-
TIN:
Form
990-PF
Department of the Treasury
Internal Revenue Service
Return of Private Foundation
or Section 4947(a)(1) Trust Treated as Private Foundation
Do not enter social security numbers on this form as it may be made public.
Information about Form 990-PF and its instructions is at
www.irs.gov/form990pf
.
OMB No. 1545-0052
20
15
Open to Public Inspection
For calendar year 2015, or tax year beginning
07-01-2015
, and ending
06-30-2016
Name of foundation
A R BURNETTE SCHOLARSHIP FUND
Number and street (or P.O. box number if mail is not delivered to street address)
PO BOX 2907 - TRUST TAX DEPT
Room/suite
City or town, state or province, country, and ZIP or foreign postal code
WILSON
,
NC
278942907
A Employer identification number
56-6593070
B
Telephone number (see instructions)
(252) 246-4935
C
If exemption application is pending, check here
G
Check all that apply:
Initial return
Initial return of a former public charity
Final return
Amended return
Address change
Name change
D 1.
Foreign organizations, check here .............
2.
Foreign organizations meeting the 85%
test, check here and attach computation ...
E
If private foundation status was terminated
under section 507(b)(1)(A), check here .......
H
Check type of organization:
Section 501(c)(3) exempt private foundation
Section 4947(a)(1) nonexempt charitable trust
Other taxable private foundation
F
If the foundation is in a 60-month termination
under section 507(b)(1)(B), check here .......
I
Fair market value of all assets at end
of year
(from Part II, col. (c),
line 16)
$
688,327
J
Accounting method:
Cash
Accrual
Other (specify)
(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)
1
Contributions, gifts, grants, etc., received (attach schedule)
2
Check
Sch. B
.............
3
Interest on savings and temporary cash investments
4
Dividends and interest from securities
...
18,146
18,146
5a
Gross rents
............
b
Net rental income or (loss)
6a
Net gain or (loss) from sale of assets not on line 10
40,720
b
Gross sales price for all assets on line 6a
437,561
7
Capital gain net income (from Part IV, line 2)
...
40,720
8
Net short-term capital gain
.........
0
9
Income modifications
...........
10a
Gross sales less returns and allowances
b
Less: Cost of goods sold
....
c
Gross profit or (loss) (attach schedule)
.....
11
Other income (attach schedule)
.......
12
Total.
Add lines 1 through 11
........
58,866
58,866
13
Compensation of officers, directors, trustees, etc.
10,673
10,673
14
Other employee salaries and wages
......
0
0
0
15
Pension plans, employee benefits
.......
0
0
16a
Legal fees (attach schedule)
.........
0
b
Accounting fees (attach schedule)
.......
c
Other professional fees (attach schedule)
....
0
17
Interest
...............
0
18
Taxes (attach schedule) (see instructions)
...
624
545
0
19
Depreciation (attach schedule) and depletion
...
0
0
20
Occupancy
..............
21
Travel, conferences, and meetings
.......
0
0
22
Printing and publications
..........
0
0
23
Other expenses (attach schedule)
.......
123
123
24
Total operating and administrative expenses.
Add lines 13 through 23
..........
11,420
11,341
0
0
25
Contributions, gifts, grants paid
.......
40,000
40,000
26
Total expenses and disbursements.
Add lines 24 and 25
51,420
11,341
0
40,000
27
Subtract line 26 from line 12:
a
Excess of revenue over expenses and disbursements
7,446
b
Net investment income
(if negative, enter -0-)
47,525
c
Adjusted net income
(if negative, enter -0-)
...
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
1
Cash—non-interest-bearing
.............
81
43
43
2
Savings and temporary cash investments
.........
45,535
37,098
37,098
3
Accounts receivable
Less: allowance for doubtful accounts
0
0
4
Pledges receivable
Less: allowance for doubtful accounts
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)
Less: allowance for doubtful accounts
0
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)
.......
335,560
315,751
385,107
c
Investments—corporate bonds (attach schedule)
.......
195,912
264,516
266,079
11
Investments—land, buildings, and equipment: basis
Less: accumulated depreciation (attach schedule)
12
Investments—mortgage loans
.............
13
Investments—other (attach schedule)
..........
31,191
0
14
Land, buildings, and equipment: basis
Less: accumulated depreciation (attach schedule)
15
Other assets (describe
)
16
Total assets
(to be completed by all filers—see the
instructions. Also, see page 1, item I)
608,279
617,408
688,327
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
)
23
Total liabilities
(add lines 17 through 22)
.........
0
Foundations that follow SFAS 117, check here
and complete lines 24 through 26 and lines 30 and 31.
24
Unrestricted
..................
25
Temporarily restricted
...............
26
Permanently restricted
...............
Foundations that do not follow SFAS 117, check here
and complete lines 27 through 31.
27
Capital stock, trust principal, or current funds
........
608,279
617,408
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)
.....
608,279
617,408
31
Total liabilities and net assets/fund balances
(see instructions)
.
608,279
617,408
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
608,279
2
Enter amount from Part I, line 27a
.....................
2
7,446
3
Other increases not included in line 2 (itemize)
3
1,683
4
Add lines 1, 2, and 3
..........................
4
617,408
5
Decreases not included in line 2 (itemize)
5
0
6
Total net assets or fund balances at end of year (line 4 minus line 5)—Part II, column (b), line 30
.
6
617,408
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
.3 ITA UNIBANCO HOLDINGS SPON ADR PFD
2011-12-23
2015-08-13
b
12. CALIFORNIA RESOURCES CORP COMMON
2015-09-11
c
14. LINCOLN ELECTRIC HOLDINGS COMMON
2014-03-07
2015-09-11
d
25. COMMVAULT SYSTEMS, INC COMMON
2014-06-09
2015-09-14
e
10. ENN ENERGY HOLDINGS -UNSP ADR
2014-03-07
2015-09-14
60. XINYI GLASS HOLDINGS LTD
2013-05-29
2015-09-14
50. COCHLEAR LIMITED UNSPONS ADR
2011-09-13
2015-09-15
20. GREENHILL & CO INC COMMON
2013-02-25
2015-09-15
40. SUPERIOR ENERGY SVCS INC
2013-12-04
2015-09-15
40. WEC ENERGY GROUP INC
2011-09-13
2015-09-15
37. AT&T INC
2009-08-14
2015-09-17
69. ABBVIE INC
2015-09-17
25. AGILENT TECHNOLOGIES
2013-02-25
2015-09-17
94. COMMON
2011-09-13
2015-09-17
12. ALBEMARLE CORP COMMON
2015-01-13
2015-09-17
58. ALLIANZ COMMON
2011-09-13
2015-09-17
36. ALTRIA GROUP INC
2011-12-23
2015-09-17
21. AMERISOURCEBERGEN CORP. COMMON
2011-09-13
2015-09-17
5. ANTHEM INC COMMON
2013-05-29
2015-09-17
26. ARM HOLDINGS PLC -SPONS ADR
2009-08-14
2015-09-17
40. ASTRAZENECA PLC SPONS ADR
2011-09-13
2015-09-17
30. ATWOOD OCEANICS INC
2011-12-23
2015-09-17
10. BANCFIRST CORP
2011-09-13
2015-09-17
55. BAXALTA INC
2011-12-23
2015-09-17
55. BAXTER INTERNATIONAL INCORPORATED
2011-12-23
2015-09-17
40. BENCHMARK ELECTRONICS COMMON
2011-09-13
2015-09-17
25. BRISTOL MYERS SQUIBB COMPANY
2011-09-13
2015-09-17
70. CALGON CAROBN CORP COMMON
2011-12-23
2015-09-17
18. CANADIAN NATL RY CO
2011-12-23
2015-09-17
5. CARE CAPITAL PROPERTIES INC COMMON
2013-12-04
2015-09-17
15. CASEY'S GENERAL STORES, INC. COMMON
2011-09-13
2015-09-17
15. CHART INDUSTRIES INC COMMON
2011-09-13
2015-09-17
26. CHEVRON TEXACO CORP COMMON
2009-08-14
2015-09-17
29. CINTAS CORP
2011-09-13
2015-09-17
40. CIVEO CORP COMMON
2011-07-19
2015-09-17
503.874 COHEN & STEERS REALTY SHARES INSTITUTION
2015-09-17
45. CONOCOPHILLIPS COM
2015-09-17
10. COOPER COS INC NEW
2013-05-29
2015-09-17
768.992 CREDIT SUISSE COMMODITY RETURN STRATEGY INSTITUTIONAL SHS FD 2
2015-09-17
19. CROWN HOLDINGS INC
2010-06-24
2015-09-17
18. DBS GROUP HOLDINGS LTD SPONS ADR
2011-12-23
2015-09-17
30. DASSAULT SYSTEMS
2011-09-13
2015-09-17
10. DIAGEO PLC SPONSORED ADR
2011-09-13
2015-09-17
16. DOMINION RESOURCES INC/VA COMMON
2011-09-13
2015-09-17
1500.657 DOUBLELINE TOTAL RETURN BOND FUND
2011-12-23
2015-09-17
8. DUKE ENERGY CORP
2011-12-23
2015-09-17
20. ENERSYS COMMON
2013-12-04
2015-09-17
25. FANUC CORP ADR
2011-03-22
2015-09-17
20. FORWARD AIR CORP
2011-12-23
2015-09-17
57. FRESENIUS MED CARE
2011-09-13
2015-09-17
3. HALYARD HEALTH INC
2011-09-13
2015-09-17
140. HARMONIC INC COM
2014-06-09
2015-09-17
8. HEALTH CARE REIT INC
2011-09-13
2015-09-17
430. HECLA MINING
2015-09-17
76. HONG KONG EXCHANGES & CLEARING LIMITED
2014-06-09
2015-09-17
12. HUMANA, INC.
2013-06-28
2015-09-17
20. IPG PHOTONICS CORP COMMON
2015-09-17
113. ICICI BANK LTD ADR
2011-06-10
2015-09-17
60. INTEL CORPORATION
2009-08-14
2015-09-17
182. ITA UNIBANCO HOLDINGS SPON ADR PFD
2015-09-17
74. JGC CORPORATION
2014-03-07
2015-09-17
18. JOY GLOBAL INC COMMON
2011-09-13
2015-09-17
12. KEYSIGHT TECHNOLOGIES INC COMMON
2013-02-25
2015-09-17
7. KIMBERLY CLARK CORPORATION
2011-09-13
2015-09-17
36. SA ADR
2011-09-13
2015-09-17
20. LAKELAND FINANCIAL CORP
2011-09-13
2015-09-17
24. LINDSAY MFG CO COMMON
2015-09-17
11. M & T BK CORP
2011-09-13
2015-09-17
20. MVC CAPITAL
2011-09-13
2015-09-17
30. STEVEN MADDEN LTD COMMON
2014-03-07
2015-09-17
75. MATTEL INC
2014-03-07
2015-09-17
13. MEDNAX INC COMMON
2010-02-22
2015-09-17
19. MERCK & CO INC
2012-03-02
2015-09-17
22. MICROSOFT CORPORATION
2009-08-14
2015-09-17
10. MOHAWK IND INC COMMON
2014-03-07
2015-09-17
10. NATIONAL GRID PLC
2011-09-13
2015-09-17
20. NAVIGATORS GROUP INC COMMON
2013-05-29
2015-09-17
60. NAVIENT CORP COMMON
2013-02-25
2015-09-17
27. NESTLE SA ADR
2011-09-13
2015-09-17
30. NETAPP INC
2013-06-28
2015-09-17
34. NOVARTIS AG
2011-09-13
2015-09-17
9. OMNICOM GROUP INCORPORATED
2011-09-13
2015-09-17
25. OUTERWALL INC COMMON
2011-12-23
2015-09-17
80. OWENS ILLINOIS INC COM NEW
2015-09-17
26. PPL CORPORATION
2011-12-23
2015-09-17
24. PRA GROUP INC COMMON
2013-05-29
2015-09-17
54. PEARSON PLC SPONSORED ADR
2011-12-23
2015-09-17
29. PEPSICO INCORPORATED
2015-09-17
66. PFIZER INCORPORATED
2015-09-17
25. PHILIP MORRIS INTERNATIONAL
2015-09-17
8. PIONEER NAT RES CO COMMON
2011-09-13
2015-09-17
50. PRESTIGE BRANDS HOLDINGS INC COMMON
2013-02-25
2015-09-17
43. REYNOLDS AMERICAN INC.
2011-12-23
2015-09-17
45. ROCHE HLDG LTD SPONS ADR
2011-09-13
2015-09-17
30. ROGERS COMMUNICATIONS INC
2013-12-04
2015-09-17
26. ROSS STORES INC COM
2011-09-13
2015-09-17
11. ROYAL DUTCH SHELL PLC SPONS ADR B
2011-12-23
2015-09-17
20. SAP AKTIENGESELLSCHAFT
2011-09-13
2015-09-17
23. SCHLUMBERGER LTD
2009-08-14
2015-09-17
77. SCHNEIDER ELECTRIC SA UNSPON ADR
2011-09-13
2015-09-17
10. SCHNITZER STEEL INDS INC CL A
2011-09-13
2015-09-17
50. SEMTECH CORP
2011-12-23
2015-09-17
13. SEMPRA ENERGY
2011-09-13
2015-09-17
61. SONOVA HOLDING AG
2011-09-13
2015-09-17
22. SOUTHERN COMPANY
2012-03-02
2015-09-17
25. SUN HYDRAULICS CORPORATION COMMON
2013-12-04
2015-09-17
110. SWATCH GROUP AG
2011-09-13
2015-09-17
20. SYNAPTICS INC
2011-12-23
2015-09-17
48. TAIWAN SEMICONDUCTOR MFG LTD SPONSORED ADR
2014-06-09
2015-09-17
9. TALEN ENERGY CORP
2015-09-17
30. TARGET CORP COM
2011-03-22
2015-09-17
12. TELEFLEX INC COMMON
2013-12-04
2015-09-17
17. TIME WARNER CABLE INC
2013-02-25
2015-09-17
30. TOLL BROTHERS INC
2014-06-09
2015-09-17
40. TORO COMPANY COMMON
2011-12-23
2015-09-17
50. TOTAL S A SPONSORED
2015-09-17
14. TOWERS WATSON & COMPANY COMMON
2013-05-29
2015-09-17
50. THE TRAVELERS COMPANIES INC.
2009-08-14
2015-09-17
267. UNICHARM CORP
2011-09-13
2015-09-17
30. UNITED NATURAL FOODS INC.
2011-12-23
2015-09-17
50. VCA ANTECH INC COMMON
2013-02-25
2015-09-17
25. VERINT SYSTEMS INC COMMON
2014-03-07
2015-09-17
14. WPP PLC ADR
2011-09-13
2015-09-17
30. WILLIAMS COS INC
2013-12-04
2015-09-17
14. ZIMMER HOLDINGS INC
2013-02-25
2015-09-17
28. ARCH CAPITAL GROUP LTD
2011-09-13
2015-09-17
10. BUNGE LIMITED COMMON
2013-02-25
2015-09-17
65. ENSCO PLC ADR CLASS A
2012-11-09
2015-09-17
25. NOBLE CORP PLC
2013-05-29
2015-09-17
12. PARTNERRE HOLDINGS LTD
2011-09-13
2015-09-17
7. SIGNET JEWELERS LTD
2011-09-13
2015-09-17
10. BAYERISCHE MOTOREN WERKE (BMW) UNSPONS A
2013-12-04
2015-12-21
5. ICICI BANK LTD ADR
2011-06-10
2015-12-21
15. IMPERIAL OIL LTD COMMON
2011-09-13
2015-12-21
5. METLIFE COMMON
2014-03-07
2015-12-21
15. MTN GROUP LTD ADR
2014-06-09
2015-12-21
10. OCCIDENTAL PETE CORP
2013-05-29
2015-12-21
96. PEARSON PLC SPONSORED ADR
2015-12-21
60. SLM CORPORATION COMMON
2013-02-25
2015-12-21
5. SHIRE PHARMACEUTICALS GROUP PLC
2015-09-17
2015-12-21
205. TURKIYE GARANTI BANKASI A.S.
2011-09-13
2015-12-21
50. BG GROUP PLC ADR
2011-09-13
2016-03-07
105. BG GROUP PLC ADR
2015-09-17
2016-03-07
.809 CALIFORNIA RESOURCES CORP COMMON
2016-04-13
.937 CALIFORNIA RESOURCES CORP COMMON
2015-09-17
2016-04-26
1.063 CALIFORNIA RESOURCES CORP COMMON
2013-02-25
2016-04-26
257. ICICI BANK LTD ADR
2016-04-26
20. OIL STATES INTERNATIONAL INC COM
2011-07-19
2016-04-26
34. SANDS CHINA LTD
2015-09-17
2016-04-26
20. AIA GROUP LTD
2013-06-28
2016-06-09
30. COMMON
2011-09-13
2016-06-09
30. ALLIANZ COMMON
2011-09-13
2016-06-09
10. ATLAS COPCO AB SP ADR
2010-06-24
2016-06-09
5. AUTODESK, INC. COMMON
2013-12-04
2016-06-09
15. BP AMOCO PLC ADS L C
2013-05-29
2016-06-09
10. BAYERISCHE MOTOREN WERKE (BMW) UNSPONS A
2013-12-04
2016-06-09
15. CDW CORP OF DELAWARE COMMON
2015-09-17
2016-06-09
25. CSL LTD -SPONSORED ADR
2011-12-23
2016-06-09
5. CANADIAN NATL RY CO
2011-12-23
2016-06-09
4. CHARTER COMMUNICATIONS INC-A COMMON
2013-02-25
2016-06-09
11. CINTAS CORP
2011-09-13
2016-06-09
10. COCA COLA COMPANY
2011-09-13
2016-06-09
36.861 COHEN & STEERS REALTY SHARES INSTITUTION
2011-09-13
2016-06-09
46.237 CREDIT SUISSE COMMODITY RETURN STRATEGY INSTITUTIONAL SHS FD 21
2015-12-21
2016-06-09
320.804 CREDIT SUISSE COMMODITY RETURN STRATEGY INSTITUTIONAL SHS FD 2
2013-05-29
2016-06-09
5. CROWN HOLDINGS INC
2010-06-24
2016-06-09
10. DASSAULT SYSTEMS
2011-09-13
2016-06-09
211.232 DODGE & COX INCOME FUND
2016-06-09
3644.161 DODGE & COX INCOME FUND
2016-06-09
5. EVERSOURCE ENERGY COMMON
2015-12-21
2016-06-09
10. FEI COMPANY COMMON
2013-02-25
2016-06-09
2361.894 FEDERATED HIGH YIELD BOND INST CL FUND #
2016-06-09
513.614 FEDERATED HIGH YIELD BOND INST CL FUND #
2014-03-07
2016-06-09
6523.111 FEDERATED SHORT-TERM INCOME FD Y-638
2014-09-03
2016-06-09
1117.974 FEDERATED SHORT-TERM INCOME FD Y-638
2016-06-09
5. FOOT LOCKER INC. COMMON
2014-06-09
2016-06-09
24.921 FORWARD SALIENT INTERNTL SMALL CAP INST
2011-09-13
2016-06-09
109. GENERAL ELECTRIC COMPANY
2015-09-17
2016-06-09
8. GENERAL MILLS, INCORPORATED
2012-03-02
2016-06-09
21. GOODYEAR TIRE & RUBBER COMPANY
2015-09-17
2016-06-09
9. GOODYEAR TIRE & RUBBER COMPANY
2014-03-07
2016-06-09
30. HCP INC
2011-12-23
2016-06-09
20. HANESBRANDS INC
2013-12-04
2016-06-09
34. HONG KONG EXCHANGES & CLEARING LIMITED
2014-06-09
2016-06-09
5. IPG PHOTONICS CORP COMMON
2014-06-09
2016-06-09
35. IMPERIAL OIL LTD COMMON
2011-09-13
2016-06-09
16. INTERNATIONAL BUSINESS MACHINES CORP
2015-09-17
2016-06-09
55. CEF ISHARES TR S&P
2015-09-17
2016-06-09
40. ITA UNIBANCO HOLDINGS SPON ADR PFD
2014-03-07
2016-06-09
115. KINDER MORGAN INC
2016-06-09
13. KINDER MORGAN INC
2015-12-21
2016-06-09
20. KONE OYJ -B-UNSPONSORED ADR
2015-09-17
2016-06-09
25. KRAFT HEINZ CO
2015-09-17
2016-06-09
10. SA ADR
2011-09-13
2016-06-09
15. UNSPON ADR
2011-09-13
2016-06-09
9. M & T BK CORP
2011-09-13
2016-06-09
15. MAXIM INTEGRATED PRODUCTS INC COMON
2014-06-09
2016-06-09
5. MCDONALDS CORPORATION
2011-12-23
2016-06-09
5. MEDNAX INC COMMON
2010-02-22
2016-06-09
5. NESTLE SA ADR
2011-09-13
2016-06-09
24. NOVO-NORDISK A S ADR
2015-09-17
2016-06-09
30. NOVO-NORDISK A S ADR
2014-06-09
2016-06-09
20. OCCIDENTAL PETE CORP
2016-06-09
10. OCCIDENTAL PETE CORP
2015-09-17
2016-06-09
8. RALPH LAUREN CORP COMMON
2015-09-17
2016-06-09
30. REYNOLDS AMERICAN INC.
2016-06-09
5. ROCKWELL COLLINS INC.
2014-06-09
2016-06-09
10. ROSS STORES INC COM
2011-09-13
2016-06-09
5. SAP AKTIENGESELLSCHAFT
2011-09-13
2016-06-09
163. SCHNEIDER ELECTRIC SA UNSPON ADR
2011-09-13
2016-06-09
5. SIGNATURE BANK COMMON
2011-09-13
2016-06-09
10. SINCLAIR BROADCAST GROUP A
2014-03-07
2016-06-09
134. SVENSKA HANDELSB-A
2015-09-17
2016-06-09
25. SYMRISE AG ADR
2014-06-09
2016-06-09
40. TAIWAN SEMICONDUCTOR MFG LTD SPONSORED ADR
2016-06-09
10. TRACTOR SUPPLY COMPANY COMMON
2011-09-13
2016-06-09
633. UNICHARM CORP
2011-09-13
2016-06-09
5. WPP PLC ADR
2011-09-13
2016-06-09
5. WESTERN DIGITAL CORP COM
2015-12-21
2016-06-09
8. WYNN RESORTS LTD COMMON
2013-05-29
2016-06-09
23. ALKERMES PLC
2015-09-17
2016-06-09
15. AMDOCS LTD ORD
2011-09-13
2016-06-09
5. ARCH CAPITAL GROUP LTD
2011-09-13
2016-06-09
5. AXIS CAPITAL HOLDINGS LTD
2013-05-29
2016-06-09
1. SEAGATE TECHNOLOGY PLC COMMON
2015-09-17
2016-06-09
40. SEAGATE TECHNOLOGY PLC COMMON
2011-12-23
2016-06-09
5. CHECKPOINT SOFTWARE TECHNOLOGY COMMON
2011-02-10
2016-06-09
CAPITAL GAIN DIVIDENDS
P
(e)
Gross sales price
(f)
Depreciation allowed
(or allowable)
(g)
Cost or other basis
plus expense of sale
(h)
Gain or (loss)
(e) plus (f) minus (g)
a
2
4
-2
b
36
91
-55
c
814
1,053
-239
d
896
1,222
-326
e
1,338
1,661
-323
593
1,053
-460
1,441
1,564
-123
655
1,203
-548
556
1,022
-466
1,914
1,234
680
1,208
934
274
4,122
1,836
2,286
915
759
156
2,239
1,817
422
544
714
-170
927
474
453
1,974
1,075
899
2,246
803
1,443
752
391
361
1,163
160
1,003
1,339
876
463
534
1,203
-669
634
346
288
2,004
1,262
742
1,999
1,482
517
881
518
363
1,558
737
821
1,133
1,075
58
1,046
692
354
163
143
20
1,690
700
990
334
721
-387
2,077
1,765
312
2,529
892
1,637
76
725
-649
22,700
21,005
1,695
2,272
2,457
-185
1,500
1,110
390
3,922
6,355
-2,433
936
474
462
903
645
258
2,161
1,075
1,086
1,102
758
344
1,104
760
344
16,402
16,657
-255
556
525
31
1,087
1,397
-310
717
630
87
894
656
238
2,316
1,890
426
101
67
34
862
1,079
-217
516
392
124
867
1,523
-656
1,824
1,444
380
2,265
1,017
1,248
1,650
1,389
261
999
1,039
-40
1,793
1,120
673
1,347
2,309
-962
2,134
5,368
-3,234
335
1,412
-1,077
406
278
128
754
450
304
1,224
708
516
848
422
426
1,776
1,646
130
1,357
799
558
179
224
-45
1,254
1,114
140
1,795
2,828
-1,033
1,097
348
749
1,012
718
294
981
521
460
2,077
1,448
629
663
493
170
1,566
1,193
373
763
734
29
2,053
1,510
543
970
1,141
-171
3,315
1,873
1,442
625
349
276
1,562
1,158
404
1,727
2,459
-732
797
717
80
1,337
1,196
141
953
1,024
-71
2,710
1,753
957
2,202
1,297
905
2,055
2,081
-26
1,005
590
415
2,444
1,178
1,266
1,828
897
931
1,501
876
625
1,017
1,319
-302
1,321
498
823
567
836
-269
1,338
987
351
1,752
1,228
524
960
833
127
149
417
-268
850
1,267
-417
1,199
661
538
1,562
941
621
950
975
-25
745
1,031
-286
2,158
2,300
-142
1,501
602
899
992
1,019
-27
117
142
-25
2,357
1,517
840
1,660
1,157
503
3,250
1,479
1,771
1,136
1,119
17
2,891
1,226
1,665
2,374
2,618
-244
1,687
1,099
588
5,125
2,345
2,780
995
836
159
1,550
1,194
356
2,848
1,113
1,735
1,179
1,179
1,477
673
804
1,372
1,101
271
1,413
1,036
377
1,984
925
1,059
714
732
-18
1,112
3,649
-2,537
328
889
-561
1,661
678
983
977
257
720
346
373
-27
38
46
-8
460
566
-106
232
266
-34
132
327
-195
653
891
-238
1,060
1,646
-586
373
405
-32
977
1,110
-133
503
781
-278
760
984
-224
1,595
1,668
-73
1
1
2
1
1
2
1
1
1,956
1,885
71
645
946
-301
1,249
1,186
63
475
339
136
636
580
56
474
245
229
261
155
106
289
232
57
492
653
-161
269
373
-104
638
629
9
1,078
411
667
300
192
108
890
712
178
1,046
338
708
456
345
111
1,758
1,397
361
239
207
32
1,659
2,435
-776
269
125
144
777
358
419
2,902
2,858
44
50,071
48,098
1,973
282
250
32
1,072
631
441
22,651
22,644
7
4,926
5,316
-390
55,577
56,034
-457
9,525
9,524
1
275
248
27
447
301
146
3,274
2,790
484
518
306
212
579
660
-81
248
250
-2
1,025
1,234
-209
530
349
181
833
646
187
430
334
96
1,131
1,320
-189
2,447
2,374
73
6,510
6,235
275
353
437
-84
2,047
4,468
-2,421
231
194
37
468
398
70
2,128
1,919
209
377
197
180
493
442
51
1,055
654
401
565
532
33
614
500
114
350
134
216
377
280
97
1,363
1,355
8
1,703
1,295
408
1,498
1,625
-127
749
687
62
748
915
-167
1,520
571
949
448
401
47
531
191
340
403
247
156
2,055
1,764
291
657
260
397
319
279
40
825
1,032
-207
402
346
56
1,041
496
545
936
338
598
2,456
1,983
473
571
240
331
241
296
-55
804
1,118
-314
1,039
1,650
-611
862
411
451
359
165
194
281
216
65
24
48
-24
948
643
305
427
242
185
1,349
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
-2
b
-55
c
-239
d
-326
e
-323
-460
-123
-548
-466
680
274
2,286
156
422
-170
453
899
1,443
361
1,003
463
-669
288
742
517
363
821
58
354
20
990
-387
312
1,637
-649
1,695
-185
390
-2,433
462
258
1,086
344
344
-255
31
-310
87
238
426
34
-217
124
-656
380
1,248
261
-40
673
-962
-3,234
-1,077
128
304
516
426
130
558
-45
140
-1,033
749
294
460
629
170
373
29
543
-171
1,442
276
404
-732
80
141
-71
957
905
-26
415
1,266
931
625
-302
823
-269
351
524
127
-268
-417
538
621
-25
-286
-142
899
-27
-25
840
503
1,771
17
1,665
-244
588
2,780
159
356
1,735
804
271
377
1,059
-18
-2,537
-561
983
720
-27
-8
-106
-34
-195
-238
-586
-32
-133
-278
-224
-73
1
1
71
-301
63
136
56
229
106
57
-161
-104
9
667
108
178
708
111
361
32
-776
144
419
44
1,973
32
441
7
-390
-457
1
27
146
484
212
-81
-2
-209
181
187
96
-189
73
275
-84
-2,421
37
70
209
180
51
401
33
114
216
97
8
408
-127
62
-167
949
47
340
156
291
397
40
-207
56
545
598
473
331
-55
-314
-611
451
194
65
-24
305
185
2
Capital gain net income or (net capital loss)
If gain, also enter in Part I, line 7
If (loss), enter -0- in Part I, line 7
2
40,720
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
...................
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?
Yes
No
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
40,020
723,514
0.055313
2013
39,692
726,450
0.054638
2012
40,077
695,626
0.057613
2011
40,000
680,989
0.058738
2010
40,075
728,750
0.054991
2
Total
of line 1, column (d)
.....................
2
0.281293
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
0.056259
4
Enter the net value of noncharitable-use assets for 2015 from Part X, line 5
.....
4
660,401
5
Multiply line 4 by line 3
......................
5
37,153
6
Enter 1% of net investment income (1% of Part I, line 27b)
...........
6
475
7
Add lines 5 and 6
........................
7
37,628
8
Enter qualifying distributions from Part XII, line 4
.............
8
40,000
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
Exempt operating foundations described in section 4940(d)(2), check here
and enter “N/A" on line 1.
Date of ruling or determination letter:
(attach copy of letter if necessary–see instructions)
b
Domestic foundations that meet the section 4940(e) requirements in Part V, check
1
475
here
and 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
475
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
475
6
Credits/Payments:
a
2015 estimated tax payments and 2014 overpayment credited to 2015
6a
204
b
Exempt foreign organizations—tax withheld at source
......
6b
c
Tax paid with application for extension of time to file (Form 8868)
...
6c
0
d
Backup withholding erroneously withheld
...........
6d
7
Total credits and payments. Add lines 6a through 6d
..............
7
204
8
Enter any
penalty
for underpayment of estimated tax.
Check here
if Form 2220 is attached.
8
0
9
Tax due.
If the total of lines 5 and 8 is more than line 7, enter
amount owed
.......
9
271
10
Overpayment.
If line 7 is more than the total of lines 5 and 8, enter the
amount overpaid
...
10
11
Enter the amount of line 10 to be:
Credited to 2015 estimated tax
0
Refunded
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.
$
(2)
On foundation managers.
$
e
Enter the reimbursement (if any) paid by the foundation during the year for political expenditure tax imposed
on foundation managers.
$
2
Has the foundation engaged in any activities that have not previously been reported to the IRS?
.......
2
No
If "Yes," attach a detailed description of the activities.
3
Has the foundation made any changes, not previously reported to the IRS, in its governing instrument, articles
of incorporation, or bylaws, or other similar instruments?
If "Yes," attach a conformed copy of the changes
....
3
No
4a
Did the foundation have unrelated business gross income of $1,000 or more during the year?
........
4a
No
b
If "Yes," has it filed a tax return on
Form 990-T
for this year?
...................
4b
5
Was there a liquidation, termination, dissolution, or substantial contraction during the year?
.........
5
No
If "Yes," attach the statement required by General Instruction T.
6
Are the requirements of section 508(e) (relating to sections 4941 through 4945) satisfied either:
By language in the governing instrument, or
By state legislation that effectively amends the governing instrument so that no mandatory directions
that conflict with the state law remain in the governing instrument?
................
6
Yes
7
Did the foundation have at least $5,000 in assets at any time during the year?
If "Yes," complete Part II, col. (c),
and Part XV.
.................................
7
Yes
8a
Enter the states to which the foundation reports or with which it is registered (see instructions)
NC
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 address
14
The books are in care of
BRANCH BANKING & TRUST COMPANY
Telephone no.
(252) 246-4935
Located at
223 W NASH ST
WILSON
NC
ZIP+4
27893
15
Section 4947(a)(1) nonexempt charitable trusts filing Form 990-PF in lieu of
Form 1041
—Check here
.......
and enter the amount of tax-exempt interest received or accrued during the year
......
15
16
At any time during calendar year 2015, did the foundation have an interest in or a signature or other authority over
Yes
No
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
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?
Yes
No
(2)
Borrow money from, lend money to, or otherwise extend credit to (or accept it from)
a disqualified person?
......................
Yes
No
(3)
Furnish goods, services, or facilities to (or accept them from) a disqualified person?
Yes
No
(4)
Pay compensation to, or pay or reimburse the expenses of, a disqualified person?
Yes
No
(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)?
...............
Yes
No
(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.)
.......
Yes
No
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
Organizations relying on a current notice regarding disaster assistance check here
........
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?
.............
Yes
No
If "Yes," list the years
20
,
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.
20
,
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?
......................
Yes
No
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
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))?
Yes
No
(2)
Influence the outcome of any specific public election (see section 4955); or to carry
on, directly or indirectly, any voter registration drive?
.............
Yes
No
(3)
Provide a grant to an individual for travel, study, or other similar purposes?
Yes
No
(4)
Provide a grant to an organization other than a charitable, etc., organization described
in section 4945(d)(4)(A)? (see instructions)
................
Yes
No
(5)
Provide for any purpose other than religious, charitable, scientific, literary, or
educational purposes, or for the prevention of cruelty to children or animals?
.....
Yes
No
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
Organizations relying on a current notice regarding disaster assistance check here
.........
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?
..........
Yes
No
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?
.....................
Yes
No
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?
Yes
No
b
If yes, did the foundation receive any proceeds or have any net income attributable to the transaction?
....
7b
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
BRANCH BANKING AND TRUST
TRUSTEE
1
10,673
PO BOX 2907
WILSON
,
NC
27894
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
...................
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
.............
0
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
.........................
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
653,949
b
Average of monthly cash balances
.......................
1b
16,509
c
Fair market value of all other assets (see instructions)
................
1c
0
d
Total
(add lines 1a, b, and c)
.........................
1d
670,458
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
670,458
4
Cash deemed held for charitable activities. Enter 1 1/2% of line 3 (for greater amount, see
instructions)
.............................
4
10,057
5
Net value of noncharitable-use assets.
Subtract line 4 from line 3. Enter here and on Part V, line 4
5
660,401
6
Minimum investment return.
Enter 5% of line 5
..................
6
33,020
Part XI
Distributable Amount
(see instructions) (Section 4942(j)(3) and (j)(5) private operating foundations and certain foreign organizations check here
and do not complete this part.)
1
Minimum investment return from Part X, line 6
....................
1
33,020
2a
Tax on investment income for 2015 from Part VI, line 5
......
2a
475
b
Income tax for 2015. (This does not include the tax from Part VI.)
...
2b
c
Add lines 2a and 2b
............................
2c
475
3
Distributable amount before adjustments. Subtract line 2c from line 1
............
3
32,545
4
Recoveries of amounts treated as qualifying distributions
................
4
0
5
Add lines 3 and 4
............................
5
32,545
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
32,545
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
40,000
b
Program-related investments—total from Part IX-B
..................
1b
0
2
Amounts paid to acquire assets used (or held for use) directly in carrying out charitable, etc.,
purposes
...............................
2
0
3
Amounts set aside for specific charitable projects that satisfy the:
a
Suitability test (prior IRS approval required)
....................
3a
0
b
Cash distribution test (attach the required schedule)
.................
3b
0
4
Qualifying distributions.
Add lines 1a through 3b. Enter here and on Part V, line 8, and Part XIII, line 4
4
40,000
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
475
6
Adjusted qualifying distributions.
Subtract line 5 from line 4
..............
6
39,525
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
32,545
2
Undistributed income, if any, as of the end of 2015:
a
Enter amount for 2014 only
.......
3,132
b
Total for prior years:
2013
,
20
,
20
0
3
Excess distributions carryover, if any, to 2015:
a
From 2010
......
0
b
From 2011
......
0
c
From 2012
......
0
d
From 2013
......
0
e
From 2014
......
0
f
Total
of lines 3a through e
........
0
4
Qualifying distributions for 2015 from Part
XII, line 4:
$
40,000
a
Applied to 2014, but not more than line 2a
3,132
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 2015 distributable amount
.....
32,545
e
Remaining amount distributed out of corpus
4,323
5
Excess distributions carryover applied to 2015.
0
0
(If an amount appears in column (d), the
same amount must be shown in column (a).)
6
Enter the net total of each column as
indicated below:
a
Corpus. Add lines 3f, 4c, and 4e. Subtract line 5
4,323
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 2014. Subtract line
4a from line 2a. Taxable amount—see
instructions
.............
0
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)
.......
0
8
Excess distributions carryover from 2010 not
applied on line 5 or line 7 (see instructions)
...
0
9
Excess distributions carryover to 2016.
Subtract lines 7 and 8 from line 6a
......
4,323
10
Analysis of line 9:
a
Excess from 2011
....
0
b
Excess from 2012
....
0
c
Excess from 2013
....
0
d
Excess from 2014
....
0
e
Excess from 2015
....
4,323
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
.......
b
Check box to indicate whether the organization is a private operating foundation described in section
4942(j)(3)
or
4942(j)(5)
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.)
1
Information Regarding Foundation Managers:
a
List 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).)
NONE
b
List 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.
NONE
2
Information Regarding Contribution, Grant, Gift, Loan, Scholarship, etc., Programs:
Check here
if the foundation only makes contributions to preselected charitable organizations and does not accept
unsolicited requests for funds. If the foundation makes gifts, grants, etc. (see instructions) to individuals or organizations under
other conditions, complete items 2a, b, c, and d.
a
The name, address, and telephone number or e-mail address of the person to whom applications should be addressed:
WILLIAM CREWS
PO BOX 2907 BBT WEALTH MGMT
WILSON
,
NC
278942907
(252) 246-4935
b
The form in which applications should be submitted and information and materials they should include:
APPLICATION
c
Any submission deadlines:
MARCH 1
d
Any restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other
factors:
WORTHY AND DESERVING GRADUATES OF TARBORO HIGH SCHOOL THAT ARE ATTENDING A COLLEGE, JUNIOR COLLEGE OR UNIVERSITY
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)
a
Paid during the year
UNC GREENSBORO
PO BOX 26170
GREENSBORO
,
NC
274026170
NONE
EXEMPT
EDUCATIONAL
5,000
UNC CHARLOTTE
9201 UNIVERSITY CITY BLVD
CHARLOTTE
,
NC
282230001
NONE
N/A
COLLEGE SCHOLARSHIP
5,000
UNC CHAPEL HILL
CB 2200 JACKSON HALL
CHAPEL HILL
,
NC
275992200
NONE
EXEMPT
EDUCATIONAL
20,000
EAST CAROLINA UNIVERSITY
EAST FIFTH STREET
GREENVILLE
,
NC
278584353
NONE
EXEMPT
EDUCATIONAL
5,000
CAMPBELL UNIVERSITY
143 MAIN ST
BUIES CREEK
,
NC
27506
NONE
N/A
COLLEGE SCHOLARSHIP
5,000
Total
.................................
3a
40,000
b
Approved for future payment
Total
.................................
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.)
1
Program service revenue:
(a)
Business code
(b)
Amount
(c)
Exclusion code
(d)
Amount
a
b
c
d
e
f
g
Fees 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
18,146
5
Net rental income or (loss) from real estate:
a
Debt-financed property
......
b
Not debt-financed property
.....
6
Net rental income or (loss) from personal property
7
Other investment income
.....
8
Gain or (loss) from sales of assets other than inventory
............
18
40,720
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)
..
58,866
13
Total.
Add line 12, columns (b), (d), and (e)
..................
13
58,866
(See worksheet in line 13 instructions to verify calculations.)
Part XVI-B
Relationship of Activities to the Accomplishment of Exempt Purposes
Line No.
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
(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?
...........
Yes
No
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.
May the IRS discuss this return
with the preparer shown below
(see instr.)?
Yes
No
Signature of officer or trustee
Date
Title
Paid Preparer Use Only
Print/Type preparer's name
Preparer's Signature
Date
Check if self-
employed
PTIN
Firm's name
Firm's EIN
Firm's address
Phone no.
Form
990-PF
(2015)
Additional Data
Software ID:
Software Version:
Form 990PF - Special Condition Description:
Special Condition Description
-
TIN:
TY 2015 OtherIncreasesSchedule
Name:
A R BURNETTE SCHOLARSHIP FUND
EIN:
56-6593070
Description
Amount
DIFF IN MUTUAL FDS REC/REPORTED
1,672
ADJUSTMENT FOR ROUNDING
11