trustees, and other
disqualified persons (attach schedule) (see page 15 of the
instructions)....................      
7 Other notes and loans receivable (attach schedule) bullet  
Less: allowance for doubtful accounts bullet        
8 Inventories for sale or use...............      
9 Prepaid expenses and deferred charges...........      
10a Investments—U.S. and state government obligations (attach schedule)      
b Investments—corporate stock (attach schedule)........ 114,893 Click to see attachment114,893 203,717
c Investments—corporate bonds (attach schedule)........      
11 Investments—land, buildings, and equipment: basis bullet  
Less: accumulated depreciation (attach schedule) bullet        
12 Investments—mortgage loans..............      
13 Investments—other (attach schedule)........... 3,753,088 Click to see attachment3,886,796 4,226,473
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) 3,979,632 4,205,748 4,634,249
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 3,979,632 4,205,748
30 Total net assets or fund balances (see page 17 of the
instructions).................... 3,979,632 4,205,748
31 Total liabilities and net assets/fund balances (see page 17 of
the instructions).................. 3,979,632 4,205,748
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 3,979,632
2 Enter amount from Part I, line 27a..................... 2 226,116
3 Other increases not included in line 2 (itemize) bullet 3  
4 Add lines 1, 2, and 3.......................... 4 4,205,748
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 4,205,748
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 Passthrough K1 Capital Gain      
b
c
d
e
(e) Gross sales price (f) Depreciation allowed
(or allowable) 		(g) Cost or other basis
plus expense of sale 		(h) Gain or (loss)
(e) plus (f) minus (g)
a       341,448
b
c
d
e
Complete only for assets showing gain in column (h) and owned by the foundation on 12/31/69 (l) Gains (Col. (h) gain minus
col. (k), but not less than -0-) or
Losses (from col.(h))
(i) F.M.V. as of 12/31/69 (j) Adjusted basis
as of 12/31/69 		(k) Excess of col. (i)
over col. (j), if any
a       341,448
b
c
d
e
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 2 341,448
3 Net short-term capital gain or (loss) as defined in sections 1222(5) and (6):
If gain, also enter in Part I, line 8, column (c) (see instructions). If (loss), enter -0-
in Part I, line 8 . . . . . . . . . . . . . . . . 		Bracket 3  
Part V
Qualification Under Section 4940(e) for Reduced Tax on Net Investment Income
(For optional use by domestic private foundations subject to the section 4940(a) tax on net investment income.)

If section 4940(d)(2) applies, leave this part blank.
Was the foundation liable for the section 4942 tax on the distributable amount of any year in the base period?
If “Yes,” the foundation does not qualify under section 4940(e). Do not complete this part.
1 Enter the appropriate amount in each column for each year; see page 18 of the instructions before making any entries.
(a)
Base period years Calendar
year (or tax year beginning in) 		(b)
Adjusted qualifying distributions 		(c)
Net value of noncharitable-use assets 		(d)
Distribution ratio
(col. (b) divided by col. (c))
2011 211,488 4,251,899 000.049740
2010 221,430 4,545,480 000.048714
2009 49,325 3,883,324 000.012702
2008 116,277 3,411,567 000.034083
2007 117,044 5,163,229 000.022669
2 Total of line 1, column (d) ...................... 2 000.167908
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. . . 		3 000.033582
4 Enter the net value of noncharitable-use assets for 2012 from Part X, line 5..... 4 4,485,742
5 Multiply line 4 by line 3....................... 5 150,640
6 Enter 1% of net investment income (1% of Part I, line 27b)........... 6 4,441
7 Add lines 5 and 6......................... 7 155,081
8 Enter qualifying distributions from Part XII, line 4.............. 8 211,473
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 4,441
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 4,441
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 4,441
6 Credits/Payments:
a 2012 estimated tax payments and 2011 overpayment credited to 2012 6a 3,300
b Exempt foreign organizations—tax withheld at source....... 6b
c Tax paid with application for extension of time to file (Form 8868) 6c 3,383
d Backup withholding erroneously withheld ........... 6d  
7 Total credits and payments. Add lines 6a through 6d.............. Tax Paid Original Return: 6683 7 6,683
8 Enter any penalty for underpayment of estimated tax. if Form 2220 is attached. Click to see attachment 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 2,242
11 Enter the amount of line 10 to be: Credited to 2013 estimated taxBullet2,242 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
 
 
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)
    bullet
    b
    If the answer is “Yes” to line 7, has the foundation furnished a copy of Form 990-PF to the Attorney
    General (or designate) of each state as required by General Instruction G? If “No,” attach explanation .
    8b
    Yes
     
    9
    Is the foundation claiming status as a private operating foundation within the meaning of section 4942(j)(3)
    or 4942(j)(5) for calendar year 2012 or the taxable year beginning in 2012 (see instructions for Part XIV)?
    If “Yes,” complete Part XIV.............................
    9
     
    No
    10
    Did any persons become substantial contributors during the tax year? If “Yes,” attach a schedule listing their names and addresses.
    10
     
    No
    11
    At any time during the year, did the foundation, directly or indirectly, own a controlled entity within the
    meaning of section 512(b)(13)? If "Yes," attach schedule. (see instructions) .............
    11
     
    No
    12
    Did the foundation make a distribution to a donor advised fund over which the foundation or a disqualified person had
    advisory privileges? If "Yes," attach statement (see instructions).................
    12
     
    No
    13
    Did the foundation comply with the public inspection requirements for its annual returns and exemption application?
    13
    Yes
     
    Website addressbullet  
    14
    The books are in care ofbulletco Foundation Source Telephone no.bullet (800) 839-1754
    Located atbullet501 Silverside Road Suite 123WilmingtonDE ZIP+4bullet198091377
    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
     
     
    c
    If the provisions of section 4942(a)(2) are being applied to any of the years listed in 2a, list the years here.
    bullet20, 20, 20, 20
    3a
    Did the foundation hold more than a 2% direct or indirect interest in any business enterprise at
    any time during the year?.........................
    b
    If “Yes,” did it have excess business holdings in 2012 as a result of (1) any purchase by the foundation
    or disqualified persons after May 26, 1969; (2) the lapse of the 5-year period (or longer period approved
    by the Commissioner under section 4943(c)(7)) to dispose of holdings acquired by gift or bequest; or (3)
    the lapse of the 10-, 15-, or 20-year first phase holding period? (Use Schedule C, Form 4720, to determine
    if the foundation had excess business holdings in 2012.)....................
    3b
     
     
    4a
    Did the foundation invest during the year any amount in a manner that would jeopardize its charitable purposes?
    4a
     
    No
    b
    Did the foundation make any investment in a prior year (but after December 31, 1969) that could jeopardize its
    charitable purpose that had not been removed from jeopardy before the first day of the tax year beginning in 2012?
    4b
     
    No
    5a
    During the year did the foundation pay or incur any amount to:
    (1) Carry on propaganda, or otherwise attempt to influence legislation (section 4945(e))?
    (2) Influence the outcome of any specific public election (see section 4955); or to carry
    on, directly or indirectly, any voter registration drive?...............
    (3) Provide a grant to an individual for travel, study, or other similar purposes?
    (4) Provide a grant to an organization other than a charitable, etc., organization described
    in section 509(a)(1), (2), or (3), or section 4940(d)(2)? (see instructions)........
    (5) Provide for any purpose other than religious, charitable, scientific, literary, or
    educational purposes, or for the prevention of cruelty to children or animals?........
    b
    If any answer is “Yes” to 5a(1)–(5), did any of the transactions fail to qualify under the exceptions described in
    Regulations section 53.4945 or in a current notice regarding disaster assistance (see instructions)? ......
    5b
     
    No
    .........bullet
    c
    If the answer is “Yes” to question 5a(4), does the foundation claim exemption from the
    tax because it maintained expenditure responsibility for the grant?............
    If “Yes,” attach the statement required by Regulations section 53.4945–5(d).
    6a
    Did the foundation, during the year, receive any funds, directly or indirectly, to pay premiums on
    a personal benefit contract?........................
    b
    Did the foundation, during the year, pay premiums, directly or indirectly, on a personal benefit contract?....
    6b
     
    No
    If “Yes” to 6b, file Form 8870.
    7a
    At any time during the tax year, was the foundation a party to a prohibited tax shelter transaction?
    b
    If yes, did the foundation receive any proceeds or have any net income attributable to the transaction? ....
    7b
     
     
    Form 990-PF (2012)
    Form 990-PF (2012)
    Page 6
    Part VIII
    Information About Officers, Directors, Trustees, Foundation Managers, Highly Paid Employees,
    and Contractors
    1 List all officers, directors, trustees, foundation managers and their compensation (see instructions).
    (a) Name and address (b) Title, and average
    hours per week
    devoted to position     		(c) Compensation
     (If not paid, enter
    -0-)     		(d) Contributions to
    employee benefit plans
    and deferred compensation     		(e) Expense account,
    other allowances
    Natalie Yee Dir / Executive Dir
    006.00     		24,000    
    Foundation Source 501 Silverside Rd
    Wilmington,DE19809
    Phillips Yee Pres / Dir
    002.00     		0    
    Foundation Source 501 Silverside Rd
    Wilmington,DE19809
    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
     
    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
     
    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
    205,923
    b
    Average of monthly cash balances.......................
    1b
    194,825
    c
    Fair market value of all other assets (see instructions)................
    1c
    4,153,305
    d
    Total (add lines 1a, b, and c).........................
    1d
    4,554,053
    e
    Reduction claimed for blockage or other factors reported on lines 1a and
    1c (attach detailed explanation) .............
    1e
     
    2
    Acquisition indebtedness applicable to line 1 assets..................
    2
     
    3
    Subtract line 2 from line 1d.........................
    3
    4,554,053
    4
    Cash deemed held for charitable activities. Enter 1 1⁄2% of line 3 (for greater amount, see
    instructions) Click to see attachment.............................
    4
    68,311
    5
    Net value of noncharitable-use assets. Subtract line 4 from line 3. Enter here and on Part V, line 4
    5
    4,485,742
    6
    Minimum investment return. Enter 5% of line 5..................
    6
    224,287
    Part XI
    Distributable Amount bullet and do not complete this part.)
    1
    Minimum investment return from Part X, line 6....................
    1
    224,287
    2a
    Tax on investment income for 2012 from Part VI, line 5......
    2a
    4,441
    b
    Income tax for 2012. (This does not include the tax from Part VI.)...
    2b
     
    c
    Add lines 2a and 2b............................
    2c
    4,441
    3
    Distributable amount before adjustments. Subtract line 2c from line 1............
    3
    219,846
    4
    Recoveries of amounts treated as qualifying distributions................
    4
     
    5
    Add lines 3 and 4............................
    5
    219,846
    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
    219,846
    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 Click to see attachment..........
    1a
    211,473
    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
    211,473
    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
    4,441
    6
    Adjusted qualifying distributions. Subtract line 5 from line 4..............
    6
    207,032
    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 7 219,846
    2 Undistributed income, if any, as of the end of 2012:
    a Enter amount for 2011 only....... 207,775
    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$ 211,473
    a Applied to 2011, but not more than line 2a 207,775
    b Applied to undistributed income of prior years
    (Election required—see instructions)......     		 
    c Treated as distributions out of corpus (Election
    required—see instructions).........     		 
    d Applied to 2012 distributable amount..... 3,698
    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 ..........     		216,148
    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).)
    NONE
    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 of the person to whom applications should be addressed:
    bThe form in which applications should be submitted and information and materials they should include:
    cAny submission deadlines:
    dAny restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other
    factors:
    Form 990-PF (2012)
    Form 990-PF (2012)
    Page 10
    Part XV
    Supplementary Information (continued)
    3 Grants and Contributions Paid During the Year or Approved for Future Payment
    Recipient If recipient is an individual,
    show any relationship to
    any foundation manager
    or substantial contributor
    		 Foundation
    status of
    recipient     		Purpose of grant or
    contribution     		Amount
    Name and address (home or business)
    aPaid during the year
    A Lujan
    CSU East Bay 25800 Carlos Bee Blvd
    Hayward,CA94542     		NONE N/A Scholarship Grant 2,000
    A Guadalupe Torres
    Sonoma State Univ 1801 E Cotati Ave
    Rohnert Park,CA94928     		NONE N/A Scholarship Grant 1,500
    A Nkhume-Crecy
    Univ of CA Berkeley 101 Sproul Hall
    Berkeley,CA94704     		NONE N/A Scholarship Grant 750
    A Bozok
    San Jose State Univ 1 Washington Sq
    San Jose,CA95112     		NONE N/A Scholarship Grant 750
    A Iqbal
    Menlo College 1000 El Camino Real
    Atherton,CA94027     		NONE N/A Scholarship Grant 2,500
    A Harney
    U of CA Santa Barbara 552 Univ Rd
    Santa Barbara,CA93106     		NONE N/A Scholarship Grant 750
    A Xie
    San Fran State 1600 Holloway Ave
    San Francisco,CA94132     		NONE N/A Scholarship Grant 1,500
    A Li
    U of CA Santa Barbara 552 Univ Rd
    Santa Barbara,CA93106     		NONE N/A Scholarship Grant 750
    A Li
    Univ of CA Berkeley 101 Sproul Hall
    Berkeley,CA94704     		NONE N/A Scholarship Grant 750
    A Phung
    Univ of CA Berkeley 101 Sproul Hall
    Berkeley,CA94704     		NONE N/A Scholarship Grant 2,000
    A Leach
    Sonoma State Univ 1801 E Cotati Ave
    Rohnert Park,CA94928     		NONE N/A Scholarship Grant 750
    A Della
    Cal Poly San Luis Obispo 1 Grnd Ave
    San Luis Obispo,CA93405     		NONE N/A Scholarship Grant 750
    B Kaur
    Univ of CA Los Ang 405 Hilgard Ave
    Los Angeles,CA90095     		NONE N/A Scholarship Grant 750
    B Rapley
    Univ of San Fran 2130 Fulton Street
    San Francisco,CA94117     		NONE N/A Scholarship Grant 750
    B Watts
    San Jose State Univ 1 Washington Sq
    San Jose,CA95112     		NONE N/A Scholarship Grant 750
    B Shiba
    CA State Univ Sacramento 6000 J St
    Sacramento,CA95819     		NONE N/A Scholarship Grant 1,000
    C Liang
    Univ of CA Berkeley 101 Sproul Hall
    Berkeley,CA94704     		NONE N/A Scholarship Grant 750
    C Selva
    University of Arizona
    Tucson,AZ85721     		NONE N/A Scholarship Grant 2,000
    C Martinez
    UC Irvine A138 Student Center
    Irvine,CA92697     		NONE N/A Scholarship Grant 500
    C Garcia
    Santa Clara Univ 500 El Camino Real
    Santa Clara,CA95053     		NONE N/A Scholarship Grant 2,000
    C Gradone
    San Jose State Univ 1 Washington Sq
    San Jose,CA95112     		NONE N/A Scholarship Grant 750
    College Track
    117 Broadway Ave
    Oakland,CA94612     		N/A 509a1 Travel and Expenses of the Nicaragua Trip 2,000
    D Surofchy
    Univ of CA Berkeley 101 Sproul Hall
    Berkeley,CA94704     		NONE N/A Scholarship Grant 2,000
    D Dugan
    Butte Com Colg 3536 Butte Campus Dr
    Oroville,CA95965     		NONE N/A Scholarship Grant 750
    D Gordon
    University of Southern California
    Los Angeles,CA90089     		NONE N/A Scholarship Grant 1,500
    D Green
    San Fran State 1600 Holloway Ave
    San Francisco,CA94132     		NONE N/A Scholarship Grant 2,000
    D Colby
    Univ of CA Berkeley 101 Sproul Hall
    Berkeley,CA94704     		NONE N/A Scholarship Grant 1,000
    E Rojas
    CSU East Bay 25800 Carlos Bee Blvd
    Hayward,CA94542     		NONE N/A Scholarship Grant 500
    E Ruiz
    Univ of CA Davis 1 Shields Ave
    Davis,CA95616     		NONE N/A Scholarship Grant 2,000
    E Roberts
    American Univ 4400 Mass Ave NW
    Washington,DC20016     		NONE N/A Scholarship Grant 1,500
    E Leyva
    St Catherine Univ 2004 Randolph Ave
    St Paul,MN55105     		NONE N/A Scholarship Grant 750
    E Wingler
    Sonoma State Univ 1801 E Cotati Ave
    Rohnert Park,CA94928     		NONE N/A Scholarship Grant 1,000
    E Aguilar
    Holy Names Univ 3500 Mountain Blvd
    Oakland,CA94619     		NONE N/A Scholarship Grant 2,000
    E Skevofilax
    Golden Gate Univ 536 Mission St
    San Francisco,CA94105     		NONE N/A Scholarship Grant 1,500
    F Tan
    Mills College 5000 MacArthur Blvd
    Oakland,CA94613     		NONE N/A Scholarship Grant 2,000
    F Li
    Univ of Pacific 3601 Pacific Ave
    Stockton,CA95211     		NONE N/A Scholarship Grant 1,000
    F Manan
    Univ of CA Berkeley 101 Sproul Hall
    Berkeley,CA94704     		NONE N/A Scholarship Grant 1,000
    F Mael
    Univ of CA Santa Cruz 1156 High St
    Santa Cruz,CA95064     		NONE N/A Scholarship Grant 500
    G Lerma
    Westmont College 955 La Paz Rd
    Santa Barbara,CA93108     		NONE N/A Scholarship Grant 2,000
    G Bolanos
    Sonoma State Univ 1801 E Cotati Ave
    Rohnert Park,CA94928     		NONE N/A Scholarship Grant 750
    G Jung
    Univ of CA Santa Cruz 1156 High St
    Santa Cruz,CA95064     		NONE N/A Scholarship Grant 1,500
    H Gomes
    OR State Univ 1500 SW Jefferson Way
    Corvallis,OR97331     		NONE N/A Scholarship Grant 750
    H Ramirez
    CSU 401 Golden Shore
    Long Beach,CA90802     		NONE N/A Scholarship Grant 1,000
    H McBrooom
    BYU Idaho 525 S Center St
    Rexburg,ID83460     		NONE N/A Scholarship Grant 2,000
    H Zafar
    Woodland Com Colg 2300 E Gibson Rd
    Woodland,CA95776     		NONE N/A Scholarship Grant 500
    H Min Chun
    Univ of CA Berkeley 101 Sproul Hall
    Berkeley,CA94704     		NONE N/A Scholarship Grant 1,000
    I Zafira
    Stanford 450 Serra Mall
    Stanford,CA94305     		NONE N/A Scholarship Grant 2,000
    I Williams
    Sacramento State Univ 6000 J St
    Sacramento,CA95819     		NONE N/A Scholarship Grant 1,500
    I Serrano
    Sacramento State Univ 6000 J St
    Sacramento,CA95819     		NONE N/A Scholarship Grant 750
    J Ayala
    Occidental College 1600 Campus Rd
    Los Angeles,CA90041     		NONE N/A Scholarship Grant 2,000
    J Selfaison
    Brigham Young Univ E Campus Dr
    Provo,UT84604     		NONE N/A Scholarship Grant 2,000
    J Cao
    Univ of CA San Diego 9500 Gilman Dr
    La Jolla,CA92093     		NONE N/A Scholarship Grant 1,500
    J Nunez
    CSU Fresno 5241 N Maple Ave
    Fresno,CA93740     		NONE N/A Scholarship Grant 2,000
    JR Kono
    Stanford University 450 Serra Mall
    Standford,CA94305     		NONE N/A Scholarship Grant 1,000
    J Domich
    Univ of CA Los Ang 405 Hilgard Ave
    Los Angeles,CA90095     		NONE N/A Scholarship Grant 1,500
    J Fang
    Dominican Univ of CA 50 Acacia Ave
    San Rafael,CA94901     		NONE N/A Scholarship Grant 3,000
    J Javier
    U of CA Santa Barbara 552 Univ Rd
    Santa Barbara,CA93106     		NONE N/A Scholarship Grant 1,000
    J Solomon
    U of CA Santa Barbara 552 Univ Rd
    Santa Barbara,CA93106     		NONE N/A Scholarship Grant 1,000
    J Peterson
    San Fran State 1600 Holloway Ave
    San Francisco,CA94132     		NONE N/A Scholarship Grant 1,500
    J Jun Huang
    Univ of CA Berkeley 101 Sproul Hall
    Berkeley,CA94704     		NONE N/A Scholarship Grant 1,000
    J Chen
    Univ of CA Los Ang 405 Hilgard Ave
    Los Angeles,CA90095     		NONE N/A Scholarship Grant 1,500
    J Sutherland
    CSU Long Beach 1250 Bellflower Blvd
    Long Beach,CA90840     		NONE N/A Scholarship Grant 1,000
    J Carlos Torres
    Univ of CA Santa Cruz 1156 High St
    Santa Cruz,CA95064     		NONE N/A Scholarship Grant 1,500
    J Elkington
    Harvard 1350 Massachusetts Ave
    Cambridge,MA02138     		NONE N/A Scholarship Grant 2,000
    K Villegas
    Univ of CA Los Ang 405 Hilgard Ave
    Los Angeles,CA90095     		NONE N/A Scholarship Grant 1,000
    K Vang
    Sacramento State Univ 6000 J St
    Sacramento,CA95819     		NONE N/A Scholarship Grant 1,000
    K Jones
    Cal State Sacramento 6000 J St
    Sacramento,CA95819     		NONE N/A Scholarship Grant 1,500
    K Fuller
    Pepperdine 24255 Pacific Coast Hwy
    Malibu,CA90263     		NONE N/A Scholarship Grant 1,000
    K Mejia-Cuellar
    Univ of CA Berkeley 101 Sproul Hall
    Berkeley,CA94704     		NONE N/A Scholarship Grant 1,000
    L Flipse
    San Fran State 1600 Holloway Ave
    San Francisco,CA94132     		NONE N/A Scholarship Grant 1,500
    L Martinez
    Regis College 235 Wellesley St
    Weston,MA02493     		NONE N/A Scholarship Grant 1,000
    L McGuiness
    Univ of CA Santa Cruz 1156 High St
    Santa Cruz,CA95064     		NONE N/A Scholarship Grant 750
    L Roberts
    Berkeley City Laney 900 Fallon St
    Oakland,CA94607     		NONE N/A Scholarship Grant 1,500
    L Tupfer
    Univ of CA Berkeley 101 Sproul Hall
    Berkeley,CA94704     		NONE N/A Scholarship Grant 1,000
    L Pulido
    Mendocino 1000 Hensley Creek Rd
    Ukiah,CA95482     		NONE N/A Scholarship Grant 1,000
    L Arroyo
    Univ of CA Santa Cruz 1156 High St
    Santa Cruz,CA95064     		NONE N/A Scholarship Grant 750
    L Kitchel
    Univ of CA Santa Cruz 1156 High St
    Santa Cruz,CA95064     		NONE N/A Scholarship Grant 750
    M Xiong
    Univ of CA Berkeley 101 Sproul Hall
    Berkeley,CA94704     		NONE N/A Scholarship Grant 1,000
    M Jay
    Brigham Young Univ E Campus Dr
    Provo,UT84604     		NONE N/A Scholarship Grant 1,500
    M Olivares-Perez
    Biola University 13800 Biola Ave
    La Mirada,CA90639     		NONE N/A Scholarship Grant 2,000
    M Simpson
    Howard University 2400 6th St NW
    Washington,DC20059     		NONE N/A Scholarship Grant 1,500
    M Cardenas
    Univ of CA Berkeley 101 Sproul Hall
    Berkeley,CA94704     		NONE N/A Scholarship Grant 1,000
    Mathematics Engineering Science And Liberal Arts Honors Academy
    Oak Park Sta PO Box 5507
    Sacramento,CA95817     		N/A 509a1 General Unrestricted 5,000
    M Garcia Serrano
    UC Irvine A138 Student Center
    Irvine,CA92697     		NONE N/A Scholarship Grant 750
    M Ceron
    Sierra College 5000 Rocklin Rd
    Rocklin,CA95677     		NONE N/A Scholarship Grant 1,500
    M Carmona
    Univ of CA Merced 5200 N Lake Rd
    Merced,CA95343     		NONE N/A Scholarship Grant 2,500
    M Khan
    Univ of CA San Diego 9500 Gilman Dr
    La Jolla,CA92093     		NONE N/A Scholarship Grant 750
    N Phung
    Univ of CA Merced 5200 N Lake Rd
    Merced,CA95343     		NONE N/A Scholarship Grant 2,000
    N Simon
    Univ of CA Los Ang 405 Hilgard Ave
    Los Angeles,CA90095     		NONE N/A Scholarship Grant 1,500
    N Burrone
    CA Polytech State Univ 1 Grand Ave
    San Luis Obispo,CA93405     		NONE N/A Scholarship Grant 1,000
    N De Leon
    Univ of CA Berkeley 101 Sproul Hall
    Berkeley,CA94704     		NONE N/A Scholarship Grant 1,000
    N Zhang
    UC Merced 5200 Lake Rd
    Merced,CA95340     		NONE N/A Scholarship Grant 500
    O Carter
    Dominican Univ of CA 50 Acacia Ave
    San Rafael,CA94901     		NONE N/A Scholarship Grant 750
    O Monical
    Willamette University 900 State St
    Salem,OR97301     		NONE N/A Scholarship Grant 1,000
    O Urquiza
    Univ of CA Santa Cruz 1156 High St
    Santa Cruz,CA95064     		NONE N/A Scholarship Grant 500
    P Moananu
    San Fran State 1600 Holloway Ave
    San Francisco,CA94132     		NONE N/A Scholarship Grant 1,000
    P Castro
    UC Merced 5200 Lake Rd
    Merced,CA95340     		NONE N/A Scholarship Grant 500
    P Lai
    Univ of CA Berkeley 101 Sproul Hall
    Berkeley,CA94704     		NONE N/A Scholarship Grant 1,500
    P Chhay
    U of CA Santa Barbara 552 Univ Rd
    Santa Barbara,CA93106     		NONE N/A Scholarship Grant 500
    R Martin
    CA Polytech State Univ 1 Grand Ave
    San Luis Obispo,CA93405     		NONE N/A Scholarship Grant 750
    R Taylor
    San Fran State 1600 Holloway Ave
    San Francisco,CA94132     		NONE N/A Scholarship Grant 1,500
    R Sunday
    U of San Fran 2130 Fulton Street
    San Francisco,CA94117     		NONE N/A Scholarship Grant 2,000
    R Yu
    University of Southern California
    Los Angeles,CA90089     		NONE N/A Scholarship Grant 2,000
    S Setungamudali
    U of CA Santa Barbara 552 Univ Rd
    Santa Barbara,CA93106     		NONE N/A Scholarship Grant 750
    S Barber
    Univ of CA Los Ang 405 Hilgard Ave
    Los Angeles,CA90095     		NONE N/A Scholarship Grant 1,000
    S Kaci
    San Fran St Univ 1600 Holloway Ave
    San Francisco,CA94132     		NONE N/A Scholarship Grant 2,000
    S Fridrich
    CA State Univ Chico 400 W First St
    Chico,CA95929     		NONE N/A Scholarship Grant 750
    S Quinn
    University of Hawaii 2600 Campus Rd
    Honolulu,HI96822     		NONE N/A Scholarship Grant 750
    S Zuniga
    Oberlin College 173 W Lorain St
    Oberlin,OH44074     		NONE N/A Scholarship Grant 1,000
    S Wiggins
    Humboldt State Univ 1 Harpst St
    Arcata,CA95521     		NONE N/A Scholarship Grant 1,000
    T El Emmet
    George Mason Univ 4400 Univ Dr
    Fairfax,VA22030     		NONE N/A Scholarship Grant 1,500
    T Brown
    Columbia College 600 S Michigan Ave
    Chicago,IL60605     		NONE N/A Scholarship Grant 1,000
    V Zavala
    Santa Clara Univ 500 El Camino Real
    Santa Clara,CA95053     		NONE N/A Scholarship Grant 2,000
    V Hsieh
    Univ of CA Berkeley 101 Sproul Hall
    Berkeley,CA94704     		NONE N/A Scholarship Grant 2,000
    V Yu
    Univ of CA Berkeley 101 Sproul Hall
    Berkeley,CA94704     		NONE N/A Scholarship Grant 1,500
    V Nguyen
    Univ of CA Santa Cruz 1156 High St
    Santa Cruz,CA95064     		NONE N/A Scholarship Grant 750
    W Ibarra
    CSU Fresno 5241 N Maple Ave
    Fresno,CA93740     		NONE N/A Scholarship Grant 2,000
    Y Xiong
    CA State Univ Chico 400 W First St
    Chico,CA95929     		NONE N/A Scholarship Grant 2,000
    Total .................................bullet 3a 153,500
    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     14 16  
    4 Dividends and interest from securities....     14 8,360  
    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     18 341,448  
    9 Net income or (loss) from special events:          
    10 Gross profit or (loss) from sales of inventory..          
    11 Other revenue: aK-1 Inc/Loss     14 129,570  
    b
    c
    d
    e
    12 Subtotal. Add columns (b), (d), and (e)..   479,394  
    13Total. Add line 12, columns (b), (d), and (e)..................
    13479,394
    (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: 12000057
    Software Version: 12.18.605.2
    Part VI Line 7 - Tax Paid Original Return: 6683


    Form 990PF - Special Condition Description:
    Special Condition Description

    Note: To capture the full content of this document, please select landscape mode (11" x 8.5") when printing.

    TY 2012 GainLossSaleOtherAssetsSch
    Name:
    Don and Roy Splawn Charitable Foundation West Inc
    EIN: 94-3276752
    Software ID:12000057
    Software Version:12.18.605.2
    Name Date Acquired How Acquired Date Sold Purchaser Name Gross Sales Price Basis Basis Method Sales Expenses Total (net) Accumulated Depreciation
    Passthrough K1 Capital Gain                 341,448  

    TY 2012 GeneralExplanationAttachment
    Name:
    Don and Roy Splawn Charitable Foundation West Inc
    EIN: 94-3276752
    Software ID:12000057
    Software Version:12.18.605.2
    Identifier Return Reference Explanation

    TY 2012 InvestmentsCorpStockSchedule
    Name:
    Don and Roy Splawn Charitable Foundation West Inc
    EIN: 94-3276752
    Software ID:12000057
    Software Version:12.18.605.2
    Name of Stock End of Year Book Value End of Year Fair Market Value
    4976 shares of MERCK CO INC 114,893 203,717

    TY 2012 InvestmentsOtherSchedule2
    Name:
    Don and Roy Splawn Charitable Foundation West Inc
    EIN: 94-3276752
    Software ID:12000057
    Software Version:12.18.605.2
    Category/ Item Listed at Cost or FMV Book Value End of Year Fair Market Value
    DTC CORE FIXED INCOME CTF   168,129 184,570
    DTC INTERNATIONAL EQUITY CTF   975,815 1,125,709
    DTC LARGE CAP US EQUITY CTF   706,343 832,526
    DTC SMALL/MID CAP US EQUITY CTF   897,781 883,668
    HERITAGE NY LLC   611,878 643,200
    HERITAGE OHIO LLC   526,850 556,800

    TY 2012 OtherExpensesSchedule
    Name:
    Don and Roy Splawn Charitable Foundation West Inc
    EIN: 94-3276752
    Software ID:12000057
    Software Version:12.18.605.2
    Description Revenue and Expenses per Books Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    Administrative Fees 29,097     29,097
    Bank Charges 32 32    
    Foundation Dues Memberships 695     695
    K-1 Exp DTC CORE FIXED INCOME CTF 437 437    
    K-1 Exp DTC INTERNATIONAL EQUITY CTF 6,826 6,826    
    K-1 Exp DTC LARGE CAP US EQUITY CTF 1,492 1,492    
    K-1 Exp DTC SMALL/MID CAP US EQUITY CTF 3,630 3,630    
    Office Supplies 1,981     1,981
    Premium Payment for Indemnification Insurance 2,200     2,200


    TY 2012 OtherIncomeSchedule2
    Name:
    Don and Roy Splawn Charitable Foundation West Inc
    EIN: 94-3276752
    Software ID:12000057
    Software Version:12.18.605.2
    Description Revenue And Expenses Per Books Net Investment Income Adjusted Net Income
    K-1 Inc/Loss DTC CORE FIXED INCOME CTF 8,053 8,006  
    K-1 Inc/Loss DTC INTERNATIONAL EQUITY CTF 27,254 27,254  
    K-1 Inc/Loss DTC LARGE CAP US EQUITY CTF 19,265 19,265  
    K-1 Inc/Loss DTC SMALL/MID CAP US EQUITY CTF 10,930 10,930  
    K-1 Inc/Loss HERITAGE NY LLC 34,084 34,084  
    K-1 Inc/Loss HERITAGE OHIO LLC 29,984 29,984  


    TY 2012 OtherProfessionalFeesSchedule
    Name:
    Don and Roy Splawn Charitable Foundation West Inc
    EIN: 94-3276752
    Software ID:12000057
    Software Version:12.18.605.2
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    Investment Management Services 22,844 22,844    


    TY 2012 TaxesSchedule
    Name:
    Don and Roy Splawn Charitable Foundation West Inc
    EIN: 94-3276752
    Software ID:12000057
    Software Version:12.18.605.2
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    Estimated Tax for 2012 3,300      
    Excise Tax for 2011 53      
    IRS Excise Tax Payment with 1st ext 990-PF 3,191