Form 990-PF Return of Private Foundation990s.foundationcenter.org/990pf_pdf_archive/341/341733685/34173… · Form 990-PF Return of Private Foundation OMB NO 1S4SOOS2 or Section 4947(a)(1)

Form 990-PF Return of Private Foundation OMB NO 1S4SOOS2

or Section 4947(a)(1) Nonexempt Charitable Trust 2004 Dapeitment o1 the Treasury Treated as e Private Foundation

Internal Revenue Service Note : The organization may be able to use a copy of this return to satisfy state reporting requbements.

For calendar ear 2004, or tee y ear be g innin g , and ending

G Check all the a Initial return Final return Amended return Address chan g e Name chan g e

Use the IRS Name of organization A Employer Identification number

label . Otherwise, HE DAVID AND LURA LOVELL FOUNDATION 34-1733685

print Number and euoot for P .O. box number If mall 19 not delivered to ouoot vaowa) RooRvouleo g Telephone number ortype . 995 E . MANZANITA RIDGE PLACE 419-244-3711

See Speclllc Instruction: . City or town, state, and ZIP code C if exemption application Is Pending . m+~w h~ , t U

UCSON AZ 85 718 0 1 . Foreign organizations, chock here . �" (~ esx test .

H Check type of organization : Section 501(0)(3) exempt private foundation 2. Foreign o hero organizations

end organizations

nnnen �,oouno mo oompurotlon . . Choc k

Section 4947 ( a )( 1 ) nonexempt Charitable trust Other taxable private foundation E It private foundation status was terminated I Fair market value of all assets at end of year J Accounting method Cash Accrual under section 507(D)(1)(A), check here (from Part 11, col. (c), line 16) ~ Other (specify) F It the foundation is in a 60-month termination 111114 10 , 961 , 128 . (Part l, column (d) must be on cash basis.) 10- under section 507( b )( 1 B check here

Analysis of Revenue and Expenses (a) Revenue and (b) Net Investment (c) Adjusted net (d) Disbursements (Thh of

equal N amounts emote

~ I~ o%~iu~,~, ' (e~~a ) ~~ ~ ~~~ expenses per books income income for charitable purpoaee (earn basis on

~w ~ < 1 Contributions, gifts, grants, etc , received 6 4 0 0 0 AS', ;' ;~ k~` '~ "ar .̀" . ~ ~~' . )

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9 '`°~~°~"v~ savings and temporary 4 Dividends and interest from securities . . . . . 296 , 356 . 296 , 356 . TA~i'~MENT' 68 Gross rents . .� � . . .

~` :\~'~~7:~\\ b NM rental Income or poaa) t,~, . :~~~.o

Net n or OII7 from sale O Chats not on m Ba line o . . ° . . . .' . . . . . . . . . . . . . . . . . . areas owes price roimi

. ... 11513,231 . ~w , "3't Q ti v s. ` S tx~ . :,~, .,~ . ;"

,` ~' ` w~s' .' .14 ~' ti , Capital own net income (from Pert N, line 2) Im1~ , : ~ 3 4 8 9 711 <~.. 8 Net short-term capital pain ~~~~' .,w .`~.'``~<'~~a.. : .

erJ 9 Income modHications . . . . . . . . . . . . . . mow; ` t;3; ''`Y", , " \ < ~ ck~'~ Mkti~c; ." s \~x~, ,~, . ~v{q;~ K tums ~,,

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s ' .~ 1~8 and dimvnnoea . . . . . . . . . .

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~~ ~^~^.{~ ,~ " JS1C v+C,LF,~K ~'. rS' ~~~T~;'s", ,

", b Lea9-a~ Coot at goods solo � ~ .i~.~' : , "wh~s.'E ~,`1 ~7,~s~~~ . . . . . . . H~~~~L.. "1i C.L~d~SR]GNi ~1 'sy§~u~+~2h1 " ' Xs

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0 t2 Total .Addlinesltnro~~~~~ .~~~~~, . . . . . . . . , 709 770 . 645 , 770 . ., aQM, wntoos. atc . , . 22 , 500 . 22 , 500 . 0 .

QZ 14 Other employee salad ~~ g

wages � , , �� , ~bs~tpplb~ etits 1 ~ 1 V I ' . . . � CIO STMT, , 3, , 1 , 866 . 1 , 866 . 0 .

b accounting tees . . . . . . . , � STMT , ,4�� 4 , 300 . 4 , 300 . 0 . c Other professional fees . . .

Z 17 Interest � , . �� , , � , . e Taxes , . STMT 5 21 , 942 . 2 , 942 . 0 .

~ 19 Depreciation and depletion ". a 20 Occupancy

a 21 Travel, conferences, and meetings 3 , 049 . 3 , 049 . 0 . r- 22 Printing and publications

23 Other expenses S TMT 6 124 , 309 . 124 , 309 . 0 . 0 24 Total operating and administrative n expenses . Add lines 13 through 23 177 , 966 . 158 1 966 . 0 . X 25 Contributions, gifts, grants paid 607 , 993 . : 607 , 993 .

26 Total expenses and disbursements . Addlines 24and25 785 959 . 158 966 . 607 993 .

27 Subtract line 26 from line 12 ,8 Excess of revenue win expenses and disbursements <76 1 189 . > b Net Investment income Of negative, enter -o-) 4 86 , 804 c Ad j usted net Income Of negative, «,u. _a) N/A

42501 LHA For Privacy Act and Paperwork Reduction Act Notice, see the Instructions . Form 990-PF (2004)

01 .p3_p5

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10211109 791298 6241 2004 .06030 THE DAVID AND LURA LOVELL F 6241 1

, 28 Total liabilities add lines 17 throu g h 22 . . . . . . . . . . . .

0 . 0 . N

Organizations that follow SFAS 117, check here and complete lines 24 through 2s and lines 90 and 91 . '` " '~`° ~ 'X

24 Unrestricted . 2 26 Temporarily restricted . . . . . . . . . . . . . . . % .~~~

aB 28 Permanently restricted ,

~". Organizations that do not follow SFAS 117, check here , . " .CE ' . ; ",'y . " ' <" s{. '~`" and complete lines 27 through 91 .

27 Capita stock, trust principal, or current funds . . 6 , 214 , 005 . 6- f l-3-7' , 816 . s~

' '`'` ; ti °' 28 Paid-in or capital surplus, or land, bldg ., and equipment fund 0 . 0 .

29 Retained earnings, accumulated Income, endowment, or other funds 0 " 0 " sr,, , 's ~ s .. s �.',<�. f' , r Z 30 Total net assets or fund balances 6 , 214 , 005 . 6 , 137 , 816 .

1 31 Total liabilities and net assets /fu nd balances 6 , 214 , 005 . 6 , 137 , 816 .

p6,tjft 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 poor years return)

2 Enter amount from Part 1, line 27a 3 Other increases not included m line 2 (itemize) 101, 4 Add lines 1, 2, and 3 5 Decreases not included in line 2 (itemize) 10, 6 Total net assets or fund balances at end of year (line 4 minus line 5) - Part II, column (b), line 30

6,214,005 . <76,189 . >

0 . 6,137,816 .

0 . 6,137,816 .

Form 990-PF (2004)

2

2004 .06030 THE DAVID AND LURA LOVELL F 6241 1 10211109 791298 6241

Form 990-PF (2004) THE DAVID AND LURA LOVELL FOUNDATION 34-1733685 Page 2

~p~g~y~Balance Sheets ~°~°°"°"~°"~s~"°~°~ Beginning of year End of ear

(c) Fair Market Value Colu"^0'a°°°°te'°'°'°i+w°'°'°m°"y a Book Value b Book Value

. Cash - non-Interest-bearing �� , . . . . , . . � . ., . . . . . � . . 2 savings and temporary cash Investments . , . . � . . , ~ ~ 397 , 596 . 302 , 726 . 302 , 726 . 8 Accounts receivable

Less . allowance for doubtful accounts ~ ., ._ 4 Pledges receivable ~

Less. allowance for doubtful accounts 1 6 Grants receivable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 Recelvables due from officers, directors, trustees, and other

disqualified persons . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..y . . ~~

7 Oau oats uno louq morJqDb . . . . . . . . . . . . . . . . . . . . . . . , ~~i ", ti~. ,~.a`c` ~~,. " ` ` `~`w`r .. '. \v

Less : allowance for doubtful accounts ~ 8 Inventories for sale or use � .�� . . . . � .� .�� . , ., , . . . . . . ., . . 9 Prepaid expenses and deterred charges � , , , ,

10e Investments - U.S . and state government obligations b investments - corporate stock . . . . . � STMT 7, 3 , 467 , 870 . 4 1 -4-69 , 869 . 9 1 13-7 , 345 . c investments - corporate bonds . � . . STMT 8 1 923 983 . 940 665 . 920 r 684 .

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k},\J~~fsj~S . ;'2` ~:'>~: "~~;', :" ' .;,~`. ;. . 1 masons - anouo ma twipffent basis . . `~"v. . .. ~. ..J~. \, sk,aw . >'s~'.' ~iav\ E \: .

Lass muwWe0 mptedidal . . . . . . . . . . . . . .

12 Investments - mortgage loans . . . . . . . . . 13 investments - other .�� . . . � �� . STMT � ,9 424 C 556 . 424 , 556 . 600 , 373 . 14 Land, buildings, and equipment basis AM ~k~, ` ~

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\ , s ` v ~~ ~i C `~ v ~,{,~;~~~~~c~ ;~ " ,`w .\ Las sommUM depreciation

16 Other assets (describe 01 ) I

6,214,005 .1 6,137,816 .1 10,961,128 . 17 Accounts payable and accrued expenses � , 18 Grants payable . . . ., . , , �� , 19 Deferred revenue , . . . � �� ., . . , � � � � � ��

20 Loans him oMoerf, directors. trustees, sad other CInquNIIIoC parsons � , 21 Mortgages and other notes payable . . �� , , 22 Other liabilities (describe " )

423511 01-03-OS

Form 990-PF 2004 THE DAVID AND LURA LOVELL FOUNDATION 34-1733685 Pa

?Past#IY~ ~ Capital Gains and Losses for Tax on Investment Income

(a) Ust and describe the kind(s) of property sold (e g ., real estate, (b1p How acquired (c) Date acquired (d) Date sold 2-story brick warehouse ; or common stock, 200 shs MLC Co .) D - Oon nation Imo , day, yr .) (mo ., day, yr.)

to b SEE ATTACHED STATEMENT

c d e

(e) Gross sales price (1) Depreciation allowed (p) Cost or other basis (h) Gain or (loss) (or allowable) plus expense of sole (e) plus (1) minus (Q)

8 b c a e 1 , 513 , 231 . 1 1 , 164 , 260 . 348 , 97

Complete only for assets showing gain In column (h) and owned by the foundation on 12/31169 (I) Gains (Col (h) gain minus (1) Adjusted basis (k) Excess of col . (I) col (k), but not less than -0-) or

(I) F M V as of 12/31/69 as of 12/31/69 over col (1),H any l Losses (from col (h))

48,971 . e

3 10211109 791298 6241 2004 .06030 THE DAVID AND LURA LOVELL F 6241 1

9

2 Capital gain net Income or net capital loss) . It aln, ; also enter in Pad I, line 7 1 2 348 , 971 . A ( ~ If ?loss), enter -0- in Part I, line 7 ~ 8 Net short-term capital gain or (loss) as defined in sections 1222(5) and (6).

It pain, also enter in Part I, line 8, column (c) . If (loss) . enter -0- in Part I, line 8 �� , �� , , �� , , , , , . � 9 N/A ' . ~ W Glualificatfon 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 )

H section 4940(d)(2) applies, leave this part blank .

Was the organization liable for the section 4942 tax on the distributabte amount of any year in the base period? , , ~ Yes ~ No If 'Yes'the organization does not quality under section 4940(e) . Do not complete this part . 1 Enter the appropriate amount in each column for each year; see Instructions before making any entries

a Base pereiod years Adjusted qualifying 'distributions Net value of nonch~aritabte-use assets

Distribution ratio Calendar ear or tax ear be innfn fn cof b divided b cot c

Zoos 588 802 . 7 , 746 , 472 . .0760091 2002 523 088 . 6 , 660 , 490 . .0785360 200 342 964 . 6 , 905 , 612 . .0496645 2000 1 659 083 . 6 , 513, 902 . 1 .2546988 1999 300,000 . 7,444,978 . .0402956

2 .4992040 2 Total of line 1, column (d), . 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 n less than 5 years 3 . 0998 408

4 Enter the net value of noncharitable-use assets for 2004 from Part X, line 5 1 4 1 9, 4 01,932 .

5 Multiply line 4 by line 3 1 5 1 938,696 .

8 Enter 1% of net investment income (t% of Part I, line 27b) 1 6 1 4,868 .

7 Add lines 5 and 6 1 7 1 943,564 .

8 Enter qualifying distributions from Part XII, line 4 1 g ~ 607,993 . It line 8 is equal to or greater than line 7, check the box m Part VI, line 1 b, and complete that part using a 196 tax rate See the Part VI instructions

azass,/o,-oa-os Form 990-PF (2004)

-,.-- . 1 a During the tax year, did the organization attempt to Influence any national, state, or local legislation or did It participate or Intervene in ~~ YAS No

any political campaign? , , � �� . . ., . b Did n spend more than $100 during the year (either directly or Indirectly) toy political purposes (see instructions for definition)? 1 h

11 the answer is "Yes" to 1 a or 1 b, attach e detailed description of the activities and copies of any materials published or ~ ~,~ ~; ~~e,

distributed by the organization In connection with the activities . ,'a~.

c Did the organization file Form 1120-POL for this year? � , � , � , �� . . . 1 c d Enter the amount (M any) of tax on political expenditures (section 4955) Imposed during the year " ~,. "BMW w,,;

0 . (2) On organization managers " a 0 1 On the organization . " $ ~ kys `

e Enter the reimbursement (fl any) paid by the organization during the year for political expenditure tax imposed on organization ~ " a 0 . managers . " : ̀~~ ,~''``�̀ ;

2 Has the organization engaged in any activities that have not previously been reported to the IRS? , . , . ., , . . . ., 2 K x, "; ; 11 °Yes, ° attach a detailed descrrptlon 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? 11 'Yes,' attach a conformed copy of the changes K

4a Did the organization have unrelated business gross Income of $1,000 or more during the year? 4a X b It 'Yes ; has ft filed a tax return on Form 990-T for this year? � �� , N/A 4b

5 was there a liquidation, termination, dissolution, or substantial contraction during the year? 5 co<;: ~ 11 'Yes," attach the statement required by General Instruction T

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

;°~;~ " By language in the governing Instrument, or

w~

~~"

" 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? ., � . . , � B X

7 Did the organization have at least $5,000 In assets at any time during the yeah 7 X I/ 'Yes," complete Part ll, coL (c), end Pan XV

8a Enter the states to which the foundation reports or with which n is registered (see instructions) OHIO

b If the answer Is 'Yes'to line 7, has the organization famished a copy of Form 990-PF to the Attorney General (or designate) of each state as required by General Instruction G? N "No,"attach explanation 8b X

9 Is the organization claiming status as a private operating foundation within the meaning of section 4942(j)(3) or 4942(j)(5) for calendar year 2004 or the taxable year beginning in 2004 (see instructions for Part XIV)? I/ "Yes," complete Part XIV 9 ,

10 Did any persons become substantial contributors during the tax years it 'Yes,' earns, a 8cneauia iieuna their narnes and addresses 10 X 11 Did the organization comply with the public inspection requirements for its annual returns and exemption applications ~ 11 X

Web site address " N/A 12 The books are m care of IN- ANN W . LOVELL Telephone no op- 419-244-3711

Locatedat " 2995 E . MANZANITA RIDGE PLACE, TUCSON, AZ zIP+4 .85718 13 Section 4947(x)(1) nonexempt charitable trusts filing Form 990-PF m lieu of Form 1041 - Check here 10. Ej

and enter the amount of tax-exempt interest received or accrued dunnp the year 0- 1 13 ~ N / A 4235303-1 01-05 Form 990-PF (2004)

4 2004 .06030 THE DAVID AND LURA LOVELL F 6241 1 10211109 791298 6241

Form 990-PF 2004 THE DAVID AND LURA LOVELL FOUNDATION 34-1733685 Pa g e 4 ;PartgYl ; ' Excise Tax Based on Investment Income Section 4940(a ), 4940 (b), 4940(e , or 4948 - see instructions

- 1 Aempt operating foundations described in section 4940(d)(2), check here " and enter VA, on line 1 31

~ ~'r~,'r1 ; '

Date of ruling letter : ~A- (attecA copy of ruling letter II necessary-see Instructions) b Domestic organizations that meet the section 4940(e) requirements In Part V, check here " 0 and enter 196 1 ~ T, 9 , 736 .

of Part I . line 27b . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ; ,, "~~ ̀ ;. c All other domestic organizations enter 2% of line 27b Exempt foreign organizations enter o96 of Part 1, line 12, cot . (D) ~~°`~

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

9 Add lines 1 and 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 9 , 73 6 .

4 Subtitle A (Income) tax (domestic section 4947(a)(1) trusts and taxable foundations only Others enter -0-) , � , �� , �� 4 08 Tai based on Investment Income . Subtract line 4 tom line 3 . If zero or less, enter -0- . . ., �� , ., . . �� . � , � , . . �� . . 6 9 , 736 .

8 Credits/Payments : "" 4 v~Hti~~ \ t', . w a 2004 estimated tax payments and 2003 overpayment credited to 2004 8a 9 , 371

b Exempt foreign organizations - tax withheld at source . � . �� . �� , .� 8b c Tax paid with application for extension of time to file (Form 8868)�� . . . � , . ., Bc 5 , 500 d Backu p withholding erroneously withhold Bd . .< s � . . . . . ` 7 Total credits and payments . Add lines 6a through 6d 7 14 , 871 .

8 Enter any penalty for underpayment of estimated tax . Check here . it Form 2220 Is attached B 9 Tax due . If the total of lines 5 and 8 Is more than line 7, enter amount owed " 9

10 Overpayment . If line 7 is more than the total of lines Sand 8, enter the amount overpaid . " 10 5 , 135 . 11 Enter the amount of line 10 to be : Credited to 2005 estimated tax " 5 . .13 5 . Refunded " 11 0 J,Part'Vl1;l statements Regarding Activities

Page 5 Form ssavF (2004) THE DAVID AND LURA LOVELL FOUNDATION 34-1733685 ParC1111=atStatements Regarding Activities for Which Form 4720 May Be Required

~~File Forth 4720 M any Item is checked in the "Yea° column, unless an exception applies . t a 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? Yes ~ No

(2) Borrow money tom, lend money to, or otherwise extend credit to (or accept it from) a disqualified person? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 Yes ~ No

(9) furnish goods, services, or facilities to (or accept them from) a disqualified persons � . � , , ., ~ Yes ~ No

(4) Pay compensation to, or pay or reimburse tie expenses of, a disqualified person? . . . . . . . . . Yes No (g) Transfer any Income or assets to a disqualified person (or make any of either available

for the benefit or use of o disqualified Person)?�� , �� , . . . . . . . . . . Yes No

(8) 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 o period after termination of government service, It terminating within 90 days .) ., , . , . , . , . . . . . . . . 0 Yes ~ No

b If any answer Is 'Yes' to ta(1)-(6), did any of the acts tall to quality 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)? N/A Organizations raying 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 la, other than excepted acts, that were not corrected before the first day of the tax year beginning in 20047 �� , .

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(p(3) or 4942(j)(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 0 No If 'Yes,' list the years 10, 1

b Are there any years listed in 2a for which the organization is hat applying the provisions of section 4942(a)(2) (relating to incorrect valuation of assets) to the years undistributed Income? (It applying section 4942(a)(2) to all years listed, answer 'No* and attach statement-see Instructions ) , . , . . . . . . . . . , , , , . . ., . , N/A

c It the provisions of section 4942(a)(2) are being applied to and of the years listed in 2a, list the years here

3a Did the organization hold more than a 296 direct or indirect Interest in any business enterprise at any time during the year? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 Yes Ej No

b It *Yes : did It have excess business holdings in 2404 as e 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 gm or bequest ; or (9) the lapse o1 the 10-, 15-, or 20-year first phase holding period? (Use Schedule C, Form 4 720, to determine 11 the organization had excess business holdings In 2004.) �� , , P /A

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 20041

6a 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))7 0 Yes EK No (2) Influence the outcome of any specific public election (see section 4955), or to carry on, directly or indirectly,

any votes registration drivel . . , , , , , . . . . . Yes [K] No (3) Provide a grant to an Individual for travel, study, or other similar purposes? ~ Yea EKI No (4) Provide a grant to an organization other than a chadtable, etc ., organization described in section

509(a)(1), (2), or (3), or section 4940(d)(2)7 � . . , Yes EK No (5) Provide for any purpose other than religious, charitable, scientific, literary, or educational purposes, or for

the prevention of cruelly to children or animals? 0 Yes [~ No b If any answer is -Yes' to Sa(1)-(5), did arty of the transactions fail to quality under the exceptions described in Regulations

section 53 4945 or in a current notice regarding disaster assistance (see instructions)? N/A Organizations relying on a current notice regarding disaster assistance check here

c If the answer is 'Yes'to question Sa(4), does the organization claim exemption from the tax because d maintained expenditure responsibility for the grant? N/A ~ Yes [~ No If "Yes, " attach the statement required by Regulations section 53 4945-5(d)

Ba Did the organization, during the year, receive any funds, directly or indirectly, to pay premiums on a personal benefit contracts ~ Yes 0 No

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

X

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X

Form 990-PF (2004 423541 01-03-p5


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Form 990-PF (2004) 6

10211109 791298 6241 2004 .06030 THE DAVID AND LUR.A LOVELL F 6241 1

THE DAVID AND LURA LOVELL FOUNDATION 34-1733685 Information About Officers, Directors, Trustees, Foundation Managers, Highly Page s

`~~'Y~~~ °° Paid Employees, and Contractors 1 List ell officers, directors, trustees, foundation managers end their compensation .

(b) Title, and average (c) Compensation (d)ca+owwaum (e) Expense hours per week devoted (II not aid, °"°°~°°°°"°"' 4'° account, other (e) Name and address to position enter ~~°°°ton allowances

LURA M . LOVELL RESIDENT 2995 E . MANZANITA RIDGE PLACE TUCSON AZ 85718 ART 0 . 0 . 0 . ANN W . LOVELL TRUSTEE 2995 E . MANZANITA RIDGE PLACE TUCSON AZ 85718 ART 22 , 500 . 0 . 0 . STEPHEN C . LOVELL TRUSTEE 2995 E . MANZANITA RIDGE PLACE TUCSON AZ 85718 ART 0 . 0 . 0 . JODEE ROBERTSON TRUSTEE 2995 E . MANZANITA RIDGE PLACE TUCSON AZ 85718 ART 0 . 0 . 0 . 2 Compensation of five highest-paid employees other than those Included online 1) . If none, enter "NONE."

~°{~^'~o~~ro Expense (a) Name and address of each employee paid more than $50,000

(b) hours Title

rs and

e~ week average

""°°'°°°"'°"~ (e)

p I (c) Compensation I ,~d~~ I account, other devoted to oosftlon comanflea, allowances

Total number of other employees paid over $50,000 , �� , , , . . . . . . . . . . . . . . . . . . . . . . . . . 1 3 Five highest-paid Independent contractors fog professional services . If none, enter "NONE."

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

Total number of others receivin g over $50,000 for professional services , 1 pmt 1X-A 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 Expenses number of organizations and other beneficiaries served, conferences convened, research papers produced, etc

i N/A

2

3

4

Form 990-PF(200a) THE DAVID AND LURA LOVELL FOUNDATION 34-1733685 Page 7

~Part~pC~B Summary of Program-Related Investments Amount investments made by the foundation during the tax year on lines 1 and 2 . Describe the two la

1 N/A

2

All other program-related Investments . See Instructions . 9

Total . Add lines 1 through 3 11111.

Minimum Investment Return (All domestic foundations must complete this part . Foreign foundations, see Instructions .) ;Pa~:~X~

1 Fair market value of assets not used (or held for use) directly fn carrying out charitable, etc , purposes a Average mouthy fair market value of securities b Average of monthly cash balances . , ., c Fair market value of all other assets d Total (add lines 1a, b, and c) �� , . . . e Reduction claimed for blockage or other factors reported on lines 1a and .

1c (attach detailed explanation) 1e 2 Acquisition Indebtedness applicable to line 1 assets 3 Subtract line 2 from line td � , �� , , 4 Cash deemed held for charitable activities Enter 1 1R% of line 3 (for greater amount, see instructions) 6 Net value of noncharltable-use assets . Subtract line 4 from line 3 Enter here and on Part V, line 4 B Minimum Investment return . Enter 596 of line 5

to 9 , 091 , 463 . 453 646 .

to 11s 9 , 545 , 109 .

0 . ~= t 0

9 9,545, 109 . 177 . 932 . 097 .

s I 9,401

DlsttibtJteblA Amount (see instructions) (Section 4942(j)(3) and (1)(5) private operating foundations and certain foreign organizations check here " and do not complete this part .)

1 Minimum Investment return from Part X, line 6 , �� , . , �� , � 1 2a Tax on Investment Income for 2004 from Part VI, line 5 , . ., . . ., 2a 9 , 736 . b Income tax toy 2004 . (This does not include the tax from Part VI .) , � , � , , 2b t Add lines 2a and 2b � . . . , , �� , , � �� . . . . . . 2c

3 Distributable amount before adjustments Subtract line 2c from line 1 , . , 3 4 Recoveries of amounts treated as qualifying distributions . , � . . . . , , . 4 6 Add lines 3 and 4 6 8 Deduction from distributable amount (see Instructions) . . . , . B 7 Dlatrlbutable amount as adjusted . Subtract line 6 from line 5 . Enter here and on Part XIII, tine 1 , , , , 7

7 .

736 . 361 .

0 . 361 .

361 .

460

Qualifying Distributions (see Instructions)

7


i Amounts pain (including administrative expenses) to accomplish charitable, etc , purposes : a Expenses, contributions, gifts, etc -total from Part I, column (d), line 26 1 a 607 , 993 . b Program-related investments - total from Part IX-8 1 b

02 Amounts paid to acquire assets used (or held for use) directly in carrying out charitable, etc , purposes 2 3 Amounts set aside for specific charitable projects that satisfy the a Suitability test (prior IRS approval required) . 3a b Cash distribution test (attach the required schedule) 3b

4 Qualifying distributions . Add lines to through 3b Enter here and on Part V, line 8, and Part XIII, line 4 4 607 , 9 9 3 . 5 Organizations that qualify under section 4940(e) for the reduced rate of tax on net investment

income. Enter 196 of Part I, line 27b 5 06 Adjusted qualifying distributions . Subtract line 5 from line 4 ~ 6 1 607,993 .

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 to those years .

Form 990-PF (2004)

423561 01-Q3-OS

1 Distrlbutable amount for 2004 from Part XI, line 7 , �� , 4 6 0 , 3 6 1 .

2 Undl 700 : Undistributed Inoomo, if any. m of the and of . . e Enter amount for 2003 only . . . . . . . . . . . . . . . . . . . . .

0' " fi ~

;b Total for prior years . '

9 Excess distributions carryover, h any, to 2004 : BFrOm 1999 . . . . . . . . . bFrom 2000 . . . . . . . . . 1 , 356 , 562 . From 2001 . . . . . . . . 2 , 651 .

.;~~

o From 2002 . . . . 198 , 203 . ~ . ,;.~~ :~~`~ W e From 2003 219 5 41 .

I TotaI of does 3a through e . ., , . 1 1 7 7 6 1 957-1 . :. :.~~ " ,~: J... .' . ti"k~". ~. tv i` .. ~~ ~v 4 Qualifying distributions for 2004 from

s ` " "" ,~c. ~~ ~~E~~~' ' ~k . ~` ; ",ti~,w ~~ ~ ~ r.,

ti ~.:\ ~ v y~~, ~: ~+ ~ '; }G PaRXll, line 4, " 607 , 993 . '~ ~`` ~>p skt`,~°,~ i~ t~~' fit.; .~+. .k. ,h4 ;~a c \~e.: .>. \~ ~ ~S. ~ kte'a~ tea \ °t~ a Applied to 2003, but not more than line 2a %,a .A~, ~` ~ ~ . w.~

. s~ "" 0 .

b Applied to undistributed Income o1 prior years (Election required -see Instructions) 0 . t~ . . .,r . . . . . . ._:%

c Treated as distributions out of corpus ,,3 ~ ;z &\ % ~ ~, ~~~ :`;<~" ^ ' ~~`" ~~ Election re q uired- seelnstructions 0 . , ;; .., " J,

d Applied t0 2004 dl5tributeble amount "2 T',1221 =01~~~ 460 361 . e Remaining amount distributed out of corpus 14 7 6 32 . M

~ . k?;E:~~"

6 Exoesadistributions earywmapplied to2004 0 . s~`yw~+ .~~ .+ ~N. ~M,~AR :i ;`v~:3 Of en amount appears In column (d), tie same amount

ffk . .~ �,

moat be shown In column (N 1 ~: a \~'~ k~:~~ ~ w k~ w y \~.:

6 Enter the net total 01 each column as ~~ Indicated below:

8 Corpus . Add lines 31, 40, and 4a Subtract line 6 sa# H,. . .

b Prior years' undistributed Income. Subtract '`N` y line 4b from tine 2b .. k ,k$k ~ ~ 1^~~f~ h Sh WIN,

c Enter the amount of prior years' >~~~t, undistributed Income for which a notice of deficiency has been Issued, or on which the section 4942 (a ) tax has been p revious ly ., s assessed ,'~~ 0 .JO . .v S~S:'Al'. " .: 4:v{ >' O " ~ ~ } N 1

d Subtract line 6c from line 6D . Taxable ;` . amount - see Instructions . . . . . . . . ~ .̀~~ O: :~ .:~;;~ :0 .`'~' %

e Undistributed Income for 2003 Subtract line r1116. { " ,"~;, :~~# ~<'~;%; ~2ti" ~,, ; ~s� ° : 4afrom line 2a Taxable amount-seelnstr ~" 0 . xf~ .:~, ~, vc

1 Undistributed income for 2004 . Subtract 4 4~K'~+T~~i'~~% ~j` ,~ns7+~ ~{ 'n>f 3 ~

r n2;s h i+ r~ is s A~ }i~} i h r lines 4d and 5 from line 1 . This amount must ?'x <>z. ""~ ;: ; ;~ X.< % '

be distributed in 2005 0 . 7 Amounts treated as distributions out of vt r+ri ~ + i r r Yv

~ v . ~k f, r y .,

corpus to satisfy requirements imposed by section 170(b)(1)(E) or 4942(8)(3) 0

8 Excess distributions carryover from 1999 not applied on line 5 or line 7 0

9 Excess distributions carryover to 2005 . Subtract lines 7 and 8 from pine 6a 1 92 4 5 89 .

10 Analysis of line 9 a Excess from 2000 1 , 356 , 562 ." b Excess from 2001 2 , 651 . c Excess from 2002 198 , 203 . r " ` d Excess from 2003 219 , 541 . e Excess from 2004 147 , 632 .

423571 Form 990-PF (2004) 01-03-05

10211109 791298 6241 2004 .06030 THE DAVID AND LUR.A LOVELL F 6241 1

Form 990-PF (2004) THE DAVID AND LURA LOVELL FOUNDATION 34-1733685 Page e

=Par<t~Xlll§ Undistributed Income (see instructions)

(a) (b) (c) (d) Corpus nears prior to 2003 2003 2004

34-173368 FOUNDATION THE DAVID (see Instructions and Part VIIA N/A Private

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

3 or 4942 (i)( 5 )

(d) 2001 (a) Total

b Check box to Indicate whether the organization is a 2 a Enter the lesser of the adjusted net Tax

Income from Part I or the minimum (8) investment return from Part X for each year listed . ., ., ., . . � . . � ., . � . � ., .,

b 8596 of line 2a � . . � . . . �� . . . �� . � , . � . ., c Qualifying distributions from Part XII,

line 4 for each year listed � �� , .�� d Amounts Included In line 2c not

used directly for active conduct of exempt activities , .� , ., . ., . . . .�� . , ., . . ,

e Qualifying distributions made directly for active conduct of exempt activities . Subtract line 2d from line 2c � ., . ., .

3 Complete 3a, b, or c for the alternative test relied upon :

a 'Assets' attemative test - enter: (1) value of all assets . , . . , .

(2) Value of assets qualifying under section 4942(p(3)(B)(I) ,

b *Endowment' alternative test -enter 2/3 of minimum investment return shown In Part X, line 6 for each year listed

c 'Suppor alternative test - enter; . (1) Total support other than gross

investment Income (Interest, dividends, rents, payments on securities loans (section 512(a)(5)), or royarifes) ��

(2) Support from general public and 5 or more exempt organizations as provided In section 4942(j)(3)(B)(lil) � , . ,

(3) Largest amount of support from an exempt organization ��

Prior 3 y ears 1b) 2003 (1)2002

423581/01-03-OS Form 990-PF (2004) 9

2004 .06030 THE DAVID AND LURA LOVELL F 6241 10211109 791298 6241

`P.a&XY; 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 n they have contributed more than $5,000) (See section 507(d)(2) )

LURA M . LOVELL b List any managers of the foundation who own 1096 or more of the stock of a corporation (or an squatty large portion of the ownership of a partnership or

other entity) of which the foundation has a 10% or greater Interest

NONE 2 Information Regarding Contribution, Grant, Gift, Loan, Scholarship, etc ., Programs :

Check here 1 EKn 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 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

t Any submission deadlines

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

°Z3s°"°'"°3"°S Form 990-PF (2004) 10

10211109 791298 6241 2004 .06030 THE DAVID AND LURA LOVELL F 6241

Unrelate0 business income F~cauaoa "oetron a~z o,a or 014 Enter gross amounts unless otherwise indicated . ~ (e)

(e) (b) ~ . (d) Related or exempt Business Amount °e Amount function Income

1 Program service revenue . code

8 b c d e I p Fees and contracts from government agencies , . . . ., ,

2 Membership dues and assessments , . . � . . . . ., . . . . ., . . ., . . 3 Interest on savings and temporary cash

Investments . . , . ., . . . . . . ., . , . . . . . . . . . . � 14 443 . a Dividends and Interest from securities�� 14 296 ( 356 . 5 Net rental Income or (loss) from peal estate

a Debt-financed property � . . . , . .� . . . . ., . b Not debt-financed property

8 Net rental income or (loss) from personal property . . . . . .

7 Other investment income . . . . . . . 8 Gain or (loss) from sales of assets other

than inventory . . , . . 18 348 , 971 . 9 Net income or (loss) from special events 10 Gross profit or (loss) tom sales of Inventory . . ., � 11 Other revenue

a b t d e

12 Subtotal Add columns (b), (d), and (e) � �� , , �� 0 6 45,770 .1 0 . 13 Total . Add line 12, columns (b), (d), and (e) �� , , � � , � , , , , � , , , . . . . . . . , , �� 19 645,770 . (See worksheet in line 13 Instructions to verity calculations 1

;Pa~;tXVI;~ Relationship of Activities to the Accomplishment of Exempt Purposes

os-ai-os Form 990-PF (2004) 11


Form 990-PF(2004) THE DAVID AND LURA LOVELL FOUNDATION 34-1733685 Page 11

fPait~XVt=A~ Analysis of income-Producing Activities

Form 990-PF(200a) THE DAVID AND LURA LOVELL FOUNDATION 34-1733685 Pa g e 12 ,'Paft',XVlH Information Regarding Transfers To and Transactions and Relationships With Noncharitable

Exempt Organizations 1 Old the organization directly or Indirectly engage in any of the following with any other organization described in section 501(c) of Yes No

.. . z . 2",~aM the Code (other than section 501(c)(3) organizations) or in section 527, relating to political organizations? , . ., .., e Transfers from the reporting organization to a nonChadtabte exempt organization of

(1) Cash . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 180 ) X

(2) Ocher assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1a (2)

b Other transactions . s~ ~{~ ~`~"~` (1 ) Soles of assets to a noncnaritoble exempt organization �� , �� , �� 1 D 1 X

(2) Purchases of assets from a nonCharftoble exempt organization � , . � , �� , . �� . . �� , � , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ., . . . . 1b (2 ) X

(9) Rental of facilities, equipment, or other assets �� . . �� , ., � , , , , . .

(4) Reimbursement arrangements �� . . �� , . ., ., ., .� , . . .� .�., . ., . . . ., . . . , , ., 1b a

(8) Loans or loan guarantees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1b 15 1

(8) Performance of services or membership or tundratslnp solicitations tb 8

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

d It 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

2a Is the organization directly or indirectly affiliated with, or related to, one or more tax-exempt organizations described in section 501(c) of the Code (other than section 501(c)(3)) or In section 527? Yes EK No

Type of organization N/A

Name of

knowledge end belief, It is true, oorrect.

423621 01-Q3-OS

10211109 791298 6241 2004 .0603

and corTW~a9~°. "ede adon otP~ Wry than taxpayer or fiduciary) auClbeao~IP~~in~g schedules an d statements, and to the

d ' St We of offl r or t stee Preparers ~-

2M C 2~ signature

Rrtn'swin(ayaws CLIFTON GUNDERSON LLP a m

as nsatf-MroIox4 . 1400 EDISON PLAZA, 300 aoo~.maztPeooe TOLEDO . OH 43604-1587

of

Schedule B (Form 990, 890-EZ, or

990-PF) Dapartma+t of the Trenuy

Schedule of Contributors OMB No. 13450047

2004 Supplementary Information for line 1 of Form 990, 090-EZ, and 690-PF (see instructions)

Nerve of organization

34-1733685 :LL FOUNDAT7 D

LHA For Paperwork Reduction Act Notice, see the Instructions Schedule B (form 990, 990-EZ, or 990-PF) (2004) for Form 990, Forth 990-EZ, and Form 990-PF .

423451 11-24-04


Employee identification number

Organization typo (check one) :

Filers of- Section:

Form 990 or 990~EZ C::] 501(c)( ) (enter number) organization

4947(c)(1) nonexempt charitable trust not treated as a private foundation

527 political organization

Form 990~PF CK 501(c)(3) exempt private foundation

0 4947(x)(1) nonexempt charitable trust treated as a pnvate foundation

501(c)(3) taxable Private foundation

Check H your organization Is covered by the General Rule or a Special Rule . (Note : Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule end e Special Rule-see instructions.)

General Rule-

For organizations filing Forth 990, 990~EZ, or 990~PF that received, during the year, $5,000 or more (in money or property) from anyone contributor . (Complete Parts I and II .)

Special Rules-

For a section 501(c)(3) organization filing Form 990, or Form 990~EZ, that met the 33 1l3% support test of the regulations under sections 509(0)(1)/170(b)(1)(A)(vl) and received from any one contributor, during the year, v contribution of the greater of $5,000 or 2% of the amount on line 1 of these forma . (Complete Parts I and II .)

0 For o section 501(c)(7),(8), or (10) organization filing Form 990, or Form 990-EZ, that received from anyone contributor, during the year, aggregate contributions or bequests of more then $1,000 for use exclusively for religious, charitable, scientific, literary, or educational purposes, or the prevention of cruelty to children or animals . (Complete Parts I, II, and III .)

For a section 501(c)(7), (8), or (10) organization filing Form 990, or Form 990~EZ, that received from any one contributor, during the year, some contributions for use eurclusivety for religious, charitable, etc., purposes, but these contributions did not aggregate to more than $1,000 . (Ii this box Is checked, enter here the total contributions that were received during the year for an exclusively religious, charitable, etc ., purpose . Do not complete any of the Parts unless the General Rule applies to this organization because it received nonexclusively religious, charitable, etc ., contributions of $5,000 or more during the year .) " $

Caution : Organizations that are not coveted by the General Rule end/or the Special Rules do not file Schedule B (Form 990, 990-EZ, of 990-Ph), but they must check the box in the heading of then Form 990, Form 990-Q, or on line 2 of their Form 990-PF, to certify that they do not meet the filing requirements of Schedule B (Form 990, 990-Q, or 990-PF).

Papo L of Z of Part i

Employer Identification number

34-1733685

Schedule B (Form 990, 99D-EL or 98dPq (2004)

Name of arpdnizatlon

THE DAVID AND LURA LOVELL

E?8f~Contributors (See SpecHic Instructions .)

~o) (b) (o) (d) No . Name , address, and ZIP + 4 Aggregate contributions T of contribution

1 LURA M . LOVELL Person Payroll

8400 N . NATIONAL DRIVE g 64,000 . Noncoeh 0

(Comploto Part II It thorn TUCSON, AZ 85742 Is v noncash contribution )

(a) (b) (c) (d) No . Name, address, end ZIP + 4 Aggregate contributions Type of contribution

Person O Payroll Noncesh 0

(Complete Part II H there is a noncash contribution )

(a) (b) (c) No. Name, address, end ZIP + 4 Aggregate contributions Type of contribution

Person 0 Payroll 0 Noncash

(Complete Pert II H there is a noncnsh contribution .)

(e) (b) I) Idl No. Name, address, end ZIP + 4 Aggregate contributions Type of contribution

Person O Payroll 0 Noncash 0

(Complete Part II K there is a noncash contribution)

la1 (b) M 1~ No . Name, address, and ZIP + 4 Aggregate contributions Type of contribution

Person O Payroll 0

g Noncash 0

(Complete Part II if there is a noncash contribution .)

(b) ca No . Name, address, and 21P + 4 Aggregate contributions Type of contribution

Person Payroll 0

$ Noncash 0

(Complete Part II if there is a noncash contnbution .)

"Zaa52 "-2'-0° 14

Schedule B (Form 990, 990-EZ, or 990-PF) (2004)


CONTINUATION FOR 990-PF, PART IV

THE DAVID AND LURA LOVELL FOUNDATION 34-1733685 PAGE 1 OF 1

!PBt;t4IVCap ital Gains end Losses for Tax on Investment Income (a) List and describe the kind(s) of property sold, e.g , real estate, (b How acquired (c) Date acquired (d) Date sold 2-story brick warehouse; or common stock, 200 shs . MLC Co . ~' - Purchase (mo., day, yo ~ (mo., day, yr ) ~y D - Donation

la 400 , 000 SIMULA INC CONY NOTES P 07 / 07/9801/05/04

b2 000 SHS RAYTHEON CO COMMON P 12/06/020M_9/_04

c 200 , 000 FIRST FEDERAL FINL SVCS DEBENTURE P 03 19/9703/15/04

d 200 , 000 LEHMAN BROS HODG INC 6 .625$ NOTES P 11/10/9904/01/04

e9 000 SHS OGLEBAY NORTON CO P 09 08 9912/01/04 t2 250 SHS CENTRAL EUROPEAN DISTR CORP P 6972-7702-127-63764

8 , 000 SHS DORAL FINANCIAL P 10 / 13 / 9507/30/04

n 5 , 000 SHS DORAL FINANCIAL P 10 13 9511/19/04 t

k I m n 0

(e) Gross sates price (f) Depreciation allowed (g) Cost or other basis (h) Gain or (loss) (or allowable) plus expense of sale (e) plus (f) minus (g)

a 400 000 . 448 000 . <48 , 000 .> b 108 155 . 102 900 . 5 , 255 . c 200 000 . 200 000 . 0 . d 200 000 . 198 364 . 1 , 636 . e 1 , 301 . 180 900 . <179 , 599 .> 1 62 , 695 . 9 , 175 . 53 , 520 .

311 346 . 15 , 336 . 296 010 . n 229 734 . 9 , 585 . 220 149 .

k I m n 0

Complete only for assets showing pain In column (n) and owned by the foundation on 12/31/69 (I) Losses (from col (h)) (1) Adjusted basis (k) Excess of col (I) Gains (excess of col (h) gain over col (k),

(I) F M.V as of 12/31/69 as of 12/31/69 over col n any but not less than '-0=

a <48 , 000 .> b 5 , 255 .

0 . d 1 , 636 . e <179 , 599 .> r 53 , 520 .

296 010 . n 220 149 .

k I m n 0

l If ain, also enter in Pad I, line 7 1 2 Capital gain net income or (net capital loss) 1

if enter'-0= in Part I, line 7 1 2 34 8 , 971 .

3 Net short-term capital gain or (loss) as defined m sections 1222(5) and (6) If gain, also enter m Part I, line 8, column (c) If (loss), enter '-0-' in Part I, line 8 3 N/A

423591 OS-01-04


16 STATEMENT S) 1, 2, 3, 4 10211109 791298 6241 2004 .06030 THE DAVID AND LURA LOVELL F 6241 1

THE DAVID AND LURA LOVELL FOUNDATION 34-1733685

FORM 990-PF INTEREST ON SAVINGS AND TEMPORARY CASH INVESTMENTS STATEMENT 1

SOURCE AMOUNT

SIGNATURE BANK 443 .

TOTAL TO FORM 990-PF, PART I, LINE 3, COLUMN A 443 .

FORM 990-PF DIVIDENDS AND INTEREST FROM SECURITIES STATEMENT 2

CAPITAL GAINS COLUMN (A) SOURCE GROSS AMOUNT DIVIDENDS AMOUNT

CARRET SECURITIES, INC 293,947 . 0 . 293,947 . CONTINUCARE CORP . 5,746 . 0 . 5,746 . LESS FOREIGN TAX PAID <3,337 .> 0 . <3,337 .>

TOTAL TO FM 990-PF, PART I, LN 4 296,356 . 0 . 296,356 .

FORM 990-PF LEGAL FEES STATEMENT 3

(A) (B) (C) (D) EXPENSES NET INVEST- ADJUSTED CHARITABLE

DESCRIPTION PER BOOKS MENT INCOME NET INCOME PURPOSES

LEGAL FEES 1,866 . 1,866 . 0 .

TO FM 990-PF, PG 1, LN 16A 1,866 . 1,866 . 0 .

FORM 990-PF ACCOUNTING FEES STATEMENT 4



ACCOUNTING FEES 4,300 . 4,300 . 0 .

TO FORM 990-PF, PG 1, LN 16B 4,300 . 4,300 . 0 .



47,022 . 47,022 . 0 . 11,210 . 11,210 . 0 .

500 . 500 . 0 . 177 . 177 . 0 .

64,000 . 64,000 . 0 . 1,400 . 1,400 . 0 .

124,309 . 124,309 . 0 . TO FORM 990-PF, PG 1, LN 23

FORM 990-PF CORPORATE STOCK STATEMENT 7

FAIR MARKET BOOK VALUE VALUE

4,469,869 . 9,137,345 .

4,469,869 . 9,137,345 . TOTAL TO FORM 990-PF, PART II, LINE lOB

17 STATEMENT S) 5, 6, 7 10211109 791298 6241 2004 .06030 THE DAVID AND LURA LOVELL F 6241 1


FORM 990-PF TAXES STATEMENT 5



OHIO FILING FEE 200 . 200 . 0 . FEDERAL INCOME TAX 19,000 . 0 . 0 ., PAYROLL TAXES 2,742 . 2,742 . 0 "

TO FORM 990-PF, PG 1, LN 18 21,942 . 2,942 . 0 "

FORM 990-PF OTHER EXPENSES STATEMENT 6

INVESTMENT FEES CONSULTANT COSTS DUES PAYROLL PROCESSING INSURANCE TRUSTEE EDUCATION

DESCRIPTION

CORPORATE STOCK

a THE DAVID AND LURA LOVELL FOUNDATION 34-1733685

FORM 990-PF CORPORATE BONDS STATEMENT 8

FAIR MARKET BOOK VALUE VALUE

940,665 . 920,684 .

940,665 . 920,684 . TOTAL TO FORM 990-PF, PART II, LINE lOC

FORM 990-PF OTHER INVESTMENTS STATEMENT 9

FAIR MARKET VALUE

600,373 .

600,373 . TOTAL TO FORM 990-PF, PART II, LINE 13 424,556 .

FORM 990-PF GRANTS AND CONTRIBUTIONS STATEMENT 10 PAID DURING THE YEAR

RECIPIENT RECIPIENT NAME AND ADDRESS STATUS PURPOSE OF GRANT

ALLIANCE FOR THE MENTALLY PUBLIC FUNDS FOR ILL OF GREATER TOLEDO, CHARITY FAMILY-TO-FAMILY TOLEDO, OH EDUCATIONAL GROUPS 25,000 .

18 STATEMENT S) 8, 9, 10 10211109 791298 6241 2004 .06030 THE DAVID AND LURA LOVELL F 6241 1

DESCRIPTION

CORPORATE BONDS

DESCRIPTION

OTHER INVESTMENTS

BOOK VALUE

424,556 .

RECIPIENT RELATIONSHP AMOUNT

N/A

ALLIANCE FOR THE MENTALLY PUBLIC FUNDS FOR POSITIVE N/A ILL OF GREATER TOLEDO, CHARITY CONNECTIONS TOLEDO, OH SUPPORT PROGRAMS 43,460 .

BRAVEWELL COLLABORATIVE, OPERATING INFRASTRUCTURE N/A MINNEAPOLIS, MN FOUNDATION 33,333 .

BRAVEWELL COLLABORATIVE, OPERATING FUNDS FOR PBS N/A MINNEAPOLIS, MN FOUNDATION DOCUMENTARY 250,000 .

CORPUS CHRISTI CHURCH, PUBLIC GENERAL FUND N/A TOLEDO, OH CHARITY RAISING 30,000 .

CULTURE JAM YOUTH CAMP, PUBLIC ASSISTANCE FOR N/A EUGENE, OR CHARITY CAMP PROGRAM 10,000 .


-INSTITUTE-FOR MENTAL HEALTH PUBLIC FUNDS FOR N/A RESEARCH, TUCSON, AZ CHARITY CONFERENCE 10,000 .

NEIGHBORHOOD PROPERTIES PUBLIC MENTAL HEALTH N/A INC, TOLEDO, OH CHARITY MONTH EVENT

SUPPORT 5,000 .

STRENGTH BUILDING PARTNERS, PUBLIC GENERAL FUND N/A TUCSON, AZ CHARITY RAISING 7,500 .

SUNSTONE CANCER SUPPORT PUBLIC SCHOLARSHIPS FOR N/A FOUNDATION, TUCSON, AZ CHARITY RETREATS 10,000 .

TECHNOLOGY ACCESS CENTER OF PUBLIC FUNDING FOR N/A TUCSON, INC ., TUCSON, AZ CHARITY SALARIES AND

SUPPLIES 60,000 .

TOLEDO SYMPHONY, TOLEDO, OH PUBLIC FUNDS FOR N/A CHARITY COMMUNITY LESSONS

AND SCHOOL 10,000 .

TU NIDITO, TUCSON, AZ PUBLIC SUPPORT FOR N/A CHARITY CHILDREN'S GRIEF

PROGRAM 15,000 .

TURNING POINT SCHOOL, PUBLIC RETURN OF GRANT N/A TUCSON, AZ CHARITY FUNDS FOR SCIENCE

KITS <2,100 .>

UNIVERSITY OF ARIZONA - PUBLIC SUPPORT FOR N/A PSYCHIATRY DEPT, TUCSON, AZ CHARITY WOMEN'S MENTAL

HEALTH SYMPOSIUM 10,000 .

UNIVERSITY OF ARIZONA PUBLIC SUPPORT FOR N/A ARTHRITIS CENTER, TUCSON, CHARITY ONGOING RESEARCH AZ PROJECTS 45,000 .

VICTORY CENTER, TOLEDO, OH PUBLIC FUNDS FOR NEWLY N/A CHARITY DIAGNOSED WORKSHOP 7,800 .

VICTORY CENTER, TOLEDO, OH PUBLIC FUND DIRECTOR OF N/A CHARITY VOLUNTEERS

POSITION 23,000 .

YOUTH ON THEIR OWN, TUCSON, PUBLIC YOUTH STIPENDS N/A AZ CHARITY 15,000 .

TOTAL TO FORM 990-PF, PART XV, LINE 3A 607,993 .

19 STATEMENT S) 10 2004 .06030 THE DAVID AND LUR.A LOVELL F 6241 1 10211109 791298 6241

0 Underpayment of Estimated Tax by Corporations °""B"°~"°5-°1°2 " DovartrnontoitnoTreasury 00, S88separate 1fIitfYClIOflt .

Inter,,� R��, Service " Attach to the corporation's tax return . FORM 9 9 0-PF 2004 Name Employer identification number

THE DAVID AND LURA LOVELL FOUNDATION I 34-1 7 33685

Note . In most cases, the corporation Is not required to file Form 2220 . (see Part I below toy exceptions) because the IRS will figure any penalty owed and bill the corporation . Even n Form 2220 Is not required, the corporation may still use n to figure the penalty . m such a case, enter the amount from papa 2, line 38 on the estimated tax pena lty line of the co rp oration's Income tax return but do not attach Form 2220 . ~ Reasons for Filing - Check the boxes below that apply If any boxes are checked, and line 6, below, is E500 or more, the corporation must

cite Forth 2220, even N K does not owe a penalty .

1 [] The corporation Is using the adjusted seasonal Installment method . 2 CE The corporation is using the annualized Income Installment method . 9 The corporation is a'larg e cor p oration' ti urin Its first re q uired Installment based on the p rior year's tax .

NPartllfiFf urin the Unde a meat �� , � , a 9 , 736 . 4 Total tax (see Instructions) . . . . . ., . . . . . . . ., . . . , . . . . . . . . . ., � . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

~.v. 5 a Personal holding company tax (Schedule PH (Form 1120), line 26) included on line 4 5a b Look-back Interest Included on line 4 under section 460(b)(2) for completed long-term , . . . contracts or of section 167(8) for depreciation under the Income forecast method

c Credit for Federal tax paid on fuels (see instructions) . ., ., 5c d Total . Add lines 5a through 5c , �� ,

8 Subtract line Sd from line 4 . It the result Is less than $500, do not complete or file this form The corporation does not owe the penalty . . . . . .

7 Enter the tax shown on the corporation's 2003 income tax return Caution: II the tax is zero or the tax year was for less than 12 months, skip this line end enter the amount horn line 8 an line 8

9,736 . 8 Enter the smaller of line 6 or line 7 . If 7

9 Installment due dates . Enter In cot (a) through ( me 15th day of the am (Form

~9a,~F+~ mon of e~~,:u~e~y~ 9 05/15/04 06/15/04 09/15/04 10/01/04 12/15/04 Exception . II one of your Installment duo data* In Sept 15 . 2004, see the Instructions .

10 Required Installments . It moooxon line 1 and/or line 2 above 10 C110CkpOnto ' the amounts horn Schedule 0. 11n316 0 . If ~s V1e box an In 3 (but not 1 Or $) 10 Ch00kOd, coo Instructions for the amounts to enter. If none of (h070 boxes NO OhOCkOd, enter zs+corin eabove in coa,o,lu �,n , . ., ., to 667 . 167 . 5 , 963 .

11 Estimated tax paid or credited for each period (see Instructions) For column (a) onry , enter the amount 9 , 371 . from line t t on line 15 Complete lines 12 through ~18~o1

~~

~%~' one column before going to the next column .

12 Enter amount, ft any, from line 18 ~,fx �.� : k>. ~h of the preceding column , � 12 ~~` ~{~~k J ~s

13 Add lines 11 and 12 13 ~ 1Z 7:+h' w : . 14 Add amounts on lines 16 and 17

of the preceding column 14 667 . 834 . 15 Subtract line 14 from line 13 If

zero or less, enter-0- 15 9 371 . 0 . 0 . 0 . h

16 If the amount on line 15 Is zero, subtraW

' line 13 from line 14 Otherwise, enter -d 16 667 .

17 Underpayment . It line 15 is leap than or equal to line 10, subtract line 15 from line 10 Then go to line 12 of the next Column OtherwAse, pp to tine 18 17 667 . 167 . 5 963 .

18 Overpayment . it line 10 Isle" than Then 5~

s ro li ne

li ne 10 fromext

li ne 15

Go to Part III on pane 2 to figure the penalty . Do not go to Part III If there are no entries on line 17 - no penalty Is owed 412801 05 JWA For Paperwork Reduction Act Notice, see separate Instructions . Form 2220 (2004)

20 2004 .06030 THE DAVID AND LURA LOVELL F 6241 1 10211109 791298 6241

s I 9,736 .

18,063 .


FORM 990-PF Form 2220(2004) THE DAVID AND LURA LOVELL FOUNDATION 34-1733685 Page 2

~'~Pert~lll Figuring the Penalty

a b c d e

19 Enter me data of payment or the 15th day of the 3rd month attar the Close of the t0A

I 7= r0im Irs-Filaii-nd'11 110rg : use oth month instead of 3rd month ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

Number 01 days from duo data Of Install. 20 nfOni on In 8 t0 the data shown 011 line 10 20

Number of days on line ZO after 21 4/1 WON and before 7naooa � , . . 21 22 Unampsymont an fine 17 x

Number of days on lima 21 x 5% , � 22 380

Number of day e on line 20 after 23 er~ortooa era betons 10nrz004 , . . . 29 24 Underpayment an line 17 x

Number of days on line 23 x Otf �� , 24 388

Number of days on line 20 after 25 8/,!0R004 end before 1/1ROOS 2$

28 underpayment on line 17 x

Numbs of days on line 2s a S!6 �� 28 368

27 NYJ~12Er004 acne before 4/1/200 . .

28 Underpayment on line 17 x

Numbs of deyn online 27 X5% �� , 28 395

29 Number of days on Ilne 20 etta arJ1aoos and before 7nrtoos . . . . 29

30 underpayment on line 17 x

Number of esyn on line 20 x 'X 385

91 Number of days on line 20 after ersortoos and before I onaoos . . . 91

32 underpayment an line 17 It

Number of save on line 31 x "tc � , 92 365

33 Number on e 20 after

34 Underpayment an line 17 x

Number of days on line 33 x "% 94 365

Numbm of days on Ilno YO after 35 i~iaoos ~a oerore znertooe . . 35 36 Underpayment on line 17 It

Number at days on line 35 x "% 38 365

37 Add does 22, 24, 28, 28, 90, 32, 94, 8 38 97

38 Penalty . Add columns (a) through (e), of line 37 Enter the total here and on form 1120, line 33, Form 1120-A, line 29, or the comparable line for other income tax returns 38

" 1 0 .

For underpayments pals after March 31, 2005 : For lines 30, 32, 34, and 36, use the penalty Interest rate for each calendar quarter, which the IRS will determine during the first month in the preceding quarter These rates are published quarterly in an IRS News Release and in a revenue ruling in the Internal Revenue Bulletin To obtain this Information on the Internet, access the IRS websfte at www.lrs .qov . You can also calf 1-800-829-1040 to get interest rate information

JWA form 2220 (2004)

4128Q2 01 -2a-OS

THE DAVID AND LLTRA LOVELL FOUNDATION 34-1733685 Page 3

2 Enter taxable Income for each period for the tax year

4s '¢ + r ' } ~ .r s

r i{ } +~ ~ ~ ;~t ~'~r `

. " + . . 12 Add lines 11a thou h 11c . 12

13 Divide line 12 b 3 13 14 Multiply the amount In columns (a) through (c) of line 10

by columns (a) through (c) of line 13 In column (d), enter the amount from line 10 column d . 14

15 Enter any alternative minimum tax for each payment

i o tnier any otner taxes for each payment period (see instr) 17 Add lines 14 through 16 18 For each period, enter the same type of credits as allowec

on Form 2220, lines 4 and Sc (see instructions) 19 Total tax after credits Subtract line 18 from line 17 If

zero or less . enter -0- 412azi 01 -oa-os JWA Form 2220 (2004)

10211109 791298 6241 2004 .06030 THE DAVID AND LURA LOVELL F 6241 1 22

[~SOhQili7i~'A1 Adjusted Seasonal Installment Method and Annualized Income Installment Method (see Instructions) Form 1120S filers : For lines 1, 2, 3, and 21, below, 'taxable Income' refers to excess net passive income or the amount on which tax is imposed under section 1374(a), whichever applies .

Part I - Adjusted Seasonal Installment Method Caution : use this method on n the base p Hod percenta g e for an 6 consecutive months is at least 7096 . See instructions . a b c d

First 3 First 5 First 8 First 11 1 Enter taxable Income for the following periods :

b Tax veer bealnnina In 2002 I 1

3 Enter taxable income for the following periods-

b Tax year beginning In 2002

c Tax year beginning In 2003 4 Divide the amount In each column on line la by the

amount In column (d) on line 3a . 5 Divide the amount In each column on line 1 b by the

amount In column (d) on line 3b . B Divide the amount in each column on line lc by the

amount In column (d) on line 3c.

10 Figure the tax on the amt on In 9 using the Instr for Form 1120 Sch J In 3 or comp arable In of co 's return 10

11a Divide the amount In columns (a) through (c) on line 3a b the amount In column (d ) on line 3a . Ile

b Divide the amount in columns (a) through (c) on line 3b b the amount In column W on line 3b . lib

c Divide the amount In columns (a) through (c) on line 3c by the amount in column fd1 on line 3c . 11e

First .4 I First 6 I First 9 I Entire year

1

<2,373 .b <663 .b 1,112 .1 6,797 .

Part III - Required Installments

Note : Complete lines 32 through 38 of one column before completing the next column .

82 If only Part I or Part II Is completed, enter the amount in each column from line 19 or line 31 . It both parts are completed, enter the smaller of the amounts in each column from line 19 or line 31 . 92

99 Add the amounts In all preceding columns of line 38 see Instructions ) . 99

34 Adjusted seasonal or annualized Income Installments . Subtract line 33 from line 32 If zero or less enter -0- . 34

35 Enter 25% of line 8 on gape 1 of Form 2220 In each column . (Note : 'Large corporations ; see the instructions for

0 . 0 . 834 . 6 , 797 .

ti, 834 .

834 . I 5,963 .

o ( )

** ANNUALIZED INCOME INSTALLMENT METHOD USING STANDARD OPTION

412872 01-03-05

10211109 791298 6241 23

2004 .06030 THE DAVID AND LURA LOVELL F 6241 1

h


Form 2220 2004 FORM 9 9 0-PF Page 4

" Part II - Annualized Income Installment Method * * 181 Ibl 1c1

First 2 First 3 First 6 First 9

20 Annualization p eriods see Instructions . 20 months months months months 21 Enter taxable Income for each annualization period (see

instructions ) 21 < 19 7 7 3 . < 8 2 8 7 . 27 , 808 . 254 , 901 .

22 Annuatizatlon amounts see Instructions ) . 22 6 .000000 4 .000000 2 .000000 1 .333333

29 Annualized taxable income, Multi ply line 21 b line 22 . 29 < 118 6 3 8 . < 3 3 14 8 . 55 , 616 . 339 , 868 . 24 Figure the tax on the amount on line 23 using tie

Instructions for Form 1120 . Schedule J, line 3 or comparable line of co rp oration's return ) . 24 < 2 3 7 3 . < 6 6 3 . 1 112 . 6 , 797 .

28 Enter any alternative minimum tax for each payment

28 For each period, enter the same type of credits as allowed on Forth 2220, lines 4 and Sc (see instructions)

29 Total tax after credits . Subtract line 28 from line 27 . If :era or less . enter -0- . 1,112 .1 6 .797 .

834 .1 6,797 .

1st I 2nd I 3rd I 4th

line 10 for the amounts to enter . 35 2 4 3 4 . 2 , 434 . 2 , 434 . 2 , 434 . 38 Subtract line 38 of the preceding column from line 37 of 'M e . :

the preceding column . 36 ~~ ' f 2 , 434 . 4 1 868 . 6 , 468 .

37 Add lines 35 and 36 37 2 , 434 . 41868 . 7 , 302 . 8 9 0 2 . 38 Required Installments . Enter the smaller of line 34 or

line 37 here and on page 1 of Form 2220, line 10 see instructions) . 38 0 . 1 0 . 1 834 . 1 5 , 963 .

JWA F rtn 2220 2004

Form 8868 (December 2000 DaoarGrnnt of the Tmmuy Internal Ravanuo 8onleo

Application for Extension of Time To File an Exempt Organization Return I OMB No ,s4s~,7os

10, File a for each return .

" If you are filing for an Automatic 3-Month Extension, complete only Pert I and check this box 01. CE " If you are filing fog an Additional (not automatic) 3-Month Extension, complete only Part II (on page 2 of this form) . Note : Do not complete Pert II unless you have already boon granted an automatic 3-month extension on o previously filed Form 8888 .

LP art;l ;~ Automatic 3-Month Extension of Time - only submit original (no copies needed)

Note : Form 090-T corporations requesting an automatic 6-month extension - check this box and complete Port 1 only � , �� , � , � All other corporations (including Form 990-C filers) must use Form 7004 to request an extension of lima to file income tax returns . Partnerships, REMICs and trusts must use Form 8 736 to request an extension of time to file Form 1065, 1066, or 1041 .

Typo or Name of Exempt Organization print

THE DAVID AND LUR.A DATION 34-1733685 File by the due date for filing your return gee Innwcuono

Number, street, and room or suite no . If e P.O . box, see Instructions . 4729 EAST SUNRISE DRIVE, N0 . 307 City, town or post office, elate, end 21P code . For a foreign address, see instructions TUCSON, AZ 85718

423931 o5-ot-oa

Employer Identification number

Check type of return to be tiled(file 8 separate application for each return) :

Form 990 0 Form 990~T (corporation) 0 Form 4720 Form 990-BL 0 Form 990-T (sec . 401(a) or 408(a) trust) 0 Form 5227 Form 990-EZ ~ Form 990~T (trust other then above) ~ Form 6069 Form 990-PF ~ Forth 1041~A ~ Form 8870

" If the organization does not have an office or place of business In the United States, check this box . � , � 10, = " Ii 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 " = . If R 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-month, for 990-T corporation) extension of time until AUGUST 15, 2 005 to file the exempt organization return for the organization named above . The extension is for the organization's return for-0- EU calendar year 2 0 0 4 or " 0 tax year beginning , and ending

2 If this tax year Is for less than 12 months, check reason : 0 Initial return ~ Final return 0 Change in accounting period

3a If this application is for Form 990-BL, 990~PF, 990~T, 4720, or 8089, enter the tentative tax, less any nonrefundable credits . See instructions , � , � , � , �� $ 14, 8 71 .

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 $ 9 , 3 71 .

Balance Due . Subtract line 3b from line 3a . Include your payment with this form, or, N required, deposit with FTD coupon or, if required, by using EFTPS (Electronic Federal Tax Payment System) . See instructions $ 5,500 .

Signature and Verification

Under penalties of perjury, I declare that I have examined this form, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete, and that I am authorized to prepare this form

Signature " ~by+~rw~l , Title t CPA Date " S~S" O.~-LHA For Paperwork Reduction Act Notice, see instruction Form 8888 (12-2000)

Name CLIFTON GUNDERSON LLP

Type or prim

Number and street (include suite, room, or apt. no .) or a P.O . box number 1400 EDISON PLAZA, 300 MADISON AVENUE City or town, province or state, and country (including postal or ZIP code) TOLEDO, OH 43 604-1587

17370804 791298 6241 2004 .05070 THE DAVID AND LURA LOVELL F 6241

Forth a (Rev 12-2004) Page 2

9 Y vu are filing for an Additional (not automatic) 3-Month Extension, complete only PaA II and check this box

Note : Only complete Part II ii you have already been granted an automatic 3-month extension on a previously filed Form 8888 . 0 11 you ore filin g for an Automatic 3-Month Extension, complete on Pert I on e 1 ) .

:Part`.U ; Additional not automatic 3-Month Extension of Time - Must file Original and One Co Employer Identification number Name of Exempt Organization Type or

HE DAVID AND LURA LOVELL FOUNDATION 34-1733685 Flie by ft ~R~:#r''++' axtendw Number, sheet, and room or suite no . If e P.O . box, soo instructions . For IRS use only duaa "tobr4729 EAST SUNRISE DRIVE NO . 307

NEW

01 01 Mw a filing L"G

,um, s~ City, town or post office state and ZIP code. For a foreign address, see instructions . ro ~

'"""°U°"°' UCSON, AZ 85718 Check type of rotum to be filed (File e sepornte application toy each return) : 0 Form 990 0 Form 990~EZ 0 Form 990~T (sec. 401(0) or 408(c) trust) ~ Form 1041 ~A ~ Form 5227 0 Form 8870 [] Form 990-BL CE Forth 990~PF ~ Form 990~T (trust other than above) ~ Forth 4720 ~ Form 8069

STOP : Do not complete Part II If you were not already granted an automatic 3-month extension on a previously filed Form 8888 .

" The books ere in the care of " LUR.A LOVELL TelephoneNo . op, 419-537-6879 FAX No. 0, 1f 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 (GENQ . If this is for the whole group, check this

box " [71 . If n is for part of the group check this box 1 0 and attach a list with the names and EINs of ell members the extension is for . 4 I request an additional 3-month extension of time until NOVEMBER 15, 2 6 For calendar year 2 0 0 4 , or other tax year beginning =-- ~- and ending 8 If this tax year is for less than 12 months, check reason : Initial return Final return Change in accounting period 7 State in dated why you need the extension

ADDITIONAL TIME IS NEEDED IN ORDER TO GATHER THE INFORMATION NECESSARY TO PREPARE A COMPLETE AND ACCURATE RETURN .

8a If this application is for Form 990-BL. 990-PR 990~T, 4720, or 8089, enter the tentative tax, less any nonrefundable credits. See Instructions , ., �� _ , �� , , �� , , �� , , , . �� S 14,871 .

b If this application is for Form 990-PF, 990-T, 4720, or 6089, enter any refundable credits end estimated tax payments made . Include any poor year overpayment allowed as a credit end any amount paid previously with Form 8868 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . S 14,871 .

c Balance Due . Subtract fine 8b from line 8a. Include your payment with this form, or, H required, deposit with FTD coupon or, H required, by using EFTPS (Electronic Federal Tax Payment System) . See Instructions $ 0

Signature and Verification Under penalties of penury, I declare that I have examined this form, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete, and that I am authorized to prepare this form .

Signature " Title " CPA Date " e-11010,(-

Notice to Applicant - To Be Completed by the IRS We have approved this application . Please attach this form to the organization's return .

[,J We have not approved this application . However, we have granted a 10-day grace period from the later of the date shown below or the due date of the organization's return Including any prior extensions) . This grace period is considered algid extension of time for elections otherwise required to be made on a timely return . Please attach this form to the organization's reE1%%Si0iJ L,,'-',- :-,

[~ We have not approved this application . After considering the reasons stated in item 7, we cannot grant your request for an extension of time to file. We are not granting a 10-day grace period . A v We cannot consider this application because it was filed after the extended due date of the return for which an extension was requested .

O Other SUE~AIS~I~N ;-��__�

By Director Date Alternate Mailing Address - Enter the address H you want the copy of this application for an additional 3-month extension returned to an address different than the one entered above

Form 8888 (Rev 12-2004)

Form 990-PF Return of Private Foundation990s.foundationcenter.org/990pf_pdf_archive/341/341733685/34173… · Form 990-PF Return of Private Foundation OMB NO 1S4SOOS2 or Section 4947(a)(1)

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