2014-05-15T13:56:41-05:00 2013-12-31 262426369 PAVLIK & CHITWOOD LLP PO BOX 626 YREKA CA 96097 990PF 2013-01-01 680445376 LILLY'S GIFT FOUNDATION LOIS G ERICSON PRESIDENT LILL 5303984373 8519 SHADY DELL ROAD MACDOEL CA 96058 LOIS G ERICSON PRESIDENT 5303984373 2014-05-14 1 MICHAEL S PAVLIK P00230100 5308422796 2014-05-14 2013 2015-12-30 17:16:21Z X 10916964 X 1161667 298762 298762 613976 4131727 613976 5025 25 2079430 912763 0 0 0 4843 4843 0 1270 1270 0 5365 3748 0 62049 62049 0 73527 71910 0 1118000 1118000 1191527 71910 1118000 887903 840853 1000 1000 1000 234563 258504 258504 3144312 3455017 4293698 5320286 6002632 6030373 473379 344290 333389 9173540 10061443 10916964 0 0 X 0 0 0 0 9173540 10061443 9173540 10061443 9173540 10061443 9173540 887903 0 10061443 0 10061443 VARIOUS SALES NORTHERN TRUST ACCT #23-60636 P 2011-07-01 2013-07-01 4026560 3517751 508809 508809 CAPITAL GAINS DIVIDENDS P 105167 105167 105167 613976 0 605623 9640834 0.062819 360000 8285267 0.043451 290000 7034790 0.041224 278134 5616346 0.049522 227694 4857734 0.046872 0.243888 0.048778 10708528 522341 8409 530750 1118000 X 8409 0 8409 0 8409 4400 4009 8409 0 0 0 0 0 0 0 0 0 0 0 1 1 CA 1 0 1 0 0 1 N/A LOIS G ERICSON 5303984373 8519 SHADY DELL ROAD MACDOEL CA 96058 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 LOIS G ERICSON 8519 SHADY DELL ROAD MACDOEL CA 96058 PRESIDENT/DIRECTOR 1.00 0 0 0 CONSTANCE D SHEPHERD 2325 TYLER STREET EUGENE OR 97405 DIRECTOR 0.00 0 0 0 STEVEN L ERICSON 7001 EAST BUTTE VALLEY ROAD DORRIS CA 96023 DIRECTOR 0.00 0 0 0 NONE 0 NONE 0 0 10709318 162284 0 10871602 0 0 10871602 163074 10708528 535426 535426 8409 8409 527017 0 527017 0 527017 1118000 0 1118000 8409 1109591 527017 18942 0 0 1118000 18942 0 0 527017 572041 0 0 572041 0 0 0 0 0 0 0 572041 572041 LILLY'S GIFT FOUNDATION 8519 SHADY DELL ROAD MACDOEL CA 96058 5303984373 POTENTIAL RECIPIENTS ARE TO SUBMIT A WRITTEN LETTER EXPLAINING NEED. NO SUBMISSION DEADLINES NO RESTRICTIONS OR LIMITATIONS ON AWARDS. 10TH DISTRICT AGRICULTURAL ASSN FRIENDS OF THE FAIR 1712 FAIRLANE ROAD YREKA CA 96097 NONE PUBLIC CHARITY FOR SUPPORT OF FAIRS. FUNDS NOT TO BE USED FOR ADMINISTRATIVE EXPENSES. 270000 ALSA - ORANGE COUNTY 2230 WEST CHAPMAN SUITE 123 ORANGE CA 92868 NONE PUBLIC CHARITY FOR ANY EXPENDITURE RELATED TO CHARITABLE PURPOSE 1000 ASHER STUDENT FOUNDATION 1408 BARRY AVENUE SUITE 205 LOS ANGELES CA 90025 NONE PUBLIC CHARITY FOR ANY STUDENT RELATED COSTS 3000 BUTTE VALLEY AMBULANCE SERVICE INC PO BOX 9 DORRIS CA 96023 NONE PUBLIC CHARITY TO PROVIDE SERVICE TO INDIVIDUALS WHO CAN NOT PAY 1000 BUTTE VALLEY FIRE PROTECTION DISTRICT PO BOX 103 MACDOEL CA 96058 NONE PUBLIC CHARITY TO PURCHASE NEW EQUIPMENT 10000 CA CHAPTER OF ROCKY MOUNTAIN ELK FOUNDATION PO BOX 8249 MISSOULA MT 59807 NONE PUBLIC CHARITY WILDLIFE ENHANCEMENT 10000 DORRIS VOLUNTEER FIRE DEPARTMENT PO BOX 768 DORRIS CA 96023 NONE PUBLIC CHARITY FOR ANY EXPENDITURE RELATED TO CHARITABLE PURPOSE 10000 FRIENDS OF BOW ISLE 16880 SE 56TH PLACE BELLEVUE WA 98006 NONE PUBLIC CHARITY FOR OPERATION OF THE CAMP 4000 FRIENDS OF THE NRA 9233 OLD FORT ROAD KLAMATH FALLS OR 97601 NONE PUBLIC CHARITY FOR ANY EXPENDITURE RELATED TO EXEMPT FUNCTION 10000 GUIDING EYES FOR THE BLIND 611 GRANITE SPRINGS RD YORKTOWN HEIGHTS NY 10598 NONE PUBLIC CHARITY SUPPORT FOR THE BLIND 7500 HOSANNA CHRISTIAN SCHOOL 5000 HOSANNA WAY KLAMATH FALLS OR 97603 NONE PUBLIC CHARITY PROGRAM ASSISTANCE TO CHRISTIAN SCHOOL 5000 KLAMATH CRISIS CENTER PO BOX 1358 KLAMATH FALLS OR 97601 NONE PUBLIC CHARITY ASSISTANCE FOR VICTIMS OF SEXUAL AND DOMESTIC VIOLEN 5000 KLAMATH FALLS GOSPEL MISSION 823 WALNUT AVE KLAMATH FALLS OR 97601 NONE PUBLIC CHARITY ASSISTANCE FOR EMERGENCY FOOD, CLOTHING AND SHELTER 5000 KLAMATH HOSPICE INC 4745 S 6TH STREET KLAMATH FALLS OR 97601 NONE PUBLIC CHARITY FOR CLIENT CARE OR CAMP EVERGREEN 5000 KLAMATH HUMANE SOCIETY PO BOX 482 KLAMATH FALLS OR 97601 NONE PUBLIC CHARITY BUILDING FUND 5000 KLAMATH LAKE COUNTIES FOOD BANK 3231 MAY WOOD DRIVE KLAMATH FALLS OR 97601 NONE PUBLIC CHARITY FOR EMERGENCY FOOD ASSISTANCE ONLY 20000 KLAMATH-LAKE CARES 2220 ELDORADO BLVD KLAMATH FALLS OR 97601 NONE PUBLIC CHARITY FOR SUPPORT OF CHILD ABUSE PROGRAM 45000 MADRONE HOSPICE INC 255 COLLIER WAY YREKA CA 96097 NONE PUBLIC CHARITY FOR CLIENT CARE 10000 MARCH OF DIMES 2222 MARTIN SUITE 155 IRVINE CA 92612 NONE PUBLIC CHARITY FOR ANY EXPENDITURE RELATED TO CHARITABLE PURPOSE 15000 MERCY HOME FOR BOYS & GIRLS 1140 W JACKSON BOULEVARD CHICAGO IL 60607 NONE PUBLIC CHARITY FOR FOOD, CLOTHING AND SHELTER FOR THOSE ASSISTED 2000 MT SHASTA RACE ASSOCIATION PO BOX 759 MT SHASTA CA 96067 NONE PUBLIC CHARITY FOR GENERAL SUPPORT OF THE SKI TEAM 15000 ORANGE COUNTY RESCUE MISSIONTHE MUSTARD SEED RANCH 1421 EDINGER SUITE B TUSTIN CA 92780 NONE PUBLIC CHARITY FOR THE MUSTARD SEED RANCH 7000 RED BUCKET EQUINE RESCUE 18381 GOLDEN WEST ST HUNTINGTON BEACH CA 92648 NONE PUBLIC CHARITY PROVIDE FUNDS TO SAVE AND REHABILITATE ABANDONED AND UNWANTED HORSES. 10000 RESCUE RANCH INC PO BOX 1192 YREKA CA 96097 NONE PUBLIC CHARITY PROVIDE FUNDS FOR DOG RESCUE AND REHABILITATION 5000 ROCKY MOUNTAIN CHILDRENS HEALTH FOUNDATION 2055 HIGH STREET SUITE 240 DENVER CO 80205 NONE PUBLIC CHARITY SUPPORT TO PEDIATRIC PATIENTS AND THEIR FAMILIES 2500 RONALD MCDONALD HOUSES OF ORANGE COUNTY 383 SOUTH BATAVIA ST ORANGE CA 92868 NONE PUBLIC CHARITY ASSIST IN HOUSING FOR SERIOUSLY ILL CHILDREN AND THEIR FAMILIES 2000 RONALD MCDONALD HOUSES OF PORTLAND OR 2620 N COMMERCIAL AVENUE PORTLAND OR 97227 NONE PUBLIC CHARITY ASSIST IN PROVIDING HOUSING FOR SERIOUSLY ILL CHILDREN 2000 SCIENTIFIC BEING RESEARCH FOUNDATION INC 2803 BARRANCA PKWY IRVINE CA 926065114 NONE PUBLIC CHARITY SCIENCE RESEARCH: SPECIFICALLY ASTRONOMY 250000 SEARCH DOG FOUNDATION 501 E OJAI AVE OJAI CA 93023 NONE PUBLIC CHARITY PROVIDE FUNDS TO RECRUIT RESCUED DOGS FOR USE BY FIRST RESPONDERS/ 10000 SMART-START MAKING A READER TODAY 219 NW 12TH AVE STE 203 PORTLAND OR 97209 NONE PUBLIC CHARITY PROVIDE FUNDS FOR READING PROGRAMS 20000 STABLE HANDS PO BOX 1852 YREKA CA 96097 NONE PUBLIC CHARITY PROVIDE FUNDS FOR THERAPEUTIC HORSEBACK RIDING. FUNDS TO BE USED FOR AREA IMPROVEMENTS AND PURCHASE OF HORSE TRAILER. 20000 THE ACADEMY OF SISTERS 62895 HAMBY ROAD BEND OR 97701 NONE PUBLIC CHARITY FOR SUPPORT OF AN AT RISK BOARDING SCHOOL FOR GIRLS. FUNDS NOT TO BE USED FOR ADMINISTATIVE EXPENSES. 15000 THE GIDEONS INTERNATIONAL 3863 HOOKER RD ROSEBURG OR 97470 NONE PUBLIC CHARITY PROVIDE FUNDS FOR BIBLE DISTRIBUTION 2000 THE SMILE TRAIN 245 FIFTH AVENUE SUITE 2201 NEW YORK NY 10016 NONE PUBLIC CHARITY PROVIDE FUNDS TO TREAT CHILDREN WITH CLEFT PALATES. 10000 TULELAKE-BUTTE VALLEY FAIR FRIENDS INC PO BOX 866 TULELAKE CA 96134 NONE PUBLIC CHARITY FOR SUPPORT OF FAIRS. FUNDS NOT TO BE USED FOR ADMINISTRATIVE EXPENSES. 270000 TWELVEACRES INC 595 MILLICH DRIVE SUITE 104 CAMPBELL CA 95008 NONE PUBLIC CHARITY PROVIDE FUNDS TO ASSIST DEVELOPMENTALLY DISABLED ADULT. 5000 ASANTE FOUNDATION 2600 SISKIYOU BLVD SUITE 100 MEDFORD OR 97504 NONE PUBLIC CHARITY PROVIDE FUNDS FOR COMMUNITY HEALTH CARE. 2000 BOY'S REPUBLIC 1907 BOYS REPUBLIC DRIVE CHINO HILLS CA 91709 NONE PUBLIC CHARITY PROVIDE FUNDS FOR THE DELLA ROBBIA WREATH PROGRAM WHICH SUPPORTS AT RISK YOUTH 3000 HEALTHY SMILES-KIDS OF ORANGE COUNT 10602 CHAPMAN AVENUE SUITE 200 GARDEN GROVE CA 92840 NONE PUBLIC CHARITY PROVIDE FUNDS FOR PROMOTING ORAL HEALTH FOR THE KIDS OF ORANGE COUNTY 5000 MILLER CHILDREN'S HOSPITAL 2801 ATLANTIC AVENUE LONG BEACH CA 908011428 NONE PUBLIC CHARITY PROVIDE FUNDS TO ASSIST IN PEDIATRIC CARE FOR CHILDREN AND YOUNG ADULTS 5000 PERFORMING ANIMAL WELFARE SOCIETY PO BOX 849 GALT CA 95632 NONE PUBLIC CHARITY PROVIDE FUNDS TO ASSIST IN PROTECTING PERFORMING ANIMALS 14000 1118000 0 14 298762 18 613976 PRIOR YEAR DONATION RETURNED 5000 FILING FEE REFUND 25 0 912738 5025 917763 11A ON 11/26/12 WE DONATED $5,000 TO THE KLAMATH ADOLESCENT PROGRAM. THE 11A ORGANIZATION WAS SHUT DOWN AND OUR CHECK WAS RETURNED TO US. 11B THE $25 REPRESENTS A REFUND WE RECEIVED FROM THE STATE OF CALIFORNIA 11B FOR OVERPAID FILING FEES IN 2010. THE FEES WERE ORIGINALLY DEDUCTED 11B AGAINST INVESTMENT INCOME 0 0 0 0 0 0 0 0 0 0 X X 1 GRISWOLD INDUSTRIES 1701 PLACENTIA AVENUE COSTA MESA CA 92627 1161667 X ACCOUNTING 1270 1270 0 CORPORATE BONDS 6002632 6030373 COMMON STOCK 3455017 4293698 COMMODITIES AT COST 344290 333389 LEGAL 4843 4843 0 INVESTMENT FEES 61889 61889 0 FILING FEES 160 160 0 PRIOR YEAR DONATION RETURNED 5000 5000 FILING FEE REFUND 25 25 25 GRISWOLD INDUSTRIES 1701 PLACENTIA AVENUE COSTA MESA CA 92627 EXCISE TAX - 2013 ESTIMATES PAID 1617 0 0 FOREIGN TAX PAID 3748 3748 0