Form 990-Pf - Return Of Private Foundation - 2012
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13990-PF
Return of Private Foundation
OMB No. 1545-0052
Form
2012
or Section 4947(a)(1) Nonexempt Charitable Trust
Treated as a Private Foundation
Department of the Treasury
Internal Revenue Service
Note. The foundation may be able to use a copy of this return to satisfy state reporting requirements.
Open to Public Inspection
For calendar year 2012 or tax year beginning
, 2012, and ending
, 20
A Employer identification number
Name of foundation
Number and street (or P.O. box number if mail is not delivered to street address)
Room/suite
B Telephone number (see instructions)
City or town, state, and ZIP code
C If exemption application is pending, check here
▶
G Check all that apply:
Initial return
Initial return of a former public charity
D 1. Foreign organizations, check here .
.
.
▶
Amended return
Final return
2. Foreign organizations meeting the 85% test,
Address change
Name change
.
.
check here and attach computation
▶
E If private foundation status was terminated under
H Check type of organization:
Section 501(c)(3) exempt private foundation
section 507(b)(1)(A), check here
.
.
.
.
▶
Section 4947(a)(1) nonexempt charitable trust
Other taxable private foundation
I
J Accounting method:
Cash
Accrual
Fair market value of all assets at
F If the foundation is in a 60-month termination
end of year (from Part II, col. (c),
Other (specify)
under section 507(b)(1)(B), check here
.
.
▶
line 16)
$
▶
(Part I, column (d) must be on cash basis.)
Part I
Analysis of Revenue and Expenses
(The total of
(d) Disbursements
(a) Revenue and
(b) Net investment
(c) Adjusted net
for charitable
amounts in columns (b), (c), and (d) may not necessarily equal
expenses per
income
income
purposes
books
the amounts in column (a) (see instructions).)
(cash basis only)
1
Contributions, gifts, grants, etc., received (attach schedule)
2
Check
if the foundation is not required to attach Sch. B
▶
3
Interest on savings and temporary cash investments
4
Dividends and interest from securities .
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5a Gross rents .
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b Net rental income or (loss)
6a Net gain or (loss) from sale of assets not on line 10
b Gross sales price for all assets on line 6a
7
Capital gain net income (from Part IV, line 2) .
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8
Net short-term capital gain .
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9
Income modifications
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10a Gross sales less returns and allowances
b Less: Cost of goods sold
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c Gross profit or (loss) (attach schedule) .
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11
Other income (attach schedule)
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12
Total. Add lines 1 through 11 .
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13
Compensation of officers, directors, trustees, etc.
14
Other employee salaries and wages .
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15
Pension plans, employee benefits
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16a Legal fees (attach schedule)
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b Accounting fees (attach schedule)
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c Other professional fees (attach schedule) .
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17
Interest
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18
Taxes (attach schedule) (see instructions)
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19
Depreciation (attach schedule) and depletion .
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20
Occupancy .
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21
Travel, conferences, and meetings
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22
Printing and publications
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23
Other expenses (attach schedule)
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24
Total operating and administrative expenses.
Add lines 13 through 23 .
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25
Contributions, gifts, grants paid
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26
Total expenses and disbursements. Add lines 24 and 25
27
Subtract line 26 from line 12:
a Excess of revenue over expenses and disbursements
b Net investment income (if negative, enter -0-)
.
c Adjusted net income (if negative, enter -0-) .
.
990-PF
For Paperwork Reduction Act Notice, see instructions.
Form
(2012)
Cat. No. 11289X
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