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 10-01-2012 , and ending 09-30-2013
Name of foundation
NATHAN B& FLORENCE R BURT FOUNDATION
 

Number and street (or P.O. box number if mail is not delivered to street address)C/O HARRY L ARKIN 166O LINCOLN STNO 2830Room/suite
City or town, state, and ZIP code
DENVER, CO80264
A Employer identification number

84-0972203
B Telephone number (see instructions)

(303) 863-8400
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$4,250,496J 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 25,196 25,196  
4 Dividends and interest from securities...... 75,478 75,478  
5a Gross rents.............. 35,365 35,365  
b Net rental income or (loss) 35,365
6a Net gain or (loss) from sale of assets not on line 10 -62,567
b Gross sales price for all assets on line 6a 511,806
7 Capital gain net income (from Part IV, line 2)... 0
8 Net short-term capital gain.........  
9 Income modifications...........  
10a Gross sales less returns and allowances  
b Less: Cost of goods sold....  
c Gross profit or (loss) (attach schedule).....    
11 Other income (attach schedule).......      
12 Total. Add lines 1 through 11........ 73,472 136,039  
Operating and Administrative Expenses 13 Compensation of officers, directors, trustees, etc. 27,600 12,420   15,180
14 Other employee salaries and wages......        
15 Pension plans, employee benefits.......        
16a Legal fees (attach schedule).........        
b Accounting fees (attach schedule)....... Click to see attachment 2,660 1,197   1,463
c Other professional fees (attach schedule).... Click to see attachment 28,893 28,893   0
17 Interest...............        
18 Taxes (attach schedule) (see instructions) Click to see attachment 4,372 1,223   1,495
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 6,204 2,844   3,361
24 Total operating and administrative expenses.
Add lines 13 through 23.......... 69,729 46,577   21,499
25 Contributions, gifts, grants paid........ 168,200 168,200
26 Total expenses and disbursements. Add lines 24 and 25 237,929 46,577   189,699
27 Subtract line 26 from line 12:
a Excess of revenue over expenses and disbursements -164,457
b Net investment income (if negative, enter -0-) 89,462
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.......... 1,003,100 1,324,669 1,340,278
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) 100,000 Click to see attachment100,000 105,137
b Investments—corporate stock (attach schedule)........ 1,012,126 Click to see attachment902,590 1,776,139
c Investments—corporate bonds (attach schedule)........      
11 Investments—land, buildings, and equipment: basis bullet67,500
Less: accumulated depreciation (attach schedule) bullet25,174 42,326 Click to see attachment42,326 520,000
12 Investments—mortgage loans..............      
13 Investments—other (attach schedule)........... 914,432 Click to see attachment537,966 508,942
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) 3,071,984 2,907,551 4,250,496
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) Click to see attachment446 Click to see attachment470
23 Total liabilities (add lines 17 through 22).......... 446 470
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......... 2,200,225 2,200,225
28 Paid-in or capital surplus, or land, bldg., and equipment fund 42,326 42,326
29 Retained earnings, accumulated income, endowment, or other funds 828,987 664,530
30 Total net assets or fund balances (see page 17 of the
instructions).................... 3,071,538 2,907,081
31 Total liabilities and net assets/fund balances (see page 17 of
the instructions).................. 3,071,984 2,907,551
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 3,071,538
2 Enter amount from Part I, line 27a..................... 2 -164,457
3 Other increases not included in line 2 (itemize) bullet 3 0
4 Add lines 1, 2, and 3.......................... 4 2,907,081
5 Decreases not included in line 2 (itemize) bullet 5 0
6 Total net assets or fund balances at end of year (line 4 minus line 5)—Part II, column (b), line 30. 6 2,907,081
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 ISHARES RUSSELL TR 1000   2010-01-01 2013-04-30
b RUSSELL FUNDS - QUANTITATIVE EQUITY   2010-01-01 2013-04-30
c RUSSELL FUNDS - SHORT TERM BOND FUND   2010-01-01 2013-06-30
d RUSSELL FUNDS - REAL ESTATE SECS   2010-01-01 2013-06-30
e RUSSELL FUNDS - US SMALL AND MID CAP   2010-01-01 2013-06-30
RUSSELL FUNDS - GLOBAL EQUITY   2010-01-01 2013-06-30
RUSSELL FUNDS - EMERGING MARKETS   2010-01-01 2013-06-30
PIMCO ALL ASSETS INS   2010-01-01 2013-04-30
PIMCO COMMODITY REAL RETURN   2010-01-01 2013-06-30
PIMCO EMERGING LOCAL BOND   2010-01-01 2013-06-30
SEI EMERGING MARKET DEBT   2010-01-01 2013-04-30
ISHARES TRUST RUSSELL   2010-01-01 2013-06-30
PIMCO HIGH-YIELD BOND   2010-01-01 2013-06-30
GOOD TIMES RESTAURANTS, INC.   2010-01-01 2012-12-31
FLEXTRONICS, INC.   2010-01-01 2012-12-31
DEAN FOODS, INC.   2010-01-01 2013-09-30
JP MORGAN CHASE GLOBAL MTN   2010-01-01 2013-05-31
ISHARES TR MSCI EAFE   2010-01-01 2013-06-30
PIMCO EMERGING MARKETS   2010-01-01 2013-06-30
RUSSELL FUNDS - INFRASTRUCTURE   2010-01-01 2013-06-30
JP MORGAN CHASE, INC.   2010-01-01 2013-06-30
RUSSELL FUNDS - STRATEGIC CALL   2010-01-01 2013-06-30
RUSSELL FUNDS - US DEFENSIVE   2010-01-01 2013-06-30
WISDOM TREE EMERGING MKTS   2012-12-31 2013-06-30
PIMCO ALL ASSETS AU   2013-04-30 2013-06-30
STONERIDGE US MASTER   2013-05-31 2013-06-30
(e) Gross sales price (f) Depreciation allowed
(or allowable) 		(g) Cost or other basis
plus expense of sale 		(h) Gain or (loss)
(e) plus (f) minus (g)
a 3,068   1,699 1,369
b 7,262   6,035 1,227
c 230,885   223,774 7,111
d 8,785   10,278 -1,493
e 4,518   3,001 1,517
9,426   8,833 593
8,238   9,739 -1,501
20,617   20,631 -14
7,440   13,976 -6,536
11,709   13,559 -1,850
4,471   4,037 434
36,258   37,302 -1,044
9,801   7,599 2,202
7,795   45,790 -37,995
8,871   34,706 -25,835
5,274   23,484 -18,210
17,140   10,941 6,199
18,128   11,817 6,311
4,191   5,666 -1,475
8,758   7,865 893
10,498   13,000 -2,502
8,654   9,196 -542
18,459   8,960 9,499
4,115   4,055 60
25,016   26,016 -1,000
12,429   12,374 55
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       1,369
b       1,227
c       7,111
d       -1,493
e       1,517
      593
      -1,501
      -14
      -6,536
      -1,850
      434
      -1,044
      2,202
      -37,995
      -25,835
      -18,210
      6,199
      6,311
      -1,475
      893
      -2,502
      -542
      9,499
      60
      -1,000
      55
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 -62,527
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 177,908 4,124,595 0.043133
2010 193,167 4,132,448 0.046744
2009 180,881 3,991,197 0.045320
2008 184,928 3,839,202 0.048168
2007 213,193 4,527,165 0.047092
2 Total of line 1, column (d) ...................... 2 0.230457
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 0.046091
4 Enter the net value of noncharitable-use assets for 2012 from Part X, line 5..... 4 4,239,783
5 Multiply line 4 by line 3....................... 5 195,416
6 Enter 1% of net investment income (1% of Part I, line 27b)........... 6 895
7 Add lines 5 and 6......................... 7 196,311
8 Enter qualifying distributions from Part XII, line 4.............. 8 189,699
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 1,789
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 1,789
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 1,789
6 Credits/Payments:
a 2012 estimated tax payments and 2011 overpayment credited to 2012 6a 1,600
b Exempt foreign organizations—tax withheld at source....... 6b
c Tax paid with application for extension of time to file (Form 8868) 6c  
d Backup withholding erroneously withheld ........... 6d  
7 Total credits and payments. Add lines 6a through 6d.............. 7 1,600
8 Enter any penalty for underpayment of estimated tax. if Form 2220 is attached. 8 14
9 Tax due. If the total of lines 5 and 8 is more than line 7, enter amount owed.......Bullet 9 203
10 Overpayment. If line 7 is more than the total of lines 5 and 8, enter the amount overpaid...Bullet 10  
11 Enter the amount of line 10 to be: Credited to 2013 estimated taxBullet   Refunded Bullet 11  
Part VII-A
Statements Regarding Activities
1a
During the tax year, did the foundation attempt to influence any national, state, or local legislation or did
Yes
No
it participate or intervene in any political campaign? ....................
1a
 
No
b
Did it spend more than $100 during the year (either directly or indirectly) for political purposes (see page 19 of
the instructions for definition)?............................
1b
 
No
If the answer is “Yes” to 1a or 1b, attach a detailed description of the activities and copies of any materials
published or distributed by the foundation in connection with the activities.
c
Did the foundation file Form 1120-POL for this year?.....................
1c
 
No
d
Enter the amount (if any) of tax on political expenditures (section 4955) imposed during the year:
(1) On the foundation. bullet$ 0(2) On foundation managers.bullet$ 0
e
Enter the reimbursement (if any) paid by the foundation during the year for political expenditure tax imposed
on foundation managers.bullet$ 0
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)
    bulletCO
    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 addressbulletWWW.BURTFOUNDATION.ORG
    14
    The books are in care ofbulletHARRY L ARKIN Telephone no.bullet (303) 863-8400
    Located atbullet1660 LINCOLN STSUITE 2830DENVERCO ZIP+4bullet80264
    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
     
     
    .........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
    HARRY L ARKIN PRESIDENT
    10.00     		27,600 0 0
    1660 LINCOLN STREET SUITE 2830
    DENVER,CO80264
    MARGARET FOMER PHD DIRECTOR
    1.00     		0 0 0
    1660 LINCOLN STREET SUITE 2830
    DENVER,CO80264
    NATALIE MEYER SECRETARY
    1.00     		0 0 0
    1660 LINCOLN STREET SUITE 2830
    DENVER,CO80264
    GREGORY W DICKSON TREASURER
    1.00     		0 0 0
    1660 LINCOLN STREET SUITE 2830
    DENVER,CO80264
    JOHN C BAKER VICE PRESIDENT
    1.00     		0 0 0
    1660 LINCOLN STREET SUITE 2830
    DENVER,CO80264
    BRUCE JAFEK MD DIRECTOR
    1.00     		0 0 0
    1660 LINCOLN STREET SUITE 2830
    DENVER,CO80264
    HARRISON F HAYES MD DIRECTOR
    1.00     		0 0 0
    1660 LINCOLN STREET SUITE 2830
    DENVER,CO80264
    BRIGADIER GENERAL BERNARD H THORN DIRECTOR
    1.00     		0 0 0
    1660 LINCOLN STREET SUITE 2830
    DENVER,CO80264
    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 (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 N/A 0
    2  
    All other program-related investments. See page 24 of the instructions.
    3  
    Total. Add lines 1 through 3..........................bullet0
    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
    2,494,844
    b
    Average of monthly cash balances.......................
    1b
    1,229,504
    c
    Fair market value of all other assets (see instructions)................
    1c
    580,000
    d
    Total (add lines 1a, b, and c).........................
    1d
    4,304,348
    e
    Reduction claimed for blockage or other factors reported on lines 1a and
    1c (attach detailed explanation) .............
    1e
    0
    2
    Acquisition indebtedness applicable to line 1 assets..................
    2
    0
    3
    Subtract line 2 from line 1d.........................
    3
    4,304,348
    4
    Cash deemed held for charitable activities. Enter 1 1⁄2% of line 3 (for greater amount, see
    instructions) .............................
    4
    64,565
    5
    Net value of noncharitable-use assets. Subtract line 4 from line 3. Enter here and on Part V, line 4
    5
    4,239,783
    6
    Minimum investment return. Enter 5% of line 5..................
    6
    211,989
    Part XI
    Distributable Amount bullet and do not complete this part.)
    1
    Minimum investment return from Part X, line 6....................
    1
    211,989
    2a
    Tax on investment income for 2012 from Part VI, line 5......
    2a
    1,789
    b
    Income tax for 2012. (This does not include the tax from Part VI.)...
    2b
     
    c
    Add lines 2a and 2b............................
    2c
    1,789
    3
    Distributable amount before adjustments. Subtract line 2c from line 1............
    3
    210,200
    4
    Recoveries of amounts treated as qualifying distributions................
    4
    0
    5
    Add lines 3 and 4............................
    5
    210,200
    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
    210,200
    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
    189,699
    b
    Program-related investments—total from Part IX-B..................
    1b
    0
    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
    189,699
    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
    0
    6
    Adjusted qualifying distributions. Subtract line 5 from line 4..............
    6
    189,699
    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 7 210,200
    2 Undistributed income, if any, as of the end of 2012:
    a Enter amount for 2011 only....... 55,734
    b Total for prior years:20, 20, 20 0
    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......... 0
    4Qualifying distributions for 2012 from Part
    XII, line 4: bullet$ 189,699
    a Applied to 2011, but not more than line 2a 55,734
    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 2012 distributable amount..... 133,965
    e Remaining amount distributed out of corpus 0
    5 Excess distributions carryover applied to 2012. 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 2011. Subtract line
    4a from line 2a. Taxable amount—see
    instructions .............     		0
    f Undistributed income for 2012. Subtract
    lines 4d and 5 from line 1. This amount must
    be distributed in 2013 ..........     		76,235
    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 2007 not
    applied on line 5 or line 7 (see instructions) ...     		0
    9Excess distributions carryover to 2013.
    Subtract lines 7 and 8 from line 6a ......     		0
    10 Analysis of line 9:
    a Excess from 2008....  
    b Excess from 2009....  
    c Excess from 2010....  
    d Excess from 2011....  
    e Excess from 2012....  
    Form 990-PF (2012)
    Form 990-PF (2012)
    Page 9
    Part XIV
    Private Operating Foundations (see instructions and Part VII-A, question 9)
    1a If the foundation has received a ruling or determination letter that it is a private operating
    foundation, and the ruling is effective for 2012, enter the date of the ruling.......bullet
     
    b Check box to indicate whether the organization is a private operating foundation described in section or
    2a Enter the lesser of the adjusted net
    income from Part I or the minimum
    investment return from Part X for each
    year listed ..........     		Tax year Prior 3 years (e) Total
    (a) 2012 (b) 2011 (c) 2010 (d) 2009
             
    b 85% of line 2a .........          
    c Qualifying distributions from Part XII,
    line 4 for each year listed .....     		         
    d Amounts included in line 2c not used directly
    for active conduct of exempt activities ....     		         
    e Qualifying distributions made directly
    for active conduct of exempt activities.
    Subtract line 2d from line 2c ....     		         
    3 Complete 3a, b, or c for the
    alternative test relied upon:
    a “Assets” alternative test—enter:
    (1) Value of all assets ......          
    (2) Value of assets qualifying
    under section 4942(j)(3)(B)(i)    		          
    b “Endowment” alternative test— enter 2⁄3
    of minimum investment return shown in
    Part X, line 6 for each year listed...     		         
    c “Support” alternative test—enter:
    (1) Total support other than gross
    investment income (interest,
    dividends, rents, payments
    on securities loans (section
    512(a)(5)), or royalties) ....     		         
    (2) Support from general public
    and 5 or more exempt
    organizations as provided in
    section 4942(j)(3)(B)(iii)....     		         
    (3) Largest amount of support
    from an exempt organization    		          
    (4) Gross investment income          
    Part XV
    Supplementary Information (Complete this part only if the organization had $5,000 or more in
    assets at any time during the year—see instructions.)
    1Information Regarding Foundation Managers:
    aList any managers of the foundation who have contributed more than 2% of the total contributions received by the foundation
    before the close of any tax year (but only if they have contributed more than $5,000). (See section 507(d)(2).)
    bList any managers of the foundation who own 10% or more of the stock of a corporation (or an equally large portion of the
    ownership of a partnership or other entity) of which the foundation has a 10% or greater interest.
    2Information Regarding Contribution, Grant, Gift, Loan, Scholarship, etc., Programs:
    Check here bullet
    aThe name, address, and telephone number or e-mail of the person to whom applications should be addressed:
    HARRY L ARKIN
    1660 LINCOLN ST SUITE 2830
    DENVER,CO80264
    (303) 836-8400
    bThe form in which applications should be submitted and information and materials they should include:
    APPLICATIONS MUST BE SUBMITTED IN A PRESCRIBED FORMAT DETERMINED BY THE FOUNDATION. PLEASE VISIT WWW.BURTFOUNDATION.ORG TO DOWNLOAD MOST RECENT GRANT MATERIALS AND APPLICATION FORM.
    cAny submission deadlines:
    THE FOUNDATION ACCEPTS GRANT APPLICATIONS AND APPROVES GRANTS TWICE A YEAR. PLEASE VISIT WWW.BURTFOU
    dAny restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other
    factors:
    NONE
    Form 990-PF (2012)
    Form 990-PF (2012)
    Page 10
    Part XV
    Supplementary Information (continued)
    3 Grants and Contributions Paid During the Year or Approved for Future Payment
    Recipient If recipient is an individual,
    show any relationship to
    any foundation manager
    or substantial contributor
    		 Foundation
    status of
    recipient     		Purpose of grant or
    contribution     		Amount
    Name and address (home or business)
    aPaid during the year
    TWO ANGLES FOUNDATION
    15801 WEST 66TH PLACE
    ARVADA,CO80007     		NONE PUBLIC GENERAL ASSISTANCE 1,000
    SAMARITAN COUNSELING CENTER
    PO BOX 122
    EDWARDS,CO81632     		NONE PUBLIC GENERAL ASSISTANCE 2,000
    TRIPS FOR KIDS DENVERBOULDER
    2840 S ELATI STREET 4
    ENGLEWOOD,CO80110     		NONE PUBLIC GENERAL ASSISTANCE 1,000
    COAL CREEK MEALS ON WHEELS
    1255 CENTAUR VILLAGE DRIVE
    LAFAYETTE,CO80026     		NONE PUBLIC GENERAL ASSISTANCE 2,500
    THE DELORES PROJECT
    PO BOX 1406
    DENVER,CO80201     		NONE PUBLIC GENERAL ASSISTANCE 2,500
    DOMESTIC VIOLENCE INITIATIVE FOR WOMEN WITH DISABILITIES
    PO BOX 300535
    DENVER,CO80203     		NONE PUBLIC GENERAL ASSISTANCE 2,500
    COLORADO MUSIC FESTIVAL & ROCKY MOUNTAIN CENTER FOR MUSICAL ARTS
    900 BASELINE ROAD COTTAGE 100
    BOULDER,CO80302     		NONE PUBLIC GENERAL ASSISTANCE 2,500
    ADAMS CAMP
    6767 S SPRUCE ST
    CENTENNIAL,CO80112     		NONE PUBLIC GENERAL ASSISTANCE 2,500
    ASSISTANCE LEAGUE OF COLO SPRINGS
    318 EAST CIMARRON STREET
    COLORADO SPRINGS,CO80903     		NONE PUBLIC GENERAL ASSISTANCE 2,500
    BAYAUD ENTERPRISES
    333 W BAYAUD AVENUE
    DENVER,CO80223     		NONE PUBLIC GENERAL ASSISTANCE 1,000
    BRENT ELEY FOUNDATION
    1721 MARION STREET
    DENVER,CO80218     		NONE PUBLIC GENERAL ASSISTANCE 2,500
    BROADWAY ASSISTANCE CENTER
    606 WEST 6TH AVENUE
    DENVER,CO80204     		NONE PUBLIC GENERAL ASSISTANCE 1,500
    CASA OF ADAMS COUNTY
    1100 JUDICIAL DRIVE
    BRIGHTON,CO80601     		NONE PUBLIC GENERAL ASSISTANCE 2,500
    CITY WILD
    PO BOX 883
    DENVER,CO80201     		NONE PUBLIC GENERAL ASSISTANCE 1,000
    COLORADO SYMPHONY
    999 18TH ST 2055
    DENVER,CO80202     		NONE PUBLIC GENERAL ASSISTANCE 2,500
    COMMUNITY MINISTRY
    1755 SOUTH ZUNI STREET
    DENVER,CO80223     		NONE PUBLIC GENERAL ASSISTANCE 1,000
    DENTAL AID
    4155 DARLEY AVE SUITE C
    BOULDER,CO80305     		NONE PUBLIC GENERAL ASSISTANCE 2,000
    DENVER KIDS INC
    1330 FOX ST
    DENVER,CO80204     		NONE PUBLIC GENERAL ASSISTANCE 5,000
    DENVER SANTA CLAUS SHOP
    PO BOX 102104
    DENVER,CO80250     		NONE PUBLIC GENERAL ASSISTANCEGENERAL ASSISTANCE 1,000
    DENVER SCHOLARSHIP FOUNDATION
    303 E 17TH AVENUE SUITE 200
    DENVER,CO80203     		NONE PUBLIC GENERAL ASSISTANCE 2,500
    EDUCATION FOUNDATION FOR THE COLORADO NATIONAL GUARD
    PO BOX 440889
    AURORA,CO80044     		NONE PUBLIC GENERAL ASSISTANCE 2,500
    FAMILIES FIRST
    2163 S YOSEMITE STREET
    DENVER,CO80231     		NONE PUBLIC GENERAL ASSISTANCE 2,500
    FAMILIES OF HOMICIDE VICTIMS & MISSING PERSONS
    1866 SO NEWTON ST
    DENVER,CO80219     		NONE PUBLIC GENERAL ASSISTANCE 2,900
    FAMILY HOMESTEADDENVER EMERG
    999 DECATUR ST
    DENVER,CO80204     		NONE PUBLIC GENERAL ASSISTANCE 2,500
    FLORENCE CRITTENTON SERVICES OF COLORADO
    55 SOUTH ZUNI STREET
    DENVER,CO80223     		NONE PUBLIC GENERAL ASSISTANCE 2,500
    GRIFFITH CENTERS FOR CHILDREN INC
    12163 PERRY PARK RD
    LARKSPUR,CO80118     		NONE PUBLIC GENERAL ASSISTANCE 2,500
    GROWING HOME
    3989 W 72ND AVE
    WESTMINSTER,CO80030     		NONE PUBLIC GENERAL ASSISTANCE 2,500
    HIGHER GROUND YOUTH CHALLENGE
    PO BOX 12145
    DENVER,CO80212     		NONE PUBLIC GENERAL ASSISTANCE 2,500
    INN BETWEEN OF LONGMONT
    250 KIMBARK STREET
    LONGMONT,CO80501     		NONE PUBLIC GENERAL ASSISTANCE 2,500
    LONGMONT MEALS ON WHEELS
    910 LONGS PEAK AVE
    LONGMONT,CO80501     		NONE PUBLIC GENERAL ASSISTANCE 2,000
    MARIA DROSTE SERVICES OF COLORADO
    1660 LINCOLN STREET
    DENVER,CO80264     		NONE PUBLIC GENERAL ASSISTANCE 2,500
    MESA YOUTH SERVICES
    1169 COLORADO AVENUE
    GRAND JUNCTION,CO81501     		NONE PUBLIC GENERAL ASSISTANCE 2,200
    METRO CARE RING
    PO BOX 300459
    DENVER,CO80203     		NONE PUBLIC GENERAL ASSISTANCE 2,500
    NORTH METRO CHILDREN'S ADVOCACY CTR
    2360 W 112TH AVENUE
    NORTHGLENN,CO80234     		NONE PUBLIC GENERAL ASSISTANCE 2,500
    OPEN DOOR MINISTRIES
    1530 MARION ST
    DENVER,CO80218     		NONE PUBLIC GENERAL ASSISTANCE 4,000
    PROVIDENCE NETWORK
    801 LOGAN STREET
    DENVER,CO80203     		NONE PUBLIC GENERAL ASSISTANCE 2,500
    SAFE HOUSE DENVER
    1649 DOWNING STREET
    DENVER,CO80218     		NONE PUBLIC GENERAL ASSISTANCE 2,500
    SAFE SHELTER OF ST VRAIN VALLEY
    PO BOX 231
    LONGMONT,CO80502     		NONE PUBLIC GENERAL ASSISTANCE 2,500
    SAVE OUR YOUTH
    3443 W 23RD AVENUE
    DENVER,CO80211     		NONE PUBLIC GENERAL ASSISTANCE 2,500
    SENIOR ASSISTANCE CENTER
    2839 WEST 44TH AVENUE
    DENVER,CO80211     		NONE PUBLIC GENERAL ASSISTANCE 1,000
    SENIOR HUB INC
    2360 WEST 90TH AVENUE
    FEDERAL HEIGHTS,CO80260     		NONE PUBLIC GENERAL ASSISTANCE 2,000
    SENIOR SUPPORT SERVICES
    846 EAST 18TH AVENUE
    DENVER,CO80218     		NONE PUBLIC GENERAL ASSISTANCE 2,000
    SUMMER SCHOLARS
    3401 QUEBEC ST
    DENVER,CO80207     		NONE PUBLIC GENERAL ASSISTANCE 2,500
    THE ADOPTION EXCHANGE
    14232 E EVANS AVENUE
    AURORA,CO80014     		NONE PUBLIC GENERAL ASSISTANCE 3,200
    THE ALZHEIMERS ASSOCIATION COLORADO CHAPTER
    455 SHERMAN STREET SUITE 500
    DENVER,CO80203     		NONE PUBLIC GENERAL ASSISTANCE 2,500
    THE RALSTON HOUSE
    10795 WEST 58TH AVENUE
    ARVADA,CO80002     		NONE PUBLIC GENERAL ASSISTANCE 5,000
    TRI-LAKES CARES
    PO BOX 1301
    MONUMENT,CO80132     		NONE PUBLIC GENERAL ASSISTANCE 2,500
    VOICES FOR CHILDREN
    2305 CANYON STREET 101
    BOULDER,CO80302     		NONE PUBLIC GENERAL ASSISTANCE 2,500
    WOMEN'S CRISIS CENTER AND FAMILY OUTREACH CENTER
    389 GILBERT ST
    CASTLE ROCK,CO80104     		NONE PUBLIC GENERAL ASSISTANCE 2,500
    YOUTH BIZ
    3535 LARIMER ST
    DENVER,CO80205     		NONE PUBLIC GENERAL ASSISTANCE 2,000
    LIFE CHOICES
    10259 NORTH WASHINGTON STREET
    THORNTON,CO80229     		NONE PUBLIC GENERAL ASSISTANCE 2,500
    VSA COLORADO
    909 SANTA FE DRIVE
    DENVER,CO80204     		NONE PUBLIC GENERAL ASSISTANCE 2,000
    PARTNERS IN HOUSING
    455 GOLD PASS HEIGHTS
    COLORADO SPRINGS,CO80906     		NONE PUBLIC GENERAL ASSISTANCE 2,000
    REVISION INTERNATIONAL
    3735 MORRISON RD
    DENVER,CO80219     		NONE PUBLIC GENERAL ASSISTANCE 2,250
    VARIETY THE CHILDREN'S CHARITY OF COLORADO
    10497 CENTENNIAL ROAD
    LITTLETON,CO80127     		NONE PUBLIC GENERAL ASSISTANCE 1,000
    ARVADA SUNRISE ROTARY CLUB FOUNDATION
    PO BOX 740144
    ARVADA,CO80006     		NONE PUBLIC GENERAL ASSISTANCE 2,500
    ATTENTION HOMES
    1443 SPRUCE ST
    BOULDER,CO80302     		NONE PUBLIC GENERAL ASSISTANCE 2,500
    BOULDER VALLEY WOMEN'S HEALTH CENTER
    2855 VALMONT ROAD
    BOULDER,CO80304     		NONE PUBLIC GENERAL ASSISTANCE 1,000
    CATHOLIC CHARITIES OF CENTRAL COLORADO
    228 N CASCADE AVENUE
    COLORADO SPRINGS,CO80903     		NONE PUBLIC GENERAL ASSISTANCE 1,000
    CHILDREN'S ADVOCACY CENTER FOR THE PIKES PEAK REGION
    423 S CASCADE AVENUE
    COLORADO SPRINGS,CO80903     		NONE PUBLIC GENERAL ASSISTANCE 1,700
    COLORADO I HAVE A DREAM FOUNDATION
    1836 GRANT STREET
    DENVER,CO80203     		NONE PUBLIC GENERAL ASSISTANCE 2,000
    COLORADO ORGANIZATION FOR LATINA OPPORTUNITY AND REPRODUCTIVE RIGHTS
    827 SHERMAN STREET
    DENVER,CO80203     		NONE PUBLIC GENERAL ASSISTANCE 2,000
    DOMINICAN SISTERS HOME HEALTH AGENCY
    2501 GAYLORD STREET
    DENVER,CO80205     		NONE PUBLIC GENERAL ASSISTANCE 2,500
    FOCUS POINTS FAMILY RESOURCE CENTER
    2501 E 48TH AVENUE
    DENVER,CO80216     		NONE PUBLIC GENERAL ASSISTANCE 2,500
    LONGS PEAK COUNCIL BOY SCOUTS OF AMERICA
    2215 23RD AVENUE
    GREELEY,CO80634     		NONE PUBLIC GENERAL ASSISTANCE 2,500
    MARION DOWNS HEARING CENTER FOUNDATION
    1793 QUENTIN ST UNIT 2
    AURORA,CO80045     		NONE PUBLIC GENERAL ASSISTANCE 1,000
    THE MEMORIAL HOSPITAL FOUNDATION
    PO BOX 1203
    CRAIG,CO81626     		NONE PUBLIC GENERAL ASSISTANCE 2,000
    A PRECIOUS CHILD
    557 BURBANK ST UNIT E
    BROOMFIELD,CO80020     		NONE PUBLIC GENERAL ASSISTANCE 2,500
    SENSE OF SECURITY
    1385 S COLORADO BLVD SUITE A-302
    DENVER,CO80222     		NONE PUBLIC GENERAL ASSISTANCE 1,000
    SWAN CENTER OUTREACH INC
    PO BOX 25749
    SILVERTHORNE,CO80497     		NONE PUBLIC GENERAL ASSISTANCE 2,200
    TELLURIDE ACADEMY
    300 S MAHONEY DR C-8
    TELLURIDE,CO81435     		NONE PUBLIC GENERAL ASSISTANCE 1,000
    TRANSFORMATIONAL LEADERSHIP FORUM
    6279 S IOLA WAY
    ENGLEWOOD,CO80111     		NONE PUBLIC GENERAL ASSISTANCE 4,500
    VIA MOBILITY SERVICES
    2855 NORTH 63RD STREET
    BOULDER,CO80301     		NONE PUBLIC GENERAL ASSISTANCE 2,500
    WESTERN SLOPE CENTER FOR CHILDREN
    259 GRAND AVENUE
    GRAND JUNCTION,CO80152     		NONE PUBLIC GENERAL ASSISTANCE 2,500
    HUMANE SOCIETY OF THE PIKES PEAK REGION
    610 ABBOT LANE
    COLORADO SPRINGS,CO80905     		NONE PUBLIC GENERAL ASSISTANCE 1,250
    Total .................................bullet 3a 168,200
    bApproved for future payment
    Total .................................bullet 3b 0
    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 25,196  
    4 Dividends and interest from securities....     14 75,478  
    5 Net rental income or (loss) from real estate:
    aDebt-financed property......          
    bNot debt-financed property.....     16 35,365  
    6Net rental income or (loss) from personal property          
    7 Other investment income.....          
    8Gain or (loss) from sales of assets other than inventory     18 -62,567  
    9 Net income or (loss) from special events:          
    10 Gross profit or (loss) from sales of inventory..          
    11 Other revenue: a
    b
    c
    d
    e
    12 Subtotal. Add columns (b), (d), and (e).. 0 73,472 0
    13Total. Add line 12, columns (b), (d), and (e)..................
    1373,472
    (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
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    Signature of officer or trustee Date Title
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    Form 990-PF (2012)
    Additional Data


    Software ID:  
    Software Version:  


    Form 990PF - Special Condition Description:
    Special Condition Description

    TY 2012 AccountingFeesSchedule
    Name:
    NATHAN B& FLORENCE R BURT FOUNDATION
    EIN: 84-0972203
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    ACCOUNTING 2,660 1,197   1,463

    TY 2012 InvestmentsCorpStockSchedule
    Name:
    NATHAN B& FLORENCE R BURT FOUNDATION
    EIN: 84-0972203
    Name of Stock End of Year Book Value End of Year Fair Market Value
    BOEING CO 48,658 117,500
    ELI LILLY & CO 12,463 50,330
    VERIZON COMMUNICATIONS 131,188 189,982
    CHEVRONTEXACO CORP 33,412 187,110
    HCP, INC. 10,871 31,941
    CONAGRA 19,204 24,272
    FORTUNE BRANDS, INC. 4,361 41,630
    MOTOROLA SOLUTIONS 10,293 10,154
    XCEL ENERGY 10,958 12,839
    INTEL CORP 83,294 91,684
    ALLIANT ENERGY 4,592 39,541
    GLAXO WELCOME PLC 56,129 50,170
    CONOCOPHILLIPS 73,179 111,216
    BP PLC SPONS ADR 40,469 42,030
    MCDONALDS 23,053 96,210
    SARA LEE CORP 0 0
    DEAN FOODS CO 15,974 19,300
    GOOD TIMES RESTAURANTS, INC 0 0
    ALLSTATE CORP 55,175 50,550
    JP MORGAN CHASE & CO 41,883 51,690
    CENTURYLINK 57,288 36,526
    ACCO BRANDS (UNIT CORP) 9,060 232,450
    FLEXTRONICS INTL 0 0
    MEDTRONIC INC 25,423 26,625
    BERKSHIRE HATHAWAY 36,693 56,755
    FRONTIER COMMUNICATIONS 8,118 4,079
    BRISTOL MYERS SQUIB 16,878 23,140
    MERCK & CO NEW 17,988 23,805
    WESTERN ASSET GOV MM FD 12,853 12,853
    HILLSHIRE BRANDS 5,084 6,148
    WHITEWAVE FOODS CORP 17,740 24,703
    PHILLIPS 66 4,625 46,256
    BEAM, INC 15,684 64,650

    TY 2012 InvestmentsGovtObligationsSch
    Name:
    NATHAN B& FLORENCE R BURT FOUNDATION
    EIN: 84-0972203
    US Government Securities - End of Year Book Value:

    100,000
    US Government Securities - End of Year Fair Market Value:

    105,137
    State & Local Government Securities - End of Year Book Value:


    0
    State & Local Government Securities - End of Year Fair Market Value:


    0


    TY 2012 InvestmentsLandSchedule2
    Name:
    NATHAN B& FLORENCE R BURT FOUNDATION
    EIN: 84-0972203
    Category/ Item Cost/Other Basis Accumulated Depreciation Book Value End of Year Fair Market Value
    LAND - 3100 SO BROADWAY, ENGLEWOOD, CO 42,326 0 42,326 42,326
    BUILDING - 3100 SO BROADWAY, ENGLEWOOD, CO 25,174 0 25,174 25,174

    TY 2012 InvestmentsOtherSchedule2
    Name:
    NATHAN B& FLORENCE R BURT FOUNDATION
    EIN: 84-0972203
    Category/ Item Listed at Cost or FMV Book Value End of Year Fair Market Value
    WESTERN ASSET ADJ RATE INC. C1 AT COST 141,641 129,904
    WESTERN ASSET GLBL STRAT INC A AT COST 315,788 299,208
    RUSSELL FUNDS - QUANTITATIVE EQUITY AT COST 0 0
    SHORT TERM BOND AT COST 0 0
    RUSSELL FUNDS - FIDELITY MUNI MONEY MARKET AT COST 0 0
    RUSSELL GLOBAL EQUITY CLASS AT COST 0 0
    FRANK RUSSELL EMERG MARKETS AT COST 0 0
    FRANK RUSSELL REAL ESTATE SECS AT COST 0 0
    FRANK RUSSELL SMALL AND MID AT COST 0 0
    PIMCO ALL ASSETS INS AT COST 0 0
    PIMCO COMMODITY REAL RETURN AT COST 0 0
    PIMCO EMERGING LOCAL BOND AT COST 0 0
    SEI EMERGING MARKET DEBT AT COST 0 0
    ISHARES TR RUSSELL 1000 AT COST 0 0
    PIMCO HIGH YIELD INSTL AT COST 0 0
    JP MORGAN CHASE & CO GLOBAL MTN AT COST 0 0
    PIMCO EMERGING MARKETS & INTRST BD AT COST 0 0
    GLOBAL INFRASTRUCTURE AT COST 0 0
    ISHARES TR MSCI EAFE INDEX AT COST 0 0
    US DEFENSIVE EQUITY CLASS S AT COST 0 0
    STRATEGIC CALL OVERWRITING FD AT COST 0 0
    JP MORGAN CHASE & CO MTN AT COST 0 0
    DEUTSCHE BK AG GLBL AT COST 0 0
    KINDER MORGAN ENERGY PARTNERS AT COST 80,537 79,830

    TY 2012 OtherExpensesSchedule
    Name:
    NATHAN B& FLORENCE R BURT FOUNDATION
    EIN: 84-0972203
    Description Revenue and Expenses per Books Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    INSURANCE 1,170 761   409
    TELEPHONE 766 306   460
    MEETINGS 1,860 745   1,115
    OFFICE SUPPLIES 1,543 629   914
    WEBSITE 704 282   423
    BANK CHARGES 161 121   40


    TY 2012 OtherLiabilitiesSchedule
    Name:
    NATHAN B& FLORENCE R BURT FOUNDATION
    EIN: 84-0972203
    Description Beginning of Year - Book Value End of Year - Book Value
    PAYROLL TAXES PAYABLE 446 470


    TY 2012 OtherProfessionalFeesSchedule
    Name:
    NATHAN B& FLORENCE R BURT FOUNDATION
    EIN: 84-0972203
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    H.L.ARKIN-INVESTMENT FEES 25,066 25,066   0
    RUSSELL FUNDS-INVESTMENT FEES 3,827 3,827   0


    TY 2012 TaxesSchedule
    Name:
    NATHAN B& FLORENCE R BURT FOUNDATION
    EIN: 84-0972203
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    PAYROLL TAXES 2,718 1,223   1,495
    FEDERAL EXCISE TAX 1,654 0   0