Form990-PF

Department of the Treasury
Internal Revenue Service
Return of Private Foundation
or Section 4947(a)(1) Trust Treated as Private Foundation
bulletDo not enter Social Security numbers on this form as it may be made public. By law, the IRS cannot redact the information on the form.
bulletInformation about Form 990-PF and its instructions is at www.irs.gov/form990pf.
OMB No. 1545-0052
2013
Open to Public Inspection
For calendar year 2013, or tax year beginning 01-01-2013 , and ending 12-31-2013
Name of foundation
MONTGOMERY HOSPITAL FBO CAPEL TRUST
 

Number and street (or P.O. box number if mail is not delivered to street address)1525 W WT HARRIS BLVD D1114-044   Room/suite
City or town, state or province, country, and ZIP or foreign postal code
CHARLOTTE, NC28262
A Employer identification number

51-0160511
B Telephone number (see instructions)

(800) 352-3705
C bullet
G Check all that apply:

D 1. bullet
2. bullet
E 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$2,283,379J Accounting method:
 
(Part I, column (d) must be on cash basis.)
F bullet
Part I Analysis of Revenue and Expenses (The total of amounts in columns (b), (c), and (d) may not necessarily equal the amounts in column (a) (see instructions).) (a) Revenue and
expenses per
books 		(b) Net investment
income 		(c) Adjusted net
income 		(d) Disbursements
for charitable
purposes
(cash basis only)
Revenue 1 Contributions, gifts, grants, etc., received (attach schedule)  
2 Check bullet
3 Interest on savings and temporary cash investments      
4 Dividends and interest from securities...... 48,288 47,474  
5a Gross rents..............      
b Net rental income or (loss)  
6a Net gain or (loss) from sale of assets not on line 10 91,390
b Gross sales price for all assets on line 6a 489,507
7 Capital gain net income (from Part IV, line 2)... 91,390
8 Net short-term capital gain......... 0
9 Income modifications...........  
10a Gross sales less returns and allowances  
b Less: Cost of goods sold....  
c Gross profit or (loss) (attach schedule).....    
11 Other income (attach schedule)....... Click to see attachment 887 955  
12 Total. Add lines 1 through 11........ 140,565 139,819  
Operating and Administrative Expenses 13 Compensation of officers, directors, trustees, etc. 24,343 15,312   9,031
14 Other employee salaries and wages......   0 0 0
15 Pension plans, employee benefits.......   0 0  
16a Legal fees (attach schedule)......... Click to see attachment 6,955 0 0 6,955
b Accounting fees (attach schedule)....... Click to see attachment 2,000 0 0 2,000
c Other professional fees (attach schedule)....       0
17 Interest...............       0
18 Taxes (attach schedule) (see instructions) Click to see attachment 446 446   0
19 Depreciation (attach schedule) and depletion... 0 0  
20 Occupancy..............        
21 Travel, conferences, and meetings.......   0 0  
22 Printing and publications..........   0 0  
23 Other expenses (attach schedule)....... Click to see attachment 1,092     1,092
24 Total operating and administrative expenses.
Add lines 13 through 23.......... 34,836 15,758 0 19,078
25 Contributions, gifts, grants paid........ 77,056 77,056
26 Total expenses and disbursements. Add lines 24 and 25 111,892 15,758 0 96,134
27 Subtract line 26 from line 12:
a Excess of revenue over expenses and disbursements 28,673
b Net investment income (if negative, enter -0-) 124,061
c Adjusted net income (if negative, enter -0-)... 0
For Paperwork Reduction Act Notice, see instructions.
Cat. No. 11289X Form 990-PF (2013)
Form 990-PF (2013)
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............... 2,803 146 146
2 Savings and temporary cash investments.......... 54,677 66,939 66,939
3 Accounts receivable bullet  
Less: allowance for doubtful accounts bullet     0 0
4 Pledges receivable bullet  
Less: allowance for doubtful accounts bullet        
5 Grants receivable.................      
6 Receivables due from officers, directors, trustees, and other
disqualified persons (attach schedule) (see instructions).....      
7 Other notes and loans receivable (attach schedule) bullet  
Less: allowance for doubtful accounts bullet0      
8 Inventories for sale or use...............      
9 Prepaid expenses and deferred charges...........      
10a Investments—U.S. and state government obligations (attach schedule)      
b Investments—corporate stock (attach schedule)........ 821,793 Click to see attachment786,701 1,692,824
c Investments—corporate bonds (attach schedule)........   Click to see attachment511,304 502,834
11 Investments—land, buildings, and equipment: basis bullet  
Less: accumulated depreciation (attach schedule) bullet        
12 Investments—mortgage loans..............      
13 Investments—other (attach schedule)........... 515,082   0
14 Land, buildings, and equipment: basis bullet  
Less: accumulated depreciation (attach schedule) bullet        
15 Other assets (describe bullet) Click to see attachment22,287 Click to see attachment20,636 Click to see attachment20,636
16 Total assets (to be completed by all filers—see the
instructions. Also, see page 1, item I) 1,416,642 1,385,726 2,283,379
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......... 1,416,642 1,385,726
28 Paid-in or capital surplus, or land, bldg., and equipment fund    
29 Retained earnings, accumulated income, endowment, or other funds    
30 Total net assets or fund balances (see page 17 of the
instructions).................... 1,416,642 1,385,726
31 Total liabilities and net assets/fund balances (see page 17 of
the instructions).................. 1,416,642 1,385,726
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 1,416,642
2 Enter amount from Part I, line 27a..................... 2 28,673
3 Other increases not included in line 2 (itemize) bulletClick to see attachment 3 3,086
4 Add lines 1, 2, and 3.......................... 4 1,448,401
5 Decreases not included in line 2 (itemize) bulletClick to see attachment 5 62,675
6 Total net assets or fund balances at end of year (line 4 minus line 5)—Part II, column (b), line 30. 6 1,385,726
Form 990-PF (2013)
Form 990-PF (2013)
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 10. AT&T INC   2013-06-03 2013-10-18
b 21. AT&T INC   2013-06-03 2013-12-18
c 10. ABBOTT LABS W/RIGHTS ATTACHED EXP 11/10/2009   2013-01-08 2013-10-18
d 81. ABBOTT LABS W/RIGHTS ATTACHED EXP 11/10/2009   2013-01-08 2013-11-15
e 94. ABBOTT LABS W/RIGHTS ATTACHED EXP 11/10/2009   2012-08-09 2013-11-15
10. ABBVIE INC   2012-08-09 2013-10-18
19. ABBVIE INC   2012-08-09 2013-12-18
11. AECOM TECHNOLOGY CORP   2013-03-11 2013-10-18
193. AECOM TECHNOLOGY CORP   2013-03-11 2013-11-04
171.409 INVESCO INTL GROWTH-Y #8516   2012-01-19 2013-01-07
33.3 INVESCO INTL GROWTH-Y #8516   2012-01-19 2013-06-11
92.478 INVESCO INTL GROWTH-Y #8516   2012-01-19 2013-12-17
3. ALLIANCE DATA SYSTEMS CORP COM   2011-11-07 2013-01-07
39. ALLIANCE DATA SYSTEMS CORP COM   2011-11-07 2013-04-22
10. ALLSTATE CORP COM W/RIGHTS ATTACHED EXP 2/12/2009   2012-10-09 2013-01-07
8. ALLSTATE CORP COM W/RIGHTS ATTACHED EXP 2/12/2009   2012-10-09 2013-10-18
15. ALLSTATE CORP COM W/RIGHTS ATTACHED EXP 2/12/2009   2012-10-09 2013-12-18
6. AMGEN INC COM W/RTS ATTACHED EXP 03/21/2007   2008-12-15 2013-01-07
4. AMGEN INC COM W/RTS ATTACHED EXP 03/21/2007   2008-12-15 2013-10-18
8. AMGEN INC COM W/RTS ATTACHED EXP 03/21/2007   2008-12-15 2013-12-18
1. APPLE COMPUTER INC COM   2013-10-07 2013-10-18
2. APPLE COMPUTER INC COM   2013-10-07 2013-12-18
87.604 ARTISAN FDS INC SMALL CAP FD #660   2012-12-26 2013-03-05
212.224 ARTISAN FDS INC SMALL CAP FD #660   2012-12-26 2013-06-11
69.808 ARTISAN FDS INC SMALL CAP FD #660   2012-08-08 2013-12-17
2932.551 ABERDEEN TOTAL RETURN BD FD-I #1524   2012-01-19 2013-03-05
28. BANK AMER CORP COM   2013-07-08 2013-10-18
56. BANK AMER CORP COM   2013-07-08 2013-12-18
12. BANK NEW YORK MELLON CORP COM   2013-08-07 2013-10-18
24. BANK NEW YORK MELLON CORP COM   2013-08-07 2013-12-18
7. BERKSHIRE HATHAWAY INC.   2013-11-15 2013-12-18
323. BERRY PLASTICS GROUP INC   2013-06-03 2013-09-20
6. BOEING CO COM   2013-11-04 2013-12-18
33. BOSTON SCIENTIFIC CORP COM   2013-10-07 2013-10-18
66. BOSTON SCIENTIFIC CORP COM   2013-10-07 2013-12-18
9. CVS CORP COM   2010-08-26 2013-01-07
7. CVS CORP COM   2010-08-26 2013-10-18
13. CVS CORP COM   2010-08-26 2013-12-18
36. CADENCE DESIGN SYS INC COM RTS EXP 02/09/2006   2012-07-12 2013-01-07
26. CADENCE DESIGN SYS INC COM RTS EXP 02/09/2006   2012-07-12 2013-10-18
463. CADENCE DESIGN SYS INC COM RTS EXP 02/09/2006   2012-07-12 2013-11-15
6. CELGENE CORP COM   2011-11-07 2013-01-07
24. CELGENE CORP COM   2011-11-07 2013-03-11
59. CELGENE CORP COM   2011-11-07 2013-04-22
4. CHEVRONTEXACO CORP COM   2007-08-27 2013-01-07
3. CHEVRONTEXACO CORP COM   2007-08-27 2013-10-18
5. CHEVRONTEXACO CORP COM   2007-08-27 2013-12-18
11. CHICAGO BRIDGE & IRON NY SHS   2012-08-09 2013-01-07
151. CHICAGO BRIDGE & IRON NY SHS   2012-08-09 2013-07-08
23. CISCO SYS INC COM W/RIGHTS ATTACHED EXPIRING 6/10/2008   2009-06-03 2013-01-07
17. CISCO SYS INC COM W/RIGHTS ATTACHED EXPIRING 6/10/2008   2009-06-03 2013-10-18
33. CISCO SYS INC COM W/RIGHTS ATTACHED EXPIRING 6/10/2008   2009-06-03 2013-12-18
8. CITIGROUP INC.   2013-02-26 2013-10-18
16. CITIGROUP INC.   2013-02-26 2013-12-18
12. COMCAST CORP NEW CL A   2011-02-11 2013-01-07
9. COMCAST CORP NEW CL A   2011-02-11 2013-10-18
17. COMCAST CORP NEW CL A   2011-02-11 2013-12-18
7. CONOCOPHILLIPS COM   2012-05-14 2013-01-07
6. CONOCOPHILLIPS COM   2012-05-14 2013-10-18
11. CONOCOPHILLIPS COM   2012-05-14 2013-12-18
5. DST SYS INC DEL COM   2013-02-26 2013-10-18
10. DST SYS INC DEL COM   2013-02-26 2013-12-18
19. DELTA AIR LINES INC   2013-07-08 2013-10-18
38. DELTA AIR LINES INC   2013-07-08 2013-12-18
8. DISNEY (WALT) COMPANY HOLDING COMPANY COM   2012-09-24 2013-01-07
111. DISNEY (WALT) COMPANY HOLDING COMPANY COM   2012-09-24 2013-01-08
10. DOW CHEM CO COM   2013-10-07 2013-10-18
19. DOW CHEM CO COM   2013-10-07 2013-12-18
6. DUKE ENERGY HOLDING CORP. COM   2011-09-15 2013-01-07
81. DUKE ENERGY HOLDING CORP. COM   2011-09-15 2013-01-08
15. E M C CORP MASS COM   2011-09-15 2013-01-07
200. E M C CORP MASS COM   2011-09-15 2013-05-14
4. EXXON MOBIL CORP COM   2004-08-03 2013-01-07
3. EXXON MOBIL CORP COM   2004-08-03 2013-10-18
6. EXXON MOBIL CORP COM   2004-08-03 2013-12-18
5. FEDEX CORP COM   2012-04-16 2013-01-07
64. FEDEX CORP COM   2012-04-16 2013-08-29
29. FIFTH THIRD BANCORP COM   2011-11-07 2013-01-07
398. FIFTH THIRD BANCORP COM   2011-11-07 2013-10-07
58.326 FLEMING CAP MUTUAL FUND GROUP J P MORGAN MID CAP VALUE FUND   2011-10-19 2013-12-17
8. FLUOR CORP NEW COM   2012-10-09 2013-01-07
5. FLUOR CORP NEW COM   2012-10-09 2013-10-18
11. FLUOR CORP NEW COM   2012-10-09 2013-12-18
13. FOOT LOCKER INC COM   2011-09-15 2013-01-07
179. FOOT LOCKER INC COM   2011-09-15 2013-08-07
23. FORD MTR CO DEL COM   2013-08-07 2013-10-18
45. FORD MTR CO DEL COM   2013-08-07 2013-12-18
13. GNC HOLDINGS INC   2012-02-21 2013-01-07
181. GNC HOLDINGS INC   2012-02-21 2013-04-22
22. GENERAL ELEC CO COM   2010-05-25 2013-01-07
16. GENERAL ELEC CO COM   2010-05-25 2013-10-18
33. GENERAL ELEC CO COM   2010-05-25 2013-12-18
3. GOLDMAN SACHS GRP INC COM   2012-10-26 2013-01-07
48. GOLDMAN SACHS GRP INC COM   2012-10-26 2013-07-08
7. GRACE W R & CO DEL NEW COM   2012-05-14 2013-01-07
94. GRACE W R & CO DEL NEW COM   2012-05-14 2013-10-07
7. HANESBRANDS INC   2013-04-22 2013-10-18
15. HANESBRANDS INC   2013-04-22 2013-12-18
47.778 HARBOR FD INTL FD   2012-01-19 2013-01-07
15.415 HARBOR FD INTL FD   2012-01-19 2013-06-11
44.366 HARBOR FD INTL FD   2012-01-19 2013-12-17
307. HERTZ GLOBAL HOLDINGS INC   2013-03-11 2013-09-20
9. HOLLYFRONTIER CORP   2012-12-12 2013-01-07
129. HOLLYFRONTIER CORP   2012-12-12 2013-10-07
8. HOME DEPOT INC COM   2009-03-30 2013-01-07
6. HOME DEPOT INC COM   2009-03-30 2013-10-18
11. HOME DEPOT INC COM   2009-03-30 2013-12-18
8. IAC/INTERACTIVECORP   2010-08-26 2013-01-07
117. IAC/INTERACTIVECORP   2010-08-26 2013-02-26
50. ISHARES MSCI EMERGING MKTS INDEX FUND   2012-03-21 2013-12-17
34. ISHARES S & P MIDCAP 400 INDEX FUND   2011-06-08 2013-12-17
15. ISHARES TR-S&P MIDCAP 400 GROWTH IND   2011-10-19 2013-12-17
8. JP MORGAN CHASE & CO COM   2006-04-10 2013-01-07
6. JP MORGAN CHASE & CO COM   2006-04-10 2013-10-18
109. JP MORGAN CHASE & CO COM   2006-04-10 2013-11-15
200. JP MORGAN ALERIAN MLP INDEX EXCHANGE TRADED NOTE   2011-12-20 2013-06-11
6. JOHNSON & JOHNSON COM   1999-01-28 2013-01-07
4. JOHNSON & JOHNSON COM   1999-01-28 2013-10-18
8. JOHNSON & JOHNSON COM   1999-01-28 2013-12-18
5. LEAR CORP   2013-09-20 2013-10-18
11. LEAR CORP   2013-09-20 2013-12-18
11. LINCOLN NATL CORP COM   2013-04-22 2013-10-18
44. LINCOLN NATL CORP COM   2013-04-22 2013-11-15
17. LINCOLN NATL CORP COM   2013-04-22 2013-12-18
16. LOWES COS INC COM W/RIGHTS ATTACHED EXPIRING 9/9/2008   2013-11-04 2013-12-18
5. MAGNA INTL INC CL A   2013-06-03 2013-10-18
11. MAGNA INTL INC CL A   2013-06-03 2013-12-18
5. MCKESSON HBOC INC COM   2009-10-19 2013-01-07
3. MCKESSON HBOC INC COM   2009-10-19 2013-10-18
7. MCKESSON HBOC INC COM   2009-10-19 2013-12-18
13. METLIFE INC COM   2011-05-27 2013-01-07
10. METLIFE INC COM   2011-05-27 2013-10-18
19. METLIFE INC COM   2011-05-27 2013-12-18
13. MICROSOFT CORP COM   1997-12-26 2013-01-07
9. MICROSOFT CORP COM   1997-12-26 2013-10-18
18. MICROSOFT CORP COM   1997-12-26 2013-12-18
41. MICRON TECHNOLOGY INC COM   2013-11-15 2013-12-18
27. MORGAN STANLEY DEAN WITTER & CO COM NEW   2013-11-04 2013-12-18
276. NRG ENERGY INC COM   2013-01-08 2013-03-11
318. NV ENERGY INC   2013-03-11 2013-06-03
7. OMNICARE INC COM W/ RTS ATTACHED EXP 06/   2013-08-07 2013-10-18
14. OMNICARE INC COM W/ RTS ATTACHED EXP 06/   2013-08-07 2013-12-18
15. ORACLE CORP COM   2010-07-12 2013-01-07
11. ORACLE CORP COM   2010-07-12 2013-10-18
21. ORACLE CORP COM   2010-07-12 2013-12-18
8. OSHKOSH TRUCK CORP CLASS B W/RIGHTS ATTA   2013-08-29 2013-10-18
16. OSHKOSH TRUCK CORP CLASS B W/RIGHTS ATTA   2013-08-29 2013-12-18
469.925 PIMCO FDS PAC INVT MGMT SER TOTAL RETURN FD II INSTL CL   2008-11-06 2013-01-07
4299.828 PIMCO FDS PAC INVT MGMT SER TOTAL RETURN FD II INSTL CL   2008-11-06 2013-03-05
279.07 PIMCO FOREIGN BOND FUND-INST   2008-11-06 2013-01-07
462.107 PIMCO FOREIGN BOND FUND-INST   2008-11-06 2013-03-05
7. PACKAGING CORP AMER COM   2013-09-20 2013-10-18
13. PACKAGING CORP AMER COM   2013-09-20 2013-12-18
8. PHILLIPS 66   2012-10-26 2013-01-07
6. PHILLIPS 66   2012-10-26 2013-10-18
11. PHILLIPS 66   2012-10-26 2013-12-18
6. QUALCOMM INC COM W/RTS ATTACHED   2012-04-16 2013-01-07
5. QUALCOMM INC COM W/RTS ATTACHED   2012-04-16 2013-10-18
9. QUALCOMM INC COM W/RTS ATTACHED   2012-04-16 2013-12-18
6. ROSS STORES INC COM   2008-05-09 2013-01-07
85. ROSS STORES INC COM   2008-05-09 2013-03-11
952.381 ROYCE PREMIER FUND W CLASS #566   2011-05-05 2013-06-11
6. SANDISK CORP COM W/RTS ATTACHED EXP 04/28/2007   2013-10-07 2013-10-18
12. SANDISK CORP COM W/RTS ATTACHED EXP 04/28/2007   2013-10-07 2013-12-18
64. SANDRIDGE ENERGY INC   2013-10-07 2013-10-18
126. SANDRIDGE ENERGY INC   2013-10-07 2013-12-18
9. SPECTRUM BRANDS HOLDINGS INC   2012-09-04 2013-01-07
7. SPECTRUM BRANDS HOLDINGS INC   2012-09-04 2013-10-18
123. SPECTRUM BRANDS HOLDINGS INC   2012-09-04 2013-11-04
15. SUNTRUST BKS INC COM   2012-09-24 2013-01-07
206. SUNTRUST BKS INC COM   2012-09-24 2013-08-07
270. SYMANTEC CORP COM W/RTS EXP 8/12/2008   2013-04-22 2013-10-07
10. TJX COS INC NEW COM   2012-11-13 2013-01-07
134. TJX COS INC NEW COM   2012-11-13 2013-06-03
16. TEREX CORP NEW COM   2012-08-09 2013-01-07
16. TEREX CORP NEW COM   2012-08-09 2013-02-26
203. TEREX CORP NEW COM   2012-08-09 2013-06-03
7. THERMO ELECTRON CORP COM W/RTS ATTACHED EXP 01/29/2006   2012-10-26 2013-01-07
92. THERMO ELECTRON CORP COM W/RTS ATTACHED EXP 01/29/2006   2012-10-26 2013-08-07
14. US BANCORP DEL COM NEW W/RIGHTS ATTACHED EXP 2/27/2011   2012-01-09 2013-01-07
198. US BANCORP DEL COM NEW W/RIGHTS ATTACHED EXP 2/27/2011   2012-01-09 2013-02-26
20. UNITED THERAPEUTICS CORP DEL COM W/RIGHTS ATTACHED EXP 12/29/2010   2013-04-22 2013-10-07
5. UNITED THERAPEUTICS CORP DEL COM W/RIGHTS ATTACHED EXP 12/29/2010   2013-04-22 2013-10-18
9. UNITED THERAPEUTICS CORP DEL COM W/RIGHTS ATTACHED EXP 12/29/2010   2013-04-22 2013-12-18
8. UNITEDHEALTH GRP INC COM   2011-07-13 2013-01-07
6. UNITEDHEALTH GRP INC COM   2011-07-13 2013-10-18
102. UNITEDHEALTH GRP INC COM   2011-07-13 2013-11-04
11. VERIZON COMMUNICATIONS COM   2010-11-04 2013-01-07
8. VERIZON COMMUNICATIONS COM   2010-11-04 2013-10-18
16. VERIZON COMMUNICATIONS COM   2010-11-04 2013-12-18
6. WABCO HOLDINGS INC   2011-01-18 2013-01-07
90. WABCO HOLDINGS INC   2011-01-18 2013-03-11
7. WAL MART STORES INC COM   2010-06-23 2013-01-07
5. WAL MART STORES INC COM   2010-06-23 2013-10-18
10. WAL MART STORES INC COM   2010-06-23 2013-12-18
5. ACTAVIS PLC   2013-11-15 2013-12-18
6. ACCENTURE PLC   2012-10-26 2013-01-07
86. ACCENTURE PLC   2012-10-26 2013-06-03
5. HERBALIFE LTD   2011-09-15 2013-10-18
10. HERBALIFE LTD   2011-09-15 2013-12-18
34. MARVELL TECHNOLOGY GRP LTD SHS   2013-06-03 2013-10-18
67. MARVELL TECHNOLOGY GRP LTD SHS   2013-06-03 2013-12-18
9. SEAGATE TECHNOLOGY   2013-05-14 2013-10-18
17. SEAGATE TECHNOLOGY   2013-05-14 2013-12-18
5. ACE LIMITED   2005-11-18 2013-01-07
74. ACE LIMITED   2005-11-18 2013-04-22
CAPITAL GAIN DIVIDENDS P    
(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 346   351 -5
b 718   738 -20
c 371   334 37
d 3,078   2,708 370
e 3,572   2,969 603
483   343 140
1,016   651 365
357   345 12
6,191   6,052 139
5,000   4,510 490
1,000   876 124
3,000   2,433 567
463   309 154
6,308   4,015 2,293
415   410 5
430   328 102
784   615 169
529   347 182
458   231 227
894   463 431
508   491 17
1,092   982 110
2,000   1,792 208
5,000   4,326 674
2,000   1,410 590
40,029   40,000 29
408   369 39
869   737 132
377   375 2
804   750 54
806   812 -6
6,635   6,834 -199
810   798 12
404   385 19
752   770 -18
446   253 193
428   196 232
902   365 537
482   395 87
375   285 90
5,876   5,078 798
503   384 119
2,678   1,534 1,144
7,452   3,772 3,680
437   349 88
359   262 97
604   436 168
519   419 100
9,058   5,753 3,305
466   442 24
391   327 64
686   635 51
409   324 85
820   649 171
453   288 165
423   216 207
846   407 439
415   370 45
439   317 122
762   581 181
397   337 60
894   674 220
474   362 112
1,029   725 304
406   423 -17
5,621   5,868 -247
413   397 16
816   755 61
387   349 38
5,250   4,712 538
362   339 23
4,605   4,518 87
351   188 163
262   141 121
593   282 311
471   441 30
6,954   5,650 1,304
450   354 96
7,133   4,862 2,271
2,000   1,321 679
482   452 30
385   282 103
851   621 230
427   282 145
6,393   3,884 2,509
403   388 15
698   759 -61
439   427 12
7,401   5,947 1,454
462   341 121
408   248 160
900   511 389
400   358 42
7,357   5,728 1,629
489   403 86
8,439   5,411 3,028
448   326 122
1,018   699 319
3,000   2,687 313
1,000   867 133
3,000   2,495 505
8,015   6,501 1,514
386   409 -23
5,311   5,862 -551
502   185 317
450   139 311
876   255 621
363   198 165
4,760   2,893 1,867
2,047   2,146 -99
4,393   3,218 1,175
2,171   1,453 718
362   335 27
324   252 72
5,974   4,570 1,404
9,258   7,572 1,686
428   252 176
365   168 197
734   336 398
375   356 19
884   784 100
498   346 152
2,190   1,383 807
861   534 327
768   795 -27
431   336 95
876   740 136
498   307 191
423   184 239
1,116   429 687
464   569 -105
493   438 55
979   832 147
348   195 153
314   135 179
651   270 381
879   802 77
839   787 52
6,959   6,300 659
7,453   6,417 1,036
399   387 12
830   774 56
516   350 166
362   257 105
718   490 228
420   369 51
801   738 63
5,000   4,704 296
45,793   43,041 2,752
3,000   2,648 352
5,000   4,385 615
425   415 10
808   770 38
409   376 33
381   282 99
808   517 291
383   397 -14
342   330 12
654   595 59
345   105 240
4,775   1,487 3,288
20,000   21,200 -1,200
411   375 36
820   751 69
439   387 52
692   762 -70
433   336 97
464   262 202
7,839   4,599 3,240
432   434 -2
7,166   5,966 1,200
6,731   6,384 347
443   415 28
6,716   5,560 1,156
472   350 122
498   350 148
7,133   4,445 2,688
459   427 32
8,447   5,615 2,832
460   394 66
6,618   5,577 1,041
1,690   1,214 476
411   304 107
786   546 240
416   419 -3
414   314 100
6,983   5,338 1,645
486   367 119
400   267 133
771   534 237
391   369 22
6,382   5,529 853
478   356 122
378   255 123
775   509 266
819   825 -6
412   402 10
7,041   5,764 1,277
323   286 37
768   572 196
399   368 31
898   726 172
447   368 79
889   695 194
406   278 128
6,576   4,113 2,463
      8,504
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       -5
b       -20
c       37
d       370
e       603
      140
      365
      12
      139
      490
      124
      567
      154
      2,293
      5
      102
      169
      182
      227
      431
      17
      110
      208
      674
      590
      29
      39
      132
      2
      54
      -6
      -199
      12
      19
      -18
      193
      232
      537
      87
      90
      798
      119
      1,144
      3,680
      88
      97
      168
      100
      3,305
      24
      64
      51
      85
      171
      165
      207
      439
      45
      122
      181
      60
      220
      112
      304
      -17
      -247
      16
      61
      38
      538
      23
      87
      163
      121
      311
      30
      1,304
      96
      2,271
      679
      30
      103
      230
      145
      2,509
      15
      -61
      12
      1,454
      121
      160
      389
      42
      1,629
      86
      3,028
      122
      319
      313
      133
      505
      1,514
      -23
      -551
      317
      311
      621
      165
      1,867
      -99
      1,175
      718
      27
      72
      1,404
      1,686
      176
      197
      398
      19
      100
      152
      807
      327
      -27
      95
      136
      191
      239
      687
      -105
      55
      147
      153
      179
      381
      77
      52
      659
      1,036
      12
      56
      166
      105
      228
      51
      63
      296
      2,752
      352
      615
      10
      38
      33
      99
      291
      -14
      12
      59
      240
      3,288
      -1,200
      36
      69
      52
      -70
      97
      202
      3,240
      -2
      1,200
      347
      28
      1,156
      122
      148
      2,688
      32
      2,832
      66
      1,041
      476
      107
      240
      -3
      100
      1,645
      119
      133
      237
      22
      853
      122
      123
      266
      -6
      10
      1,277
      37
      196
      31
      172
      79
      194
      128
      2,463
       
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 91,390
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))
2012 87,740 1,863,730 0.047078
2011 91,452 1,944,423 0.047033
2010 102,036 2,007,347 0.050831
2009 108,390 1,912,975 0.05666
2008 87,000 2,310,975 0.037646
2 Total of line 1, column (d) ...................... 2 0.239248
3 Average distribution ratio for the 5-year base period—divide the total on line 2 by 5, or by
the number of years the foundation has been in existence if less than 5 years. . . 		3 0.04785
4 Enter the net value of noncharitable-use assets for 2013 from Part X, line 5..... 4 2,117,209
5 Multiply line 4 by line 3....................... 5 101,308
6 Enter 1% of net investment income (1% of Part I, line 27b)........... 6 1,241
7 Add lines 5 and 6......................... 7 102,549
8 Enter qualifying distributions from Part XII, line 4.............. 8 96,134
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 (2013)
Form 990-PF (2013)
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 2,481
hereBulletand enter 1% of Part I, line 27b...................
c All other domestic foundations enter 2% of line 27b. Exempt foreign organizations enter 4% of Part I, line 12, col. (b)
2 Tax under section 511 (domestic section 4947(a)(1) trusts and taxable foundations only. Others enter -0-) 2 0
3 Add lines 1 and 2............................ 3 2,481
4 Subtitle A (income) tax (domestic section 4947(a)(1) trusts and taxable foundations only. Others enter -0-). 4 0
5 Tax based on investment income. Subtract line 4 from line 3. If zero or less, enter -0- ..... 5 2,481
6 Credits/Payments:
a 2013 estimated tax payments and 2012 overpayment credited to 2013 6a 1,344
b Exempt foreign organizations—tax withheld at source....... 6b
c Tax paid with application for extension of time to file (Form 8868) 6c 0
d Backup withholding erroneously withheld ........... 6d  
7 Total credits and payments. Add lines 6a through 6d.............. 7 1,344
8 Enter any penalty for underpayment of estimated tax. if Form 2220 is attached. 8 0
9 Tax due. If the total of lines 5 and 8 is more than line 7, enter amount owed.......Bullet 9 1,137
10 Overpayment. If line 7 is more than the total of lines 5 and 8, enter the amount overpaid...Bullet 10  
11 Enter the amount of line 10 to be: Credited to 2014 estimated taxBullet0 RefundedBullet 11 0
Part VII-A
Statements Regarding Activities
1a
During the tax year, did the foundation attempt to influence any national, state, or local legislation or did
Yes
No
it participate or intervene in any political campaign? ....................
1a
 
No
b
Did it spend more than $100 during the year (either directly or indirectly) for political purposes (see page 19 of
the instructions for definition)?............................
1b
 
No
If the answer is "Yes" to 1a or 1b, attach a detailed description of the activities and copies of any materials
published or distributed by the foundation in connection with the activities.
c
Did the foundation file Form 1120-POL for this year?.....................
1c
 
No
d
Enter the amount (if any) of tax on political expenditures (section 4955) imposed during the year:
(1) On the foundation. bullet$   (2) On foundation managers.bullet$  
e
Enter the reimbursement (if any) paid by the foundation during the year for political expenditure tax imposed
on foundation managers.bullet$  
2
Has the foundation engaged in any activities that have not previously been reported to the IRS?.......
2
 
No
If "Yes," attach a detailed description of the activities.
3
Has the foundation made any changes, not previously reported to the IRS, in its governing instrument, articles
of incorporation, or bylaws, or other similar instruments? If "Yes," attach a conformed copy of the changes....
3
 
No
4a
Did the foundation have unrelated business gross income of $1,000 or more during the year?........
4a
 
No
b
If "Yes," has it filed a tax return on Form 990-T for this year?...................
4b
 
 
5
Was there a liquidation, termination, dissolution, or substantial contraction during the year?.........
5
 
No
If "Yes," attach the statement required by General Instruction T.
6
Are the requirements of section 508(e) (relating to sections 4941 through 4945) satisfied either:
  • By language in the governing instrument, or
  • By state legislation that effectively amends the governing instrument so that no mandatory directions
    • that conflict with the state law remain in the governing instrument?................
    6
    Yes
     
    7
    Did the foundation have at least $5,000 in assets at any time during the year? If "Yes," complete Part II, col. (c), and Part XV.
    7
    Yes
     
    8a
    Enter the states to which the foundation reports or with which it is registered (see instructions)
    bulletNC
    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 2013 or the taxable year beginning in 2013 (see instructions for Part XIV)?
    If "Yes," complete Part XIV.............................
    9
     
    No
    10
    Did any persons become substantial contributors during the tax year? If "Yes," attach a schedule listing their names and addresses.
    10
     
    No
    11
    At any time during the year, did the foundation, directly or indirectly, own a controlled entity within the
    meaning of section 512(b)(13)? If "Yes," attach schedule. (see instructions) .............
    11
     
    No
    12
    Did the foundation make a distribution to a donor advised fund over which the foundation or a disqualified person had
    advisory privileges? If "Yes," attach statement (see instructions).................
    12
     
    No
    13
    Did the foundation comply with the public inspection requirements for its annual returns and exemption application?
    13
    Yes
     
    Website addressbullet  
    14
    The books are in care ofbulletWELLS FARGO BANK NA Telephone no.bullet (800) 352-3705
    Located atbullet1 WEST 4TH STREETWINSTONSALEMNC ZIP+4bullet27101
    15
    Section 4947(a)(1) nonexempt charitable trusts filing Form 990-PF in lieu of Form 1041.........bullet
    and enter the amount of tax-exempt interest received or accrued during the year ......bullet
    15  
    16 At any time during calendar year 2013, did the foundation have an interest in or a signature or other authority over YesNo
    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 (2013)
    Form 990-PF (2013)
    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
     
     
    .........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 2013?.............
    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 2013, did the foundation have any undistributed income (lines 6d
    and 6e, Part XIII) for tax year(s) beginning before 2013?...............
    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 2013 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 2013.)....................
    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 2013?
    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
     
     
    .........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 (2013)
    Form 990-PF (2013)
    Page 6
    Part VIII
    Information About Officers, Directors, Trustees, Foundation Managers, Highly Paid Employees,
    and Contractors
    1 List all officers, directors, trustees, foundation managers and their compensation (see instructions).
    (a) Name and address (b) Title, and average
    hours per week
    devoted to position     		(c) Compensation
     (If not paid, enter
    -0-)     		(d) Contributions to
    employee benefit plans
    and deferred compensation     		(e) Expense account,
    other allowances
    WELLS FARGO BANK Trustee
    40     		20,416    
    1525 W W T HARRIS BLVD D1114 044
    CHARLOTTE,NC282885709
    FIRST BANK CO TRUSTEE
    40     		3,927    
    PO Box 508
    Troy,NC27271
    2 Compensation of five highest-paid employees (other than those included on line 1—see instructions). If none, enter “NONE."
    (a) Name and address of each employee paid more than $50,000 (b) Title, and average
    hours per week
    devoted to position     		(c) Compensation (d) Contributions to
    employee benefit
    plans and deferred
    compensation     		(e) Expense account,
    other allowances
    NONE
    Total number of other employees paid over $50,000...................bullet 0
    3 Five highest-paid independent contractors for professional services (see instructions). If none, enter "NONE".
    (a) Name and address of each person paid more than $50,000 (b) Type of service (c) Compensation
    NONE
    Total number of others receiving over $50,000 for professional services.............bullet0
    Part IX-A
    Summary of Direct Charitable Activities
    List the foundation’s four largest direct charitable activities during the tax year. Include relevant statistical information such as the number of organizations and other beneficiaries served, conferences convened, research papers produced, etc. Expenses
    1
     
    2  
    3  
    4  
    Form 990-PF (2013)
    Form 990-PF (2013)
    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
     
    b
    Average of monthly cash balances.......................
    1b
     
    c
    Fair market value of all other assets (see instructions)................
    1c
     
    d
    Total (add lines 1a, b, and c).........................
    1d
     
    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
    Cash deemed held for charitable activities. Enter 1 1/2% of line 3 (for greater amount, see
    instructions) .............................
    4
     
    5
    Net value of noncharitable-use assets. Subtract line 4 from line 3. Enter here and on Part V, line 4
    5
     
    6
    Minimum investment return. Enter 5% of line 5..................
    6
     
    Part XI
    Distributable Amount bullet and do not complete this part.)
    1
    Minimum investment return from Part X, line 6....................
    1
    105,860
    2a
    Tax on investment income for 2013 from Part VI, line 5......
    2a
    2,481
    b
    Income tax for 2013. (This does not include the tax from Part VI.)...
    2b
     
    c
    Add lines 2a and 2b............................
    2c
    2,481
    3
    Distributable amount before adjustments. Subtract line 2c from line 1............
    3
    103,379
    4
    Recoveries of amounts treated as qualifying distributions................
    4
    0
    5
    Add lines 3 and 4............................
    5
    103,379
    6
    Deduction from distributable amount (see instructions).................
    6
    0
    7
    Distributable amount as adjusted. Subtract line 6 from line 5. Enter here and on Part XIII,
    line 1................................
    7
    103,379
    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
     
    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
     
    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
     
    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 (2013)
    Form 990-PF (2013)
    Page 8
    Part XIII
    Undistributed Income (see instructions)
    (a)
    Corpus     		(b)
    Years prior to 2012     		(c)
    2012     		(d)
    2013
    1 Distributable amount for 2013 from Part XI, line 7 103,379
    2 Undistributed income, if any, as of the end of 2013:
    a Enter amount for 2012 only....... 91,846
    b Total for prior years:2011, 20, 20 0
    3 Excess distributions carryover, if any, to 2013:
    a From 2008....... 0
    b From 2009....... 0
    c From 2010....... 0
    d From 2011....... 0
    e From 2012....... 0
    fTotal of lines 3a through e......... 0
    4Qualifying distributions for 2013 from Part
    XII, line 4: bullet$ 96,134
    a Applied to 2012, but not more than line 2a 91,846
    b Applied to undistributed income of prior years
    (Election required—see instructions)......     		0
    c Treated as distributions out of corpus (Election
    required—see instructions).........     		0
    d Applied to 2013 distributable amount..... 4,288
    e Remaining amount distributed out of corpus 0
    5 Excess distributions carryover applied to 2013. 0 0
    (If an amount appears in column (d), the
    same amount must be shown in column (a).)
    6Enter the net total of each column as
    indicated below:
    a Corpus. Add lines 3f, 4c, and 4e. Subtract line 5 0
    b Prior years’ undistributed income. Subtract
    line 4b from line 2b ...........     		0
    c Enter the amount of prior years’ undistributed
    income for which a notice of deficiency has
    been issued, or on which the section 4942(a)
    tax has been previously assessed......     		0
    d Subtract line 6c from line 6b. Taxable amount
    —see instructions ...........     		0
    e Undistributed income for 2012. Subtract line
    4a from line 2a. Taxable amount—see
    instructions .............     		0
    f Undistributed income for 2013. Subtract
    lines 4d and 5 from line 1. This amount must
    be distributed in 2014 ..........     		99,091
    7 Amounts treated as distributions out of
    corpus to satisfy requirements imposed by
    section 170(b)(1)(F) or 4942(g)(3) (see
    instructions) .............     		0
    8Excess distributions carryover from 2008 not
    applied on line 5 or line 7 (see instructions) ...     		0
    9Excess distributions carryover to 2014.
    Subtract lines 7 and 8 from line 6a ......     		0
    10 Analysis of line 9:
    a Excess from 2009.... 0
    b Excess from 2010.... 0
    c Excess from 2011.... 0
    d Excess from 2012.... 0
    e Excess from 2013.... 0
    Form 990-PF (2013)
    Form 990-PF (2013)
    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 2013, 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) 2013 (b) 2012 (c) 2011 (d) 2010
             
    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 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 (2013)
    Form 990-PF (2013)
    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
    First Health Montgomery
    Hospital
    PO BOX 508
    TROY,NC273710508     		NONE PUBLIC CHARITY GENERAL SUPPORT 77,056
    Total .................................bullet 3a 77,056
    bApproved for future payment
    Total .................................bullet 3b  
    Form 990-PF (2013)
    Form 990-PF (2013)
    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....          
    3
    Interest on savings and temporary cash investments ............     		         
    4 Dividends and interest from securities....     14 48,288  
    5 Net rental income or (loss) from real estate:
    aDebt-financed property......          
    bNot debt-financed property.....          
    6
    Net rental income or (loss) from personal property .............     		         
    7 Other investment income.....          
    8
    Gain or (loss) from sales of assets other than inventory .............     		    18 91,390  
    9 Net income or (loss) from special events:          
    10 Gross profit or (loss) from sales of inventory..          
    11 Other revenue: aUS TREAS REFUND     01 15  
    bMF OTHER INC     01 865  
    cMONEY MKT INT     01 7  
    d
    e
    12 Subtotal. Add columns (b), (d), and (e)..   140,565  
    13Total. Add line 12, columns (b), (d), and (e)..................
    13140,565
    (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 (2013)
    Form 990-PF (2013)
    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 501(c) of the Code (other than section 501(c)(3) organizations) or in section 527, relating to political
    Yes
    No
    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 (2013)
    Additional Data


    Software ID:  
    Software Version:  


    Form 990PF - Special Condition Description:
    Special Condition Description

    TY 2013 AccountingFeesSchedule
    Name:
    MONTGOMERY HOSPITAL FBO CAPEL TRUST
    EIN: 51-0160511
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    TAX PREPARATION FEE (NON-ALLOC 2,000     2,000

    TY 2013 InvestmentsCorpBondsSchedule
    Name:
    MONTGOMERY HOSPITAL FBO CAPEL TRUST
    EIN: 51-0160511
    Name of Bond End of Year Book Value End of Year Fair Market Value
    261980494 DREYFUS EMG MKT DEBT 33,000 30,394
    693390551 PIMCO TOTAL RETN FD    
    693390882 PIMCO FOREIGN BD FD 37,304 41,352
    693391559 PIMCO EMERG MKTS BD- 30,000 28,629
    72369B406 PIONEER HIGH YIELD F    
    76628T645 RIDGEWORTH SEIX HY B 69,000 69,489
    921937850 VANGUARD S/T BD IND    
    957663701 WESTERN ASSET INTERM 70,000 69,439
    256210105 DODGE & COX INCOME F 70,000 68,784
    693390304 PIMCO LOW DURATION F 28,000 27,946
    693390700 PIMCO TOTAL RET FD-I 70,000 66,114
    741478101 T ROWE CORPORATE INC 60,000 57,027
    77957P105 T ROWE PRICE SHORT T 44,000 43,660

    TY 2013 InvestmentsCorpStockSchedule
    Name:
    MONTGOMERY HOSPITAL FBO CAPEL TRUST
    EIN: 51-0160511
    Name of Stock End of Year Book Value End of Year Fair Market Value
    126650100 CVS/CAREMARK CORPORA 2,919 7,443
    246248306 DELAWARE POOLED TR    
    318910106 FIRST BANCORP N C 36,740 731,363
    345370860 FORD MOTOR COMPANY 5,987 5,478
    364760108 GAP INC    
    437076102 HOME DEPOT INC 2,063 7,328
    654106103 NIKE INC CL B    
    693390551 PIMCO TOTAL RETURN    
    693390882 PIMCO FOREIGN BOND    
    72369B406 PIONEER HIGH YIELD    
    742719109 PROCTER & GAMBLE CO    
    778296103 ROSS STORES INC    
    902494103 TYSON FOODS INC CL A    
    931142103 WAL MART STORES INC 4,123 6,374
    94984B348 WELLS FARGO ADVANT.    
    94984B397 WELLS FARGO ADVANT.    
    94985D244 WELLS FARGO ADVANT.    
    166764100 CHEVRON CORP 3,576 5,121
    171798101 CIMAREX ENERGY CO    
    20825C104 CONOCOPHILLIPS 4,175 6,147
    30231G102 EXXON MOBIL CORPORAT 2,347 5,060
    406216101 HALLIBRUTON CO    
    674599105 OCCIDENTAL PETE CORP    
    03076C106 AMERIPRISE FINL INC    
    172967101 CITIGROUP INC    
    46625H100 JPMORGAN CHASE & CO    
    693475105 PNC FINANCIAL SVCS    
    91529Y106 UNUM GROUP    
    031162100 AMGEN INC 3,704 7,301
    110122108 BRISTOL MYERS SQUIBB    
    14149Y108 CARDINAL HEALTH INC    
    345838106 FOREST LABS INC    
    478160104 JOHNSON & JOHNSON 2,686 5,862
    58155Q103 MCKESSON CORP 3,433 9,038
    58405U102 MEDCO SOLUTIONS INC    
    235851102 DANAHER CORP    
    369604103 GENERAL ELECTRIC CO 3,997 7,232
    907818108 UNION PACIFIC CORP    
    913017109 UNITED TECHNOLOGIES    
    88579Y101 3M CO    
    037833100 APPLE INC 3,360 6,732
    17275R102 CISCO SYSTEMS INC 4,801 5,944
    219350105 CORNING INC    
    428236103 HEWLETT PACKARD CO    
    44919P508 IAC/INTERACTIVECORP    
    458140100 INTEL CORP    
    459200101 IBM CORP    
    594918104 MICROSOFT CORP 2,202 5,499
    68389X105 ORACLE CORPORATION 3,967 6,504
    882508104 TEXAS INSTRUMENTS    
    459506101 INTERNATL FLAVORS    
    81211K100 SEALED AIR CORP    
    92343V104 VERIZON COMMUNICATIO 4,306 6,339
    210371100 CONSTELLATION ENERGY    
    H0023R105 ACE LIMITED    
    G6852T105 PARTNERRE LTD COM    
    H8912P106 TYCO ELECTRONICS LTD    
    H89128104 TYCO INTERNATL LTD    
    008882532 INVESCO INTL GROWTH- 28,181 37,629
    04314H204 ARTISAN INTERNATIONA 37,000 54,765
    22544R305 CREDIT SUISSE COMM R 39,605 33,968
    339128100 JP MORGAN MID CAP VA 19,072 29,572
    464287234 ISHARES MSCI EMERGIN 34,623 35,526
    464287507 ISHARES CORE S&P MID 40,632 61,553
    464287606 ISHARES S&P MID-CAP 20,035 31,540
    46625H365 JP MORGAN ALERIAN ML 7,572 9,270
    683974505 OPPENHEIMER DEVELOPI 35,000 39,359
    780905451 ROYCE PREMIER FUND W 13,800 15,032
    78463X863 SPDR DJ WILSHIRE INT 38,649 42,848
    922908553 VANGUARD REIT VIPER 55,792 61,978
    318910106 FIRST BANCORP N C    
    26441C105 DUKE ENERGY HOLDING    
    G2554F113 COVIDIEN PLC    
    G4412G101 HERBALIFE LTD 4,578 6,296
    124857202 CNS CORP NEW    
    20030N101 COMCAST CORP CLASS A 3,307 7,171
    344849104 FOOT LOCKER INC    
    92927K102 WABCO HOLDINGS INC    
    637071101 NATIONAL OILWELL VAR    
    064058100 BANK NEW YORK MELLON 6,031 6,743
    316773100 FIFTH THIRD BANCORP    
    59156R108 METLIFE INC 5,833 8,088
    754730109 RAYMOND JAMES FINL    
    151020104 CELGENE CORP COM    
    91324P102 UNITEDHEALTH GROUP I    
    00846U101 AGILENT TECH INC    
    018581108 ALLIANCE DATA SYS CO    
    268648102 E M C CORP MASS    
    871503108 SYMANTEC CORP    
    774415103 ROCKWOOD HLDGS INC    
    002824100 ABBOTT LABS    
    020002101 ALLSTATE CORP 4,836 6,436
    04314H105 ARTISAN FDS INC SMAL 11,472 16,935
    127387108 CADENCE DESIGN SYSTE    
    167250109 CHICAGO BRIDGE & IRO    
    254687106 WALT DISNEY CO    
    26441C204 DUKE ENERGY HOLDING    
    31428X106 FEDEX CORPORATION    
    343412102 FLUOR CORP NEW 4,913 6,985
    36191G107 GNC HOLDINGS INC    
    38141G104 GOLDMAN SACHS GROUP    
    38388F108 W. R. GRACE & CO COM    
    411511306 HARBOR INTERNATION F 30,951 39,079
    413838202 OAKMARK INTERNATIONA 40,000 50,689
    436106108 HOLLYFRONTIER CORP    
    464287887 ISHARES S&P SMALL-CA 19,241 27,873
    718546104 PHILLIPS 66 4,276 7,019
    747525103 QUALCOMM INC 4,692 5,272
    84763R101 SPECTRUM BRANDS HOLD    
    867914103 SUNTRUST BANKS INC    
    872540109 TJX COS INC NEW    
    880779103 TEREX CORP NEW    
    883556102 THERMO FISHER SCIENT    
    902973304 US BANCORP DEL NEW    
    G1151C101 ACCENTURE PLC    
    00206R102 AT & T INC 5,795 5,801
    00287Y109 ABBVIE INC 5,092 7,922
    060505104 BANK OF AMERICA CORP 5,821 6,882
    084670702 BERKSHIRE HATHAWAY I 6,496 6,639
    097023105 BOEING CO 6,385 6,552
    101137107 BOSTON SCIENTIFIC CO 6,082 6,262
    172967424 CITIGROUP INC. 5,109 6,566
    233326107 DST SYS INC COM 5,190 6,987
    247361702 DELTA AIR LINES INC 5,816 8,378
    260543103 DOW CHEMICAL CO 6,039 6,749
    410345102 HANESBRANDS INC 5,455 8,222
    464287879 ISHARES S&P SMALL-CA 22,146 26,146
    521865204 LEAR CORP 6,055 6,882
    534187109 LINCOLN NATL CORP IN 4,148 6,814
    548661107 LOWES COS INC 6,359 6,342
    559222401 MAGNA INTL INC CL A 5,785 7,057
    595112103 MICRON TECHNOLOGY IN 6,432 7,156
    617446448 MORGAN STANLEY 6,293 6,774
    681904108 OMNICARE INC 6,191 6,760
    688239201 OSHKOSH CORPORATION 5,952 6,499
    695156109 PACKAGING CORP OF AM 6,042 6,455
    80004C101 SANDISK CORP COM 6,132 6,913
    80007P307 SANDRIDGE ENERGY INC 6,054 6,076
    902641646 E-TRACS ALERIAN MLP 9,118 9,463
    91307C102 UNITED THERAPEUTICS 4,372 8,142
    G0083B108 ACTAVIS PLC 6,431 6,552
    G5876H105 MARVELL TECHNOLOGY G 5,754 7,636
    G7945M107 SEAGATE TECHNOLOGY 5,680 7,806

    TY 2013 InvestmentsOtherSchedule2
    Name:
    MONTGOMERY HOSPITAL FBO CAPEL TRUST
    EIN: 51-0160511
    Category/ Item Listed at Cost or FMV Book Value End of Year Fair Market Value
    1ST BANCORP 2010 DIV ADDED      
    04315J209 ARTIO TOTAL RETURN B      
    256210105 DODGE & COX INCOME F      
    261980494 DREYFUS EMG MKT DEBT      
    693390304 PIMCO LOW DURATION F      
    693390551 PIMCO TOTAL RETN FD      
    693390700 PIMCO TOTAL RET FD-I      
    693390882 PIMCO FOREIGN BD FD      
    693391559 PIMCO EMERG MKTS BD-      
    741478101 T ROWE CORPORATE INC      
    76628T645 RIDGEWORTH SEIX HY B      
    77957P105 T ROWE PRICE SHORT T      
    957663701 WESTERN ASSET INTERM      

    TY 2013 LegalFeesSchedule
    Name:
    MONTGOMERY HOSPITAL FBO CAPEL TRUST
    EIN: 51-0160511
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    LEGAL FEES - PRINCIPAL (ALLOCA 6,955     6,955


    TY 2013 OtherAssetsSchedule
    Name:
    MONTGOMERY HOSPITAL FBO CAPEL TRUST
    EIN: 51-0160511
    Description Beginning of Year - Book Value End of Year - Book Value End of Year - Fair Market Value
    MONEY MKT FROM CAPEL TRUST 22,287 20,636 20,636


    TY 2013 OtherDecreasesSchedule
    Name:
    MONTGOMERY HOSPITAL FBO CAPEL TRUST
    EIN: 51-0160511
    Description Amount
    MUTUAL FUND EFFECRIVE DATE AFTER TYE 1,973
    ROC ADJUST 701
    2012 RMD CKING ACCT ADJUSTMENT RECD 1/2013 60,001


    TY 2013 OtherExpensesSchedule
    Name:
    MONTGOMERY HOSPITAL FBO CAPEL TRUST
    EIN: 51-0160511
    Description Revenue and Expenses per Books Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    ATTORNEY MISC EXPENSES 1,092 0   1,092


    TY 2013 OtherIncomeSchedule2
    Name:
    MONTGOMERY HOSPITAL FBO CAPEL TRUST
    EIN: 51-0160511
    Description Revenue And Expenses Per Books Net Investment Income Adjusted Net Income
    US TREAS REFUND 15 0  
    MUTUAL FUND OTHER INCOME 865 865  
    MONEY MARKET INTEREST 7 7  
    CD INTEREST   83  


    TY 2013 OtherIncreasesSchedule
    Name:
    MONTGOMERY HOSPITAL FBO CAPEL TRUST
    EIN: 51-0160511
    Description Amount
    MUTUAL FUND EFFECTIVE DATE BEFORE TYE 3,086


    TY 2013 TaxesSchedule
    Name:
    MONTGOMERY HOSPITAL FBO CAPEL TRUST
    EIN: 51-0160511
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    FOREIGN TAXES 58 58   0
    FOREIGN TAXES ON QUALIFIED FOR 239 239   0
    FOREIGN TAXES ON NONQUALIFIED 149 149   0