Form990-PF
Click to see attachment

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
BLANCHE FISCHER FOUNDATION
 

Number and street (or P.O. box number if mail is not delivered to street address)1509 SW SUNSET BLVD NO 1-B   Room/suite
City or town, state or province, country, and ZIP or foreign postal code
PORTLAND, OR97239
A Employer identification number

93-0790099
B Telephone number (see instructions)

(503) 246-4921
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$1,898,763J 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...... 33,781 33,781 33,781
5a Gross rents..............      
b Net rental income or (loss)  
6a Net gain or (loss) from sale of assets not on line 10 70,889
b Gross sales price for all assets on line 6a 309,262
7 Capital gain net income (from Part IV, line 2)... 70,889
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 38,916 38,916 38,916
12 Total. Add lines 1 through 11........ 143,586 143,586 72,697
Operating and Administrative Expenses 13 Compensation of officers, directors, trustees, etc. 0 0 0 0
14 Other employee salaries and wages...... 18,534 0 18,534 18,534
15 Pension plans, employee benefits.......        
16a Legal fees (attach schedule).........        
b Accounting fees (attach schedule)....... Click to see attachment 1,870 623 1,247 1,247
c Other professional fees (attach schedule).... Click to see attachment 19,709 18,629 1,080 1,080
17 Interest...............        
18 Taxes (attach schedule) (see instructions) Click to see attachment 4,032 2,143 1,889 1,889
19 Depreciation (attach schedule) and depletion...      
20 Occupancy.............. 7,082 0 7,082 7,082
21 Travel, conferences, and meetings....... 796 0 796 796
22 Printing and publications..........        
23 Other expenses (attach schedule)....... Click to see attachment 5,128 11 5,117 5,117
24 Total operating and administrative expenses.
Add lines 13 through 23.......... 57,151 21,406 35,745 35,745
25 Contributions, gifts, grants paid........ 37,117 37,117
26 Total expenses and disbursements. Add lines 24 and 25 94,268 21,406 35,745 72,862
27 Subtract line 26 from line 12:
a Excess of revenue over expenses and disbursements 49,318
b Net investment income (if negative, enter -0-) 122,180
c Adjusted net income (if negative, enter -0-)... 36,952
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............... -1,595 675 675
2 Savings and temporary cash investments.......... 29,461 62,427 62,427
3 Accounts receivable bullet  
Less: allowance for doubtful accounts bullet   14,374    
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 bullet        
8 Inventories for sale or use...............      
9 Prepaid expenses and deferred charges...........      
10a Investments—U.S. and state government obligations (attach schedule)      
b Investments—corporate stock (attach schedule)........ 1,340,983 Click to see attachment1,368,406 1,605,194
c Investments—corporate bonds (attach schedule)........      
11 Investments—land, buildings, and equipment: basis bullet  
Less: accumulated depreciation (attach schedule) bullet        
12 Investments—mortgage loans..............      
13 Investments—other (attach schedule)........... 227,700 Click to see attachment227,700 227,700
14 Land, buildings, and equipment: basis bullet9,611
Less: accumulated depreciation (attach schedule) bullet9,611      
15 Other assets (describe bullet) Click to see attachment2,767 Click to see attachment2,767 Click to see attachment2,767
16 Total assets (to be completed by all filers—see the
instructions. Also, see page 1, item I) 1,613,690 1,661,975 1,898,763
Liabilities 17 Accounts payable and accrued expenses.......... 4,018 2,985
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).......... 4,018 2,985
Net Assets or Fund Balances bullet
and complete lines 24 through 26 and lines 30 and 31.
24 Unrestricted.................... 1,609,672 1,658,990
25 Temporarily restricted................    
26 Permanently restricted................    
bullet
and complete lines 27 through 31.
27 Capital stock, trust principal, or current funds.........    
28 Paid-in or capital surplus, or land, bldg., and equipment fund    
29 Retained earnings, accumulated income, endowment, or other funds    
30 Total net assets or fund balances (see page 17 of the
instructions).................... 1,609,672 1,658,990
31 Total liabilities and net assets/fund balances (see page 17 of
the instructions).................. 1,613,690 1,661,975
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 1,609,672
2 Enter amount from Part I, line 27a..................... 2 49,318
3 Other increases not included in line 2 (itemize) bullet 3 0
4 Add lines 1, 2, and 3.......................... 4 1,658,990
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 1,658,990
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 42.368 SSGE EMERGING MKTS P 2013-03-07 2013-07-22
b 1515.826 ALLIANZGI NFJ DIV P 2011-03-07 2013-07-22
c 1473.152 AMER CENT MID CAP VALUE P 2011-03-07 2013-07-22
d 547.919 INVERSE SM CAP GROWTH P 2011-03-07 2013-07-22
e 1462.584 JANUS GROWTH & INCOME P 2011-03-07 2013-07-22
276.494 NEABERGER BERMON RE TRUST P 2011-03-07 2013-05-23
8576.356 PIMCO STOCKPLUS ABSOLUTE P 2011-03-07 2013-07-22
2481.965 SSGA EMERGING MKTS P 2011-03-07 2013-07-22
40.59 THOMAS WHITE INT'L P 2011-03-07 2013-05-23
693.495 WELLS FARGO UTILITY & TELECOMM P 2011-03-07 2013-07-22
CAPITAL GAINS 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 797   815 -18
b 22,176   18,018 4,158
c 22,664   19,196 3,468
d 20,128   17,234 2,894
e 59,017   47,115 11,902
4,117   3,244 873
89,224   68,829 20,395
46,711   54,576 -7,865
757   716 41
11,279   8,630 2,649
32,392     32,392
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       -18
b       4,158
c       3,468
d       2,894
e       11,902
      873
      20,395
      -7,865
      41
      2,649
      32,392
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 70,889
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 -18
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 69,054 1,615,055 0.042756
2011 84,614 1,603,146 0.052780
2010 55,032 1,477,644 0.037243
2009 74,052 1,359,129 0.054485
2008 98,240 1,730,641 0.056765
2 Total of line 1, column (d) ...................... 2 0.244029
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 0.048806
4 Enter the net value of noncharitable-use assets for 2013 from Part X, line 5..... 4 1,763,828
5 Multiply line 4 by line 3....................... 5 86,085
6 Enter 1% of net investment income (1% of Part I, line 27b)........... 6 1,222
7 Add lines 5 and 6......................... 7 87,307
8 Enter qualifying distributions from Part XII, line 4.............. 8 72,862
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 2,444
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 2,444
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 2,444
6 Credits/Payments:
a 2013 estimated tax payments and 2012 overpayment credited to 2013 6a 1,440
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 1,440
8 Enter any penalty for underpayment of estimated tax. if Form 2220 is attached. 8  
9 Tax due. If the total of lines 5 and 8 is more than line 7, enter amount owed.......Bullet 9 1,004
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 taxBullet   RefundedBullet 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)
    bulletOR
    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
    Yes
     
    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.BFF.ORG
    14
    The books are in care ofbulletMICHAEL MILLHOLLEN Telephone no.bullet (503) 936-7746
    Located atbullet1509 SW SUNSET BLVD 1-BPORTLANDOR ZIP+4bullet97239
    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
     
    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 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
     
     
    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
    KIRT TOOMBS PRESIDENT
    2.00     		0 0 0
    C/O BLANCHE FISCHER FDN 1509 SW
    SUNSET BLVD 1-B
    PORTLAND,OR97239
    MICHAEL MILLHOLLEN TREASURER
    4.00     		0 0 0
    C/O BLANCHE FISCHER FDN 1509 SW
    SUNSET BLVD 1-B
    PORTLAND,OR97239
    GINNY BAYNES SECRETARY
    2.00     		0 0 0
    C/O BLANCHE FISCHER FDN 1509 SW
    SUNSET BLVD 1-B
    PORTLAND,OR97239
    CATHY SANDERS GRANT CHAIR
    2.00     		0 0 0
    C/O BLANCHE FISCHER FDN 1509 SW
    SUNSET BLVD 1-B
    PORTLAND,OR97239
    AARON JOINER DIRECTOR
    1.00     		0 0 0
    C/O BLANCHE FISCHER FDN 1509 SW
    SUNSET BLVD 1-B
    PORTLAND,OR97239
    STACEY HASSEL DIRECTOR
    1.00     		0 0 0
    C/O BLANCHE FISCHER FDN 1509 SW
    SUNSET BLVD 1-B
    PORTLAND,OR97239
    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 CHARITABLE ACTIVITIES CONSIST SOLELY OF GIVING MONEY TO OR FOR DISABLED OR PHYSICALLY HANDICAPPED PEOPLE SHOWING FINANCIAL NEED IN THE STATE OF OREGON. 35,745
    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.........................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
     
    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
     
    2a
    Tax on investment income for 2013 from Part VI, line 5......
    2a
     
    b
    Income tax for 2013. (This does not include the tax from Part VI.)...
    2b
     
    c
    Add lines 2a and 2b............................
    2c
     
    3
    Distributable amount before adjustments. Subtract line 2c from line 1............
    3
     
    4
    Recoveries of amounts treated as qualifying distributions................
    4
     
    5
    Add lines 3 and 4............................
    5
     
    6
    Deduction from distributable amount (see instructions).................
    6
     
    7
    Distributable amount as adjusted. Subtract line 6 from line 5. Enter here and on Part XIII,
    line 1................................
    7
     
    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  
    2 Undistributed income, if any, as of the end of 2013:
    a Enter amount for 2012 only.......  
    b Total for prior years:20, 20, 20  
    3 Excess distributions carryover, if any, to 2013:
    a From 2008.......  
    b From 2009.......  
    c From 2010.......  
    d From 2011.......  
    e From 2012.......  
    fTotal of lines 3a through e.........  
    4Qualifying distributions for 2013 from Part
    XII, line 4: bullet$  
    a Applied to 2012, but not more than line 2a  
    b Applied to undistributed income of prior years
    (Election required—see instructions)......     		 
    c Treated as distributions out of corpus (Election
    required—see instructions).........     		 
    d Applied to 2013 distributable amount.....  
    e Remaining amount distributed out of corpus  
    5 Excess distributions carryover applied to 2013.    
    (If an amount appears in column (d), the
    same amount must be shown in column (a).)
    6Enter the net total of each column as
    indicated below:
    a Corpus. Add lines 3f, 4c, and 4e. Subtract line 5  
    b Prior years’ undistributed income. Subtract
    line 4b from line 2b ...........     		 
    c Enter the amount of prior years’ undistributed
    income for which a notice of deficiency has
    been issued, or on which the section 4942(a)
    tax has been previously assessed......     		 
    d Subtract line 6c from line 6b. Taxable amount
    —see instructions ...........     		 
    e Undistributed income for 2012. Subtract line
    4a from line 2a. Taxable amount—see
    instructions .............     		 
    f Undistributed income for 2013. Subtract
    lines 4d and 5 from line 1. This amount must
    be distributed in 2014 ..........     		 
    7 Amounts treated as distributions out of
    corpus to satisfy requirements imposed by
    section 170(b)(1)(F) or 4942(g)(3) (see
    instructions) .............     		 
    8Excess distributions carryover from 2008 not
    applied on line 5 or line 7 (see instructions) ...     		 
    9Excess distributions carryover to 2014.
    Subtract lines 7 and 8 from line 6a ......     		 
    10 Analysis of line 9:
    a Excess from 2009....  
    b Excess from 2010....  
    c Excess from 2011....  
    d Excess from 2012....  
    e Excess from 2013....  
    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
    36,952 16,218 5,407 73,882 132,459
    b 85% of line 2a ......... 31,409 13,785 4,596 62,800 112,590
    c Qualifying distributions from Part XII,
    line 4 for each year listed .....     		72,862 69,054 90,099 55,032 287,047
    d Amounts included in line 2c not used
    directly for active conduct of exempt activities ...........     		0 0 0 0 0
    e Qualifying distributions made directly
    for active conduct of exempt activities.
    Subtract line 2d from line 2c ....     		72,862 69,054 90,099 55,032 287,047
    3 Complete 3a, b, or c for the
    alternative test relied upon:
    a “Assets" alternative test—enter:
    (1) Value of all assets ......         0
    (2) Value of assets qualifying
    under section 4942(j)(3)(B)(i)    		         0
    b “Endowment" alternative test— enter 2/3
    of minimum investment return shown in
    Part X, line 6 for each year listed...     		58,794 53,835 53,438 49,255 215,322
    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) ....     		        0
    (2) Support from general public
    and 5 or more exempt
    organizations as provided in
    section 4942(j)(3)(B)(iii)....     		        0
    (3) Largest amount of support
    from an exempt organization    		         0
    (4) Gross investment income         0
    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 address of the person to whom applications should be addressed:
    BLANCHE FISCHER FOUNDATION
    1509 SW SUNSET BLVD 1-B
    PORTLAND,OR97239
    (503) 246-4921
    bThe form in which applications should be submitted and information and materials they should include:
    PER APPLICATION - SEE COPY OF APPLICATION ATTACHED
    cAny submission deadlines:
    NONE
    dAny restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other
    factors:
    APPLICANTS MUST HAVE DISABILITIES OF A PHYSICAL NATURE AND DEMONSTRATE FINANCIAL NEED WHILE RESIDING IN THE STATE OF OREGON.
    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
    ADOW QASSIM
    280 SE 12TH AVE 102
    HILLSBORO,OR97123     		NONE N/A BUS PASS 432
    ADOW QASSIM
    280 SE 12TH AVE 102
    HILLSBORO,OR97123     		NONE N/A TALKING SCALE 60
    APONTE NOEL
    20726 ALAN A DALE CT
    BEND,OR97702     		NONE N/A COMPUTER 957
    BIXBY ROCKY
    18126 SW 133RD
    TUALATIN,OR97062     		NONE N/A DRAGON DICTATE 172
    BROMLEY JAY
    340 SW RIMROCK WAY 68
    REDMOND,OR97556     		NONE N/A WHEELCHAIR BATTERIES/TIRES 322
    BURKE EMILY
    127 SE WILSON ST
    BEND,OR97702     		NONE N/A LAPTOP, PRINTER 359
    BURT BRADEN
    16932 SE PINE
    PORTLAND,OR97233     		NONE N/A IPAD 598
    BURT GAGE
    16932 SE PINE
    PORTLAND,OR97233     		NONE N/A IPAD & APPS 607
    BURT JACKSON
    16932 SE PINE
    PORTLAND,OR97233     		NONE N/A IPAD & APPS 607
    COOPER JEFF
    1310 ORCHARD HEIGHTS RD 1310
    SALEM,OR97304     		NONE N/A COMPUTER HARDWARE 994
    CREIGHTON PAMELA
    800 VALLEY VIEW RD
    TALENT,OR97540     		NONE N/A FUEL PUMP 162
    CREIGHTON PAMELA
    800 VALLEY VIEW RD
    TALENT,OR97540     		NONE N/A ELECTRIC BILL 695
    DAVEE TARA
    1950 2ND ST D104
    SPRINGFIELD,OR97477     		NONE N/A COMPRESSION GARMENTS 740
    DIAZ-GUITIERREZ JOSE
    12365 SW CONESTOGA DR 50
    BEAVERTON,OR97008     		NONE N/A BUS PASS 864
    DURAN JOHN DAVID
    5824 NE 42ND AVE
    PORTLAND,OR97218     		NONE N/A COMPUTER 1,000
    FIELDS JOY
    3113 BRISTOL AVE 26
    KLAMATH FALLS,OR97601     		NONE N/A COMPRESSION GARMENTS 365
    FISCHER KELLY
    2400 NE 27TH DR 103
    GRESHAM,OR97030     		NONE N/A ORTHOPEDIC SHOES 180
    FRAELICH NICHOLAS
    8718 SE 92ND
    HAPPY VALLEY,OR97086     		NONE N/A LAPTOP, RECORDER 568
    GAINES CHARLES
    732 SE JACKSON ST 10
    ROSEBURG,OR97470     		NONE N/A RENT ASSISTANCE 800
    GLISAN SONRISA
    5925 SE 128TH AVE
    PORTLAND,OR97236     		NONE N/A RENT ASSISTANCE 900
    GRITTERS KIM
    6909 SE ALBERTA ST
    PORTLAND,OR97206     		NONE N/A RAMP 360
    GUSTAFSON NANCY
    1655 NE HOYT TERR
    GRESHAM,OR97230     		NONE N/A SHOWER CHAIR 1,000
    HANLON NICHOLE
    410 NE OAK ST B15
    MADRAS,OR97741     		NONE N/A TRAILER FOR WHEELCHAIR 500
    HANLON NICHOLE
    410 NE OAK ST B15
    MADRAS,OR97741     		NONE N/A SWITCHES 324
    HASSEL GARRETT
    1696 SW BONNIE JEAN PL
    MCMINNVILLE,OR97128     		NONE N/A POWERCHAIR COPAY 1,000
    HUSSEIN ABDIKADIR
    12568 RAMONA ST
    PORTLAND,OR97236     		NONE N/A IPAD & APPS 688
    JOHNSTON PETER
    1665 OAK PATCH RD
    EUGENE,OR97402     		NONE N/A DENTAL 780
    KERNES MICHELLE
    377 W 8TH AVE 203
    EUGENE,OR97401     		NONE N/A SERVICE DOG TRAINING 960
    KONONEN KATIE
    1310 ORCHARD HEIGHTS RD 1310
    SALEM,OR97304     		NONE N/A DENTAL 1,000
    LANDERS JONMICHAEL
    324 SE 79TH AVE
    PORTLAND,OR97215     		NONE N/A COMPUTER, MONITOR 757
    LANE ANTHONY
    8008 SE TETON DR
    GRESHAM,OR97080     		NONE N/A HIPPOTHERAPY 1,000
    MARTIN MINTA
    10 N 5TH ST
    LEBANON,OR97355     		NONE N/A IPAD 599
    MEEKINS JORDAN
    PO BOX 514
    HALSEY,OR97348     		NONE N/A SCHOOL EXPENSES 1,000
    MENDELL RHONDA
    91473 INDIAN CREEK RD
    SWISS HOME,OR97480     		NONE N/A ORTHOTICS 296
    MOHAMED ABDI
    280 SE 12TH B507
    HILLSBORO,OR97123     		NONE N/A HAND CONTROLS 628
    MORROW DAVID
    6404 SE 23RD AVE 205
    PORTLAND,OR97202     		NONE N/A WHEELCHAIR LIFT 988
    NEIN MCKENZIE
    PO BOX 3333
    BEND,OR97708     		NONE N/A BRAIN TRAINING PROGRAM 493
    NICHOLSON JAKOB
    1206 SE 163RD PL
    PORTLAND,OR97211     		NONE N/A WINDOW FOR VENTILATION 950
    OLSEN LINDA
    3802 HAYES ST 214
    NEWBERG,OR97312     		NONE N/A MOBILITY DEVICES 891
    OWEN JORDAN
    61089 LARKSPUR LOOP
    BEND,OR97702     		NONE N/A BEHAVIOR MOD. EQUIPMENT 276
    OWEN LAWRENCE
    PO BOX 1015
    DRAIN,OR97405     		NONE N/A SCOOTER MOUNT 750
    PATTERSON ELEANOR
    1293 HWY 99 N 4
    EUGENE,OR97402     		NONE N/A COMPRESSION GARMENTS 960
    PERDUR DEBRA
    1062 MAIN ST 4
    SPRINGFIELD,OR97477     		NONE N/A SERVICE DOG TRAINING 400
    PLUNK TANYA
    5235 NE 25TH
    PORTLAND,OR97211     		NONE N/A COMPRESSION GARMENTS 740
    PORTER BILLIE
    763 NE TIERRA RD
    BEND,OR97701     		NONE N/A SCOOTER MOUNT 1,000
    PURCELL COLLETTE
    1278 SW 5TH AVE
    ONTARIO,OR97914     		NONE N/A COMPRESSION GARMENTS 1,000
    QUINTERO RITA
    1278 SW 5TH AVE
    ONTARIO,OR97914     		NONE N/A POOL PASS 246
    QUINTERO RITA
    1278 SW 5TH AVE
    ONTARIO,OR97914     		NONE N/A SWIM SUIT 50
    RAY STORMY
    715 CANYON 2 RD
    ONTARIO,OR97914     		NONE N/A TRANSPORTATION 256
    RAY STORMY
    715 CANYON 2 RD
    ONTARIO,OR97914     		NONE N/A VAN DOOR REPAIR 524
    RONINGER LOGAN
    34927 SUMMERTREE LANE
    CHILOQUIN,OR97624     		NONE N/A THRESHOLD RAMPS 474
    SHANE KEIRA
    200 SW FLORENCE AVE D4
    GRESHAM,OR97080     		NONE N/A HIPPOTHERAPY 1,000
    SOUTHWORTH JEFFREY
    2606 NE LONGFELLOW CT
    BEND,OR97701     		NONE N/A IPAD & APPS 724
    TATOM MARK
    1712 21ST AVE
    FOREST GROVE,OR97116     		NONE N/A ARM PROTHESIS 862
    TREAT BRANDON
    39 NE 102ND 40
    PORTLAND,OR97220     		NONE N/A CELL PHONE & SERVICE 430
    VANDEHEY DAMON
    2095 SE CURRIN LN
    HILLSBORO,OR97123     		NONE N/A SCREEN READER 614
    VELLA MICHELE
    2539 WILLAKENZIE RD 2
    EUGENE,OR97402     		NONE N/A DEHUMIDIFIER 378
    WARD EUNICE
    2219 RADCLIFF AVE
    KLAMATH FALLS,OR97601     		NONE N/A RAMP 600
    WILSON SANDRA
    1633 NE 127TH AVE
    PORTLAND,OR97220     		NONE N/A EXERCISE EQUIPMENT 237
    Total .................................bullet 3a 37,117
    bApproved for future payment
    Total .................................bullet 3b 0
    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....         33,781
    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.....         38,916
    8
    Gain or (loss) from sales of assets other than inventory .............     		        70,889
    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 0 143,586
    13Total. Add line 12, columns (b), (d), and (e)..................
    13143,586
    (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.)
    3 THIS ORGANIZATION ENGAGES IN NO SERVICE PER SE, AND SEEKS NO
    4 CONTRIBUTIONS. IT MAINTAINS ITS INVESTMENTS AND FROM THAT SOURCE
    7 OBTAINS THE FUNDS THAT IT PAYS OUT TO OR FOR QUALIFYING APPLICANTS
    11 AND CHARITABLE ORGANIZATIONS, WHICH ALSO HAVE 501(C) (3) STATUS.
    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:
    BLANCHE FISCHER FOUNDATION
    EIN: 93-0790099
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    ACCOUNTING 1,870 623 1,247 1,247

    TY 2013 GeneralExplanationAttachment
    Name:
    BLANCHE FISCHER FOUNDATION
    EIN: 93-0790099
    Identifier Return Reference Explanation
    INVESTMENTS IN CORPORATE STOCK FORM 990-PF PART II LINE 10B FORM 990-PF - BLANCHE FISCHER FOUNDATIONFID # 93-0790099 2013SCHEDULE A BEG OF YEAR END OF YEARPART II LINE 10B, INVESTMENTS IN CORPORATE STOCK BOOK VALUE BOOK VALUE MKT. VALUE 9340.845 ALLIANZ NFJ DIVIDEND VALUE FD 126573.31 111707.44 149360.117282.613 AMERICAN CENTURY MID CAP VALUE 106656.24 95516.84 114555.505082.443 ARTISAN INTERNATIONAL INVESTOR 88040.58 118879.10 154912.865862.843 CREDIT SUISSE COMMD RTRN STRTGY 57146.71 57146.71 42388.354381.671 GATEWAY FUND 97276.83 117406.90 127068.462131.218 INVESCO SMALL CAP GROWTH 80508.01 67690.59 87316.003794.849 JANUS GROWTH AND INCOME 167457.74 122937.99 168756.948855.206 LAZARD EMERG MRKT EQUITY BLEND 0.00 92636.06 96678.656842.737 MERGER FUND 72143.42 108650.71 109552.225981.431 NEUBERGER BERMAN REAL ESTATE 68635.74 70862.05 75545.4725250.693 PIMCO STOCKSPLUS TOTAL RETURN 247214.49 210368.37 252506.932481.965 SSGA EMERGING MARKETS 55391.54 0.00 0.007582.53 THOMAS WHITE INTERNATIONL 107638.96 134971.04 148010.994742.837 WELLS FARGO UTILITY & TELECOMM 66299.15 59632.64 78541.38 340982.72 1368406.44 1605193.86
    SUPPLEMENTARY INFORMATION - COPY OF APPLICATION FORM 990-PF PART XV LINE 2B BLANCHEFISCHERFOUNDATION1509 S.W. SUNSET BLVD., SUITE 1-BPORTLAND, OR 97239PHONE: 503.819.8205E-MAIL: BFF@BFF.ORG WEB: WWW.BFF.ORGTHE BLANCHE FISCHER FOUNDATION IS A PRIVATE, NONPROFIT CHARITABLE INSTITUTION FOUNDED IN 1981 FOR THE PURPOSE OF ASSISTING PERSONS WHO HAVE A DISABILITY THAT CHALLENGES THEM PHYSICALLY AND WHO HAVE FINANCIAL NEED. THERE ARE THREE CRITERIA FOR CONSIDERATION FOR A GRANT FROM THE FOUNDATION:1. YOU MUST BE AN OREGON RESIDENT;2. YOU MUST HAVE A DISABILITY OF A PHYSICAL NATURE; AND3. YOU MUST DEMONSTRATE FINANCIAL NEED.APPLICANTS MAY APPLY FOR FINANCIAL AID FOR EDUCATION, SPECIAL EQUIPMENT OR FOR SUCH OTHER PURPOSES AS THE FOUNDATION FINDS APPROPRIATE.PLEASE NOTE.. THE APPLICATION MUST BE FILLED OUT COMPLETELY AND SIGNED BY THE APPLICANT OR APPLICANT'S LEGAL GUARDIAN... MEDICAL OR OTHER SATISFACTORY VERIFICATION OF DISABILITY (LETTER FROM PHYSICIAN OR OTHER HEALTH CARE PROFESSIONAL) IS REQUIRED... WE DO NOT ACCEPT FAXED APPLICATIONS. YOU MUST MAIL THE ORIGINAL, ALONG WITH DOCUMENTATION, TO THE FOUNDATION. THIS IS NECESSARY FOR THE FOUNDATION TO COMPLY WITH STATE AND FEDERAL REQUIREMENTS.GRANT APPLICATIONNAME OF APPLICANT (PERSON FOR WHOM ASSISTANCE IS REQUESTED):ADDRESS:STREET NO. APT./UNIT CITY ZIPTELEPHONE/TTY: ( ) E-MAIL:AP090102.DOC PAGE 1 OF 4I. INFORMATION ABOUT YOUR DISABILITY1. BRIEFLY DESCRIBE YOUR DISABILITY:2. HOW LONG HAS THIS CONDITION EXISTED?3. IS YOUR CONDITION PERMANENT? YES NOIF NO, EXPECTED DURATION:4. HOW DOES THIS AFFECT YOUR DAILY LIFE AND INDEPENDENCE?5. FOR WHAT PURPOSE ARE YOU REQUESTING FUNDING?6. HOW MUCH DOES IT COST? $7. HOW MUCH DO YOU NEED THE BLANCHE FISCHER FOUNDATION TO CONTRIBUTE? $8. HOW WILL THIS GRANT IMPROVE YOUR QUALITY OF LIFE?9. NAME AND ADDRESS OF VENDOR OR SUPPLIER (ATTACH COPY OF PRICE QUOTE OR ORDER INFORMATION):YES, IT'S ATTACHED!10. HAVE YOU APPLIED FOR GRANTS FROM ANY OTHER SOURCE(S)? YES NOFROM WHOM? HOW MUCH? $11. HAVE ANY BEEN APPROVED? YES NOBY WHOM? IN WHAT AMOUNT(S)? $12. HAVE YOU EVER RECEIVED VOCATIONAL TRAINING? YES NO13. FROM WHOM (STATE AGENCY, FEDERAL, PRIVATE ORGANIZATION)?WHEN?DID THIS TRAINING RESULT IN EMPLOYMENT? YES NO14. ATTACH A LETTER OR REPORT FROM YOUR DOCTOR OR OTHER LICENSED HEALTH CARE PROFESSIONAL (SOCIAL WORKER, CASE MANAGER, ETC.) VERIFYING YOUR DISABILITY. YES, IT'S ATTACHED! AP090102.DOC PAGE 2 OF 4II. APPLICATION FOR BENEFITNOTE: ALL HOUSEHOLD MEMBERS MUST BE CONSIDERED IN REPLYING TO INCOME-RELATED QUESTIONS.GENERAL INFORMATIONAPPLICANT'S BIRTH DATEIF A MINOR, NAME OF PARENT(S) OR GUARDIAN(S):AGE OF EACH CHILD IN HOUSEHOLD:NUMBER AND RELATIONSHIP (PARENT, SPOUSE, CAREGIVER, ETC.) OF ADULTS IN HOUSEHOLD:NUMBER OF WAGE EARNERS IN HOUSEHOLD:OCCUPATION(S):EMPLOYER(S) NAME(S):WORK PHONE (IF APPLICABLE): ( )INCOME AND EXPENSESA. MONTHLY INCOME SALARY AND WAGES:1. PRIMARY WAGE-EARNER:GROSS MONTHLY SALARY: $MONTHLY TAKE-HOME PAY: $2. SECOND WAGE-EARNER:GROSS MONTHLY SALARY: $MONTHLY TAKE-HOME PAY: $B. MONTHLY INCOME OTHERSOCIAL SECURITY $CHILD SUPPORT $FOOD STAMPS/OREGON TRAIL $OTHER (DESCRIBE): $C. MONTHLY EXPENSESCATEGORY MONTHLY PAYMENT BALANCE OWEDFOOD $CLOTHING $UTILITIES $HEALTH CARE (MEDICAL, DENTAL,VISION, PRESCRIPTIONS, ETC.) $ $INSURANCE $PAYMENTS (CREDIT CARDS,CAR PAYMENTS, LOANS, ETC.) $ $OTHER (DESCRIBE):$ $D. WHAT KIND OF MEDICAL INSURANCE, IF ANY, DO YOU HAVE? CHECK ALL APPLICABLE RESPONSES:NONEPRIVATE HEALTH INSURANCE YES NOMEDICARE YES NOOREGON HEALTH PLAN YES NOOTHER (DESCRIBE): YES NOAP090102.DOC PAGE 3 OF 4E. ASSETSDO YOU RENT OR OWN YOUR RESIDENCE? RENT OWNWHAT IS YOUR MONTHLY PAYMENT? $DO YOU OWN ANY OTHER REAL PROPERTY? YES NOIF YES, PLEASE DESCRIBE:AUTOMOBILE(S):AUTOMOBILE 1MAKE AND YEAR: VALUE $AUTOMOBILE 2MAKE AND YEAR: VALUE $AMOUNT OF CASH IN BANK ACCOUNTS AND ANY STOCKS, BONDS OR SECURITIES, INCLUDING RETIREMENT PLANS AND LIVING TRUSTS:DESCRIBE:VALUE $III. OTHER INFORMATION YOU MAY WISH US TO CONSIDER (ATTACH LETTER, IF DESIRED):ALL GRANTS MADE ASSUME THE ACCURACY OF THIS APPLICATION. I UNDERSTAND THAT IF A GRANT IS AWARDED, PAYMENT CAN BE MADE ONLY TO THE SUPPLIER OF GOODS OR SERVICES. I FURTHER UNDERSTAND THAT ALL DECISIONS AS TO ELIGIBILITY AND GRANTS ARE MADE AT THE SOLE DISCRETION OF THE BLANCHE FISCHER FOUNDATION AND THAT ITS DECISIONS ARE FINAL.I UNDERSTAND THAT ALL GRANTS AWARDED BY THE BLANCHE FISCHER FOUNDATION MUST BE REPORTED ON THE FOUNDATION'S FEDERAL AND STATE TAX RETURNS, AND AS SUCH, GRANTEES' NAMES, ADDRESSES AND GRANT AMOUNTS ARE A MATTER OF PUBLIC RECORD.SIGNATURE(S):APPLICANT PARENT/GUARDIAN (CIRCLE WHICHEVER IS APPROPRIATE)DATE PARENT/GUARDIAN (CIRCLE WHICHEVER IS APPROPRIATE)YOUR RESPONSE TO THE FOLLOWING QUESTION WILL NOT INFLUENCE IN ANY WAY THE OUTCOME OF THIS GRANT APPLICATION:WOULD YOU LIKE US TO SEND YOU A VOTER REGISTRATION CARD, ALONG WITH THE NAMES OF YOUR STATE SENATOR, REPRESENTATIVE AND U.S. CONGRESSIONAL REPRESENTATIVE? YES NOBEFORE MAILING THIS APPLICATION . . .1. ARE ALL SECTIONS COMPLETE?2. HAVE YOU ATTACHED DOCUMENTATION FROM A MEDICAL OR OTHER PROFESSIONAL VERIFYING DISABILITY?3. HAVE YOU ATTACHED A COPY OF YOUR VENDOR'S PRICE QUOTE?MAIL THE COMPLETED APPLICATION AND DOCUMENTATION TO:BLANCHE FISCHER FOUNDATION1509 S.W. SUNSET BLVD., SUITE 1-BPORTLAND, OR 97239 AP090102.DOC PAGE 4 OF 4

    TY 2013 InvestmentsCorpStockSchedule
    Name:
    BLANCHE FISCHER FOUNDATION
    EIN: 93-0790099
    Name of Stock End of Year Book Value End of Year Fair Market Value
    VARIOUS MUTUAL FUNDS 1,368,406 1,605,194

    TY 2013 InvestmentsOtherSchedule2
    Name:
    BLANCHE FISCHER FOUNDATION
    EIN: 93-0790099
    Category/ Item Listed at Cost or FMV Book Value End of Year Fair Market Value
    ROCK QUARRY AT COST 227,700 227,700

    TY 2013 OtherAssetsSchedule
    Name:
    BLANCHE FISCHER FOUNDATION
    EIN: 93-0790099
    Description Beginning of Year - Book Value End of Year - Book Value End of Year - Fair Market Value
    ARTIFACTS AND PAINTINGS, DRIFTWOOD LIBRARY 2,767 2,767 2,767


    TY 2013 OtherExpensesSchedule
    Name:
    BLANCHE FISCHER FOUNDATION
    EIN: 93-0790099
    Description Revenue and Expenses per Books Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    LICENSES & FEES 50 0 50 50
    OFFICE AND TELEPHONE 2,790 0 2,790 2,790
    BANK CHARGES & FEES 11 11 0 0
    INSURANCE 1,742 0 1,742 1,742
    VOLUNTEER RECOGNITION 143 0 143 143
    DUES & SUBSCRIPTIONS 392 0 392 392


    TY 2013 OtherIncomeSchedule2
    Name:
    BLANCHE FISCHER FOUNDATION
    EIN: 93-0790099
    Description Revenue And Expenses Per Books Net Investment Income Adjusted Net Income
    SALE OF ROCK IN PLACE FROM QUARRY 38,308 38,308 38,308
    GRANT REFUNDS 608 608 608


    TY 2013 OtherProfessionalFeesSchedule
    Name:
    BLANCHE FISCHER FOUNDATION
    EIN: 93-0790099
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    OUTSIDE SERVICES 1,080 0 1,080 1,080
    INVESTMENT FESS 18,629 18,629 0 0


    TY 2013 TaxesSchedule
    Name:
    BLANCHE FISCHER FOUNDATION
    EIN: 93-0790099
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    PAYROLL TAXES 1,889 0 1,889 1,889
    INTERNAL REVENUE SERVICE 1,434 1,434 0 0
    OREGON DEPT OF JUSTICE 226 226 0 0
    FOREIGN TAXES 483 483 0 0