Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
For. 990-PF
, and ending
Empl
26 -0344869
Room/suite
336-617-5329
NC
GREENSBORO
27403
Initial return
Final return
Address change
6,795,079
a)
$
Analysis of Revenue and Expenses
1
2
3
4
5a
Gross rents
Net rental income or (loss)
Other (specify)
(Part I, column (d) must be on cash basis.)
(The total of
amounts in columns (b), (c), and (d) may not necessarily equal
the amounts in column (a) (see instructions).)
b
6a
b
712
2011
Note. The foundation may be able to use a copy of this return to satisfy state reporting requirements.
(d) Disbursements
for charitable
purposes
(cash basis only)
7,619,153N
57,166
57,166
57,166
7,792,820
67,000
36,038
7,882
600
1,050
173,686
57,166
S tint 1
116,520
co
a)
to
C
a)
a.
w
a)
to
.0
E
C
co
C
74=
as
Q.
S tint 4
Depreciation (attach schedule) and depletion
19
Occupancy
20
Travel, conferences, and meetings
21
Printing and publications
22
S tint 6
Stmt 5
23
Other expenses (att. sch.)
24 Total operating and administrative expenses.
Add lines 13 through 23
Contributions, gifts, grants paid
25
Total expenses and disbursements. Add lines 24 and 25
26
Subtract line 26 from line 12:
27
a Excess of revenue over expenses and disbursements
b Net investment income (if negative, enter -0-)
2
3
4,889
8,789
26,213
498
61,455
214,414
193,658
408,072
67,000
36,038
7 882
600
1,050
8,789
26,213
498
39,466
20,808
20,808
187,536
193,658
381,194
20,808
152,878
57,166
Form
990-PF (2oll)
Balance Sheets
Page 2
End o f year
Beginning of year
1
Cashnon-interest-bearing
2
Savings and temporary cash investments
3 Accounts receivable
Less: allowance for doubtful accounts
4
Pledges receivable
Less: allowance for doubtful accounts
5
Grants receivable
6
Receivables due from officers, directors, trustees, and other
disqualified persons (attach schedule) (see
50,405
14,865
335,589
50,405
6,729,612
6,729,612
18,436
15,062
15,062
368,890
1
6,795,079
6,795,079
7,056
7,057
2,313
2,313
361,833
6,792,766
361,833
6,792,766
368,890
6,795,079
instructions)
7
12 Investmentsmortgage loans
13
Investmentsother (attach schedule)
14
Land, buildings, and equipment: basis
Less: accumulated depreciation (attach sch.) PO-
15
16
41,214
Strut 7
26,152
21
Mortgages and other notes payable (attach schedule)
See Statement
22 Other liabilities (describe
23
Total liabilities (add lines 17 through 22)
Foundations that follow SFAS 117, check here
and complete lines 24 through 26 and lines 30 and 31
24
25
26
Unrestricted
Temporarily restricted
Permanently restricted
Foundations that do not follow SFAS 117, check here
and complete lines 27 through 31.
27
28
29
30
31
..........
1
2
3
4
5
6
361,833
7,384,748
7,746,581
953,815
6,792,766
Form
DAA
990-PF (2oll)
......
-
Page
(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.)
la
26-0344869
Capital --
d
e
(e) Gross sales price
(g)
114,739
1,781
114,739
1,781
b
c
d
e
Complete only for assets showing gain in column (h) and owned by the foundation on 12/31/69
(i) F.M.V. as of 12/31/69
W Adjusted basis
as of 12/31/69
114,739
1,781
b
c
d
e
2 Capital gain net income or (net capital loss)
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
116,520
Qualification Under Section 4940(e) for Reduced Tax on Net Investment Income
rt
(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.
Yes
Was the foundation liable for the section 4942 tax on the distributable amount of any year in the base period?
No
If "Yes," the foundation does not qualify under section 4940(e). Do not complete this part.
1 Enter the a
ro riate amount in each column for each year; see the instructions before making any entries.
(a)
(b)
Adjusted qualifying distributions
2010
2009
2008
2007
2006
(d)
Distribution ratio
(col. (b) divided by col. (c))
(c)
Net value of nonchadtable-use assets
292,380
251,092
146,520
2,262
0.819035
0.624391
0.681248
0.101086
356,981
402,139
215,076
22,377
2.225760
0.556440
4 Enter the net value of noncharitable-use assets for 2011 from Part X, line 5
6,689,761
3,722 , 451
1, 529
3,723,980
8
8 Enter aualifvina distributions from Part XII, line 4
If line 8 is equal to or greater than line 7, check the box in Part VI, line 1 b, and complete that part using a 1% tax rate. See the
381,194
Part VI instructions.
Form
DAA
990-PF (2oll)
26-0344869
Page
Excise Tax Based on Investment Income (Section 4940(a), 4940(b), 4940(e), or 4948see instructions
1a
3
4
3,058
74
3,132
Credits/Payments:
6
a 2011 estimated tax payments and 2010 overpayment credited to 2011
b Exempt foreign organizationstax withheld at source
c Tax paid with application for extension of time to file (Form 8868)
d Backup withholding erroneously withheld
7
Total credits and payments. Add lines 6a through 6d
8
Enter any penalty for underpayment of estimated tax. Check here
)t if Form 2220 is attached
Tax due. If the total of lines 5 and 8 is more than line 7, enter amount owed
9
Overpayment. If line 7 is more than the total of lines 5 and 8, enter the amount overpaid
10
11 .. Enter . the amount of line 10 to be: Credited to 2012 estimated tax
Refunded
9
10
11
la
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?
b 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 lb, attach a detailed description of the activities and copies of any materials
published or distributed by the foundation in connectio
c Did the foundation file Form 1120-POL for this year?
d Enter the amount (if any) of tax on political expenditures (section 4955) imposed during the year:
$
(1) On the foundation.
(2) On foundation managers. $
e
Enter the reimbursement (if any) paid by the foundation during the year for political expenditure tax imposed
on foundation managers. $
Has the foundation engaged in any activities that have not previously been reported to the IRS?
2
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
3
incorporation, or bylaws, or other similar instruments? If "Yes," attach a conformed copy of the changes
4a Did the foundation have unrelated business gross income of $1,000 or more dur
b If "Yes," has it filed a tax return on Form 990-T for this year?
5
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:
6
NC
b If the answer is "Yee 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
9
10
DAA
4942(j)(5) for calendar year 2011 or the taxable year beginning in 2011 (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
24
F TP
FTP
45 TOT
TOT
8/15 INT
8b
X
X
10
3,201Form
3,201
Form990-PF
990-PFpoll)
poll)
Form990-PF(2011)
26-0344869
Page
13
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)
Did the foundation make a distribution to a donor advised fund over which the foundation or a disqualified
person had advisory privileges? If "Yes," attach statement (see instructions)
Did the foundation comply with the public inspection requirements for its annual returns and exemption application?
14
www.f4dc.org
Website address
The books are in care of
11
12
MARNIE THOMPSON
11
12
13
Telephone no.
X
X
336-275-1781
NC
Located at 110. GREENSBORO
Section 4947(a)(1) nonexempt charitable trusts filing Form 990-PF in lieu of Form 1041Check here
27403
ZIP+4
and enter the amount of tax-exempt interest received or accrued during the year
At any time during calendar year 2011, did the foundation have an interest in or a signature or other authority
over a bank, securities, or other financial account in a foreign country?
See the instructions for exceptions and filing requirements for Form TD F 90-22.1. If "Yes," enter the name of
I 15
Yes
No
16
irtl 1I B
la
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?
(2) Borrow money from, lend money to, or otherwise extend credit to (or accept it from) a
disqualified person?
Yes
X No
Yes
X
X
No
No
(3) Furnish goods, services, or facilities to (or accept them from) a disqualified person?
(4) Pay compensation to, or pay or reimburse the expenses of, a disqualified person?
(5) Transfer any income or assets to a disqualified person (or make any of either available for
Yes
Yes
Yes
No
Yes
No
No
2
a
c
3a
Yes
No
N/A
, 20
, 20
, 20
20
Did the foundation hold more than a 2% direct or indirect interest in any business enterprise
Yes
No
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 2011.)
4a Did the foundation invest during the year any amount in a manner that would jeopardize its charitable purposes?
b Did the foundation make any investment in a prior year (but after December 31, 1969) that could jeopardize its
charitable purpose that had not been removed from jeopardy before the first day of the tax year beginning in 2011?
DAA
N/A
X
4b
Form 990-PF (2oll)
4 4 8 6 9
Page
Yes
IX No
Yes
Yes
No
X No
Yes
X No
Yes
No
N/A
Regulations section 53.4945 or in a current notice regarding disaster assistance (see instructions)?
6a
N/A
Required (continued)
Yes
No
Yes
No
Yes
No
N/A
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
hours per week
devoted to position
MARNIE THOMPSON
712 SOUTH ELAM AVE.
ED WHITFIELD
712 SOUTH ELAM AVE
GREENSBORO
COMbIGNG DIR
NC 27403
GREENSBORO
20.00
C0MNGNG DIR
32.00
NC
27403
(c) Compensation
(d) Contributions to
employee benefit
plans and deferred
compensation
26,333
40,667
2 Compensation of five highest-paid employees (other than those included on line 1see instructions). If none, enter
"NONE."
(a) Name and address of each employee paid more than $50,000
(c) Compensation
(d) Contributions to
employee benefit
plans and deferred
compensation
NONE
DAA
0
990-PF (2oll)
Form990-PFROM
PartVfa
Page 7
Information About Officers, Directors, Trustees, Foundation Managers, Highly Paid Employees,
and Contractors (continued)
3 Five highest-paid independent contractors for professional services (see instructions). If none, enter "NONE."
(a) Name and address of each person paid more than $50,000
(c) Compensation
NONE
Expenses
Amount
N/A
DAA
26-0344869
(All
domestic
foundations
must
complete
this part. Foreign foundations,
Minimum Investment Return
see instructions.
Page
Fair market value of assets not used (or held for use) directly in carrying out charitable, etc.,
purposes:
a Average monthly fair market value of securities
la
lb
29,736
lc
ld
6 , 791 , 636
le
6 , 761 , 900
6 , 791 , 636
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
Distributable Amount (see instructions) (Section 49426)(3) and (j)(5) private operating
and do not complete this part.)
foundations and certain foreign organizations check here
4
5
6
101,875
6 , 689 , 761
334,488
334,488
2a
2b
05
3,058
331,430
2c
3
4
5
331,430
331,430
line 1
3
a Suitability test (prior IRS approval required)
b Cash distribution test (attach the required schedule)
Qualifying distributions. Add lines la through 3b. Enter here and on Part V, line 8, and Part XIII, line 4
4
5
Foundations that qualify under section 4940(e) for the reduced rate of tax on net investment income.
381 194
la
lb
2
3a
3b
4
381 194
381 194
DAA
990-PF (2011)
Page 9
(a)
(b)
(c)
(d)
Corpus
2010
2011
49,764
Form 990-PF (2011)
DAA
:?Fatt:XIM
1a
b
2a
Page 10
If the foundation has received a ruling or determination letter that it is a private operating
foundation, and the ruling is effective for 2011, enter the date of the ruling
Check box to indicate whether the foundation is a private operating foundation described in section
Prior 3 years
Tax year
Enter the lesser of the adjusted net
MNW
(b)
2010
(a)
2011
income from Part I or the minimum
4942(j)(3) or
4942(j)(5)
(e) Total
(d) 2008
85% of line 2a
Qualifying distributions from Part XII,
3
a
Supplementary Information (Complete this part only if the foundation had $5,000 or more in assets at
any time during the yearsee instructions.)
Information Regarding Foundation Managers:
a List any managers of the foundation who have contributed more than 2% of the total contributions received by the foundation
before the close of any tax year (but only if they have contributed more than $5,000). (See section 507(d)(2).)
See Statement 10
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
Information Regarding Contribution, Grant, Gift, Loan, Scholarship, etc., Programs:
if the foundation only makes contributions to preselected charitable organizations and does not accept
Check here
unsolicited requests for funds. If the foundation makes gifts, grants, etc. (see instructions) to individuals or organizations under
other conditions, complete items 2a, b, c, and d.
a The name, address, and telephone number of the person to whom applications should be addressed:
See Statement 11
c Any submission deadlines:
See Statement 12
d Any restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other
factors:
See Statement 13
DAA
FOIM
990-PF (2oll)
Page 11
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
193,658
Total
Approved for future payment
3a
3b
193,658
N/A
Total
DAA
Form
990-PF (2011)
Address
Type
Purpose
Amount ite Awarded
Grantee
$1,390.76
01/28/11
Faith Action International House 705 North Greene Street Greensboro NC
Matching Grant
General Operating Support
General Operating Support (1st payment on 2011 grant)
$4,880.67
03/04/11
Interactive Resource Center
3115 East Bessemer Avenue Greensboro N( Matching Grant
Sponsor Eastern Conference for Workplace Democracy
$1,500.00
03/14/11
Sponsorship
PO Box 115, Riverdale MD 20738-0115
EDINA/GEO
General Operating Support (2nd payment on 2011 grant)
$1,550.00
03/16/11
Interactive Resource Center
3115 East Bessemer Avenue Greensboro N( Matching Grant
Send Aunt Molly Jackson Cooperative Members to Co-op Worl
$300.00
04/08/11
Cooperation Works
29630 109th Avenue North, Hanover, MN f. Sponsorship
Discretionary Grai General Operating Support for Southern Organizing Strategy $120,000.00
05/12/11
Project South
9 Gammon Avenue Atlanta GA 30315
$12,000.00
05/12/11
Federation of Southern Coopera 2769 Church Street East Point GA 30344
Discretionary Grai Rebuilding after Tornado
$5,400.00
05/25/11
Reynolds Shareholder Activism
Campaign for Migrant Worker JL. 1221 Broadway Street, Toledo, Ohio 43609 Matching Grant
Sponsorship of 2011 Annual Conference
$2,500.00
06/08/11
NC Center for Nonprofits
1110 Navaho Drive, Suite 200, Raleigh, NC 'z Sponsorship
$5,000.00
06/17/11
Levante Program
Student Action for Farmworkers 1317 W Pettigrew Street, Durham, NC 2770E Matching Grant
06/17/11
Matching Grant
Nommo Project
$3,003.62
Spirit House
PO Box 61865 Durham NC 27715
$765.00
06/27/11
For Ownership Appalachia
Center for Participatory Change 34 Wall Street, Ste. 601, Asheville NC 28801 Matching Grant
06/27/11
For Grilled Cheese Bus
$5,000.00
Action for Community in Raleigh 331 West Main Street Suite 408 Durham NC Matching Grant
07/26/11
Upgrade to Constant Contact
$315.00
National Farmworker Ministry
4907 Garrett Road, Durham, NC 27403
Matching Grant
$500.00
08/18/11
Sponsorship
Sponsorship of Annual Meeting
Federation of Southern Coopera 2769 Church Street East Point GA 30344
08/19/11
Sponsorship of 2010-11 Sustainability Film Series
$250.00
UNCG Sustainability Committee UNCG, PO Box 26170, Greensboro, NC 274 Sponsorship
$4,322.00
08/22/11
Interactive Resource Center
3115 East Bessemer Avenue Greensboro N( Matching Grant
General Operating Support
09/15/11
Handy Capable
7339 West Friendly Ave. Suite H, Greensbor Matching Grant
Van purchase
$2,500.00
Bountiful Backyards & The Business Advisors to Coop Works!
09/22/11
$3,050.00
Cooperation Works
29630 109th Avenue North, Hanover, MN f. Sponsorship
Training
$500.00
09/28/11
NC A. Philip Randolph Institute 3609 Willow Creek Drive, Raleigh NC 27604 Matching Grant
Durham branch, Youth Education Work
10/20/11
Co-opoly production
Toolbox for Education Social Act 26 Center Street, Unit 1, North Hampton, MA Sponsorship
$250.00
Southerners on New Ground
250 Georgia Avenue, Ste 201, Atlanta, GA 31 Sponsorship
Oct 29 Strategy meeting for NC organizing
$1,500.00
10/21/11
$100.00
11/04/11
Alan Brillant
1310 Glenwood Avenue, Greensboro, NC 27 Sponsorship
Thank you for Occupy Support
Interactive Resource Center
3115 East Bessemer Avenue Greensboro N( Matching Grant
General Operating Support (3rd payment on 2011 grant)
$1,625.00
11/15/11
$5,000.00
11/16/11
Louisiana Bucket Brigade
4226 Canal Street, New Orleans, LA 70119 Discretionary Grai Participatory Budgeting Project
Southerners on New Ground
$1,500.00
11/16/11
250 Georgia Avenue, Ste 201, Atlanta, GA 31 Sponsorship
Sponsorship of Jan 19-22 Summit in CLT
Southerners on New Ground
250 Georgia Avenue, Ste 201, Atlanta, GA 31 Sponsorship
$1,220.00
12/05/11
Dec 10 2011 All of Us NC meeting in Greensboro
Spirit House
$1,550.38
12/14/11
PO Box 61865 Durham NC 27715
Matching Grant
Nommo Project (last installment on 2011 grant)
Just Economics of Western NC PO Box 2396 Asheville NC 28802
$2,152.50
12/19/11
Matching Grant
General Operating Support
12/27/11
Interactive Resource Center
3115 East Bessemer Avenue Greensboro N( Matching Grant
General Operating Fupport (last installment on 2011 grant)
$4,033.00
El Kilombo Intergalactico
324B West Geer Street Durham NC PO Box Matching Grant
12/30/11
$5,000.00
General Operating Support
Abundance Foundation
220 Lorax Lane, Box 5, Pittsboro, NC 27312 Matching Grant
For Slow Money NC General Operating Support
$5,000.00
12/30/11
$203,657.93
NC Housing Coalition
Discretionary Grai Returned 2010 grant to support resident-owned mobile home c -$10,000.00
07/12/11
Total: $193657.93
Ite
Page 12
NP4
Enter gross amounts unless otherwise indicated.
(b)
(e)
Relatedorftm0
code
1p :ogram service revenue:
a
o
o
Fees and contracts from government agencies
um embership dues and assessments
3 In terest on savings and temporary cash investments
4 D vidends and interest from securities
57,166
116,501
0
13
173,667
173,667
Explain below how each activity for which income is reported in column (e) of Part XVI-A contributed importantly to the
accomplishment of the foundation's exempt purposes (other than by providing funds for such purposes). (See instructions.)
N/A
Form 990-PF
DAA
poll)
Page
13
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?
a Transfers from the reporting foundation to a noncharitable exempt organization of:
(1) Cash
(2) Other assets
b 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
la(1)
1a(2)
1b(1)
1 b(2)
1 b(3)
I b(4)
1 b(5)
1 b(6)
1c
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 retum
with the preparer shown below
(see instructions)?
Yes
Sign
Here
Paid
Preparer CHUCK AVERRE
Use Only Finn's name III.
Firm's address 110'
DAA
PRESIDENT
No
Date
Title
Date
Preparers signature
08/14/12
CHUCK AVERRE
Check
if
self-employed
PTIN
Firm's EIN 110.
Phone no.
P00280366
56-2119415
919-848-4100
Form 990-PF (2oll)
Form 990-PF
For, 2220
2011
Name
26-0344869
Note: Generally, the corporation is not required to file Form 2220 (see Part II below for exceptions) because the IRS will fgure any penalty
owed and bill the corporation. However, the corporation may still use Form 2220 to figure the penalty. If so, enter the amount from page 2, line
38 on the estimated tax penalty line of the corporation's income tax return, but do not attach Form 2220.
Part I
3,058
2a
2b
2c
2d
3 058
3 058
Enter the tax shown on the corporation's 2010 income tax return (see instructions). Caution: If the tax is zero or
the tax year was for less than 12 months, skip this line and enter the amount from line 3 on line 5
5 Required annual payment. Enter the smaller of line 3 or line 4. If the corporation is required to skip line 4, enter
the amount from line 3
Reasons for FilingCheck the boxes below that apply. If any boxes are checked, the corporation must file
(a)
(b)
(c)
05/15/11
06/15/11
09/15/11
10
765
765
765
763
765
0
1,530
2,295
0
765
1,530
11
12
13
14
15
16
DAA
765
763
Form
2220 (2011)
Form 2220
. . .... . . .. (2011)
.. . .. . . ...... .
26-0344869
Page 2
(b)
(d)
(c)
19
20
21
x 4%
22
23
24
25
26
27
28
29
30
x *%
32
33
34
35
36
37 Add lines 22, 24, 26, 28, 30, 32, 34, and 36
37
31
38 Penalty. Add columns (a) through (d) of line 37. Enter th e total here and on Form 1120, line 33; or the comparable
line for other income tax returns
74
38
*Use the penalty interest rate for each calendar quarter, which the IRS will determine during the first month in the preceding quarter.
These rates are published quarterly in an IRS News Release and in a revenue ruling in the Internal Revenue Bulletin. To obtain this
information on the Internet, access the IRS website at www.irs.gov . You can also call 1-800-829-4933 to get interest rate
information.
Form
DAA
2220 (2011)
2011
2220
, and ending
Name
26-0344869
05/15/11
3rd Quarter
2nd Quarter
1st Quarter
765
06/15/11
765
09/15/11
765
4th Quarter
12/15/11
763
1st Payment
3rd Payment
4th Payment
5th Payment
Date of payment
Amount of payment
Qtr
From
To
5/15/11
9/30/11
6/15/11
9/30/11
9/15/11
9/30/11
12/15/11
9/30/11
5/15/12
9/30/11
5/15/12
9/30/11
5/15/12
5/15/12
1
2
2
3
3
4
Total Penalty
Underpayment
765
765
765
765
765
765
763
#Days
138
228
107
228
15
228
152
Rate
4.00
3.00
4.00
3.00
4.00
3.00
3.00
Penalty
12
14
9
14
14
10
74
Form
4562
2011
(99)
Attachment
Sequence No.
79
Identifying number
26-0344869
Indirect Depreciation
Election To Expense Certain Property Under Section 179
Note: If you have any listed property, complete Part V before you complete Part I.
1
2
1
2
3
4
3
4
5
Reduction in limitation. Subtract line 3 from line 2. If zero or less, enter -0Dollar limitation for tax year. Subtract line 4 from line 1. If zero or less, enter -0-. If ma vied filing separately, see instructions
5
6
2,000,000
500,000
7
Listed property. Enter the amount from line 29
7
Total
elected
cost
of
section
179
property.
Add
amounts
in
column
(c),
lines
6
and
7
8
Tentative deduction. Enter the smaller of line 5 or line 8
9
Carryover of disallowed deduction from line 13 of your 2010 Form 4562
10
Business income limitation. Enter the smaller of business income (not less than zero) or line 5 (see instructions)
11
Section 179 expense deduction. Add lines 9 and 10, but do not enter more than line 11
12
13
Carryover of disallowed deduction to 2012. 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.
8
9
10
11
12
Special Depreciation Allowance and Other Depreciation (Do not include listed property.) See instructions
14
Special depreciation allowance for qualified property (other than listed property) placed in service
15
16
14
15
16
717
17
18
If you are electing to group any assets placed in service during the tax year into one or more general asset accounts, check here
Illo
Section BAssets Placed in Service During 2011 Tax Year Using the General Depreciation System
(a) Classification of property
h
i
Residential rental
property
(d) Recovery
period
(e) Convention
25 yrs.
27.5 yrs.
MM
MM
MM
S/L
S/L
S/L
S/L
Nonresidential real
property
MM
S/L
Section CAssets Placed in Service During 2011 Tax Year Using the Alternative Depreciation System
Class life
b 12-year
c 40-year
27.5 yrs.
39 yrs.
S/L
S/L
20a
...
12 yrs.
S/L
23
For assets shown above and placed in service during the current year, enter the
p ortion
MM
40 yrs.
21
22
(f) Method
21
Enter here
22
4 889
23
Form 4562 (2011)
26-0344869
Page
Listed Property (Include automobiles, certain other vehicles, 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 ADe reciation and Other Information (Caution: See the instructions for limits for passenger automobiles.)
24a
(a)
Type of property
(list vehicles first)
(c)
Business/
investment use
percentage
No
Yes
(e)
Basis for depreciation
(business/investment
use only)
(d)
Cost or other basis
25
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)
26
27
24b
Yes
(B)
Method/
Convention
(f)
Recovery
period
No
(i)
Elected section 179
cost
Depreciation
deduction
25
S/LS/L28
29
Add am ounts in column (i), line 26. Enter here and on line 7, page 1
Section BInformation on Use of Vehicles
Complete this section for vehicles used by a sole proprietor, partner, or other "more than 5% owner," or related person. If you provided vehicles
you meet an exception to completin g this section for those vehicles.
to your employees first answer the questions in Section
28
29
Add am ounts in column (h), lines 25 through 27. Enter here and on line 21, page 1
30
31
32
33
driven
Total miles driven during the year. Add lines
34
30 through 32
Was the vehicle available for personal use
35
(a)
(b)
(c)
(d)
(e)
(f)
Vehicle 1
Vehicle 2
Vehicle 3
Vehicle 4
Vehicle 5
Vehicle 6
Yes
No
No
Yes
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Do you maintain a written policy statement that prohibits all personal use of vehicles, including commuting, by
38
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
39
40
41
......... ... ..
(e)
(a)
Description of costs
(b)
Date amortization
begins
(c)
(d)
Amortizable amount
Code section
42
Amortization of costs that begins during your 2011 tax year (see instructions):
43
44
DAA
Amortization
period or
percentage
(t)
Amortization for this year
1,181
1,181
43
44
Form
4562(2011)
8/14/2012 11:34 AM
Statements
Whom
Sold
Description
Date
Acquired
How
Received
Sale
Price
Date
Sold
QUICKBOOKS PREMIER
8/30/07
PARALLELS DESKTOP 3.0 FOR MAC
10/20/07
NETWORK & ROUTER EQUIPMENT
9/23/08
Total
1/01/11 $
Purchase
$
Purchase
438 $
1/01/11
Net
Gain / Loss
Depreciation
Expense
Cost
438 $
100
100
165
703 $
146
684 $
Purchase
1/01/11
0 $
0 $
-19
-19
Description
Indirect Legal Fees
Total
600
600
$
$
$
$
Charitable
Purpose
Adjusted
Net
Net
Investment
0
$
$
$
$
600
600
$
$
1,050
1,050
$
$
Charitable
Purpose
Adjusted
Net
Net
Investment
Total
Description
$
$
$
$
1,050
1,050
1-3
8/14/2012 11:34 AM
Description
Prior Year
Cost
Depreciation
Basis
Method
Life
5 $
Current Year
Depreciation
Net Investment
Income
Adjusted Net
Income
641 $
23
143
16
49
123
17
27
1,106
3
3
3
3
8/14/2012 11:34 AM
Statements
Life
Method
576
97
15
136
0 $
200DB
1,947
200DB
225
200DB
225
200DB
320
4,889 $
16,529
Cost
Basis
Prior Year
Amortization
Life
COGS
START UP COSTS
Total
6/05/07 $
$
17,726 $
17,726 $
4,235
4,235
15 $
1,181 $
1,181 $
$
0
4-5
8/14/2012 11:34 AM
Statements
$
985
17,980
236
116
1,058
20,808
2,139
2,255
5,037
1,109
54
1,580
2,223
4,694
60,274
Adjusted
Net
Net
Investment
Total
Charitable
Purpose
$
985
17,980
236
116
1,058
20,808
20,808
2,139
2,255
5,037
1,109
54
1,580
2,223
4,694
39,466
8/14/2012 11:34 AM
Statements
Statement 7 - Form 990-PF, Part II, Line 14 - Land, Building, and Equipment
FURNISHINGS
OFFICE EQUIPMENT
COMPUTER EQUIPMENT
SOFTWARE
START UP COSTS
ACCUMULATED DEPRECIATION
ACCUMULATED AMORTIZATION
Total
End
Cost / Basis
Beginning
Net Book
Description
$
1,381
9,652
6,870
3,570
17,726
39,199
1,381
9,973
9,102
3,032
17,726
41,214
Net
FMV
End Accumulated
Depreciation
$
20,735
5,417
26,152
422
1,668
656
6
12,310
15,062
8/14/2012 11:34 AM
DEPOSITS - SPONSORSHIPS
Total
End of
Year
Beginning
of Year
Description
$
$
$
$
7,056
7,056
2,313
2,313
Amount
$
$
953,815
953,815
8-9
8/14/2012 11:34 AM
Statement 10 - Form 990-PF, Part XV, Line 1a - Managers Who Contributed Over 2% or $5,000
Amount
Name of Manager
STEPHEN JOHNSON
MARNIE THOMPSON
Total
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 .
1 0-1 3