t 6av fh asrr VN 2D 410-1`/'7-79S-5'990s.foundationcenter.org/990pf_pdf_archive/521/... · D 1....

15
0 cV LU 2 Fom; 990 - PF Retum of Private Foundation OMB No. 1545.0052 or Section 4947(a)(1) Nonexempt Charitable Trust Department of the Treasury Treated as a Private Foundation Q 1 O Internal Revenue service Note . The foundation may be able to use a copy of this return to satisfy state reporting requirements. For calendar year 2010, or tax year beginning t; '(j,31 ( It 7410 , 2010, and ending 5 f (41133 iZ "5Z) 20 Al G Check all that apply: q Initial return q Initial return of a former public charity q Final return n Amended return n Address chancre (1 Name chance Name of foundation A Employer Identification number M ('V FR-s o N, 11V6 - I q'7 -' 6 12 Number afid street (or P.O box number if mall Is not delivered to street addnisa) t 6av fh asrr VN 2D RoonVsuite B Telephone number (see page 10 of the Instructions) 410-1`/'7-79S-"5' City or town , state, and code v Y V' & lv M ^) !/r (t C If exemption application Is pending , check here q D 1 . Foreign organizations, check here . . q H Check type of organization : q Section 501 (c)(3) exempt private foundation q Section 4947(1)( 1 ) nonexempt charitable trust q Other taxab a private foundation 2. Foreign organizations meeting the 85% test. check here and attach computation 0 I Fair market value of all assets at end of year from Part It, col. (c), fine 16 ) $ f 4 - J Accountin g method : Cash q Accrual q Other (specify) .... ... ---------------°------- d7 {Part 1, column ( must be on cash basis) E s private foundation status was terminated under If section 507(b)(1)(A), check here q F It the foundation Is in a 60-month termination under section 507(b)(1XB), check here C] Analysis of Revenue and Expenses (The total of amounts In columns (b), (c), and ( d) may not necessarily equal (a) (seepage 71 of the Instructions).) the amounts In column (a) Revenue and expenses per books (b) Net Investment Income (c) Adjusted net Income (d) Disbursements for charitable p urposes (cash baonis IY) I Contributions , gifts, grants , etc., received (attach schedule) O D 2 Check q if the foundation is not required to attach Sch. B 3 Interest on savings and temporary cash investments c^ co 4 Dividends and interest from securities . . . . 0 m 5a Gross rents . . . . . . . . . . . . . b Net rental income or (loss) m 6a Net gain or (loss) from sale of assets not on line 10 b Gross sales price for all assets on line 6a > Capital gain net income (from Part IV , line 2) . pp : o - ^ U VN 6iort-term capital gain . . . . . . . . r a Co %.' ncome modifications . . . . . ti . I o 100 Gross sales less returns and allowances 3 gft^ Cost of goods sold . . . c Gross profit or (loss) (attach schedule) . . O © d L C^Gi7^C offl {attach schedule) . . . . . . p L O 1 6 o a d lines 1 throu gh 11 "' -^ !D 6 c, n F fipensation of officers , directors , trustees , etc. o n 0 14 Other employee salaries and wages . . . . . ci 0 0 m 15 Pension plans, employee benefits . . . . . O p O 16a Legal fees (attach schedule) . . . . . . . 0 b Accounting fees (attach schedule) . . . . - G 0 0 c Other professional fees (attach schedule) . . . a O 0 b 17 Interes ,, 0 6 O LA t 18 Taxes (a a sohiedule) (see page/14 of the insb(tctions) d D E 19 Depreciation (attach schedule) and depletion p 6 Q 20 Occupancy . . . . . . . . . . . . . 0 d o b 21 Travel, conferences , and meetings . . . . . O 22 Printing and publications . . . . . . . . 0 eJ p 23 Other expenses (attach schedule) . . . . . 0 of 24 Total operating and administrative expenses. Add lines 13 through 23 . (,Q 6c3 0 6 6 a 25 Contributions , gifts, grants paid 0 6 28 Total expenses and disbursements . Add lines 24 and 25 27 Subtract line 26 from line 12: a Excess of revenue over expenses and disbursements - p b Net Investment Income ( if negative , enter -0-) (' c Adj usted net Income If n eg ative , enter -0-) d For Paperwork Reduction Act Notice, see page 30 of the instructions . Cat. No. 11289X Form 990-PF polo) 7

Transcript of t 6av fh asrr VN 2D 410-1`/'7-79S-5'990s.foundationcenter.org/990pf_pdf_archive/521/... · D 1....

Page 1: t 6av fh asrr VN 2D 410-1`/'7-79S-5'990s.foundationcenter.org/990pf_pdf_archive/521/... · D 1. Foreignorganizations, checkhere . . q H Checktypeoforganization: q Section501(c)(3)

0cV

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2

Fom; 990-PF Retum of Private Foundation OMB No. 1545.0052

or Section 4947(a)(1) Nonexempt Charitable TrustDepartment of the Treasury Treated as a Private Foundation Q 1 OInternal Revenue service Note. The foundation may be able to use a copy of this return to satisfy state reporting requirements.

For calendar year 2010, or tax year beginning t; '(j,31 (It7410 , 2010, and ending 5f(41133 iZ "5Z) 20 Al

G Check all that apply: q Initial return q Initial return of a former public charity q Final return

n Amended return n Address chancre (1 Name chanceName of foundation A Employer Identification number

M('VFR-s o N, 11V6 - I q'7 -' 6 12Number afid street (or P.O box number if mall Is not delivered to street addnisa)

t 6av fh asrr VN 2DRoonVsuite B Telephone number (see page 10 of the Instructions)

410-1`/'7-79S-"5'City or town , state , and code

v Y V' & lv M ^) !/r (t

C If exemption application Is pending , check here ► q

D 1 . Foreign organizations, check here . . ► q

H Check type of organization : q Section 501 (c)(3) exempt private foundationq Section 4947(1)( 1 ) nonexempt charitable trust q Other taxab a private foundation

2. Foreign organizations meeting the 85% test.check here and attach computation • • ►0

I Fair market value of all assets atend of year from Part It, col. (c),fine 16) $ f 4

-J Accounting method : Cash q Accrual

q Other (specify) .... . . . ---------------°-------d7{Part 1, co lumn ( must be on cash basis)

E s private foundation status was terminated underIfsection 507(b)(1)(A), check here ► q

F It the foundation Is in a 60-month terminationunder section 507(b)(1XB), check here ► C]

Analysis of Revenue and Expenses (The total ofamounts In columns (b), (c), and (d) may not necessarily equal

(a) (seepage 71 of the Instructions).)the amounts In column

(a) Revenue andexpenses per

books(b) Net Investment

Income(c) Adjusted net

Income

(d) Disbursementsfor charitablepurposes

(cash baonis IY)

I Contributions , gifts, grants , etc., received (attach schedule) O D2 Check ►q if the foundation is not required to attach Sch. B3 Interest on savings and temporary cash investments c^ co4 Dividends and interest from securities . . . . 0 m5a Gross rents . . . . . . . . . . . . .b Net rental income or (loss)

m 6a Net gain or (loss) from sale of assets not on line 10b Gross sales price for all assets on line 6a

> Capital gain net income (from Part IV , line 2) .pp : o-

^U VN • 6iort-term capital gain . . . . . . . . r a

Co %.'ncome modifications . . . . . ti . I o100 Gross sales less returns and allowances

3 gft^ Cost of goods sold . . .

c Gross profit or (loss) (attach schedule) . . O © d

L C^Gi7^C offl {attach schedule) . . . . . . p L O 1

6o a d lines 1 through 11"' -^ !D 6 c, n

F fipensation of officers, directors , trustees , etc. o n 014 Other employee salaries and wages . . . . . ci 0 0

m 15 Pension plans, employee benefits . . . . . O p O

16a Legal fees (attach schedule) . . . . . . . 0b Accounting fees (attach schedule) . . . . - G 0 0c Other professional fees (attach schedule) . . . a O 0

b 17 Interes ,, 0 6 OLA

t18 Taxes (a a sohiedule) (see page/14 of the insb(tctions) d D

E 19 Depreciation (attach schedule) and depletion p 6Q 20 Occupancy . . . . . . . . . . . . . 0 d ob 21 Travel, conferences , and meetings . . . . . O

22 Printing and publications . . . . . . . . 0 eJ p23 Other expenses (attach schedule) . . . . . 0

of

24 Total operating and administrative expenses.Add lines 13 through 23 . (,Q 6c3 0 6 6

a 25 Contributions , gifts, grants paid 0 628 Total expenses and disbursements . Add lines 24 and 2527 Subtract line 26 from line 12:

a Excess of revenue over expenses and disbursements - pb Net Investment Income (if negative , enter -0-) ('c Adjusted net Income If negative, enter -0-) d

For Paperwork Reduction Act Notice, see page 30 of the instructions . Cat. No. 11289X Form 990-PF polo)

7

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Page 4: t 6av fh asrr VN 2D 410-1`/'7-79S-5'990s.foundationcenter.org/990pf_pdf_archive/521/... · D 1. Foreignorganizations, checkhere . . q H Checktypeoforganization: q Section501(c)(3)

Form 990-P9 (2010)

on or 4948-see page 18 of the

1a Exempt operating foundations described in section 40(d)(2), check here 10- q and enter "N/A" on line 1.A (attach copy of letter if necessary-see instructions)Date of ruling or determination letter: *U/

b Domestic foundations that meet the secti n 4940(e) requirements in Part V, check 1

here ► q and enter 1 % of Part I, line 27b . . . . . . . . . . . . . . . . .

c All other domestic foundations enter 2% of line 27b. Exempt foreign organizations enter 4% ofPart I, line 12, col. (b).

2 Tax under section 511 (domestic section 4947(a)(1) trusts and taxable foundations only. Others enter -0-) 2

3 Add lines 1 and 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

4 Subtitle A (income) tax (domestic section 4947(a)(1) trusts and taxable foundations only. Others enter -0-) 4

5 Tax based on investment income. Subtract line 4 from line 3. If zero or less, enter -0- . . . . 5

6 Credits/Payments:

a 2010 estimated tax payments and 2009 overpayment credited to 2010 6a

b Exempt foreign organizations-tax withheld at source . . . . . 6b

c Tax paid with application for extension of time to file (Form 8868) . 6c

d Backup withholding erroneously withheld . . . . . . . . . 6d

7 Total credits and payments. Add lines 6a through 6d . . . . . . . . . . . . . . . 7

8 Enter any penalty for underpayment of estimated tax. Check here q if Form 2220 is attached 8

9 Tax due. If the total of lines 5 and 8 is more than line 7, enter amount owed . . . . . . ► 9

10 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 2011 estimated tax ► Refunded ► 11

0

4

1 a During the tax year, did the foundation attempt to influence any national, state, or local legislation or did it Yes No

participate or intervene in any political campaign? . . . . . . . . . . . . . . . . . . . 1a

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)? . . . . . . . . . . . . . . . . . . . . . . . . . 1 b

If the answer is "Yes" to la or 1b, attach a detailed description of the activities and copies of any matenals

published or distributed by the foundation in connection with the activities.

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. ► $ 1b (2) On foundation managers. ► $ 2)e Enter the reimbursement (if any) paid by the foundation during the year for political expenditure tax imposed

on foundation managers. ► $ 02 Has the foundation engaged in any activities that have not previously been reported to the IRS? . . . .

If "Yes, " attach a detailed description of the activities.

3 Has the foundation made any changes, not previously reported to the IRS, in its governing instrument, articles ofincorporation, 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 during the year? . . . . .

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.

6 Are the requirements of section 508(e) (relating to sections 4941 through 4945) satisfied either:

• By language in the governing instrument, or

• By state legislation that effectively amends the governing instrument so that no mandatory directions that

conflict with the state law remain in the governing instrument? . . . . . . . . . . . . . . .

7 Did the foundation have at least $5,000 in assets at any time during the.year? If "Yes," complete Part Il, col. (c), and Part XV

8a Enter the states to which the foundation reports or with which it is registered (see page 19 of the

instructions) ►-------------------------------------------------------------------------------------------------------------------------

b If the answer is "Yes" to line 7, has the foundation furnished a copy of Form 990-PF to the Attorney General

(or designate) of each state as required by General Instruction G? If "No," attach explanation . . . . .

9

10

Is the foundation claiming status as a private operating foundation within the meaning of section 4942(j)(3) or4942 0)(5) for calendar year 2010 or the taxable year beginning in 2010 (see instructions for Part XIV on page

27)? 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 . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1c

2

34a

4b

5

6

7

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1 10 1 1 VForm 990-PF (2010)

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Form 990-PF (2010) Page 5

11 At any time during the year, did the foundation , directly or indirectly, own a controlled entity within themeaning of section 512 (b)(13)? If "Yes," attach schedule (see page 20 of the instructions) . . . . . . 11

12 Did the foundation acquire a direct or indirect interest in any applicable insurance contract beforeAugust 17 , 2008? . ... . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

13 Did the foundation comply with the public inspection requirements for its annual returns and exemption application? 13 X

Website address ► '" +c^ i1 ft!>s Zr7i'?-0^ N- ----- -- - -- ---R -^-m--- ----- ------------------------------------ ---------- ------------------------------------

14 The books are in care of ► cot A2 Telephone no . ► -?

ZIP+4 ► 'Lt ► ]L t d '^oca e a • _rti _4 Z7 ( !_CytSQ/S) t.SJ o4- --- --- - (̂- ^- -- 4+

15 Section 4947(a)(1) nonexempt charitable trusts filing Form 990-PF in lieu of Form 11 -Check here. . . ► q

and enter the amount of tax-exempt interest received or accrued during the year . . . . . ► 15 X16 At any time during calendar year 2010 , did the foundation have an interest in or a signature or other authority Yes No

over a bank , securities , or other financial account in a foreign country? . . . . . . . . . . . . . 16

See page 20 of the instructions for exceptions and filing requirements for Form TD F 90-22.1. If " Yes," entethe name of the foreign country ►

Statements Regarding Activities for Which Form 4720 May Be Required

File Form 4720 if any item is checked in the "Yes" column , unless an exception applies. Yes No

la 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? [I Yes 4Q No(2) Borrow money from , lend money to, or otherwise extend credit to (or accept it from) a

disqualified person? . . . . . . . . . . . . . . . . . . . . . . . q Yes 91 No

(3) Furnish goods , services, or facilities to (or accept them from) a disqualified person ? . q Yes No

(4) Pay compensation to, or pay or reimburse the expenses of, a disqualified person? . q Yes No(5) Transfer any income or assets to a disqualified person (or make any of either available for

the benefit or use of a disqualified person)? . . . . . . . . . . . . . . . q Yes No

(6) Agree to pay money or property to a government official? (Exception . Check "No" if thefoundation agreed to make a grant to or to employ the official for a period aftertermination of government service, if terminating within 90 days.) . . . . . . . . q Yes 4 No

b If any answer is "Yes" to 1 a(1)-(6), did any of the acts fail to qualify under the exceptions described in Regulationssection 53.4941(d)-3 or in a current notice regarding disaster assistance (see page 22 of the instructions)? . . 1bOrganizations relying on a current notice regarding disaster assistance check here . . . . . .

c Did the foundation engage in a prior year in any of the acts described in 1 a, other than excepted acts, thatwere not corrected before the first day of the tax year beginning in 2010? . . . . . . . . . . . 1c

2 Taxes on failure to distribute income (section 4942) (does not apply for years the foundation was a privateoperating foundation defined in section 49426)(3) or 4942(j)(5)): . , -

a At the end of tax year 2010, did the foundation have any undistributed income (lines 6d and6e, Part XIII) for tax year(s) beginning before 2010? . . . . . . . . . . . . . . q Yes j6 No

If "Yes," list the years ► 20 , 20 , 20 , 20----- ------ ------

b Are there any years listed in 2a for which the foundation is not applying the provisions of section 4942(a)(2)(relating to incorrect valuation of assets) to the year's undistributed income? (If applying section 4942(a)(2) toall years listed, answer "No" and attach statement-see page 22 of the instructions.) . . . . . . . . 2b

c If the provisions of section 4942(a)(2) are being applied to any of the years listed in 2a, list the years here.► 20 , 20 , 20 , 20

3a---- ----- ----- ------

3Did the foundation hold more than a 2% direct or indirect interest in any business enterpriseat any time during the year? . . . . . . . . . . . . . . . . . . . . . . q Yes q No

b If "Yes," did it have excess business holdings in 2010 as a result of (1) any purchase by the foundation ordisqualified persons after May 26, 1969; (2) the lapse of the 5-year period (or longer period approved by theCommissioner under section 4943(c)(7)) to dispose of holdings acquired by gift or bequest; or (3) the lapse ofthe 10-, 15-, or 20-year first phase holding period? (Use Schedule C, Form 4720, to determine if thefoundation had excess business holdings in 2010.) . . . . . . . . . . . . . . . . . b

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 2010?

4a

14b I I ii`Forth 990-PF (2010)

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Form 990-PF (2010),

5a During the year did the foundation pay or incur any amount to:

(1) Carry on propaganda , or otherwise attempt to influence legislation (section 4945(e))? . q Yes [Oo(2) Influence the outcome of any specific public election (see section 4955); or to carry on,

directly or indirectly , any voter registration drive? . . . . . . . . . . . . . q Yes g[No

(3) Provide a grant to an individual for travel, study , or other similar purposes? . . . . . q Yes LNo(4) Provide a grant to an organization other than a charitable , etc., organization described in

section 509(a)(1), (2), or (3), or section 4940(d)(2)? (see page 22 of the instructions) . . q Yes ;K No(5) Provide for any purpose other than religious , charitable , scientific , literary, or educational

purposes, or for the prevention of cruelty to children or animals? . . . . . . . . qYes QS Nob If any answer is "Yes" to 5a(1)-{5), did any of the transactions fail to qualify under the exceptions described in

Regulations section 53 .4945 or in a current notice regarding disaster assistance (see page 22 of the instructions)? 5b NOrganizations relying on a current notice regarding disaster assistance check here . . . . . . ► q

c If the answer is "Yes" to question 5a(4), does the foundation claim exemption from the taxbecause it maintained expenditure responsibility for the grant? . . . . . . . . . . q Yes KNo

If "Yes," attach the statement required by Regulations section 53. 4945-5(d).

6a Did the foundation , during the year, receive any funds, directly or indirectly , to pay premiumson a personal benefit contract? . . . . . . . . . . . . . . . . . . . . q Yes E No

b Did the foundation , during the year , pay premiums , directly or indirectly , on a personal benefit contract? 6b

If "Yes " to 6b, file Form 8870.

7a At any time during the tax year , was the foundation a party to a prohibited tax shelter transaction? q Yes 9Nob If "Yes ," did the foundation receive any proceeds or have any net income attributable to the transaction? . 7b

Page 6

JL&JEM Information About Officers, Directors, Trustees, Foundation Managers, Highly Paid Employees,and Contractors

I List all officers, directors, trustees, foundation managers and their compensation (see page 22 of the instructions).

(a) Name and address(b) Title, and average

hours per week(c) Compensation(If not paid , enter

(d) Contributions toemployee benefit plans (e) Expense account,

other allowancesdevoted to position -0-) and deferred compensation

iZLS^iu^ 1(R t l(9tic 1 o^sA^r 0-7 5 0

^'^!-!^ - m t?Q LIB -nrrrs0

1,51 rl ir0 ( 0

c?jC'^d - yn rP !2 !fit '.1Om- o m

Z ► ► c 12-)7 r otu v

-V14 - ---& -------------------------- ---- --- o oJ,e2Z

2 Comoe sation of five hiah st-oaid emolovees (other than those included on line 1-see oaae 23 of the instructions).If none, enter "NONE."

(a) Name and address of each employee paid more than $50,000(b) Title , and average

hours per weekdevoted to position

(c) Compensation

(d) Contributions toemployee benefitplans and deferredcompensation

(e) Expense account,o er allowances

------------------------------------------------ ------------------------------

--------------------- --- ------- ----------------------------------------- D^ ^L v

-------------------------------------------------------------- - Z----------------------------------------------------------------------------------Total number of other employees paid over $50 ,000. . . . . . . . ►

Form 990-PF (2010)

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Form 990-PF (2010) 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 page 23 of the instructions). If none, enter "NONE."(a) Name and address of each person paid more than $50 , 000 (b) Type of service (c) Compensation

-------------------------------------------------------------------------------------

---------------------- --------- -- ----------------------------------------------------

---------- ---------^V$^ ^( 1n

----------------------------------------------------------- - --------------------------------------------------------------------------

Total number of others receiving over $50,000 for professional services . . . . . . . . . . ►

Summary of Direct Charitable Activities

List the foundation ' s four largest direct charitable activities during the tax year Include relevant statistical information such as the number ofExpenses

organizations and other beneficiaries served , conferences convened, research papers produced, etc.

1 S.v 1 trA l^ _ f^^i2v^9'tTc)ll)--Nl)^sts2 ^d ^l ^LO2 R j^^j^° 0 9r-a2

----------------------------- -------- N- 41 ---A

- W t uGAv11

2 C43r' i (^ u>r^ v v s cow C"( (-- 5^ou ^

4D ^- &1Z6_0C_- p} (" -^- Y^v4 wt I

--------------------------- ---- ---------------- ^-c2 l+rr6 Trt

v rtt

3 m- ^- --------i l 141 1 (,U^-!- ---

01>02 /------------------------------- - --- ------------ ----

_ _

i^ ¢-^ C'l

44 &UIJ

F

•= 5 _--1 A r t^ -_ I----cc' v2 - - - -- - - t.^Z.r4•L------------------ --- -- jRj..^r^lc, r

- I 2Ti -L!j' fiD1"^_prTT w^t6r S P i2=------ui---Ar'Q-WA

Summary of Program-Related Investments (see'page 24 of the instructions)

Describe the two largest program -related investments made by the foundation during the tax year on lines 1 and 2 . Amount

------------------------------ - ----------------------------------------------------------------------------------------------------------------1

--------------------- ------------------------------------------------------------------------------------------------------------

2

All other program-relate;nvestmnent,, See page 24 of the instructions.

3 - --------------------- ----------------------------------------------------------------------------------------------------------------------

--------------- --------------------------------------------------------------------------------------------------------------- -

Total . Add lines 1 through 3 . ►

vc,:6f'!5

V

Form 990-PF (2010)

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Forth 990-PF (2010) Page 8

Minimum Investment Return (All domestic foundations must complete this part. Foreign foundations,see page 24 of the instructions.)

I 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 . . . . . . . . . . . . . . . . . 1a (j

b Average of monthly cash balances . . . . . . . . . . . . . . . . . . . . . 1b bo

c Fair market value of all other assets (see page 25 of the instructions) . . . . . . . . . . 1c 10

d Total (add lines 1 a, b, and c) . . . . . . . . . . . . . . . . . . . . . . . 1d e3e Reduction claimed for blockage or other factors reported on lines 1 a and

1 c (attach detailed explanation) . . . . . . . . . . . . . le

2 Acquisition indebtedness applicable to line 1 assets . . . . . . . . . . . . . . . . 2

3 Subtract line 2 from line 1d . . . . . . . . . . . . . . . . . . . . . . . . 3 4N04 Cash deemed held for charitable activities. Enter 1 1/2 % of line 3 (for greater amount, see page 25 of

the instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . 4 010-0

5 Net value of noncharitable -use assets . Subtract line 4 from line 3. Enter here and on Part V, line 4 56 Minimum investment return . Enter 5% of line 5 . . . . . . . . . . . 6[EM Distributable Amount (see page 25 of the instructions) (Section 4942(j)(3) and (j)(5) private operating

foundations and certain foreign organizations check here ► 0 and do not complete this part.)

1 Minimum investment return from Part X, line 6 . . . . . . . . . . . . 1 e

2a Tax on investment income for 2010 from Part VI, line 5 . . . . . . . 2a m

b Income tax for 2010. (This does not include the tax from Part VI.) . . 2b

c Add lines 2a and 2b . . . . . . . . . . . . . . . . . . . . . . . . . . 2c 6

3 Distributable amount before adjustments. Subtract line 2c from line 1 . . . . . . . . . . 3 6--4 Recoveries of amounts treated as qualifying distributions . . . . . . . . . . . . . . 4 Oa-

5 Add lines 3 and 4 . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 ey

6 Deduction from distributable amount (see page 25 of the instructions) . . . . . . . . . . 67 Distributable amount as adjusted. Subtract line 6 from line 5. Enter here and on Part XIII,

line1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

MCIM. Qualifying Distributions (see page 25 of the instructions)

1 Amounts paid (including administrative expenses) to accomplish charitable, etc., purposes:

a Expenses, contributions, gifts, etc. -total from Part I, column (d), line 26 . . . . . . . . . is 8

b Program-related investments-total from Part IX-B . . . . . . . . . . . . . . 1b2 Amounts paid to acquire assets used (or held for use) directly in carrying out charitable, etc.,

purposes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

3 Amounts set aside for specific charitable projects that satisfy the:

a Suitability test (prior IRS approval required) . . . . . . . . . . . . . . . . . . . 3a 0

b Cash distribution test (attach the required schedule) . . . . . . . . . . . . . . . . 3b

4 Qualifying distributions . Add lines 1 a through 3b. Enter here and on Part V, line 8, and Part XIII, line 4 4

5 Foundations that qualify under sectiori 4940(e) for the reduced rate of tax on net investment income.

Enter 1 % of Part I, line 27b (see page 26 of the instructions) . . . . . . . . . . . . . 5

6 Adjusted qualifying distributions . Subtract line 5 from line 4 . . . . . . . . . . . . 6

Note. The amount on line 6 will be used in Part V, column (b), in subsequent years when calculating whequalifies for the section 4940(e) reduction of tax in those years.

ther the foundation

Form 990-PF (2010)

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Form 990-PF (2010) 9

(a) (b) (c)(d)

1 Distributable amount for 2010 from Part XI, Corpus Years prior to 2009 2009 2010

line 7 . . . . . . . . . . . . .

2 Undistributed income, if any, as of the end of 2010:

a Enter amount for 2009 only . . . . . . d

b Total for prior years: 20 20 ,20 O

3 Excess distributions carryover, if any, to 2010:

a From 2005 . . . .

b From 2006 . . . .

c From 2007 . . . .

d From 2008 . . . .e From 2009 . . . .

f Total of lines 3a through e

..

. . . . .4 Qualifying distributions for 2010 from Part XII,

line 4: ® $ p

a Applied to 2009, but not more than line 2a .b Applied to undistributed income of prior years

(Election required-see page 26 of the instructions) 0

c Treated as distributions out of corpus (Electionrequired-see page 26 of the instructions) . 0

d Applied to 2010 distributable amount ___

e Remaining amount distributed out of corpus

5 Excess distributions carryover applied to 2010 _(if an amount appears in column (d), the sameamount must be shown in column (a).)

6 Enter the net total of each column asindicated below:

a Corpus. Add lines 3f, 4c, and 4e. Subtract line 5b Prior years' undistributed income. Subtract

line 4b from line 2b . . . . . . . .

c Enter the amount of prior years' undistributedincome for which a notice of deficiency hasbeen issued, or on which the section 4942(a)tax has been previously assessed . . . .

d Subtract line 6c from line 6b. Taxableamount-see page 27 of the instructions .

e Undistributed income for 2009. Subtract line4a from line 2a. Taxable amount-see page27 of the instructions . . . . . . . .

f Undistributed income for 2010. Subtract lines4d and 5 from line 1. This amount must bedistributed in 2011 . . . . . . . . .

7 Amounts treated as distributions out of corpusto satisfy requirements imposed by section170(b)(1)(F) or 4942(g)(3) (see page 27 of the Qinstructions) . . . . . . . . . . .

8 Excess distributions carryover from 2005 notapplied on line 5 or line 7 (see page 27 of the c2instructions) . . . . . . . . . . .

9 Excess distributions carryover to 2011.Subtract lines 7 and 8 from line 6a . . .

10 Analysis of line 9:

a Excess from 2006 . . . .

b Excess from 2007 . . .

c Excess from 2008 . .

d Excess from 2009 . .e Excess from 2010 .

Form 990-PF (2010)

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Form 990-PF (201

la

b2a

bc

d

If the foundation has received a ruling or determination letter that it is a private operating

foundation, and the ruling is effective for 2010, enter the date of the ruling . . . . . . ►L

Check box to indicate whether the foundation is a private operating foundation described in section

Enter the lesser of the adjusted netincome from Part I or the minimuminvestment return from Part X foreach year listed . . . . . . .

85% of line 2a . . . . . . .

Qualifying distributions from Part XII,

line 4 for each year listed . . . .

Amounts included in line 2c not used directly

for active conduct of exempt activities . .

e Qualifying distributions made directly

for active conduct of exempt activities.

Subtract line 2d from line 2c . . .

3 Complete 3a, b, or 'c for the

alternative test relied upon:

a "Assets" alternative test-enter:

(1) Value of all assets . . . . .

(2) Value of assets qualifying under

section 49420)(3)(B)(i) . . . .

b "Endowment" alternative test-enter 2/3of minimum investment return shown inPart X, line 6 for each year listed .

c "Support" alternative test-enter:

(1) Total support other than grossinvestment income (interest,dividends, rents, payments onsecurities loans (section512(a)(5)), or royalties) . . . .

(2) Support from general publicand 5 or more exemptorganizations as provided insection 49420)(3)(B)(iii) . . . .

(3) Largest amount of support from

an exempt organization . . .

(4) Gross investment income .

Page 10

I 4942(1)(3) or f-1 4942(i)(5)Tax year Prior 3 years

(a) T t l(a) 2010 (b) 2009 (c) 2008 (d) 2007

o a

o p D0 0

p Q 9 0

o elf 6' aD 0 0 ,16

o o Q 0 ?9

0 a 0

0 0 0

,C A O D 'p

a 9 6

4ORM

o o °' B a I

Supplementary Information (Complete this part-only if the foundation Fyad $5,000 or more in assets atany time during the year-see page 28 of the instructions.) 0/y^

1 Information Regarding Foundation Managers:

a List any managers of the foundation who have contributed more than 2% of the total contributions received by the foundationbefore the close of any tax ear (but only if they have contributed more than $5,000). (See section 507(d)(2).)

NVb 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 partnersh ip r other entity) of which the foundation has a 10% or greater interest.

tJf

2 Information Regarding Contribution, Grant, Gift, Loan, Scholarship, etc., Programs:

Check here ► q if the foundation only makes contributions to preselected charitable organizations and does not acceptunsolicited requests for funds. If the foundation makes gifts, grants, etc. (see page 28 of the instructions) to individuals ororganizations under other conditions, complete items 2a, b, c, and d.

a The name, address, and tele hone number of the person to whom applications should be addressed:

(^b The form in which applications should be submitted and information and materials they should include:

c Any submission deadline,s^:r

I-A

d Any restrictions or limitation on awards, such as by geographical areas, charitable fields, kinds of institutions, or otherfactors: 7A

Form 990-PF (2010)

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Form 990-PF (2010) Page 11

Supplementary Information (continued)3 Grants and Contributions Paid During the Year or Approved for Future Payment

Recipient If recipient is an individual,show any relationship to

Foundationstatus

Purpose of grant oramount

Name and address (home or business)any foundation manageror substantial contributor recipient

contribution

a Paid during the year

Total . . . . . . . . . . . . . . . . . . . . . ► 3a

b Approved for future payment

Total. ► 3b lForm 990-PF (2010)

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Form 990-PF (2010) Page 12

Analysis of Income-Producing Activities

Enter gross a'-c .- _ otherwise indicated. Unrelated business income Excluded by section 512, 513, or 514 (e)

evenue:

(a)Business code

(b)Amount

(c)Exclusion code

(d)Amount

Related or exemptfunction income(See page 28 ofthe instructions.)

=--d contracts from government agencies

.-.. _-" : dues and assessments .

savings and temporary cash investments

=-S and interest from securities . . .

l f l t t- oss) rom rea es a e:- :,Lcome or (

_._.' anced property . . . . . . .

:-::mot-financed property . . . . . .

ncome or (loss) from personal property

-astment income . . . . . . . .

: :ss) from sales of assets other than inventory s

-__-e or (loss) from special events . .

__ :-3fit or (loss) from sales of inventory

--- :venue: a

dQ^

=al. Add columns (b), (d), and (e) to

1 =

`_ -"zaf. Add line 12, columns (b), (d), and (e) . . . . . . . . . . . 13

-- s Iheet in line 13 instructions on page 29 to verify calculations.)

Relationship of Activities to the Accomplishment of Exempt Purposes©. Explain below how ea--^ e^ . -y. `or which income is reported in column (e) of Part XVI-A contributed important)y to the

accomplishment of the `_..-=__^ s exempt purposes (other than by providing funds for such purposes). (See page 29 of theinstructions.)

Ov cI L c^ ii (b C w c A r t I L Iv-( o vYl rrv VJ* A-cri Vl r t

^a , V i-J the

r tZi G^ (-i I a C05IC J SC D - Gr/ 1 12^ 1 fr^u

Form 990-PF (2o1 o)

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I

Form 990-PF (201 Q) Page 13

Information Regarding Transfers To and Transactions and Relationships With Noncharitable

1 Did the organization directly or indirectly engage in any of the following with any other organization described Yes No

in section 501(c) of the Code (other than section 501 (c)(3) organizations) or in section 527, relating to politicalorganizations?

a Transfers from the reporting foundation to a noncharitable exempt organization of:

(1) Cash . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . la(l)

(2) Other assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . la(2)

b Other transactions:

(1) Sales of assets to a noncharitable exempt organization . . . . . . . . . . . . . . . . 1b(1) ^cT

(2) Purchases of assets from a noncharitable exempt organization . . . . . . . . . . . . . . 1b(2)

(3) Rental of facilities, equipment, or other assets . . . . . . . . . . . . . . . . . . . 1b(3)

(4) Reimbursement arrangements . . . . . . . . . . . . . . . . . . . . . . . . . 1b(4)

(5) Loans or loan guarantees . . . . . . . . . . . . . . . . . . . . . . . . . . 1b(5) Ile(6) Performance of services or membership or fundraising solicitations I

c Sharing of facilities, equipment, mailing lists, other assets, or paid employees . . . . . . . . . . 1c

d If the answer to any of the above is "Yes," complete the following schedule. Column (b) should always show the fair marketvalue of the goods, other assets, or services given by the reporting foundation. If the foundation received less than fair marketvalue in any transaction or sharing arrangement, show in column (d) the value of the goods, other assets, or services received.

(a) Name of or anization (b) Type oforgan ion (c) Description o onship

Un ies of perjury, I declare that I have examined this return,

Sign ief, it is true, rrect, and complete Declaration of preparer (other than

Here 'lure of office stee

PaidnntlType preparer's a Preparer's signatu

PreparerUse Only Firm's name ►

Firm's address ►

N

2a Is the toundatlon alrectly or Inalrectly arriiiatea witn, or relatea 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? . . . . . . . q Yes q Nob If "Yes," complete th -followinq schedule.

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MeyerStation, Inc., a 501©3 Corporation, 52-14930121600 MeyerStation Road, Odenton, MD 21113-2306

For Fiscal Year 10/1/2010 to 9/30/2011

Supplemental Schedule #1Part 1, Line 10c, Form 990-PF

Contributor Name AmountHunter Safety Organization $ 175,00National Wild Turkey Organization 1,000.00Buz Meyer 300.00Daniel Meyer 1,000.00Christopher Vincent 50.00Boy Scout Troop 873 50.00Boy Scout Troop 725 50.00

Total $2,625.00

Supplemental Schedule #2Part 1, Line 11, Form 990-PF

There have been unsolicited, voluntary donations of small amounts though the year byappreciative participants (they pay no charge for their attendance). There were eleven donationstotaling $2625.00 towards required maintenance. There were seven donations totaling $1275towards utilities costs and general expenses. The remaining donation income was personalinfusion of cash by Russell G. Meyer and occasional amounts from family and officers as doneover the years since 1987 (a total of ten donations for current fiscal year). There have been nocharges or requests for donation from groups or individuals visiting or utilizing the facility byreservation only. Any such donation is purely voluntary by the attendees Total of all voluntarycontributions for this fiscal year was $2,175.00.

Supplemental Schedule #3Part 1 , Line 23, Form 990-PF

Other expenses:Internet Website $273-Membership Fees (Conservation Associations) 60Subscriptions (Nature and Conservation) 40Seed for Habitat for food, both distributed and grown 211Gasoline for Tractor 312Repairs and Maintenance of equipment and building 2289Printing (Handouts) and Miscellaneous Office Purchases 25Insurance 910Electricity 848Postage 8Bank charges 6Rental 1250State permits, tax and licenses 100

Total $6332

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Supplemental Schedule #4Part VII-A, Line 8b, Form 990-PF

A complete copy of this return has been sent to:Attorney General of Maryland,200 St. Paul Place,Baltimore, MD 21202 Attn: Charitable Organization Oversights