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LILLYS GIFT FOUNDATION: Form 990PF, tax year 2011

View the entire original 990 at ProPublica ↗

Organization
LILLYS GIFT FOUNDATION (EIN 68-0445376)
Tax period
2011-01-01 to 2011-12-31
Filed
2012-03-28
IRS object ID
201210889349100611
Schema version
2011v1.2
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)
Timestamp2012-03-28T18:39:41-05:00Timestamp
Tax Period End Date2011-12-31TaxPeriodEndDate

Preparer Firm PreparerFirm

FieldValueIRS element (for citing)
EIN262426369EIN

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1PAVLIK & CHITWOOD LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1PO BOX 626AddressLine1
CityYREKACity
StateCAState
ZIP Code96097ZIPCode
FieldValueIRS element (for citing)
Return Type990PFReturnType
Tax Period Begin Date2011-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN680445376EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1LILLY'S GIFT FOUNDATION LOIS G ERICSON PRESIDENTBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlLILLNameControl
Phone5303984373Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line18519 SHADY DELL ROADAddressLine1
CityMACDOELCity
StateCAState
ZIP Code96058ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameLOIS G ERICSONName
TitlePRESIDENTTitle
Phone5303984373Phone
Date Signed2012-03-06DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameMICHAEL S PAVLIKName
PTINP00230100PTIN
Phone5308422796Phone
Date Prepared2012-03-06DatePrepared
FieldValueIRS element (for citing)
Tax Year2011TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990-PF IRS990PF

FieldValueIRS element (for citing)
Exempt PFXExemptPF
FMV Assets EOY8681682FMVAssetsEOY
Method Of Accounting CashXMethodOfAccountingCash

Analysis Of Revenue And Expenses AnalysisOfRevenueAndExpenses

FieldValueIRS element (for citing)
Contri Received Rev And Expnss1100165ContriReceivedRevAndExpnss
Dividends Rev And Expnss242000DividendsRevAndExpnss
Dividends Net Invst Incm242000DividendsNetInvstIncm
Net Gain Sale Assets Rev And Expnss146612NetGainSaleAssetsRevAndExpnss
Gross Sales Price3505006GrossSalesPrice
Capital Gain Net Incm Net Invst Incm146612CapitalGainNetIncmNetInvstIncm
Total Revenue And Expenses1488777TotalRevenueAndExpenses
Total Net Investment Income388612TotalNetInvestmentIncome
Comp Ofcr Dir Trst Rev And Expnss0CompOfcrDirTrstRevAndExpnss
Comp Ofcr Dir Trst Net Invst Incm0CompOfcrDirTrstNetInvstIncm
Comp Ofcr Dir Trst Dsbrs Chrtbl Prps0CompOfcrDirTrstDsbrsChrtblPrps
Legal Fees Rev And Expnss7374LegalFeesRevAndExpnss
Legal Fees Net Invst Incm7374LegalFeesNetInvstIncm
Legal Fees Dsbrs Chrtbl Prps0LegalFeesDsbrsChrtblPrps
Accounting Fees Rev And Expnss1750AccountingFeesRevAndExpnss
Accounting Fees Net Invst Incm1750AccountingFeesNetInvstIncm
Accounting Fees Dsbrs Chrtbl Prps0AccountingFeesDsbrsChrtblPrps
Taxes Rev And Expnss14857TaxesRevAndExpnss
Taxes Net Invst Incm0TaxesNetInvstIncm
Taxes Dsbrs Chrtbl Prps0TaxesDsbrsChrtblPrps
Other Expenses Rev And Expnss22810OtherExpensesRevAndExpnss
Other Expenses Net Invst Incm22810OtherExpensesNetInvstIncm
Other Expenses Dsbrs Chrtbl Prps0OtherExpensesDsbrsChrtblPrps
Tot Opr Expenses Rev And Expnss46791TotOprExpensesRevAndExpnss
Tot Opr Expenses Net Invst Incm31934TotOprExpensesNetInvstIncm
Tot Opr Expenses Dsbrs Chrtbl Prps0TotOprExpensesDsbrsChrtblPrps
Contri Gifts Paid Rev And Expnss360000ContriGiftsPaidRevAndExpnss
Contri Gifts Paid Dsbrs Chrtbl Prps360000ContriGiftsPaidDsbrsChrtblPrps
Total Expenses Rev And Expnss406791TotalExpensesRevAndExpnss
Total Expenses Net Invst Incm31934TotalExpensesNetInvstIncm
Total Expenses Dsbrs Chrtbl Prps360000TotalExpensesDsbrsChrtblPrps
Excess Of Revenue Over Expenses1081986ExcessOfRevenueOverExpenses
Net Investment Income356678NetInvestmentIncome

Balance Sheets BalanceSheets

FieldValueIRS element (for citing)
Cash EOY1000CashEOY
Cash EOYFMV1000CashEOYFMV
Savings And Temp Cash Invst BOY332215SavingsAndTempCashInvstBOY
Savings And Temp Cash Invst EOY194479SavingsAndTempCashInvstEOY
Savings And Temp Cash Invst EOYFMV194479SavingsAndTempCashInvstEOYFMV
Investments Corp Stock BOY2298917InvestmentsCorpStockBOY
Investments Corp Stock EOY2898302InvestmentsCorpStockEOY
Investments Corp Stock EOYFMV3171109InvestmentsCorpStockEOYFMV
Investments Corp Bonds BOY4129441InvestmentsCorpBondsBOY
Investments Corp Bonds EOY4817786InvestmentsCorpBondsEOY
Investments Corp Bonds EOYFMV4888458InvestmentsCorpBondsEOYFMV
Investments Other BOY399524InvestmentsOtherBOY
Investments Other EOY330516InvestmentsOtherEOY
Investments Other EOYFMV426636InvestmentsOtherEOYFMV
Total Assets BOY7160097TotalAssetsBOY
Total Assets EOY8242083TotalAssetsEOY
Total Assets EOYFMV8681682TotalAssetsEOYFMV
Total Liabilities BOY0TotalLiabilitiesBOY
Total Liabilities EOY0TotalLiabilitiesEOY
Org That Do Not Follow SFAS117XOrgThatDoNotFollowSFAS117
Capital Stock BOY0CapitalStockBOY
Capital Stock EOY0CapitalStockEOY
Paid In Or Capital Surplus BOY0PaidInOrCapitalSurplusBOY
Paid In Or Capital Surplus EOY0PaidInOrCapitalSurplusEOY
Retained Earnings BOY7160097RetainedEarningsBOY
Retained Earnings EOY8242083RetainedEarningsEOY
Total Net Assets BOY7160097TotalNetAssetsBOY
Total Net Assets EOY8242083TotalNetAssetsEOY
Total Liabilities Net Assets BOY7160097TotalLiabilitiesNetAssetsBOY
Total Liabilities Net Assets EOY8242083TotalLiabilitiesNetAssetsEOY

Changes In Net Assets Fund Balances ChangesInNetAssetsFundBalances

FieldValueIRS element (for citing)
Total Net Assets Fund Balances BOY7160097TotalNetAssetsFundBalancesBOY
Excess Of Revenue Over Expenses1081986ExcessOfRevenueOverExpenses
Other Increases0OtherIncreases
Subtotal8242083Subtotal
Other Decreases0OtherDecreases
Total Net Assets Fund Balances EOY8242083TotalNetAssetsFundBalancesEOY

Capital Gains And Losses CapitalGainsAndLosses

Capital Gains And Losses Info CapitalGainsAndLossesInfo (2 entries)

Description Of AssetDescriptionOfAssetHow AcquiredHowAcquiredDate AcquiredDateAcquiredDate SoldDateSoldGross Sales PriceGrossSalesPriceCost Or Other BasisCostOrOtherBasisGain Or LossGainOrLossGains Minus Excess Or LossesGainsMinusExcessOrLosses
VARIOUS SALES NORTHERN TRUST ACCT #23-60636P2009-07-012011-07-01342570933583946731567315
CAPITAL GAINS DIVIDENDSP792977929779297
FieldValueIRS element (for citing)
Capital Gain Net Income146612CapitalGainNetIncome

Qlfy Und Sect4940e For Reduced Tax QlfyUndSect4940eForReducedTax

FieldValueIRS element (for citing)
Liable For4942 Tax0LiableFor4942Tax
Qualifying Distributions Year1290000QualifyingDistributionsYear1
Noncharitable Assets Year17034790NoncharitableAssetsYear1
Distribution Ratio Year10.041224DistributionRatioYear1
Qualifying Distributions Year2278134QualifyingDistributionsYear2
Noncharitable Assets Year25616346NoncharitableAssetsYear2
Distribution Ratio Year20.049522DistributionRatioYear2
Qualifying Distributions Year3227694QualifyingDistributionsYear3
Noncharitable Assets Year34857734NoncharitableAssetsYear3
Distribution Ratio Year30.046872DistributionRatioYear3
Qualifying Distributions Year4177000QualifyingDistributionsYear4
Noncharitable Assets Year44351648NoncharitableAssetsYear4
Distribution Ratio Year40.040674DistributionRatioYear4
Qualifying Distributions Year5142000QualifyingDistributionsYear5
Noncharitable Assets Year53493630NoncharitableAssetsYear5
Distribution Ratio Year50.040645DistributionRatioYear5
Total Distribution Ratio0.218937TotalDistributionRatio
Average Distribution Ratio0.043787AverageDistributionRatio
Net Noncharitable Assets8285267NetNoncharitableAssets
Adjusted Noncharitable Assets362787AdjustedNoncharitableAssets
One Percent Net Investment Income3567OnePercentNetInvestmentIncome
Adj Nonchrtbl Assets And One366354AdjNonchrtblAssetsAndOnePct
Qualifying Distributions360000QualifyingDistributions

Excise Tax Based On Investment Incm ExciseTaxBasedOnInvestmentIncm

FieldValueIRS element (for citing)
Investment Income Excise Tax7134InvestmentIncomeExciseTax
Tax Under Section5110TaxUnderSection511
Subtotal7134Subtotal
Subtitle A Tax0SubtitleATax
Tax Based On Investment Income7134TaxBasedOnInvestmentIncome
Est Tax Payments And Overpayment9040EstTaxPaymentsAndOverpayment
Total Credits And Payments9040TotalCreditsAndPayments
Penalty For Underpayment13PenaltyForUnderpayment
Overpayment1893Overpayment
Amount Credited To Next Year1893AmountCreditedToNextYear
Amount To Be Refunded0AmountToBeRefunded

Statements Regarding Activities StatementsRegardingActivities

FieldValueIRS element (for citing)
Legislative Political Activities0LegislativePoliticalActivities
More Than100 Spent0MoreThan100Spent
Form1120 POL Filed0Form1120POLFiled
Sect4955 Tax On Organization0Sect4955TaxOnOrganization
Sect4955 Tax On Managers0Sect4955TaxOnManagers
Reimbursement Of Tax0ReimbursementOfTax
Activities Not Prev Reported0ActivitiesNotPrevReported
Changes To Articles Or Bylaws0ChangesToArticlesOrBylaws
Unrelated Bus Income Over10000UnrelatedBusIncomeOver1000
Termination Etc0TerminationEtc
Requirements Of Sect508e1RequirementsOfSect508e
At Least5000 In Assets1AtLeast5000InAssets
States Filed WithCAStatesFiledWith
Form990 PF Filed With AG1Form990PFFiledWithAG
Private Operating Foundation0PrivateOperatingFoundation
New Substantial Contributors1NewSubstantialContributors
Interest In Controlled Entity0InterestInControlledEntity
Applicable Insurance Contract0ApplicableInsuranceContract
Comply With Public Inspection Rqr1ComplyWithPublicInspectionRqr
Website AddressN/AWebsiteAddress
Books In Care Of Person NameLOIS G ERICSONBooksInCareOfPersonName
Books In Care Of Phone Number5303984373BooksInCareOfPhoneNumber

Books In Care Of US Address BooksInCareOfUSAddress

FieldValueIRS element (for citing)
Address Line18519 SHADY DELL ROADAddressLine1
CityMACDOELCity
StateCAState
ZIP Code96058ZIPCode
FieldValueIRS element (for citing)
Foreign Bank0ForeignBank

Statements Regarding Acty4720 StatementsRegardingActy4720

FieldValueIRS element (for citing)
Sale Or Exchange With Dsqfly Person0SaleOrExchangeWithDsqflyPerson
Borrow Or Lend With Dsqfly Person0BorrowOrLendWithDsqflyPerson
Furnished Goods With Dsqfly Person0FurnishedGoodsWithDsqflyPerson
Pay Compensation To Dsqfly Person0PayCompensationToDsqflyPerson
Transfer Assets To Dsqfly Person0TransferAssetsToDsqflyPerson
Payment To Government Offical0PaymentToGovernmentOffical
Uncorrected Prior Acts0UncorrectedPriorActs
Undistributed Income Prior Years0UndistributedIncomePriorYears
Business Holdings0BusinessHoldings
Jeopardy Investments0JeopardyInvestments
Uncorrected Jeopardy Investments0UncorrectedJeopardyInvestments
Influence Legislation0InfluenceLegislation
Influence Election0InfluenceElection
Grants To Individuals0GrantsToIndividuals
Grants To Organizations0GrantsToOrganizations
Noncharitable Purpose0NoncharitablePurpose
Rcv Funds To Pay Prsnl Bnft Contract0RcvFundsToPayPrsnlBnftContract
Pay Premiums Prsnl Bnft Contract0PayPremiumsPrsnlBnftContract
Prohibited Tax Shelter Transactn0ProhibitedTaxShelterTransactn

Ofcr Dir Trustees Key Employee Info OfcrDirTrusteesKeyEmployeeInfo

Ofcr Dir Trustees Or Key Employee OfcrDirTrusteesOrKeyEmployee (3 entries)

Address Line1USAddress/AddressLine1CityUSAddress/CityStateUSAddress/StateZIP CodeUSAddress/ZIPCodeTitleTitleAvg Hours Per Wk Devoted To PositionAvgHoursPerWkDevotedToPositionCompensationCompensationContri To Empl Benefit Plans EtcContriToEmplBenefitPlansEtcExpense Account Other AllowancesExpenseAccountOtherAllowances
LOIS G ERICSON
8519 SHADY DELL ROADMACDOELCA96058PRESIDENT/DIRECTOR1.00000
CONSTANCE D SHEPHERD
2325 TYLER STREETEUGENEOR97405DIRECTOR0.00000
STEVEN L ERICSON
7001 EAST BUTTE VALLEY ROADDORRISCA96023DIRECTOR0.00000
FieldValueIRS element (for citing)
Comp Of Highest Paid Empl NONENONECompOfHighestPaidEmplNONE
Tot Number Of Oth Empl Paid Over50k0TotNumberOfOthEmplPaidOver50k
Comp Of Hghst Paid Cntrct NONENONECompOfHghstPaidCntrctNONE
Tot Number Of Cntrct Paid Over50k0TotNumberOfCntrctPaidOver50k

Sum Of Program Related Investments SumOfProgramRelatedInvestments

FieldValueIRS element (for citing)
Total0Total

Minimum Investment Return MinimumInvestmentReturn

FieldValueIRS element (for citing)
Avg Monthly FMV Of Securities8175794AvgMonthlyFMVOfSecurities
Avg Monthly Cash Balances235645AvgMonthlyCashBalances
FMV All Other Noncharitable Assets0FMVAllOtherNoncharitableAssets
Total FMV Of Unused Assets8411439TotalFMVOfUnusedAssets
Reduction Claimed0ReductionClaimed
Acquisition Indebtedness0AcquisitionIndebtedness
Adj Total FMV Of Unused Assets8411439AdjTotalFMVOfUnusedAssets
Cash Deemed Charitable126172CashDeemedCharitable
Net Noncharitable Assets8285267NetNoncharitableAssets
Minimum Investment Return414263MinimumInvestmentReturn

Distributable DistributableAmount

FieldValueIRS element (for citing)
Minimum Investment Return414263MinimumInvestmentReturn
Tax Based On Investment Income7134TaxBasedOnInvestmentIncome
Total Tax7134TotalTax
Distributable Amount Before Adj407129DistributableAmountBeforeAdj
Recoveries Qlfy Distributions0RecoveriesQlfyDistributions
Distributable Amount Before Ded407129DistributableAmountBeforeDed
Deduction Fr Distributable$0DeductionFrDistributableAmount
Distributable Amount As Adjusted407129DistributableAmountAsAdjusted

Qualifying Distributions QualifyingDistributions

FieldValueIRS element (for citing)
Expenses And Contributions360000ExpensesAndContributions
Program Related Investments Total0ProgramRelatedInvestmentsTotal
Qualifying Distributions360000QualifyingDistributions
One Pct Sect4940e Org Net Invst Incm0OnePctSect4940eOrgNetInvstIncm
Adj Qualifying Distributions360000AdjQualifyingDistributions

Undistributed Income UndistributedIncome

FieldValueIRS element (for citing)
Distributable Amount As Adjusted407129DistributableAmountAsAdjusted
Undistributed Income Prior Year104148UndistributedIncomePriorYear
Total For Prior Years0TotalForPriorYears
Total Excess Distri Carryover0TotalExcessDistriCarryover
Qualifying Distributions360000QualifyingDistributions
Applied To Year1104148AppliedToYear1
Applied To Prior Years0AppliedToPriorYears
Treated As Distri From Corpus0TreatedAsDistriFromCorpus
Applied To Current Year255852AppliedToCurrentYear
Remaining Distri From Corpus0RemainingDistriFromCorpus
Excess Distri Cyov App CY Corpus0ExcessDistriCyovAppCYCorpus
Excess Distri Cyov Applied CY0ExcessDistriCyovAppliedCY
Total Corpus0TotalCorpus
Prior Year Undistributed Income0PriorYearUndistributedIncome
Prior Year Deficiency Or Tax0PriorYearDeficiencyOrTax
Taxable Amount10TaxableAmount1
Taxable Amount20TaxableAmount2
Undistributed Income CY151277UndistributedIncomeCY
Distri From Corpus170b1 E Or4942g30DistriFromCorpus170b1EOr4942g3
Excess Distri Cyov From Year50ExcessDistriCyovFromYear5
Excess Distri Cyov To Next Year0ExcessDistriCyovToNextYear

Supplementary Information SupplementaryInformation

Appication Submission Info AppicationSubmissionInfo

FieldValueIRS element (for citing)
Recipient NameLILLY'S GIFT FOUNDATIONRecipientName

Recipient US Address RecipientUSAddress

FieldValueIRS element (for citing)
Address Line18519 SHADY DELL ROADAddressLine1
CityMACDOELCity
StateCAState
ZIP Code96058ZIPCode
FieldValueIRS element (for citing)
Recipient Phone Number5303984373RecipientPhoneNumber
Form And Info And MaterialsPOTENTIAL RECIPIENTS ARE TO SUBMIT A WRITTEN LETTER EXPLAINING NEED.FormAndInfoAndMaterials
Submission DeadlinesNO SUBMISSION DEADLINESSubmissionDeadlines
Restrictions On AwardsNO RESTRICTIONS OR LIMITATIONS ON AWARDS.RestrictionsOnAwards

Grant Or Contri Paid During Year GrantOrContriPaidDuringYear (39 entries)

Address Line1RecipientUSAddress/AddressLine1CityRecipientUSAddress/CityStateRecipientUSAddress/StateZIP CodeRecipientUSAddress/ZIPCodeRecipient RelationshipRecipientRelationshipRecipient Foundation StatusRecipientFoundationStatusPurpose Of Grant Or ContributionPurposeOfGrantOrContributionAmountAmount
ALSA - ORANGE COUNTY
2230 WEST CHAPMAN SUITE 123ORANGECA92868NONEPUBLIC CHARITYFOR ANY EXPENDITURE RELATED TO CHARITABLE PURPOSE$1,000
ASHER STUDENT FOUNDATION
1408 BARRY AVENUE SUITE 205LOS ANGELESCA90025NONEPUBLIC CHARITYFOR ANY STUDENT RELATED COSTS$3,000
BUTTE VALLEY AMBULANCE SERVICE INC
PO BOX 9DORRISCA96023NONEPUBLIC CHARITYTO PROVIDE SERVICE TO INDIVIDUALS WHO CAN NOT PAY$1,000
BUTTE VALLEY FIRE PROTECTION DISTRICT
PO BOX 103MACDOELCA96058NONEPUBLIC CHARITYTO PURCHASE NEW EQUIPMENT$10,000
CA CHAPTER OF ROCKY MOUNTAIN ELK FOUNDATION
PO BOX 8249MISSOULAMT59807NONEPUBLIC CHARITYWILDLIFE ENHANCEMENT$6,000
DORRIS VOLUNTEER FIRE DEPARTMENT
PO BOX 768DORRISCA96023NONEPUBLIC CHARITYFOR ANY EXPENDITURE RELATED TO CHARITABLE PURPOSE$10,000
EASTER SEAL SOCIETY OF NO CA
20 LANDING CIRCLE SUITE 302CHICOCA95973NONEPUBLIC CHARITYFOR THE SUMMER CAMP PROGRAM AT EAGLE LAKE OR GRIZZ.$8,000
FRIENDS OF BOW ISLE
16880 SE 56TH PLACEBELLEVUEWA98006NONEPUBLIC CHARITYFOR OPERATION OF THE CAMP$4,000
FRIENDS OF THE NRA
9233 OLD FORT ROADKLAMATH FALLSOR97601NONEPUBLIC CHARITYFOR ANY EXPENDITURE RELATED TO EXEMPT FUNCTION$10,000
GUIDING EYES FOR THE BLIND
611 GRANITE SPRINGS RDYORKTOWN HEIGHTSNY10598NONEPUBLIC CHARITYSUPPORT FOR THE BLIND$7,500
HOSANNA CHRISTIAN SCHOOL
5000 HOSANNA WAYKLAMATH FALLSOR97603NONEPUBLIC CHARITYPROGRAM ASSISTANCE TO CHRISTIAN SCHOOL$5,000
HUMAN OPTIONS
5540 TRABUCO RD STE 100IRVINECA92620NONEPUBLIC CHARITYASSISTANCE TO WOMEN AND THEIR FAMILIES AFFECTED BY D$10,000
KLAMATH ADOLESCENT PROGRAM INC
2130 ARTHUR STREETKLAMATH FALLSOR97601NONEPUBLIC CHARITYFOR FOOD, CLOTHING AND SHELTER FOR THOSE ASSISTED$5,000
KLAMATH CRISIS CENTER
PO BOX 1358KLAMATH FALLSOR97601NONEPUBLIC CHARITYASSISTANCE FOR VICTIMS OF SEXUAL AND DOMESTIC VIOLEN$5,000
KLAMATH FALLS GOSPEL MISSION
823 WALNUT AVEKLAMATH FALLSOR97601NONEPUBLIC CHARITYASSISTANCE FOR EMERGENCY FOOD, CLOTHING AND SHELTER$5,000
KLAMATH HOSPICE INC
4745 S 6TH STREETKLAMATH FALLSOR97601NONEPUBLIC CHARITYFOR CLIENT CARE OR CAMP EVERGREEN$5,000
KLAMATH HUMANE SOCIETY
PO BOX 482KLAMATH FALLSOR97601NONEPUBLIC CHARITYBUILDING FUND$5,000
KLAMATH LAKE COUNTIES FOOD BANK
3231 MAY WOOD DRIVEKLAMATH FALLSOR97601NONEPUBLIC CHARITYFOR EMERGENCY FOOD ASSISTANCE ONLY$20,000
MADRONE HOSPICE INC
255 COLLIER WAYYREKACA96097NONEPUBLIC CHARITYFOR CLIENT CARE$10,000
MARCH OF DIMES
2222 MARTIN SUITE 155IRVINECA92612NONEPUBLIC CHARITYFOR ANY EXPENDITURE RELATED TO CHARITABLE PURPOSE$10,000
MERCY HOME FOR BOYS & GIRLS
1140 W JACKSON BOULEVARDCHICAGOIL60607NONEPUBLIC CHARITYFOR FOOD, CLOTHING AND SHELTER FOR THOSE ASSISTED$2,000
MERLE WEST-CANCER TREATMENT-MAMMOGRAPHIC FUND
2610 UHRMANN ROADKLAMATH FALLSOR97601NONEPUBLIC CHARITYFOR CANCER TREATMENT/MAMMOGRAPHIC$2,000
MT SHASTA RACE ASSOCIATION
PO BOX 759MT SHASTACA96067NONEPUBLIC CHARITYFOR GENERAL SUPPORT OF THE SKI TEAM$15,000
ORANGE COUNTY RESCUE MISSIONTHE MUSTARD SEED RANCH
1421 EDINGER SUITE BTUSTINCA92780NONEPUBLIC CHARITYFOR THE MUSTARD SEED RANCH$7,000
RESCUE RANCH INC
PO BOX 1192YREKACA96097NONEPUBLIC CHARITYPROVIDE FUNDS FOR DOG RESCUE AND REHABILITATION$5,000
RONALD MCDONALD HOUSES OF PORTLAND OR
2620 N COMMERCIAL AVENUEPORTLANDOR97227NONEPUBLIC CHARITYASSIST IN PROVIDING HOUSING FOR SERIOUSLY ILL CHILDREN$2,000
SMART-START MAKING A READER TODAY
219 NW 12TH AVE STE 203PORTLANDOR97209NONEPUBLIC CHARITYPROVIDE FUNDS FOR READING PROGRAMS$15,000
STABLE HANDS
PO BOX 1852YREKACA96097NONEPUBLIC CHARITYPROVIDE FUNDS THERAPEUTIC HORSEBACK RIDING. FUNDS TO BE USED FOR AREA IMPROVEMENTS AND PURCHASE OF HORSE TRAILER.$38,000
THE GIDEONS INTERNATIONAL
3863 HOOKER RDROSEBURGOR97470NONEPUBLIC CHARITYPROVIDE FUNDS FOR BIBLE DISTRIBUTION$2,000
THE SMILE TRAIN
245 FIFTH AVENUE SUITE 2201NEW YORKNY10016NONEPUBLIC CHARITYPROVIDE FUNDS TO TREAT CHILDREN WITH CLEFT PALATES.$10,000
TWELVEACRES INC
595 MILLICH DRIVE SUITE 104CAMPBELLCA95008NONEPUBLIC CHARITYPROVIDE FUNDS TO ASSIST DEVELOPMENTALLY DISABLED ADULT.$5,000
YREKA FAMILY YMCA
350 FOOTHILL DRIVEYREKACA96097NONEPUBLIC CHARITYFOR THE AFTER SCHOOL PROGRAM$17,000
KLAMATH-LAKE CARES
2220 ELDORADO BLVDKLAMATH FALLSOR97601NONEPUBLIC CHARITYFOR SUPPORT OF CHILD ABUSE PROGRAM$50,000
THE ACADEMY OF SISTERS
62895 HAMBY ROADBENDOR97701NONEPUBLIC CHARITYFOR SUPPORT OF AN AT RISK BOARDING SCHOOL FOR GIRLS. FUNDS NOT TO BE USED FOR ADMINISTATIVE EXPENSES.$10,000
TULELAKE-BUTTE VALLEY FAIR FRIENDS INC
PO BOX 866TULELAKECA96134NONEPUBLIC CHARITYFOR SUPPORT OF FAIRS. FUNDS NOT TO BE USED FOR ADMINISTRATIVE EXPENSES.$10,000
10TH DISTRICT AGRICULTURAL ASSN FRIENDS OF THE FAIR
1712 FAIRLANE ROADYREKACA96097NONEPUBLIC CHARITYFOR SUPPORT OF FAIRS. FUNDS NOT TO BE USED FOR ADMINISTRATIVE EXPENSES.$10,000
RONALD MCDONALD HOUSES OF ORANGE COUNTY
383 SOUTH BATAVIA STORANGECA92868NONEPUBLIC CHARITYASSIST IN HOUSING FOR SERIOUSLY ILL CHILDREN AND THEIR FAMILIES$2,000
SEARCH DOG FOUNDATION
501 E OJAI AVEOJAICA93023NONEPUBLIC CHARITYPROVIDE FUNDS TO RECRUIT RESCUED DOGS FOR USE BY FIRST RESPONDERS/$7,500
RED BUCKET EQUINE RESCUE
18381 GOLDEN WEST STHUNTINGTON BEACHCA92648NONEPUBLIC CHARITYPROVIDE FUNDS TO SAVE AND REHABILITATE ABANDONED AND UNWANTED HORSES.$10,000
FieldValueIRS element (for citing)
Tot Grant Or Contri Paid During Year360000TotGrantOrContriPaidDuringYear
Tot Grant Or Contri Approved Future0TotGrantOrContriApprovedFuture

Analysis Income Producing Acty AnalysisIncomeProducingActy

Dividends And Int From Sec Part VII DividendsAndIntFromSecPartVII

FieldValueIRS element (for citing)
Exclusion Code14ExclusionCode
Exclusion$242,000ExclusionAmount

Gain Sales Assets Oth Than Invntry GainSalesAssetsOthThanInvntry

FieldValueIRS element (for citing)
Exclusion Code18ExclusionCode
Exclusion$146,612ExclusionAmount

Subtotals Part XVIA SubtotalsPartXVIA

FieldValueIRS element (for citing)
Unrelated Business Income$0UnrelatedBusinessIncomeAmount
Exclusion$388,612ExclusionAmount
Related Or Exempt Function Income0RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Part XVIA388612TotalPartXVIA

Trnsfr Tr Rln With Noncharitable EO TrnsfrTrRlnWithNoncharitableEO

FieldValueIRS element (for citing)
Trnsfr Of Cash To Noncharitable EO0TrnsfrOfCashToNoncharitableEO
Trnsfr Oth Assets Noncharitable EO0TrnsfrOthAssetsNoncharitableEO
Sales Or Exchanges Of Assets0SalesOrExchangesOfAssets
Purchase Assets Noncharitable EO0PurchaseAssetsNoncharitableEO
Rental Of Facilities Etc0RentalOfFacilitiesEtc
Reimbursement Arrangements0ReimbursementArrangements
Loans Or Loan Guarantees0LoansOrLoanGuarantees
Performance Of Services Etc0PerformanceOfServicesEtc
Sharing Of Facilities Etc0SharingOfFacilitiesEtc
Relationships Noncharitable E Os0RelationshipsNoncharitableEOs

Schedule B IRS990ScheduleB

FieldValueIRS element (for citing)
Organization501c3 Exempt PFXOrganization501c3ExemptPF
General RuleXGeneralRule

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor Number1ContributorNumber
Contributor Name IndividualGRISWOLD INDUSTRIESContributorNameIndividual

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line11701 PLACENTIA AVENUEAddressLine1
CityCOSTA MESACity
StateCAState
ZIP Code92627ZIPCode
FieldValueIRS element (for citing)
Aggregate Contributions1100000AggregateContributions
Person Contribution TypeXPersonContributionType

Accounting Fees Schedule AccountingFeesSchedule

Accounting Fees AccountingFees

FieldValueIRS element (for citing)
CategoryACCOUNTINGCategory
Amount$1,750Amount
Net Investment Income1750NetInvestmentIncome
Disbursements Charitable Prps0DisbursementsCharitablePrps

Investments Corp Bonds Schedule InvestmentsCorpBondsSchedule

Investments Corp Bonds InvestmentsCorpBonds

FieldValueIRS element (for citing)
Name Of BondCORPORATE BONDSNameOfBond
EOY Book Value4817786EOYBookValue
EOYFMV4888458EOYFMV

Investments Corp Stock Schedule InvestmentsCorpStockSchedule

Investments Corp Stock InvestmentsCorpStock

FieldValueIRS element (for citing)
Name Of StockCOMMON STOCKNameOfStock
EOY Book Value2898302EOYBookValue
EOYFMV3171109EOYFMV

Investments Other Schedule2 InvestmentsOtherSchedule2

Investments Other InvestmentsOther

FieldValueIRS element (for citing)
Category Or ItemCOMMODITIESCategoryOrItem
Listed At Cost Or FMVAT COSTListedAtCostOrFMV
Book Value330516BookValue
EOYFMV426636EOYFMV

Legal Fees Schedule LegalFeesSchedule

Legal Fees LegalFees

FieldValueIRS element (for citing)
CategoryLEGALCategory
Amount$7,374Amount
Net Investment Income7374NetInvestmentIncome
Disbursements Charitable Prps0DisbursementsCharitablePrps

Other Expenses Schedule OtherExpensesSchedule

Other Expenses OtherExpenses (2 entries)

DescriptionDescriptionRevenue And Expenses Per BooksRevenueAndExpensesPerBooksNet Investment IncomeNetInvestmentIncomeDisbursements Charitable PrpsDisbursementsCharitablePrps
INVESTMENT FEES22625226250
FILING FEE1851850

Substantial Contributors Sch SubstantialContributorsSch

Substantial Contributor SubstantialContributor

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1GRISWOLD INDUSTRIESBusinessNameLine1

US Address USAddress

FieldValueIRS element (for citing)
Address Line1PO BOX 1325AddressLine1
CityNEWPORT BEACHCity
StateCAState
ZIP Code926590325ZIPCode

Taxes Schedule TaxesSchedule

Taxes Taxes (2 entries)

CategoryCategoryAmountAmountNet Investment IncomeNetInvestmentIncomeDisbursements Charitable PrpsDisbursementsCharitablePrps
EXCISE TAX - 2010 FORM 990-PF$5,81700
EXCISE TAX - 2011 ESTIMATE$9,04000