Form990-PF
Click to see list of attachments

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
2015
Open to Public Inspection
For calendar year 2015, or tax year beginning 01-01-2015 , and ending 12-31-2015
Name of foundation
Albert Haller Foundation
 
Number and street (or P.O. box number if mail is not delivered to street address)PO Box 2739
  Room/suite
City or town, state or province, country, and ZIP or foreign postal code
Sequim, WA98382
A Employer identification number

91-1556810
B Telephone number (see instructions)

(360) 683-1119
C bullet
G Check all that apply:

D 1. bullet
2. bullet
E bullet
H Check type of organization:
F bullet
I Fair market value of all assets at end
of year (from Part II, col. (c),
line 16)bullet$9,420,297J Accounting method:
 
(Part I, column (d) must be on cash basis.)
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) 10,000
2 Check bullet Sch. B .............
3 Interest on savings and temporary cash investments 2,650 2,650  
4 Dividends and interest from securities... 186,141 186,141  
5a Gross rents............      
b Net rental income or (loss)  
6a Net gain or (loss) from sale of assets not on line 10 749,029
b Gross sales price for all assets on line 6a 1,211,843
7 Capital gain net income (from Part IV, line 2)... 749,029
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 158,286 104,286  
12 Total. Add lines 1 through 11........ 1,106,106 1,042,106  
Operating and Administrative Expenses 13 Compensation of officers, directors, trustees, etc.        
14 Other employee salaries and wages......        
15 Pension plans, employee benefits.......        
16a Legal fees (attach schedule)......... Click to see attachment 3,678     1,103
b Accounting fees (attach schedule)....... Click to see attachment 9,520     4,760
c Other professional fees (attach schedule).... Click to see attachment 28,475 28,475    
17 Interest...............        
18 Taxes (attach schedule) (see instructions)... Click to see attachment 2,605 2,605    
19 Depreciation (attach schedule) and depletion...      
20 Occupancy..............        
21 Travel, conferences, and meetings....... 268     134
22 Printing and publications..........        
23 Other expenses (attach schedule)....... Click to see list of attachments 16,189 156   2,500
24 Total operating and administrative expenses.
Add lines 13 through 23.......... 60,735 31,236   8,497
25 Contributions, gifts, grants paid....... 545,648 545,648
26 Total expenses and disbursements. Add lines 24 and 25 606,383 31,236   554,145
27 Subtract line 26 from line 12:
a Excess of revenue over expenses and disbursements 499,723
b Net investment income (if negative, enter -0-) 1,010,870
c Adjusted net income (if negative, enter -0-)...  
For Paperwork Reduction Act Notice, see instructions.
Cat. No. 11289X Form 990-PF (2015)
Form 990-PF (2015)
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......... 429,359 404,284 404,284
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) bullet895,965
Less: allowance for doubtful accounts bullet     895,965 895,965
8 Inventories for sale or use..............      
9 Prepaid expenses and deferred charges.......... 4,848 2,829 2,829
10a Investments—U.S. and state government obligations (attach schedule)      
b Investments—corporate stock (attach schedule).......      
c Investments—corporate bonds (attach schedule).......      
11 Investments—land, buildings, and equipment: basis bullet  
Less: accumulated depreciation (attach schedule) bullet   419,873    
12 Investments—mortgage loans.............      
13 Investments—other (attach schedule).......... 6,981,885 7,031,909 8,110,458
14 Land, buildings, and equipment: basis bullet  
Less: accumulated depreciation (attach schedule) bullet        
15 Other assets (describe bullet) Click to see attachment6,060 Click to see attachment6,761 Click to see attachment6,761
16 Total assets (to be completed by all filers—see the
instructions. Also, see page 1, item I) 7,842,025 8,341,748 9,420,297
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.................. 7,842,025 8,341,748
25 Temporarily restricted...............    
26 Permanently restricted...............    
bullet
and complete lines 27 through 31.
27 Capital stock, trust principal, or current funds........    
28 Paid-in or capital surplus, or land, bldg., and equipment fund    
29 Retained earnings, accumulated income, endowment, or other funds    
30 Total net assets or fund balances (see instructions)..... 7,842,025 8,341,748
31 Total liabilities and net assets/fund balances (see instructions). 7,842,025 8,341,748
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
7,842,025
2
Enter amount from Part I, line 27a .....................
2
499,723
3
Other increases not included in line 2 (itemize) bullet
3
 
4
Add lines 1, 2, and 3 ..........................
4
8,341,748
5
Decreases not included in line 2 (itemize) bullet
5
 
6
Total net assets or fund balances at end of year (line 4 minus line 5)—Part II, column (b), line 30 .
6
8,341,748
Form 990-PF (2015)
Form 990-PF (2015)
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 Land - Inherited A Haller Est P 1992-01-08 2015-11-06
b Capital Gain Distributions P 2014-01-01 2015-12-31
c
d
e
(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 1,100,000   462,814 637,186
b 111,843     111,843
c
d
e
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       637,186
b       111,843
c
d
e
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 2 749,029
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))
2014 557,998 10,961,569 0.05091
2013 507,244 10,475,156 0.04842
2012 494,914 9,907,904 0.04995
2011 491,339 9,911,741 0.04957
2010 452,279 8,909,991 0.05076
2
Total of line 1, column (d) .....................
20.249612
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
0.049922
4
Enter the net value of noncharitable-use assets for 2015 from Part X, line 5.....
4
10,650,799
5
Multiply line 4 by line 3......................
5
531,709
6
Enter 1% of net investment income (1% of Part I, line 27b)...........
6
10,109
7
Add lines 5 and 6........................
7
541,818
8
Enter qualifying distributions from Part XII, line 4.............
8
554,145
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 (2015)
Form 990-PF (2015)
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 Bullet and enter “N/A" on line 1. Bracket
Date of ruling or determination letter:   (attach copy of letter if necessary–see instructions)
b 1 10,109
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  
3 Add lines 1 and 2........................... 3 10,109
4 Subtitle A (income) tax (domestic section 4947(a)(1) trusts and taxable foundations only. Others enter -0-) 4  
5 Tax based on investment income. Subtract line 4 from line 3. If zero or less, enter -0- ..... 5 10,109
6 Credits/Payments:
a 2015 estimated tax payments and 2014 overpayment credited to 2015 6a 12,938
b Exempt foreign organizations—tax withheld at source...... 6b
c Tax paid with application for extension of time to file (Form 8868)... 6c  
d Backup withholding erroneously withheld ........... 6d  
7 Total credits and payments. Add lines 6a through 6d.............. 7 12,938
8 Enter any penalty for underpayment of estimated tax. if Form 2220 is attached. 8  
9 Tax due. If the total of lines 5 and 8 is more than line 7, enter amount owed.......Bullet 9  
10 Overpayment. If line 7 is more than the total of lines 5 and 8, enter the amount overpaid...Bullet 10 2,829
11 Enter the amount of line 10 to be: Credited to 2015 estimated taxBullet2,829 RefundedBullet 11  
Part VII-A
Statements Regarding Activities
1a
During the tax year, did the foundation attempt to influence any national, state, or local legislation or did
Yes
No
it participate or intervene in any political campaign? ....................
1a
 
No
b
Did it spend more than $100 during the year (either directly or indirectly) for political purposes (see 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
 
No
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)
    bulletWA
    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 2015 or the taxable year beginning in 2015 (see instructions for Part XIV)?
    If "Yes," complete Part XIV.............................
    9
     
    No
    10
    Did any persons become substantial contributors during the tax year? If "Yes," attach a schedule listing their names
    and addresses. ...............................
    10
     
    No
    Form 990-PF (2015)
    Form 990-PF (2015)
    Page 5
    Part VII-A
    Statements Regarding Activities (continued)
    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 ofbulletMeyer & Company CPAs PS Telephone no.bullet (360) 683-6677

    Located atbulletPO Box 1629SequimWA ZIP+4bullet98382
    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 2015, 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  
    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
     
    No
    ........bullet
    c
    Did the foundation engage in a prior year in any of the acts described in 1a, other than excepted acts,
    that were not corrected before the first day of the tax year beginning in 2015?.............
    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 2015, did the foundation have any undistributed income (lines 6d
    and 6e, Part XIII) for tax year(s) beginning before 2015?.............
    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 2015 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 2015.)..................
    3b
     
    No
    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 2015?
    4b
     
    No
    Form 990-PF (2015)
    Form 990-PF (2015)
    Page 6
    Part VII-B
    Statements Regarding Activities for Which Form 4720 May Be Required (Continued)
    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
     
    No
    .........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
     
    No
    Form 990-PF (2015)
    Form 990-PF (2015)
    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
    Gary Smith President
    1.00     		0    
    11 Sturdevent
    Sequim,WA98382
    David Blake Sec/Treas
    1.00     		0    
    1870 Woodcock Road
    Sequim,WA98382
    Richard Schneider Vice President
    0.50     		0    
    PO Box 385
    Sequim,WA98382
    Marc Jackson Director
    0.50     		0    
    216 East 4th St
    Port Angeles,WA98362
    Gary Neal Director
    0.50     		0    
    503 N Sequim Ave
    Sequim,WA98382
    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  
    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.............bullet  
    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  
    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  
    Form 990-PF (2015)
    Form 990-PF (2015)
    Page 8
    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
    8,504,503
    b
    Average of monthly cash balances.......................
    1b
    408,827
    c
    Fair market value of all other assets (see instructions)................
    1c
    1,899,664
    d
    Total (add lines 1a, b, and c).........................
    1d
    10,812,994
    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
     
    3
    Subtract line 2 from line 1d.........................
    3
    10,812,994
    4
    Cash deemed held for charitable activities. Enter 1 1/2% of line 3 (for greater amount, see
    instructions) .............................
    4
    162,195
    5
    Net value of noncharitable-use assets. Subtract line 4 from line 3. Enter here and on Part V, line 4
    5
    10,650,799
    6
    Minimum investment return. Enter 5% of line 5..................
    6
    532,540
    Part XI
    Distributable Amount bullet
    1
    Minimum investment return from Part X, line 6....................
    1
    532,540
    2a
    Tax on investment income for 2015 from Part VI, line 5......
    2a
    10,109
    b
    Income tax for 2015. (This does not include the tax from Part VI.)...
    2b
     
    c
    Add lines 2a and 2b............................
    2c
    10,109
    3
    Distributable amount before adjustments. Subtract line 2c from line 1............
    3
    522,431
    4
    Recoveries of amounts treated as qualifying distributions................
    4
     
    5
    Add lines 3 and 4............................
    5
    522,431
    6
    Deduction from distributable amount (see instructions).................
    6
     
    7
    Distributable amount as adjusted. Subtract line 6 from line 5. Enter here and on Part XIII, line 1 ...
    7
    522,431
    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
    554,145
    b
    Program-related investments—total from Part IX-B..................
    1b
     
    2
    Amounts paid to acquire assets used (or held for use) directly in carrying out charitable, etc.,
    purposes...............................
    2
     
    3
    Amounts set aside for specific charitable projects that satisfy the:
    a
    Suitability test (prior IRS approval required)....................
    3a
     
    b
    Cash distribution test (attach the required schedule) .................
    3b
     
    4
    Qualifying distributions. Add lines 1a through 3b. Enter here and on Part V, line 8, and Part XIII, line 4
    4
    554,145
    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
    10,109
    6
    Adjusted qualifying distributions. Subtract line 5 from line 4..............
    6
    544,036
    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 (2015)
    Form 990-PF (2015)
    Page 9
    Part XIII
    Undistributed Income (see instructions)
    (a)
    Corpus     		(b)
    Years prior to 2014     		(c)
    2014     		(d)
    2015
    1 Distributable amount for 2015 from Part XI, line 7 522,431
    2 Undistributed income, if any, as of the end of 2015:
    a Enter amount for 2014 only.......  
    b Total for prior years:20, 20, 20  
    3 Excess distributions carryover, if any, to 2015:
    a From 2010...... 14,135
    b From 2011...... 922
    c From 2012...... 5,145
    d From 2013......  
    e From 2014...... 20,206
    fTotal of lines 3a through e........ 40,408
    4Qualifying distributions for 2015 from Part
    XII, line 4: bullet$ 554,145
    a Applied to 2014, but not more than line 2a  
    b Applied to undistributed income of prior years
    (Election required—see instructions).....     		 
    c Treated as distributions out of corpus (Election
    required—see instructions)........     		0
    d Applied to 2015 distributable amount..... 522,431
    e Remaining amount distributed out of corpus 31,714
    5 Excess distributions carryover applied to 2015.    
    (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 72,122
    b Prior years’ undistributed income. Subtract
    line 4b from line 2b ..........     		 
    c Enter the amount of prior years’ undistributed
    income for which a notice of deficiency has
    been issued, or on which the section 4942(a)
    tax has been previously assessed......     		 
    d Subtract line 6c from line 6b. Taxable amount
    —see instructions ...........     		 
    e Undistributed income for 2014. Subtract line
    4a from line 2a. Taxable amount—see
    instructions .............     		 
    f Undistributed income for 2016. 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) .......     		 
    8Excess distributions carryover from 2010 not
    applied on line 5 or line 7 (see instructions) ...     		14,135
    9Excess distributions carryover to 2016.
    Subtract lines 7 and 8 from line 6a ......     		57,987
    10 Analysis of line 9:
    a Excess from 2011.... 922
    b Excess from 2012.... 5,145
    c Excess from 2013....  
    d Excess from 2014.... 20,206
    e Excess from 2015.... 31,714
    Form 990-PF (2015)
    Form 990-PF (2015)
    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 2015, 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) 2015 (b) 2014 (c) 2013 (d) 2012
             
    b 85% of line 2a .........          
    c Qualifying distributions from Part XII,
    line 4 for each year listed .....     		         
    d Amounts included in line 2c not used directly
    for active conduct of exempt activities ..........     		         
    e Qualifying distributions made directly
    for active conduct of exempt activities.
    Subtract line 2d from line 2c ....     		         
    3 Complete 3a, b, or c for the
    alternative test relied upon:
    a “Assets" alternative test—enter:
    (1) Value of all assets ......          
    (2) Value of assets qualifying
    under section 4942(j)(3)(B)(i)    		          
    b “Endowment" alternative test— enter 2/3
    of minimum investment return shown in
    Part X, line 6 for each year listed...     		         
    c “Support" alternative test—enter:
    (1) Total support other than gross
    investment income (interest,
    dividends, rents, payments
    on securities loans (section
    512(a)(5)), or royalties) ....     		         
    (2) Support from general public
    and 5 or more exempt
    organizations as provided in
    section 4942(j)(3)(B)(iii)....     		         
    (3) Largest amount of support
    from an exempt organization    		          
    (4) Gross investment income          
    Part XV
    Supplementary Information (Complete this part only if the organization had $5,000 or more in
    assets at any time during the year—see instructions.)
    1Information Regarding Foundation Managers:
    aList any managers of the foundation who have contributed more than 2% of the total contributions received by the foundation
    before the close of any tax year (but only if they have contributed more than $5,000). (See section 507(d)(2).)
    bList any managers of the foundation who own 10% or more of the stock of a corporation (or an equally large portion of the
    ownership of a partnership or other entity) of which the foundation has a 10% or greater interest.
    2Information Regarding Contribution, Grant, Gift, Loan, Scholarship, etc., Programs:
    Check here bullet
    aThe name, address, and telephone number or e-mail 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:
    Scholarships: Contact Superintendents of Public High SchoolsGrants: Contact United Way for application @ 360-457-3011
    cAny submission deadlines:
    Scholarships & Grants: January of senior year & June
    dAny restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other
    factors:
    Restricted to residents of Clallam County, Washington
    Form 990-PF (2015)
    Form 990-PF (2015)
    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
    PA Education Foundation
    PO Box 787
    Port Angeles,WA98362     		N/A 501c3 To provide a basic student health needs fund for low income students 4,000
    Sequim School District
    503 N Sequim Ave
    Sequim,WA98382     		N/A P/Schl Pays school supplies, sport fees and band shirts for low income middle school students 1,000
    First United Methodist
    110 East 7th St
    Port Angeles,WA98362     		N/A Church Friendship Dinner program which provides free hot dinners weekly to the community and serves 130-150 low income citizens 8,000
    Forks Food Bank
    PO Box 2532
    Forks,WA98331     		N/A 501c3 Food for food bank 10,000
    Port Angeles Food Bank
    PO Box 1885
    Port Angeles,WA98362     		N/A 501c3 Weekend Food Bag Program purchases food to send home on Fridays to low income children to supplement their food supply 13,000
    St Vincent de Paul Queen of Angels
    PO Box 535
    Port Angeles,WA98362     		N/A 501c3 Utilities and fuel assistance for low income families 8,000
    St Vincent de Paul Sequim
    PO Box 2114
    Sequim,WA98382     		N/A 501c3 Utilities and rent assistance for low income families 8,000
    Sequim Community Aid
    PO Box 1591
    Sequim,WA98382     		N/A 501c3 Emergency aid for rent, utilities, bus passes and basic needs 7,000
    Sequim Food Bank
    PO Box 1453
    Sequim,WA98382     		N/A 501c3 Holiday meal baskets 13,000
    Serenity House
    PO Box 4047
    Port Angeles,WA98363     		N/A 501c3 Emergency shelters, housing crisis response, and solutions for single adults and families 8,000
    United Way
    PO Box 937
    Port Angeles,WA98362     		N/A 501c3 Support for annual fund drive 13,000
    First Step Family Support
    PO Box 249
    Port Angeles,WA98362     		N/A 501c3 Family resource coordinator for PA drop in center and family enrichment program 6,000
    Volunteers in Medicine Olympic Clin
    PO Box 639
    Port Angeles,WA98362     		N/A 501c3 Core services for free clinic which serves low income and uninsured patients 8,000
    Clallam BaySekiu Crisis Center
    PO Box 638
    Clallam Bay,WA98326     		N/A 501c3 Emergency fund for rent, utilities, firewood, food, and holiday food baskets 3,000
    MANNA
    139 W 8th
    Port Angeles,WA98362     		N/A 501c3 Emergency rent, utilities, propane, bus passes and laundry assistance for Port Angeles residents 9,000
    Port Angeles School District
    216 E 4th
    Port Angeles,WA98362     		N/A P/Schl Americorps tutor/mentor programfor K-12 in Port Angeles and Crescent schools 9,000
    The Caring Place
    PO Box 2111
    Forks,WA98331     		N/A 501c3 Basic resources and outreach support for families in need 5,000
    Healthy Families
    1210 E Front St C
    Port Angeles,WA98362     		N/A 501c3 Rent, groceries, medical services, clothing and supplies for families fleeing domestic violence 6,000
    Forks Abuse Program
    PO Box 1775
    Forks,WA98331     		N/A 501c3 Holiday meal for individuals & children fleeing from domestic abuse 3,000
    Olympic Community Action
    823 Commerce Loop
    Port Townsend,WA98368     		N/A 501c3 Meals on Wheels program 5,500
    Peninsula Behavioral Health
    118 East 8th St
    Port Angeles,WA98362     		N/A 501c3 Provides emergency housing, transportation, clothing and personal hygiene items for low income patients with mental health needs 6,000
    Joyce Education Foundation
    PO Box 20
    Joyce,WA98343     		N/A 501c3 Mini grants to teachers and for low income students. It will provides coats, shoes, boots, glasses and school supplies & fees 4,000
    Quillayute Valley School Distr
    411 S Spartan Ave
    Forks,WA98331     		N/A P/Schl Winter coats/boots/shoe vouchers for students from low income families 2,000
    Boys Girls Club Olympic Peninsula
    PO Box 4167
    Sequim,WA98382     		N/A 501c3 Back to School program provides supplies, tutors and clothing for under-resourced students ages 5-18 6,000
    Clallam Mosaic
    PO Box 3081
    Sequim,WA98382     		N/A 501c3 Parent Network meeting provides respite care, and scholarships for programs that promote life skills for clients with developmental disabilities 8,000
    Dungeness Valley Health Wellness
    PO Box 3434
    Sequim,WA98382     		N/A 501c3 Operating costs Core Programs for the working poor and under-insured 8,000
    Makah Tribe Food Bank
    PO Box 115
    Neah Bay,WA98357     		N/A Govt Food for food bank 6,000
    Sequim Education Foundation
    PO Box 3065
    Sequim,WA98382     		N/A 501c3 Select 4-6 teams of teachers and fund projects that enhance learning with an emphasis on applied sciences 4,000
    New Leash on Life
    183 Alderwood Creek Dr
    Port Angeles,WA98362     		N/A 501c3 Training service dogs for disabled veterans 4,000
    Camp Beausite Northwest
    PO Box 1227
    Port Hadlock,WA98339     		N/A 501c3 Respite weekends, augmentative communication camp and equine therapy programs for low income developmentally disabled people in Clallam County 5,000
    Soroptimists Intl Olympic Rain Fore
    PO Box 329
    Forks,WA98331     		N/A 501c3 Forks Jr High recognizes and rewards students' good grades, behavior, homework completion, respect and responsibility 3,000
    New Hope Food Bank
    PO Box 336
    Clallam Bay,WA98326     		N/A Church Food for food bank 6,000
    Lutheran Community Services
    301 Lopez Ave
    Port Angeles,WA98362     		N/A 501c3 Healthy Families Project for families in crisis-funds a resource specialist to connect families with stabilizing services 5,000
    Clallam County Pro Bono Lawyers
    228 W Fir St N
    Port Angeles,WA98362     		N/A 501c3 Provides legal aid services to low income clients and funds overhead costs 5,000
    Crescent Co-op Preschool
    PO Box 20
    Joyce,WA98343     		N/A 501c3 Pre-3 years old/pre-school programs provide nutrition, winter clothing, supplies, books for children and evening classes for parents 5,000
    Peninsula College Foundation
    1502 E Lauridsen Blve
    Port Angeles,WA98362     		N/A 501c3 Funding "Promise" scholarships for Clallam County students 117,187
    Parenting Matters Foundation
    PO Box 3323
    Sequim,WA98382     		N/A 501c3 Funding for monthly newsletter 5,000
    Sequim School District
    503 N Sequim Ave
    Sequim,WA98382     		N/A P/Schl Helen Haller Elementary reading tutor program 400
    Sequim School District
    503 N Sequim Ave
    Sequim,WA98382     		N/A P/Schl Helen Haller Elementary reading at home program for K-3 age groups 800
    American Red Cross
    PO Box 188
    Carlsborg,WA98324     		N/A 501c3 Emergency disaster relief services 3,000
    Concerned Citizens
    PO Box 1787
    Forks,WA98331     		N/A 501c3 Heat pump for adult family home 1,000
    The Salvation Army
    PO Box 2229
    Port Angeles,WA98362     		N/A 501c3 Purchase food for a Christmas Meal to benefit needy families 10,000
    The Answer for Youth
    PO Box 633
    Port Angeles,WA98362     		N/A 501c3 Funds NUTS and SWEETS programs for homeless and at risk youth and young adults 6,500
    Bonny Hazelett
    52321 Hwy 112
    Port Angeles,WA98363     		N/A N/A Scholarship 1,961
    Sequim School District
    503 N Sequim Ave
    Sequim,WA98382     		N/A P/Schl Helen Haller Elementary mental health counseling program for at risk students 6,000
    Volunteer Hospice of Clallam County
    540 E 8th St
    Port Angeles,WA98362     		N/A 501c3 Renovation of hospice house 8,000
    Soroptimist Intl Olympic Rain Fores
    PO Box 329
    Forks,WA98331     		N/A 501c3 Weekend Backpack Program for Forks Elementary, Middle and High School students-targets chronic hunger 3,000
    Sequim School District
    503 N Sequim Ave
    Sequim,WA98382     		N/A P/Schl High School Activities Fees Assistance Progarm 1,000
    Sequim School District
    503 N Sequim Ave
    Sequim,WA98382     		N/A P/Schl Greywolf Elementary READBOX reading incentive program to increase literacy 1,000
    Sequim School District
    503 N Sequim Ave
    Sequim,WA98382     		N/A P/Schl Greywolf Elementary clothing closet for students in need of coats, shoes, and in some cases vision/dental services 500
    My Choices
    824 E 8th Suite A
    Port Angeles,WA98362     		N/A 501c3 Earn While You Learn Program for young parents 3,000
    Shipley Center
    921 E Hammond
    Sequim,WA98382     		N/A 501c3 Funds annual memberships, activities and foot care for low income seniors 3,000
    Amanda Larson
    184 W Maple St
    Sequim,WA98382     		N/A N/A Scholarship 4,000
    Briauna Joy Luchte
    1011 Thornton Dr
    Sequim,WA98382     		N/A N/A Scholarship 4,000
    Justin Moon
    1910 West Duval Place
    Port Angeles,WA98363     		N/A N/A Scholarship 4,000
    Chase Sharp
    2642 S Francis St
    Port Angeles,WA98362     		N/A N/A Scholarship 4,000
    Austin Joel Roberson
    PO Box 2670
    Port Angeles,WA98362     		N/A N/A Scholarship 4,000
    Madison A Hinrichs
    2810 Wast Bay St
    Port Angeles,WA98362     		N/A N/A Scholarship 4,000
    Nicholas Johnston
    1046 Heuhslein Rd
    Port Angeles,WA98362     		N/A N/A Scholarship 4,000
    Evan William Messinger
    PO Box 74
    Forks,WA98331     		N/A N/A Scholarship 4,000
    Feiro Marine Life Center
    PO Box 625
    Port Angeles,WA98362     		N/A 501c3 Free passes to low income for people during school breaks 2,000
    Port Angeles School District
    216 E 4th
    Port Angeles,WA98362     		N/A P/Schl Academic support for Native American Students-purchased kindles downloaded with required reading for 9th-12th grades 3,000
    Sequim School District
    503 N Sequim Ave
    Sequim,WA98382     		N/A P/Schl Supplements medical supply/services/health care needs for students 800
    Boys and Girls Club Olympic Peninsu
    PO Box 4167
    Sequim,WA98382     		N/A 501c3 USDA summer food and nutrition program for youth under age 18 from low income families 7,000
    Clallam County Homeless Outreach
    PO Box 804
    Port Angeles,WA98362     		N/A 501c3 Food, supplies etc for annual Homeless Connect event for at risk-homeless people 1,000
    St Matthew Lutheran Church
    123 E 13th St
    Port Angeles,WA98362     		N/A Church Weekly Free Community Dinners for the hungry 7,000
    Sequim Elks Lodge 2642
    143 Port Williams Rd
    Sequim,WA98382     		N/A 501c8 Backpack food program-targets weekend hunger 3,500
    Voices for Veterans
    PO Box 2810
    Port Angeles,WA98362     		N/A 501c3 Medical supplies, exams, and storage for clothing ans supplies during stand down program for veterans and their dependents 3,000
    Kathleen Sutton Fund
    PO Box 727
    Kingston,WA98346     		N/A 501c3 Travel expenses for Clallam County women with cancer for treatment and follow up appointments 4,500
    Volunteers in Medicine Olympic Clin
    PO Box 639
    Port Angeles,WA98362     		N/A 501c3 Adult Dental Program for the under and un-insured 3,000
    Captain Joseph House Foundation
    1108 S Oak
    Port Angeles,WA98362     		N/A 501c3 Renovation of respite stay house for gold star military families 2,000
    Concerned Citizens
    PO Box 1787
    Forks,WA98331     		N/A 501c3 Promotes healthy learning and early intervention services for young children 6,000
    Green Alliance for Veteran Educatio
    216 S Francis
    Port Angeles,WA98362     		N/A 501c3 Expands Robin Hill veterans victory garden by purchasing more beds, garden coordinator and chipper/shredder for composting 3,000
    Olympic Community Action
    823 Commerce Loop
    PortTownsend,WA98368     		N/A 501c3 Adult day care service that is a music based cognitive function program for seniors 4,000
    Prevention Works
    PO Box 1913
    Port Angeles,WA98362     		N/A 501c3 Funds parent resource packets for anti-bullying trainer, early education materials and library access for pre-school curriculum 2,000
    Shipley Center
    921 E Hammond
    Sequim,WA98382     		N/A 501c3 Senior nutrition and dinner meal program, room fees and newsletter 2,000
    The Museum of Arts
    175 W Cedar
    Sequim,WA98382     		N/A 501c3 Elevator lift for the Dungeness School House 20,000
    Tyler Rixon
    c/o PA School District 216 E 4th St
    Port Angeles,WA98362     		N/A N/A Scholarship 4,000
    Sabrina Marie Williams
    2134 W 12 St
    Port Angeles,WA98363     		N/A N/A Scholarship 4,000
    Bailee N Palmer
    233 W 11th st
    Port Angeles,WA98362     		N/A N/A Scholarship 4,000
    Wyatt Randolf Frantz
    948 Joyce Piedmart Rd
    Port Angeles,WA98363     		N/A N/A Scholarship 4,000
    Javier Contreras
    PO Box 1493
    Forks,WA98331     		N/A N/A Scholarship 4,000
    Kassidy Coburn
    1150 Bogachiel Way
    Forks,WA98331     		N/A N/A Scholarship 4,000
    Kathyrn Bertelson
    583 Camp Hayden Rd
    Port Angeles,WA98363     		N/A N/A Scholarship 4,000
    Sarah Kaytlyn Thomas
    525 McCurdy Rd C101
    Sequim,WA98382     		N/A N/A Scholarship 4,000
    Cheyenne Sokkappa
    341 Amethyst Dr
    Sequim,WA98382     		N/A N/A Scholarship 4,000
    Josiah David Anastasi
    102 Madera Place
    Sequim,WA98382     		N/A N/A Scholarship 4,000
    Inga Erickson
    151 Vista Dr
    Sekiu,WA98381     		N/A N/A Scholarship 4,000
    Total .................................bullet 3a 545,648
    bApproved for future payment
    Total .................................bullet 3b  
    Form 990-PF (2015)
    Form 990-PF (2015)
    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 ...........     		    14 2,650  
    4 Dividends and interest from securities....     14 186,141  
    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.....     15 104,286  
    8
    Gain or (loss) from sales of assets other than inventory ............     		    18 749,029  
    9 Net income or (loss) from special events:          
    10 Gross profit or (loss) from sales of inventory..          
    11 Other revenue:
    aPrior Grant Refund     		        50,000
    bPrior Scholarship Refunds         4,000
    c
    d
    e
    12 Subtotal. Add columns (b), (d), and (e)..   1,042,106 54,000
    13Total. Add line 12, columns (b), (d), and (e)..................
    131,096,106
    (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.)
    11b Scholarships granted to graduating seniors are refunded to the foundation when the students change colleges or do not complete the term.
    11a Grants are refunded to the foundation when the grantee changes the purpose of the original grant request or does not use all of the funds.
    Form 990-PF (2015)
    Form 990-PF (2015)
    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 organizations?
    Yes
    No
    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 name SmallBullet
    		 Firm's EIN SmallBullet
    Firm's address SmallBullet


    		 Phone no.
    Form 990-PF (2015)
    Additional Data


    Software ID: 15000324
    Software Version: 2015v2.0


    Form 990PF - Special Condition Description:
    Special Condition Description
    Schedule B
    (Form 990, 990-EZ,
    or 990-PF)
    Department of the Treasury
    Internal Revenue Service
    Schedule of Contributors
    Arrow Bullet Attach to Form 990, 990-EZ, or 990-PF.
    Arrow Bullet Information about Schedule B (Form 990, 990-EZ, or 990-PF) and its instructions is at www.irs.gov/form990.
    OMB No. 1545-0047
    2015
    Name of the organization
    Albert Haller Foundation
     
    Employer identification number

    91-1556810
    Organization type (check one):
    Filers of:
    Section:
    Form 990 or 990-EZ





    Form 990-PF




    Check if your organization is covered by the General Rule or a Special Rule.  
    Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.
    General Rule
    Special Rules
    ......... Arrow Bullet $  
    Caution. An organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990,
    990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its
    Form 990-EZ or on its Form 990PF, Part I, line 2, to certify that it does not meet the filing requirements of Schedule B (Form 990,
    990-EZ, or 990-PF).
    For Paperwork Reduction Act Notice, see the Instructions
    for Form 990, 990-EZ, or 990-PF.
    Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2015)
    Schedule B (Form 990, 990-EZ, or 990-PF) (2015) Page 2
    Name of organization
    Albert Haller Foundation
          		Employer identification number
    91-1556810
    Part I
    Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Total contributions    		 (d)
    Type of contribution
    1
     
     

    John Birch Estate  
    20 Quarry Point
     
    Hudson, QuebecJOP1HOCA

    		$ 10,000


    (Complete Part II for noncash contributions.)
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Total contributions    		 (d)
    Type of contribution
     
     
     

       
     
     

    		$  


    (Complete Part II for noncash contributions.)
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Total contributions    		 (d)
    Type of contribution
     
     
     

       
     
     

    		$  


    (Complete Part II for noncash contributions.)
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Total contributions    		 (d)
    Type of contribution
     
     
     

       
     
     

    		$  


    (Complete Part II for noncash contributions.)
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Total contributions    		 (d)
    Type of contribution
     
     
     

       
     
     

    		$  


    (Complete Part II for noncash contributions.)
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Total contributions    		 (d)
    Type of contribution
     
     
     

       
     
     

    		$  


    (Complete Part II for noncash contributions.)
    Schedule B (Form 990, 990-EZ, or 990-PF) (2015)
    Schedule B (Form 990, 990-EZ, or 990-PF) (2015)
    Page 3
    Name of organization
    Albert Haller Foundation
          		Employer identification number

    91-1556810
    Part II
    Noncash Property (see instructions). Use duplicate copies of Part II if additional space is needed.
    (a)
    No.from Part I    		 (b)
    Description of noncash property given    		 (c)
    FMV (or estimate)
    (see instructions)     		(d)
    Date received
     
    		$    
    (a)
    No.from Part I    		 (b)
    Description of noncash property given    		 (c)
    FMV (or estimate)
    (see instructions)     		(d)
    Date received
     
    		$    
    (a)
    No.from Part I    		 (b)
    Description of noncash property given    		 (c)
    FMV (or estimate)
    (see instructions)     		(d)
    Date received
     
    		$    
    (a)
    No.from Part I    		 (b)
    Description of noncash property given    		 (c)
    FMV (or estimate)
    (see instructions)     		(d)
    Date received
     
    		$    
    (a)
    No.from Part I    		 (b)
    Description of noncash property given    		 (c)
    FMV (or estimate)
    (see instructions)     		(d)
    Date received
     
    		$    
    (a)
    No.from Part I    		 (b)
    Description of noncash property given    		 (c)
    FMV (or estimate)
    (see instructions)     		(d)
    Date received
     
    		$    
    Schedule B (Form 990, 990-EZ, or 990-PF) (2015)
    Schedule B (Form 990, 990-EZ, or 990-PF) (2015)
    Page 4
    Name of organization
    Albert Haller Foundation
          		Employer identification number

    91-1556810
    Part III
    Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10) that total more than $1,000 for the year from any one contributor. Complete columns (a) through (e) and the following line entry. For organizations completing Part III, enter the total of exclusively religious, charitable, etc., contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet$  
    Use duplicate copies of Part III if additional space is needed.
    (a)
    No.from Part I    		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
     
    (e) Transfer of gift
    Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
     
     
         
     
    (a)
    No.from Part I    		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
     
    (e) Transfer of gift
    Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
     
     
         
     
    (a)
    No.from Part I    		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
     
    (e) Transfer of gift
    Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
     
     
         
     
    (a)
    No.from Part I    		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
     
    (e) Transfer of gift
    Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
     
     
         
     
    Schedule B (Form 990, 990-EZ, or 990-PF) (2015)

    Additional Data


    Software ID: 15000324
    Software Version: 2015v2.0

    TY 2015 AccountingFeesSchedule
    Name:
    Albert Haller Foundation
    EIN:
    91-1556810
    Software ID:
    15000324
    Software Version:
    2015v2.0
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    Meyer & Company CPAs PS 9,520 0 0 4,760

    TY 2015 LegalFeesSchedule
    Name:
    Albert Haller Foundation
    EIN:
    91-1556810
    Software ID:
    15000324
    Software Version:
    2015v2.0
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    Alan Millet PS 3,678 0 0 1,103


    TY 2015 OtherAssetsSchedule
    Name:
    Albert Haller Foundation
    EIN:
    91-1556810
    Software ID:
    15000324
    Software Version:
    2015v2.0
    Description Beginning of Year - Book Value End of Year - Book Value End of Year - Fair Market Value
    Dividends in Transit 6,060 6,761 6,761


    TY 2015 OtherExpensesSchedule
    Name:
    Albert Haller Foundation
    EIN:
    91-1556810
    Software ID:
    15000324
    Software Version:
    2015v2.0
    Description Revenue and Expenses per Books Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    Bank Fees 250 156    
    Excise Tax 10,109      
    Liability Insurance 3,330      
    United Way-Grant Review 2,500     2,500


    TY 2015 OtherIncomeSchedule2
    Name:
    Albert Haller Foundation
    EIN:
    91-1556810
    Software ID:
    15000324
    Software Version:
    2015v2.0
    Description Revenue And Expenses Per Books Net Investment Income Adjusted Net Income
    Other Investment Income 104,286 104,286  
    Prior Grant Refund 50,000    
    Prior Scholarship Refunds 4,000    


    TY 2015 OtherProfessionalFeesSchedule
    Name:
    Albert Haller Foundation
    EIN:
    91-1556810
    Software ID:
    15000324
    Software Version:
    2015v2.0
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    Ameritrade Management Fees 28,475 28,475 0 0


    TY 2015 TaxesSchedule
    Name:
    Albert Haller Foundation
    EIN:
    91-1556810
    Software ID:
    15000324
    Software Version:
    2015v2.0
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    Foreign Tax Credit per 1099 2,605 2,605