9'9q-f'f return of private...
TRANSCRIPT
9'9Q-F'F Return of Private Foundation Foam or Section 4947(a)(1) Nonexempt Charitable Trust
Department of the Treasury Treated as a Private Foundation inieiriai Revenue Samce Note The organization may be able to use a copy of this return to satisfy stale reporting recur
For calendar ear 2001, or tax ear be innin , 2001, and ending
G Check all that apply Initial return Final return Amended return Address Name of organization I
1
change I I Name chain A Employer identification number
Use lheIRS label
Otherwise print
or type See Specific Instructions
no-GVCCJIC
Room/suite B Telephone number (see page 10 01 the instructions)
336 835-5105 C if exemption application is
pending check here D 1 Foreign orgam:mona once here
3 Foreign organizations meeting the esx test Check here and arach computation
,
City or town, stale, and ZIP code
H Check type of organization I x I Section 501(c)(3) exempt private foundation
- E I'Pfl
" ate lounamnn sumo was termimiea under secwn Sm(i check nne 1 O
F n me ronemion n m a Amnm teimmm under secmn5o7(o)(1)(B)Chock nere
(c) Adjusted net (d) disbursements
for cnanlable income purposes
1 contribution ft gams et'
~eceHeaIsmcnsmeamq
ChecN ~ ~I lie fourWanon is not required to attach Son B
Z Distributions from split-interest trusts
3 Interest on savings and temporary cash Investments
4 Dividends and interest from securities
Sa Gross rents
y b (Net rental income a (loss)
6 a Nel gain or (toss) Train sale of assets not on line 10 b Gross ales price for all
y assets on line 6a 50,519
7 Capital gain net income (from Part IV, line 2)
e Net short-term capital gain
9 Income modifications 10a Gross sales less returns
and aVmvances ~---b Less Cosh of goods sold
c Gross profit or (loss) (attach schedule)
71 Other income (attach schedule)
1 3 Compensation of officers directors trustees etc
14 Other employee salaries and wages
15 Pension plans, employee benefits
J x 16a Legal lees (attach schedule) b Accounting tees (attach uhedule)
7 c Other professional fees (attach schedule)
C .~.. 17 Interest h ~J,J c 1 B Tares (anach schedule) (vee gape Tit of dxTfl7lCcte3s)
19 Depreciation (attach schedule) and depletion a 20 Occupancy
21 Travel, conferences;, and meetings m -.r.
d'SFA1rU1 line 12
a Ucesa of revenue over <.v<nae
.
aria aheunememe -29 b Net investment income (il negaIrve, enter-O-)
c Adjusted net income (d negaUve, enter -0.)
IE trio 7 00o For Paperwork Reduction Act Nonce, see the instructions
GCBORH 14285 05/09/2002 16 21 42
Foam 990-PF (2001)
Number and street (or P O box number d mail is not delivered to street address)
I Fair market value of all assets al end J Accounting method U Cash U Accrual of year ()-om Part 11 cot (c), fine Q Other (specify) i 6 . 996 , 527 (Part l, column (d) must be on cash basis ) ~~ Analysis of Revenue and Expenses
(The total 01 amounts in columns It), (c) and (a) Revenue and (b) Net investment (of may not necessarily equal the amounts in expenses ver income column /al (see nacre 10 0/ the instructions) 1 books
faftach schedule) $'1'MT 4 S_'[hngT VI
4 Total operatin a?Id administrative expenses
,V
Ml
lirp~yy thro8h 23 LUCK. 1
5 ribuuonsgiQS, grants paid
z
~ 24 Unrestricted
rv 25 Temporarily restricted
m 26 Permanently restricted
c Organizations that do not follow SFAS 117, ,3 check here and complete lines 27 through 31 v- X
0 27 Capital stock, trust principal, or current funds
d 28 Paid in of capital surplus or land bidg and equipment fund
,~ 19 Retained earnings accumulated income endowment or other funds
30 Total net assets or fund balances (see page 17 0l the 1 Z instructions)
31 Total liabilities and net assets/fund balances (see page 17 of
the instructions)
Analysis of Changes in Net Assets or Fund Balances
Ju I E1420 7 000
GCBORH 14285 05/09/2002 12 38 44
Attached description
and amounts in the Be loom of ~Balance sfleet5 aescnotioncolumn should .belo,
1 Cash -non-mteresi bearing
2 Savings and temporary cash investments
7 Accounts receivable ll~
Less allowance for doubtful accounts
4 Pledges receivable
Less allowance for doubtful accounts
5 Giants receivable
6 Recervables due bolo officers directors trustees and other
disqualified persons fir schedule) (see page 15 of the instructions)
7 Other holes and loans receivable (attach schedule) Ill'i
Less allowance for doubtful accounts
e Inventories for sale or use
9 Prepaid expenses and deterred charges
10 a Inveslmenis U 5 and state government obligations (attach schedule)
b Investments - corporate stock (attach schedule) $'jTJ'K $
c Investments - corporate bands (attach schedule) ~ ~ Investments land buildings 10
and equipment bass ___________________ Less accumulated depreciation (attach schedule)
12 Investments - mortgage loans
11 Investments - other (attach schedule) 74 Land buildings and
equipment basis ___________________ Less accumulated deprttiaiion 1 (attach wnedule) _ _ _ _ _ _ _ _
15 Other assets (describe 1 )
16 Total assets (lo be completed by all tilers see page 16 0l
17 Accounts payable and accrued expenses
18 Grants payable
y 19 Deterred revenue
20 Loans from officers directors trustees and other d:squalffled persons
m 27 Mortgages and other holes payable (attach schedule)
J 42 Other liabilities (describe 1 )
Organizations that follow SFAS 117, check here " L_ and complete lines 24 through 26 and lines 30 and 31
t Total net assets or fund balances al beginning of year - Part II, column (a), line 30 (must agree with end-of-yeas figure reported on prior years return) 1 966
z Enter amount from Part I, line 27a 2 -29 3 Other increases not included in line 2 (itemize) " 3 a Add lines 1 2 and 3 4 936 5 Decreases not included m line 2 (rtemrze) " I 5 I
Farm 990-P F (2001 )
(I) Gains (Col (h) gain minus cot (k), but not less than -0.) or
Losses (from cot (h))
If gain, also enter in Part I, line 7 2 Capital gain net income or (net capital loss) { 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 B, column (c) (see pages 13 and 17 of the instructions) If llnaal nn1or -n- . . Port 1 Inn 0.
Was the organization liable for the section 4942 lax on the distributable amount of any year in the base period? F_]Yes Fx~ No If 'Yes, the orga ni zation does not qualify under sectio n 4940(e) Do not complete this part
1 Enter the appropriate amount in each column for each year see page 18 of the instructions before making any entries
a Base period years Calendar year
(b) (~) I Distribution ratio
225
7 Add lines 5 and 6
8 Enter qualifying distributions from Part XII, line 4 1 8 1 51,000 II line 8 is equal to or greater than line 7 chMN Ire on. ,n Pan VI line lb and rnmplete that part using a 7% tax rate See the Pan VI instructions on edge 18
JSR
e 1430 3 000 Form 990-P F ( 2001) GCBORH M285 05/09/2002 12 38 44
Form 990 PF (20q1 56-
Capital Gams and Losses for Tax on Investment Income
' (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 )
1a SEE PART IV SCHEDULE
b
c
d
e
(e) Gross sales pace (f) Depreciation allowed (g) Cosl or other basis (of allowable) plus expense of sale
a
d
Dmplete only for assets showing gain in column (h) and owned b the foundation on 12/31
(i) F M V as of 12/31/69 U) Adjusted basis (k) Excess of cot (i) as of 12131/69 over tot 0) it any
a
3
(c) Date acquned (d) Date sold acquired qacnasel (mo day yr ) (mo , day yr ~
(h) Gain or (loss) (e) plus (1) minus (g)
(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
ear beginning in TAdjusted qualdy4ng disinbNions Net value of noncharnade use assets
2000 1 46,824 ~ 1,025,341
1999 18 .495 996 .536
1997 1996
2 Total of line 1, column (d) I 2 3 Average distribution ratio (or the 5-year base period-divide the total on line 2 by 5, or by
the number of years the foundation has been in existence d less than 5 years
4 Enter the net value of noncharitable-use assets for 2001 from Part X, line 5 1 4
5 Multiply line 4 by line 3
6 Enter 1% of net investment income (1°h of Part I, line 27b) 1 6
0 04566675867
0
1 .022 .813 .
or 4948 - see bade 18 of the Eicise Tax Based on Investment Income
1 a Exempt operating foundations described in section 4940(d)(2), check here 1 and enter N/A' on line 7
Dale of ruling lever (attach copy of ruling letter if necessary - see instructions)
b Domestic o~ anizations that meet the section 4940(e) requirements in Part V check
here " X and enter 1 % of Part 1 line 27b
c All other domestic organizations enter 2% of line 276 Exempt foreign organizations enter 4°,6 0l Pant line 12, cot
2 Tax Under section 511 (domestic section 4947(x)(1) busts and taxable foundations only Others enter -0-)
3 Add lines 1 and 2
4 Subtitle A (income) lax (domestic section 4947(a)(1) busts and taxable foundations only Others enter -11)
5 Tax based on investment income Subtract line 4 from line 3 II zero or less enter -0-
6 Credits/Payments
a 2001 estimated tax payments and 2000 overpayment credited to 2001 6a
b Exempt foreign organizations - (ax withheld al source 66
c lax paid with application for extension of lime to file (Form 8868) 6c
d Backup withholding erroneously withheld 6d
7 Total credits and payments Add lines 6a through 6d
e Enter any penalty for underpayment of estimated tax Check here Flil Form 2220 is attached
9 Tax due II the total of lines 5 and 8 is more than line 7 enter amount owed
10 Overpayment 11 line 7 is more than the total of lines 5 and 8, enter the amount overpaid
Activities
GC80RH M285 05/09/2002 12 38 44
1 a During the tax year, did the organization attempt to influence any national, state, or local legislation or did Yes No
it participate or intervene in any political campaign? 1 a X
b Did it spend more than $100 during the year (either directly or indirectly) for political purposes (see page
19 0l the instructions for deGndion)l 16 X
If the answer rs 'Yes' to la or i6 attach a detailed description of the activities and copies o/ any matenah
published or distributed by the organization in connection with the activities
c Did the organization file Form 1120 "POL for this years t c X
d Enter the amount (if any) of lax on political expenditures (section 4955) imposed during the year
(1) On the organization fl~ $ (z) on organization managers " $
e Enter the reimbursement (if any) paid by the organization during the year for political expenditure tax imposed
on organization managers Ili, 3
2 Has the organization engaged m any activities that have not previously been reported to the IRS 2 X II 'Yes 'attach a detailed description of the activities
9 Has the organization made any changes, not previously reported to the IRS, in its governing instrument, articles of incorporation, or bylaws, or other similar instruments 11 'Yes 'attach a conformed copy o! the changes , , 7 X
4 a Did the organization have unrelated business gross income o151 000 or more during the yeah _ 4a X b II "Yes has it filed a tax return on Form 990-T for this year? _ 4b N A
5 Was there a liquidation, termination, dissolution, or substantial contraction dunng the yeah _ 5 X
/I "Yes " attach the statement required by General Instruction T
6 Are the requirements of section SOB(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? 6 X
7 did the organization have at least $5,000 in assets at any time during the year? If 'Yes,' complete Part 11 cot (c), and PartXV 7 X
e a Enter the states to which the foundation reports or with which it is registered (see page 19 of the
instructions) 1, NORTH CAROLINA b II the answer is'Yes' to line 7, has the organization furnished a copy of Form 990.PF to the Attorney
General (or designate) of each stale as required by General Instruction G7 1/ "No 'attach explanation e b X 9 Is the organization claiming status as a private operating foundation within the meaning of section 4942Q)(3)
or 49420(5) for calendar year 2001 or the taxable year beginning in 2001 (see instructions for Part XIV on
page 25)? d"Yes"complelaPartXIV 9 X
10 Did any persons become substantial contributors during the tax year If 'Yes "attach a schedule listing their names and addresses 7 0 X 11 Did the organization comply with the public inspection requirements for its annual returns and exemption applications 11 X
Web site address 11 The books are in care of " FRED G EIDSON _ _ _-_ _ _ Telephone no " 336-835-5105
Located at AEI.}(IN_NC---_--------------------_ LP-4 28621______________ 17 Section 4947(x)(1) nonexempt charitable trusts tiling Form 990.PF m lieu of Form 1041 -Chttk here _ _ "~
and enter the amount of lax-exempt interest received or accrued during the year ~ I 17 I
J~ Form 990-PF (2007) 1e wo 4 o00
S Form 9q0 PF
Statements Regarding Activities for Which Form 4720 May Be
GCBOAH M285 05/09/2002 12 39 44
File Foam 4720 if any item is checked in the Yes column unless an exception apples
7 a During the year did the organization (either directly or indirectly)
(1 I Engage in the sale or exchange or leasing of property with a disqualified persons EJYes aX No
(2) Borrow money from lend money to or otherwise extend credit to (or accept d from)
a disqualified persons Yes X No
(3) Furnish goods services, or facilities to (or accept them from) a disqualified person"
~
Yes No
(J) Pay compensation to or pay or reimburse the expenses of, a disqualified persons . . Yes X 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) O Yes OX No
(6) Agree to pay money or property to a government oflicial7 (Exception Check No
if the organization agreed to make a grant to or to employ the official for a period
after termination of government service if terminating within 90 days ) ~ Yes ~X No
b II any answer is Yes to 1a(1)-(6) did any of the acts fail to quality under the exceptions described in Regulations
section 53 4941(d)-3 or in a current notice regarding disaster assistance (see page 19 0l the instructions)?
Organizations relying on a current notice regarding disaster assistance check here . ~ L.1
c Did the organization engage in a prior year in any of the acts described in to other than excepted acts,
that were not corrected before the first day of the tax year beginning in 2001
2 Taxes on failure to distribute income (section 4942) (does not apply for years the organization was a private
operating foundation defined in section 49420)(3) w 4942Q)(5))
a At the end of tax year 2001, did the organization have any undistributed income (lines 6d
and 6e Part XIII) /or tax year(s) beginning before 2007 ID Yes ~X No
II Yes list lheyears " __________ ____-_-__, _---____, _______-
b Are there any years listed in 2a for which the organization is not applying the provisions of section 4942(a)(2)
(relating to incorrect valuation of assets) to the year's undistributed incomes (If applying section 4942(a)(2)
to all years listed, answer' No" and attach statement - see page 19 0( the instructions ) - -
c II the provisions of section 4942(a)(2) are being applied to any of the years listed in 2a list the years here
3 a Did the organization hold more than a 2% direct or indirect interest in any business
enterprise at any time during the yea( F-1 Yes a No
b II Yes' did it have excess business holdings in 2001 as a result of (1) any purchase by the organization
or disqualified persons alter May 26, 7969, (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 (7)
the lapse of the 10-, 75- or 20-year first phase holding periods (Use Schedule C Form 4720 to detemrine
if the organization had excess business holdings in 2007 )
4 a Did the organization invest during the year any amount in a manner that would jeopardize its charitable purposes? -La-b Did the organization make any investment in a prior year (but alter December 31 7969) that could jeopardize its charitable
purpose that had not been removed from jeopardy before the first day of the tax year beginning in 20017 46
5 a During the year did the organization pay or incur any amount to (7) Carry on propaganda or otherwise attempt to influence legislation (section 4945(e))~ O Yes O No
(2) Influence the outcome of any specific public election (see section 4955) or to carry
on directly or indirectly, any voter registration drivel 8 Yes BX No
(3) Provide a grant to an individual for travel study, or other similar purposes Yes X No
(a) 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)? ~ Yes N 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 , _ 0 Yes N No
b II any answer is 'Yes'to Sa(1)-(5) did any of the transactions tail to qualify under the exceptions described in
Regulations section 53 4945 or in a current notice regarding disaster assistance (see page 20 0l the instruclions)~ - 51,
Organizations relying on a current notice regarding disaster assistance check here c If the answer is "Vex' to question Sa(4) does the organization claim exemption from the
tax because it maintained expenditure responsibility for the grants Yes X No
11 'Yes " aHach the statement required by Regulations section 53 49455(d)
6 a Did the organization, during the year receive any funds directly or indirectly to pay premiums on a personal benefit contract? E ]Yes F-X1 No
b Did the organisation during the year pay premiums, directly or indirectly, on a personal benefit contract? 6 b I7 you answered 'Yes" to 66 also ale Form 8870
Form 990-PF (2001)
iv e 1450 A o00
2 Compensation of five highest-paid employees (other than those included on line 1 - see page 21 of the instructions) If none, enter "NONE "
o) I life and average 'o~ Contributions ~o hours per week (c) Compensation employee cement plans let Expense, account
devoted ro position I I and deleuedmmcen +aiwn I other allowances
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Total number of others receiving over $50,000 for professional services
Summary of Direct Charitable Activities
List tie foundation s lour largest direct charitable activities during the lax year Include rele2nt statistical information such as tie number Expenrses of organizations and other beneficiaries served conferences convened research papers produced etc
1 THE FOUNDATION DISBURSED A TOTAL OF y°51I000 TO _20-__-_-_-___--_-__---_-_
-ORGANIZATIONS FOR EDUCATIONAL, MEDICAL OR OTFER CHARITABLE
2 ----------------------------------
---------------------------------- ------------------------------
3
----------------------------------------------------------------------------
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - - - - - - - - - - - - - - - - - -- - - - -- - -- - - - - - - - - - - - - - - - - - -
Form 990-PF (2001)
Ju i e i asa 3 000
GCHORH M285 05/09/2002 12 38 44
Form 997-PF (2007) 56-2088318 I ' Page 6 Information About Officers, Directors, Trustees, Foundation Managers, Highly Paid Employees, and Contractors
1 List all officers, directors, trustees, foundation managers and their compensation see page 20 of the instructions (b) Title and average (~~ Compensation je)Conlueulons ~o (e) Expense account (a) Name and address hours per wee4 III not paid, enter employee eeneu plans devoted to position ~ ano deferred compenv,~on other allowances
RACHEL 5 BOYL.ES PRESIDENt < 1 HR,
JANE B EIDSON ~VP c SECRE< 1
ELFCIN, NC I
FRED G EIDSON VP b TREAS< 1
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
(a) Name and address of each employee pain mote than $50 000
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
-------------------------------------
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
-----------------------------------
Total number of other employees paid over $50,000 3 Five highest-paid independent contractors for professional services - (see page 27 of the instructions) K none, enter
"NONE"
- - - - - - - - - - - - - - - - -- - - - - - - - - -- - --- - -------- ----- - - - - - -NONE
----------------------------------------------------
----------------------------------------------------
------------------------------------------------
4
Amount Describe the two largest program-related
1 NONE
foundation lines
------------------------------------------------ ---------------------------------------------------------------------------
2
---------------------------------------------------------------------------
see page 22 of the instructions ) 1 Fair market value of assess nod used (or held for use) directly in carrying out charitable etc ,
purposes a Average monthly fair market value of securities b Average of monthly cash balances c Fair market value of all other assets see page 22 of the instructions) d Total (add lines 1 a, b, and c) e Reduction claimed for blockage or other factors reported on lines 1 a and
1c (attach detailed explanation) I 1e I 2 Acquisition indebtedness applicable to line 1 assets 3 Subtract line 2 from line 1d 4 Cash deemed held for charitable activities Enter 1 1/2% of line 3 ((or greater amount, see page 23
of the instructions) 5 Net value of nonchantable-use assets Subtract line 4 from line 3 Enter here and on Part V, line 4 6 Minimum investment return Enter 5% of line 5
lal 1,028,956
2 38
4
Distributable Amount (see page 23 of the instructions) (Section 4942Q)(3) and 0)(5) private foundations and certain foreign organizations check here ji. n and do riot complete this part
1 Minimum investment return from Part X, line 6 2 a Tax on investment income for 2007 from Part VI line 5 2a b Income tax for 2001 (This does not include the tax from Part VI ) 2 b c Add lines 2a and 2b
3 Distributable amount before adjustments Subtract line 2c from line 1 4 a Recoveries of amounts treated as qualifying distributions 4a b Income distributions from section 4947(a)(2) trusts 4b c Add lines 4a and 4b
5 Add lines 3 and 4c 6 Deduction from distributable amount (see page 23 of the instructions) 7 Distributable amount as adjusted Subtract line 6 from line 5 Enter here and on Part
2c
4c
line 7 50,916
Qualifying Distributions (see page 23 of the instructions)
1 Amounts paid (including administrative expenses) to accomplish charitable, etc ,purposes a Expenses, contributions, gifts, etc - total from Part 1, column (d) line 26 1 a 51 , 000 b Program-related investments-Total from Part 1X-B 1 b NONE
2 Amounts paid to acquire assets used (or held for use) directly in carrying out charitable, etc , purposes 2 NONE
1 Amounts set aside for specific charitable projects that satisfy the a Suitability test (prior IRS approval required) 3a NONE b Cash distribution test (attach the required schedule) 3b NONE
4 Qualifying distributions Add lines to through 3b Enter here and on Part V, line 8 and Part XIII line 4 4 51,000 5 Organizations that qualify under section 4940(e) (or the reduced rate of tax on net investment
income Enter 1% of Part I, line 27b (see page 24 0( the instructions) 5 225 6 Adjusted qualifying distributions Subtract line 5 from brie 4 ~ 6 ~ 50,775
Note The amount on line 6 will be used in Part V column (b), in subsequent years when calculating whether the foundation qualifies for (he section 4940(e) reduction o/ fax in those years
Jy, Form 990-PF (2001) I E1470 a goo
GCBORH M285 05/09/2002 12 38 44
All other program related investmen¢ See page 22 of the instructions
3 NONE
---------------------------------------------------------------------------
vaugh 3 m Investment Return (All domestic foundations must complete this part Foreign
I i I
r 1
Form 990 PF (1001)
Undistributed Income (see page 24 of the instructions)
56-2088318
(c) (d) 2000 2007
50 , 916
50 , 282
50 , 292
718 .
NONE
50 , 198 .
Fam990-PF (2001)
(a) I (b) Corpus Years prior l0 2000
GCBOAH M285 05/09/2002 12 38 44
1 Disiributable amount for 2001 from Part XI
line 7
2 Undistributed income a any as of the end of 2000
a Enter amount for 2000 only
b Total for prior years
3 Excess distributions carryover if any to 2001
a From 1996 NO!
b From 1997 NOP
c From 1998 N02
d From 1999 NOP
e From 2000 NOE
f Total of lines 3a through e
4 Qualifying distributions for 2001 from Part
X11, line 4 . 51 , 000 a Applied to 2000 but not more than line 2a
b Applied to undistributed income of prior years
(Election required see page 24 of the instructions)
c Treated as distributions out of corpus (Election required - see page 24 of the instructions)
d Applied to 2001 disiributable amount
e Remaining amount distributed out of corpus 5 Excess distributions carryover applies to 2001
(H an amount appears in column (d) the same amount must be shown in column (a))
6 Enter the net total of each column as indicated below
a Corpus Add lines 31, 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 nonce of deficiency has been issued, or on which the section 4942(a) tax has been previousy assessed
d Subtract line 6C from line 6b Taxable amount - see page 25 0l the instructions
e Undistributed income for 2000 Subtract line <a from line 7a Taxable amount see page 25 of the instructions
( Undistributed income for 2001 Subtract lines 4d and 5 from line 1 This amount must be distributed m 2002
7 Amounts treated as distributions out of corpus to satisfy requirements imposed by section 170(b)(1 )(E) or G942(g)(3) (see page 25 0l the instructions)
8 Excess distributions carryover from 1996 nod applied on line 5 or line 7 (see page 25 of the instructions)
9 Excess distributions carryover l0 2002 Subtract lines 7 and 8 from line 6a
10 Analysis of line 9 a Excess from 1997 r
b Excess from 1998 c Excess from 1999 d Excess from 2000 e Fmesx from J001 T
Ju i E 1480 < ooa
8
9 Form 99U PF
I a II the foundation has received a ruling or determination letter that it is a private operating foundation, and the ruling is effective for 2001 enter the date of the ruling
b Check box to indicate whether the organization is a private operating foundation described m section
2 a Enter the iessPi of the Tax year Prior 3 ears
adjusted net income from a 1001 b I000 c 1999 Part I or the minimum investment velum from Pan X for each year listed
b BS A o1 line 2a
c Qualifying distrIbuirans from Pan All line 4 loi each year idea
d Amounts included in line 7c not
used directly for 2CINe conduct
of exempt aclu n ses
Qualifying ecVnpulpnamade directly for acurve conduct of exempt acWmes suntan lure 7a from iris 2.
3 Complete 7a a is c W m< alternative test relied upon
d FS!llfi dRtT]W! 1[5/ enter
Ii I Value be .11 ..ft (Z) Value of ... . of qualifying
under seenon 4s4zUMaMeI(d
b 'Enaowmenralternative test -Enter 213 of minimum investment return snoxn in Part X Iane6loreach year listed
C 'SUOPOT alternative test enter
(1) Total support otuer man gross imeiMent income (interest, ONdME7 !!rib payment on securities loam Ikon St2(a)(511 or ioyaNn)
[2) Suppon from general public and 5 or mole exempt .,ganucatam. as peoxaM n section 49420A3X8X+)
(3) Largest amount of support nom an exempt oiganvaeon
d Any restrictions or limitations on awards such as by geographical areas charitable fields kinds of institutions or other factors
Jv I E 1490 7 000
GCHORH M285 05/09/2002 12 38 44 Form 990-PF (2001)
. Private
«R" Supplementary Information (Complete this part only if the organization had SS,000 or more in assets at any time during the year - see page 26 of the instructions )
t Information Regarding Foundation Managers a List any managers of the foundation who have contributed more than 2°b of the total contributions received by the foundation
before the close of any tax year (but only if they have contributed more than $S 000) (See section 507(d)(2)
b List any managers of the foundation who own 10°6 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
2 Information Regarding Contribution, Grant, Gift, Loan, Scholarship, etc , Programs Check here 1 X if the organization only makes contiibulions to preselected charitable organizations and does rrol accept unsolicited requests for funds
II the organization makes gifts , wants e1C (see page 26 al the instructions) to individuals of organizations under other conditions complete reins 2a, D, c, and d
a The name, address, and telephone 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 deadlines
Farm 990-PF (2000 Jv
iE ;491 7 000
GCHORH M285 05/09/2002 12 38 44
Farm 99D PF (7001) 56-2088318 Supplementary Information (continued)
3 Grants and Contributions Paid Dunn the Year or Approved for Future Payment
Recipient II recipient is an inenidual Foundalion show any relationship to
sialus of Purpose of giant or
Name and address (home or business) any foundation manager <ec ve contribution or substantial coNnoutoi
a Paid during the year
SEE STATEMENT 6
b Approved for future payment
Amount
56-2088318 ' Form 990.PF,(2001) 11
Ju IE1497a000
GCHORH M2B5 05/09/2002 12 38 44
Analysis of Income-Produan Activities Enter gross amounts unless othermse indicated Unrelated business income Excluded b section 512 513, or 514 Related~or exempt
~b~ (c) (d) Junction income Business Exclusion (Sce page 26 0l 7 Program sernce revenue code Amount code Amount the instructions
a
b
c
d
e
1
g Fees and contracts from government agencies
2 Membership dues and assessments
7 Interest on savings and temporary czis, investments 14 248
4 Dividends and interest from securities 19 1 B 828
5 Net rental income or (loss) from real estate
a Debt-financed property
b Not debt-financed property
6 Net rental income or (loss) from personal property
7 Other investment income
8 Gain or (loss) from sales of assets other than inventory 4 , 449
9 Net income or (loss) from special events
10 Gross profit or (loss) from sales of inventory 11 Other revenue a
b
c d
e
12 Subtotal Add columns (b) (d), and (e) 23 , 525 13 Total Add line 12, columns (b) (d), and (e) , , ff~ 13 23,525
Relationship of Activities to the Accomplishment of Exempt Purposes Explain below how each activity for which income is reported in column (e) of Part XVI-A contributed importantly to Line No the accomplishment of the organization's exempt purposes (other than by providing funds for such purposes) (See page 27 of the instructions )
Form990-PF (200t)
Foim 990 PF 2001 56-2088318 Page 12
Information Regarding Transfers To and Transactions and Relationships With Nonchantable Exempt Organizations
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 organization to a noncharitaDle exempt organization of (7I Cash
(2) Other assets
b Other Transactions
(1) Sales of assets to a noncharitable exempt organization
(2) Purchases of assets from a noncharitable exempt organization
(1) Rental of facilities, equipment, or other assets
(4) Reimbursement arrangements
(5) Loans or loan guarantees
(6) Performance of services or membership or fundraising solicitations
c Sharing of facilities equipment, mailing lisps, other assets, or paid employees
d II the answer to any of the above is "Yes,' complete the following schedule Column (b) should always show the lair market
value of the goods, other assets, or services given by the reporting organization If the organization received less than fair
market value in any transaction or sharing arrangement, show in column (d) the value of the goods other assets or services
2 a Is the organization directly or indirectly affiliated with, or related to one or more lax-exempt organizations
described in section 501(c) of the Code (other than section 501(c)(3)) or in section 527 F-1 Yes X No b If 'Yes ' comolete the lollovnna schedule
use ie,.s> > o00
GCB0RH M285 05/09/2002 12 38 44
Under penalties of penury 1 declare that I have examined this return including accompanying schedules and statements and to the best of my knowledge and belie) it is true correct co piece c ai preparer (other than taxpayer or 1i
N 1 Signature of ollper or trustee d S c -° a preparers ' m ~ ̀m ,/~ y a a o signature
aj Firm sname (oryours 'BATC}iELOR TILLERY if sell-employed), address, 3105 GLENFIOOD AVE and ZIP code
FORM 990-PF - PART IV ' CAPITAL GAINS AND LOSSES FOR TAX ON INVESTMENT INCOME
Kind of Property Description Dale Date sold acquired
Gross sale Depreciation Cost or FMV Add basis Excess of Gain price less allowed/ other as of as of FMV over or
ex penses of sale allowable 13116
2
12131169 ad basis loss
1400 SHS AOL TIME WARNER INC 11/17/1998 11/08/2001 PROPERTY TYPE SECURITIES
50,496 96,070 4,426
FRAC SHS JEFFERSON PILOT CORP 11/17/1998 09/18/2001
PROPERTY TYPE SECURITIES
23 NONE 23
TOTAL GAIN(LOSS) _ 4,449
4 1730 1 000
GCBORH M285 05/09/2002 12 :38 :44 is 1 E
STATEMENT 1 GCBORH M285 05/09/2002 12 :38'44
BOYLES-EIDSON FAMILY FOUNDATION 56-2088318
FORM 990PF, PART I - INTEREST ON TEMPORARY CASH INVESTMENTS
REVENUE AND NET
EXPENSES INVESTMENT DESCRIPTION PER BOOKS INCOME ----------- --------- ------
MERRILL LYNCH INTEREST INCOME 248 . 248 .
------------ ------------
TOTAL 248 . 248 .
GCBORH M285 05/09/2002 12-38 :44 STATEMENT 2
BOYLES-EIDSON FAMILY FOUNDATION 56-2088318
FORM 990PF, PART I - DIVIDENDS AND INTEREST FROM SECURITIES
REVENUE AND NET
EXPENSES INVESTMENT DESCRIPTION PER BOOKS INCOME ----------- --------- ------
MERRILL LYNCH DIVIDENDS 18,828 . 18,828 . ------------ ------------
TOTAL 18,828 . 18,828 .
BUSINESS EXCISE TAX FOREIGN TAXES PAID
176 . 573 . 573 .
------------ ------------749 . 573 .
GCBORH M285 05/09/2002 12 :38 :44 STATEMENT 3
BOYLES-EIDSON FAMILY FOUNDATION
FORM 990PF, PART I - TAXES
DESCRIPTION
TOTALS
56-2088318
REVENUE AND NET
EXPENSES INVESTMENT PER BOOKS INCOME --------- ------
83 . --- ---------
83 .
83 . ------------
83 .
BANK SERVICE CHARGES
STATEMENT 4 ccsoRx rimes o5/o9/2oo2 12 :3e :44
SOYLES-EIDSON FAMILY FOUNDATION
FORM 990PF, PART I - OTHER EXPENSES
DESCRIPTION
TOTALS
REVENUE AND
EXPENSES PER BOOKS
56-2088318
NET INVESTMENT
INCOME
6120 SHS BANCO SANT CTL HISP 75,375 . 75,375 . 50,796 6120 SHS BANCO SANT CTL HISP 75,375 . 75,375 . 50,796 2000 SHS BANK OF AMERICA CORP 154,750 154,750 . 125,900 549 SHS VIACOM INC CL S 16,065 . 16,065 . 24,238 3960 SHS CITIGROUP INC 122,834 122,834 199,901 900 SHS EMERSON ELECTRIC 58,046 58,046 51,390 200 SHS EMERSON ELECTRIC 12,887 12,887 . 11,420 100 SHS EMERSON ELECTRIC 5,422 5,422 5,710 500 SHS 1ST CAROLINA INVS SSI 34,250 34,250 41,000 500 SHS 1ST CAROLINA INVS SBI 34,250 34,250 41,000 765 SHS JEFFERSON PILOT CORP 52,625 35,099 . 35,397 382 SHS JEFFERSON PILOT CORP NONE 17,526 17,675 1400 SHS KIMBERLY CLARK 70,630 70,630 . 83,720 . 2025 SHS PFIZER INC DEL PV$ .05 74,459 74,459 80,696 1400 SHS TIME WARNER INC 69,105 NONE NONE 700 SHS AOL TIME WARNER INC NONE 23,035 22,470 1080 SHS TRICON GLOBAL RESTRNT 36,382 . 36,382 53,136 800 SHS WM WRIGLEY JR CO 71,412 . 35,706 41,096 800 SHS WM WRIGLEY JR CO NONE 35,706 41,096
--------------- --------------- ---------------
TOTALS 963,867 917,797 977,437
GC130RH M285 05/09/2002 15-31 :40 STATEMENT 5
BOYLES-EIDSON FAMILY FOUNDATION 56-2088318
FORM 990pF, PART II - CORPORATE STOCK
BEGINNING ENDING ENDING DESCRIPTION BOOK VALUE BOOK VALUE FMV ----------- ---------- ---------- ---
BOYLC9-EIDSON FAMILY ECUNDnSION 56-2088318
FORM 990PF, PART kV - GR:~NTS AND CONTRIBUTIONS PnID DURING THE YEAR
RELATIONSHIP TO SUBSTANTIAL CONTRIBUTOR
AND
RECIPIENT NFME AM DRESS FOUNDATION STATUS OF RECIPIENT PURPOSE OF G[LS'i OR CONTRIBUTION
- ----------------------- ------ ----------------------- --------------------------------
HUGH CHATHAM MEMORIAL HOSPITAL MEDICAL
NON-PROFIT
42RICAN CANCER SOCIETY MEDICAL
NON-PROFIT
UNC-CFLkPEL HILL EDUCATIONAL
NON-PROFIT
TRI-COUNTY UNITED WAY CHARITABLE
NON-PROFIT
ECHO MINISTRY RELIGIOUS
NON-PROFIT
WINSTON-SALEM FOUNDATION CHARITABLE
NON-PROFIT
iftI-C CHRISTIAN CRISIS CONTROL RELIGIOUS
NON-PROFIT
SURAY COMMUNITY COLLEGE FOUNDATION EDUCATIONAL
NON-PROFIT
UPPER YD VhL HABITAT FOR HUMANITY CHARITABLE
NON-PROFIT
GCBORH M285 05/09/2002 12 36 44
AMOUNT
1,000
500
2,000
2,500
10,000
7,500
10,000
2,000
I
2,000
STATEMENT 6
BOYLE3-EIDSON FAMILY FOUNDATION 56-2008318
FOFM 990PF, PART nV - G(W7i5 :.ND CONTRIBUTIONS PAID DURING THE ZEAR
RELATIO14SHIP TO SUBSTANTIAL CONTRIBUTOR
AND RECIPIENT NAME AM ADDRESS FO1INDXYIOH STATUS OF RECIPIENT PURPOSE OF GRANT OR CONTRIBUTION ------------------------- ------------------------------ --------------------------------
YADKIN VALLEY SENIOR COMM CTR CHARITABLE
NON-PROFIT
YADKIN RIVER GFEEHwAY COUNCIL CHARITABLE
NON-PROFIT
ALLEGHANY WELLNESS CENTER MEDICAL
NON-PROFIT
CANNON/SLOOP HEALTH CARE FDN MEDICAL
NOV-PROFIT
BLOWING ROCK FIRE DEPT CHARITABLE
NON-PROFIT
THE SALVATION hMtt CHARITABLE
NON-PROFIT
FIRST UNITED METHODIST CHURCH RELIGIOUS
NON-PROFIT
ALZHEIMER$ ASSOCIATION MEDICAL
NON-PROFIT
CYSTIC FIBROSIS FDN MEDICAL
NON-PROFIT
GCBORFI lIIBS 05/09/2002 12 38 44
:?YJUNT
5,000
1,000
1,000
1,000
1,000
1,000
1,000
1,000
500
STATEMENT 7
STATEMENT 8 GCHORH l485 05/09/2002 12 38 44
BOtLES-EIDSON FAMILi FOUNDATION
FORM 990 Pi, P~JiT nv - GF:.VyS ,~D CONTRIBUTIONS P..ID DURING THE YEAR
RELATIONSHIP TO SUBSTANTIAL CONTRIBUTOR
AND
RECIPIENT NAME AND ADDRESS FOUNDATION STATPUS OF RECIPIENT -------------------------- ------------------------------
HOSPICE OF SURRY COUNTY
NON-PROFIT
LIFELINE PREGNANCY HELP CENTER NON-PROFIT
56-20BB31B
PURPOSE OF GRANT OR CONTRIBUTION ------------- ------------------ -------------
CHARITABLE
CHARITABLE
TOTS. CONTRIBUTIONS PAID
AMOUNT ' II
500
500
------------
51,000
OMB14O 1545-0092 Capital Gains and Losses Attach to Form 1041 (or Form 5227) See the separate instructions for 200 1 Department of lie Leasury
Name of estate o! /1u51 Employer identification numbs
s need to Note'
Short-Term Capital Gams and Losses -Assets Held One Year or Less
100 shares 7'k I1 acq. med (c) Dale sold fit) Safes pace (e) Cost or other basis (f) Gam of (LOSS)
a of Z Co 1 I (mo drv v~ 7 I Imo day yr ) I I (see page 19) ` (col (d) less cot (i
(l) Gar. of (Loss~ I - . or ILOSS)
6
7 Long-term capital gain or (loss) from Forms 2439, 4684 6252, 6781, and 8824 8 Net long-term gain or (loss) from partnerships, S corporations, and other estates or trusts 9 Capital gain distributions
10 Gain from Form 4797, Part I 71 Long-term capital loss carryover Enter in both columns (f) and (g) the amount,
d any, from line 14, of the 2000 Capital Loss Carryover Worksheet 12 Combine lines 6 through 11 in column (g) 13 Net long-term gain or (loss ) Combine lines 6 through 11 in column (() Enter
'28% rate gain or loss includes all collectibles gains and losses' (as defined on page 30 of the instructions) and up to 50% of the eligible gain on qualified small business stock (see page 28 of the instructions)
(1) Beneficiaries' I (2) Estate's I (3) Total (see page 30) or trusts Summary of Parts I and II
GCBORH M285 05/09/2002 12 :38 :44
SCHEDULED . (Form 1041)
2 Short-term capital gain or (loss) from Forms 4684, 6252 6787 and 8824 2
7 Net short-term gain or (loss) from partnerships, 5 corporations, and other
estates or trusts 3
4 Short-term capital loss carryover Enter the amount, if any, from line 9 of the
2000 Capital Loss Carryover Worksheet 4
5 Net short-term gain or (loss) Combine lines 1 through 4 in column (f) Enter here and on line 14 below ~ 5
Long -Term Capital Gains and Losses -Assets Held More Than One Year
(a) Description of
P'oper'y
(D) Oate (Eaample 100 shares 7% acqmred (c) Dale sold (el cost or other basis
Imo day yr ) (e) Sales pace (see page 29) o,aiP~~m of ~v r.~ ~ inn na~ ~, i
74 Net short-term gain or (loss) (from line 5 above) 14 1 5 Net long-term gain or (loss)
a 28% rate gain or (loss) (from line 12 above) 15a b Unrecaptured section 1250 gain (see line 17 of the worksheet
on page 37) 15b c Total for year (from line 13 above) 15C I 4,449 _
16 Total net gain or (loss) Combine tines 14 and 15c " 16 4,449 __ Note Il line 16 column (3) is a net gain enter the gain on Form 1041 line 4 11 Gnes ISc and 16 column l2/, are net gains, go to Part V and do
not complete Part IV if line 16, column (J) is a net loss complete Part IV and the Capibl Loss Carryover Wbrksheet; as necessary Fog Paperwork Reduction Act Notice, see the Instructions for Form 1041 Schedule D (Form 1041) 2001
JSN
IF17102OOD
GCBOAH M285 05/09/2002 12 38 44
Schedul e L1(FOrm 1 0.77) 10 01
Capital Loss Limitation
17 Enter here and enter as a (loss) on Form 1041 line 4 the smaller of a The loss on line 76 column (3) or 6 $3,000 17
II the loss on line 16, column (3) is more than 83 000 or i( Form 1041 page 7, line 22, is a loss complete the Capital Low Carryover Worksheet on page 32 0( the instructions to determine your capital loss carryover
Tax Computation Using Maximum Capital Gams Rates (Complete this part only if both lines 15c and 16 in column (2) are gains, and Form 1041, line 22 is more than zero )
Note If line 15a, column (2) of line 156 column (2) is more than zero complete the worksheet on page 34 to figure the instructions to figure the amount to enter on lines 20 27 and 38 below and skip all other lines below Otherwise, go (o line 18
1 8 Enter taxable income from Form 104 t, line 22 18
19 Enter the smaller of line 1 Sc or 16 in column (2) 1 9 20 If the estate or trust is filing Form 4952 enter
the amount from line 4e, otherwise, enter-0- " 20 21 Subtract line 20 from line 19 I( zero or less, enter -0- 21 22 Subtract line 21 from line 18 If zero or less, enter-0- 22 23 Figure the tax on the amount on line 22 Use the 2001 Tax Rate Schedule on page 20 of the
instructions . 23 24 Enter the smaller of the amount on line 18 or $1,800 24
If line 24 is greater than line 22, go to line 25 Otherwise, skip lines 25 through 31 and go to line 32
25 Enter the amount from line 22 ZS
26 Subtract line 25 from line 24 If zero or less, enter -0- and go to line 32 26
27 Enter the estate s or trust's allocable portion of qualified 5-year gain, if any, from line 7c of the worksheet on page 33 27
28 Enter the smaller of line 26 or line 27 ZB 29 Multiply line 28 by 8% (0B) - 29 70 Subtract line 28 from line 26 30 .
31 Multiply line 30 by 10°h ( 10) 31
If the amounts on lines 21 and 26 are the same, skip lines 32 through 35 and go to line 36
32 Enter the smaller of line 18 or line 21 , , 33 Enter the amount, d any, from line 26 33
34 Subtract line 33 from line 32 34
]5 Multiply line 34 by 20% ( 20) 35
36 Add lines 23, 29, 31, and 35 76 37 Figure the lax on the amount on line 18 Use the 2001 Tax Rate Schedule on page 20 of the
instructions 37 78 Tax on all taxable Income (including capital gains) Enter the smaller of line 36 or line 37 here
and on line 1 a of Schedule G Form 1041 I 38 Schedule D (Form 104t)2001
JSA IF 1220 3 ooo
GCBORH M285 05/09/2002 12-38 .44 STATEMENT
BOYLES-EIDSON FAMILY FOUNDATION 56-2088318 Schedule D Detail of Long-term Capital Gains and Losses
Date Date Gross Sales Cost or Other Long-term Descript ion Acq uired Sold Price Basis I Gain/Loss
CAPITAL GAINS LOSSES HELD FOR INVESTMENT PURPOSES
1400 SHS AOL TIME WARNER INC 11 / 17 / 1998 11 /08 /2001 50,496 46 , 070 4 , 426 FRAC SHS JEFFERSON PILOT CORP 11 / 17 / 1998 04 /18 /2001 23 NONE 23
TOTAL CAPITAL GAINS LOSSES HELD FOR INVESTMENT PURPOSES 50 , 519 46 , 070 4 449
totals 50 , 519 . 46 070 4 449
JSA
i F0970 I 000