| Category | Amount | Net Investment Income | Adjusted Net Income | Disbursements for Charitable Purposes |
|---|---|---|---|---|
| ACCOUNTING | 2,235 | 745 | 1,490 | 1,490 |
| Identifier | Return Reference | Explanation |
|---|---|---|
| INVESTMENTS IN CORPORATE STOCK | FORM 990-PF PART II LINE 10B | SCHEDULE A BEG OF YEAR END OF YEARPART II LINE 10B, INVESTMENTS IN CORPORATE STOCK BOOK VALUE BOOK VALUE MKT. VALUE ALLIANZGI EMERGING MKTS OPP 0.00 76686.27 69701.47 ALLIANZGI NFJ DIVIDEND VALUE FD 80089.80 81762.48 103106.86 AMERICAN CENTURY MID CAP VALUE 93773.43 85746.05 90860.89 ARTISAN INTERNATIONAL INVESTOR 115697.00 133948.84 144888.78 CREDIT SUISSE COMMD RTRN STRTGY 132686.71 114799.80 63772.41 GATEWAY FUND 65377.15 88364.26 93658.45 INVESCO SMALL CAP GROWTH 34740.53 43257.31 43019.27 JANUS GROWTH AND INCOME 108056.64 104000.41 134751.64 LAZARD EMERG MRKT EQUITY BLEND 111485.43 0.00 0.00 MERGER FUND 71074.54 80914.62 78114.24 NEUBERGER BERMAN REAL ESTATE 45048.39 43803.96 49423.30 PIMCO STOCKSPLUS TOTAL RETURN 179468.81 165862.62 164308.60 THOMAS WHITE INTERNATIONL 185203.61 172128.23 146641.98 WELLS FARGO UTILITY & TELECOMM 59554.28 45761.56 60667.53 LOOMIS SAYLES BOND RETAIL 108769.47 124593.31 103384.67 TEMPLETON GLOBAL BOND 21592.59 34618.40 30950.95 WESTERN ASSET TOTAL RTN 71296.36 66361.56 62877.74 1483914.74 1462609.68 1440128.78 |
| SUPPLEMENTARY INFORMATION - COPY OF APPLICATION | FORM 990-PF PART XV LINE 2B | BLANCHEFISCHERFOUNDATION1509 S.W. SUNSET BLVD., SUITE 1-BPORTLAND, OR 97239PHONE: 503.819.8205E-MAIL: BFF@BFF.ORG WEB: WWW.BFF.ORGTHE BLANCHE FISCHER FOUNDATION IS A PRIVATE, NONPROFIT CHARITABLE INSTITUTION FOUNDED IN 1981 FOR THE PURPOSE OF ASSISTING PERSONS WHO HAVE A DISABILITY THAT CHALLENGES THEM PHYSICALLY AND WHO HAVE FINANCIAL NEED. THERE ARE THREE CRITERIA FOR CONSIDERATION FOR A GRANT FROM THE FOUNDATION:1. YOU MUST BE AN OREGON RESIDENT;2. YOU MUST HAVE A DISABILITY OF A PHYSICAL NATURE; AND3. YOU MUST DEMONSTRATE FINANCIAL NEED.APPLICANTS MAY APPLY FOR FINANCIAL AID FOR EDUCATION, SPECIAL EQUIPMENT OR FOR SUCH OTHER PURPOSES AS THE FOUNDATION FINDS APPROPRIATE.PLEASE NOTE.. THE APPLICATION MUST BE FILLED OUT COMPLETELY AND SIGNED BY THE APPLICANT OR APPLICANT'S LEGAL GUARDIAN... MEDICAL OR OTHER SATISFACTORY VERIFICATION OF DISABILITY (LETTER FROM PHYSICIAN OR OTHER HEALTH CARE PROFESSIONAL) IS REQUIRED... WE DO NOT ACCEPT FAXED APPLICATIONS. YOU MUST MAIL THE ORIGINAL, ALONG WITH DOCUMENTATION, TO THE FOUNDATION. THIS IS NECESSARY FOR THE FOUNDATION TO COMPLY WITH STATE AND FEDERAL REQUIREMENTS.GRANT APPLICATIONNAME OF APPLICANT (PERSON FOR WHOM ASSISTANCE IS REQUESTED):ADDRESS:STREET NO. APT./UNIT CITY ZIPTELEPHONE/TTY: ( ) E-MAIL:AP090102.DOC PAGE 1 OF 4I. INFORMATION ABOUT YOUR DISABILITY1. BRIEFLY DESCRIBE YOUR DISABILITY:2. HOW LONG HAS THIS CONDITION EXISTED?3. IS YOUR CONDITION PERMANENT? YES NOIF NO, EXPECTED DURATION:4. HOW DOES THIS AFFECT YOUR DAILY LIFE AND INDEPENDENCE?5. FOR WHAT PURPOSE ARE YOU REQUESTING FUNDING?6. HOW MUCH DOES IT COST? $7. HOW MUCH DO YOU NEED THE BLANCHE FISCHER FOUNDATION TO CONTRIBUTE? $8. HOW WILL THIS GRANT IMPROVE YOUR QUALITY OF LIFE?9. NAME AND ADDRESS OF VENDOR OR SUPPLIER (ATTACH COPY OF PRICE QUOTE OR ORDER INFORMATION):YES, IT'S ATTACHED!10. HAVE YOU APPLIED FOR GRANTS FROM ANY OTHER SOURCE(S)? YES NOFROM WHOM? HOW MUCH? $11. HAVE ANY BEEN APPROVED? YES NOBY WHOM? IN WHAT AMOUNT(S)? $12. HAVE YOU EVER RECEIVED VOCATIONAL TRAINING? YES NO13. FROM WHOM (STATE AGENCY, FEDERAL, PRIVATE ORGANIZATION)?WHEN?DID THIS TRAINING RESULT IN EMPLOYMENT? YES NO14. ATTACH A LETTER OR REPORT FROM YOUR DOCTOR OR OTHER LICENSED HEALTH CARE PROFESSIONAL (SOCIAL WORKER, CASE MANAGER, ETC.) VERIFYING YOUR DISABILITY. YES, IT'S ATTACHED! AP090102.DOC PAGE 2 OF 4II. APPLICATION FOR BENEFITNOTE: ALL HOUSEHOLD MEMBERS MUST BE CONSIDERED IN REPLYING TO INCOME-RELATED QUESTIONS.GENERAL INFORMATIONAPPLICANT'S BIRTH DATEIF A MINOR, NAME OF PARENT(S) OR GUARDIAN(S):AGE OF EACH CHILD IN HOUSEHOLD:NUMBER AND RELATIONSHIP (PARENT, SPOUSE, CAREGIVER, ETC.) OF ADULTS IN HOUSEHOLD:NUMBER OF WAGE EARNERS IN HOUSEHOLD:OCCUPATION(S):EMPLOYER(S) NAME(S):WORK PHONE (IF APPLICABLE): ( )INCOME AND EXPENSESA. MONTHLY INCOME SALARY AND WAGES:1. PRIMARY WAGE-EARNER:GROSS MONTHLY SALARY: $MONTHLY TAKE-HOME PAY: $2. SECOND WAGE-EARNER:GROSS MONTHLY SALARY: $MONTHLY TAKE-HOME PAY: $B. MONTHLY INCOME OTHERSOCIAL SECURITY $CHILD SUPPORT $FOOD STAMPS/OREGON TRAIL $OTHER (DESCRIBE): $C. MONTHLY EXPENSESCATEGORY MONTHLY PAYMENT BALANCE OWEDFOOD $CLOTHING $UTILITIES $HEALTH CARE (MEDICAL, DENTAL,VISION, PRESCRIPTIONS, ETC.) $ $INSURANCE $PAYMENTS (CREDIT CARDS,CAR PAYMENTS, LOANS, ETC.) $ $OTHER (DESCRIBE):$ $D. WHAT KIND OF MEDICAL INSURANCE, IF ANY, DO YOU HAVE? CHECK ALL APPLICABLE RESPONSES:NONEPRIVATE HEALTH INSURANCE YES NOMEDICARE YES NOOREGON HEALTH PLAN YES NOOTHER (DESCRIBE): YES NOAP090102.DOC PAGE 3 OF 4E. ASSETSDO YOU RENT OR OWN YOUR RESIDENCE? RENT OWNWHAT IS YOUR MONTHLY PAYMENT? $DO YOU OWN ANY OTHER REAL PROPERTY? YES NOIF YES, PLEASE DESCRIBE:AUTOMOBILE(S):AUTOMOBILE 1MAKE AND YEAR: VALUE $AUTOMOBILE 2MAKE AND YEAR: VALUE $AMOUNT OF CASH IN BANK ACCOUNTS AND ANY STOCKS, BONDS OR SECURITIES, INCLUDING RETIREMENT PLANS AND LIVING TRUSTS:DESCRIBE:VALUE $III. OTHER INFORMATION YOU MAY WISH US TO CONSIDER (ATTACH LETTER, IF DESIRED):ALL GRANTS MADE ASSUME THE ACCURACY OF THIS APPLICATION. I UNDERSTAND THAT IF A GRANT IS AWARDED, PAYMENT CAN BE MADE ONLY TO THE SUPPLIER OF GOODS OR SERVICES. I FURTHER UNDERSTAND THAT ALL DECISIONS AS TO ELIGIBILITY AND GRANTS ARE MADE AT THE SOLE DISCRETION OF THE BLANCHE FISCHER FOUNDATION AND THAT ITS DECISIONS ARE FINAL.I UNDERSTAND THAT ALL GRANTS AWARDED BY THE BLANCHE FISCHER FOUNDATION MUST BE REPORTED ON THE FOUNDATION'S FEDERAL AND STATE TAX RETURNS, AND AS SUCH, GRANTEES' NAMES, ADDRESSES AND GRANT AMOUNTS ARE A MATTER OF PUBLIC RECORD.SIGNATURE(S):APPLICANT PARENT/GUARDIAN (CIRCLE WHICHEVER IS APPROPRIATE)DATE PARENT/GUARDIAN (CIRCLE WHICHEVER IS APPROPRIATE)YOUR RESPONSE TO THE FOLLOWING QUESTION WILL NOT INFLUENCE IN ANY WAY THE OUTCOME OF THIS GRANT APPLICATION:WOULD YOU LIKE US TO SEND YOU A VOTER REGISTRATION CARD, ALONG WITH THE NAMES OF YOUR STATE SENATOR, REPRESENTATIVE AND U.S. CONGRESSIONAL REPRESENTATIVE? YES NOBEFORE MAILING THIS APPLICATION . . .1. ARE ALL SECTIONS COMPLETE?2. HAVE YOU ATTACHED DOCUMENTATION FROM A MEDICAL OR OTHER PROFESSIONAL VERIFYING DISABILITY?3. HAVE YOU ATTACHED A COPY OF YOUR VENDOR'S PRICE QUOTE?MAIL THE COMPLETED APPLICATION AND DOCUMENTATION TO:BLANCHE FISCHER FOUNDATION1509 S.W. SUNSET BLVD., SUITE 1-BPORTLAND, OR 97239 AP090102.DOC PAGE 4 OF 4 |
| Name of Stock | End of Year Book Value | End of Year Fair Market Value |
|---|---|---|
| VARIOUS MUTUAL FUNDS | 1,462,610 | 1,440,129 |
| Category/ Item | Listed at Cost or FMV | Book Value | End of Year Fair Market Value |
|---|---|---|---|
| ROCK QUARRY | AT COST | 227,700 | 227,700 |
| Description | Beginning of Year - Book Value | End of Year - Book Value | End of Year - Fair Market Value |
|---|---|---|---|
| ARTIFACTS AND PAINTINGS, DRIFTWOOD LIBRARY | 2,767 | 2,767 | 2,767 |
| Description | Revenue and Expenses per Books | Net Investment Income | Adjusted Net Income | Disbursements for Charitable Purposes |
|---|---|---|---|---|
| LICENSES & FEES | 50 | 0 | 50 | 50 |
| OFFICE AND TELEPHONE | 2,574 | 0 | 2,574 | 2,574 |
| BANK CHARGES & FEES | 21 | 0 | 21 | 21 |
| INSURANCE | 1,712 | 0 | 1,712 | 1,712 |
| DUES & REGISTRATIONS | 340 | 0 | 340 | 340 |
| Description | Revenue And Expenses Per Books | Net Investment Income | Adjusted Net Income |
|---|---|---|---|
| SALE OF ROCK IN PLACE FROM QUARRY | 41,952 | 41,952 | 41,952 |
| Description | Beginning of Year - Book Value | End of Year - Book Value |
|---|---|---|
| PAYROLL TAX WITHHELD | 0 | 1,786 |
| Category | Amount | Net Investment Income | Adjusted Net Income | Disbursements for Charitable Purposes |
|---|---|---|---|---|
| OUTSIDE SERVICES | 45 | 0 | 45 | 45 |
| INVESTMENT FESS | 20,298 | 20,298 | 0 | 0 |
| Category | Amount | Net Investment Income | Adjusted Net Income | Disbursements for Charitable Purposes |
|---|---|---|---|---|
| PAYROLL TAXES | 2,001 | 0 | 2,001 | 2,001 |
| INTERNAL REVENUE SERVICE | 5,591 | 5,591 | 0 | 0 |
| OREGON DEPT OF JUSTICE | 252 | 252 | 0 | 0 |
| FOREIGN TAXES | 597 | 597 | 0 | 0 |