Return of Private Foundation. Section 4947(a)(1) nonexempt charitable trust. Treated as a Private Foundation

Transcription

1 Form Part I 990-PF Analysis of Revenue and Expenses (The total of Return of Private Foundation or Section 4947(a) Nonexempt Charitale Trust Treated as a Private Foundation Department of the Treasury Internal Revenue Service Note. The foundation may e ale to use a copy of this return to satisfy state reporting requirements. For calendar year 2010, or tax year eginning, and ending G H I Revenue Operating and Administrative Expenses Check all that apply: Initial return Initial return of a former pulic charity Final return Name of foundation Section 4947(a) nonexempt charitale trust Fair market value of all assets at J Accounting method: Cash Accrual a 6a a 11 c 12 Total. Add lines 1 through Compensation of officers, directors, trustees, etc Other employee salaries and wages Pension plans, employee enefits a Legal fees (attach schedule) Accounting fees (attach schedule) c Other professional fees (attach schedule) Interest Taxes (attach schedule) (see page 14 of the instructions) Depreciation (attach schedule) and depletion Occupancy Travel, conferences, and meetings Printing and pulications Other expenses (att. sch.) Total operating and administrative expenses Amended return Address change Name change Numer and street (or P.O. ox numer if mail is not delivered to street address) City or town, state, and ZIP code Section 501(c) exempt private foundation a Excess of revenue over expenses and disursements... Net investment income (if negative, enter -0-) c Adjusted net income (if negative, enter -0-) For Paperwork Reduction Act Notice, see page 30 of the instructions. DAA COOK FAMILY FOUNDATION 312 W MAIN ST 3W OWOSSO MI Check type of organization: Other taxale private foundation end of year (from Part II, col. (c), Other (specify) line 16) u $ (Part I, column (d) must e on cash asis.) 10,025,872 amounts in columns (), (c), and (d) may not necessarily equal the amounts in column (a) (see page 11 of the instructions).) Contriutions, gifts, grants, etc., received (attach schedule).... Check u if the foundation is not required to attach Sch. B Interest on savings and temporary cash investments Dividends and interest from securities Gross rents Net rental income or (loss) Net gain or (loss) from sale of assets not on line Gross sales price for all assets on line 6a Capital gain net income (from Part IV, line 2) Net short-term capital gain Income modifications Gross sales less returns & allowances Less: Cost of goods sold Gross profit or (loss) (attach schedule) Other income (attach schedule) Add lines 13 through Contriutions, gifts, grants paid Total expenses and disursements. Add lines 24 and 25.. Sutract line 26 from line 12: 1,606,604 Room/suite A B C Employer identification numer OMB No Telephone numer (see page 10 of the instructions) If exemption application is pending, check here D 1. Foreign organizations, check here E F Foreign organizations meeting the 85% test, check here and attach computation If private foundation status was terminated under section 507()(A), check here If the foundation is in a 60-month termination under section 507()(B), check here (a) Revenue and (d) Disursements expenses per () Net investment (c) Adjusted net for charitale ooks income income purposes (cash asis only) , , , ,216 7,784 SEE STMT 1 1,409 STMT 2 3,125 STMT 3 3,887 STMT 4 2,359 STMT 5 7,021 13,855 15,342 4,451 STMT 6 11, , , ,287-86, , , ,722 3, ,359 2,771 1,405 11,593 11, , u u u u u 30,189 7,006 1,409 2,396 3,690 11,084 15,342 4,451 10,014 85, , ,000 Form 990-PF (2010)

2 Form 990-PF (2010) Part II Balance Sheets Page 2 Attached schedules and amounts in the description column Beginning of year End of year should e for end-of-year amounts only. (See instructions.) (a) Book Value () Book Value (c) Fair Market Value Cash non-interest-earing Savings and temporary cash investments Accounts receivale u , , ,258 Less: allowance for doutful accounts u Pledges receivale u Less: allowance for doutful accounts u Grants receivale Receivales due from officers, directors, trustees, and other disqualified persons (attach schedule) (see page 15 of the instructions) Assets a c 11 Other notes and loans receivale (att. schedule) u Less: allowance for doutful accounts u Inventories for sale or use Prepaid expenses and deferred charges Investments U.S. and state government oligations (attach schedule).. STMT Investments corporate stock (attach schedule) SEE STMT ,596,346 4,745,097 SEE STMT 9 3,064,158 2,942,773 Investments corporate onds (attach schedule) Investments land, uildings, and equipment: asis u ,952,546 3,068,929 Liailities Net Assets or Fund Balances Total assets (to e completed y all filers see the Total liailities (add lines 17 through 22) Foundations that follow SFAS 117, check here u and complete lines 24 through 26 and lines 30 and Part III Less: accumulated depreciation (attach sch.) u Investments mortgage loans Investments other (attach schedule).. SEE STATEMENT Land, uildings, and equipment: asis u , Less: accumulated depreciation (attach sch.) u.. STMT , ,278 22,257 Other assets (descrie u ) instructions. Also, see page 1, item l) Accounts payale and accrued expenses Grants payale Deferred revenue Loans from officers, directors, trustees, and other disqualified persons Mortgages and other notes payale (attach schedule) Other liailities (descrie u ) Unrestricted Temporarily restricted Permanently restricted Foundations that do not follow SFAS 117, check here u and complete lines 27 through Capital stock, trust principal, or current funds Paid-in or capital surplus, or land, ldg., and equipment fund Retained earnings, accumulated income, endowment, or other funds Total net assets or fund alances (see page 17 of the instructions) Total liailities and net assets/fund alances (see page 17 of the instructions) Analysis of Changes in Net Assets or Fund Balances Total net assets or fund alances at eginning of year Part II, column (a), line 30 (must agree with 7,801,089 end-of-year figure reported on prior year's return) Enter amount from Part I, line 27a Other increases not included in line 2 (itemize) u Add lines 1, 2, and Decreases not included in line 2 (itemize) u Total net assets or fund alances at end of year (line 4 minus line 5) Part II, column (), line ,801,089 7,801,089 7,801,089 7,714, ,714,525 7,714,525 7,714,525 10,025,872 7,801,089-86,564 7,714,525 7,714,525 Form 990-PF (2010) DAA

3 Form 990-PF (2010) Page 3 Part IV 1a c d e a c d Capital Gains and Losses for Tax on Investment Income (e) Gross sales price (a) List and descrie the kind(s) of property sold (e.g., real estate, 2-story rick warehouse; or common stock, 200 shs. MLC Co.) () How acquired P Purchase D Donation Qualification Under Section 4940(e) for Reduced Tax on Net Investment Income (c) Date acquired (mo., day, yr.) (f) Depreciation allowed (g) Cost or other asis (h) Gain or (loss) (or allowale) plus expense of sale (e) plus (f) minus (g) (d) Date sold (mo., day, yr.) e Complete only for assets showing gain in column (h) and owned y the foundation on 12/31/69 (l) Gains (Col. (h) gain minus (j) Adjusted asis (k) Excess of col. (i) col. (k), ut not less than -0-) or (i) F.M.V. as of 12/31/69 as of 12/31/69 over col. (j), if any Losses (from col. (h)) a c d e Part V SEE WORKSHEET Capital gain net income or (net capital loss) (a) Base period years Calendar year (or tax year eginning in) If gain, also enter in Part I, line 7 If (loss), enter -0- in Part I, line 7 Net short-term capital gain or (loss) as defined in sections 1222 and : If gain, also enter in Part I, line 8, column (c) (see pages 13 and 17 of the instructions). If (loss), enter -0- in Part I, line (For optional use y domestic private foundations suject to the section 4940(a) tax on net investment income.) If section 4940(d) applies, leave this part lank. Was the foundation liale for the section 4942 tax on the distriutale amount of any year in the ase period? Yes No If "Yes," the foundation does not qualify under section 4940(e). Do not complete this part. Enter the appropriate amount in each column for each year; see page 18 of the instructions efore making any entries () Adjusted qualifying distriutions } } (c) Net value of noncharitale-use assets ,185 (d) Distriution ratio (col. () divided y col. (c)) 7, ,773 8,264, ,973 10,156, ,701 11,631, ,277 10,907, ,235 10,302, Total of line 1, column (d) Enter the net value of noncharitale-use assets for 2010 from Part, line Multiply line 4 y line Enter 1% of net investment income (1% of Part I, line 27) Add lines 5 and Enter qualifying distriutions from Part II, line If line 8 is equal to or greater than line 7, check the ox in Part VI, line 1, and complete that part using a 1% tax rate. See the DAA Average distriution ratio for the 5-year ase period divide the total on line 2 y 5, or y the numer of years the foundation has een in existence if less than 5 years Part VI instructions on page ,364, ,361 5, , ,000 Form 990-PF (2010)

4 Form 990-PF (2010) Page 4 Excise Tax Based on Investment Income (Section 4940(a), 4940(), 4940(e), or 4948 see page 18 of the instructions) a 2010 estimated tax payments and 2009 overpayment credited to a Exempt foreign organizations tax withheld at source c Tax paid with application for extension of time to file (Form 8868) c d Backup withholding erroneously withheld d 7 Total credits and payments. Add lines 6a through 6d Enter any penalty for underpayment of estimated tax. Check here if Form 2220 is attached Tax due. If the total of lines 5 and 8 is more than line 7, enter amount owed u 9 10 Overpayment. If line 7 is more than the total of lines 5 and 8, enter the amount overpaid u Enter the amount of line 10 to e: Credited to 2011 estimated tax u Refunded u 11 1a During the tax year, did the foundation attempt to influence any national, state, or local legislation or did it Yes No c d e On the foundation. u $ On foundation managers. u $ 2 Has the foundation engaged in any activities that have not previously een reported to the IRS? If "Yes," attach a detailed description of the activities. 3 incorporation, or ylaws, or other similar instruments? If "Yes," attach a conformed copy of the changes a Did the foundation have unrelated usiness gross income of $1,000 or more during the year? a If "Yes," has it filed a tax return on Form 990-T for this year? N/A Was there a liquidation, termination, dissolution, or sustantial contraction during the year? If "Yes," attach the statement required y General Instruction T. 6 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 V a Enter the states to which the foundation reports or with which it is registered (see page 19 of the 9 10 Part VI 1a Exempt operating foundations descried in section 4940(d), check here u and enter "N/A" on line 1. Date of ruling or determination letter: (attach copy of letter if necessary see instructions) Domestic foundations that meet the section 4940(e) requirements in Part V, check } 1 here u and enter 1% of Part I, line All other domestic foundations enter 2% of line 27. Exempt foreign organizations enter 4% of Part I, line 12, col. () Tax under section 511 (domestic section 4947(a) trusts and taxale foundations only. Others enter -0-) Add lines 1 and Sutitle A (income) tax (domestic section 4947(a) trusts and taxale foundations only. Others enter -0-) Tax ased on investment income. Sutract line 4 from line 3. If zero or less, enter c Credits/Payments: Part VII-A Statements Regarding Activities participate or intervene in any political campaign? Did it spend more than $100 during the year (either directly or indirectly) for political purposes (see page 19 of the instructions for definition)? If the answer is "Yes" to 1a or 1, attach a detailed description of the activities and copies of any materials pulished or distriuted y 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: Enter the reimursement (if any) paid y the foundation during the year for political expenditure tax imposed on foundation managers. u $ Has the foundation made any changes, not previously reported to the IRS, in its governing instrument, articles of 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 MI 9,360 instructions) u 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 y General Instruction G? If "No," attach explanation Is the foundation claiming status as a private operating foundation within the meaning of section 4942(j) or 4942(j) for calendar year 2010 or the taxale year eginning in 2010 (see instructions for Part IV on page 14,421 27)? If "Yes," complete Part IV Did any persons ecome sustantial contriutors during the tax year? If "Yes," attach a schedule listing their names and addresses a 1 1c , , ,061 14,421 9,360 Form 990-PF (2010) DAA

5 Form 990-PF (2010) Page Part VII-B 1a 2 Part VII-A c a c 3a 4a 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 During the year did the foundation (either directly or indirectly): Engage in the sale or exchange, or leasing of property with a disqualified person? Yes No Borrow money from, lend money to, or otherwise extend credit to (or accept it from) a disqualified person? Yes No Furnish goods, services, or facilities to (or accept them from) a disqualified person? Yes No Pay compensation to, or pay or reimurse the expenses of, a disqualified person? Yes No Transfer any income or assets to a disqualified person (or make any of either availale for Statements Regarding Activities (continued) At any time during the year, did the foundation, directly or indirectly, own a controlled entity within the meaning of section 512()? If "Yes," attach schedule (see page 20 of the instructions) Did the foundation acquire a direct or indirect interest in any applicale insurance contract efore August 17, 2008? Did the foundation comply with the pulic inspection requirements for its annual returns and exemption application? N/A THOMAS COOK Wesite address u The ooks are in care of u Telephone no. u P O BO 278, 312 W MAIN STREET, #3W Located at u. OWOSSO MI ZIP+4 u Section 4947(a) nonexempt charitale 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 At any time during calendar year 2010, did the foundation have an interest in or a signature or other authority over a ank, securities, or other financial account in a foreign country? See page 20 of the instructions for exceptions and filing requirements for Form TD F If "Yes," enter the name of the foreign country u the enefit or use of a disqualified person)? 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.) If any answer is "Yes" to 1a-, did any of the acts fail to qualify under the exceptions descried in Regulations section (d)-3 or in a current notice regarding disaster assistance (see page 22 of the 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 descried in 1a, other than excepted acts, that were not corrected efore the first day of the tax year eginning in 2010? Taxes on failure to distriute income (section 4942) (does not apply for years the foundation was a private operating foundation defined in section 4942(j) or 4942(j)): At the end of tax year 2010, did the foundation have any undistriuted income (lines 6d and 6e, Part III) for tax year(s) eginning efore 2010? If "Yes," list the years u , , , Are there any years listed in 2a for which the foundation is not applying the provisions of section 4942(a) (relating to incorrect valuation of assets) to the year's undistriuted income? (If applying section 4942(a) to all years listed, answer "No" and attach statement see page 22 of the instructions.) If the provisions of section 4942(a) are eing applied to any of the years listed in 2a, list the years here. u , , , Did the foundation hold more than a 2% direct or indirect interest in any usiness enterprise at any time during the year? If "Yes," did it have excess usiness holdings in 2010 as a result of any purchase y the foundation or disqualified persons after May 26, 1969; the lapse of the 5-year period (or longer period approved y the Commissioner under section 4943(c)) to dispose of holdings acquired y gift or equest; or 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 usiness holdings in 2010.) Did the foundation invest during the year any amount in a manner that would jeopardize its charitale purposes? Did the foundation make any investment in a prior year (ut after Decemer 31, 1969) that could jeopardize its charitale purpose that had not een removed from jeopardy efore the first day of the tax year eginning in 2010? Yes Yes Yes Yes No No N/A No N/A No N/A c 2 3 4a 4 Yes No Form 990-PF (2010) DAA

6 Form 990-PF (2010) 5a purposes, or for the prevention of cruelty to children or animals? If any answer is "Yes" to 5a, did any of the transactions fail to qualify under the exceptions descried in 7a At any time during the tax year, was the foundation a party to a prohiited tax shelter transaction? Yes No If Yes, did the foundation receive any proceeds or have any net income attriutale to the transaction? Part VII-B c 6a Part VIII Statements Regarding Activities for Which Form 4720 May Be Required (continued) During the year did the foundation pay or incur any amount to: Regulations section or in a current notice regarding disaster assistance (see page 22 of the instructions)? Organizations relying on a current notice regarding disaster assistance check here u If the answer is "Yes" to question 5a, does the foundation claim exemption from the tax If "Yes" to 6, file Form Carry on propaganda, or otherwise attempt to influence legislation (section 4945(e))? Influence the outcome of any specific pulic election (see section 4955); or to carry on, directly or indirectly, any voter registration drive? Provide a grant to an individual for travel, study, or other similar purposes? Provide a grant to an organization other than a charitale, etc., organization descried in section 509(a),, or, or section 4940(d)? (see page 22 of the instructions) Provide for any purpose other than religious, charitale, scientific, literary, or educational ecause it maintained expenditure responsiility for the grant? If "Yes," attach the statement required y Regulations section (d). Did the foundation, during the year, receive any funds, directly or indirectly, to pay premiums on a personal enefit contract? Did the foundation, during the year, pay premiums, directly or indirectly, on a personal enefit contract? Information Aout Officers, Directors, Trustees, Foundation Managers, Highly Paid Employees, and Contractors List all officers, directors, trustees, foundation managers and their compensation (see page 22 of the instructions). (a) Name and address.. SEE..... STATEMENT () Title, and average hours per week devoted to position N/A (c) Compensation (If not paid, enter -0-) Yes Yes Yes Yes Yes Yes Yes No No No No No N/A No No N/A (d) Contriutions to employee enefit plans and deferred compensation Page 6 (e) Expense account, other allowances Compensation of five highest-paid employees (other than those included on line 1 see page 23 of the instructions). If none, enter "NONE." (a) Name and address of each employee paid more than $50,000.. NONE () Title, and average hours per week devoted to position (c) Compensation (d) Contriutions to employee enefit plans and deferred compensation (e) Expense account, other allowances Total numer of other employees paid over $50, Form 990-PF (2010) DAA

7 Form 990-PF (2010) Page 7 Part VIII Information Aout Officers, Directors, Trustees, Foundation Managers, Highly Paid Employees, and Contractors (continued) 3 Five highest-paid independent contractors for professional services (see page 23 of the instructions). If none, enter "NONE." (a) Name and address of each person paid more than $50,000 () Type of service (c) Compensation NONE Total numer of others receiving over $50,000 for professional services Part I-A Summary of Direct Charitale Activities u List the foundation's four largest direct charitale activities during the tax year. Include relevant statistical information such as the numer of organizations and other eneficiaries served, conferences convened, research papers produced, etc. N/A Expenses Part I-B Summary of Program-Related Investments (see page 24 of the instructions) Descrie the two largest program-related investments made y the foundation during the tax year on lines 1 and 2. N/A Amount All other program-related investments. See page 24 of the instructions Total. Add lines 1 through Form 990-PF (2010) DAA

8 Form 990-PF (2010) Page 8 1 Part a Average monthly fair market value of securities a Average of monthly cash alances c Fair market value of all other assets (see page 25 of the instructions) c d Total (add lines 1a,, and c) d e Fair market value of assets not used (or held for use) directly in carrying out charitale, etc., purposes: Reduction claimed for lockage or other factors reported on lines 1a and 1c (attach detailed explanation) e 2 Acquisition indetedness applicale to line 1 assets Sutract line 2 from line 1d Cash deemed held for charitale activities. Enter 1½ % of line 3 (for greater amount, see page 25 of the instructions) Net value of noncharitale-use assets. Sutract line 4 from line 3. Enter here and on Part V, line Minimum investment return. Enter 5% of line Part I 1 Minimum investment return from Part, line a Tax on investment income for 2010 from Part VI, line a 5,061 Income tax for (This does not include the tax from Part VI.) c Add lines 2a and c 3 Distriutale amount efore adjustments. Sutract line 2c from line Recoveries of amounts treated as qualifying distriutions Add lines 3 and Deduction from distriutale amount (see page 25 of the instructions) Distriutale amount as adjusted. Sutract line 6 from line 5. Enter here and on Part III, line Part II Minimum Investment Return (All domestic foundations must complete this part. Foreign foundations, see page 24 of the instructions.) Distriutale Amount (see page 25 of the instructions) (Section 4942(j) and (j) private operating foundations and certain foreign organizations check here u Qualifying Distriutions (see page 25 of the instructions) and do not complete this part.) 0 7 9,314, ,705 25,800 9,506, ,506, ,604 9,364, , ,217 5, , , , a a Suitaility test (prior IRS approval required) a Cash distriution test (attach the required schedule) Qualifying distriutions. Add lines 1a through 3. Enter here and on Part V, line 8, and Part III, line Amounts paid (including administrative expenses) to accomplish charitale, etc., purposes: Expenses, contriutions, gifts, etc. total from Part I, column (d), line Program-related investments total from Part I-B Amounts paid to acquire assets used (or held for use) directly in carrying out charitale, etc., purposes Amounts set aside for specific charitale projects that satisfy the: Foundations that qualify under section 4940(e) for the reduced rate of tax on net investment income. Enter 1% of Part I, line 27 (see page 26 of the instructions) Adjusted qualifying distriutions. Sutract line 5 from line Note. The amount on line 6 will e used in Part V, column (), in susequent years when calculating whether the foundation qualifies for the section 4940(e) reduction of tax in those years. 1a , ,000 5, ,939 Form 990-PF (2010) DAA

9 Part III a a c d e Undistriuted Income (see page 26 of the instructions) Form 990-PF (2010) Page 9 f Total of lines 3a through e Qualifying distriutions for 2010 from Part II, a Distriutale amount for 2010 from Part I, line Undistriuted income, if any, as of the end of 2010: Enter amount for 2009 only Total for prior years: 20, 20, 20 Excess distriutions carryover, if any, to 2010: From From From From From line 4: u $ 550,000 14,747 46,211 4, ,479 85,709 Applied to 2009, ut not more than line 2a Applied to undistriuted income of prior years (a) () (c) (d) Corpus Years prior to , ,156 c (Election required see page 26 of the instructions) Treated as distriutions out of corpus (Election 5 d e 6 Enter the net total of each column as a required see page 26 of the instructions) Applied to 2010 distriutale amount Remaining amount distriuted out of corpus Excess distriutions carryover applied to (If an amount appears in column (d), the same amount must e shown in column (a).) indicated elow: Corpus. Add lines 3f, 4c, and 4e. Sutract line Prior years' undistriuted income. Sutract 86, , ,156 c d e f 7 line 4 from line Enter the amount of prior years' undistriuted income for which a notice of deficiency has een issued, or on which the section 4942(a) tax has een previously assessed Sutract line 6c from line 6. Taxale amount see page 27 of the instructions Undistriuted income for Sutract line 4a from line 2a. Taxale amount see page 27 of the instructions Undistriuted income for Sutract lines 4d and 5 from line 1. This amount must e distriuted in Amounts treated as distriutions out of corpus to satisfy requirements imposed y section 170()(F) or 4942(g) (see page 27 of the 0 8 instructions) Excess distriutions carryover to a c d e DAA instructions) Excess distriutions carryover from 2005 not applied on line 5 or line 7 (see page 27 of the Sutract lines 7 and 8 from line 6a Analysis of line 9: Excess from Excess from Excess from Excess from Excess from ,211 4, ,479 85,709 86,844 14, ,655 Form 990-PF (2010)

10 Form 990-PF (2010) Page 10 Part IV Private Operating Foundations (see page 27 of the instructions and Part VII-A, question 9) 1a 2a If the foundation has received a ruling or determination letter that it is a private operating foundation, and the ruling is effective for 2010, enter the date of the ruling Check ox to indicate whether the foundation is a private operating foundation descried in section u 4942(j) or 4942(j) Enter the lesser of the adjusted net Tax year Prior 3 years income from Part I or the minimum investment return from Part for (a) 2010 () 2009 (c) 2008 (d) 2007 (e) Total c d e 3 a c each year listed % of line 2a Qualifying distriutions from Part II, line 4 for each year listed Amounts included in line 2c not used directly for active conduct of exempt activities..... Qualifying distriutions made directly for active conduct of exempt activities. Sutract line 2d from line 2c Complete 3a,, or c for the alternative test relied upon: "Assets" alternative test enter: Value of all assets Value of assets qualifying under section 4942(j)(B)(i) "Endowment" alternative test enter 2/3 of minimum investment return shown in Part, line 6 for each year listed..... "Support" alternative test enter: Total support other than gross investment income (interest, dividends, rents, payments on securities loans (section 512(a)), or royalties) Support from general pulic and 5 or more exempt organizations as provided in section 4942(j)(B)(iii) Largest amount of support from Part V Supplementary Information (Complete this part only if the foundation had $5,000 or more in assets at any time during the year see page 28 of the instructions.) 1 Information Regarding Foundation Managers: a 2 Information Regarding Contriution, Grant, Gift, Loan, Scholarship, etc., Programs: Check here u if the foundation only makes contriutions to preselected charitale organizations and does not accept a c d DAA an exempt organization Gross investment income List any managers of the foundation who have contriuted more than 2% of the total contriutions received y the foundation efore the close of any tax year (ut only if they have contriuted more than $5,000). (See section 507(d).) N/A 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 unsolicited requests for funds. If the foundation makes gifts, grants, etc. (see page 28 of the instructions) to individuals or organizations under other conditions, complete items 2a,, c, and d. The name, address, and telephone numer of the person to whom applications should e addressed: TOM COOK, EECUTIVE DIRECTOR P O BO 278, 312 W MAIN ST #3W OWOSSO MI The form in which applications should e sumitted and information and materials they should include: LETTER OR GRANT FORMAT Any sumission deadlines: ANNUAL Any restrictions or limitations on awards, such as y geographical areas, charitale fields, kinds of institutions, or other factors: STATE OF MICHIGAN-FOCUSES ON SHIAWASSEE COUNTY Form 990-PF (2010)

11 Form 990-PF (2010) Page 11 Part V Supplementary Information (continued) 3 Grants and Contriutions Paid During the Year or Approved for Future Payment a Recipient Name and address (home or usiness) Paid during the year SEE STATEMENT 13 If recipient is an individual, Foundation show any relationship to Purpose of grant or status of Amount any foundation manager contriution recipient or sustantial contriutor 464,419 Total Approved for future payment N/A u 3a 464,419 Total u 3 DAA Form 990-PF (2010)

12 Form 990-PF (2010) Page 12 Part VI-A a c d e f g Part VI-B Analysis of Income-Producing Activities Enter gross amounts unless otherwise indicated. Program service revenue: a Det-financed property Not det-financed property Net rental income or (loss) from personal property Other investment income Gain or (loss) from sales of assets other than inventory Net income or (loss) from special events Gross profit or (loss) from sales of inventory Other revenue: a c d e 12 Sutotal. Add columns (), (d), and (e) Total. Add line 12, columns (), (d), and (e) Line No. q Fees and contracts from government agencies Memership dues and assessments Interest on savings and temporary cash investments Dividends and interest from securities Net rental income or (loss) from real estate: (See worksheet in line 13 instructions on page 29 to verify calculations.) N/A Unrelated usiness income Excluded y section 512, 513, or 514 (e) Related or exempt (a) () (c) (d) function income Business code Amount Exclusion Amount code (See page 28 of the instructions.) Relationship of Activities to the Accomplishment of Exempt Purposes Explain elow how each activity for which income is reported in column (e) of Part VI-A contriuted importantly to the accomplishment of the foundation's exempt purposes (other than y providing funds for such purposes). (See page 29 of the instructions.) , , , ,723 DAA Form 990-PF (2010)

13 Form 990-PF (2010) Page 13 Part VII organizations? Information Regarding Transfers To and Transactions and Relationships With Noncharitale Exempt Organizations 1 Did the organization directly or indirectly engage in any of the following with any other organization descried Yes No a Cash a Other assets a Sales of assets to a noncharitale exempt organization Purchases of assets from a noncharitale exempt organization Rental of facilities, equipment, or other assets Reimursement arrangements Loans or loan guarantees Performance of services or memership or fundraising solicitations c d Sharing of facilities, equipment, mailing lists, other assets, or paid employees If the answer to any of the aove is "Yes," complete the following schedule. Column () should always show the fair market 1c N/A in section 501(c) of the Code (other than section 501(c) organizations) or in section 527, relating to political Transfers from the reporting foundation to a noncharitale exempt organization of: Other transactions: value of the goods, other assets, or services given y 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. () Amount involved (c) Name of noncharitale 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 descried in section 501(c) of the Code (other than section 501(c)) or in section 527? Yes No If "Yes," complete the following schedule. N/A (a) Name of organization () Type of organization (c) Description of relationship Sign Here Paid Preparer Use Only Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the est of my knowledge and elief, it is true, correct, and complete. Declaration of preparer (other than taxpayer or fiduciary) is ased on all information of which preparer has any knowledge. Signature of officer or trustee Date Title Print/Type preparer's name Preparer's signature PRESIDENT Date Check self-employed ROBERT J. VOGL 04/25/11 Firm's name u VOGL & MEDER, PLLC PTIN P Firm's address u P.O. BO 37 Firm's EIN u OWOSSO, MI Phone no Form 990-PF (2010) if DAA

14 Form Name Capital Gains and Losses for Tax on Investment Income 990-PF 2010 For calendar year 2010, or tax year eginning, and ending Employer Identification Numer (a) List and descrie the kind(s) of property sold, e.g., real estate, () How acquired (c) Date acquired (d) Date sold 2-story rick warehouse; or common stock, 200 shs. MLC Co. P-Purchase (mo., day, yr.) (mo., day, yr.) D-Donation SHS BLACKROCK EQ DIVIDEND A P 01/22/08 01/14/10 21 SHS BLACKROCK EQ DIVIDEND A P 04/18/08 01/14/10 21 SHS BLACKROCK EQ DIVIDEND A P 07/18/08 01/14/10 1 SH BLACKROCK EQ DIVIDEND A P 07/21/08 01/14/10 33 SHS BLACKROCK EQ DIVIDEND A P 10/24/08 01/14/10 41 SHS BLACKROCK EQ DIVIDEND A P 12/12/08 01/14/ SHS BLACKROCK EQ DIVIDEND A P 04/08/09 01/14/10 32 SHS BLACKROCK EQ DIVIDEND A P 04/24/09 01/14/10 1 SH BLACKROCK EQ DIVIDEND A P 04/27/09 01/14/10 28 SHS BLACKROCK EQ DIVIDEND A P 07/24/09 01/14/10 1 SH BLACKROCK EQ DIVIDEND A P 07/27/09 01/14/10 26 SHS BLACKROCK EQ DIVIDEND A P 10/23/09 01/14/10 1 SH BLACKROCK EQ DIVIDEND A P 10/26/09 01/14/10 14 SHS BLACKROCK EQ DIVIDEND A P 12/11/09 01/14/10 20,000 BELLSOUTH CAP FUN 7.75% P 10/07/04 02/16/10 (e) Gross sales price (f) Depreciation allowed (g) Cost or other asis (h) Gain or (loss) (or allowale) plus expense of sale (e) plus (f) minus (g) 34,863 38,761-3, ,413 10,002 3, ,000 20,000 Complete only for assets showing gain in column (h) and owned y the foundation on 12/31/69 (l) Gains (Col. (h) gain minus (i) F.M.V. as of 12/31/69 (j) Adjusted asis (k) Excess of col. (i) col. (k), ut not less than -0-) or as of 12/31/69 over col. (j), if any Losses (from col. (h)) -3, ,

15 Form Name Capital Gains and Losses for Tax on Investment Income 990-PF 2010 For calendar year 2010, or tax year eginning, and ending Employer Identification Numer (a) List and descrie the kind(s) of property sold, e.g., real estate, () How acquired (c) Date acquired (d) Date sold 2-story rick warehouse; or common stock, 200 shs. MLC Co. P-Purchase (mo., day, yr.) (mo., day, yr.) D-Donation 25,000 NM COLUMBIA/HCB HLTCAREBE P 05/24/99 02/10/10 1,100 SHS BURLNGTN N SNTA FE $0.01 P 09/12/97 02/16/10 25,000 SEMPRA ENERGY 7.95% 2010 P 05/06/05 03/01/ SHS QUESTAR CORP P 12/09/97 03/15/10 1,700 SHS QUESTAR CORP P 12/09/97 03/15/10 40,000 VIACOM INC 7.70% JUL30 10 P 04/18/06 04/30/10 7, SHS ABRDN INTERNNL EQUITY P 08/04/08 04/22/10 22 SHS ABRDN INTERNNL EQUITY P 12/22/08 04/22/ SHS ABRDN INTERNNL EQUITY P 06/22/09 04/22/10 19 SHS ABRDN INTERNNL EQUITY P 12/21/09 04/22/10 1 SH ABRDN INTERNNL EQUITY P 12/22/09 04/22/10 11 SHS ABRDN INTERNNL EQUITY P 03/22/10 04/22/10 2, SHS FIDITY ADV NEW INSIGHT P 02/25/08 04/22/10 1 SH FIDITY ADV NEW INSIGHT A P 02/28/08 04/22/10 1 SH FIDITY ADV NEW INSIGHT A P 12/24/09 04/22/10 (e) Gross sales price (f) Depreciation allowed (g) Cost or other asis (h) Gain or (loss) (or allowale) plus expense of sale (e) plus (f) minus (g) 25,000 25, ,000 34,261 75,739 25,000 25,000 4, ,283 72,350 16,545 55,805 40,728 40, , ,009-16, ,392 1, ,582 47,723-3, Complete only for assets showing gain in column (h) and owned y the foundation on 12/31/69 (l) Gains (Col. (h) gain minus (i) F.M.V. as of 12/31/69 (j) Adjusted asis (k) Excess of col. (i) col. (k), ut not less than -0-) or as of 12/31/69 over col. (j), if any Losses (from col. (h)) 75,739 3,283 55, , ,