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
PETERSBURG HOSPITAL INCORPORATED
 

Number and street (or P.O. box number if mail is not delivered to street address)228 S SYCAMORE ST   Room/suite
City or town, state or province, country, and ZIP or foreign postal code
PETERSBURG, VA23803
A Employer identification number

54-0800802
B Telephone number (see instructions)

(804) 732-8900
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$0J 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).............. 910
2 Check bullet
Sch. B ...............
3 Interest on savings and temporary cash investments      
4 Dividends and interest from securities...... 219,819 219,819  
5a Gross rents..............      
b Net rental income or (loss)  
6a Net gain or (loss) from sale of assets not on line 10 1,631,217
b Gross sales price for all assets on line 6a 16,295,611
7 Capital gain net income (from Part IV, line 2)... 1,631,217
8 Net short-term capital gain.........  
9 Income modifications...........  
10a Gross sales less returns and allowances  
b Less: Cost of goods sold....  
c Gross profit or (loss) (attach schedule).....    
11 Other income (attach schedule)....... Click to see attachment 369 369  
12 Total. Add lines 1 through 11........ 1,852,315 1,851,405  
Operating and Administrative Expenses 13 Compensation of officers, directors, trustees, etc. 0 0   0
14 Other employee salaries and wages......        
15 Pension plans, employee benefits.......        
16a Legal fees (attach schedule).........        
b Accounting fees (attach schedule)....... Click to see attachment 3,570 3,570   0
c Other professional fees (attach schedule).... Click to see attachment 55,528 37,528   0
17 Interest...............        
18 Taxes (attach schedule) (see instructions)... Click to see attachment 2,550 0   0
19 Depreciation (attach schedule) and depletion...      
20 Occupancy..............        
21 Travel, conferences, and meetings.......        
22 Printing and publications..........        
23 Other expenses (attach schedule)....... Click to see attachment 4,026 0   4,026
24 Total operating and administrative expenses.
Add lines 13 through 23.......... 65,674 41,098   4,026
25 Contributions, gifts, grants paid........ 7,872,847 675,000
26 Total expenses and disbursements. Add lines 24 and 25 7,938,521 41,098   679,026
27 Subtract line 26 from line 12:
a Excess of revenue over expenses and disbursements -6,086,206
b Net investment income (if negative, enter -0-) 1,810,307
c Adjusted net income (if negative, enter -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...............      
2 Savings and temporary cash investments..........      
3 Accounts receivable bullet  
Less: allowance for doubtful accounts bullet        
4 Pledges receivable bullet  
Less: allowance for doubtful accounts bullet        
5 Grants receivable.................      
6 Receivables due from officers, directors, trustees, and other
disqualified persons (attach schedule) (see 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)........ 7,354,911    
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)...........      
14 Land, buildings, and equipment: basis bullet  
Less: accumulated depreciation (attach schedule) bullet        
15 Other assets (describe bullet) Click to see attachment13,032 Click to see attachment0 Click to see attachment0
16 Total assets (to be completed by all filers—see the
instructions. Also, see page 1, item I) 7,367,943 0 0
Liabilities 17 Accounts payable and accrued expenses.......... 11,584  
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).......... 11,584 0
Net Assets or Fund Balances bullet
and complete lines 24 through 26 and lines 30 and 31.
24 Unrestricted................... 741,188 0
25 Temporarily restricted................ 6,597,314 0
26 Permanently restricted................ 17,857 0
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 instructions)...... 7,356,359 0
31 Total liabilities and net assets/fund balances (see instructions).. 7,367,943 0
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 7,356,359
2 Enter amount from Part I, line 27a..................... 2 -6,086,206
3 Other increases not included in line 2 (itemize) bullet 3 0
4 Add lines 1, 2, and 3.......................... 4 1,270,153
5 Decreases not included in line 2 (itemize) bulletClick to see attachment 5 1,270,153
6 Total net assets or fund balances at end of year (line 4 minus line 5)—Part II, column (b), line 30. 6 0
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 1770453.64 SHS FEDERATED MMKT PRIME OBLIG-I #10 P 2014-01-01 2014-12-31
b 100507.904 SHS RIDGEWORTH CORE BD # RCG P 2014-01-01 2014-12-22
c 70046.93 SHS RIDGEWORTH US GOVT SECS #RGCH P 2014-01-01 2014-12-22
d 535 SHS AIR PRODUCTS & CHEMICALS P 2014-01-01 2014-12-22
e 3000 SHS ALCOA INC. P 2014-01-01 2014-12-22
316 SHS ALLEGION PLC P 2014-01-01 2014-03-27
800 SHS AMERICAN EXPRESS CO. P 2014-01-01 2014-12-22
600 SHS AMGEN INC. P 2014-01-01 2014-12-22
875 SHS APPLE INC. P 2014-01-01 2014-12-22
1800 SHS ARCHER DANIELS MIDLAND CO. P 2014-01-01 2014-12-22
900 SHS AUTOMATIC DATA PROCESSING INC. P 2014-01-01 2014-12-22
610 SHS BECTON DICKINSON P 2014-01-01 2014-12-22
320 SHS CALIFORNIA RESOURCES CORP P 2014-01-01 2014-12-15
730 SHS CATERPILLAR INC. P 2014-01-01 2014-12-22
300 SHS CDK GLOBAL HOLDINGS LLC P 2014-01-01 2014-10-30
800 SHS CHUBB CORP P 2014-01-01 2014-12-22
2950 SHS CISCO SYSTEMS INC. P 2014-01-01 2014-12-22
2000 SHS COACH INC. P 2014-01-01 2014-12-22
3600 SHS CORNING INC. P 2014-01-01 2014-12-22
550 SHS COSTCO WHOLESALE CORP P 2014-01-01 2014-12-22
925 SHS DISNEY WALT CO NEW P 2014-01-01 2014-12-22
1130 SHS EMERSON ELEC CO. P 2014-01-01 2014-12-22
850 SHS EXXONMOBIL CORP P 2014-01-01 2014-12-22
3922013.64 FEDERATED MMKT PRIME OBLIG-I #10 FFS P 2014-01-01 2014-12-22
500 SHS FEDEX CORPORATION P 2014-01-01 2014-12-22
600 SHS GENERAL DYNAMICS CORP P 2014-01-01 2014-12-22
2750 SHS GENERAL ELECTRIC CORP P 2014-01-01 2014-12-22
70 SHS GOOGLE INC. CL A P 2014-01-01 2014-12-22
70 SHS GOOGOLE INC. CLASS C P 2014-01-01 2014-12-22
75 SHS HALYARD HEALTH INC. P 2014-01-01 2014-11-28
900 SHS HOME DEPOT INC. P 2014-01-01 2014-12-22
800 SHS ILLINOIS TOOL WKS INC. P 2014-01-01 2014-12-22
950 SHS INGERSOLL-RAND PLC P 2014-01-01 2014-05-30
2400 SHS INTEL CORP P 2014-01-01 2014-12-22
1340 SHS INTERNATIONAL PAPER CO. P 2014-01-01 2014-12-22
450 SHS INTL BUSINESS MACHINES CORP P 2014-01-01 2014-12-22
750 SHS JOHNSON & JOHNSON P 2014-01-01 2014-12-22
1200 SHS JP MORGAN CHASE & CO. P 2014-01-01 2014-12-22
600 SHS KIMBERLY CLARK CORP P 2014-01-01 2014-12-22
700 SHS MCODONALDS CORP P 2014-01-01 2014-12-22
1500 SHS MICROSOFT CORP P 2014-01-01 2014-12-22
2000 SHS MORGAN STANLEY P 2014-01-01 2014-12-22
1275 SHS NUCOR CORP P 2014-01-01 2014-12-22
1000 SHS OCCIDENTAL PETE CORP P 2014-01-01 2014-12-22
800 SHS PEPSICO P 2014-01-01 2014-12-22
2400 SHS PFIZER INC. P 2014-01-01 2014-12-22
850 SHS PROCTER & GAMBLE CO. P 2014-01-01 2014-12-22
1050 SHS QUALCOMM INC. P 2014-01-01 2014-12-22
450 SHS RALPH LAUREN CORP P 2014-01-01 2014-12-22
800 SHS SCHLUMBERGER LTD P 2014-01-01 2014-12-22
800 SHS STRYKER CORPORATION P 2014-01-01 2014-12-22
118.75 SHS TIME INC. P 2014-01-01 2014-12-22
1050 SHS TIME WARNER INC. P 2014-01-01 2014-12-22
1800 SHS UNILEVER NV NY SHARES P 2014-01-01 2014-12-22
780 SHS UNION PAC CORP P 2014-01-01 2014-12-22
1700 SHS US BANCORP P 2014-01-01 2014-12-22
25.619 SHS VERITIVE CORP P 2014-01-01 2014-12-22
1450 SHS VERIZON COMMUNICATIONS P 2014-01-01 2014-12-22
870 SHS WAL MART STORES INC. P 2014-01-01 2014-12-22
1495 SHS WALGREEN CO. P 2014-01-01 2014-12-22
1800 SHS ZOETIS INC. P 2014-01-01 2014-12-22
480 SHS 3M CO. P 2014-01-01 2014-12-22
2501728.54 SHS FEDERATED MMKT PRIME P 2014-01-01 2014-12-22
230131.137 SHS PIMCO TOTAL RETURN FUND-INST. P 2014-01-01 2014-12-22
(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 1,770,454   1,770,454 0
b 1,095,536   1,105,831 -10,295
c 587,694   609,130 -21,436
d 74,454   22,009 52,445
e 81,135   77,492 3,643
16,893   4,133 12,760
71,210   21,222 49,988
96,583   40,176 56,407
94,538   22,984 71,554
87,920   37,282 50,638
75,004   38,566 36,438
82,580   21,776 60,804
1,848   2,576 -728
64,910   53,841 11,069
8,904   5,478 3,426
81,293   50,871 30,422
78,742   73,589 5,153
71,361   97,146 -25,785
75,624   48,426 27,198
75,816   29,105 46,711
84,034   26,340 57,694
66,341   47,551 18,790
75,733   70,103 5,630
3,922,014   3,922,014 0
83,013   30,263 52,750
81,910   32,229 49,681
67,111   76,348 -9,237
35,386   11,498 23,888
35,241   11,528 23,713
2,908   1,592 1,316
88,031   30,431 57,600
73,958   33,432 40,526
54,814   16,248 38,566
86,917   61,197 25,720
70,742   44,237 26,505
68,317   58,289 10,028
77,447   38,991 38,456
71,370   39,849 31,521
67,753   37,025 30,728
63,269   34,546 28,723
68,229   36,909 31,320
71,803   48,558 23,245
61,973   33,551 28,422
77,237   87,077 -9,840
74,388   42,236 32,152
74,495   75,495 -1,000
76,507   41,237 35,270
75,242   43,819 31,423
79,446   71,089 8,357
67,277   44,236 23,041
72,820   38,761 34,059
2,893   1,947 946
86,432   53,510 32,922
69,503   56,026 13,477
94,298   10,562 83,736
74,276   42,521 31,755
1,185   642 543
66,519   56,848 9,671
72,478   46,504 25,974
106,777   60,148 46,629
73,908   56,213 17,695
75,863   27,704 48,159
2,501,729   2,501,729 0
2,501,525   2,431,274 70,251
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       0
b       -10,295
c       -21,436
d       52,445
e       3,643
      12,760
      49,988
      56,407
      71,554
      50,638
      36,438
      60,804
      -728
      11,069
      3,426
      30,422
      5,153
      -25,785
      27,198
      46,711
      57,694
      18,790
      5,630
      0
      52,750
      49,681
      -9,237
      23,888
      23,713
      1,316
      57,600
      40,526
      38,566
      25,720
      26,505
      10,028
      38,456
      31,521
      30,728
      28,723
      31,320
      23,245
      28,422
      -9,840
      32,152
      -1,000
      35,270
      31,423
      8,357
      23,041
      34,059
      946
      32,922
      13,477
      83,736
      31,755
      543
      9,671
      25,974
      46,629
      17,695
      48,159
      0
      70,251
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 1,631,217
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 352,688 7,227,005 0.048801
2012 351,712 6,791,362 0.051788
2011 340,568 7,029,623 0.048448
2010 323,614 6,962,384 0.046480
2009 0 6,064,273 0.000000
2 Total of line 1, column (d) ...................... 2 0.195517
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 0.039103
4 Enter the net value of noncharitable-use assets for 2014 from Part X, line 5..... 4 7,218,345
5 Multiply line 4 by line 3....................... 5 282,259
6 Enter 1% of net investment income (1% of Part I, line 27b)........... 6 18,103
7 Add lines 5 and 6......................... 7 300,362
8 Enter qualifying distributions from Part XII, line 4.............. 8 679,026
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 18,103
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 18,103
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 18,103
6 Credits/Payments:
a 2014 estimated tax payments and 2013 overpayment credited to 2014 6a 1,638
b Exempt foreign organizations—tax withheld at source....... 6b
c Tax paid with application for extension of time to file (Form 8868)... 6c 3,000
d Backup withholding erroneously withheld ........... 6d  
7 Total credits and payments. Add lines 6a through 6d.............. 7 4,638
8 Enter any penalty for underpayment of estimated tax. if Form 2220 is attached. Click to see attachment 8 1
9 Tax due. If the total of lines 5 and 8 is more than line 7, enter amount owed.......Bullet 9 13,466
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 2015 estimated taxBullet0 RefundedBullet 11 0
Part VII-A
Statements Regarding Activities
1a
During the tax year, did the foundation attempt to influence any national, state, or local legislation or did
Yes
No
it participate or intervene in any political campaign? ....................
1a
 
No
b
Did it spend more than $100 during the year (either directly or indirectly) for political purposes (see 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
Yes
 
If "Yes," attach the statement required by General Instruction T.Click to see list of attachments
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)
    bulletVA
    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 addressbulletN/A
    14
    The books are in care ofbulletTHE CAMERON FOUNDATION Telephone no.bullet (804) 732-8900
    Located atbullet228 S SYCAMORE STPETERSBURGVA ZIP+4bullet23803
    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
     
     
    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
    Yes
     
    .........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). Click to see attachment
    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
    REV GRADY W POWELL CHAIRMAN
    1.00     		0 0 0
    228 S SYCAMORE STREET
    PETERSBURG,VA23803
    CLEVELAND A WRIGHT VICE CHAIRMAN
    1.00     		0 0 0
    228 S SYCAMORE STREET
    PETERSBURG,VA23803
    GURPAL S BHULLER MD COMMISSIONER
    1.00     		0 0 0
    228 S SYCAMORE STREET
    PETERSBURG,VA23803
    MARK ENDE MD COMMISSIONER
    1.00     		0 0 0
    228 S SYCAMORE STREET
    PETERSBURG,VA23803
    JACK R HUNDLEY COMMISSIONER
    1.00     		0 0 0
    228 S SYCAMORE STREET
    PETERSBURG,VA23803
    CARLTON E MILLER MD COMMISSIONER
    1.00     		0 0 0
    228 S SYCAMORE STREET
    PETERSBURG,VA23803
    MARK B SPECTER COMMISSIONER
    1.00     		0 0 0
    228 S SYCAMORE STREET
    PETERSBURG,VA23803
    ANN C TAYLOR COMMISSIONER
    1.00     		0 0 0
    228 S SYCAMORE STREET
    PETERSBURG,VA23803
    JAMES L THACKER JR COMMISSIONER
    1.00     		0 0 0
    228 S SYCAMORE STREET
    PETERSBURG,VA23803
    ANDREW J WHITE COMMISSIONER
    1.00     		0 0 0
    228 S SYCAMORE STREET
    PETERSBURG,VA23803
    WILLIAM A YOUNG JR COMMISSIONER
    1.00     		0 0 0
    228 S SYCAMORE STREET
    PETERSBURG,VA23803
    DONALD L HARAWAY TREASURER
    1.00     		0 0 0
    228 S SYCAMORE STREET
    PETERSBURG,VA23803
    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.........................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
    7,328,269
    b
    Average of monthly cash balances.......................
    1b
    0
    c
    Fair market value of all other assets (see instructions)................
    1c
    0
    d
    Total (add lines 1a, b, and c).........................
    1d
    7,328,269
    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
    7,328,269
    4
    Cash deemed held for charitable activities. Enter 1 1/2% of line 3 (for greater amount, see
    instructions) .............................
    4
    109,924
    5
    Net value of noncharitable-use assets. Subtract line 4 from line 3. Enter here and on Part V, line 4
    5
    7,218,345
    6
    Minimum investment return. Enter 5% of line 5..................
    6
    360,917
    Part XI
    Distributable Amount bullet and do not complete this part.)
    1
    Minimum investment return from Part X, line 6....................
    1
    360,917
    2a
    Tax on investment income for 2014 from Part VI, line 5......
    2a
    18,103
    b
    Income tax for 2014. (This does not include the tax from Part VI.)...
    2b
     
    c
    Add lines 2a and 2b............................
    2c
    18,103
    3
    Distributable amount before adjustments. Subtract line 2c from line 1............
    3
    342,814
    4
    Recoveries of amounts treated as qualifying distributions................
    4
    0
    5
    Add lines 3 and 4............................
    5
    342,814
    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
    342,814
    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
    679,026
    b
    Program-related investments—total from Part IX-B..................
    1b
    0
    2
    Amounts paid to acquire assets used (or held for use) directly in carrying out charitable, etc.,
    purposes...............................
    2
     
    3
    Amounts set aside for specific charitable projects that satisfy the:
    a
    Suitability test (prior IRS approval required)....................
    3a
     
    b
    Cash distribution test (attach the required schedule) .................
    3b
     
    4
    Qualifying distributions. Add lines 1a through 3b. Enter here and on Part V, line 8, and Part XIII, line 4
    4
    679,026
    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
    18,103
    6
    Adjusted qualifying distributions. Subtract line 5 from line 4..............
    6
    660,923
    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 7 342,814
    2 Undistributed income, if any, as of the end of 2014:
    a Enter amount for 2013 only....... 313,969
    b Total for prior years:20, 20, 20 0
    3 Excess distributions carryover, if any, to 2014:
    a From 2009.......  
    b From 2010.......  
    c From 2011.......  
    d From 2012.......  
    e From 2013.......  
    fTotal of lines 3a through e......... 0
    4Qualifying distributions for 2014 from Part
    XII, line 4: bullet$ 679,026
    a Applied to 2013, but not more than line 2a 313,969
    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..... 342,814
    e Remaining amount distributed out of corpus 22,243
    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 22,243
    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 ..........     		0
    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 ......     		22,243
    10 Analysis of line 9:
    a Excess from 2010....  
    b Excess from 2011....  
    c Excess from 2012....  
    d Excess from 2013....  
    e Excess from 2014.... 22,243
    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
    THE CAMERON FOUNDATION
    228 S SYCAMORE ST
    PETERSBURG,VA23803     		NONE PRIVATE FOUNDATION HEALTH PROGRAM SUPPORT FOR ORGANIZATIONS PROVIDING SERVICES TO INDIVIDUALS. 675,000
    Total .................................bullet 3a 675,000
    bApproved for future payment
    Total .................................bullet 3b 0
    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....     14 219,819  
    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.....     14 369  
    8
    Gain or (loss) from sales of assets other than inventory .............     		    18 1,631,217  
    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 1,851,405 0
    13Total. Add line 12, columns (b), (d), and (e)..................
    131,851,405
    (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:
    PETERSBURG HOSPITAL INCORPORATED
    EIN: 54-0800802
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
      3,570 3,570   0

    TY 2014 DissolutionStmt
    Name:
    PETERSBURG HOSPITAL INCORPORATED
    EIN: 54-0800802
    Dissolution Name Dissolution Address Explanation Dissolution Amount
    228 S SYCAMORE ST
    PETERSBURG,VA23803     		A PLAN OF TERMINATION WAS ADOPTED ON DECEMBER 15, 2014 AND WAS ORDERED BY THE CIRCUIT COURT OF PETERSBURG VIRGINIA ON THE SAME DATE. ALL ASSETS DISTRIBUTED CONSISTED OF CASH. 7,872,847


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

    TY 2014 ExpenditureResponsibilityStmt
    Name:
    PETERSBURG HOSPITAL INCORPORATED
    EIN: 54-0800802
    Grantee's Name Grantee's Address Grant Date Grant Amount Grant Purpose Amount Expended By Grantee Any Diversion By Grantee? Dates of Reports By Grantee Date of Verification Results of Verification
     
          		228 SOUTH SYCAMORE STREET
    PETERSBURG,VA23803     		2014-12-22 675,000 HEALTH PROGRAM SUPPORT FOR ORGANIZATIONS PROVIDING SERVICES TO INDIVIDUALS. 675,000 NO DECEMBER 2014, JUNE 2015, NOVEMBER 2015   TO THE KNOWLEDGE OF PETERSBURG HOSPITAL INCORPORATED, GRANTEE HAS NOT DIVERTED ANY PORTION OF THE GRANT FUNDS FROM THE PURPOSE OF THE GRANT. PETERSBURG HOSPITAL INCORPORATED HAS NO REASON TO DOUBT THE ACCURACY OR RELIABILITY OF THE GRANTEE'S REPORTS.

    TY 2014 LiquidationExplanationStmt
    Name:
    PETERSBURG HOSPITAL INCORPORATED
    EIN: 54-0800802
    Statement:
    DURING THE CURRENT YEAR PETERSBURG HOSPITAL INC. MADE THE FOLLOWING DISTRIBUTIONS IN COMPLETE LIQUIDATION: THESE DISTRIUBTIONS DO CONSTITUTE A FINAL DISTRIBUTION OF THE FOUNDATIONS ASSETS. THE FINAL DISTRIBUTION WAS MADE ON DECEMBER 23, 2014


    TY 2014 OtherAssetsSchedule
    Name:
    PETERSBURG HOSPITAL INCORPORATED
    EIN: 54-0800802
    Description Beginning of Year - Book Value End of Year - Book Value End of Year - Fair Market Value
    INTEREST RECEIVABLE 12,144    
    TAXES RECEIVABLE 888    


    TY 2014 OtherDecreasesSchedule
    Name:
    PETERSBURG HOSPITAL INCORPORATED
    EIN: 54-0800802
    Description Amount
       


    TY 2014 OtherExpensesSchedule
    Name:
    PETERSBURG HOSPITAL INCORPORATED
    EIN: 54-0800802
    Description Revenue and Expenses per Books Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    MISCELLANEOUS 4,026 0   4,026


    TY 2014 OtherIncomeSchedule2
    Name:
    PETERSBURG HOSPITAL INCORPORATED
    EIN: 54-0800802
    Description Revenue And Expenses Per Books Net Investment Income Adjusted Net Income
    SUNTRUST CUSTODIAN ACCOUNTS 369 369 369


    TY 2014 OtherProfessionalFeesSchedule
    Name:
    PETERSBURG HOSPITAL INCORPORATED
    EIN: 54-0800802
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
      55,528 37,528   0


    TY 2014 TaxesSchedule
    Name:
    PETERSBURG HOSPITAL INCORPORATED
    EIN: 54-0800802
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    EXCISE TAX 2,550 0   0