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ggp_p~ Return of Private Foundation OMB No 1545-0052 Form Department of the Treasury Of Section 4947(a)(1) Nonexempt Charitable Trust Treated as a Private Foundation Internal Revenue s~c- Note : The organization ma be able to use a co of this return to satis fy state reporting re wrements 2004 For calendar ear 2004, or tax ear beginning , 2004, and ending

Check all that apply: ~ ~ Initial return ~ ~ Final return ~ ~ Amended return I X I Address change ~ ~ Name chant Name of organization A Employer identification number

00 Use the IRS ~ � label . THE HALLOWELL FOUNDATION I/M A/C 1525022312 23-6234545

Otherwise, Number and street (or P.O . box number if mail is not delivered to street address) Room/suite B Telephone number (seepage 10 of print the instructions)

--~ or type . 100 NORTH MAIN STREET, 13TH FLOOR (336) 732-5252 ~6ee Specific

~ Q nstructions. City or town, state, and ZIP code C P~,d~ g oheck hleretl~ ~ . . . . .

O :~C D 1 . Foreign organizations, check here , 1

WINSTON-SALEM NC 27150 2. Foreign organizations meeting the 85% test, check here and attach Check type of orgarnzation~ X Section 501(c 3 exempt private foundation computation . . . . . . . . .

o Section 4947 (a)( 1 ) nonexempt charitable trust Other taxable private foundation E If pnvate foundaLOn status was terminated

al Fair market value of all assets at end J Accounting method Cash Accrual under section 507(b)(1)(A), check here . of year (from Part 11, co/ (c), line F-] Other (specify) ------ - - ----- F If the foundation is m a 60-month termination 16) " $ 9 , 661 , 968 . (Part l, column (d) must be n a asis.) under section 5o7(b)(,)(e), check here , o- F-1

Analysis of Revenue and Expenses (d) Disbursements (The total of amounts in columns (b), (c), and (a) Revenue and (b) Net investment (c) Adjusted net for charitable (d) may not necessarily equal the amounts in expenses per income income purposes column a (see p age 11 of the instructions ) books cash basis on

1 Contributions, a~n s, grants, etc, received (attach schedule) . STMT 1 check ~ ~ ~ if the foundation is not required to

LJ attach Sch B 3 interest on sarongs and temporary cash investments 7, 122 . 7,122 . STMT a Dividends and interest from securities , , , 253,595 . 253, 595 . STMT 3 5 a Gross rents . . . , , . , , . , . , . , , . , b Net rental income or (loss)

d 6 8 Net gam or (loss) from sale of assets not on line 10 241 , 12 0 . b Gross sales price for all

y assets on line 6a 7 Capital gain net income (from Part IV, line 2) , 241,120 .

8 Net short-term capital gain . . . . . . . . . 9 Income modifications 10a Gross sales less returns

and allowances b Less Cost of goods sold

Gro ~r ~ttac.LL hedule) . , , 11 AedcK~a~pE~edule) , , , , ,

ota~ . a,dd lines !1 throw 501 , 837 . 501 , 837 . 1 ~ o~,3117 ~~ ~,ott~' 1 4,~tnustees, etc , , 38,512 . 38,512 .

N 1 ther e`r~lp y e salaries a ~y ges . . , , h 1 P ~~~ . . . . . . a 1 IT2AS at q s eu~e) ,

b Accounting fees (attac ule)STMT . 4 . 1,050 . NON NON 1,050 . c Other professional fees (attach schedule) . . ,

17 Interest . , , . , . . , . . , . , . . , . .

LA 1 8 Taxes (attach schedule) (see page 14 of ATAL.5.) 15 ,37 0 . E 19 Depreciation (attach schedule) and depletion a 20 Occupancy . . � . . , . . . . , . . . . . -o 21 Travel, conferences, and meetings , , , , , X 22 Panting and publications . . . , . . . . . c 23 Other expenses (attach schedule) STMT, 6 , 26,358 . 26,358 .

C) ~Lm 24 Total operating and administrative expenses . c. Add lines 13 through 23 . . . . . . . . . . 81,290 . 38,512 . NON 27,408 . X 25 Contributions, gifts, grants paid , , , , , , . 560,000 . 560 ,000 .

26 Total exp enses and disbursements Add lines 24 and 25 641 , 29 0 . 38 ,512 . NON 587 , 4 0 8 .

27 Subtract line 26 from line 12 . VII a Excess of revenue over expenses and disbursements , , - 139,453 .

b Net investment income (if negative, enter -0-) 463,325 . c Adjusted net income if negative, enter -0- ) . .

For Privacy Act and Paperwork Reduction Act Notice, see the instructions . Form 990-PF (2004) JSA 4E14102000

RK8061 543P 06/27/2005 14 :49 :50 1525022312 7 -

JSA 4E1420 2 000

RK8061 543P 06/27/2005 14 :49 :50 1525022312 8 -

Form sso-PF ( 2004 ) ~ + 1 1 23-6234545 attached schedules and amounts in the Beginning of ear End of ear

Balance SI18etS description column should be for end-of-year amounts onl y See instructions a Book Value b Book Value c Fair Market Value

1 Cash - non-interest-bearing , , , , , , , , , , , , , , , , , , 9,910 . 9,910 . 2 Savings and temporary cash investments , , , , , , , , , , , 813,612 . 3 Accounts receivable

Less allowance for doubtful accounts 01 4 Pledges receivable

Less' allowance for doubtful accounts 5 Grants receivable �� 6 Receivables due from officers, directors, trustees, and other

disqualified persons (attach schedule) (see page 15 of the instructions) 7 Other notes and loans receivable (attach schedule) 0 .

Less . allowance for doubtful accounts y 8 Inventories for sale or use , , , , , , , , r+ y 9 Prepaid expenses and deferred charges , , , , , , , , , , , , a 10 a Investments - U S and state government obligations (attach schedule) ,

b Investments - corporate stock (attach schedule) , , , , , , , c Investments - corporate bonds (attach schedule) , , , , , , ,

11 Investments - land, buildings, 10. and equipment basis ___________________ Less accumulated depreciation (attach schedule) -------------------

12 Investments - mortgage loans , , , , , , , . , , , . , , , 13 Investments-other (attach schedule) , , , , , , , , , , , , , 4,271,367 . 4, 935, 616 . 9,652,058 . 14 Land, buildings, and

equipment. basis ___________________ Less accumulated depreciation (attach schedule) --------------------

15 Other assets (describe 1 ___-________________ ) 16 Total assets (to be completed by all filers - see page 16 of

the instructions Also see page 1 item I . . . . . . . . . . . 5 , 084 , 979 . 4 , 945 , 526 . 9 , 661 , 96-8 . 17 Accounts payable and accrued expenses , , , , , , , , , , , 18 Grants payable �� ,

d19 Deferred revenue �� , 20 Loans from officers, directors, trustees, and other disqualified persons

~ 21 Mortgages and other notes payable (attach schedule) , , , , , ~ 22 Other liabilities (describe 1 _-___--___--____-_ )

23 Total liabilities ( a dd lines 17 throu h 22 Organizations that follow SFAS 117, check here Do-" and complete lines 24 through 26 and lines 30 and 31 .

N X 24 Unrestricted . . . . . . . . , . . . . . . . . . . . . , . . . X 25 Temporarily restricted . . . . . . . . . . . . . . . . . . . . m 26 Permanently restricted " ~ " " " ~ ~ " " c Organizations that do not follow SFAS 117,

check here and complete lines 27 through 31 . " FX 0 27 Capital stock, trust principal, or current funds . . . . . . . . . 5,084,979 . 4,945,526 .

28 Paid-in or capital surplus, or land, bldg , and equipment fund , , , , , y 29 Retained earnings, accumulated income, endowment, or other funds , w 30 Total net assets or fund balances (see page 77 of the z instructions) �� . ., . ., . � ., . � . � , ., 5 , 084 , 979 . 4 , 945 , 526 .

31 Total liabilities and net assets/fund balances (see page 17 of the instructions 5, 084, 979 . 4, 945, 526 .

Analysis of Changes in Net Assets or Fund Balances

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) . , , , , , , , , . , , , , . , , , , . , , , , . , , , . , 1 5, 084, 979 .

2 Enter amount from Part I, line 27a , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , 2 -139,453 . 3 Other increases not included m line 2 (itemize) "_____-____-_____-_-___________ 3 - 4 Add lines 1, 2, and 3 , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , 4 4, 945, 526 .

5 Decreases not included m line 2 (itemize) "________________________________________ 5 6 Total net assets or fund balances at end of ear ( line 4 minus line 5 - Part II column b line 30 . . . . 6 4, 945, 526 .

Form 990-PF (zooa)

23-6234545 . ,

WITUM Capital Gains and Losses for Tax on Investment In (a) List and describe the kind(s) of property sold (e.g , real estate,

' '2-story back warehouse, or common stock, 200 shs. MLC Co.) 1a SEE PART IV SCHEDULE b

d e

(e) Gross sales price

a b c d

(fl Depreciation allowed (g) Cost or other basis (or allowable) plus expense of sale

(I) Gains (Col . (h) gain minus col . (k), but not less than -0-) or

Losses (from cd . (h))

d

8 Enter qualifying distributions from Part XII, line 4 , , , , , , , , , , , , , , , , , , , , , , , , , 1 8 1 587,408 . If line B is equal to or greater than line 7, check the box in Part VI, line 1b, and complete that part using a 1 % tax rate Seethe Part VI instructions on page 18

Jsa, Form 990-PF (2004) 4E 1430 2 000

RK8061 543P 06/27/2005 14 :49 :50 1525022312 9 -

Comp lete only for assets showing gain in column h) and owned b the foundation on 12/31/69

(t) F.M .V as of 12/31/69 0) Adjusted basis (k) Excess of cd . (i) as of 12/31/69 over cd . (j), if any

b

(c) Date (d) Date sold acquired (mo ., day, yr .) (mo, day, yr.)

(h) Gain or (lass) (e) plus (f) minus (g)

If gam, 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 } 2 241,120 .

3 Net short-term capital gam or (loss) as defined in sections 1222(5) and (6) : If gain, also enter in Part I, line 8, column (c) (see pages 13 and 17 of the instructions) . If ( loss ) , enter -0- m Part I, line 8

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

Was the organization liable for the section 4942 tax on the distributable amount of any year in the base period? . . . . F-] Yes F_~ No If "Yes," the organization does not qualify under section 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.

d Base period years Calendar year Adjusted qualifying distributions Net value of noncharitable-use assets

Distribution ratio (or tax year beginning in) col b diwded b col c

2003 575,325 . 9,136,965 . 0 .06296675099 2002 603,360 . 9,762,173 . 0 .06180591145 200 609,894 . 11,483,862 . 0 .05310878866 2000 655,470 . 12,349,130 . 0 .05307823304 999 585,443 . 12,369,302 . 0 .04733031823

2 Total of line 1, column (d) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 0 .27829000237

3 Average distribution ratio for 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 if less than 5 years , , , , , , , , , 3 0 .05565800047

4 Enter the net value of noncharitable-use assets for 2004 from Part X, line 5 4 9,574,354 .

5 532, 889 . 5 Multiply line 4 by line 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6 Enter 1% of net investment income (1% of Part I, line 27b) , , , , , , , , , , , , , , , , , , , 6 4,633 .

7 Add lines 5 and 6 7 537,522 .

i

23-6234545 . .

4 18 of the Excise Tax Based on Investment Income Section 4940 (a~ , 4940 (b ) , 4940 (e ) , or 4948 - see

1 a Exempt operating foundations described in section 4940(d)(2), check here 1 and enter "N/A" on line 1 Date of ruling letter . _ _ _ _----- (attach copy of ruling letter If necessary-see Instructions)

b Domestic organisations that meet the section 4940(e) requirements in Part V, check here " Fland enter 1 % of Part I, line 27b , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , All other domestic organizations enter 2% of line 27b Exempt foreign organizations enter 4% of Part I, line 12, col (b)

2 Tax under section 511 (domestic section 4947(a)(1) trusts and taxable foundations only. Others enter -0-) , , , 3 Add lines 1 and 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 Subtitle A (income) tax (domestic section 4947(a)(1) trusts and taxable foundations only . Others enter -0-) , , , 5 Tax based on investment income. Subtract line 4 from line 3. If zero or less, enter -0- , , , , , , , , , , , , , 6 Credits/Payments: a 2004 estimated tax payments and 2003 overpayment credited to 2004 , , , 6a 8 , 780 . b Exempt foreign organizations - tax withheld at source , , , , , , , , , , , , 6b NONE c Tax paid with application for extension of time to file (Form 8868), 6c NON d Backup withholding erroneously withheld , , , , , , , , , , , , 6d

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

" "

" ~ " " " " " " " ~ . " " " " " . . . . " . . g Enter any penalty for underpayment of estimated tax Check here ~ if Form 2220 is attached , , , , , ~ ~ ~ ,

g Tax due. If the total of lines 5 and 8 is more than line 7, enter amount owed , , , , , , , , , , , , , 7 0 Overpayment. If line 7 is more than the total of lines 5 and 8, enter the amount overpaid , , , , , , , 11 Enter the amount of line 10 to be: Credited to 2005 estimated tax jo. 4,147 . Refunded 11111-

4,633 .

4, 633 . NONE

4,633 . 4

8 .780 . 8 9

4,147 .

Statements Re

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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 of the instructions for definition)? , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , 1 b X

If the answer is "Yes" to 1a or 1b, attach a detailed description of the activities and cqoies of any materials published or distributed by the organization in connection with the activities.

c Did the organization file Form 1120-POL for this year? , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , 1 c X d Enter the amount (if any) of tax on political expenditures (section 4955) imposed during the year:

(1) On the organization " $ (2) On organization managers " $

e Enter the reimbursement (if any) paid by the organization during the year for political expenditure tax imposed on organization managers . t $ Has the organization engaged in any activities that have not previously been reported to the IRS? , , , , , , , , , 2 If "Yes, " attach a detailed description of the activities

3 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? If "Yes,"attach a conformed copy of the changes , , , , , , , , , , 3

4a Did the organization have unrelated business gross insane of $1,000 or more during the year? , , , , , , , , , , , , , , , 4a b If "Yes," has it filed a tax return on Form 990-T for this year? , , , , , , , , , , , , , , , , , , , , , , , , , , , , , 4 b

5 Was there a liquidation, termination, dissolution, or substantial contraction during the year? , , , , , , , , , , , , , S 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? , , , , , , , , , , , , , , , , , , , , , , , , , , 6

7 Did the organization have at least $5,000 m assets at any time during the year? If 'Yes," complete Part 1l, cd (c), and Part XV. 7 8a Enter the states to which the foundation reports or with which it is registered (see page 19 of the

instructions) jo. SEE STATEMENT 7 b If 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 state as required by General Instruction G? If "No,"attach explanation , , , , , , , , , , , , , , 8b 9 Is the organization claiming status as a private operating foundation within the meaning of section 4942Q)(3)

or 4942(j)(5) for calendar year 2004 or the taxable year beginning in 2004 (see instructions for Part XIV on page 25)? If "Yes, "" complete Part XIV . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

10 Did any persons become substantial contributors during the tax years a 'Yes," attach a schedule listing their names and addresses , , 10 17 Did the organization comply with the public inspection requirements for its annual returns and exemption application? all

Web site address " N/A 12 The books are in care of " _ WACHOVIA BANK, N _A-______---______---Telephone no . " __ (336) 732- 5252 -------

Located at 111. _ 100_ N . MAIN STREET, Winston-Salem, NC ziP+a " 27150-6732 13 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 . . "" II 13 I aEiaao 2 000 Form 990-PF (2004)

23-6234545 . .

Form 990-PF 5 Statements Rega Activities for Which Form 4720 May Be Required

File Form 4720 if any item is checked in the "Yes" column, unless an exception applies . 1a During the year did the organization (either directly or indirectly)

(1) Engage in the sale or exchange, or leasing of property with a disqualified person? , , , , , , , , 1:1 Yes X No

(2) Borrow money from, lend money to, or otherwise extend credit to (or accept it from) a disqualified person? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , Yes X No

(3) Furnish goods, services, or facilities to (or accept them from) a disqualified persons , . . . . , , Yes X No

(4) Pay compensation to, or pay or reimburse the expenses of, a disqualified person? . . . . . . . . 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)? . . . . . . . , , . . . . . . . . . . . . . . . , Yes E~ No

(6) Agree to pay money or property to a government official? (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 E~ No

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 page 20 of the instructions)? Organizations relying on a current notice regarding disaster assistance check here . , . . . . . . . . . . . ~ 0 "

c Did the organization engage in a prior year in any of the acts described in 1a, other than excepted acts, that were not corrected before the first day of the tax year beginning in 2004? , , , . , . . , . , , . , , . , , , , , , . . ,

2 Taxes on failure to distribute income (section 4942) (does not apply for years the organization was a private operating foundation defined in section 4942(j)(3) or 49420(5)):

a At the end of tax year 2004, did the organization have any undistributed income (lines 6d and 6e, Part XIII) for tax year(s) beginning before 2004? . . . . . . . . . . . . . . . . . . . . . . Yes FZ No If "Yes ." list the years " ---------- '--------- '--------- '---------

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 income? (If applying section 4942(a)(2) to all years listed, answer "No" and attach statement - see page 20 of the instructions .) . . . . . . . . , . . . . . . . . . . .

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

3a Did the organization hold more than a 2% direct or indirect interest in any business enterprise at any time during the year? , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , Yes E~ No

b If "Yes," did it have excess business holdings in 2004 as a result of (1) any purchase by the organization or 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 ; a (3) the lapse of the 10-, 15-, or 20-year first phase holding period? (Use Schedule C, Form 4720, to determine if the organization had excess business hddings in 2004) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4a Did the organization invest during the year any amount in a manner that would jeopardize its charitable purposes? . . . . . . . b Did the organization 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 2004? . . . . . . . . . . . 5 a During the year did the organization pay or incur any amount to:

(1) Carry on propaganda, or otherwise attempt to influence legislation (section 4945(e))? , , , , , , F-1 Yes E~ No (2) Influence the outcome of any specific public election (see section 4955) ; or to carry

on, directly or indirectly, any voter registration drive? Yes X No (3) Provide a grant to an individual for travel, study, or other similar purposes? " . . . . . . . . . . _ B Yes BX No (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)? , , , , , , , , , , , , , , , , , , , , , Yes X 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? , , , , , , , , , , F-1 Yes X No

b 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 20 of the instructions)? " Organizations relying on a current notice regarding disaster assistance check here , , . , , . , , , , , , , ,

~

c If the answer is "Yes" to question 5a(4), does the organization claim exemption from the tax because it maintained expenditure responsibility for the grant? . . , . . . . . , , . , , , , , , Yes X No

If "Yes," attach the statement required by Regulations section 53.4945-5(d) 6a Did the organization, during the year, receive any funds, directly or indirectly, to pay

premiums on a personal benefit contract? , , , , , , , , , , , , , , , , , , , , , , , , , , , , .

Yes X No

b Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract? . . . . . , , If you answered "Yes" to 6b, also file Form 8870

X

Form 990-PF (2004)

11 - RK8061 543P 06/27/2005 14 :49 :50 1525022312

X

X

X

X X

X

X

JSA 4E1450 2 000

Total number of others receiving over $50,000 for professional services , , " NONE

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

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

---------------------------------------------------------------------------- NONE

2

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3

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4

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Form 990-PF (zooa~ JSA 4E1460 2 000

RK8061 543P 06/27/2005 14 :49 :50 1525022312 12 -

23-6234545 Form 990-PF (2004) Page s

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).

a Name and address (b) Title, and average (c) Compensation (d) Contributions to (a) Expense account,

1 hours per week (If not paid, enter employee benefit plans other allowances

SEE STATEMENT 8 ~ I 38,512 .1 -0- 1 -0-

2 Compensation of five highest-paid employees (other than those included on line 1 - see page 21 of the instructions) . If none, enter "NONE."

b Title and average (d) Contributions to

(a) Name and address of each employee paid more than $50,000 ~ hours erweek(~) Compensation employee benefit (e) Expense account, plans and deferred other allowances

devoted to position compensation

-------------------------------------NONE

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

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

Total number of other employees paid over $50,000 . " NONE 3 Five highest-paid independent contractors for professional services - (see page 21 of the instructions). If none, enter

"NONE." (a) Name and address of each person paid more than $50,000 (b) Type of service (e) Compensation

-----------------------------------------------------NONE

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

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

. ,

Form 990-PF (2ooa) 23-6234545 Pace 7 Summary of Program-Related Investments (see page 22 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 NONE --------------------------------------------------------------------- ---------------------------------------------------------------------------

2

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

All other program-related investments See page 22 of the instructions 3 NONE

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

Total. Add lines 1 through 3 - Minimum Investment Return (All domestic foundations must complete this part . Foreign foundations, see page 22 of the instructions .)

1 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 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 a 9,713,245 . b Average of monthly cash balances . , . . . , . , . . . , . . , . . . . . . . . . . , . . . . . . . . . 1 b 3,272 . c Fair market value of all other assets (see page 22 of the instructions) , , , , , , , , , . , , , . , , . , , 1 c 3,639 . d Total (addlines 1a,b,andc) . . . . . . . . , . . . . . , . . . , , . . , . . , . . . . . . , . . . . . . 1d 9,720,156 . e Reduction claimed for blockage or other factors reported on Imes 1a and

1 c (attach detailed explanation) . , . . . . . . , . . . . . . , . 1 e 2 Acquisition indebtedness applicable to line 1 assets 2 NONE 3 Subtract line 2 from line 1d _ . . . . . , . . . . , . . 3 9, 720, 156 . 4 Cash deemed held for charitable activities . Enter 1 1 /2 % of line Y (f~; greater amount, see page 23

of the instructions) , . . . . . . . . . . . . 4 145,802 . 5 Net value of noncharitable-use assets . Subtract line 4 from line 3 Enter here and on Part V, Ime 4 . . 5 9,574,354 . g Minimum investment return . Enter 5% of line 5 , 6 478 , 718 .

Distributable Amount (see page 23 of the instructions) (Section 4942(j)(3) and (j)(5) private operating foundations and certain foreign organizations check here lip. n and do not complete this part )

1 Minimum investment return from Part X, line 6 . . . . . . . . . . . . . . . . . . . . . . , . . . . . , 2a Tax on investment income for 2004 from Part VI, line 5 2a ~ 4,633 . b Income tax for 2004 . (This does not include the taxfrom Part VI .) . . . _2b c Add lines 2a and 2b

3 Distributable amount before adjustments. Subtract line 2c from line 1 , , . . . , . . , . , , . . . . . . 4 Recoveries of amounts treated as qualifying distributions , , , , , , , , , , , , , , , , , , , , , , , , , 5 Add lines 3 and 4 6 Deduction from distnbutable amount (see page 23 of the instructions) , . . , , . . , . . , 7 Distributable amount as adjusted Subtract line 6 from line 5. Enter here and on Part XIII,

line 1

478,718 .

4,633 . 4,085 .

NONE 474,085 .

474,085 .

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 I, column (d), line 26 . . . , . . , . . , . . . , . . , 1 a 587,408 . b Program-related investments - total from Part IX-B . . . . . . . . . . . . . . . 1 b

2 Amounts paid to acquire assets used (or held for use) directly in carrying out charitable, etc ., purposes . . . . . . . . . . . . . . . . . . . . . . . . . 2 NONE

3 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 1 a through 3b . Enter here and on Part V, line 8, and Part XIII, line 4 , , , , , , 4 587,408 . 5 Organizations that qualify under section 4940(e) for the reduced rate of tax on net investment

income . Enter 1% of Part I, line 27b (see page 24 of the instructions) . . . . . . . . . . . . . . . . . . 5 4 , 633 . 6 Adjusted qualifying distributions. Subtract line 5 from line 4 . . . . , . . . , . 6 582 , 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 the section 4940(e) reduction of tax in those years .

Form 990-PF (2004)

JSA 4E1470 2 000

RK8061 543P 06/27/2005 14 :49 :50 1525022312 13 -

JSA 4E1480 2 000

RK8061 543P 06/27/2005 14 :49 :50 1525022312 14 -

a a ~ l 23-6234545

Form 990-PF(2004) Page $

Undistributed Income (see page 24 of the instructions)

(a) (b) (c) (d) 1 Distributable amount for 2004 from Part XI, Corpus Years prior to 2003 2003 2004

line 7 �� 474 085 .

2 Undistributed income, if any, as of the end of 2003 a Enter amount for 2003 only , , , , , , , , , , 262,671 . b Total for prior years 2002 NON

3 Excess distributions carryover, if any, to 2004 a From 1999 , , , , , , NONE b From 2000 , , , , , NONE c From 2001 , , , , , , NONE d From 2002 NONE

e From 2003 , . , , . , NONE

f Total of lines 3a through e , , , , , , , , , , , NON

4 Qualifying distributions for 2004 from Part x11, line 4 t $ 587,408 .

a Applied to 2003, but not more than line 2a , , , 262,671 .

b Applied to undistributed income of prior years (Election required - see page 24 of the instructions) , , NON

c Treated as distributions out of corpus (Election required - see page 24 of the instructions) , , , NON

d Applied to 2004 distributable amount, , , , , , 324,737 .

e Remaining amount distributed out of corpus , , NON 5 Excess distributions carryover applied to 2004 NON NONE

(If an amount appears in column (d), the same amount must be shown in column (a) )

s Enter the net total of each column as indicated below :

a Corpus . Add lines 3f, 4c, and 4e . Subtract line 5 NON

b Prior years' undistributed income. Subtract line 4b from line 2b , , , , NON

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) tax has been previously assessed , , , , , , , , NON

d Subtract line 6c from line 6b Taxable amount - see page 25 of the instructions , , , NON

e Undistributed income for 2003 Subtract line 4a from line 2a Taxable amount - see page 25 of the instructions

f Undistributed income for 2004 . Subtract lines 4d and 5 from line 1 This amount must be distributed in 2005 , , , 149, 348 .

7 Amounts treated as distributions out of corpus to satisfy requirements imposed by section 170(b)(1 )(E) or 4942(8)(3) (seepage 25 of the instructions) , . , , , , . NON

S Excess distributions carryover from 1999 not applied on line 5 or line 7 (see page 25 of the instructions) . . . . . . . . . . . . . . . NON

9 Excess distributions carryover to 2005. Subtract lines 7 and 8 from line 6a . . . . . . NON

10 Analysis of line 9 : a Excess from 2000 . . . NONE

b Excess from 2001 . . . NONE

c Excess from 2002 . . . NONE

d Excess from 2003 . . . NONE e Excess from 2004 . . ~ NONE

Form 990-PF (zooa)

a~aao 2 000 Form 990-PF (2004) RK8061 543P 06/27/2005 14 :49 :50 1525022312 15 -

Form 990-PF(2004) 23-6234545 Private Operating Foundations (see page 25 of the instructions and Part VII-A, question 9) NOT APPLICABLE

1 a If the foundation has received a ruling or determination letter that it is a private operating foundation, and the ruling is effective for 2004, enter the date of the ruling . . .

b Check box to indicate whether the organization is a private operating foundation described in section 4942(j)(3) or 4942(j)(5)

2 a Enter the lesser of the Tax year Prior 3 years

adjusted net income from (a) 2004 (b) 2003 (c) 2002 (d) 2001 (a) Total Part I or the minimum investment return from Part X for each year listed .

b 85% of line 2a . . . , .

C Qualifying distributions from Part XII, line 4 for each year listed

Amounts included in line 2c not used directly (or active conduct of exempt activities . . . . .

B qualifying distributions made directly for active conduct of exempt activities Subtract line 2d from line 2c . Complete 3a, b, w c for the

alternative test retied upon a "Assets" alternative test - enter

(1 ) Value of atl assets (2) Value of assets qualifying

under section 4942Q )(3)(BHi) . . . . .

b "Endowment" alternative test -enter 2/3 of minimum investment return shown m Part X, line 8 for each year listed . . . . . . . .

C "Support" alternative test - enter

Total support other than gross investment income (interest, dividends, rents, payments on securities loans (section 512(a)(5)), or royalhes),

(2) Support from general public and 5 w more exempt organizations as provided in section 4942U)(3)(BHm) . . . .

(3) Largest amount of support from an exempt organization

4 Gross investment income . Supplementary Information (Complete this part only if the organization had $5,000 or more in assets at any time during the year - see page 26 of the instructions .)

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 foundation

before the close of any tax year (but only if they have contributed more than $5,000). (See section 507(d)(2).)

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

Check here 1 ~ if the organization only makes contributions to preselected charitable organizations and does not accept unsolicited requests for funds

If the organization makes gifts grants, etc (see page 26 of the instructions) to individuals or organizations under other conditions, complete items 2a, b, 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 .

d Any restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other factors .

23-6234545 Form 990-PF(2004)

Supplementary Information (continued)

JSA 4E1491 2 000

16 RK8061 543P 06/27/2005 14 :49 :50 1525022312

Form 990-PF (zooa)

Form 990-PF (2004) JSA 4E1492 2 000

RK8061 543P 06/27/2005 14 :49 :50 1525022312 17 -

s 4 c

23-6234545 Form 990-PF(2004) Page 1 1

Analysis of Income-Producin Activities Enter gross amounts unless otherwise indicated . Unrelated business insane Excluded b section 512, 513, or 514 Related(o~ exempt

(a) (p) (c) (d) function income Business Exclu in See page 26 of

1 Program sernce revenue: code Amount 6666- Amount the instructions . a b c d e f g Fees and contracts from government agencies

2 Membership dues and assessments , , , , , 3 Interest on sarongs and temporary cash investments 14 7, 122 .

4 Dividends and interest from securities 14 253,595 .

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 18 241,120 .

9 Net income or (lass) from special events , , ,

10 Gross profit or (loss) from sales of inventory . . 11 Other revenue: a

b c d e

501,837 . 12 Subtotal . Add columns (b), (d), and (e) , , , , 13 Total. Add line 12, columns (b), (d), and (e) , , , , , , , , , , , , , , , , , , , , . , , , . . , . , . , . . , , 7 3 501,837 .

(See worksheet in line 13 instructions on page 26 to verify calculations .) 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 .)

NOT APPLICABLE

Form990-PF 200423-6234545 Information Regarding Transfers To and Transactions and Relationships With Noncharitable Exem pt Organizations

1 Did the organization directly or indirectly engage in any of the following with any other organization described in section Yes No 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 nonchantable exempt organization of: (1)Cash . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1a1 X (2) Other assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1a ( 2 ) X

b Other transactions : (1) Sales of assets to a noncharitable exempt organization , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , 1 b( l ) X (2) Purchases of assets from a nonchantable exempt organization , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , 1 b 2 X (3) Rental of facilities, equipment, or other assets , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , 1 b(3 ) X (4) Reimbursement arrangements , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , 1 b 4 X (5) Loans or loan guarantees , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , 1 WS ) X (6) Performance of services or membership or fundraising solicitations , , , , , , , , , , , , , , , , , , , , , , , 1 b(6 ) X

c Sharing of facilities, equipment, mailing lists, other assets, a paid employees , , , , , , , , , , , , , , , , , , , , , , , , , 1 c X d If the answer to any of the above is "Yes," complete the following schedule. Column (b) should always show the fair 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, a services

2 a Is the organization directly or indirectly affiliated with, or related to, one or more tax-exempt organizations described m section 501(c) of the Code (other than section 501(c)(3)) a in section 527? , , , , , , , , , , , , , , , , , , E] Yes I Al No ~~ .. .,__ ,. ,. ..__ . . . .,. .~_ r ..~~_. . .._,. .,_~_a . .~, .

(b) Type of organization (a) Name of organization (c) Description of

' _ WYYu ,~m Signature of officer or trustee 11-

d 2 C

to i ?, Preparer's ' p signature

9- d m Firm's name (or yours if self-employed), address, and ZIP code

AACHOVIA BANK, N . 100 NORTH MAIN ST WINSTON-SALEM

JSA 4E1493 2 000

RK8061 543P 06/27/2005 14 :49 :50

Under penalties of penury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is tryq correct, and complete Declaration of preparer (other than taxpayer or fiduciary) is based on all mfnrtnatron of which preparer has any knowledge

r

FORM 990-PF - PART IV CAPITAL GAINS AND LOSSES FOR TAX ON INVESTMENT INCOME

P Kind of Property Description Date Date sold

acquired Gross sale Depreciation Cost or FMV Add basis Excess of Gam pace less allowed/ other as of as of F MV over or

ex enses of sale a ll owable ad basis (l oss )

TOTAL LONG-TERM CAPITAL GAIN DIVIDENDS 6,277 .

1302 . MEDCO HEALTH SOLUTIONS INC 01/01/1986 04/19/2004 PROPERTY TYPE : SECURITIES

44,293 . 2,221 . 42,072 .

600 . ABBOTT LABS W/RIGHTS ATTACHE 01/01/1986 08/27/2004 PROPERTY TYPE : SECURITIES

24,696 . 2,401 . 22,295 .

8000 . BRISTOL-MYERS SQUIBB CO COM 06/13/1988 08/27/2004 PROPERTY TYPE : SECURITIES

191,116 . 67,655 . 123,461 .

2500 . DUKE ENERGY CORP CO COM W/RI 04/08/2002 08/27/2004 PROPERTY TYPE : SECURITIES

54,730 . 98,125 . -43,395 .

960 . HOSPIRA INC-W/I 01/01/1986 08/27/2004 PROPERTY TYPE : SECURITIES

27,089 . 2,548 . 24,541 .

600 . JOHNSON & JOHNSON COM 01/01/1986 08/27/2004 PROPERTY TYPE : SECURITIES

34,604 . 1,973 . 32,631 .

800 . MERCK & CO INC COM 01/01/1986 08/27/2004 PROPERTY TYPE : SECURITIES

36,127 . 2,889 . 33,238 .

TOTAL GAIN(LOSS) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .~ 241,120 .

J A 4 E1730 1 000

RK8061 543P 06/27/2005 14 :49 :50 1525022312 19 -

FORM 990PF, PART I - CONTRIBUTIONS, GIFTS AND GRANTS RECEIVED

DATE

XD577 2 000

- RK8061 543P 06/27/2005 14 ;49 :50 1525022312 STATEMENT 1 20

THE HALLOWELL FOUNDATION I/M A/C 1525022312

NAME AND ADDRESS ----------------

DOROTHY WILLITS HALLOWELL AGENCY TRUST WACHOVIA BANK, N .A . PHILADELPHIA, PA

23-6234545

FORM 990PF, PART I - INTEREST ON TEMPORARY CASH INVESTMENTS

NET INVESTMENT

INCOME

WACHOVIA PT MONEY MARKET

XD577 2 000

- RK8061 543P 06/27/2005 14 :49 :50 21 1525022312 STATEMENT 2


DESCRIPTION

TOTAL

REVENUE AND

EXPENSES PER BOOKS

7,122 .

--------------7,122 .

23-6234545

7,122 .

--------------7,122 .

FORM 990PF, PART I - DIVIDENDS AND INTEREST FROM SECURITIES

REVENUE AND

EXPENSES DESCRIPTION PER BOOKS ----------- ---------

NET INVESTMENT INCOME

XD577 2 000

- RK8061 543P 06/27/2005 14 :49 :50 1525022312 22 STATEMENT 3

THE HALLOWELL FOUNDATION I/M A/C 1525022312 23-6234545

WACHOVIA PT MONEY MARKET ABBOTT LABS W/RIGHTS ATTACHED LXP 11/10/ BP PLC SPONSORED ADR BRISTOL-MYERS SQUIBB CO COM DUKE ENERGY CORP CO COM w/RIGHTS ATTACHL EVERGREEN CORE BOND FUND CL I (FD #474) EVERGREEN ADJUSTABLE RATE FUND CL I (FD EVERGREEN INTERNATIONAL GROWTH FUND CL I EXXON MOBIL CORP COM FPL GRP INC COM W/RTS ATTACHED EXP 6/30/ FREDDIE MAC COM VTG GENERAL ELEC CO COM HEINZ H J CO COM INTEL CORP COM JOHNSON & JOHNSON COM LILLY ELI & CO COM W/RTS EXP 7/28/2008 MERCK & CO INC COM MICROSOFT CORP COM PNC FINL SVCS GROUP INC COM W/RIGHTS ATT PROCTER & GAMBLE CO COM SARA LEE CORP COM W/RTS ATTACHED LXP 05/ 3M CO COM VERIZON COMMUNICATIONS COM WELLS FARGO & CO NEW COM W/RIGHTS ATTACH WEYERHAEUSER CO COM WYTTH COM

TOTAL

236 . 9,684 . 4,906 . 6,720 . 2,063 .

37,629 . 33,782 . 5,986 .

16,960 . 680 .

1,500 . 16,000 . 6,660 . 1,280 .

10,341 . 11,360 . 15,788 . 22,120 . 8,000 .

10,948 . 6,000 . 6,912 . 3,080 . 1,200 . 6,400 . 7,360 .

--------------253,595 .

236 . 9,684 . 4,906 . 6,720 . 2,063 .

37,629 . 33,782 . 5,986 .

16,960 . 680 .

1,500 . 16,000 . 6,660 . 1,280 .

10,341 . 11,360 . 15,788 . 22,120 . 8,000 .

10,948 . 6,000 . 6,912 . 3,080 . 1,200 . 6,400 . 7,360 .

--------------253,595 .

FORM 990PF, PART 2 - ACCOUNTING FEES

REVENUE AND

EXPENSES PER BOOKS

CHARITABLE PURPOSES

NET ADJUSTED INVESTMENT NET INCOME INCOME ------ ------

1,050 . 1,050 . -------------- -------------- -------------- --------------

1,050 . NONE NONE 1,050 .

XD577 2 000

- RK8061 543P 06/27/2005 14 :49 :50 1525022312 23 STATEMENT 4


DESCRIPTION

TAX PREPARATION FEE (NON-ALLOC

TOTALS

23-6234545

FEDERAL TAX PAYMENT - PRIOR YE 6,589 . FEDERAL ESTIMATES - INCOME 6,660 . FEDERAL ESTIMATES - PRINCIPAL 2,121 .

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

TOTALS 15,370 .

STATEMENT 5

xo676 2 000 RK8061 543P 06/27/2005 14 :49 :50 1525022312 24

. , - THE HALLOWELL FOUNDATION I/M A/C 1525022312 23-6234545

FORM 990PF, PART I - TAXES

REVENUE AND

EXPANSES DESCRIPTION PER BOOKS ----------- ---------

XD577 2 000

- RK8061 543P 06/27/2005 14 :49 :50 1525022312 25 STATEMENT 6

THE HALLOW$LL FOUNDATION I/M A/C 1525022312 23-6234545

FORM 990PF, PART I - OTHER EXPANSES

REVENUE AND

EXPENSES CHARITABLE DESCRIPTION PER BOOKS PURPOSES ----------- --------- --------

INSURANCE PREMIUMS 21,417 . 21,417 .

RENT FOR FDN OFFICE 4,923 . 4,923 .

CKING A/C SVC CHG 18 . 18 . -------------- --------------

TOTALS 26,358 . 26,358 .

xo576 2 000 RK8061 543P 06/27/2005 14 :49 :50 1525022312 26 -


-----------------------------------------------OTHER STATES WHERE THE FOUNDATION IS REGISTERED

PA

STATEMENT 7


FORM 990PF, PART VIII - LIST OF OFFICERS, DIRECTORS, AND TRUSTEES

TRUSTEE

38,512 .

XD577 2 000

- RK8061 543P 06/27/2005 14 :49 :50 27 1525022312 STATEMENT 8

NAME AND ADDRESS ----------------

HOWARD T HALLOWELL, III 139 ELLINGWOOD DRIVE ROCHESTER, NY 14618,

ANNE H MILLER 5285 JAMES LANDING ROAD SALISBURY, MD 21801-70,

MERRITT W HALLOWELL P O BOX 123 RYDAL, PA 19046,

DOROTHY w HALLOWELL P O BOX 4057 RYDAL, PA 19046,

WACAOVIA BANK, NA 100 N. MAIN STREET WINSTON-SALEM� NC 27150

TITLE AND TIME DEVOTED TO POSITION COMPENSATION ------------------- ------------

TRUSTEE

TRUSTED

TRUSTEE

INVESTMENT 40

GRAND TOTALS

38,512 .

------------ TOTAL CONTRIBUTIONS PAID 560,000 .

XD577 2 000

- RK8061 543P 06/27/2005 14 :49 :50 1525022312 28 STATEMENT 9


FORM 990PE, PART XV - GRANTS AND CONTRIBUTIONS PAID DURING THE YEAR

RELATIONSHIP TO SUBSTANTIAL CONTRIBUTOR AND

RECIPIENT NAME AND ADDRESS FOUNDATION STATUS OF RECIPIENT -------------------------- ------------------------------

SEE ATTACHED NONE PUBLIC CHARITY

23-6234545

PURPOSE OF GRANT OR CONTRIBUTION AMOUNT -------------------------------- ------

GENERAL 560,000 .

Taxable Amt Explanation Explanation (line 2)

-140000.00 CHARITABLE CONTRIBUTION ROCHESTER AREA COMMUNITY PER INSTRUCTIONS OF H HALLOWELL GIFT FROM HA FOUNDATION

-50000.00 CHARITABLE CONTRIBUTION CIVIL WAR PRESERVATION TRUST BLE CONTRIBUTION EIN #54-1426643 CHARITA

-20000.00 CHARITABLE CONTRIBUTION LOWER SHORE ENTERPRISES, INC. ERDUE-KRESGE CHALLENGE GRANT EIN # 52-0857128 FUND P

-10000.00 CHARITABLE CONTRIBUTION COLONIAL WILLIAMSBURG RALEIGH TAVERN SOCIETY EIN# 54-0505888 FOUNDATION THE

-10000.00 CHARITABLE CONTRIBUTION PENINSULA REGIONAL FOUNDATION, CHARITABLE CONTRIBUTION EIN# 52-1851935 INC .

-10000.00 CHARITABLE CONTRIBUTION THE ACADEMY OF THE NEW CHURCH F GEORGE M MILLER CLASS OF'54 GIFT EIN #23-1433F GIFT O

-500000 CHARITABLE CONTRIBUTION DELAWARE CHAMBER MUSIC CHARITABLE CONTRIBUTION EIN #51-0311626 FESTIVAL, INC

-5000.00 CHARITABLE CONTRIBUTION FIRST PRESBYTERIAN CHURCH CONTRIBUTION CHARITABLE

-5000.00 CHARITABLE CONTRIBUTION MID-DELMARVA YMCA FOR "LEARN TO " AND "WATER SAFETY PROGRAMS" EIN # 52-0854683 , SWIM

-5000.00 CHARITABLE CONTRIBUTION TRUSTEES OF THE UNIVERSITY OF LVANIA FOR FENCING PROGRAMS AND FENCING EQU -PENNSY

-400000 CHARITABLE CONTRIBUTION UNIVERSITY OF TAMPA CROSS OSTER CLUB CHARITABLE CONTRIBUTION EIN 59-0624-COUNTRY BO

-1000.00 CHARITABLE CONTRIBUTION MARINE CORP LEAGUE FOR BILLETING FAMILY MEMBERS OF INJURED MARINES, SAILOR AND OF

-40000.00 CHARITABLE CONTRIBUTION ANNA T JEANES FOUNDATION GIFT ALLOWELL FOUNDATION FROM H

-40000.00 CHARITABLE CONTRIBUTION ST. JOHN'S EPISCOPAL CHURCH GIFT M HALLOWELL FOUNDATION FRO

-30000.00 CHARITABLE CONTRIBUTION FOX CHASE CANCER CENTER GIFT LLOWELL FOUNDATION FROM HA

-30000.00 CHARITABLE CONTRIBUTION MOUNT HOLYOKE COLLEGE GIFT FROM DWELL FOUNDATION HALL

-15000.00 CHARITABLE CONTRIBUTION AMERICAN RED CROSS FLORIDA RELIEF HURRICANE t

-81400.00 CHARITABLE CONTRIBUTION SWARTHMORE COLLEGE GIFT FROM W. HALLOWELL MERRITT

-25000.00 CHARITABLE CONTRIBUTION WHARTON ANNUAL FUND (CLASS OF GIFT FROM MERRITT W HALLOWELL 1963)

-2100000 CHARITABLE CONTRIBUTION JARRETTOWN WARD LATTER DAY FT FROM MERRITT W. HALLOWELL SAINTS GI

-5000.00 CHARITABLE CONTRIBUTION CATO INSTITUTE GIFT FROM MERRITT HALLOWELL W.

-2500.00 CHARITABLE CONTRIBUTION ABINGTON MEMORIAL HOSPITAL GIFT MERRITT W. HALLOWELL FROM

-1000.00 CHARITABLE CONTRIBUTION HOLY REDEEMER HEALTH FROM MERRITT W. HALLOWELL FOUNDATION GIFT

-100000 CHARITABLE CONTRIBUTION JEANES HOSPITAL (ANNA T . JEANES DATION) GIFT FROM MERRITT W HALLOWELL FOUN

-1000.00 CHARITABLE CONTRIBUTION THE HERITAGE FOUNDATION GIFT RRITT W. HALLOWELL FROM ME

-500.00 CHARITABLE CONTRIBUTION ABINGTON FRIENDS SCHOOL GIFT RRITT W. HALLOWELL FROM ME

1525022312 149 12/17/2004

06/27/2005 4:02:06 PM CS - List of Payments by Account - 149 tax code : 543P Page 1

Account Tax Code Posting Date

1525022312 149 08/17/2004

1525022312 149 10/08/2004

1525022312 149 10/08/2004

1525022312 149 10/08/2004

1525022312 149 10/08/2004

1525022312 149 10/08/2004

1525022312 149 10/0812004

1525022312 149 10/08/2004

1525022312 149 10/08/2004

1525022312 149 10/08/2004

1525022312 149 10/08/2004

1525022312 149 10/0812004

1525022312 149 10/13/2004

1525022312 149 10/13/2004

1525022312 149 10/13/2004

1525022312 149 10/13/2004

1525022312 149 10/14/2004

1525022312 149 12J17/2004

1525022312 149 12/17/2004

1525022312 149 12/1712004

1525022312 149 12117/2004

1525022312 149 12/1712004

1525022312 149 12/17/2004

1525022312 149 12/17/2004

1525022312 149 12117/2004

Account Tax Code Posting Taxable Amt Explanation Date

1525022312 149 12/17/2004 -500.00 CHARITABLE CONTRIBUTION ABINGTON YMCA GIFT FROM MERRITT W. H

1525022312 149 12/17/2004 -300.00 CHARITABLE CONTRIBUTION ABINGTON FREE LIBRARY GIFT FROM MERR

1525022312 149 12/17/2004 -300.00 CHARITABLE CONTRIBUTION THE SUNSTONE FOUNDATION GIFT FROM ME

1525022312 149 12/17/2004 -300.00 CHARITABLE CONTRIBUTION WILLIAM PENN CHARTER SCHOOL (CLASS O

1525022312 149 12/17/2004 -200.00 CHARITABLE CONTRIBUTION DIALOGUE GIFT FROM MERRITT W. HALLOW

'~ SC~D~ ODD ~~ - `I ~~

06/27/2005 4:02:06 PM CS - List of Payments by Account - 149 tax code : 543P Page 2

Explanation (line 2)

ALLOWELL

ITT W. HALLOWELL

RRITT W. HALLOWELL

F 1957) GIFT FROM MERRITT W. HALLOWELL

ELL

y

t 16 1

JSA 4F1210 4 000

RK8061 543P 06/27/2005 14 :49 :50 35 - 1525022312

SCHEDULE D OMB No 1sas-oosz (Form ,04,) Capital Gains and Losses Department ormeTreasury , t Attach to Form 1041, Form 5227, or Form 990-T. See the separate 200 intemai Revenue se'rvice instructions for Form 7041 (also for Form 5227 or Form 990-T, if applicable) . Name of estate or trust Employer identification number

THE HALLOWELL FOUNDATION I/M A/C 1525022312 23-6234545 Note : Form 5227 filers need to complete only Parts / and //

Short-Term Capital Gains and Losses - Assets Held One Year or Less (a) Description of property (b) Date (Q Gain or (Loss) (Example, 100 shares 7% acquired (c) Date sold (d) Sales price (e) Cost or other basis for the entire year

referred of "Z" Co mo, day, r Imo,day, yr ) (see page 33) (col (d) less w1 (e))

1

2 Short-term capital gam or (loss) from Forms 4684, 6252, 6781, and 8824 , , , , , , , , , , , , , , , , , , 2 3 Net short-term gam or (loss) from partnerships, S corporations, and other estates or trusts , , , , , , , , , 3 4 Short-term capital loss carryover. Enter the amount, if any, from line 9 of the 2003 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 13,

column 3 below " 5

Long-Term Capital Gains and Losses - Assets Held More Than One Year

(a) Description of property (b) Date (fl Gain or (Loss) (Example, 100 shares 7% acquired (c) Date sold (e) Cost or other basis for the entire year

referred of (mo , day, yr ) (d) Sales price (see page 33) "Z" Co mo,da ,r (c01 (d) less col (e))

6 LONG-TERM CAPITAL GAIN DIVIDENDS STMT 2~ ~ ~ 6,277 . SEE STATEMENT 1 412,655 . 177,812 . 234,843 .

7 Long-term capital gain or (loss) from Forms 2439, 4684, 6252, 6781, and 8824 . . . . , . . . . . . . . 7 8 Net long-term gain or (loss) from partnerships, S corporations, and other estates or trusts 8 9 Capital gain distributions�� 9

10 Gain from Form 4797,Part l �� , 10 11 Long-term capital loss carryover. Enter the amount, if any, from line 14 of the 2003 Capital Loss

Carryover Worksheet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ~ ~ 12 Net long-term gain or (loss) . Combine lines 6 through 11 in column (f). Enter here and on line 14a,

column (3) below , " 12 241 , 120 . Summary of Parts I and II (1) Beneficiaries' (2) Estate's I (3) Total Caution: Read the instructions before completing this part. ~ (see page 34) ~ or trust's

13 Net short-term gain or (loss) . . . . . . . . . . . . . . . . . . . . 1 3 14 Net long-term gain or (loss) :

a Total for year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14a 241,120 .

b Unrecaptured section 1250 gain (see line 18 of the worksheet on page 34) . . . . . . . . . . . . . . . . . . . . . . 14b

c 28% rate gain or (loss) . . . . . . . . . . . . . . . . . . . . . . . . .

15 Total net gain or (loss) . Combine lines 13 and 14a . . . . . . . 11111- 115 1 1 1 241,120 .

Note: If line 15, column (3), is a net gain, enter the gain on Form 1041, line 4 . If lines 14a and 15, column (2), are net gains, go to Part V, and do not complete Part IV. If line 15, column (3), is a net lass, complete Part IV and the Capital Loss Carryover Worksheet as necessary.

For Paperwork Reduction Act Notice, see the Instructions for Form 1041 . Schedule D (Form 1041) 2004

Schedule D (Form 1041) 2004 page 2

Capital Loss Limitation

16 Enter here and enter as a (loss) on Form 1041, line 4, the smaller of: a The loss on line 15, column (3) or b $3,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

If the loss on line 15, column (3), is more than $3,000, or if Form 1041, page 1, line 22, is a lass, complete the Capital Lass Carryover Worksheet on page 36 of the instructions to determine your capital loss carryover.

M/ Tax Computation Using Maximum Capital Gains Rates (Complete this part only if both lines 14a and 15 in column (2) are gains, or an amount is entered in Part I or Part II and there is an entry on Form 1041, line 2b(2), and Form 1041, line 22 is more than zero.)

Note : If line 14b, column (2) or line 14c, column (2) is more than zero, complete the worksheet on page 37 of the instructions and skip Part V. Otherwise, go to line 17.

31 Multiply line 30by15%(.15) �� , 32 Figure the tax on the amount on line 23 . Use the 2004 Tax Rate Schedule on page 22 of the

instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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17 Enter taxable income from Form 1041, line 22 18 Enter the smaller of line 14a or 15 in column (2) " ~

but not less than zero , , , , , , , , , , , , , , , 18 19 Enter the estate's or trusts qualified dividends

from Form 1041, line 2b(2) , , . , , , , , , , , , ~ 19 L

20 Add lines 18 and 19 . . . . . . . . . . . . . . . . 24 21 If the estate or trust is filing Form 4952, enter the

amount from line 4g ; otherwise, enter-0- . . 1 27

22 Subtract line 21 from line 20 If zero or less, enter -0- . . . . . . . . . . . . .

23 Subtract line 22 from line 17 . If zero or less, enter-0- . . . . . . . . . . . . . 23

24 Enter the smaller of the amount on line 17 or $1,950 , , , , , , . , , , , 24 25 Is the amount on line 23 equal to or more than the amount on line 24? B Yes. Skip lines 25 through 27 ; go to line 28 and check the ."No" box. . .

No. Enter the amount from line 23 .

25

26 Subtract line 25 from line 24 . . � . � . . , . � . . , . . , . . . , . . , 26

27 Multiply line 26 by 5% ( 05) , . . � . , . . , . . , . . . . . , . . , . . , . . � . . . . � . . . . � 27 28 Are the amounts on lines 22 and 26 the same?

H Yes. Skip lines 28 through 31 ; go to line 32 . No. Enter the smaller of line 17 or line 22 , , , , , , , , , , , , , , , , 28

29 Enter the amount from line 26 (If line 26 is blank, enter -0-) , , , , , , , , , , 29

30 Subtract line 29 from line 28 � . � . � � � � . � . � , . � � 30

33 Addlines 27,31,and32�� 33 34 Figure the tax on the amount on line 17 . Use the 2004 Tax Rate Schedule on page 22 of the

instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 35 Tax on all taxable income. Enter the smaller of line 33 or line 34 here and on line 1a of

Schedule G Form 1041 35 Schedule D (Form 1047) 2004

.F

;K8061 543P 06/27/2005 14 :49:50 1525022312 37 STATEMENT 1


Schedule D Detail of Long-term Capital Gains and Losses

Date Date Gross Sales Cost or Other Long-term Description Acquired Sold Price Basis Gain/Loss

CAPITAL GAINS (LOSSES) HELD FOR INVESTMENT PURPOSES

1302 . MEDCO HEALTH SOLUTIONS INC COM 01/01/1996 04/19/2009 44,293 . 2,221 . 42,072 . 600 . ABBOTT LABS W/RIGHTS ATTACHED EXP 11/10/2009 01/01/1986 08/21/2004 29,696 . 2,401 . 22,295 .

8000 . BRISTOL-MYERS SQUIBB CO COM 06/13/1988 08/27/2009 191,116 . 67,655 . 123,961 . 2500 . DUKE ENERGY CORP CO COM W/RIGHTS ATTACHED EXPIRING 12/16/2 04/08/2002 08/27/2004 54,730 . 98,125 . -43,395. 960 . HOSPIRA INC-W/I COM 01/01/1986 08127/2004 27,089 . 2,598 . 24,591 . 600 . JOHNSON & JOHNSON COM 01/01/1986 08/27/2004 34,604 . 1,973 . 32,631 . 800 . MERCK & CO INC COM 01/01/1986 08/27/2004 36,127 . 2,889 . 33,238 .

TOTAL CAPITAL GAINS (LOSSES) HELD FOR INVESTMENT PURPOSES 412,655 177,812 . 239,843.

Totals 912,655 177,812 . 234,893 .

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23-6234545

15% RATE CAPITAL GAIN DIVIDENDS

6,277 . ------------

XD578 2000 RK8061 543P 06/27/2005 14 :49 :50 1525022312 38 E

~ r ~, V 1 ~ 0 , ~, V i w


FEDERAL CAPITAL GAIN DIVIDENDS

LONG-TERM CAPITAL GAIN DIVIDENDS --------------------------------

EVERGREEN CORE BOND FUND CL I (FD #474)

TOTAL 15% RATE CAPITAL GAIN DIVIDENDS

TOTAL LONG-TERM CAPITAL GAIN DIVIDENDS

6,277 . ------------

6,277 .

STATEMENT 2

RUN FEB 19 05 WACHOVIA BANK, N.A . AT 1 :30 PM INVEST AFC/AFP INTERFACE

DETAIL LIST SELECTED ACCOUNTS 12/31/04 THROUGH 12/31/04

SETTLE DATE POSITION FOR 1525022312 HALLOWELL FNDN AS OF 12/31/04

CUSIP # SECURITY NAME UNITS / ORIG . FACE BOOK VALUE MARKET VALUE

PRINCIPAL

DEPOSIT ACCOUNTS

997981006 WACHOVIA PT MONEY MARKET ----------------

TOTAL DEPOSIT ACCOUNTS

MUTUAL FUNDS - FIXED TAXABLE

299908103 EVERGREEN CORE BOND FD INST CL ----------------------------(FD #474)

299913202 EVERGREEN ADJUSTABLE RATE FD CL I (FD #056)

TOTAL MUTUAL FUNDS - FIXED TAXABLE

COMMON STOCKS

002824100 ABBOTT LABS COM -------------

055622104 BP PLC SPONSORED ADR

172758102 CISCO SYS INC COM

302316102 EXXON MOBIL CORP COM

302571104 FPL GRP INC COM

313400301 FREDDIE MAC COM VTG

369604103 GENERAL ELEC CO COM

423074103 HEINZ H J CO COM

458140100 INTEL CORP COM

478160104 JOHNSON & JOHNSON COM

532457108 LILLY ELI & CO COM

454,540 .00 454,540 .00

454,540 .00 454,540 .00

r 83,575 .821658 909,240 .04 895,097 .05 909,237 .07 909,237 .07

104,602 .510004 1,000,000 .00 984,309 .62 1,000,000 .00 1,000,000 .00

188,178 .331662 1,909,240 .04 1,879,406 .67 1,909,237 .07 1,909,237.07

9,000 36,007 .77 419,850 .00 36,007 .77 36,007 .77

2,952 46,388 .34 172,396 .80 46,388 .34 46,388 .34

10,000 238,125 .00 193,200 .00 238,125 .00 238,125 .00

16,000 110,250 .00 820,160 .00 110,250 .00 110,250 .00

1,000 68,578 .00 74,750 .00 68,578 .00 68,578 .00 r

2,500 165,825 .00 184,250 .00 165,825.00 165,825 .00 s

20,000 74,001 .27 730,000 .00 73,269 .50 73,269 .50

6,000 77,273 .69 233,940 .00 77,273 .69 77,273 .69

8,000 248,625 .00 187,120 .00 248,625 .00 248,625 .00

9,000 29,601 .56 570,780 .00 29,601 .56 29,601 .56 I

8,000 54,431 .00 454,000 .00 54,431 .00 54,431 .00

PAGE 36 AS OF 02/22/05

FED TAX COST STATE TAX COST

INCOME CASH 0.00 0 .00

********* INCOME TOTAL 0.00 0 .00 0 .00 0.00

ASSET FILE TOTAL 392,122 .472862 4,935,615 .87 9,652,057 .64 4,441,253 .14 4,441,253.14

RUN FEB 19 05 WACHOVIA BANK, N.A . PAGE 37 AT 1:30 PM INVEST AFC/AFP INTERFACE AS OF 02/22/05

DETAIL LIST SELECTED ACCOUNTS 12/31/04 THROUGH 12/31/04

SETTLE DATE POSITION FOR 1525022312 HALLOWELL FNDN AS OF 12/31/04

CUSIP # SECURITY NAME UNITS / ORIG . FACE BOOK VALUE MARKET VALUE FED TAX COST STATE TAX COST

589331107 MERCK & CO INC COM 10,000 36,113 .53 321,400 .00 36,113 .53 36,113 .53

594918104 MICROSOFT CORP COM 7,000 249,265 .63 187,040 .00 249,265 .63 249,265 .63

693475105 PNC FINL SVCS GROUP INC COM 4,000 70,000 .00 229,760 .00 70,000 .00 70,000 .00

742718109 PROCTER & GAMBLE CO COM 11,200 118,276 .59 616,896 .00 118,276 .59 118,276 .59

803111103 SARA LEE CORP COM 8,000 44,348 .05 193,120 .00 44,348 .05 44,348 .05

88579Y101 3M CO COM 4,800 51,727 .77 393,936 .00 51,727 .77 51,727 .77 s

92343V104 VERIZON COMMUNICATIONS COM 2,000 88,480 .00 81,020 .00 88,480 .00 88,480 .00

949746101 WELLS FARGO & CO NEW COM 2,500 147,132 .00 155,375 .00 147,132 .00 147,132 .00

962166104 WEYERHAEUSER CO COM 4,000 98,701 .70 268,680 .00 98,701 .70 98,701 .70

983024100 WYETH COM 8,000 83,445 .00 340,720 .00 83,445 .00 83,445 .00

TOTAL COMMON STOCKS 153,952 2,136,596 .90 6,828,593 .80 2,135,865 .13 2,135,865 .13

LIFE INS . - POL . & ANNUITIES

9CR020251 NEW ENGLAND INS POL NO 8125141 39,087 .98 39,087 .98 ---------------------------- 12/14/1984

TOTAL LIFE INS . - POL . & ANNUITIES 39,087 .98 39,087 .98

MUTUAL FUNDS - INTERNATIONAL EQUITY -----------------------------------

299924704 EVERGREEN INTERNATIONAL EQUITY 49,992 .1412 396,150 .95 450,429 .19 396,150 .94 396,150 .94 FD CL I (FD #252)

r TOTAL MUTUAL FUNDS - INTERNATIONAL EQUITY 49,992 .1412 396,150 .95 450,429 .19 396,150 .94 396,150 .94

PRINCIPAL CASH 0 .00 0 .00

********* PRINCIPAL TOTAL 392,122 .472862 4,935,615.87 9,652,057 .64 4,441,253 .14 4,441,253 .14

INCOME

If you are fling for an Automatic 3-Month Extension, complete only Part I and check this box , , . . . . . . , , . . . . . . 11110 . X If you are filing for an Additional (not automatic) 3-Month Extension, complete only Part II (on page 2 of this form).

Do notcomplete Part 1l unless you have already been ranted an automatic 3-month extension on a previously filed Form 8868 . F7, M, Automatic 3-Month Extension of Time - Only submit original (no copies needed) Form 990-T corporations requesting an automatic 6-month extension - check this box and complete Part I only . . . . . , , . , , " a All other corporations (including Form 990-C filers) must use Form 7004 to request an extension of time to file income tax returns. Partnerships, REMICs, and trusts must use Form 8736 to request an extension of time to file Form 1065, 1066, or 1041 . Electronic Filing (e-file) . Form 8868 can be fled electronically if you want a 3-month automatic extension of time to file one of the returns noted below (6 months for corporate Form 990-T filers) . However, you cannot file it electronically if you want the additional (not automatic) 3-month extension, instead you must submit the fully completed signed page 2 (Part II) of Form 8868 . For more details on the electronic filing of this form, visit www.irs.gov/efile . Type Or Name of Exempt Organization Employer identification number print THE HALLOWELL FOUNDATION I/M A/C 1525022312 23-6234545 File by the Number, street, and room or suite no . If a P.O . box, see instructions. due date for 100 NORTH MAIN STREET, 13TH FLOOR - � n n re~tumySee City, town or post office, state, and ZIP code . For a foreign address, see instruc s.-instructions WINSTON-SALEM, NC 27150

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Form 8868 Application for Extension of Time To File an (Rev December2004) Exempt Organization Return OMB No. 1545-1709 Department of the Treasury Internal Revenue Service " File a separate application for each return .

Check type of return to be filed (file a se crate application for each return) : Form 990 Form 990-T (corporation) Form 4720 Form 990-BL Form 990-T(sec . 401(a) or 408(a) trust) Form 5227 Form 990-EZ Form 990-T (trust other than above) Form 6069 Form 990-PF Form 1041-A Form 8870

The books are in the care of " WACHOVIA BANK, N . A .

Telephone No . Ili- (704) 383-5589 FAX No. lo.

If the organization does not have an office or place of business in the United States, check this box If this is for a Group Return, enter the organization's four digit Group Exemption Number (GEN) .If this is

for the whole group, check this box " F-] . If it is for part of the group, check this box " and attach a list with the names and EINs of all members the extension will cover. 1 I request an automatic 3-month (6-months for a Form 990-T corporation) extension of time until 08/15 , 2005

to file the exempt organization return for the organization named above. The extension is for the organization's return for: 00. XB calendar year 2004 or

tax year beginning , and ending

2 If this tax year is for less than 12 months, check reason: Ej initial return E] Final return 7 Change in accounting period

3a If this application is for Form 990-BL, 990-PF, 990-T, 4720, or 6069, enter the tentative tax, less any nonrefundable credits . See instructions , , , , , , , . . . . . . . . . , , . . . . . $ 4,638 .

b If this application is for Form 990-PF or 990-T, enter any refundable credits and estimated tax payments made . Include any prior year overpayment allowed as a credit , , , , , , , , . , , . . . . . . . . . . . . , . , $ 8,780 .

c Balance Due. Subtract line 3b from line 3a . Include your payment with this form, or, if required, deposit with FTD coupon or, if required, by using EFTPS (Electronic Federal Tax Payment System). See instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $

Caution. If you are going to make an electronic fund withdrawal with this Form 8868, see Form 8453-EO and Form 8879-EO for payment instructions . For Privacy Act and Paperwork Reduction Act Notice, see Instructions. Form 8868 Rev. 12-2ooa)

i a ggp p~ return of private...

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