Form990-PF

Department of the Treasury
Internal Revenue Service

Return of Private Foundation
or Section 4947(a)(1) Trust Treated as Private Foundation
bulletDo not enter social security numbers on this form as it may be made public.
bulletInformation about Form 990-PF and its instructions is at www.irs.gov/form990pf.
OMB No. 1545-0052
2014
Open to Public Inspection
For calendar year 2014, or tax year beginning 2014, and ending , 20
Name of foundation
MONTGOMERY HOSPITAL FBO CAPEL TRUST
 

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

51-0160511
B Telephone number (see instructions)

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

D 1. bullet
2. bullet
E bullet
H Check type of organization:
I Fair market value of all assets at end
of year (from Part II, col. (c),
line 16)bullet$2,314,966J 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
Sch. B ...............
3 Interest on savings and temporary cash investments      
4 Dividends and interest from securities...... 51,766 50,710  
5a Gross rents..............      
b Net rental income or (loss)  
6a Net gain or (loss) from sale of assets not on line 10 70,362
b Gross sales price for all assets on line 6a 308,665
7 Capital gain net income (from Part IV, line 2)... 70,362
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 975 975  
12 Total. Add lines 1 through 11........ 123,103 122,047  
Operating and Administrative Expenses 13 Compensation of officers, directors, trustees, etc. 25,892 16,346   9,545
14 Other employee salaries and wages......   0 0 0
15 Pension plans, employee benefits.......   0 0  
16a Legal fees (attach schedule)......... Click to see attachment 8,059 0 0 8,059
b Accounting fees (attach schedule)....... Click to see attachment 2,050 50 0 2,000
c Other professional fees (attach schedule)....       0
17 Interest...............       0
18 Taxes (attach schedule) (see instructions)... Click to see attachment 4,084 463   0
19 Depreciation (attach schedule) and depletion... 0 0  
20 Occupancy..............        
21 Travel, conferences, and meetings.......   0 0  
22 Printing and publications..........   0 0  
23 Other expenses (attach schedule).......        
24 Total operating and administrative expenses.
Add lines 13 through 23.......... 40,085 16,859 0 19,604
25 Contributions, gifts, grants paid........ 113,445 113,445
26 Total expenses and disbursements. Add lines 24 and 25 153,530 16,859 0 133,049
27 Subtract line 26 from line 12:
a Excess of revenue over expenses and disbursements -30,427
b Net investment income (if negative, enter -0-) 105,188
c Adjusted net income (if negative, enter -0-)... 0
For Paperwork Reduction Act Notice, see instructions.
Cat. No. 11289X Form 990-PF (2014)
Form 990-PF (2014)
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............... 146 1,449 1,449
2 Savings and temporary cash investments.......... 66,939 58,950 58,950
3 Accounts receivable bullet  
Less: allowance for doubtful accounts bullet     0 0
4 Pledges receivable bullet  
Less: allowance for doubtful accounts bullet        
5 Grants receivable.................      
6 Receivables due from officers, directors, trustees, and other
disqualified persons (attach schedule) (see instructions).....      
7 Other notes and loans receivable (attach schedule) bullet  
Less: allowance for doubtful accounts bullet0      
8 Inventories for sale or use...............      
9 Prepaid expenses and deferred charges...........      
10a Investments—U.S. and state government obligations (attach schedule)      
b Investments—corporate stock (attach schedule)........ 786,701 Click to see attachment782,931 1,762,409
c Investments—corporate bonds (attach schedule)........ 511,304 Click to see attachment508,677 492,158
11 Investments—land, buildings, and equipment: basis bullet  
Less: accumulated depreciation (attach schedule) bullet        
12 Investments—mortgage loans..............      
13 Investments—other (attach schedule)...........     0
14 Land, buildings, and equipment: basis bullet  
Less: accumulated depreciation (attach schedule) bullet        
15 Other assets (describe bullet) Click to see attachment20,636    
16 Total assets (to be completed by all filers—see the
instructions. Also, see page 1, item I) 1,385,726 1,352,007 2,314,966
Liabilities 17 Accounts payable and accrued expenses..........    
18 Grants payable..................    
19 Deferred revenue..................    
20 Loans from officers, directors, trustees, and other disqualified persons    
21 Mortgages and other notes payable (attach schedule)......    
22 Other liabilities (describe bullet)    
23 Total liabilities (add lines 17 through 22)..........   0
Net Assets or Fund Balances bullet
and complete lines 24 through 26 and lines 30 and 31.
24 Unrestricted...................    
25 Temporarily restricted................    
26 Permanently restricted................    
bullet
and complete lines 27 through 31.
27 Capital stock, trust principal, or current funds......... 1,385,726 1,352,007
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 instructions)...... 1,385,726 1,352,007
31 Total liabilities and net assets/fund balances (see instructions).. 1,385,726 1,352,007
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 1,385,726
2 Enter amount from Part I, line 27a..................... 2 -30,427
3 Other increases not included in line 2 (itemize) bulletClick to see attachment 3 1,973
4 Add lines 1, 2, and 3.......................... 4 1,357,272
5 Decreases not included in line 2 (itemize) bulletClick to see attachment 5 5,265
6 Total net assets or fund balances at end of year (line 4 minus line 5)—Part II, column (b), line 30. 6 1,352,007
Form 990-PF (2014)
Form 990-PF (2014)
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 165. AT&T INC   2013-06-03 2014-01-22
b 150. ABBVIE INC   2013-01-08 2014-02-05
c 8. AETNA INC-NEW COM   2014-06-09 2014-06-25
d 9. AETNA INC-NEW COM   2014-06-09 2014-11-03
e 118. ALLSTATE CORP COM W/RIGHTS ATTACHED EXP 2/12/2009   2012-10-09 2014-06-09
64. AMGEN INC COM W/RTS ATTACHED EXP 03/21/2007   2008-12-15 2014-04-30
7. APPLE COMPUTER INC COM   2013-10-07 2014-06-25
9. APPLE COMPUTER INC COM   2010-07-12 2014-11-03
14. ARCHER DANIELS MIDLAND CO COM   2014-02-05 2014-06-25
17. ARCHER DANIELS MIDLAND CO COM   2014-02-05 2014-11-03
22. ARRIS GROUP INC   2014-07-31 2014-11-03
176.118 ARTISAN FDS INC SMALL CAP FD #660   2012-08-08 2014-07-02
38. BANK AMER CORP COM   2013-07-08 2014-06-25
404. BANK AMER CORP COM   2013-07-08 2014-08-28
193. BANK NEW YORK MELLON CORP COM   2013-08-07 2014-01-17
5. BERKSHIRE HATHAWAY INC.   2013-11-15 2014-06-25
6. BERKSHIRE HATHAWAY INC.   2013-11-15 2014-11-03
2. BIOGEN INC   2014-08-28 2014-11-03
4. BOEING CO COM   2013-11-04 2014-06-25
44. BOEING CO COM   2013-11-04 2014-10-08
44. BOSTON SCIENTIFIC CORP COM   2013-10-07 2014-06-25
477. BOSTON SCIENTIFIC CORP COM   2013-10-07 2014-10-08
9. CVS CORP COM   2010-08-26 2014-06-25
11. CVS CORP COM   2010-08-26 2014-11-03
9. CAPITAL ONE FINL CORP COM RTS EXP 11/29/2005   2014-10-08 2014-11-03
9. CARDINAL HLTH INC COM   2014-01-22 2014-06-25
11. CARDINAL HLTH INC COM   2014-01-22 2014-11-03
4. CHEVRONTEXACO CORP COM   2007-08-27 2014-06-25
37. CHEVRONTEXACO CORP COM   2007-08-27 2014-10-08
23. CISCO SYS INC COM W/RIGHTS ATTACHED EXPIRING 6/10/2008   2009-06-03 2014-06-25
28. CISCO SYS INC COM W/RIGHTS ATTACHED EXPIRING 6/10/2008   2009-06-03 2014-11-03
11. CITIGROUP INC.   2013-02-26 2014-06-25
115. CITIGROUP INC.   2013-02-26 2014-10-08
12. COMCAST CORP NEW CL A   2011-02-11 2014-06-25
15. COMCAST CORP NEW CL A   2011-02-11 2014-11-03
87. CONOCOPHILLIPS COM   2012-05-14 2014-02-05
9. CONOCOPHILLIPS COM   2014-07-31 2014-11-03
7. DST SYS INC DEL COM   2013-02-26 2014-06-25
8. DST SYS INC DEL COM   2013-02-26 2014-11-03
26. DELTA AIR LINES INC   2013-07-08 2014-06-25
90. DELTA AIR LINES INC   2013-07-08 2014-08-28
22. DELTA AIR LINES INC   2013-07-08 2014-11-03
18. DELTA AIR LINES INC   2013-07-08 2014-12-12
13. DOW CHEM CO COM   2013-10-07 2014-06-25
16. DOW CHEM CO COM   2013-10-07 2014-11-03
28. E*TRADE GROUP   2014-02-05 2014-06-25
34. E*TRADE GROUP   2014-02-05 2014-11-03
4. EXXON MOBIL CORP COM   2004-08-03 2014-06-25
5. EXXON MOBIL CORP COM   2004-08-03 2014-11-03
9. FACEBOOK INC   2014-02-05 2014-06-25
11. FACEBOOK INC   2014-02-05 2014-11-03
200. FIRST BANCORP COM   2014-07-02 2014-07-09
87. FLUOR CORP NEW COM   2012-10-09 2014-01-22
30. FORD MTR CO DEL COM   2013-08-07 2014-06-25
37. FORD MTR CO DEL COM   2013-08-07 2014-11-03
258. GENERAL ELEC CO COM   2010-05-25 2014-01-22
7. GILEAD SCIENCES INC COM   2014-03-12 2014-06-25
9. GILEAD SCIENCES INC COM   2014-03-12 2014-11-03
5. GOLDMAN SACHS GRP INC COM   2014-08-28 2014-11-03
12. HALLIBURTON CO COM W/RIGHTS EXP 12/15/2005   2014-08-28 2014-11-03
10. HANESBRANDS INC   2013-04-22 2014-06-25
29. HANESBRANDS INC   2013-04-22 2014-07-31
10. HANESBRANDS INC   2013-04-22 2014-10-08
8. HANESBRANDS INC   2013-04-22 2014-11-03
18. HEWLETT-PACKARD CO COM   2014-04-07 2014-06-25
22. HEWLETT-PACKARD CO COM   2014-04-07 2014-11-03
8. HOME DEPOT INC COM   2009-03-30 2014-06-25
9. HOME DEPOT INC COM   2009-03-30 2014-11-03
40. ISHARES SMALLCAP 600/ BARRA FD   2013-06-11 2014-07-02
45. ISHARES S & P SMALLCAP 600/GRO   2012-12-26 2014-07-02
5. JOHNSON & JOHNSON COM   1999-01-28 2014-06-25
7. JOHNSON & JOHNSON COM   1999-01-28 2014-11-03
7. LEAR CORP   2013-09-20 2014-06-25
9. LEAR CORP   2013-09-20 2014-11-03
11. LINCOLN NATL CORP COM   2013-04-22 2014-06-25
14. LINCOLN NATL CORP COM   2013-04-22 2014-11-03
11. LOWES COS INC COM W/RIGHTS ATTACHED EXPIRING 9/9/2008   2013-11-04 2014-06-25
13. LOWES COS INC COM W/RIGHTS ATTACHED EXPIRING 9/9/2008   2013-11-04 2014-11-03
7. MAGNA INTL INC CL A   2013-06-03 2014-06-25
9. MAGNA INTL INC CL A   2013-06-03 2014-11-03
7. MASTERCARD INC   2014-01-22 2014-06-25
77. MASTERCARD INC   2014-01-22 2014-07-31
5. MCKESSON HBOC INC COM   2009-10-19 2014-06-25
6. MCKESSON HBOC INC COM   2009-10-19 2014-11-03
13. MERCK & CO INC NEW   2014-10-08 2014-11-03
150. METLIFE INC COM   2012-06-13 2014-02-05
12. MICROSOFT CORP COM   1997-12-26 2014-06-25
16. MICROSOFT CORP COM   1997-12-26 2014-11-03
28. MICRON TECHNOLOGY INC COM   2013-11-15 2014-06-25
52. MICRON TECHNOLOGY INC COM   2013-11-15 2014-10-08
29. MICRON TECHNOLOGY INC COM   2013-11-15 2014-11-03
18. MORGAN STANLEY DEAN WITTER & CO COM NEW   2013-11-04 2014-06-25
23. MORGAN STANLEY DEAN WITTER & CO COM NEW   2013-11-04 2014-11-03
10. NATIONAL OILWELL INC COM   2014-10-08 2014-11-03
5. NORTHROP GRUMMAN CORP COM W/RTS ATTACHED EXP 10/31/2008   2014-01-22 2014-06-25
6. NORTHROP GRUMMAN CORP COM W/RTS ATTACHED EXP 10/31/2008   2014-01-22 2014-11-03
112. OMNICARE INC COM W/ RTS ATTACHED EXP 06/   2013-08-07 2014-03-12
14. ORACLE CORP COM   2010-07-12 2014-06-25
18. ORACLE CORP COM   2010-07-12 2014-11-03
129. OSHKOSH TRUCK CORP CLASS B W/RIGHTS ATTA   2013-08-29 2014-06-09
484.496 PIMCO FDS PAC INVT MGMT SER LOW DURATION FD INSTL CL   2012-01-19 2014-11-04
1372.37 PIMCO FDS PAC INVT MGMT SER TOTAL RETURN FD INSTL CL   2012-12-26 2014-11-04
102. PACKAGING CORP AMER COM   2013-09-20 2014-04-30
8. PHILLIPS 66   2012-10-26 2014-06-25
10. PHILLIPS 66   2012-10-26 2014-11-03
73. PHILLIPS 66   2012-10-26 2014-11-11
6. QUALCOMM INC COM W/RTS ATTACHED   2012-04-16 2014-06-25
8. QUALCOMM INC COM W/RTS ATTACHED   2012-04-16 2014-11-03
594.059 RIDGEWORTH SEIX HY BD-I #5855   2012-12-26 2014-07-02
83. RITE AID CORP COM   2014-04-30 2014-06-25
890. RITE AID CORP COM   2014-04-30 2014-08-28
209.118 ROYCE PREMIER FUND W CLASS #566   2011-08-11 2014-07-02
8. SANDISK CORP COM W/RTS ATTACHED EXP 04/28/2007   2013-10-07 2014-06-25
10. SANDISK CORP COM W/RTS ATTACHED EXP 04/28/2007   2013-10-07 2014-11-03
1001. SANDRIDGE ENERGY INC   2013-10-07 2014-02-05
26. SOUTHWEST AIRLINES CO COM   2014-02-05 2014-06-25
37. SOUTHWEST AIRLINES CO COM   2014-02-05 2014-10-08
28. SOUTHWEST AIRLINES CO COM   2014-02-05 2014-11-03
31. SOUTHWEST AIRLINES CO COM   2014-02-05 2014-11-11
21. SPIRIT AEROSYTSEMS HOLD-CL A   2014-10-08 2014-11-03
15. TRINITY INDS INC COM W/RIGHTS ATTACHED EXP 4/27/2009   2014-06-09 2014-06-25
18. TRINITY INDS INC COM W/RIGHTS ATTACHED EXP 4/27/2009   2014-06-09 2014-11-03
6. UNITED THERAPEUTICS CORP DEL COM W/RIGHTS ATTACHED EXP 12/29/2010   2013-04-22 2014-06-25
66. UNITED THERAPEUTICS CORP DEL COM W/RIGHTS ATTACHED EXP 12/29/2010   2013-04-22 2014-08-28
10. VALERO ENERGY CORP NEW COM   2014-04-30 2014-06-25
13. VALERO ENERGY CORP NEW COM   2014-04-30 2014-11-03
60. VANGUARD REIT VIPER   2011-05-05 2014-11-04
11. VERIZON COMMUNICATIONS COM   2010-11-04 2014-06-25
14. VERIZON COMMUNICATIONS COM   2010-11-04 2014-11-03
104. VERIZON COMMUNICATIONS COM   2010-11-04 2014-12-12
16. VOYA FINANCIAL INC   2014-01-17 2014-06-25
20. VOYA FINANCIAL INC   2014-01-17 2014-11-03
7. WAL MART STORES INC COM   2010-06-23 2014-06-25
9. WAL MART STORES INC COM   2010-06-23 2014-11-03
65. WAL MART STORES INC COM   2010-06-23 2014-11-11
3. ACTAVIS PLC   2013-11-15 2014-06-25
4. ACTAVIS PLC   2013-11-15 2014-11-03
7. HERBALIFE LTD   2011-09-15 2014-06-25
73. HERBALIFE LTD   2011-09-15 2014-07-31
45. MARVELL TECHNOLOGY GRP LTD SHS   2013-06-03 2014-06-25
56. MARVELL TECHNOLOGY GRP LTD SHS   2013-06-03 2014-11-03
25. SEAGATE TECHNOLOGY   2013-05-14 2014-01-22
114. SEAGATE TECHNOLOGY   2013-05-14 2014-04-07
CAPITAL GAIN DIVIDENDS P    
(e) Gross sales price (f) Depreciation allowed
(or allowable) 		(g) Cost or other basis
plus expense of sale 		(h) Gain or (loss)
(e) plus (f) minus (g)
a 5,501   5,795 -294
b 7,160   5,092 2,068
c 659   633 26
d 739   712 27
e 6,976   4,836 2,140
7,082   3,704 3,378
632   491 141
981   335 646
614   541 73
803   657 146
664   769 -105
5,000   3,558 1,442
585   500 85
6,472   5,320 1,152
6,341   6,031 310
635   580 55
839   696 143
640   684 -44
508   532 -24
5,398   5,853 -455
558   514 44
5,688   5,568 120
678   253 425
948   309 639
745   731 14
625   612 13
863   748 115
525   349 176
4,278   3,227 1,051
569   442 127
686   538 148
525   446 79
5,936   4,663 1,273
639   288 351
829   359 470
5,501   4,175 1,326
646   745 -99
642   472 170
774   539 235
1,022   496 526
3,594   1,716 1,878
889   420 469
868   343 525
683   516 167
789   636 153
587   536 51
770   651 119
407   188 219
481   235 246
606   562 44
823   687 136
3,702   3,668 34
7,270   4,913 2,357
516   506 10
515   624 -109
6,723   3,997 2,726
572   554 18
983   713 270
953   888 65
654   812 -158
960   466 494
2,846   1,352 1,494
1,087   466 621
850   373 477
604   591 13
791   722 69
644   185 459
865   209 656
4,661   3,770 891
5,493   3,733 1,760
528   210 318
747   294 453
619   499 120
828   641 187
565   346 219
761   440 321
513   546 -33
741   646 95
755   471 284
883   605 278
512   584 -72
5,732   6,419 -687
935   307 628
1,219   368 851
750   766 -16
7,150   5,833 1,317
503   180 323
755   240 515
903   547 356
1,621   1,017 604
976   567 409
579   524 55
803   670 133
713   716 -3
603   602 1
821   722 99
6,436   6,191 245
565   327 238
699   420 279
7,229   5,952 1,277
5,000   5,015 -15
15,000   15,576 -576
6,770   6,042 728
648   376 272
775   470 305
5,402   3,431 1,971
471   397 74
626   529 97
6,000   6,036 -36
594   604 -10
5,598   6,474 -876
5,000   4,557 443
824   501 323
948   626 322
6,157   6,054 103
700   535 165
1,189   761 428
975   576 399
1,237   638 599
860   777 83
648   625 23
639   750 -111
528   364 164
6,048   4,008 2,040
509   573 -64
656   745 -89
4,767   3,549 1,218
543   367 176
702   467 235
4,727   3,472 1,255
584   579 5
782   724 58
529   356 173
683   458 225
5,138   3,309 1,829
666   495 171
970   660 310
451   401 50
4,017   4,177 -160
648   488 160
758   607 151
1,529   1,021 508
6,259   4,658 1,601
      12,574
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       -294
b       2,068
c       26
d       27
e       2,140
      3,378
      141
      646
      73
      146
      -105
      1,442
      85
      1,152
      310
      55
      143
      -44
      -24
      -455
      44
      120
      425
      639
      14
      13
      115
      176
      1,051
      127
      148
      79
      1,273
      351
      470
      1,326
      -99
      170
      235
      526
      1,878
      469
      525
      167
      153
      51
      119
      219
      246
      44
      136
      34
      2,357
      10
      -109
      2,726
      18
      270
      65
      -158
      494
      1,494
      621
      477
      13
      69
      459
      656
      891
      1,760
      318
      453
      120
      187
      219
      321
      -33
      95
      284
      278
      -72
      -687
      628
      851
      -16
      1,317
      323
      515
      356
      604
      409
      55
      133
      -3
      1
      99
      245
      238
      279
      1,277
      -15
      -576
      728
      272
      305
      1,971
      74
      97
      -36
      -10
      -876
      443
      323
      322
      103
      165
      428
      399
      599
      83
      23
      -111
      164
      2,040
      -64
      -89
      1,218
      176
      235
      1,255
      5
      58
      173
      225
      1,829
      171
      310
      50
      -160
      160
      151
      508
      1,601
       
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 70,362
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 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))
2013 96,134 2,117,209 0.045406
2012 87,740 1,863,730 0.047078
2011 91,452 1,944,423 0.047033
2010 102,036 2,007,347 0.050831
2009 108,390 1,912,975 0.05666
2 Total of line 1, column (d) ...................... 2 0.247008
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 0.049402
4 Enter the net value of noncharitable-use assets for 2014 from Part X, line 5..... 4 2,313,854
5 Multiply line 4 by line 3....................... 5 114,309
6 Enter 1% of net investment income (1% of Part I, line 27b)........... 6 1,052
7 Add lines 5 and 6......................... 7 115,361
8 Enter qualifying distributions from Part XII, line 4.............. 8 133,049
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 (2014)
Form 990-PF (2014)
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 1,052
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 1,052
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 1,052
6 Credits/Payments:
a 2014 estimated tax payments and 2013 overpayment credited to 2014 6a 2,484
b Exempt foreign organizations—tax withheld at source....... 6b
c Tax paid with application for extension of time to file (Form 8868)... 6c 34
d Backup withholding erroneously withheld ........... 6d  
7 Total credits and payments. Add lines 6a through 6d.............. 7 2,518
8 Enter any penalty for underpayment of estimated tax. if Form 2220 is attached. 8 0
9 Tax due. If the total of lines 5 and 8 is more than line 7, enter amount owed.......Bullet 9  
10 Overpayment. If line 7 is more than the total of lines 5 and 8, enter the amount overpaid...Bullet 10 1,466
11 Enter the amount of line 10 to be: Credited to 2015 estimated taxBullet1,052 RefundedBullet 11 414
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 Instructions
for definition)?.................................
1b
 
No
If the answer is "Yes" to 1a or 1b, attach a detailed description of the activities and copies of any materials
published or distributed by the foundation in connection with the activities.
c
Did the foundation file Form 1120-POL for this year?.....................
1c
 
No
d
Enter the amount (if any) of tax on political expenditures (section 4955) imposed during the year:
(1) On the foundation. bullet$   (2) On foundation managers.bullet$  
e
Enter the reimbursement (if any) paid by the foundation during the year for political expenditure tax imposed
on foundation managers.bullet$  
2
Has the foundation engaged in any activities that have not previously been reported to the IRS?.......
2
 
No
If "Yes," attach a detailed description of the activities.
3
Has the foundation made any changes, not previously reported to the IRS, in its governing instrument, articles
of incorporation, or bylaws, or other similar instruments? If "Yes," attach a conformed copy of the changes....
3
 
No
4a
Did the foundation have unrelated business gross income of $1,000 or more during the year?........
4a
 
No
b
If "Yes," has it filed a tax return on Form 990-T for this year?...................
4b
 
 
5
Was there a liquidation, termination, dissolution, or substantial contraction during the year?.........
5
 
No
If "Yes," attach the statement required by General Instruction T.
6
Are the requirements of section 508(e) (relating to sections 4941 through 4945) satisfied either:
  • By language in the governing instrument, or
  • By state legislation that effectively amends the governing instrument so that no mandatory directions
    • that conflict with the state law remain in the governing instrument?................
    6
    Yes
     
    7
    Did the foundation have at least $5,000 in assets at any time during the year? If "Yes," complete Part II, col. (c),
    and Part XV..................................
    7
    Yes
     
    8a
    Enter the states to which the foundation reports or with which it is registered (see instructions)
    bulletNC
    b
    If the answer is "Yes" to line 7, has the foundation furnished a copy of Form 990-PF to the Attorney
    General (or designate) of each state as required by General Instruction G? If "No," attach explanation .
    8b
    Yes
     
    9
    Is the foundation claiming status as a private operating foundation within the meaning of section 4942(j)(3)
    or 4942(j)(5) for calendar year 2014 or the taxable year beginning in 2014 (see instructions for Part XIV)?
    If "Yes," complete Part XIV.............................
    9
     
    No
    Form 990-PF (2014)
    Form 990-PF (2014)
    Page 5
    Part VII-A
    Statements Regarding Activities (continued)
    10
    Did any persons become substantial contributors during the tax year? If "Yes," attach a schedule listing their names
    and addresses. ...............................
    10
     
    No
    11
    At any time during the year, did the foundation, directly or indirectly, own a controlled entity within the
    meaning of section 512(b)(13)? If "Yes," attach schedule. (see instructions) .............
    11
     
    No
    12
    Did the foundation make a distribution to a donor advised fund over which the foundation or a disqualified person had
    advisory privileges? If "Yes," attach statement (see instructions).................
    12
     
    No
    13
    Did the foundation comply with the public inspection requirements for its annual returns and exemption application?
    13
    Yes
     
    Website addressbullet  
    14
    The books are in care ofbulletWELLS FARGO BANK NA Telephone no.bullet (800) 352-3705
    Located atbullet1 WEST 4TH STREETWINSTONSALEMNC ZIP+4bullet27101
    15
    Section 4947(a)(1) nonexempt charitable trusts filing Form 990-PF in lieu of Form 1041.........bullet
    and enter the amount of tax-exempt interest received or accrued during the year ......bullet
    15  
    16 At any time during calendar year 2014, 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 FinCEN Form 114, Report of Foreign Bank and Financial Accounts (FBAR). If "Yes", enter the name of the foreign country bullet  
    Form 990-PF (2014)
    Form 990-PF (2014)
    Page 6
    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 instructions)? ........
    1b
     
     
    .........bullet
    c
    Did the foundation engage in a prior year in any of the acts described in 1a, other than excepted acts,
    that were not corrected before the first day of the tax year beginning in 2014?.............
    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 2014, did the foundation have any undistributed income (lines 6d
    and 6e, Part XIII) for tax year(s) beginning before 2014?...............
    If "Yes," list the years bullet20, 20, 20, 20
    b
    Are there any years listed in 2a for which the foundation is not applying the provisions of section 4942(a)(2)
    (relating to incorrect valuation of assets) to the year’s undistributed income? (If applying section 4942(a)(2)
    to all years listed, answer "No" and attach statement—see instructions.) ..............
    2b
     
    No
    c
    If the provisions of section 4942(a)(2) are being applied to any of the years listed in 2a, list the years here.
    bullet20, 20, 20, 20
    3a
    Did the foundation hold more than a 2% direct or indirect interest in any business enterprise at
    any time during the year?........................
    b
    If "Yes," did it have excess business holdings in 2014 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 2014.)....................
    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 2014?
    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 4945(d)(4)(A)? (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 (2014)
    Form 990-PF (2014)
    Page 7
    Part VIII
    Information About Officers, Directors, Trustees, Foundation Managers, Highly Paid Employees,
    and Contractors
    1 List all officers, directors, trustees, foundation managers and their compensation (see instructions).
    (a) Name and address (b) Title, and average
    hours per week
    devoted to position     		(c) Compensation
     (If not paid, enter
    -0-)     		(d) Contributions to
    employee benefit plans
    and deferred compensation     		(e) Expense account,
    other allowances
    WELLS FARGO BANK Co-Trustee
    40     		21,795    
    1525 W W T HARRIS BLVD D1114 044
    CHARLOTTE,NC282885709
    FIRST BANK Co Trustee
    40     		4,097    
    PO Box 508
    Troy,NC27271
    2 Compensation of five highest-paid employees (other than those included on line 1—see instructions). If none, enter “NONE."
    (a) Name and address of each employee paid more than $50,000 (b) Title, and average
    hours per week
    devoted to position     		(c) Compensation (d) Contributions to
    employee benefit
    plans and deferred
    compensation     		(e) Expense account,
    other allowances
    NONE
    Total number of other employees paid over $50,000...................bullet 0
    3 Five highest-paid independent contractors for professional services (see instructions). If none, enter "NONE".
    (a) Name and address of each person paid more than $50,000 (b) Type of service (c) Compensation
    NONE
    Total number of others receiving over $50,000 for professional services.............bullet0
    Part IX-A
    Summary of Direct Charitable Activities
    List the foundation’s four largest direct charitable activities during the tax year. Include relevant statistical information such as the number of organizations and other beneficiaries served, conferences convened, research papers produced, etc. Expenses
    1
     
    2  
    3  
    4  
    Form 990-PF (2014)
    Form 990-PF (2014)
    Page 8
    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 instructions.
    3  
    Total. Add lines 1 through 3.........................bullet  
    Part X
    Minimum Investment Return (All domestic foundations must complete this part. Foreign foundations,
    see instructions.)
    1
    Fair market value of assets not used (or held for use) directly in carrying out charitable, etc.,
    purposes:
    a
    Average monthly fair market value of securities...................
    1a
    2,275,646
    b
    Average of monthly cash balances.......................
    1b
    61,657
    c
    Fair market value of all other assets (see instructions)................
    1c
    11,787
    d
    Total (add lines 1a, b, and c).........................
    1d
    2,349,090
    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
    2,349,090
    4
    Cash deemed held for charitable activities. Enter 1 1/2% of line 3 (for greater amount, see
    instructions) .............................
    4
    35,236
    5
    Net value of noncharitable-use assets. Subtract line 4 from line 3. Enter here and on Part V, line 4
    5
    2,313,854
    6
    Minimum investment return. Enter 5% of line 5..................
    6
    115,693
    Part XI
    Distributable Amount bullet and do not complete this part.)
    1
    Minimum investment return from Part X, line 6....................
    1
    115,693
    2a
    Tax on investment income for 2014 from Part VI, line 5......
    2a
    1,052
    b
    Income tax for 2014. (This does not include the tax from Part VI.)...
    2b
     
    c
    Add lines 2a and 2b............................
    2c
    1,052
    3
    Distributable amount before adjustments. Subtract line 2c from line 1............
    3
    114,641
    4
    Recoveries of amounts treated as qualifying distributions................
    4
    0
    5
    Add lines 3 and 4............................
    5
    114,641
    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
    114,641
    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
    133,049
    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
    0
    3
    Amounts set aside for specific charitable projects that satisfy the:
    a
    Suitability test (prior IRS approval required)....................
    3a
    0
    b
    Cash distribution test (attach the required schedule) .................
    3b
    0
    4
    Qualifying distributions. Add lines 1a through 3b. Enter here and on Part V, line 8, and Part XIII, line 4
    4
    133,049
    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
    1,052
    6
    Adjusted qualifying distributions. Subtract line 5 from line 4..............
    6
    131,997
    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 (2014)
    Form 990-PF (2014)
    Page 9
    Part XIII
    Undistributed Income (see instructions)
    (a)
    Corpus     		(b)
    Years prior to 2013     		(c)
    2013     		(d)
    2014
    1 Distributable amount for 2014 from Part XI, line 7 114,641
    2 Undistributed income, if any, as of the end of 2014:
    a Enter amount for 2013 only....... 99,091
    b Total for prior years:2012, 20, 20 0
    3 Excess distributions carryover, if any, to 2014:
    a From 2009....... 0
    b From 2010....... 0
    c From 2011....... 0
    d From 2012....... 0
    e From 2013....... 0
    fTotal of lines 3a through e......... 0
    4Qualifying distributions for 2014 from Part
    XII, line 4: bullet$ 133,049
    a Applied to 2013, but not more than line 2a 99,091
    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 2014 distributable amount..... 33,958
    e Remaining amount distributed out of corpus 0
    5 Excess distributions carryover applied to 2014. 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 2013. Subtract line
    4a from line 2a. Taxable amount—see
    instructions .............     		0
    f Undistributed income for 2014. Subtract
    lines 4d and 5 from line 1. This amount must
    be distributed in 2015 ..........     		80,683
    7 Amounts treated as distributions out of
    corpus to satisfy requirements imposed by
    section 170(b)(1)(F) or 4942(g)(3) (Election may
    be required - see instructions) .......     		0
    8Excess distributions carryover from 2009 not
    applied on line 5 or line 7 (see instructions) ...     		0
    9Excess distributions carryover to 2015.
    Subtract lines 7 and 8 from line 6a ......     		0
    10 Analysis of line 9:
    a Excess from 2010.... 0
    b Excess from 2011.... 0
    c Excess from 2012.... 0
    d Excess from 2013.... 0
    e Excess from 2014.... 0
    Form 990-PF (2014)
    Form 990-PF (2014)
    Page 10
    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 2014, 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) 2014 (b) 2013 (c) 2012 (d) 2011
             
    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 email address of the person to whom applications should be addressed:
    bThe form in which applications should be submitted and information and materials they should include:
    cAny submission deadlines:
    dAny restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other
    factors:
    Form 990-PF (2014)
    Form 990-PF (2014)
    Page 11
    Part XV
    Supplementary Information (continued)
    3 Grants and Contributions Paid During the Year or Approved for Future Payment
    Recipient If recipient is an individual,
    show any relationship to
    any foundation manager
    or substantial contributor
    		 Foundation
    status of
    recipient     		Purpose of grant or
    contribution     		Amount
    Name and address (home or business)
    aPaid during the year
    First Health Montgomery
    Hospital
    PO BOX 508
    TROY,NC273710508     		N/A PC GENERAL SUPPORT 113,445
    Total .................................bullet 3a 113,445
    bApproved for future payment
    Total .................................bullet 3b  
    Form 990-PF (2014)
    Form 990-PF (2014)
    Page 12
    Part XVI-A
    Analysis of Income-Producing Activities
    Enter gross amounts unless otherwise indicated. Unrelated business income Excluded by section 512, 513, or 514 (e)
    Related or exempt
    function income
    (See instructions.)
    1Program service revenue: (a)
    Business code     		(b)
    Amount     		(c)
    Exclusion code     		(d)
    Amount
    a
    b
    c
    d
    e
    f
    gFees and contracts from government agencies          
    2 Membership dues and assessments....          
    3
    Interest on savings and temporary cash investments ............     		         
    4 Dividends and interest from securities....     14 51,766  
    5 Net rental income or (loss) from real estate:
    aDebt-financed property......          
    bNot debt-financed property.....          
    6
    Net rental income or (loss) from personal property .............     		         
    7 Other investment income.....          
    8
    Gain or (loss) from sales of assets other than inventory .............     		    18 70,362  
    9 Net income or (loss) from special events:          
    10 Gross profit or (loss) from sales of inventory..          
    11 Other revenue: aJP MORGAN ALERIAN     01 466  
    bMUTUAL FUND     01 442  
    cFINAL CD INTEREST     01 55  
    dFINAL MONEY MKT IN     01 12  
    e
    12 Subtotal. Add columns (b), (d), and (e)..   123,103  
    13Total. Add line 12, columns (b), (d), and (e)..................
    13123,103
    (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 (2014)
    Form 990-PF (2014)
    Page 13
    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) 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 (2014)
    Additional Data


    Software ID:  
    Software Version:  


    Form 990PF - Special Condition Description:
    Special Condition Description

    TY 2014 AccountingFeesSchedule
    Name:
    MONTGOMERY HOSPITAL FBO CAPEL TRUST
    EIN: 51-0160511
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    TAX PREPERATION FEE 2,000     2,000
    TRADING ACTIVITY FEE 50 50    

    TY 2014 InvestmentsCorpBondsSchedule
    Name:
    MONTGOMERY HOSPITAL FBO CAPEL TRUST
    EIN: 51-0160511
    Name of Bond End of Year Book Value End of Year Fair Market Value
    261980494 DREYFUS EMG MKT DEBT 33,000 27,063
    693390551 PIMCO TOTAL RETN FD    
    693390882 PIMCO FOREIGN BD FD 37,304 42,335
    693391559 PIMCO EMERG MKTS BD- 30,000 27,131
    72369B406 PIONEER HIGH YIELD F    
    76628T645 RIDGEWORTH SEIX HY B 62,964 56,257
    921937850 VANGUARD S/T BD IND    
    957663701 WESTERN ASSET INTERM 70,000 70,522
    256210105 DODGE & COX INCOME F 70,000 70,055
    693390304 PIMCO LOW DURATION F 22,985 22,297
    693390700 PIMCO TOTAL RET FD-I 54,424 51,299
    741478101 T ROWE CORPORATE INC 60,000 58,596
    77957P105 T ROWE PRICE SHORT T 44,000 43,296
    262028855 DRIEHAUS ACTIVE INCO 16,000 15,509
    77958B402 T ROWE PRICE INST FL 8,000 7,798

    TY 2014 InvestmentsCorpStockSchedule
    Name:
    MONTGOMERY HOSPITAL FBO CAPEL TRUST
    EIN: 51-0160511
    Name of Stock End of Year Book Value End of Year Fair Market Value
    126650100 CVS HEALTH CORPORATI 2,358 8,090
    246248306 DELAWARE POOLED TR    
    318910106 FIRST BANCORP N C 36,740 812,772
    345370860 FORD MOTOR COMPANY 4,857 4,464
    364760108 GAP INC    
    437076102 HOME DEPOT INC 1,669 7,558
    654106103 NIKE INC CL B    
    693390551 PIMCO TOTAL RETURN    
    693390882 PIMCO FOREIGN BOND    
    72369B406 PIONEER HIGH YIELD    
    742719109 PROCTER & GAMBLE CO    
    778296103 ROSS STORES INC    
    902494103 TYSON FOODS INC CL A    
    931142103 WAL MART STORES INC    
    94984B348 WELLS FARGO ADVANT.    
    94984B397 WELLS FARGO ADVANT.    
    94985D244 WELLS FARGO ADVANT.    
    166764100 CHEVRON CORP    
    171798101 CIMAREX ENERGY CO    
    20825C104 CONOCOPHILLIPS 5,794 4,834
    30231G102 EXXON MOBIL CORPORAT 1,924 3,790
    406216101 HALLIBURTON CO 6,020 3,500
    674599105 OCCIDENTAL PETE CORP    
    03076C106 AMERIPRISE FINL INC    
    172967101 CITIGROUP INC    
    46625H100 JPMORGAN CHASE & CO    
    693475105 PNC FINANCIAL SVCS    
    91529Y106 UNUM GROUP    
    031162100 AMGEN INC    
    110122108 BRISTOL MYERS SQUIBB    
    14149Y108 CARDINAL HEALTH INC 5,506 6,539
    345838106 FOREST LABS INC    
    478160104 JOHNSON & JOHNSON 2,183 5,438
    58155Q103 MCKESSON CORP 2,759 9,341
    58405U102 MEDCO SOLUTIONS INC    
    235851102 DANAHER CORP    
    369604103 GENERAL ELECTRIC CO    
    907818108 UNION PACIFIC CORP    
    913017109 UNITED TECHNOLOGIES    
    88579Y101 3M CO    
    037833100 APPLE INC 2,534 7,506
    17275R102 CISCO SYSTEMS INC 3,820 5,952
    219350105 CORNING INC    
    428236103 HEWLETT PACKARD CO 5,582 6,822
    44919P508 IAC/INTERACTIVECORP    
    458140100 INTEL CORP    
    459200101 IBM CORP    
    594918104 MICROSOFT CORP 1,782 5,528
    68389X105 ORACLE CORPORATION 3,221 6,206
    882508104 TEXAS INSTRUMENTS    
    459506101 INTERNATL FLAVORS    
    81211K100 SEALED AIR CORP    
    92343V104 VERIZON COMMUNICATIO    
    210371100 CONSTELLATION ENERGY    
    H0023R105 ACE LIMITED    
    G6852T105 PARTNERRE LTD COM    
    H8912P106 TYCO ELECTRONICS LTD    
    H89128104 TYCO INTERNATL LTD    
    008882532 INVESCO INTL GROWTH- 28,181 35,830
    04314H204 ARTISAN INTERNATIONA 37,000 53,831
    22544R305 CREDIT SUISSE COMM R 39,605 28,236
    339128100 JP MORGAN MID CAP VA 19,072 31,281
    464287234 ISHARES MSCI EMERGIN 34,623 33,397
    464287507 ISHARES CORE S&P MID 40,632 66,608
    464287606 ISHARES S&P MID-CAP 20,035 33,531
    46625H365 JP MORGAN ALERIAN ML 7,572 9,190
    683974505 OPPENHEIMER DEVELOPI    
    780905451 ROYCE PREMIER FUND W 9,243 9,272
    78463X863 SPDR DJ WILSHIRE INT 38,649 43,233
    922908553 VANGUARD REIT VIPER 51,441 72,900
    318910106 FIRST BANCORP N C    
    26441C105 DUKE ENERGY HOLDING    
    G2554F113 COVIDIEN PLC    
    G4412G101 HERBALIFE LTD    
    124857202 CNS CORP NEW    
    20030N101 COMCAST CORP CLASS A 2,660 6,439
    344849104 FOOT LOCKER INC 6,086 6,236
    92927K102 WABCO HOLDINGS INC    
    637071101 NATIONAL OILWELL INC 5,654 5,177
    064058100 BANK NEW YORK MELLON    
    316773100 FIFTH THIRD BANCORP    
    59156R108 METLIFE INC    
    754730109 RAYMOND JAMES FINL    
    151020104 CELGENE CORP COM    
    91324P102 UNITEDHEALTH GROUP I    
    00846U101 AGILENT TECH INC    
    018581108 ALLIANCE DATA SYS CO    
    268648102 E M C CORP MASS    
    871503108 SYMANTEC CORP    
    774415103 ROCKWOOD HLDGS INC    
    002824100 ABBOTT LABS    
    020002101 ALLSTATE CORP    
    04314H105 ARTISAN FDS INC SMAL 7,915 11,627
    127387108 CADENCE DESIGN SYSTE    
    167250109 CHICAGO BRIDGE & IRO    
    254687106 WALT DISNEY CO    
    26441C204 DUKE ENERGY HOLDING    
    31428X106 FEDEX CORPORATION    
    343412102 FLUOR CORP NEW    
    36191G107 GNC HOLDINGS INC    
    38141G104 GOLDMAN SACHS GROUP 6,035 6,590
    38388F108 W. R. GRACE & CO COM    
    411511306 HARBOR INTERNATION F 30,951 35,651
    413838202 OAKMARK INTERNATIONA 40,000 44,949
    436106108 HOLLYFRONTIER CORP    
    464287887 ISHARES S&P SMALL-CA 15,509 23,254
    718546104 PHILLIPS 66    
    747525103 QUALCOMM INC 3,767 4,237
    84763R101 SPECTRUM BRANDS HOLD    
    867914103 SUNTRUST BANKS INC    
    872540109 TJX COS INC NEW    
    880779103 TEREX CORP NEW    
    883556102 THERMO FISHER SCIENT    
    902973304 US BANCORP DEL NEW    
    G1151C101 ACCENTURE PLC    
    00206R102 AT & T INC    
    00287Y109 ABBVIE INC    
    060505104 BANK OF AMERICA CORP    
    084670702 BERKSHIRE HATHAWAY I 5,220 6,757
    097023105 BOEING CO    
    101137107 BOSTON SCIENTIFIC CO    
    172967424 CITIGROUP INC.    
    233326107 DST SYS INC COM 4,179 5,837
    247361702 DELTA AIR LINES INC 2,841 7,329
    260543103 DOW CHEMICAL CO 4,887 5,610
    410345102 HANESBRANDS INC 2,798 6,697
    464287879 ISHARES S&P SMALL-CA 18,376 22,998
    521865204 LEAR CORP 4,915 6,768
    534187109 LINCOLN NATL CORP IN 3,363 6,171
    548661107 LOWES COS INC 5,167 7,155
    559222401 MAGNA INTL INC CL A 4,708 7,608
    595112103 MICRON TECHNOLOGY IN 4,301 7,702
    617446448 MORGAN STANLEY 5,099 6,790
    681904108 OMNICARE INC    
    688239201 OSHKOSH CORPORATION    
    695156109 PACKAGING CORP OF AM    
    80004C101 SANDISK CORP COM 5,006 7,838
    80007P307 SANDRIDGE ENERGY INC    
    902641646 E-TRACS ALERIAN MLP 9,118 9,744
    91307C102 UNITED THERAPEUTICS    
    G0083B108 ACTAVIS PLC 5,277 8,237
    G5876H105 MARVELL TECHNOLOGY G 4,660 6,235
    G7945M107 SEAGATE TECHNOLOGY    
    00817Y108 AETNA INC-NEW 5,773 6,485
    039483102 ARCHER DANIELS MIDLA 5,181 6,968
    04270V106 ARRIS GROUP INC 5,805 5,012
    09062X103 BIOGEN IDEC INC 6,160 6,110
    14040H105 CAPITAL ONE FINANCIA 5,851 5,944
    15135B101 CENTENE CORP DEL 6,060 6,646
    269246401 E*TRADE GROUP 5,075 6,428
    30303M102 FACEBOOK INC 5,061 6,320
    375558103 GILEAD SCIENCES INC 5,464 6,504
    58933Y105 MERCK & CO INC NEW 5,833 5,622
    589509207 MERGER FUND-INST #30 16,000 15,135
    666807102 NORTHROP GRUMMAN COR 5,655 6,927
    683974604 OPPENHEIMER DEVELOPI 35,000 36,693
    72348P104 PINNACLE FOODS INC 6,149 6,248
    74925K581 ROBECO BP LNG/SHRT R 16,000 16,331
    844741108 SOUTHWEST AIRLINES C 3,785 7,787
    848574109 SPIRIT AEROSYTSEMS H 5,808 6,757
    896522109 TRINITY INDS INC 5,879 3,949
    91913Y100 VALERO ENERGY CORP 5,670 4,901
    929089100 VOYA FINANCIAL INC 5,428 6,357

    TY 2014 LegalFeesSchedule
    Name:
    MONTGOMERY HOSPITAL FBO CAPEL TRUST
    EIN: 51-0160511
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    LEGAL FEES - PRINCIPAL (ALLOCA 8,059     8,059


    TY 2014 OtherAssetsSchedule
    Name:
    MONTGOMERY HOSPITAL FBO CAPEL TRUST
    EIN: 51-0160511
    Description Beginning of Year - Book Value End of Year - Book Value End of Year - Fair Market Value
    MONEY MKT FROM CAPEL TRUST 20,636 0 0


    TY 2014 OtherDecreasesSchedule
    Name:
    MONTGOMERY HOSPITAL FBO CAPEL TRUST
    EIN: 51-0160511
    Description Amount
       
       


    TY 2014 OtherIncomeSchedule2
    Name:
    MONTGOMERY HOSPITAL FBO CAPEL TRUST
    EIN: 51-0160511
    Description Revenue And Expenses Per Books Net Investment Income Adjusted Net Income
    JP MORGAN ALERIAN 466 466  
    MUTUAL FUND INCOME 442 442  
    FINAL CD INTEREST 55 55  
    FINAL MONEY MARKET INTEREST 12 12  


    TY 2014 OtherIncreasesSchedule
    Name:
    MONTGOMERY HOSPITAL FBO CAPEL TRUST
    EIN: 51-0160511
    Description Amount
       


    TY 2014 TaxesSchedule
    Name:
    MONTGOMERY HOSPITAL FBO CAPEL TRUST
    EIN: 51-0160511
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    FOREIGN TAXES 35 35   0
    FEDERAL TAX PAYMENT - PRIOR YE 1,137 0   0
    FEDERAL ESTIMATES - PRINCIPAL 2,484 0   0
    FOREIGN TAXES ON QUALIFIED FOR 263 263   0
    FOREIGN TAXES ON NONQUALIFIED 165 165   0