Professional Documents
Culture Documents
Form 990-P F
~~
, and ending
Name of foundation
26-0344869
712
2013
Do not enter Social Security numbers on this form as it may be made public.
Room/suite
336-497-1854
City or town, state or province, country, and ZIP or foreign postal code
27403
NC
GREENSBORO
D Initial return
Final return
change
Address
lt
~~ r-
~ LA
F-7
II.
; 1
~~
9,324,404
Part I
1
2
3
4
5a
w
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a)
re
b
6a
b
7
8
9
10a
b
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as
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E
-0
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c
(a
0)
c
.47
.
E
a)
11
12
13
14
15
16a
b
c
17
18
19
20
21
22
23
24
(The total of
amounts in columns (b), (c), and (d) may not necessarily equal
the amounts in column (a) (see instructions).)
(d) Disbursements
for charitable
purposes
(cash basis only)
713,248
157,429
157,429
157,429
Gross rents
Net rental income or (loss)
319,255
2,134,096
319,255
Stmt 4
1,189,932
97,632
189,610
23,425
Stmt 2
Stmt 3
Stmt 5
476,684
157,429
97,632
189,610
23,425
1,250
1,250
5,316
13,517
11,856
59,400
299
90,789
493;094
727,757
1,220,851
11,856
41,127
41,127
41,127
41,127
41,127
41,127
59,400
299
48,480
431,952
727,757
1,159,709
435,557
116,302
Form
990-PF
(2013)
4
5
6
Page 2
End of year
Beginning of year
Balance Sheets
Part II
1
2
3
Cash - non-interest-bearing
Savings and temporary cash investments
Accounts receivable ~~
Less: allowance for doubtful accounts ~~
Pledges receivable ~~
Less: allowance for doubtful accounts ~~
170,116
7,789,109
191,611
9,107,303
191,611
9,107,303
16,059
20,734
4,756
20,734
4,756
7,975,284
9,324,404
9,324,404
3,938
3,938
56,255
56,255
7,971,346
9,268,149
7,971,346
9,268,149
7,975,284
9,324,404
Grants receivable
Receivables due from officers, directors, trustees, and other
disqualified persons (attach schedule) (see
instructions)
7
(0
.6
(0
u)
<
Ill
8
9
10a
b
c
11
~~
12
13
14
Il
;.-.
=.5
17
20
21
22
23
ca
:1
0
i.)
c
24
25
26
Rsp3
a
c
J-
1-
27
28
29
30
31
=a)
(0
0
ci
s'
15
16
18
19
co
cu
70,043
49,309
Stmt 6
)
See Statement 7
Grants payable
Deferred revenue
Loans from officers, directors, trustees, and other disqualified persons
Mortgages and other notes payable (attach schedule)
See Statement 8
)
~~ X
Unrestricted
Temporarily restricted
Permanently restricted
Foundations that do not follow SFAS 117, check here
and complete lines 27 through 31.
~~
Part III
..
1 Total net assets or fund balances at beginning of year - Part II, column (a), line 30 (must agree with
end-of-year figure reported on prior year's return)
2 Enter amount from Part I, line 27a .......................................
3 Other increases not included in line 2 (itemize)
~~ See Statement 9
...................
1
2
3
4
5
6
7,971,346
-30,919
1,327,722
9,268,149
9,268,149
Form
DAA
990-PF (2013)
26-0344869
Page
(a) List and describe the kind(s) of property sold (e.g., real estate,
2-story brick warehouse; or common stock, 200 shs. MLC Co.)
u See Worksheet
b
c
d
e
(e) Gross sales price
a
b
c
d
e
Complete only for assets showing gain in column (h) and owned by the foundation on 12/31/69
(i) F.M.V. as of 12/31/69
a
b
c
d
e
If gain, also enter in Part I, line 7
If (loss), enter -0- in Part I, line 7
3 Net short-term capital gain or (loss) as defined in sections 1222(5) and (6):
If gain, also enter in Part I, line 8, column (c) (see instructions). If (loss), enter -0- in
2 Capital gain net income or (net capital loss)
Part I, line 8
Part V
319,255
-10,116
Qualification Under Section 4940(e) for Reduced Tax on Net Investment Income
(For optional use by domestic private foundations subject to the section 4940(a) tax on net investment income.)
If section 4940(d)(2) applies, leave this part blank.
7 Yes _3c1 No
Was the foundation liable for the section 4942 tax on the distributable amount of any year in the base period?
If "Yes," the foundation does not qualify under section 4940(e). Do not complete this part.
1 Enter the appropriate amount in each column for each year; see the instructions before making any entries.
(a)
Base period years
Calendar year (or tax year beginning in)
(b)
Adjusted qualifying distributions
2012
2011
2010
2009
2008
(d)
Distribution ratio
(col. (b) divided by col. (c))
(c)
Net value of noncharitable-use assets
575,906
381,194
292,380
251,092
146,520
7,615,871
6,689,761
356,981
402,139
215,076
0.075619
0.056982
0.819035
0.624391
0.681248
2.257275
0.451455
4 Enter the net value of noncharitable-use assets for 2013 from Part X, line 5
8,744,189
3,947,608
4, 356
3 I 951 , 964
8
8 Enter oualifvina distributions from Part XI I, line 4
If line 8 is equal to or greater than line 7, check the box in Part VI, line 1 b, and complete that part using a 1% tax rate. See the
1 I 159 I 709
Part VI instructions.
Form
DAA
990-P F (2013)
Part VI
26-0344869
Page
Excise Tax Based on Investment Income (Section 4940(a), 4940(b), 4940(e), or 4948 see instructions
la
8 711
c All other domestic foundations enter 2% of line 27b. Exempt foreign organizations enter 4% of
2
3
4
5
6
Credits/Payments:
6a
a 2013 estimated tax payments and 2012 overpayment credited to 2013
6b
b Exempt foreign organizations tax withheld at source
6c
c Tax paid with application for extension of time to file (Form 8868)
6d
d Backup withholding erroneously withheld
Tax Paid w/ O.R.
7 Total credits and payments. Add lines 6a through 6d
X if Form 2220 is attached
Enter any penalty for underpayment of estimated tax. Check here
8
Tax due. If the total of lines 5 and 8 is more than line 7, enter amount owed
9
Overpayment. If line 7 is more than the total of lines 5 and 8, enter the amount overpaid
10
Enter the amount of line 10 to be: Credited to 2014 estimated tax ~~
11
Part VII-A
0
8 711
0
2
3
4
5
8 711
3,800
4,928
Refunded
~~
~~
~~
8,728
17
7
8
9
10
11
Yes
During the tax year, did the foundation attempt to influence any national, state, or local legislation or did it
participate or intervene in any political campaign?
b Did it spend more than $100 during the year (either directly or indirectly) for political purposes (see
Instructions for the definition)?
If the answer is "Yes" to la or lb, attach a detailed description of the activities and copies of any materials
published or distributed by the foundation in connection with the activities.
2
3
7
8a
1b
Enter the reimbursement (if any) paid by the foundation during the year for political expenditure tax imposed
on foundation managers. ~~ $
Has the foundation engaged in any activities that have not previously been reported to the IRS?
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?
Was there a liquidation, termination, dissolution, or substantial contraction during the year?
5
6
lc
No
la
N/A
4b
5
6
7
X
X
8b
NC
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
Is the foundation claiming status as a private operating foundation within the meaning of section 49420)(3) or
9
4942(j)(5) for calendar year 2013 or the taxable year beginning in 2013 (see instructions for Part XIV)? If "Yes,"
10
DAA
X
990-PF (2013)
10
Form
Part VII-A
Page 5
11
At any time during the year, did the foundation, directly or indirectly, own a controlled entity within the
meaning of section 512(b)(13)? If "Yes," attach schedule (see instructions)
12
Did the foundation make a distribution to a donor advised fund over which the foundation or a disqualified
person had advisory privileges? If "Yes," attach statement (see instructions)
13
Did the foundation comply with the public inspection requirements for its annual returns and exemption application?
Website address ~~ www.f4dc.org
14 The books are in care of ~~ MARNIE THOMPSON
Telephone no.
~~
15
16
GREENSBORO
Located at
Section 4947(a)(1) nonexempt charitable trusts filing Form 990-PF in lieu of Form 1041 Check here
and enter the amount of tax-exempt interest received or accrued during the year
NC
ZP+4
11
12
13
~~ 336-275-1781
~~ 27403
~~
~~115I
Yes
At any time during calendar year 2013, did the foundation have an interest in or a signature or other authority
over a bank, securities, or other financial account in a foreign country?
No
16
See the instructions for exceptions and filing requirements for Form TD F 90-22.1. If "Yes," enter the name of
the foreign country ~~
Part VII-B
File Form 4720 if any item is checked in the "Yes" column, unless an exception applies.
I a During the year did the foundation (either directly or indirectly):
(1) Engage in the sale or exchange, or leasing of property with a disqualified person?
(2) Borrow money from, lend money to, or otherwise extend credit to (or accept it from) a
disqualified person?
(3) Furnish goods, services, or facilities to (or accept them from) a disqualified person?
(4) Pay compensation to, or pay or reimburse the expenses of, a disqualified person?
(5) Transfer any income or assets to a disqualified person (or make any of either available for
the benefit or use of a disqualified person)?
(6) Agree to pay money or property to a government official? (Exception. Check "No" if the
foundation agreed to make a grant to or to employ the official for a period after
termination of government service, if terminating within 90 days.)
b If any answer is "Yes" to 1a(1)(6), did any of the acts fail to qualify under the exceptions described in Regulations
section 53.4941(d)-3 or in a current notice regarding disaster assistance (see instructions)?
Yes
11 Yes
No
No
Yes
Yes
Yes
IX
Yes
Yes
rk No
No
IX No
No
No
1b
ILJ
were not corrected before the first day of the tax year beginning in 2013?
Taxes on failure to distribute income (section 4942) (does not apply for years the foundation was a private
operating foundation defined in section 4942(j)(3) or 4942(j)(5)):
a At the end of tax year 2013, did the foundation have any undistributed income (lines 6d and
N/A
lc
Yes
j No
, 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) to
N/A
all years listed, answer "No" and attach statement see instructions.)
c If the provisions of section 4942(a)(2) are being applied to any of the years listed in 2a, list the years here.
3a
2b
, 20
, 20
, 20
~~20
Did the foundation hold more than a 2% direct or indirect interest in any business enterprise
Yes
No
disqualified persons after May 26, 1969; (2) the lapse of the 5-year period (or longer period approved by the
Commissioner under section 4943(c)(7)) to dispose of holdings acquired by gift or bequest; or (3) the lapse of
the 10-, 15-, or 20-year first phase holding period? (Use Schedule C, Form 4720, to determine if the
foundation had excess business holdings in 2013.)
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 2013?
3b
4a
4b
Form
DM
990-PF (2013)
Part VII-B
5a
2 6- 03 4 4 8 6 9
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))?
(2) Influence the outcome of any specific public election (see section 4955); or to carry on,
directly or indirectly, any voter registration drive?
(3) Provide a grant to an individual for travel, study, or other similar purposes?
(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 instructions)
(5) Provide for any purpose other than religious, charitable, scientific, literary, or educational
purposes, or for the prevention of cruelty to children or animals?
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 instructions)?
Organizations relying on a current notice regarding disaster assistance check here
If the answer is "Yes" to question 5a(4), does the foundation claim exemption from the tax
because it maintained expenditure responsibility for the grant?
If "Yes," attach the statement required by Regulations section 53.4945-5(d).
Did the foundation, during the year, receive any funds, directly or indirectly, to pay premiums
on a personal benefit contract?
Did the foundation, during the year, pay premiums, directly or indirectly, on a personal benefit contract?
7a
b
6a
Part VIII
Page
Statements Regarding Activities for Which Form 4720 May Be Required (continued
LX
Yes
No
Yes
Yes
X
X
No
No
Yes
Yes
ljt
Yes
Yes
No
No
5b
6b
No
Yes
No
No
N/A
Information About Officers, Directors, Trustees, Foundation Managers, Highly Paid Employees,
and Contractors
7b
1 List all officers, directors, trustees, foundation managers and their compensation (see instructions).
(b) Title, and average
hours per week
devoted to position
MARN I E THOMPSON
620 SOUTH ELM STREET STE 35
ED WHITFIELD
620 SOUTH ELM STREET STE 35
GREENSBORO
NC 27403
GREENSBORO
NC 27403
COMNGNG DIR
20.00
C0MNGNG DIR
32.00
(c) Compensation
(If not paid,
enter -0-)
(d) Contributions to
employee benefit
plans and deferred
compensation
48,816
48,816
Compensation of five highest-paid employees (other than those included on line 1 see instructions). If none, enter
"NONE."
(a) Name and address of each employee paid more than $50,000
(c) Compensation
(d) Contributions to
employee benefit
plans and deferred
compensation
NONE
DAA
0
990-PF (2013)
11442 07/25/2016
a 17 PM
Part VIII
3
Page 7
Information About Officers, Directors, Trustees, Foundation Managers, Highly Paid Employees,
and Contractors (continued)
Five highest-paid independent contractors for professional services (see instructions). If none, enter "NONE."
(a) Name and address of each person paid more than $50,000
(c) Compensation
NONE
Part IX-A
List the foundation's four largest direct charitable activities during the tax year. Include relevant statistical information such as the number of
organizations and other beneficiaries served, conferences convened, research papers produced, etc.
1
Expenses
Part IX-B
Describe the two largest program-related investments made by the foundation during the tax year on lines 1 and 2.
1
Amount
N/A
DAA
990-PF (2013)
Page 8
Part X
1
a
b
c
d
e
2
Fair market value of assets not used (or held for use) directly in carrying out charitable, etc.,
purposes:
Average monthly fair market value of securities
Average of monthly cash balances
Fair market value of all other assets (see instructions)
Total (add lines 1a, b, and c)
Reduction claimed for blockage or other factors reported on lines 1a and
1c (attach detailed explanation)
Acquisition indebtedness applicable to line 1 assets
le
la
1b
lc
ld
8 , 792 , 823
84,526
0
8 , 877, 349
2
3
8 , 877 , 349
3
4
4
5
6
133,160
8 , 744 , 189
437,209
~~
2b
c
3
4
5
6
7
2c
3
4
5
line 1
Part XII
1
a Expenses, contributions, gifts, etc. total from Part I, column (d), line 26
b Program-related investments total from Part IX-B
Amounts paid to acquire assets used (or held for use) directly in carrying out charitable, etc.,
2
la
1b
purposes
Amounts set aside for specific charitable projects that satisfy the:
3
a Suitability test (prior IRS approval required)
b Cash distribution test (attach the required schedule)
Qualifying distributions. Add lines la through 3b. Enter here and on Part V, line 8, and Part XIII, line 4
4
Foundations that qualify under section 4940(e) for the reduced rate of tax on net investment income.
5
1 1 159 709
3a
3b
4
1 , 159 , 709
5
6
1 , 159 , 709
Form
DAA
990-PF (2013)
Part XIII
Page 9
line 7
Undistributed income, if any, as of the end of 2013:
Corpus
(I))
Years prior to 2012
(c)
(d)
2012
2013
a From 2008
b From 2009
From 2010
d From 2011
e From 2012
f Total of lines 3a through e
Qualifying distributions for 2013 from Part XII,
4
1,159,709
line 4: $
a Applied to 2012, but not more than line 2a
b Applied to undistributed income of prior ye ars
(Election required see instructions)
Treated as distributions out of corpus (Ele ction
required see instructions)
d Applied to 2013 distributable amount
e Remaining amount distributed out of corp US
Excess distributions carryover applied to 2013
5
(If an amount appears in column (d), the same
amount must be shown in column (a).)
1,159,709
indicated below:
a Corpus. Add lines 3f, 4c, and 4e. Subtract line 5
b Prior years' undistributed income. Subtract
line 4b from line 2b
c Enter the amount of prior years' undistributed
income for which a notice of deficiency has
been issued, or on which the section 4942(a)
1,159,709
instructions
Undistributed income for 2013. Subtract li nes
4d and 5 from line 1. This amount must be
distributed in 2014
Amounts treated as distributions out of co rpus
to satisfy requirements imposed by sectio n
170(b)(1)(F) or 4942(g)(3) (see instruction s)
Excess distributions carryover from 2008 not
Analysis of line 9:
Excess from 2009
b
c
d
e
DAA
990-PF
(2013)
Part XIV
Page 10
If the foundation has received a ruling or determination letter that it is a private operating
foundation, and the ruling is effective for 2013, enter the date of the ruling
Xi 4942(j)(3) or
b Check box to indicate whether the foundation is a private o peratin g foundation described in section
Prior 3 years
Tax year
2a Enter the lesser of the adjusted net
(d)2010
(c)2011
(a)2013
(b)2olz
income from Part I or the minimum
1a
06/05/07
4942(0(5)
le) rou
116,302
98,857
82,035
69,730
57,166
48,591
21
18
255,524
217,196
1,159,709
575,906
381,194
292,380
2,409,189
728,924
226,096
193,658
145,578
1,294,256
430,785
349,810
187,536
146,802
1,114,933
291,473
253,863
222,992
11,899
780,227
b 85% of line 2a
c Qualifying distributions from Part XII,
Part XV
1
Supplementary Information (Complete this part only if the foundation had $5,000 or more in assets at
any time during the year - see instructions.)
N/A
b List any managers of the foundation who own 10% or more of the stock of a corporation (or an equally large portion of the
ownership of a partnership or other entity) of which the foundation has a 10% or greater interest.
N/A
2
a The name, address, and telephone number or e-mail address 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:
See Statement 10
See Statement 11
d Any restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other
factors:
See Statement
DAA
12
Form
990-PF (2013)
Page
Part XV
Recipient
Name and address (home or business)
a
If recipient is an individual,
show any relationship to
any foundation manager
or substantial contributor
Foundation
status of
recipient
Purpose of grant or
contribution
11
Amount
SEE ATTACHED
SEE ATTACHED
SEE ATTACHED NC 27609
Total
Approved for future payment
SEE ATTACHED
727,757
~~ 3a
727,757
N/A
Total
DAA
~~3b
Form
Grantee
Address
Type
Purpose
Amount
Date
Awarded
$2,000.00 03/17/13
$25,000.00 5/15/2013
$7,500.00 6/19/2013
$15,000.001 09/06/13
$3,000.00.
$25,000.001
$15,000.00 . 12/09/13
$15,000.00 12/11/2013
$10,000.00 12/11/2013
$10,000.00 12/18/13
$10,000.00 12/18/13
$15,000.00 12/18/2013
$10,000.00! 12/18/13
$50,000.00
Cooperation Texas
Highlander Center
Federation of Southern Cooperatives
Renaissance Community Cooperative (F4DC is fiscal
sponsor)
Campaign for Southern Equality
Hispanic Liaison of Chatham County
EDINA/GEO
Interactive Resource Center
Coped (Inquiring Systems, Inc is fiscal sponsor)
YWCA
Student Action with Farmworkers
$5,000.00 1/16/2013
$5,000.00 10/15/2013
11/15/13
12/18/13
$10,000.00 12/19/13
$50,000.001 12/19/13
$343,292.00 1/3/2014
$5,000.00 08/21/13
Matching
Matching
Matching
Matching
$2,135.00 09/06/13
$2,500.00 9/17/2013
$1,007.00 09/25/13
$5,000.00 12/18/13
Matching
Matching
Matching
Matching
$3,565.00
$14,314.28
$5,000.00
12/20/13
12/20/13
12/28/13
$2,305.00
$500.00
01/24/13
-$479.33
02/27/13
$250.00
$2,500.00
03/14/13
03/14/13
Reading Connections
Face to Face
$200.00
$250.00
03/14/13
04/03/13
$100.00
05/01/13
$500.00
06/11/13
$50.00
06/11/13
$250.00
06/26/13
$1,000.00
07/23/13
$160.00
$250.00
07/30/13
08/21/13
$250.00
08/28/13
SponsorshipReWeaving NC conference
$250.00
09/17/13
$355.74
09/19/13
$1,275.00
10/02/13
$1,200.00
10/02/13
$350.00.
10/30/13
$500.00
11/14/13
$727,757/3.
Page
12
Part XVI-A
(c)
Exclusion
code
(b)
Amount
le)
Related or exempt
function income
(See instructions.)
(d)
Amount
157,429
319,255
11 0 her revenue: a
b
d
e
12 S ibtotal. Add columns (b), (d), and (e)
13 Total. Add line 12, columns (b), (d), and (e)
(See worksheet in line 13 instructions to verify calculations.)
Part XVI-B
Line No.
V
476,684
476,684
13
N/A
Form
DAA
990-PF (2013)
Page 13
Part XVII
1 Did the organization directly or indirectly engage in any of the following with any other organization described
in section 501(c) of the Code (other than section 501(c)(3) organizations) or in section 527, relating to political
organizations?
a Transfers from the reporting foundation to a noncharitable exempt organization of:
No
Yes
(1) Cash
(2) Other assets
b Other transactions:
(1) Sales of assets to a noncharitable exempt organization
1a(1)
1a(2)
1b(1)
1 b(2)
1 b(3)
1 b(4)
1 b(5)
1 b(6)
1c
value in any transaction or sharing arrangement, show in column (d) the value of the goods, other assets, or services received
(a) Line no.
N/A
2a Is the foundation directly or indirectly affiliated with, or related to, one or more tax-exempt organizations
described in section 501(c) of the Code (other than section 501(c)(3)) or in section 527?
b If "Yes." com p lete the followin g schedule.
(a) Name of organization
Yes
No
N/A
Sign
Here
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true,
correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.
May the IRS discuss this return
with the preparer shown below
(see instructions)? [Xi Yes I
PRESIDENT
I
Signature of officer or trustee
Print/Type preparer's name
Paid
CHUCK AVERRE
Preparer
Hollingsworth
Firm's name
Use Only
~~
Date
Title
Preparer's signature
Date
07/25/16
CHUCK AVERRE
Check 1 . if
self-employed
PTIN
Firm's EIN
Phone no_
P00280366
~~ 56-2119415
919-848-4100
Form
DM
No
990-PF
(2013)
Schedule B
(Form 990, 990-EZ,
or 990-PF)
Department of the Treasury
Internal Revenue Service
Schedule of Contributors
~ Attach to Form 990, Form 990-EZ, or Form 990-PF.
~ Information about Schedule B (Form 990, 990-EZ, 990-PF) and its instructions is at www.irs,gov/form990.
2013
26-0344869
Section:
501(c)(
~~ $
Caution. An organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer "No" on Part IV, line 2, of its Form 990; or check the box on line H of its Form 990-EZ or on its
Form 990-PF, Part I, line 2, to certify that it does not meet the filing requirements of Schedule B (Form 990, 990-EZ, or 990-PF).
For Paperwork Reduction Act Notice, see the Instructions for Form 990, 990-EZ, or 990-PF.
DAA
Page
Part I
26-0344869
Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
(c)
Total contributions
(b)
Name, address, and ZIP + 4
(a)
No.
W
Name of organization
(d)
Type of contribution
Person
AURORA ROAD
P 0 BOX 46730
BEDFORD HEIGHTS
OH
713,248
44146
Payroll
Noncash
(Complete Part II for
noncash contributions.)
(a)
No.
(c)
Total contributions
(b)
Name, address, and ZIP + 4
Person
Payroll
Noncash
(Complete Part II for
noncash contributions.)
(a)
No.
(c)
Total contributions
(b)
Name, address, and ZIP + 4
(c)
(b)
Name, address, and ZIP + 4
Total contributions
(c)
(b)
Name, address, and ZIP + 4
Total contributions
(c)
(b)
Name, address, and ZIP + 4
(d)
Type of contribution
Person
_I
Payroll
Noncash
(Complete Part II for
noncash contributions.)
(a)
No.
(d)
Type of contribution
Person
Payroll
Noncash
(Complete Part II for
noncash contributions.)
(a)
No.
(d)
Type of contribution
Person
Payroll
I_
Noncash
(Complete Part II for
noncash contributions.)
(a)
No.
(d)
Type of contribution
Total contributions
(d)
Type of contribution
Person
Payroll
I
1
Noncash
_
(Complete Part II for
noncash contributions.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2013)
DAA
7/25/2016 5:17 PM
7/25/2016 5:17 PM
Statements
$
$
1,250
1,250
$
$
Charitable
Purpose
Adjusted
Net
Net
Investment
Total
Description
$
$
1,250
1,250
$
$
Indirect Taxes/Licenses
Total
$
$
5,316
5,316
$
$
Charitable
Purpose
Adjusted
Net
Net
Investment
Total
Description
$
$
$
$
Date
Acquired
Description
Cost
Prior Year
Basis
Depreciation
10/19/07 $
4,664 $
4,664 200DB
WESTERN DIGITAL 250 GB MYBOOK PRO
10/19/07
171
171 200DB
DESK, HUTCH, CHAIR, CABINET, BKCASE, DSKTOP
1/10/08
1,143
888 200DB
SMALL DESK, TABLE
5/01/08
50
39 200DB
LEATHER OFFICE CHAIR
128
10/02/08
100 200DB
HP LASERJET PRINTER
1/14/08
419
395 200DB
1 COMPAC PRESARIO LAPTOPS
2/01/08 1,065
1,003 200DB
500 GB EXTERNAL DRIVE
2/01/08
145
137 200DB
Method
Life
Current Year
Depreciation
Net Investment
Income
5 $
Adjusted Net
Income
$
5
7
102
11
24
62
1 -3
7/25/2016 5:17 PM
Statements
8/02/11
1,947
REFURB COMPAQ LAPTOP
8/31/11
225
REFURB COMPAQ LAPTOP #2
8/31/11
225
PROJECTOR
8/10/11
320
MACBOOK AIR LAPTOP
3/19/12
2,063
BROTHER COLOR LASER PRINTER
5/24/12
357
ADOBE UPGRADE
3/05/12
72
Method
Life
5 $
Net Investment
Income
Current Year
Depreciation
14 $
553
3
3
3
3
3
1,947 200DB
225 200DB
225 200DB
320 200DB
1,238 200DB
330
214 200DB
58
12
46
Adjusted Net
Income
7/25/2016 5:17 PM
Statements
Method
Life
Current Year
Depreciation
3 $
34 $
22
200DB
25
200DB
25
200DB
18
200DB
55
200DB
29
200DB
12
200DB
12
200DB
21
200DB
559
200DB
200DB
12
200DB
40
200DB
5,023
200DB
760
192
Net Investment
Income
Adjusted Net
Income
$
7/25/2016 5:17 PM
Statements
Description
Prior Year
Cost
Depreciation
Basis
Date
Acquired
3 $
178 $
96
200DB
202
200DB
5,012
13,517 $
28,009
Adjusted Net
Income
Net Investment
Income
Current Year
Depreciation
Life
Method
0 $
Description
Date
Acquired
START UP COSTS
Total
6/05/07 $
$
Cost
Basis
Prior Year
Amortization
17,726 $
17,726 $
Current Year
Amortization
Life
15 $
6,598
6,598
Net Investment
Income
1,182
COGS
1,182 $
Adjusted Net
Income
0 $
Description
Expenses
INVESTING & BANKING FEES
OUTSIDE CONTRACTOR SERVICES
OFFICE SUPPLIES
INSURANCE
EVENT FOOD
Net
Investment
Total
$
41,127
28,114
4,091
3,081
2,884
Adjusted
Net
$
41,127
Charitable
Purpose
$
41,127
28,114
4,091
3,081
2,884
3-5
7/25/2016 5:17 PM
Statements
Total
2,546
1,845
1,662
1,652
1,319
535
362
303
56
30
89,607
Adjusted
Net
Net
Investment
$
41,127
41,127
Charitable
Purpose
2,546
1,845
1,662
1,652
1,319
535
362
303
56
30
48,480
Statement 6 - Form 990-PF, Part II, Line 14 - Land, Building, and Equipment
Description
FURNISHINGS
OFFICE EQUIPMENT
COMPUTER EQUIPMENT
SOFTWARE
START UP COSTS
Total
Beginning
Net Book
916
2,782
1,076
157
11,128
16,059
End
Cost / Basis
2,814
$
25,057
20,285
4,161
17,726
70,043
End Accumulated
Depreciation
2,194
$
18,791
16,728
Net
FMV
$
3,816
7,780
49,309
617
6,266
3,561
344
9,946
20,734
5-6
7/25/2016 5:17 PM
Beginning
of Year
Description
DUE FROM RCC
Total
$
$
End of
Year
0
Fair Market
Value
$
$
4,756
4,756
$
$
4,756
4,756
Beginning
of Year
Description
DEPOSITS - SPONSORSHIPS
CREDIT CARD BALANCE
LOAN - COMMUNITY FOUNDATION
Total
End of
Year
2,313
1,625
3,938
3,308
2,947
50,000
56,255
Description
UNREALIZED GAIN ON INVESTMENTS
Total
Amount
$
$
1,327,722
1,327,722
Statement 10 - Form 990-PF, Part XV, Line 2b - Application Format and Required Contents
Description
GRANT APPLICANTS MUST COMPLETE THE GRANT APPLICATION
AVAILABLE ONLINE AT WWW.F4DC.ORG .
Statement 11 - Form 990-PF, Part XV, Line 2c - Submission Deadlines
Description
F4DC ACCEPTS GRANT APPLICATIONS ON A ROLLING BASIS.
INTERESTED PARTIES SHOULD CONSULT WWW.F4DC.ORG TO LEARN
MORE ABOUT OUR GRANT GUIDELINES.
Statement 12 - Form 990-PF, Part XV, Line 2d - Award Restrictions or Limitations
Description
F4DC CONCENTRATES ITS GRANTMAKING IN THE SOUTHEASTERN US,
WITH PARTICULAR INTEREST IN THE NORTH CAROLINA PIEDMONT.
OUR FOCUS IS ON PROJECTS AND PROGRAMS THAT NURTURE
GRANTEES MUST SIGN A GRANT
GRASSROOTS DEMOCRACY.
AGREEMENT FORM STATING THAT THE GRANT WILL BE USED FOR THE
PURPOSE INTENDED. OTHER GUIDELINES ARE LAID OUT IN A
DOWNLOADABLE DOCUMENT TITLED "MATCHING GRANT
INFORMATION PACKET" AT WWW.F4DC.ORG .
7-12
Form
4562
2013
(99)
Attachment
Sequence No.
179
Identifying number
26-0344869
Indirect Depreciation
Election To Expense Certain Property Under Section 179
Note: If you have any listed property, complete Part V before you complete Part I.
Part I
Reduction in limitation. Subtract line 3 from line 2. If zero or less, enter -0Dollar limitation for tax year. Subtract line 4 from line 1. If zero or less, enter -0-. If ma tied filing separately, see instructions
5
6
7
8
9
10
11
8
9
10
11
12
Business income limitation. Enter the smaller of business income (not less than zero) or line 5 (see instructions)
Section
179 expense deduction. Add lines 9 and 10, but do not enter more than line 11
12
~ 1 13
Carryover
of disallowed deduction to 2014. Add lines 9 and 10, less line 12
13
Note: Do not use Part II or Part III below for listed property. Instead, use Part V.
Special Depreciation Allowance and Other Depreciation (Do not include listed property.)
Part II
2,000 000
500 000
1
2
3
4
5
1
2
3
4
See instructions.
Special depreciation allowance for qualified property (other than listed property) placed in service
14
15
16
Part III
14
15
16
9,688
17
984
174
17
MACRS deductions for assets placed in service in tax years beginning before 2013
18
If you are electing to group any assets placed in service during the tax year into one or more general asset accounts, check here
~n
Section BAssets Placed in Service During 2013 Tax Year Using the General Depreciation System
(a) Classification of property
19a
b
c
d
e
f
g
h
i
3-year property
5-year property
7-year property
10-year property
15-year property
20-year property
25-year property
Residential rental
property
9,156
172
(d) Recovery
period
(e) Convention
MQ
MQ
5.0
7.0
25 yrs.
27.5 yrs.
MM
MM
MM
27.5 yrs.
39 yrs.
Class life
b 12-year
c 40-year
Part IV
23
12 yrs.
1,641
30
200DB
200DB
S/L
S/L
40 yrs.
Summary
MM
S/L
S/L
S/L
(See instructions.
21
and on the appropriate lines of your return. Partnerships and S corporationssee instructions
22
13 517
For assets shown above and placed in service during the current year, enter the
DAA
S/L
S/L
Nonresidential real
property
MM
S/L
Section CAssets Placed in Service During 2013 Tax Year Using the Alternative Depreciation System
20a
21
22
(f) Method
23
Form
4562 (2013)
Part V
Page
Listed Property (Include automobiles, certain other vehicles, certain computers, and property used for
entertainment, recreation, or amusement.)
Note: For any vehicle for which you are using the standard mileage rate or deducting lease expense, complete only 24a,
24b, columns (a) through (c) of Section A, all of Section B, and Section C if applicable.
Section ADepreciation and Other Information (Caution: See the instructions for limits for passenger automobiles.)
24a
Yes
(a)
Type of property
(list vehicles first)
(b)
Date placed
in service
(c)
Business/
investment use
percentage
(d)
No
(e)
Basis for depreciation
(business/investment
use only)
25
Special depreciation allowance for qualified listed property placed in service during
26
the tax year and used more than 50% in a qualified business use (see instructions)
Property used more than 50% in a q ualified business use:
27
(9)
Method/
Convention
Recovery
period
S/L-
S/L-
Add amounts in column (h) lines 25 through 27. Enter here and on line 21, page 1
29
Add amounts in column (i), line 26. Enter here and on line 7, page 1
(i)
Elected section 179
cost
Depreciation
deduction
25
28
Yes
(h)
28
I 29
31
32
33
34
35
36
miles driven
Total miles driven during the year. Add
lines 30 through 32
Was the vehicle available for personal
use during off-duty hours?
Was the vehicle used primarily by a more
than 5% owner or related person?
Is another vehicle available for personal use?
(a)
(b)
(c)
(d)
(e)
(f)
Vehicle 1
Vehicle 2
Vehicle 3
Vehicle 4
Vehicle 5
Vehicle 6
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Section CQuestions for Employers Who Provide Vehicles for Use by Their Employees
Answer these questions to determine if you meet an exception to completing Section B for vehicles used by employees who are not
more than 5% owners or related persons (see instructions).
37
Do you maintain a written policy statement that prohibits all personal use of vehicles, including commuting, by
38
your employees?
Do you maintain a written policy statement that prohibits personal use of vehicles, except commuting, by your
employees? See the instructions for vehicles used by corporate officers, directors, or 1% or more owners
39
40
41
Part VI
Amortization
(a)
Description of costs
(b)
Date amortization
begins
(c)
(d)
Amortizable amount
Code section
42
Amortization of costs that begins during your 2013 tax year (see instructions):
43
44
DAA
(e)
Amortization
period or
percentage
(t)
Amortization for this year
1 182
43
44
Form
1 182
4562 (2013)