STRATEGY STUDIO / PUBLIC DATA EXPLORER

HARRY AND THELMA SURRENA MEMORIAL FUND: Form 990PF, tax year 2013

View the entire original 990 at ProPublica ↗

Organization
HARRY AND THELMA SURRENA MEMORIAL FUND (EIN 23-7435554)
Tax period
2013-11-01 to 2014-10-31
Filed
2015-03-13
IRS object ID
201520729349100702
Schema version
2013v4.0
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Return2015-03-13T09:08:16-05:00ReturnTs
Tax Period End2014-10-31TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN830232295PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1MOHATT RINALDO JOHNSON & GODWIN LLPBusinessNameLine1

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line1PO BOX 603AddressLine1
CitySHERIDANCity
StateWYState
ZIP Code828010603ZIPCode
FieldValueIRS element (for citing)
Return Type990PFReturnTypeCd
Tax Period Begin2013-11-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN237435554EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1HARRY & THELMA SURRENA MEMORIALBusinessNameLine1
FieldValueIRS element (for citing)
Business Name ControlHARRBusinessNameControlTxt
Phone3076726494PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1P O BOX 603AddressLine1
CitySHERIDANCity
StateWYState
ZIP Code82801ZIPCode

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonJOHN M PRADEREPersonNm
Person TitleTRUSTEEPersonTitleTxt
Phone3076726494PhoneNum
Signature2015-03-11SignatureDt
Discuss With Paid PreparerYes (true)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonMICHAEL B JOHNSONPreparerPersonNm
PTINP00912386PTIN
Phone3076726494PhoneNum
Preparation2015-03-13PreparationDt
Self EmployedYes (X)SelfEmployedInd
FieldValueIRS element (for citing)
Tax2013TaxYr
Build TS2016-02-25 16:41:14ZBuildTS

Form 990-PF IRS990PF

FieldValueIRS element (for citing)
Organization501c3 Exempt PFYes (X)Organization501c3ExemptPFInd
FMV Assets EOY$6,039,145FMVAssetsEOYAmt
Method Of Accounting CashYes (X)MethodOfAccountingCashInd

Analysis Of Revenue And Expenses AnalysisOfRevenueAndExpenses

FieldValueIRS element (for citing)
Schedule B Not RequiredYes (X)ScheduleBNotRequiredInd
Interest On Sav Rev And Expnss$18,155InterestOnSavRevAndExpnssAmt
Interest On Sav Net Invst Incm$16,592InterestOnSavNetInvstIncmAmt
Dividends Rev And Expnss$110,675DividendsRevAndExpnssAmt
Dividends Net Invst Incm$110,675DividendsNetInvstIncmAmt
Net Gain Sale Ast Rev And Expnss$185,322NetGainSaleAstRevAndExpnssAmt
Gross Sales Price$1,188,144GrossSalesPriceAmt
Cap Gain Net Incm Net Invst Incm$185,322CapGainNetIncmNetInvstIncmAmt
Other Income Rev And Expnss$340,500OtherIncomeRevAndExpnssAmt
Other Income Net Invst Incm$340,500OtherIncomeNetInvstIncmAmt
Total Rev And Expnss$654,652TotalRevAndExpnssAmt
Total Net Invst Incm$653,089TotalNetInvstIncmAmt
Comp Ofcr Dir Trst Rev And Expnss$38,982CompOfcrDirTrstRevAndExpnssAmt
Comp Ofcr Dir Trst Net Invst Incm$19,491CompOfcrDirTrstNetInvstIncmAmt
Comp Ofcr Dir Trst Dsbrs Chrtbl$19,491CompOfcrDirTrstDsbrsChrtblAmt
Accounting Fees Rev And Expnss$2,500AccountingFeesRevAndExpnssAmt
Accounting Fees Net Invst Incm$1,875AccountingFeesNetInvstIncmAmt
Accounting Fees Chrtbl Prps$625AccountingFeesChrtblPrpsAmt
Other Prof Fees Rev And Expnss$31,323OtherProfFeesRevAndExpnssAmt
Other Prof Fees Net Invst Incm$31,323OtherProfFeesNetInvstIncmAmt
Taxes Rev And Expnss$9,404TaxesRevAndExpnssAmt
Taxes Net Invst Incm$1,958TaxesNetInvstIncmAmt
Taxes Dsbrs Chrtbl$1,491TaxesDsbrsChrtblAmt
Other Expenses Rev And Expnss$190OtherExpensesRevAndExpnssAmt
Other Expenses Net Invst Incm$190OtherExpensesNetInvstIncmAmt
Tot Opr Expenses Rev And Expnss$82,399TotOprExpensesRevAndExpnssAmt
Tot Opr Expenses Net Invst Incm$54,837TotOprExpensesNetInvstIncmAmt
Tot Opr Expenses Dsbrs Chrtbl$21,607TotOprExpensesDsbrsChrtblAmt
Contri Paid Rev And Expnss$285,000ContriPaidRevAndExpnssAmt
Contri Paid Dsbrs Chrtbl$285,000ContriPaidDsbrsChrtblAmt
Total Expenses Rev And Expnss$367,399TotalExpensesRevAndExpnssAmt
Total Expenses Net Invst Incm$54,837TotalExpensesNetInvstIncmAmt
Total Expenses Dsbrs Chrtbl$306,607TotalExpensesDsbrsChrtblAmt
Excess Revenue Over Expenses$287,253ExcessRevenueOverExpensesAmt
Net Investment Income$598,252NetInvestmentIncomeAmt

Form990 PF Balance Sheets Form990PFBalanceSheetsGrp

FieldValueIRS element (for citing)
Sav And Temp Cash Invst BOY$264,900SavAndTempCashInvstBOYAmt
Sav And Temp Cash Invst EOY$313,095SavAndTempCashInvstEOYAmt
Sav And Temp Cash Invst EOYFMV$313,095SavAndTempCashInvstEOYFMVAmt
US Government Obligations BOY$207,072USGovernmentObligationsBOYAmt
US Government Obligations EOY$126,246USGovernmentObligationsEOYAmt
US Govt Obligations EOYFMV$124,828USGovtObligationsEOYFMVAmt
Corporate Stock BOY$2,945,307CorporateStockBOYAmt
Corporate Stock EOY$2,903,285CorporateStockEOYAmt
Corporate Stock EOYFMV$4,240,774CorporateStockEOYFMVAmt
Corporate Bonds BOY$889,008CorporateBondsBOYAmt
Corporate Bonds EOY$1,251,091CorporateBondsEOYAmt
Corporate Bonds EOYFMV$1,275,323CorporateBondsEOYFMVAmt
Other Assets BOY$22,982OtherAssetsBOYAmt
Other Assets EOY$22,982OtherAssetsEOYAmt
Other Assets EOYFMV$85,125OtherAssetsEOYFMVAmt
Total Assets BOY$4,329,269TotalAssetsBOYAmt
Total Assets EOY$4,616,699TotalAssetsEOYAmt
Total Assets EOYFMV$6,039,145TotalAssetsEOYFMVAmt
Other Liabilities BOY$1,546OtherLiabilitiesBOYAmt
Other Liabilities EOY$1,723OtherLiabilitiesEOYAmt
Total Liabilities BOY$1,546TotalLiabilitiesBOYAmt
Total Liabilities EOY$1,723TotalLiabilitiesEOYAmt
Org Does Not Follow SFAS117Yes (X)OrgDoesNotFollowSFAS117Ind
Capital Stock BOY$2,443,594CapitalStockBOYAmt
Capital Stock EOY$2,443,594CapitalStockEOYAmt
Retained Earning BOY$1,884,129RetainedEarningBOYAmt
Retained Earning EOY$2,171,382RetainedEarningEOYAmt
Tot Net Ast Or Fund Balances BOY$4,327,723TotNetAstOrFundBalancesBOYAmt
Tot Net Ast Or Fund Balances EOY$4,614,976TotNetAstOrFundBalancesEOYAmt
Total Liabilities Net Ast BOY$4,329,269TotalLiabilitiesNetAstBOYAmt
Total Liabilities Net Ast EOY$4,616,699TotalLiabilitiesNetAstEOYAmt

Chg In Net Assets Fund Balances ChgInNetAssetsFundBalancesGrp

FieldValueIRS element (for citing)
Tot Net Ast Or Fund Balances BOY$4,327,723TotNetAstOrFundBalancesBOYAmt
Excess Revenue Over Expenses$287,253ExcessRevenueOverExpensesAmt
Subtotal$4,614,976SubtotalAmt
Tot Net Ast Or Fund Balances EOY$4,614,976TotNetAstOrFundBalancesEOYAmt

Cap Gains Loss Tx Invst Incm Detail CapGainsLossTxInvstIncmDetail

Cap Gains Loss Tx Invst Incm CapGainsLossTxInvstIncmGrp (53 entries)

PropertyPropertyDescHow AcquiredHowAcquiredCdAcquiredAcquiredDtSoldSoldDtGross Sales PriceGrossSalesPriceAmtCost Or Other BasisCostOrOtherBasisAmtGain Or LossGainOrLossAmtGains Minus Excess Or LossesGainsMinusExcessOrLossesAmt
734-BRISTOL MYERS SQUIBB COMPANYP2013-02-052014-02-05$35,428$27,126$8,302$8,302
0.27-GENERAL MOTORS CO WARRANTS EXPP2012-10-012014-01-13$3$3$3
233-MCDONALDS CORPORATIONP2012-08-032014-09-04$21,639$20,957$682$682
373.297-VANGUARD INFLATION-PROTECTEDP2004-03-112013-12-10$9,676$9,358$318$318
100000-FED NATL MTG ASSN NOTES STRP2013-11-192014-06-20$100,000$100,000
0.342-GENERAL MOTORS CO WARRANTS EXPP2012-10-012014-01-10$7$7$7
283-MCKESSON CORPORATIONP2012-09-132014-01-17$47,532$24,884$22,648$22,648
784.11-VANGUARD INFLATION-PROTECTEDP2011-04-062013-12-10$20,324$20,272$52$52
1202-FREEPORT MCMORAN COPPER & GOLDP2013-01-222013-12-17$41,605$42,605-$1,000-$1,000
3298.153-HARBOR COMMODITY REAL RETURP2011-10-252014-02-12$20,218$25,000-$4,782-$4,782
428-MICROSOFT CORPORATIONP2012-10-172014-09-04$19,343$12,672$6,671$6,671
340.668-VANGUARD INTERMEDIATE-TERM IP2009-09-172013-11-26$3,362$3,267$95$95
7173.601-HARBOR COMMODITY REAL RETURP2013-04-112014-02-12$43,974$50,000-$6,026-$6,026
3429.355-HARBOR COMMODITY REAL RETURP2012-07-272014-02-12$21,022$25,000-$3,978-$3,978
341-NORTHERN TRUST CORPORATIONP2009-09-172014-09-04$23,536$20,562$2,974$2,974
4873.096-VANGUARD INTERMEDIATE-TERMP2009-09-172013-11-22$48,000$46,733$1,267$1,267
1000-VANGUARD EMERGING MARKETS ETFP2013-04-112014-03-03$38,144$42,945-$4,801-$4,801
392-ILLINOIS TOOL WORKS INCP2011-04-062014-04-14$31,898$21,428$10,470$10,470
200-NORTHERN TRUST CORPORATIONP2009-10-222014-09-04$13,804$10,689$3,115$3,115
985.222-VANGUARD INTERMEDIATE-TERM IP2010-12-072013-11-26$9,724$10,000-$276-$276
1000-VANGUARD EMERGING MARKETS ETFP2013-10-022014-03-03$38,144$41,030-$2,886-$2,886
162-INTEL CORPORATIONP1993-06-282014-03-28$4,130$571$3,559$3,559
200-NORTHERN TRUST CORPORATIONP2010-02-122014-09-04$13,804$10,021$3,783$3,783
3766.105-VANGUARD INTERMEDIATE-TERMP2011-10-252013-11-26$37,171$38,000-$829-$829
284-APPLE COMPUTER INCP2009-10-052014-09-04$27,835$7,579$20,256$20,256
500-INTEL CORPORATIONP2009-10-222014-03-28$12,748$10,007$2,741$2,741
200-NORTHERN TRUST CORPORATIONP2010-10-262014-09-04$13,804$10,115$3,689$3,689
6286.848-VANGUARD SHORT-TERM INVESTMP2004-03-112013-11-22$67,584$68,401-$817-$817
255-CATERPILLAR INCP2010-02-122014-09-04$27,732$14,218$13,514$13,514
400-INTEL CORPORATIONP2011-10-252014-03-28$10,199$9,892$307$307
0.25-NOW INCP2013-01-292014-06-09$8$7$1$1
374.883-VANGUARD SHORT-TERM INVESTMEP2011-10-252013-11-22$4,030$4,000$30$30
81-CATERPILLAR INCP2010-05-142014-09-04$8,809$5,229$3,580$3,580
756-INTEL CORPORATIONP2012-05-042014-03-28$19,276$21,195-$1,919-$1,919
145-NOW INCP2013-01-292014-08-01$4,643$4,329$314$314
907-EXELON CORPORATIONP2012-09-272014-01-17$24,625$32,514-$7,889-$7,889
402-JOHNSON CONTROLS INCP2011-07-272013-11-20$19,544$14,953$4,591$4,591
1000-PFIZER INCP1985-05-062013-11-26$32,003$1,896$30,107$30,107
280-EXXON MOBIL CORPORATIONP1983-06-242014-09-04$27,510$1,211$26,299$26,299
500-JOHNSON CONTROLS INCP2011-10-252013-11-20$24,309$16,285$8,024$8,024
663-SKYWORKS SOLUTIONS INC.P2013-08-232014-09-04$36,350$16,674$19,676$19,676
50000-FED HOME LOAN BANK NOTES 3P2009-10-222014-09-12$50,000$51,196-$1,196-$1,196
250-JOHNSON CONTROLS INCP2011-12-272013-11-20$12,154$7,757$4,397$4,397
15000-US BANCORP 4P2010-03-222014-05-15$15,000$15,725-$725-$725
0.574-GENERAL MOTORS COP2012-10-012014-01-10$22$22$22
292-MCDONALDS CORPORATIONP2010-02-122014-09-04$27,118$18,601$8,517$8,517
300-VANGUARD EMERGING MARKETS ETFP2010-12-072014-03-03$11,443$14,403-$2,960-$2,960
0.27-GENERAL MOTORS CO WARRANTS EXPP2012-10-012014-01-13$6$6$6
150-MCDONALDS CORPORATIONP2010-03-122014-09-04$13,931$9,844$4,087$4,087
300-VANGUARD EMERGING MARKETS ETFP2011-10-252014-03-03$11,443$12,149-$706-$706
0.342-GENERAL MOTORS CO WARRANTS EXPP2012-10-012014-01-10$10$10$10
200-MCDONALDS CORPORATIONP2010-09-132014-09-04$18,574$14,838$3,736$3,736
400-VANGUARD EMERGING MARKETS ETFP2012-11-282014-03-03$15,258$16,684-$1,426-$1,426
FieldValueIRS element (for citing)
Capital Gain Net Income$185,322CapitalGainNetIncomeAmt
Net Short Term Capital Gain Loss-$6,411NetShortTermCapitalGainLossAmt

Qlfy Und Sect4940e Reduced Tax QlfyUndSect4940eReducedTaxGrp

FieldValueIRS element (for citing)
Liable Section4942 TaxfalseLiableSection4942TaxInd
Adjusted Qlfy Distri Yr1$258,436AdjustedQlfyDistriYr1Amt
Net Vl Noncharitable Assets Yr1$5,125,398NetVlNoncharitableAssetsYr1Amt
Distribution Yr10.050423DistributionYr1Rt
Adjusted Qlfy Distri Yr2$244,959AdjustedQlfyDistriYr2Amt
Net Vl Noncharitable Assets Yr2$4,807,448NetVlNoncharitableAssetsYr2Amt
Distribution Yr20.050954DistributionYr2Rt
Adjusted Qlfy Distri Yr3$234,756AdjustedQlfyDistriYr3Amt
Net Vl Noncharitable Assets Yr3$4,609,464NetVlNoncharitableAssetsYr3Amt
Distribution Yr30.050929DistributionYr3Rt
Adjusted Qlfy Distri Yr4$207,821AdjustedQlfyDistriYr4Amt
Net Vl Noncharitable Assets Yr4$4,402,615NetVlNoncharitableAssetsYr4Amt
Distribution Yr40.047204DistributionYr4Rt
Adjusted Qlfy Distri Yr5$186,524AdjustedQlfyDistriYr5Amt
Net Vl Noncharitable Assets Yr5$3,996,482NetVlNoncharitableAssetsYr5Amt
Distribution Yr50.046672DistributionYr5Rt
Total Distribution0.246182TotalDistributionRt
Average Distribution0.049236AverageDistributionRt
Net Vl Noncharitable Assets$5,565,108NetVlNoncharitableAssetsAmt
Adj Net Vl Noncharitable Assets$274,004AdjNetVlNoncharitableAssetsAmt
Net Investment Income Pct$5,983NetInvestmentIncomePctAmt
Adj Nonchrtbl Net Invst Incm Pct$279,987AdjNonchrtblNetInvstIncmPctAmt
Qualifying Distributions$306,607QualifyingDistributionsAmt

Excise Tax Based On Invst Incm ExciseTaxBasedOnInvstIncmGrp

FieldValueIRS element (for citing)
Domestic Org Meeting Sect4940eYes (X)DomesticOrgMeetingSect4940eInd
Investment Income Excise Tax$5,983InvestmentIncomeExciseTaxAmt
Subtotal$5,983SubtotalAmt
Tax Based On Investment Income$5,983TaxBasedOnInvestmentIncomeAmt
Estimated Plus Ovpmt Incm Tx$4,260EstimatedPlusOvpmtIncmTxAmt
Total Payments And Credits$4,260TotalPaymentsAndCreditsAmt
Tax Due$1,723TaxDueAmt

Statements Regarding Acty StatementsRegardingActyGrp

FieldValueIRS element (for citing)
Legislative Political ActyfalseLegislativePoliticalActyInd
More Than100 SpentfalseMoreThan100SpentInd
Form1120 POL FiledfalseForm1120POLFiledInd
Activities Not Previously RptfalseActivitiesNotPreviouslyRptInd
Changes To Articles Or BylawsfalseChangesToArticlesOrBylawsInd
Unrelated Bus Incm Over LimitfalseUnrelatedBusIncmOverLimitInd
Organization Dissolved EtcfalseOrganizationDissolvedEtcInd
Section508e Rqr SatisfiedYes (true)Section508eRqrSatisfiedInd
At Least5000 In AssetsYes (true)AtLeast5000InAssetsInd
Org Report Or Register StateWYOrgReportOrRegisterStateCd
Form990 PF Filed With Atty GenYes (true)Form990PFFiledWithAttyGenInd
Private Operating FoundationfalsePrivateOperatingFoundationInd
New Substantial ContributorsfalseNewSubstantialContributorsInd
Own Controlled EntityfalseOwnControlledEntityInd
Donor Advised FundfalseDonorAdvisedFundInd
Comply With Public Insp RqrYes (true)ComplyWithPublicInspRqrInd
Website AddressN/AWebsiteAddressTxt

Persons With Books Name PersonsWithBooksName

FieldValueIRS element (for citing)
Business Name Line1MOHATT RINALDO JOHNSON & GODWINBusinessNameLine1
FieldValueIRS element (for citing)
Phone3076726494PhoneNum

Location Of Books US Address LocationOfBooksUSAddress

FieldValueIRS element (for citing)
Address Line1PO BOX 603AddressLine1
CitySHERIDANCity
StateWYState
ZIP Code82801ZIPCode
FieldValueIRS element (for citing)
Foreign Accounts QuestionfalseForeignAccountsQuestionInd

Statements Regarding Acty4720 StatementsRegardingActy4720Grp

FieldValueIRS element (for citing)
Sale Or Exch Disqualified PrsnfalseSaleOrExchDisqualifiedPrsnInd
Brrw Or Lend Disqualified PrsnfalseBrrwOrLendDisqualifiedPrsnInd
Furn Goods Disqualified PrsnfalseFurnGoodsDisqualifiedPrsnInd
Pay Comp Disqualified PrsnYes (true)PayCompDisqualifiedPrsnInd
Transfer Ast Disqualified PrsnfalseTransferAstDisqualifiedPrsnInd
Payment To Government OfficialfalsePaymentToGovernmentOfficialInd
Acts Fail To Qlfy As ExceptionsfalseActsFailToQlfyAsExceptionsInd
Undistributed Income PYfalseUndistributedIncomePYInd
Business HoldingsfalseBusinessHoldingsInd
Jeopardy InvestmentsfalseJeopardyInvestmentsInd
Uncorrected PY Jeopardy InvstfalseUncorrectedPYJeopardyInvstInd
Influence LegislationfalseInfluenceLegislationInd
Influence ElectionfalseInfluenceElectionInd
Grants To IndividualsfalseGrantsToIndividualsInd
Grants To OrganizationsfalseGrantsToOrganizationsInd
Noncharitable PurposefalseNoncharitablePurposeInd
Rcv Fnds To Pay Prsnl Bnft CntrctfalseRcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft CntrctfalsePayPremiumsPrsnlBnftCntrctInd
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTransInd

Officer Dir Trst Key Empl Info OfficerDirTrstKeyEmplInfoGrp

Officer Dir Trst Key Empl OfficerDirTrstKeyEmplGrp (3 entries)

Address Line1USAddress/AddressLine1CityUSAddress/CityStateUSAddress/StateZIP CodeUSAddress/ZIPCodeTitleTitleTxtAverage Hrs Per Wk Devoted To PosAverageHrsPerWkDevotedToPosRtCompensationCompensationAmtEmployee Benefit ProgramEmployeeBenefitProgramAmtExpense Account Other AllwncExpenseAccountOtherAllwncAmt
RALPH C ROBINSON
PO BOX 27BUFFALOWY82834TRUSTEE4.00$12,994$0$0
JOHN PRADERE
PO BOX 603SHERIDANWY82801TRUSTEE4.00$12,994$0$0
ROBERT WYATT
PO BOX 603SHERIDANWY82081TRUSTEE4.00$12,994$0$0
FieldValueIRS element (for citing)
Comp Of Hghst Pd Empl Or NONENONECompOfHghstPdEmplOrNONETxt
Comp Of Hghst Pd Cntrct Or NONENONECompOfHghstPdCntrctOrNONETxt

Sum Of Program Related Invst SumOfProgramRelatedInvstGrp

FieldValueIRS element (for citing)
Description1N/ADescription1Txt

Minimum Investment Return MinimumInvestmentReturnGrp

FieldValueIRS element (for citing)
Average Monthly FMV Of Sec$5,450,457AverageMonthlyFMVOfSecAmt
Average Monthly Cash Balances$171,637AverageMonthlyCashBalancesAmt
FMV All Other Noncharitable Ast$27,762FMVAllOtherNoncharitableAstAmt
Total FMV Of Unused Assets$5,649,856TotalFMVOfUnusedAssetsAmt
Adjusted Total FMV Of Unused Ast$5,649,856AdjustedTotalFMVOfUnusedAstAmt
Cash Deemed Charitable$84,748CashDeemedCharitableAmt
Net Vl Noncharitable Assets$5,565,108NetVlNoncharitableAssetsAmt
Minimum Investment Return$278,255MinimumInvestmentReturnAmt

Distributable Amount DistributableAmountGrp

FieldValueIRS element (for citing)
Minimum Investment Return$278,255MinimumInvestmentReturnAmt
Tax Based On Investment Income$5,983TaxBasedOnInvestmentIncomeAmt
Total Tax$5,983TotalTaxAmt
Distributable Before Adj$272,272DistributableBeforeAdjAmt
Distributable Before Ded$272,272DistributableBeforeDedAmt
Distributable As Adjusted$272,272DistributableAsAdjustedAmt

Qualifying Distri Part XII QualifyingDistriPartXIIGrp

FieldValueIRS element (for citing)
Expenses And Contributions$306,607ExpensesAndContributionsAmt
Qualifying Distributions$306,607QualifyingDistributionsAmt
Pct Sect4940e Org Net Invst Incm$5,983PctSect4940eOrgNetInvstIncmAmt
Adjusted Qualifying Distri$300,624AdjustedQualifyingDistriAmt

Undistributed Income UndistributedIncomeGrp

FieldValueIRS element (for citing)
Distributable As Adjusted$272,272DistributableAsAdjustedAmt
Undistributed Income PY$50,504UndistributedIncomePYAmt
Qualifying Distributions$306,607QualifyingDistributionsAmt
Applied To Year1$50,504AppliedToYear1Amt
Applied To Current Year$256,103AppliedToCurrentYearAmt
Undistributed Income CY$16,169UndistributedIncomeCYAmt

Supplementary Information SupplementaryInformationGrp

Application Submission Info ApplicationSubmissionInfoGrp

FieldValueIRS element (for citing)
Recipient PersonSURRENA MEMORIAL FUNDRecipientPersonNm

Recipient US Address RecipientUSAddress

FieldValueIRS element (for citing)
Address Line1BOX 27AddressLine1
CityBUFFALOCity
StateWYState
ZIP Code82834ZIPCode
FieldValueIRS element (for citing)
Recipient Phone3076845574RecipientPhoneNum
Form And Info And MaterialsWRITTEN APPLICATIONFormAndInfoAndMaterialsTxt
Submission DeadlinesNONESubmissionDeadlinesTxt
Restrictions On AwardsCHARITABLE, RELIGIOUS, SCIENTIFIC, & EDUCATIONAL PURPOSES IN THE U.S.RestrictionsOnAwardsTxt

Grant Or Contribution Pd Dur Yr GrantOrContributionPdDurYrGrp (24 entries)

Address Line1RecipientUSAddress/AddressLine1CityRecipientUSAddress/CityStateRecipientUSAddress/StateZIP CodeRecipientUSAddress/ZIPCodeRecipient RelationshipRecipientRelationshipTxtRecipient Foundation StatusRecipientFoundationStatusTxtGrant Or Contribution PurposeGrantOrContributionPurposeTxtAmtAmtBusiness Name Line2RecipientBusinessName/BusinessNameLine2
BREAD OF LIFE
PO BOX 909BUFFALOWY82834NONEEXEMPT ORG.GENERAL OPERATIONS$10,000
BUFFALO SENIOR CENTER
671 W FETTERMANBUFFALOWY82834NONEEXEMPT ORG.GENERAL OPERATIONS$10,000
CHILDREN'S CENTER - BUFFALO
151 KLONDIKEBUFFALOWY82834NONEEXEMPT ORG.GENERAL OPERATIONS$50,000
JOHNSON COUNTY LIBRARY
171 N ADAMSBUFFALOWY82834NONEEXEMPT ORG.GENERAL OPERATIONS$10,000FOUNDATION
JOHNSON COUNTY YMCA
101 SOUTH KLONDIKEBUFFALOWY82834NONEEXEMPT ORG.GENERAL OPERATIONS$20,000
METHODIST CHURCH
132 N ADAMS AVEBUFFALOWY82834NONEEXEMPT ORG.GENERAL OPERATIONS$5,000OF BUFFALO WYOMING
MOUNTAIN PLAINS HERITAGE
PO BOX 27BUFFALOWY82834NONEEXEMPT ORG.GENERAL OPERATIONS$3,000
CLEARMONT COMMUNITY LIBRARY
PO BOX 26CLEARMONTWY82835NONEEXEMPT ORG.GENERAL OPERATIONS$5,000
TONGUE RIVER BRANCH LIBRARY
PO BOX 909RANCHESTERWY82839NONEEXEMPT ORG.GENERAL OPERATIONS$5,000
TONGUE RIVER CHILD'S PLACE
84 DAYTON STREETRANCHESTERWY82839NONEEXEMPT ORG.GENERAL OPERATIONS$10,000
CHILDREN'S CENTER
863 HIGHLAND AVESHERIDANWY82801NONEEXEMPT ORG.GENERAL OPERATIONS$30,000
GENESIS FOUNDATION
444 CRESCENT DRSHERIDANWY82801NONEEXEMPT ORG.GENERAL OPERATIONS$35,000
HABITAT FOR HUMANITY - BUFFALO
615 BURRITT AVEBUFFALOWY82834NONEEXEMPT ORG.GENERAL OPERATIONS$10,000
LUNCH TOGETHER SOUP KITCHEN
102 S CONNER STSHERIDANWY82801NONEEXEMPT ORG.GENERAL OPERATIONS$10,000
METHODIST CHURCH
215 W WORKSSHERIDANWY82801NONEEXEMPT ORG.GENERAL OPERATIONS$5,000OF SHERIDAN WYOMING
SCOTTISH RITE CHILDHOOD
8 RIVERBEND COURTSHERIDANWY82801NONEEXEMPT ORG.GENERAL OPERATIONS$5,000LANGUAGE CLINIC C/O TOM NEIGHBORS
SENIOR CITIZENS COUNCIL
211 SMITH STREETSHERIDANWY82801NONEEXEMPT ORG.GENERAL OPERATIONS$10,000
SHERIDAN COLLEGE
3059 COFFEEN AVESHERIDANWY82801NONEEXEMPT ORG.GENERAL OPERATIONS$10,000FOUNDATION
SHERIDAN COUNTY LIBRARY
335 W ALGERSHERIDANWY82801NONEEXEMPT ORG.GENERAL OPERATIONS$5,000FOUNDATION INC
SHERIDAN COUNTY YMCA
417 NORTH JEFFERSONSHERIDANWY82801NONEEXEMPT ORG.GENERAL OPERATIONS$20,000
VOLUNTEERS OF AMERICA OF
PO BOX 6291SHERIDANWY82801NONEEXEMPT ORG.HOMELESS SHELTER$5,000WYOMING AND MONTANA
STORY BRANCH LIBRARY
PO BOX 188STORYWY82842NONEEXEMPT ORG.GENERAL OPERATIONS$5,000
STORY COMMUNITY CHURCH
PO BOX 415STORYWY82842NONEEXEMPT ORG.GENERAL OPERATIONS$5,000
THE FOOD GROUP
PO BOX 1500SHERIDANWY82801NONEEXEMPT ORG.GENERAL OPERATIONS$2,000
FieldValueIRS element (for citing)
Total Grant Or Contri Pd Dur Yr$285,000TotalGrantOrContriPdDurYrAmt

Analysis Income Producing Acty AnalysisIncomeProducingActyGrp

Int On Sav And Temp Cash Invst IntOnSavAndTempCashInvstGrp

FieldValueIRS element (for citing)
Exclusion14ExclusionCd
Exclusion$18,155ExclusionAmt

Div And Int From Sec Part VII DivAndIntFromSecPartVIIGrp

FieldValueIRS element (for citing)
Exclusion14ExclusionCd
Exclusion$110,675ExclusionAmt

Gain Sales Ast Oth Than Invntry GainSalesAstOthThanInvntryGrp

FieldValueIRS element (for citing)
Exclusion18ExclusionCd
Exclusion$185,322ExclusionAmt

Other Revenue Described OtherRevenueDescribedGrp

FieldValueIRS element (for citing)
DescMINERAL LEASE BONUSDesc
Exclusion16ExclusionCd
Exclusion$340,500ExclusionAmt

Subtotals Incm Producing Acty SubtotalsIncmProducingActyGrp

FieldValueIRS element (for citing)
Exclusion$654,652ExclusionAmt
FieldValueIRS element (for citing)
Total Income Producing Acty$654,652TotalIncomeProducingActyAmt

Trnsfr Trans Rln Nonchrtbl EO TrnsfrTransRlnNonchrtblEOGrp

FieldValueIRS element (for citing)
Trnsfr Of Cash To Nonchrtbl EOfalseTrnsfrOfCashToNonchrtblEOInd
Trnsfr Other Asset Nonchrtbl EOfalseTrnsfrOtherAssetNonchrtblEOInd
Sales Or Exchanges Of AssetsfalseSalesOrExchangesOfAssetsInd
Purchase Of Assets Nonchrtbl EOfalsePurchaseOfAssetsNonchrtblEOInd
Rental Of Facilities Oth AssetsfalseRentalOfFacilitiesOthAssetsInd
Reimbursement ArrangementsfalseReimbursementArrangementsInd
Loans Or Loan GuaranteesfalseLoansOrLoanGuaranteesInd
Performance Of Services EtcfalsePerformanceOfServicesEtcInd
Sharing Of Facilities EtcfalseSharingOfFacilitiesEtcInd
Relationships Nonchrtbl EOfalseRelationshipsNonchrtblEOInd

Accounting Fees Schedule AccountingFeesSchedule

Accounting Fees Detail AccountingFeesDetail

FieldValueIRS element (for citing)
CategoryACCOUNTING FEESCategoryTxt
Amt$2,500Amt
Net Investment Income$1,875NetInvestmentIncomeAmt
Disbursements Charitable Prps$625DisbursementsCharitablePrpsAmt

Compensation Explanation CompensationExplanation

Compensation Explanation CompensationExplanationGrp (3 entries)

RALPH C ROBINSON
JOHN PRADERE
ROBERT WYATT

Investments Corp Bonds Schedule InvestmentsCorpBondsSchedule

Investments Corporate Bonds InvestmentsCorporateBondsGrp (18 entries)

BondBondNmEOY Book ValueEOYBookValueAmtEOYFMVEOYFMVAmt
BLACKROCK INC$50,000$56,718
CSX CORP 6.25%$50,920$57,226
DODGE & COX INCOME FUND$100,000$103,723
HEWLETT PACKARD 2.125$50,999$50,566
HEWLWTT PACKARD 2.650$51,498$51,232
MCKESSON CORP$50,114$50,110
AT&T .900$44,990$45,069
GENERAL ELECTRIC CAP 5.1%$100,000$109,425
LILLY ELI & CO$26,963$27,399
EATON CORP$50,200$49,908
OPPENHEIMER INTERNATIONAL BOND FUND$200,000$190,596
WELLPOINT 2.3$50,407$50,409
TEMPLETON GLOBAL BOND FUND$200,000$198,167
US BANCORP
VANGUARD HIGH YIELD CORPORATE PORT$125,000$136,790
VANGUARD INTERMEDIATE-TERM INVEST
VANGUARD SHORT TERM CORP FUND
EASTON VANCE FLOATING RATE FUND$100,000$97,985

Investments Corp Stock Schedule InvestmentsCorpStockSchedule

Investments Corporate Stock InvestmentsCorporateStockGrp (67 entries)

StockStockNmEOY Book ValueEOYBookValueAmtEOYFMVEOYFMVAmt
AMAZON$29,712$26,269
AMERICAN EXPRESS$68,271$84,733
APACHE CORPORATION$41,032$35,435
APPLE COMPUTER INC$86,246$175,716
BAKER HUGHES INC$90,171$100,041
BB&T CORPORATION$46,393$53,183
BERKSHIRE HATHAWAY INC - CL B$28,212$50,738
BOEING CO$24,398$49,964
BRISTOL MYERS SQUIBB$37,844$59,586
CATERPILLAR INC$28,743$33,567
CALGENE$42,704$94,453
CHEVRON CORP$23,337$57,936
CISCO SYSTEMS$46,883$53,320
CITIGROUP$129,478$134,414
COSTCO WHOLESALE CORPORATION$22,193$51,748
DEERE & COMPANY$61,710$66,037
DISNEY WALT CO HOLDINGS$34,847$98,508
DU PONT E I DE NEMOURS & COMPANY$46,841$68,528
EMC CORPORATION$72,441$97,481
EMERSON ELECTRIC CO$29,700$59,319
EXELON CORPORATION
EXXON MOBIL CORP$14,995$63,055
FORD MOTOR COMPANY$61,227$77,340
FREEPORT MCMORAN COPPER AND GOLD CLA
GENERAL ELECTRIC CO$70,025$95,084
GENERAL MOTORS$659
GILEAD SCIENCES INC.$38,612$117,040
ILLINOIS TOOL WORKS INC
INTEL CORP
JACOBS ENGINEERING$39,635$32,408
JOHNSON CONTROLS INC
J.P. MORGAN CHASE & CO$96,381$152,652
MCDONALDS CORPORATION
MCKESSON CORPORATION$30,159$69,770
MICROSOFT CORPORATION$63,327$96,107
MONDELEZ INTERNATIONAL INC$37,618$61,000
NATIONAL OILWELL VARCO INC$38,565$42,204
NORDSTROM$63,435$77,402
NORTHERN TRUST CORPORATION
PEPSICO$22,825$71,358
PFIZER INC
PHILIP MORRIS INTERNATIONAL$42,075$58,213
PROCTOR & GAMBLE CO$33,393$63,009
QUALCOMM INC$33,468$73,485
SCHLUMBERGER LIMITED$41,005$59,788
SKYWORKS SOLUTIONS INC$46,075$106,696
SOUTHERN CO$6,839$46,360
TARGET CORP$65,335$78,264
TERADATA CORP$68,339$49,218
US BANCORP$59,055$63,900
UNION PACIFIC$63,729$93,393
UNITEDHEALTH GROUP INC$62,156$111,257
PUBLIC STORAGE 6.50% PFD$25,000$26,250
TENN VALLEY AUTH 6/1/28$49,980$47,961
ROUCHE HOLDINGS LTD$73,486$103,538
BHP BILLITON LIMITED ADR$58,854$47,433
GS-INTERNATIONAL SML CAP INSIGHTS$50,000$53,287
OPPENHEIMER MAIN ST SMALL CAP$50,000$81,474
T ROWE PRICE MID CAP FUND$50,000$78,743
T ROWE PRICE MID CAP VALUE FUND$50,000$74,706
AMERICAN EUROPACIFIC GROWTH FUND$73,447$101,305
HARBOR INTERNATIONAL FUND$58,089$93,878
OPPENHEIMER DEVELOPING MARKETS FUND$125,000$139,565
VANGUARD EMERGIN MARKETS ETF
HARBOR COMMODITY REAL RETURN STRATEG
PRINCIPAL GOLBAL REAL ESTATE SEC$150,000$167,988
WARRANTS$14,008

Investments Govt Obligations Sch InvestmentsGovtObligationsSch

FieldValueIRS element (for citing)
US Govt Obligations Book Vl EOY$75,727USGovtObligationsBookVlEOYAmt
US Govt Obligations EOYFMV$74,828USGovtObligationsEOYFMVAmt
State Local Sec Book Vl EOY$50,519StateLocalSecBookVlEOYAmt
State Local Sec EOYFMV$50,000StateLocalSecEOYFMVAmt

Other Assets Schedule OtherAssetsSchedule

Other Assets Schedule OtherAssetsScheduleGrp

FieldValueIRS element (for citing)
DescMINERAL RIGHTSDesc
BOY Book Value$22,982BOYBookValueAmt
EOY Book Value$22,982EOYBookValueAmt
EOYFMV$85,125EOYFMVAmt

Other Expenses Schedule OtherExpensesSchedule

Other Expenses Schedule OtherExpensesScheduleGrp (2 entries)

DescDescRevenue And Expenses Per BooksRevenueAndExpensesPerBooksAmtNet Investment IncomeNetInvestmentIncomeAmt
EXPENSES
WIRE TRANSFER FEES$190$190

Other Income Schedule2 OtherIncomeSchedule2

Other Income Detail OtherIncomeDetail

FieldValueIRS element (for citing)
DescMINERAL LEASE BONUSDesc
Revenue And Expenses Per Books$340,500RevenueAndExpensesPerBooksAmt
Net Investment Income$340,500NetInvestmentIncomeAmt

Other Liabilities Schedule OtherLiabilitiesSchedule

Other Liabilities Detail OtherLiabilitiesDetail

FieldValueIRS element (for citing)
DescFEDERAL TAXES PAYABLEDesc
BOY Book Value$1,546BOYBookValueAmt
EOY Book Value$1,723EOYBookValueAmt

Other Professional Fees Schedule OtherProfessionalFeesSchedule

Other Professional Fees Detail OtherProfessionalFeesDetail

FieldValueIRS element (for citing)
CategoryINVESTMENT MANAGEMENT FEESCategoryTxt
Amt$31,323Amt
Net Investment Income$31,323NetInvestmentIncomeAmt

Taxes Schedule TaxesSchedule

Taxes Detail TaxesDetail (3 entries)

CategoryCategoryTxtAmtAmtNet Investment IncomeNetInvestmentIncomeAmtDisbursements Charitable PrpsDisbursementsCharitablePrpsAmt
PAYROLL TAXES$2,982$1,491$1,491
2013 990-PF EXCISE TAXES$5,955
FOREIGN TAXES$467$467