Académique Documents
Professionnel Documents
Culture Documents
Form
990-PF
2014
u Do not enter social security numbers on this form as it may be made public.
26-0344869
Number and street (or P.O. box number if mail is not delivered to street address)
Room/suite
336-497-1854
City or town, state or province, country, and ZIP or foreign postal code
GREENSBORO
G Check all that apply:
NC 27403
Initial return
Final return
Address change
..
Revenue
amounts in columns (b), (c), and (d) may not necessarily equal
the amounts in column (a) (see instructions).)
1
2
3
4
5a
b
6a
b
7
8
9
10a
b
c
11
12
13
14
15
16a
b
c
17
18
19
20
21
22
23
24
STMT 1
income
income
purposes
(cash basis only)
279,416
137,332
137,332
137,332
777,253
777,441
8,443
STMT 6
STMT 7
expenses per
books
1,194,001
101,476
218,987
32,028
750
10,263
13,803
7,863
18,775
98,626
2,105
174,742
679,418
390,556
1,069,974
914,773
145,775
101,476
218,987
32,028
750
10,263
45,900
45,900
45,900
45,900
45,900
45,900
18,775
98,626
2,105
127,660
610,670
390,556
1,001,226
124,027
868,873
99,875
Form
990-PF (2014)
Part II
1
2
3
4
5
6
Assets
Balance Sheets
Cash non-interest-bearing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Savings and temporary cash investments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Accounts receivable u . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Less: allowance for doubtful accounts u . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Pledges receivable u . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Less: allowance for doubtful accounts u . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Grants receivable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Receivables due from officers, directors, trustees, and other
disqualified persons (attach schedule) (see
instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
SEE WRK
Page
Beginning of year
(a) Book Value
End of year
(b) Book Value
141,611
9,107,303
182,160
8,444,023
182,159
8,444,023
50,000
50,000
50,000
20,734
18,070
18,070
9,319,648
8,694,253
8,694,252
56,255
56,255
53,671
53,671
9,263,393
8,640,582
9,263,393
8,640,582
9,319,648
8,694,253
50,000
12
13
14
57,342
39,272
STMT 8
Liabilities
15
16
17
18
19
20
21
22
23
24
25
26
Unrestricted . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Temporarily restricted . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Permanently restricted . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Foundations that do not follow SFAS 117, check here . . . . . . . . . u
and complete lines 27 through 31.
27
28
29
30
31
Part III
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) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2 Enter amount from Part I, line 27a . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3 Other increases not included in line 2 (itemize) u . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4 Add lines 1, 2, and 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5 Decreases not included in line 2 (itemize) u SEE
. . . . . . . . . STATEMENT
. . . . . . . . . . . . . . . . . . . . . .10
...............................................
6 Total net assets or fund balances at end of year (line 4 minus line 5) Part II, column (b), line 30 . . . . . . . . . . . . . . . . . . . . . .
DAA
1
2
3
4
5
6
9,263,393
124,027
9,387,420
746,838
8,640,582
Form 990-PF (2014)
Part IV
(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.)
1a
b
c
d
e
Page
SEE WORKSHEET
a
b
c
d
e
Complete only for assets showing gain in column (h) and owned by the foundation on 12/31/69
(j) Adjusted basis
as of 12/31/69
a
b
c
d
e
If gain, also enter in Part I, line 7
}
If (loss), enter -0- in Part I, line 7
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 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2 Capital gain net income or (net capital loss) |
Part V
777,441
8,443
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.
Yes
No
1 Enter the appropriate amount in each column for each year; see the instructions before making any entries.
(a)
Base period years
Calendar year (or tax year beginning in)
(b)
Adjusted qualifying distributions
1,164,465
575,906
381,194
292,380
251,092
2013
2012
2011
2010
2009
(d)
Distribution ratio
(col. (b) divided by col. (c))
(c)
Net value of noncharitable-use assets
8,744,189
7,615,871
6,689,761
356,981
402,139
0.133170
0.075619
0.056982
0.819035
0.624391
1.709197
0.341839
4 Enter the net value of noncharitable-use assets for 2014 from Part X, line 5
.......................................
8,922,490
...............................................................................................
3,050,055
.........................................................
8,689
3,058,744
1,001,226
Form
DAA
990-PF (2014)
Exempt operating foundations described in section 4940(d)(2), check here u and enter N/A on line 1.
Date of ruling or determination letter: . . . . . . . . . . . . . . . . . . (attach copy of letter if necessarysee instructions)
Domestic foundations that meet the section 4940(e) requirements in Part V, check
} 1
here u
and enter 1% of Part I, line 27b . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
All other domestic foundations enter 2% of line 27b. Exempt foreign organizations enter 4% of
Part I, line 12, col. (b).
Tax under section 511 (domestic section 4947(a)(1) trusts and taxable foundations only. Others enter -0-) . . . . . . .
2
Add lines 1 and 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3
Subtitle A (income) tax (domestic section 4947(a)(1) trusts and taxable foundations only. Others enter -0-) . . . . . .
4
Tax based on investment income. Subtract line 4 from line 3. If zero or less, enter -0- . . . . . . . . . . . . . . . . . . . . . . . . . .
5
Credits/Payments:
2014 estimated tax payments and 2013 overpayment credited to 2014 . . . . . . . . . . .
6a
8,720
Exempt foreign organizations tax withheld at source . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6b
Tax paid with application for extension of time to file (Form 8868) . . . . . . . . . . . . . . . . .
6c
Backup withholding erroneously withheld . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6d
Total credits and payments. Add lines 6a through 6d . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
7
Enter any penalty for underpayment of estimated tax. Check hereX if Form 2220 is attached . . . . . . . . . . . . . . . . . . . . .
8
Tax due. If the total of lines 5 and 8 is more than line 7, enter amount owed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . u
9
Overpayment. If line 7 is more than the total of lines 5 and 8, enter the amount overpaid . . . . . . . . . . . . . . . . . . . u
10
Enter the amount of line 10 to be: Credited to 2015 estimated tax u
Refunded u
11
Part VII-A
1a
b
c
d
e
2
3
4a
b
5
6
Page
17,377
0
17,377
0
17,377
8,720
38
8,695
During the tax year, did the foundation attempt to influence any national, state, or local legislation or did it
participate or intervene in any political campaign? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Did it spend more than $100 during the year (either directly or indirectly) for political purposes (see
Instructions for the definition)? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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.
Did the foundation file Form 1120-POL for this year? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Enter the amount (if any) of tax on political expenditures (section 4955) imposed during the year:
(1) On the foundation. u $
(2) On foundation managers. u $
Enter the reimbursement (if any) paid by the foundation during the year for political expenditure tax imposed
on foundation managers. u $
Has the foundation engaged in any activities that have not previously been reported to the IRS? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
If Yes, attach a detailed description of the activities.
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 . . . . . . . . . . . . . . . . . . . . . . .
Did the foundation have unrelated business gross income of $1,000 or more during the year? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
If Yes, has it filed a tax return on Form 990-T for this year? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . N/A
......
Was there a liquidation, termination, dissolution, or substantial contraction during the year? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
If Yes, attach the statement required by General Instruction T.
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? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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 .
Enter the states to which the foundation reports or with which it is registered (see instructions) u
Yes
No
1a
1b
1c
3
4a
4b
5
X
X
7
8a
6
7
X
X
8b
NC
. .....................................................................................................................................
b
9
10
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 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Is the foundation claiming status as a private operating foundation within the meaning of section 4942(j)(3) or
4942(j)(5) for calendar year 2014 or the taxable year beginning in 2014 (see instructions for Part XIV)? If Yes,
complete Part XIV . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Did any persons become substantial contributors during the tax year? If Yes, attach a schedule listing their
names and addresses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
10
Form
DAA
990-PF (2014)
Part VII-A
11
12
13
14
Page
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
X
Did the foundation make a distribution to a donor advised fund over which the foundation or a disqualified
X
person had advisory privileges? If Yes, attach statement (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
12
X
Did the foundation comply with the public inspection requirements for its annual returns and exemption application? . . . . . . . . . .
13
Website address u . WWW.F4DC.ORG
....................................................................................................................................
The books are in care of u . .MARNIE
Telephone no. u .336-497-1854
. . . . . . . . . . . . . . . THOMPSON
........................................................
.............................
Located at u GREENSBORO
ZIP+4 u . .27403
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .NC
..........
............................
Section 4947(a)(1) nonexempt charitable trusts filing Form 990-PF in lieu of Form 1041 Check here . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . u
and enter the amount of tax-exempt interest received or accrued during the year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . u
15
At any time during calendar year 2014, did the foundation have an interest in or a signature or other authority
Yes No
X
over a bank, securities, or other financial account in a foreign country? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
16
See the instructions for exceptions and filing requirements for FinCEN Form 114, (formerly TD F 90-22.1). If
"Yes," enter the name of the foreign country u
Part VII-B
1a
c
2
a
c
3a
b
4a
b
File Form 4720 if any item is checked in the Yes column, unless an exception applies.
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
X No
(2) Borrow money from, lend money to, or otherwise extend credit to (or accept it from) a
disqualified person? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes
X No
(3) Furnish goods, services, or facilities to (or accept them from) a disqualified person? . . . . . . . . . . . . . . . . .
Yes
X No
(4) Pay compensation to, or pay or reimburse the expenses of, a disqualified person? . . . . . . . . . . . . . . . . . . . X 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
X 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
X No
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)? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Organizations relying on a current notice regarding disaster assistance check here . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . u
Did the foundation engage in a prior year in any of the acts described in 1a, other than excepted acts, that
were not corrected before the first day of the tax year beginning in 2014? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . N/A
......
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)):
At the end of tax year 2014, did the foundation have any undistributed income (lines 6d and
6e, Part XIII) for tax year(s) beginning before 2014? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes
X No
If Yes, list the years u 20 . . . . . , 20 . . . . . , 20 . . . . . , 20 . . . . .
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.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . N/A
......
If the provisions of section 4942(a)(2) are being applied to any of the years listed in 2a, list the years here.
u 20 . . . . . , 20 . . . . . , 20 . . . . . . , 20 . . . . .
Did the foundation hold more than a 2% direct or indirect interest in any business enterprise
at any time during the year? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes
X No
If Yes, did it have excess business holdings in 2014 as a result of (1) any purchase by the foundation or
disqualified persons after May 26, 1969; (2) the lapse of the 5-year period (or longer period approved by the
Commissioner under section 4943(c)(7)) to dispose of holdings acquired by gift or bequest; or (3) the lapse of
the 10-, 15-, or 20-year first phase holding period? (Use Schedule C, Form 4720, to determine if the
foundation had excess business holdings in 2014.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . N/A
......
Did the foundation invest during the year any amount in a manner that would jeopardize its charitable purposes? . . . . . . . . . . . . . .
Did the foundation make any investment in a prior year (but after December 31, 1969) that could jeopardize its
charitable purpose that had not been removed from jeopardy before the first day of the tax year beginning in 2014? . . . . . . . . . . .
Yes
1b
1c
2b
3b
4a
4b
Form
DAA
No
990-PF (2014)
Part VII-B
5a
6a
b
7a
b
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
X No
(2) Influence the outcome of any specific public election (see section 4955); or to carry on,
X No
directly or indirectly, any voter registration drive? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes
X No
(3) Provide a grant to an individual for travel, study, or other similar purposes? . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes
(4) Provide a grant to an organization other than a charitable, etc., organization described in
section 4945(d)(4)(A)? (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes
X No
(5) Provide for any purpose other than religious, charitable, scientific, literary, or educational
X No
purposes, or for the prevention of cruelty to children or animals? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes
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)? . . . . . . . . . . . . . . . . . . . . . N/A
......
Organizations relying on a current notice regarding disaster assistance check here . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . u
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? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .N/A
Yes
No
.....
If Yes, attach the statement required by Regulations section 53.49455(d).
Did the foundation, during the year, receive any funds, directly or indirectly, to pay premiums
on a personal benefit contract? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes
X No
Did the foundation, during the year, pay premiums, directly or indirectly, on a personal benefit contract? . . . . . . . . . . . . . . . . . . . . . . .
If Yes to 6b, file Form 8870.
X No
At any time during the tax year, was the foundation a party to a prohibited tax shelter transaction? . . . . . .
Yes
......
If Yes, did the foundation receive any proceeds or have any net income attributable to the transaction? . . . . . . . . . . . . . . . . N/A
Part VIII
Page
Statements Regarding Activities for Which Form 4720 May Be Required (continued)
5b
6b
7b
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).
(b) Title, and average
(a) Name and address
(d) Contributions to
. . . . . . . . . . .THOMPSON
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . GREENSBORO
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .CO-MNGNG
. . MARNIE
DIR
620 SOUTH ELM STREET STE 355
NC 27406
40.00
. ED
. . . . . WHITFIELD
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . GREENSBORO
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .C0-MNGNG DIR
620 SOUTH ELM STREET STE 355
NC 27406
40.00
(c) Compensation
51,928
49,548
. ........................................................................................
. ........................................................................................
Compensation of five highest-paid employees (other than those included on line 1 see instructions). If none, enter
NONE.
(d) Contributions to
(c) Compensation
.......................................................................................
. . NONE
. ........................................................................................
. ........................................................................................
. ........................................................................................
. ........................................................................................
DAA
0
990-PF (2014)
Part VIII
3
Page
Information About Officers, Directors, Trustees, Foundation Managers, Highly Paid Employees,
and Contractors (continued)
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
(c) Compensation
NONE
. ....................................................................................................
. ....................................................................................................
. ....................................................................................................
. ....................................................................................................
. ....................................................................................................
Part IX-A
..........................................................
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
. ...............................................................................................................................
. ...............................................................................................................................
1,001,226
2
. ...............................................................................................................................
. ...............................................................................................................................
. ...............................................................................................................................
. ...............................................................................................................................
. ...............................................................................................................................
. ...............................................................................................................................
Part IX-B
Describe the two largest program-related investments made by the foundation during the tax year on lines 1 and 2.
Amount
N/A
. ...............................................................................................................................
. ...............................................................................................................................
. ...............................................................................................................................
. ...............................................................................................................................
. ...............................................................................................................................
. ...............................................................................................................................
.................................................................................................
Form
DAA
990-PF (2014)
Part X
1
a
b
c
d
e
2
3
4
5
6
Fair market value of assets not used (or held for use) directly in carrying out charitable, etc.,
purposes:
Average monthly fair market value of securities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Average of monthly cash balances . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Fair market value of all other assets (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Total (add lines 1a, b, and c) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Reduction claimed for blockage or other factors reported on lines 1a and
0
1c (attach detailed explanation) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1e
Acquisition indebtedness applicable to line 1 assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Subtract line 2 from line 1d . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Cash deemed held for charitable activities. Enter 1% of line 3 (for greater amount, see
instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Net value of noncharitable-use assets. Subtract line 4 from line 3. Enter here and on Part V, line 4 . . . . . . . . . . . .
Minimum investment return. Enter 5% of line 5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Part XI
1
2a
b
c
3
4
5
6
7
3
a
b
4
5
6
Page
1a
1b
1c
1d
8,907,842
150,523
0
9,058,365
2
3
0
9,058,365
4
5
6
135,875
8,922,490
446,125
2c
3
4
5
6
7
1,001,226
1,001,226
0
1,001,226
Form
DAA
Distributable Amount (see instructions) (Section 4942(j)(3) and (j)(5) private operating foundations
and certain foreign organizations check here X
u and do not complete this part.)
Part XII
1
a
b
2
Minimum Investment Return (All domestic foundations must complete this part. Foreign foundations,
see instructions.)
990-PF (2014)
Part XIII
1
2
a
b
3
a
b
c
d
e
f
4
a
b
c
d
e
5
6
a
b
c
d
e
8
9
10
a
b
c
d
e
Page
(a)
(b)
(c)
(d)
Corpus
2013
2014
1,001,226
1,001,226
Form
DAA
990-PF (2014)
Part XIV
1a
b
2a
b
c
d
e
3
a
Page
If the foundation has received a ruling or determination letter that it is a private operating
foundation, and the ruling is effective for 2014, enter the date of the ruling . . . . . . . . . . . . . . . . . . . . . . . . u
Check box to indicate whether the foundation is a private operating foundation described in section
X 4942(j)(3) or
Tax year
Prior 3 years
Enter the lesser of the adjusted net
income from Part I or the minimum
investment return from Part X for
each year listed . . . . . . . . . . . . . . . . . . . . .
85% of line 2a . . . . . . . . . . . . . . . . . . . . . . .
Qualifying distributions from Part XII,
line 4 for each year listed . . . . . . . . . . .
Amounts included in line 2c not used directly
for active conduct of exempt activities . . . .
Qualifying distributions made directly
for active conduct of exempt activities.
Subtract line 2d from line 2c . . . . . . . .
Complete 3a, b, or c for the
alternative test relied upon:
Assets alternative test enter:
(1) Value of all assets . . . . . . . . . . . . . . .
(2) Value of assets qualifying under
section 4942(j)(3)(B)(i) . . . . . . . . . .
Endowment alternative test enter 2/3
of minimum investment return shown in
Part X, line 6 for each year listed . . .
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
1
a
10
(a) 2014
(b) 2013
(c) 2012
N/A
4942(j)(5)
(e) Total
(d) 2011
99,875
84,894
116,302
98,857
82,035
69,730
57,166
48,591
355,378
302,072
1,001,226
1,164,465
575,906
381,194
3,122,791
455,259
728,924
226,096
193,658
1,603,937
545,967
435,541
349,810
187,536
1,518,854
297,417
291,473
253,863
222,992
1,065,745
Supplementary Information (Complete this part only if the foundation had $5,000 or more in assets at
any time during the year see instructions.)
N/A
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.
N/A
2
The form in which applications should be submitted and information and materials they should include:
Any restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other
factors:
SEE STATEMENT 11
SEE STATEMENT 12
SEE STATEMENT 13
DAA
Form
990-PF (2014)
Page
11
Part XV
Supplementary Information (continued)
3 Grants and Contributions Paid During the Year or Approved for Future Payment
Recipient
Name and address (home or business)
a
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
SEE ATTACHED
390,556
390,556
Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . u 3a
Approved for future payment
N/A
Total
DAA
...................................................................................................................
u 3b
Form
990-PF (2014)
Part XVI-A
Page
(b)
Amount
Exclusion
code
(d)
Amount
Part XVI-B
Line No.
12
137,332
777,253
914,585
914,585
13
N/A
Form
DAA
990-PF (2014)
Part XVII
1
c
d
Page
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?
Transfers from the reporting foundation to a noncharitable exempt organization of:
(1) Cash . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(2) Other assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Other transactions:
(1) Sales of assets to a noncharitable exempt organization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(2) Purchases of assets from a noncharitable exempt organization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(3) Rental of facilities, equipment, or other assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(4) Reimbursement arrangements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(5) Loans or loan guarantees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(6) Performance of services or membership or fundraising solicitations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Sharing of facilities, equipment, mailing lists, other assets, or paid employees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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.
13
Yes
No
1a(1)
1a(2)
X
X
1b(1)
1b(2)
1b(3)
1b(4)
1b(5)
1b(6)
1c
X
X
X
X
X
X
X
N/A
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
Yes
No
N/A
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 instructions)?
Yes
Sign
Here
No
PRESIDENT
Signature of officer or trustee
Print/Type preparer's name
Paid
CHUCK AVERRE
Preparer
Firm's name
HOLLINGSWORTH
Use Only
Firm's address
Date
Title
Preparer's signature
Date
CHUCK AVERRE
Check
if
self-employed
04/28/15
PTIN
Firm's EIN
Phone no.
P00280366
56-2119415
919-848-4100
Form
DAA
990-PF (2014)
Schedule B
(Form 990, 990-EZ,
or 990-PF)
Department of the Treasury
Internal Revenue Service
Schedule of Contributors
u Attach to Form 990, Form 990-EZ, or Form 990-PF.
u Information about Schedule B (Form 990, 990-EZ, 990-PF) and its instructions is at www.irs.gov/form990.
2014
26-0344869
Section:
501(c)(
For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, contributions totaling $5,000
or more (in money or property) from any one contributor. Complete Parts I and II. See instructions for determining a
contributor's total contributions.
Special Rules
For an organization described in section 501(c)(3) filing Form 990 or 990-EZ that met the 331/3 % support test of the
regulations under sections 509(a)(1) and 170(b)(1)(A)(vi), that checked Schedule A (Form 990 or 990-EZ), Part II, line
13, 16a, or 16b, and that received from any one contributor, during the year, total contributions of the greater of (1)
$5,000 or (2) 2% of the amount on (i) Form 990, Part VIII, line 1h, or (ii) Form 990-EZ, line 1. Complete Parts I and II.
For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one
contributor, during the year, total contributions of more than $1,000 exclusively for religious, charitable, scientific,
literary, or educational purposes, or for the prevention of cruelty to children or animals. Complete Parts I, II, and III.
For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one
contributor, during the year, contributions exclusively for religious, charitable, etc., purposes, but no such
contributions totaled more than $1,000. If this box is checked, enter here the total contributions that were received
during the year for an exclusively religious, charitable, etc., purpose. Do not complete any of the parts unless the
General Rule applies to this organization because it received nonexclusively religious, charitable, etc., contributions
totaling $5,000 or more during the year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
$ ...........................
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 990-PF, 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.
DAA
PAGE 1 OF 1
Page
Employer identification number
Name of organization
. ......
26-0344869
Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
. ..........................................................................
(a)
No.
(b)
Name, address, and ZIP + 4
. ......
. ..........................................................................
............................................................................
279,416
...........................
(c)
Total contributions
...........................
. ..........................................................................
(a)
No.
(b)
Name, address, and ZIP + 4
. ......
............................................................................
............................................................................
(c)
Total contributions
...........................
............................................................................
(a)
No.
(b)
Name, address, and ZIP + 4
. ......
. ..........................................................................
............................................................................
(c)
Total contributions
...........................
. ..........................................................................
(a)
No.
(b)
Name, address, and ZIP + 4
. ......
. ..........................................................................
............................................................................
(c)
Total contributions
...........................
............................................................................
(a)
No.
(b)
Name, address, and ZIP + 4
. ......
. ..........................................................................
............................................................................
. ..........................................................................
(c)
Total contributions
...........................
(d)
Type of contribution
Person
X
Payroll
Noncash
(Complete Part II for
noncash contributions.)
(d)
Type of contribution
Person
Payroll
Noncash
(Complete Part II for
noncash contributions.)
(d)
Type of contribution
Person
Payroll
Noncash
(Complete Part II for
noncash contributions.)
(d)
Type of contribution
Person
Payroll
Noncash
(Complete Part II for
noncash contributions.)
(d)
Type of contribution
Person
Payroll
Noncash
(Complete Part II for
noncash contributions.)
(d)
Type of contribution
Person
Payroll
Noncash
(Complete Part II for
noncash contributions.)
990-PF
Form
2014
, and ending
26-0344869
(b)
List and describe the kind(s) of property sold, e.g., real estate,
2-story brick warehouse; or common stock, 200 shs. MLC Co.
How acquired
P-Purchase
D-Donation
(f)
Depreciation allowed
(or allowable)
P
P
P
P
P
P
P
P
P
P
P
P
P
P
P
(g)
160,000
20,000
38,774
31,226
23,000
770,000
623,595
109,284
37,121
357,908
82,092
7,066
39,468
770,000
2,450
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
(11)
(12)
(13)
(14)
(15)
152,251
19,283
35,378
30,000
21,185
704,298
482,955
88,378
30,000
314,998
73,000
6,588
37,000
686,912
2,473
(c)
Date acquired
(mo., day, yr.)
01/16/14
01/16/14
04/12/11
03/12/13
04/12/11
04/12/11
04/12/11
03/11/13
03/12/13
04/12/11
03/12/13
04/12/11
03/12/13
04/12/11
06/03/13
(d)
Date sold
(mo., day, yr.)
06/25/14
07/29/14
06/25/14
06/25/14
07/29/14
08/28/14
08/28/14
08/28/14
08/28/14
08/28/14
08/28/14
04/25/14
04/25/14
08/28/14
02/19/14
(h)
Gain or (loss)
(e) plus (f) minus (g)
7,749
717
3,396
1,226
1,815
65,702
140,640
20,906
7,121
42,910
9,092
478
2,468
83,088
-23
Complete only for assets showing gain in column (h) and owned by the foundation on 12/31/69
(i)
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
(11)
(12)
(13)
(14)
(15)
F.M.V. as of 12/31/69
(j)
Adjusted basis
as of 12/31/69
(k)
7,749
717
3,396
1,226
1,815
65,702
140,640
20,906
7,121
42,910
9,092
478
2,468
83,088
-23
990-PF
Form
2014
, and ending
26-0344869
(b)
List and describe the kind(s) of property sold, e.g., real estate,
2-story brick warehouse; or common stock, 200 shs. MLC Co.
How acquired
P-Purchase
D-Donation
(e)
(f)
Depreciation allowed
(or allowable)
P
P
P
P
P
P
P
P
(g)
6,424
8,617
63,660
47,529
130,000
44,000
440,000
175,000
261,859
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
(11)
(12)
(13)
(14)
(15)
6,507
8,608
63,532
39,006
104,708
35,304
354,654
174,614
(c)
Date acquired
(mo., day, yr.)
06/03/13
03/15/13
03/15/13
04/12/11
04/12/11
04/12/11
04/12/11
06/03/13
(d)
Date sold
(mo., day, yr.)
09/26/14
07/29/14
10/31/14
05/28/14
06/25/14
07/29/14
08/28/14
06/25/14
(h)
Gain or (loss)
(e) plus (f) minus (g)
-83
9
128
8,523
25,292
8,696
85,346
386
261,859
Complete only for assets showing gain in column (h) and owned by the foundation on 12/31/69
(i)
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
(11)
(12)
(13)
(14)
(15)
F.M.V. as of 12/31/69
(j)
Adjusted basis
as of 12/31/69
(k)
-83
9
128
8,523
25,292
8,696
85,346
386
261,859
4/28/2015 1:10 PM
Statements
Whom
Sold
Description
Date
Acquired
Date
Sold
How
Received
Sale
Price
PURCHASE
$
PURCHASE
Cost
Expense
4,664 $
Depreciation
$
Net
Gain / Loss
4,664 $
171
171
1,896
1,896
298
298
145
145
241
241
1,065
1,065
9,599
9,599
53
53
225
225
225
225
72
58
-14
199
158
-41
135
103
-32
279
178
-101
PURCHASE
PURCHASE
PURCHASE
PURCHASE
PURCHASE
PURCHASE
PURCHASE
PURCHASE
PURCHASE
PURCHASE
PURCHASE
PURCHASE
PURCHASE
4/28/2015 1:10 PM
Statements
Whom
Sold
Description
Date
Acquired
How
Received
Sale
Price
Date
Sold
TOTAL
Cost
0 $
Expense
19,267 $
Net
Gain / Loss
Depreciation
0 $
19,079 $
-188
Net
Investment
Total
$
$
750
750
$
$
Adjusted
Net
0
$
$
Charitable
Purpose
0
$
$
750
750
Net
Investment
Total
$
$
10,263
10,263
$
$
Adjusted
Net
0
$
$
Charitable
Purpose
0
$
$
10,263
10,263
Net
Investment
Total
$
$
13,803
13,803
$
$
Adjusted
Net
0
$
$
Charitable
Purpose
0
$
$
1-4
4/28/2015 1:10 PM
Statements
Description
Cost
Prior Year
Basis
Depreciation
Method
Life
Current Year
Depreciation
5 $
Net Investment
Income
$
Adjusted Net
Income
$
5
7
102
11
5
5
5
5
5
5
7
3
3
3
3
3
4/28/2015 1:10 PM
Statements
Description
Cost
Prior Year
Basis
Depreciation
136
Method
Life
Current Year
Depreciation
3 $
Net Investment
Income
$
1,947 200DB
225 200DB
225 200DB
320 200DB
1,568 200DB
198
272 200DB
34
58
158
103
139 200DB
17
139 200DB
17
104 200DB
13
312 200DB
40
162 200DB
20
69 200DB
69 200DB
Adjusted Net
Income
$
4/28/2015 1:10 PM
Statements
Description
Cost
Prior Year
Basis
Depreciation
CORDLESS PHONES
2/09/12 $
171 $
INTERPRETATION EQUIPMENT
3/06/12
4,563
MICROWAVE
3/12/12
35
MINI REFRIGERATOR
3/12/12
100
PORTABLE HARD DRIVES (3)
6/12/12
326
2 MACBOOK AIRS
2/07/13
7,441
MAC MINI 2.3 SERVER
9/11/13
1,322
QUICKBOOKS
2/21/13
294
PHP RUNNER FOR MFD DATABASE
3/06/13
279
ADOBE CREATIVE SUITE 6
3/12/13
150
RR# 247 VIDEO CAMERA
4/10/13
344
CANON 5255 COPIER
12/30/13
9,547
TABLET COMPUTER
2/04/14
655
MACBOOK AIR
6/18/14
1,396
CANON ZOOM LENS
8/21/14
1,956
CANON EOS 6D
8/21/14
1,725
BESCOR STUDIO LIGHT KIT
8/21/14
834
Method
119 200DB
Life
7 $
Current Year
Depreciation
Net Investment
Income
14 $
3,166 200DB
399
24 200DB
69 200DB
226 200DB
28
5,023 200DB
967
760 200DB
225
192
49
178
96
25
202 200DB
41
5,012 200DB
1,814
200DB
393
200DB
838
200DB
1,118
200DB
986
200DB
477
Adjusted Net
Income
$
4/28/2015 1:10 PM
Statements
Date
Acquired
TOTAL
58,884 $
Method
Current Year
Depreciation
Life
41,526
Net Investment
Income
7,863 $
Adjusted Net
Income
0 $
Cost
Basis
Prior Year
Amortization
Life
Current Year
Amortization
Net Investment
Income
Adjusted Net
Income
COGS
START UP COSTS
TOTAL
6/05/07 $
$
17,726 $
17,726 $
7,780
7,780
15 $
$
1,182 $
1,182 $
$
0 $
5-6
4/28/2015 1:10 PM
Statements
Net
Investment
Total
$
EXPENSES
OUTSIDE CONTRACTOR SERVICES
INVESTING & BANKING FEES
DUES/SUBSCRIPTIONS
EVENT FOOD & SUPPLIES
OFFICE SUPPLIES
INSURANCE
WEB & INTERNET
BUSINESS MEALS
TELEPHONE
COMPUTER EXPENSE
BOOKS, SUBSCRIPTIONS
PAYROLL PROCESSING
VOLUNTEER APPRECIATION
DEVELOPMENT
POSTAGE, MAILING SERVICE
CREDIT CARD FEES
TOTAL
$
80,962
45,900
10,230
7,403
6,865
3,702
3,525
3,499
2,791
2,159
1,719
1,658
1,272
1,149
687
39
173,560
Adjusted
Net
Charitable
Purpose
$
80,962
45,900
45,900
45,900
45,900
10,230
7,403
6,865
3,702
3,525
3,499
2,791
2,159
1,719
1,658
1,272
1,149
687
39
127,660
Statement 8 - Form 990-PF, Part II, Line 14 - Land, Building, and Equipment
Beginning
Net Book
Description
FURNISHINGS
OFFICE EQUIPMENT
COMPUTER EQUIPMENT
SOFTWARE
START UP COSTS
TOTAL
620
6,266
3,557
345
9,946
20,734
End
Cost / Basis
$
2,814
19,920
15,600
1,282
17,726
57,342
End Accumulated
Depreciation
$
2,440
14,027
12,643
1,200
8,962
39,272
Net
FMV
$
374
5,892
2,957
82
8,765
18,070
7-8
4/28/2015 1:10 PM
Description
DEPOSITS - SPONSORSHIPS
CREDIT CARD BALANCE
LOAN - COMMUNITY FOUNDATION
TOTAL
End of
Year
3,308
2,947
50,000
56,255
2,313
1,358
50,000
53,671
Amount
$
$
746,838
746,838
Statement 11 - Form 990-PF, Part XV, Line 2b - Application Format and Required Contents
Description
GRANT APPLICANTS MUST COMPLETE THE GRANT APPLICATION
AVAILABLE ONLINE AT WWW.F4DC.ORG.
9-13
Form
4562
2014
Attachment
Sequence No.
(99)
179
Identifying number
26-0344869
INDIRECT DEPRECIATION
Part I
1
2
3
4
5
6
Part II
15
16
8
9
10
11
12
Special Depreciation Allowance and Other Depreciation (Do not include listed property.) (See instructions.)
Special depreciation allowance for qualified property (other than listed property) placed in service
during the tax year (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Property subject to section 168(f)(1) election . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Other depreciation (including ACRS) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Part III
2,000,000
7
Listed property. Enter the amount from line 29 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
7
8
Total elected cost of section 179 property. Add amounts in column (c), lines 6 and 7 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
9
Tentative deduction. Enter the smaller of line 5 or line 8 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
10 Carryover of disallowed deduction from line 13 of your 2013 Form 4562 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
11 Business income limitation. Enter the smaller of business income (not less than zero) or line 5 (see instructions)
12 Section 179 expense deduction. Add lines 9 and 10, but do not enter more than line 11 . . . . . . . . . . . . . . . . . . . . . . . . . . .
13 Carryover of disallowed deduction to 2015. Add lines 9 and 10, less line 12 . . . . . . . . .
13
Note: Do not use Part II or Part III below for listed property. Instead, use Part V.
14
500,000
1
2
3
4
5
14
15
16
3,283
17
3,977
74
17
18
MACRS deductions for assets placed in service in tax years beginning before 2014 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
If you are electing to group any assets placed in service during the tax year into one or more general asset accounts, check here . . . . . . . .
Section BAssets Placed in Service During 2014 Tax Year Using the General Depreciation System
(a) Classification of property
19a
b
c
d
e
f
g
h
i
3-year property
5-year property
7-year property
10-year property
15-year property
20-year property
25-year property
Residential rental
property
1,025
2,258
(d) Recovery
period
5.0
7.0
25 yrs.
27.5 yrs.
27.5 yrs.
39 yrs.
(e) Convention
HY
HY
MM
MM
MM
(f) Method
200DB
200DB
205
324
S/L
S/L
12 yrs.
40 yrs.
MM
S/L
S/L
S/L
S/L
S/L
MM
S/L
Section CAssets Placed in Service During 2014 Tax Year Using the Alternative Depreciation System
Nonresidential real
property
Part IV
21
7,863
22
Form
4562 (2014)
Part V
Page 2
Listed Property (Include automobiles, certain other vehicles, certain aircraft, certain computers, and property
used for entertainment, recreation, or amusement.)
Note: For any vehicle for which you are using the standard mileage rate or deducting lease expense, complete only 24a,
24b, columns (a) through (c) of Section A, all of Section B, and Section C if applicable.
Section ADepreciation and Other Information (Caution: See the instructions for limits for passenger automobiles.)
24a
Type of property
(list vehicles first)
25
26
Yes
(b)
Date placed
in service
(c)
Business/
investment use
percentage
No
Special depreciation allowance for qualified listed property placed in service during
the tax year and used more than 50% in a qualified business use (see instructions)
Property used more than 50% in a qualified business use:
Yes
(h)
Depreciation
deduction
(g)
Method/
Convention
(f)
Recovery
period
(e)
Basis for depreciation
(business/investment
use only)
(d)
No
(i)
25
..................
27
%
Property used 50% or less in a qualified business use:
S/L-
28
29
S/L%
Add amounts in column (h), lines 25 through 27. Enter here and on line 21, page 1 . . . . . . . . . . . . . . . . . .
28
Add amounts in column (i), line 26. Enter here and on line 7, page 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
29
(a)
Vehicle 1
Yes
No
(b)
Vehicle 2
Yes
No
(c)
Vehicle 3
Yes
No
(d)
Vehicle 4
Yes
No
(e)
Vehicle 5
Yes
No
(f)
Vehicle 6
Yes
No
Yes
No
Section CQuestions for Employers Who Provide Vehicles for Use by Their Employees
Answer these questions to determine if you meet an exception to completing Section B for vehicles used by employees who are not
more than 5% owners or related persons (see instructions).
37
38
39
40
41
Do you maintain a written policy statement that prohibits all personal use of vehicles, including commuting, by
your employees? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Do you maintain a written policy statement that prohibits personal use of vehicles, except commuting, by your
employees? See the instructions for vehicles used by corporate officers, directors, or 1% or more owners . . . . . . . . . . . . . . . . . . . . . . .
Do you treat all use of vehicles by employees as personal use? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Do you provide more than five vehicles to your employees, obtain information from your employees about the
use of the vehicles, and retain the information received? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Do you meet the requirements concerning qualified automobile demonstration use? (See instructions.) . . . . . . . . . . . . . . . . . . . . . . . . . .
Note: If your answer to 37, 38, 39, 40, or 41 is "Yes," do not complete Section B for the covered vehicles.
Part VI
Amortization
(a)
Description of costs
(b)
Date amortization
begins
(c)
Amortizable amount
(d)
Code section
(e)
Amortization
period or
percentage
42
Amortization of costs that begins during your 2014 tax year (see instructions):
43
44
DAA
(f)
Amortization for this year
1,182
1,182
43
44
Form
4562 (2014)
Address
Purpose
113
North
Church
Street
#305,
Greensboro,
NC
27401
Touring
Theatre
of
NC
sponsorhip
220
Lorax
Lane
Box
#5
Pittsboro,
NC
27312
Climate
Change
Adaptation
Conference
804
Old
Fayetteville
St,
Durham
NC
27701
Youth
Organizing
Institute
3305
16th
Ave.
Southeast
#109
Newton,
NC
28658
General
Operating
support
P.O.
Box
61865
Durham,
NC
27715
General
Operating
Support
for
Spirit
House
2323
Broadway,
Suite
223,
Oakland,
CA
94612
Cooperation
Amongst
Cooperatives
Conference
1904
Franklin
#400,
Oakland,
CA
94612
Support
Asset
Mapping
Project
4400
Massachusetts
Avenue,
NW,
Washington,
DC
20016
Caucus
Launch
Conference
P.O.
Box
361270
Decatur,
GA
30036-1270
Support
Additional
Staff
for
Local
Organizing
1904
Franklin
#400,
Oakland,
CA
94612
USFWC
2014
Conference
1904
Franklin
#400,
Oakland,
CA
94612
Support
RCDG
Matching
105
East
2nd
Street,
Siler
City,
NC
27344
General
Operating
Support
388
Atlantic
Avenue,
Brooklyn,
NY
11217
PBP
Annual
Celebration
PO
Box
1932,
Jackson,
MS
39215
Audoi-visual
equipment
130
Poplar
Grove
Connector,
Boone,
NC
28607-5915
Staff
development
-
Cooperation
Works
Training
5800
W
Friendly
Ave,
Greensboro,
NC
27410
Immigrant
&
Refugee
SE
Conference
436
14th
Street
#500,
Oakland,
CA
94612
Climate
Justice
Alliance
"Our
Power"
Campaign
PO
Box
95,
Epes,
AL
35460
Support
for
CoopEcon
2014
Conference
PO
Box
2241,
Durham,
NC
27702
RCDG
Grant-writing
support
P.O.
Box
364,
Asheville,
NC,
28802
General
operating
Support
-
LGBT
Equality
1904
Franklin
Street,
Suite
705
Oakland
CA
94612
Money
for
Our
Movements
220
Lorax
Lane,
Pittsboro,
NC
27312
Bio-Diesel
Conference
PO
Box
1565
Canal
St.
Station,
NY,
NY
10013
Documentary
-
Own
the
Change
1904
Franklin
#400,
Oakland,
CA
94612
RCDG
Grant-writing
support
PO
Box
95
Epes,
AL
35460
Annual
Banquet
c/o
Common
Enterprise
Development
Corporation
,1057
Parkview
Lane
Victoria,
ACE
silent
MN
5a5386
uction
fundraiser
908
Gregory
Street,
Greensboro,
NC
27403
We
Just
Can't
Let
Them
Win!
Festival:
984
Shep
Cook
Avenue,
Forkland,
AL
36740
RCDG/SSDPG
proposal
development
220
Lorax
Lane,
Pittsboro,
NC
27312
General
Operating
Support
-
Slow
Money
NC
2
Bluestone
Lane,
Greensboro,
NC
27407
Fly
and
Focused
Summer
Camp
2040
N.
Milwaukee
Ave.,
Chicago
IL
60647
General
Operating
Support
5604
Manor
Rd
AUSTIN
TX
78723
General
Operating
Support
100
S
Boylan
Ave,
Raleigh,
NC
27603
Annual
dinner
2040
N.
Milwaukee
Ave.,
Chicago
IL
60647
General
Operating
Support
PO
Box
26170
Greensboro,
NC
27402-6170
UNCG
Sustainability
Film
Series
1408
Hillsborough
Street,
Raleigh,
NC
27605
Fertile
Ground
Market
Study
1401
Rowan
Avenue
High
Poing
NC
27260
General
Operating
Support
-
Organization
for
Black
Struggle
130
Poplar
Grove
Connector,
Boone,
NC
28607-5915
General
Operating
Support
5605
Mt
Sinai
Rd,
Durham,
NC
27705
Climate
Justice
Conference
PO
Box
2241,
Durham,
NC
27702
RCDG
Match
2014-2015
1317
W
Pettigrew
Street,
Durham,
NC
27705
General
Operating
Support
21885
Bonness
Road,
Sonoma,
CA
95476
General
Operating
Support
-
COFED
250
GEORGIA
AVE.,
SUITE
315
ATLANTA,
GA
30312
General
Operating
Support
1959
Highlander
Way
NEW
MARKET
TN
38720
Democratic
Curriculum
Project
1904
Franklin
#400,
Oakland,
CA
94612
General
Operating
Support
130
Poplar
Grove
Connector,
Boone,
NC
28607-5915
General
Operating
Support
394
Broadway,
5th
Floor
NEW
YORK
NY
10013
Peer
program
and
general
operating
support
1904
Franklin
Street,
Ste
400,
Oakland,
CA
94612
USFWC
Newsletter
4907
Garrett
Road,
Durham,
NC
27707
General
Operating
Support
P.O.
Box
98
Prince
St.
Station
NEW
YORK
NY
10012
General
Operating
Support
2600
East
Franklin
Ave.
#2
MINNEAPOLIS
MN
55406
Northcountry
coop
dev't
fund
-
Southern
worker
coop
initiative
220
Lorax
Lane,
Pittsboro,
NC
27312
Running
on
Local
Campaign
2107
Hillandale
Road,
Durham,
NC
27705
General
Operating
Support
-
Organize
2020
P.O.
Box
87119,
College
Park,
GA
30337
General
Operating
Support
-
SE
Immigrant
Rights
Network
PO
Box
115
RIVERDALE
MD
20738
General
operating
support
PO
Box
10645
Raleigh,
NC
27605
General
Operating
Support
Amount
$500.00
$5,000.00
$4,384.00
$633.00
$1,662.00
$250.00
$5,000.00
$471.69
$8,000.00
$2,000.00
$5,000.00
$5,000.00
$130.37
$938.46
$1,000.00
$500.00
$100.00
$15,000.00
$5,000.00
$5,000.00
$2,500.00
$5,000.00
$5,000.00
$5,000.00
$1,000.00
$23.50
$500.00
$5,000.00
$5,000.00
$425.00
$100.00
$3,000.00
$250.00
$50.00
$250.00
$2,500.00
$5,000.00
$1,492.61
$1,000.00
$15,000.00
$6,000.00
$8,000.00
$15,000.00
$50,000.00
$15,000.00
$245.00
$50,000.00
$150.00
$5,000.00
$5,000.00
$45,000.00
$5,000.00
$5,000.00
$5,000.00
$5,000.00
$7,500.00
Date
1/28/14
1/31/14
2/24/14
2/24/14
2/24/14
2/24/14
3/1/14
3/4/14
3/9/14
3/9/14
3/28/14
4/18/14
5/1/14
5/2/14
5/7/14
5/14/14
5/28/14
5/31/14
6/2/14
6/9/14
6/11/14
6/13/14
6/17/14
7/9/14
7/28/14
7/30/14
7/30/14
8/1/14
8/6/14
8/7/14
8/12/14
9/10/14
9/10/14
9/17/14
9/18/14
9/19/14
9/29/14
10/14/14
10/22/14
10/23/14
10/23/14
11/5/14
11/6/14
11/11/14
11/19/14
11/24/14
12/1/14
12/1/14
12/4/14
12/5/14
12/11/14
12/11/14
12/11/14
12/11/14
12/12/14
12/12/14
Address
P.O.
Box
61865
Durham,
NC
27715
5604
Manor
Rd
AUSTIN
TX
78723
PO
Box
2241,
Durham,
NC
27702
PO
Box
95
Epes,
AL
35460
Purpose
General
Operating
Support
-
Spirithouse
General
operating
support
Organizing
Staff
for
Fertile
Ground
Food
Coop
CoopEcon
2014
Amount
$5,000.00
$5,000.00
$15,000.00
$20,000.00
$395,555.63
Date
12/12/14
12/19/14
12/19/14
12/29/14