HARRY AND THELMA SURRENA MEMORIAL FUND: Form 990PF, tax year 2012

View the entire original 990 at ProPublica ↗

Organization: HARRY AND THELMA SURRENA MEMORIAL FUND (EIN 23-7435554)
Tax period: 2012-11-01 to 2013-10-31
Filed: 2013-12-16
IRS object ID: 201323509349100007
Schema version: 2012v2.3
Source: Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header
Form 990-PF
Accounting Fees Schedule
Compensation Explanation
Investments Corp Bonds Schedule
Investments Corp Stock Schedule
Investments Govt Obligations Sch
Other Assets Schedule
Other Expenses Schedule
Other Liabilities Schedule
Other Professional Fees Schedule
Taxes Schedule

Return header ReturnHeader

Field	Value	IRS element (for citing)
Timestamp	2013-12-16T08:41:10-06:00	Timestamp
Tax Period End Date	2013-10-31	TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

Field	Value	IRS element (for citing)
Business Name Line1	MOHATT RINALDO JOHNSON & GODWIN LLP	BusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

Field	Value	IRS element (for citing)
Address Line1	PO BOX 603	AddressLine1
City	SHERIDAN	City
State	WY	State
ZIP Code	828010603	ZIPCode

Field	Value	IRS element (for citing)
Return Type	990PF	ReturnType
Tax Period Begin Date	2012-11-01	TaxPeriodBeginDate

Filer Filer

Field	Value	IRS element (for citing)
EIN	237435554	EIN

Name Name

Field	Value	IRS element (for citing)
Business Name Line1	HARRY & THELMA SURRENA MEMORIAL	BusinessNameLine1

Field	Value	IRS element (for citing)
Name Control	HARR	NameControl
Phone	3076726494	Phone

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	P O BOX 603	AddressLine1
City	SHERIDAN	City
State	WY	State
ZIP Code	82801	ZIPCode

Officer Officer

Field	Value	IRS element (for citing)
Name	JOHN M PRADERE	Name
Title	TRUSTEE	Title
Phone	3076726494	Phone
Date Signed	2013-12-13	DateSigned
Authorize Third Party	true	AuthorizeThirdParty

Preparer Preparer

Field	Value	IRS element (for citing)
Name	MICHAEL B JOHNSON	Name
Phone	3076726494	Phone
Date Prepared	2013-12-16	DatePrepared
Self Employed	X	SelfEmployed

Field	Value	IRS element (for citing)
Tax Year	2012	TaxYear
Build TS	2016-02-25 16:41:14Z	BuildTS

Form 990-PF IRS990PF

Field	Value	IRS element (for citing)
Exempt PF	X	ExemptPF
FMV Assets EOY	5378062	FMVAssetsEOY
Method Of Accounting Cash	X	MethodOfAccountingCash

Analysis Of Revenue And Expenses AnalysisOfRevenueAndExpenses

Field	Value	IRS element (for citing)
Not Required To Attach Schedule B	X	NotRequiredToAttachScheduleB
Interest On Savings Rev And Expnss	25063	InterestOnSavingsRevAndExpnss
Interest On Savings Net Invst Incm	23500	InterestOnSavingsNetInvstIncm
Dividends Rev And Expnss	120041	DividendsRevAndExpnss
Dividends Net Invst Incm	120041	DividendsNetInvstIncm
Net Gain Sale Assets Rev And Expnss	312207	NetGainSaleAssetsRevAndExpnss
Gross Sales Price	1734286	GrossSalesPrice
Capital Gain Net Incm Net Invst Incm	312207	CapitalGainNetIncmNetInvstIncm
Total Revenue And Expenses	457311	TotalRevenueAndExpenses
Total Net Investment Income	455748	TotalNetInvestmentIncome
Comp Ofcr Dir Trst Rev And Expnss	25437	CompOfcrDirTrstRevAndExpnss
Comp Ofcr Dir Trst Net Invst Incm	12719	CompOfcrDirTrstNetInvstIncm
Comp Ofcr Dir Trst Dsbrs Chrtbl Prps	12718	CompOfcrDirTrstDsbrsChrtblPrps
Accounting Fees Rev And Expnss	2000	AccountingFeesRevAndExpnss
Accounting Fees Net Invst Incm	1500	AccountingFeesNetInvstIncm
Accounting Fees Dsbrs Chrtbl Prps	500	AccountingFeesDsbrsChrtblPrps
Other Prof Fees Rev And Expnss	14553	OtherProfFeesRevAndExpnss
Other Prof Fees Net Invst Incm	14553	OtherProfFeesNetInvstIncm
Taxes Rev And Expnss	6726	TaxesRevAndExpnss
Taxes Net Invst Incm	1467	TaxesNetInvstIncm
Taxes Dsbrs Chrtbl Prps	973	TaxesDsbrsChrtblPrps
Other Expenses Rev And Expnss	43	OtherExpensesRevAndExpnss
Other Expenses Net Invst Incm	43	OtherExpensesNetInvstIncm
Tot Opr Expenses Rev And Expnss	48759	TotOprExpensesRevAndExpnss
Tot Opr Expenses Net Invst Incm	30282	TotOprExpensesNetInvstIncm
Tot Opr Expenses Dsbrs Chrtbl Prps	14191	TotOprExpensesDsbrsChrtblPrps
Contri Gifts Paid Rev And Expnss	248500	ContriGiftsPaidRevAndExpnss
Contri Gifts Paid Dsbrs Chrtbl Prps	248500	ContriGiftsPaidDsbrsChrtblPrps
Total Expenses Rev And Expnss	297259	TotalExpensesRevAndExpnss
Total Expenses Net Invst Incm	30282	TotalExpensesNetInvstIncm
Total Expenses Dsbrs Chrtbl Prps	262691	TotalExpensesDsbrsChrtblPrps
Excess Of Revenue Over Expenses	160052	ExcessOfRevenueOverExpenses
Net Investment Income	425466	NetInvestmentIncome

Balance Sheets BalanceSheets

Field	Value	IRS element (for citing)
Savings And Temp Cash Invst BOY	77828	SavingsAndTempCashInvstBOY
Savings And Temp Cash Invst EOY	264900	SavingsAndTempCashInvstEOY
Savings And Temp Cash Invst EOYFMV	264900	SavingsAndTempCashInvstEOYFMV
Investments Govt Oblig BOY	360168	InvestmentsGovtObligBOY
Investments Govt Oblig EOY	207072	InvestmentsGovtObligEOY
Investments Govt Oblig EOYFMV	208044	InvestmentsGovtObligEOYFMV
Investments Corp Stock BOY	2794416	InvestmentsCorpStockBOY
Investments Corp Stock EOY	2945307	InvestmentsCorpStockEOY
Investments Corp Stock EOYFMV	3963509	InvestmentsCorpStockEOYFMV
Investments Corp Bonds BOY	912289	InvestmentsCorpBondsBOY
Investments Corp Bonds EOY	889008	InvestmentsCorpBondsEOY
Investments Corp Bonds EOYFMV	918627	InvestmentsCorpBondsEOYFMV
Other Assets BOY	22982	OtherAssetsBOY
Other Assets EOY	22982	OtherAssetsEOY
Other Assets EOYFMV	22982	OtherAssetsEOYFMV
Total Assets BOY	4167683	TotalAssetsBOY
Total Assets EOY	4329269	TotalAssetsEOY
Total Assets EOYFMV	5378062	TotalAssetsEOYFMV
Other Liabilities BOY	12	OtherLiabilitiesBOY
Other Liabilities EOY	1546	OtherLiabilitiesEOY
Total Liabilities BOY	12	TotalLiabilitiesBOY
Total Liabilities EOY	1546	TotalLiabilitiesEOY
Org That Do Not Follow SFAS117	X	OrgThatDoNotFollowSFAS117
Capital Stock BOY	2443594	CapitalStockBOY
Capital Stock EOY	2443594	CapitalStockEOY
Retained Earnings BOY	1724077	RetainedEarningsBOY
Retained Earnings EOY	1884129	RetainedEarningsEOY
Total Net Assets BOY	4167671	TotalNetAssetsBOY
Total Net Assets EOY	4327723	TotalNetAssetsEOY
Total Liabilities Net Assets BOY	4167683	TotalLiabilitiesNetAssetsBOY
Total Liabilities Net Assets EOY	4329269	TotalLiabilitiesNetAssetsEOY

Changes In Net Assets Fund Balances ChangesInNetAssetsFundBalances

Field	Value	IRS element (for citing)
Total Net Assets Fund Balances BOY	4167671	TotalNetAssetsFundBalancesBOY
Excess Of Revenue Over Expenses	160052	ExcessOfRevenueOverExpenses
Subtotal	4327723	Subtotal
Total Net Assets Fund Balances EOY	4327723	TotalNetAssetsFundBalancesEOY

Capital Gains And Losses CapitalGainsAndLosses

Capital Gains And Losses Info CapitalGainsAndLossesInfo (107 entries)

Description Of AssetDescriptionOfAsset	How AcquiredHowAcquired	Date AcquiredDateAcquired	Date SoldDateSold	Gross Sales PriceGrossSalesPrice	Cost Or Other BasisCostOrOtherBasis	Gain Or LossGainOrLoss	Gains Minus Excess Or LossesGainsMinusExcessOrLosses
69-AMERICAN EXPRESS COMPANY	P	2013-08-29	2013-10-02	5115	5001	114	114
450-AMGEN INC	P	2007-05-15	2013-06-13	44117	24152	19965	19965
1000-COCA COLA COMPANY	P	2008-01-09	2013-04-11	41049	32015	9034	9034
50000-FED NATL MTG ASSN NOTES 1	P	2012-05-14	2013-10-28	50000	50451	-451	-451
2714.33-GNMA POOL 2009-61	P	2010-06-08	2013-02-20	2714	2966	-252	-252
47.333333-KRAFT FOODS GROUP INC	P	2010-08-06	2012-11-02	2132	1519	613	613
1100-PFIZER INC	P	1985-05-06	2013-06-13	31778	2086	29692	29692
1524.971-VANGUARD INFLATION-PROTECTE	P	2004-03-11	2013-08-27	40000	38228	1772	1772
115-BRISTOL MYERS SQUIBB COMPANY	P	2013-02-05	2013-10-02	5381	4250	1131	1131
50-AMGEN INC	P	2007-05-15	2013-04-11	5390	2684	2706	2706
600-CONSOLIDATED EDISON INC	P	1995-05-19	2012-11-28	32966	16915	16051	16051
400-FLUOR CORPORATION	P	2011-04-06	2013-04-11	25095	29022	-3927	-3927
2811.56-GNMA POOL 2009-61	P	2010-06-08	2013-03-20	2812	3073	-261	-261
150-KRAFT FOODS GROUP INC	P	2011-10-25	2012-11-05	6700	5567	1133	1133
46-PHILIP MORRIS INTERNATIONAL	P	2011-09-26	2013-10-02	4008	2959	1049	1049
DELL SECURITIES LITIGATION INCOME	P			44		44	44
360-CELGENE CORP	P	2012-12-11	2013-07-18	48006	29802	18204	18204
31-APACHE CORPORATION	P	2012-08-20	2013-10-02	2655	2771	-116	-116
26-COSTCO WHOLESALE CORPORATION	P	2009-10-22	2013-10-02	2971	1512	1459	1459
200-FLUOR CORPORATION	P	2011-10-25	2013-04-11	12547	11239	1308	1308
2481.88-GNMA POOL 2009-61	P	2010-06-08	2013-04-20	2482	2712	-230	-230
58-MCDONALDS CORPORATION	P	2010-02-12	2013-10-02	5507	3695	1812	1812
78-PROCTER & GAMBLE COMPANY	P	2003-06-16	2013-10-02	5896	3608	2288	2288
23-CELGENE CORP	P	2012-12-11	2013-10-02	3563	1904	1659	1659
17-APPLE COMPUTER INC	P	2009-10-05	2013-10-02	8307	3176	5131	5131
53-DEERE & COMPANY	P	2011-07-11	2013-10-02	4344	4432	-88	-88
100-FLUOR CORPORATION	P	2011-11-04	2013-04-11	6274	5463	811	811
1438.73-GNMA POOL 2009-61	P	2010-06-08	2013-05-20	1439	1572	-133	-133
40-MCKESSON CORPORATION	P	2012-09-13	2013-10-02	5208	3517	1691	1691
100000-PRUDENTIAL FINANCIAL INC	P	2008-04-07	2013-04-15	100000	100000
100000-FORD MOTOR CREDIT NOTES	P	2013-04-11	2013-10-01	100000	102967	-2967	-2967
93-BAKER HUGHES INC	P	2012-03-05	2013-10-02	4606	4469	137	137
73-DISNEY WALT CO HOLDINGS	P	2009-01-15	2013-10-02	4723	1467	3256	3256
242-FORD MOTOR COMPANY	P	2012-07-05	2013-10-02	4121	2326	1795	1795
5500-HUNTINGTON BANCSHARES INC	P	2012-02-28	2013-08-28	45071	33055	12016	12016
1800-MDU RESOURCES GROUP INC	P	2003-06-16	2012-11-28	36596	27086	9510	9510
64-QUALCOMM INC	P	2000-03-03	2013-10-02	4309	4116	193	193
85-FREEPORT MCMORAN COPPER & GOLD CL	P	2013-01-22	2013-10-02	2831	3013	-182	-182
72-BB&T CORPORATION	P	2012-04-12	2013-10-02	2420	2240	180	180
59-DU PONT E I DE NEMOURS & COMPANY	P	2010-10-26	2013-10-02	3464	2774	690	690
3719-FORD MOTOR COMPANY	P	2012-07-05	2013-07-18	62972	35739	27233	27233
58-ILLINOIS TOOL WORKS INC	P	2011-04-06	2013-10-02	4372	3170	1202	1202
1000-MERCK & CO INC	P	2010-02-17	2012-12-13	44573	37313	7260	7260
25000-ROYAL BANK OF SCOTLAND PLC 3	P	2010-08-23	2013-08-23	25000	25281	-281	-281
290-GILEAD SCIENCES INC.	P	2012-05-04	2012-12-11	22223	14713	7510	7510
27-BERKSHIRE HATHAWAY INC - CL B	P	2010-02-17	2013-10-02	3064	2058	1006	1006
448.752-EATON VANCE PARAMETRIC TAX M	P	2007-12-12	2013-04-11	21575	25000	-3425	-3425
1930-GENERAL ELECTRIC CAP CORP 6.10%	P	2005-06-23	2013-01-02	48250	49987	-1737	-1737
122-INTEL CORPORATION	P	1993-06-28	2013-10-02	2778	430	2348	2348
200-MERCK & CO INC	P	2010-03-31	2012-12-13	8915	7521	1394	1394
69-SCHLUMBERGER LIMITED	P	2011-11-23	2013-10-02	6180	4601	1579	1579
165-INTERNATIONAL BUSINESS MACHINES	P	2012-09-13	2013-08-23	30496	34059	-3563	-3563
211-BERKSHIRE HATHAWAY INC - CL B	P	2010-02-17	2013-08-29	23669	16082	7587	7587
322.181-EATON VANCE PARAMETRIC TAX M	P	2009-09-17	2013-04-11	15490	13000	2490	2490
100-GENERAL ELECTRIC COMPANY	P	1992-08-13	2013-10-02	2418	634	1784	1784
50-INTERNATIONAL BUSINESS MACHINES C	P	2009-10-05	2013-08-23	9241	6005	3236	3236
118-MONDELEZ INTERNATIONAL INC	P	2010-06-02	2013-10-02	3602	2239	1363	1363
52-TARGET CORPORATION	P	2004-04-19	2013-10-02	3291	2277	1014	1014
186-MICROSOFT CORPORATION	P	2012-10-17	2013-10-02	6311	5507	804	804
56-BHP BILLITON LIMITED ADR	P	2009-09-17	2013-10-02	3725	3863	-138	-138
389.372-EATON VANCE PARAMETRIC TAX M	P	2011-10-25	2013-04-11	18721	17000	1721	1721
178-GENERAL ELECTRIC COMPANY	P	2008-12-02	2013-10-02	4304	3064	1240	1240
100-INTERNATIONAL BUSINESS MACHINES	P	2010-02-12	2013-08-23	18482	12230	6252	6252
25000-MORGAN STANLEY STR 4.0000% 10/	P	2011-04-07	2013-10-16	25000	24000	1000	1000
400-TEVA PHARMACEUTICAL INDUSTRIES L	P	2010-02-24	2013-02-05	15144	23808	-8664	-8664
39-NATIONAL OILWELL VARCO INC	P	2013-01-29	2013-10-02	3079	2880	199	199
350-BOEING COMPANY	P	1997-03-21	2013-04-11	30936	18533	12403	12403
237-EMC CORPORATION	P	2010-02-24	2013-10-02	6072	4147	1925	1925
700-GENERAL MILLS INC	P	1992-02-11	2013-04-11	34450	10077	24373	24373
100-INTERNATIONAL BUSINESS MACHINES	P	2010-03-12	2013-08-23	18482	12797	5685	5685
400-NEXTERA ENERGY INC	P	2009-09-17	2013-01-22	28693	22055	6638	6638
200-TEVA PHARMACEUTICAL INDUSTRIES L	P	2010-03-12	2013-02-05	7572	12314	-4742	-4742
95-ROCHE HOLDINGS LTD SPONS ADR	P	2012-12-11	2013-10-02	6350	4823	1527	1527
45-CATERPILLAR INC	P	2010-02-12	2013-10-02	3763	2509	1254	1254
74-EMERSON ELECTRIC COMPANY	P	2001-02-05	2013-10-02	4743	2734	2009	2009
300-GENERAL MILLS INC	P	2011-04-06	2013-04-11	14764	10980	3784	3784
98-JOHNSON CONTROLS INC	P	2011-07-27	2013-10-02	4041	3645	396	396
400-NEXTERA ENERGY INC	P	2009-10-22	2013-01-22	28693	21275	7418	7418
150-TEVA PHARMACEUTICAL INDUSTRIES L	P	2010-06-02	2013-02-05	5679	8052	-2373	-2373
182-SKYWORKS SOLUTIONS INC.	P	2013-08-23	2013-10-02	4572	4577	-5	-5
33-CHEVRON CORP	P	2003-06-16	2013-10-02	3976	1240	2736	2736
985-EXELON CORPORATION	P	2011-10-25	2013-01-22	29871	41793	-11922	-11922
52-GILEAD SCIENCES INC.	P	2012-05-04	2013-10-02	3226	1319	1907	1907
347-JP MORGAN CHASE & COMPANY	P	2000-03-03	2012-12-11	14864	18585	-3721	-3721
200-NEXTERA ENERGY INC	P	2011-10-25	2013-01-22	14347	11082	3265	3265
350-TEVA PHARMACEUTICAL INDUSTRIES L	P	2010-07-07	2013-02-05	13251	18630	-5379	-5379
77-TERADATA CORP	P	2013-08-23	2013-10-02	4240	4697	-457	-457
209-CHEVRON CORP	P	2003-06-16	2013-01-29	24455	7854	16601	16601
15-EXELON CORPORATION	P	2011-10-25	2013-10-02	444	636	-192	-192
2874.67-GNMA POOL 2009-61	P	2010-06-08	2012-11-20	2875	3141	-266	-266
179-JP MORGAN CHASE & COMPANY	P	2000-03-03	2013-10-02	9294	9587	-293	-293
59-NORTHERN TRUST CORPORATION	P	2009-09-17	2013-10-02	3153	3558	-405	-405
77-UNITEDHEALTH GROUP INC	P	2011-05-19	2013-10-02	5567	3900	1667	1667
132-ABBOTT LABORATORIES	P	2011-04-06	2012-11-28	8485	6694	1791	1791
200-CISCO SYSTEMS INC	P	2000-06-15	2013-10-02	4642	13043	-8401	-8401
48-EXELON CORPORATION	P	2012-09-27	2013-10-02	1421	1721	-300	-300
2717.9-GNMA POOL 2009-61	P	2010-06-08	2012-12-20	2718	2970	-252	-252
216.666667-KRAFT FOODS GROUP INC	P	2010-06-02	2012-11-02	9759	6667	3092	3092
2000-ORACLE CORPORATION	P	2009-09-16	2013-08-23	64111	44415	19696	19696
4346.972-VANGUARD GNMA FUND ADMIRAL	P	2007-12-20	2013-08-27	45295	45078	217	217
400-AMGEN INC	P	2007-05-02	2013-04-11	43119	26449	16670	16670
21-CISCO SYSTEMS INC	P	2004-02-25	2013-10-02	487	492	-5	-5
68-EXXON MOBIL CORPORATION	P	1983-06-24	2013-10-02	5832	294	5538	5538
2657.34-GNMA POOL 2009-61	P	2010-06-08	2013-01-20	2657	2904	-247	-247
86-KRAFT FOODS GROUP INC	P	2010-08-06	2012-11-05	3841	2760	1081	1081
58-PEPSICO INC	P	1996-05-29	2013-10-02	4583	1787	2796	2796
4659.832-VANGUARD GNMA FUND ADMIRAL	P	2009-09-17	2013-08-27	48555	50000	-1445	-1445

Field	Value	IRS element (for citing)
Capital Gain Net Income	312207	CapitalGainNetIncome
Net Short Term Capital Gain Or Loss	24018	NetShortTermCapitalGainOrLoss

Qlfy Und Sect4940e For Reduced Tax QlfyUndSect4940eForReducedTax

Field	Value	IRS element (for citing)
Liable For4942 Tax	false	LiableFor4942Tax
Qualifying Distributions Year1	244959	QualifyingDistributionsYear1
Noncharitable Assets Year1	4807448	NoncharitableAssetsYear1
Distribution Ratio Year1	0.050954	DistributionRatioYear1
Qualifying Distributions Year2	234756	QualifyingDistributionsYear2
Noncharitable Assets Year2	4609464	NoncharitableAssetsYear2
Distribution Ratio Year2	0.050929	DistributionRatioYear2
Qualifying Distributions Year3	207821	QualifyingDistributionsYear3
Noncharitable Assets Year3	4402615	NoncharitableAssetsYear3
Distribution Ratio Year3	0.047204	DistributionRatioYear3
Qualifying Distributions Year4	186524	QualifyingDistributionsYear4
Noncharitable Assets Year4	3996482	NoncharitableAssetsYear4
Distribution Ratio Year4	0.046672	DistributionRatioYear4
Qualifying Distributions Year5	176828	QualifyingDistributionsYear5
Noncharitable Assets Year5	5058764	NoncharitableAssetsYear5
Distribution Ratio Year5	0.034955	DistributionRatioYear5
Total Distribution Ratio	0.230714	TotalDistributionRatio
Average Distribution Ratio	0.046143	AverageDistributionRatio
Net Noncharitable Assets	5125398	NetNoncharitableAssets
Adjusted Noncharitable Assets	236501	AdjustedNoncharitableAssets
One Percent Net Investment Income	4255	OnePercentNetInvestmentIncome
Adj Nonchrtbl Assets And One	240756	AdjNonchrtblAssetsAndOnePct
Qualifying Distributions	262691	QualifyingDistributions

Excise Tax Based On Investment Incm ExciseTaxBasedOnInvestmentIncm

Field	Value	IRS element (for citing)
Domestic Org Meeting Sect4940e	X	DomesticOrgMeetingSect4940e
Investment Income Excise Tax	4255	InvestmentIncomeExciseTax
Subtotal	4255	Subtotal
Tax Based On Investment Income	4255	TaxBasedOnInvestmentIncome
Est Tax Payments And Overpayment	2709	EstTaxPaymentsAndOverpayment
Total Credits And Payments	2709	TotalCreditsAndPayments
Tax Due	1546	TaxDue

Statements Regarding Activities StatementsRegardingActivities

Field	Value	IRS element (for citing)
Legislative Political Activities	false	LegislativePoliticalActivities
More Than100 Spent	false	MoreThan100Spent
Form1120 POL Filed	false	Form1120POLFiled
Activities Not Prev Reported	false	ActivitiesNotPrevReported
Changes To Articles Or Bylaws	false	ChangesToArticlesOrBylaws
Unrelated Bus Income Over1000	false	UnrelatedBusIncomeOver1000
Termination Etc	false	TerminationEtc
Requirements Of Sect508e	true	RequirementsOfSect508e
At Least5000 In Assets	true	AtLeast5000InAssets
States Filed With	WY	StatesFiledWith
Form990 PF Filed With AG	true	Form990PFFiledWithAG
Private Operating Foundation	false	PrivateOperatingFoundation
New Substantial Contributors	false	NewSubstantialContributors
Interest In Controlled Entity	false	InterestInControlledEntity
Applicable Insurance Contract	false	ApplicableInsuranceContract
Comply With Public Inspection Rqr	true	ComplyWithPublicInspectionRqr
Website Address	N/A	WebsiteAddress

Books In Care Of Business Name BooksInCareOfBusinessName

Field	Value	IRS element (for citing)
Business Name Line1	MOHATT RINALDO JOHNSON & GODWIN	BusinessNameLine1

Field	Value	IRS element (for citing)
Books In Care Of Phone Number	3076726494	BooksInCareOfPhoneNumber

Books In Care Of US Address BooksInCareOfUSAddress

Field	Value	IRS element (for citing)
Address Line1	PO BOX 603	AddressLine1
City	SHERIDAN	City
State	WY	State
ZIP Code	82801	ZIPCode

Field	Value	IRS element (for citing)
Foreign Bank	false	ForeignBank

Statements Regarding Acty4720 StatementsRegardingActy4720

Field	Value	IRS element (for citing)
Sale Or Exchange With Dsqfly Person	false	SaleOrExchangeWithDsqflyPerson
Borrow Or Lend With Dsqfly Person	false	BorrowOrLendWithDsqflyPerson
Furnished Goods With Dsqfly Person	false	FurnishedGoodsWithDsqflyPerson
Pay Compensation To Dsqfly Person	true	PayCompensationToDsqflyPerson
Transfer Assets To Dsqfly Person	false	TransferAssetsToDsqflyPerson
Payment To Government Offical	false	PaymentToGovernmentOffical
Acts Fail To Qualify As Exceptions	false	ActsFailToQualifyAsExceptions
Undistributed Income Prior Years	false	UndistributedIncomePriorYears
Business Holdings	false	BusinessHoldings
Jeopardy Investments	false	JeopardyInvestments
Uncorrected Jeopardy Investments	false	UncorrectedJeopardyInvestments
Influence Legislation	false	InfluenceLegislation
Influence Election	false	InfluenceElection
Grants To Individuals	false	GrantsToIndividuals
Grants To Organizations	false	GrantsToOrganizations
Noncharitable Purpose	false	NoncharitablePurpose
Rcv Funds To Pay Prsnl Bnft Contract	false	RcvFundsToPayPrsnlBnftContract
Pay Premiums Prsnl Bnft Contract	false	PayPremiumsPrsnlBnftContract
Prohibited Tax Shelter Transactn	false	ProhibitedTaxShelterTransactn

Ofcr Dir Trustees Key Employee Info OfcrDirTrusteesKeyEmployeeInfo

Ofcr Dir Trustees Or Key Employee OfcrDirTrusteesOrKeyEmployee (3 entries)

Address Line1USAddress/AddressLine1	CityUSAddress/City	StateUSAddress/State	ZIP CodeUSAddress/ZIPCode	TitleTitle	Avg Hours Per Wk Devoted To PositionAvgHoursPerWkDevotedToPosition	CompensationCompensation	Contri To Empl Benefit Plans EtcContriToEmplBenefitPlansEtc	Expense Account Other AllowancesExpenseAccountOtherAllowances
RALPH C ROBINSON
PO BOX 27	BUFFALO	WY	82834	TRUSTEE	4.00	12719	0	0
JOHN PRADERE
PO BOX 603	SHERIDAN	WY	82801	TRUSTEE	4.00	12718	0	0
ROBERT WYATT
PO BOX 603	SHERIDAN	WY	82081	TRUSTEE	4.00	0	0	0

Field	Value	IRS element (for citing)
Comp Of Highest Paid Empl NONE	NONE	CompOfHighestPaidEmplNONE
Comp Of Hghst Paid Cntrct NONE	NONE	CompOfHghstPaidCntrctNONE

Sum Of Program Related Investments SumOfProgramRelatedInvestments

Field	Value	IRS element (for citing)
Description1	N/A	Description1

Minimum Investment Return MinimumInvestmentReturn

Field	Value	IRS element (for citing)
Avg Monthly FMV Of Securities	5033779	AvgMonthlyFMVOfSecurities
Avg Monthly Cash Balances	146689	AvgMonthlyCashBalances
FMV All Other Noncharitable Assets	22982	FMVAllOtherNoncharitableAssets
Total FMV Of Unused Assets	5203450	TotalFMVOfUnusedAssets
Adj Total FMV Of Unused Assets	5203450	AdjTotalFMVOfUnusedAssets
Cash Deemed Charitable	78052	CashDeemedCharitable
Net Noncharitable Assets	5125398	NetNoncharitableAssets
Minimum Investment Return	256270	MinimumInvestmentReturn

Distributable DistributableAmount

Field	Value	IRS element (for citing)
Minimum Investment Return	256270	MinimumInvestmentReturn
Tax Based On Investment Income	4255	TaxBasedOnInvestmentIncome
Total Tax	4255	TotalTax
Distributable Amount Before Adj	252015	DistributableAmountBeforeAdj
Distributable Amount Before Ded	252015	DistributableAmountBeforeDed
Distributable Amount As Adjusted	252015	DistributableAmountAsAdjusted

Qualifying Distributions QualifyingDistributions

Field	Value	IRS element (for citing)
Expenses And Contributions	262691	ExpensesAndContributions
Qualifying Distributions	262691	QualifyingDistributions
One Pct Sect4940e Org Net Invst Incm	4255	OnePctSect4940eOrgNetInvstIncm
Adj Qualifying Distributions	258436	AdjQualifyingDistributions

Undistributed Income UndistributedIncome

Field	Value	IRS element (for citing)
Distributable Amount As Adjusted	252015	DistributableAmountAsAdjusted
Undistributed Income Prior Year	61180	UndistributedIncomePriorYear
Qualifying Distributions	262691	QualifyingDistributions
Applied To Year1	61180	AppliedToYear1
Applied To Current Year	201511	AppliedToCurrentYear
Undistributed Income CY	50504	UndistributedIncomeCY

Supplementary Information SupplementaryInformation

Appication Submission Info AppicationSubmissionInfo

Field	Value	IRS element (for citing)
Recipient Name	SURRENA MEMORIAL FUND	RecipientName

Recipient US Address RecipientUSAddress

Field	Value	IRS element (for citing)
Address Line1	BOX 27	AddressLine1
City	BUFFALO	City
State	WY	State
ZIP Code	82834	ZIPCode

Field	Value	IRS element (for citing)
Recipient Phone Number	3076845574	RecipientPhoneNumber
Form And Info And Materials	WRITTEN APPLICATION	FormAndInfoAndMaterials
Submission Deadlines	NONE	SubmissionDeadlines
Restrictions On Awards	CHARITABLE, RELIGIOUS, SCIENTIFIC, & EDUCATIONAL PURPOSES IN THE U.S.	RestrictionsOnAwards

Grant Or Contri Paid During Year GrantOrContriPaidDuringYear (23 entries)

Address Line1RecipientUSAddress/AddressLine1	CityRecipientUSAddress/City	StateRecipientUSAddress/State	ZIP CodeRecipientUSAddress/ZIPCode	Recipient RelationshipRecipientRelationship	Recipient Foundation StatusRecipientFoundationStatus	Purpose Of Grant Or ContributionPurposeOfGrantOrContribution	AmountAmount	Business Name Line2RecipientBusinessName/BusinessNameLine2
BREAD OF LIFE
PO BOX 909	BUFFALO	WY	82834	NONE	EXEMPT ORG.	GENERAL OPERATIONS	$5,000
BUFFALO SENIOR CENTER
671 W FETTERMAN	BUFFALO	WY	82834	NONE	EXEMPT ORG.	GENERAL OPERATIONS	$500
CHILDREN'S CENTER
863 HIGHLAND AVE	SHERIDAN	WY	82801	NONE	EXEMPT ORG.	GENERAL OPERATIONS	$30,000
CHILDREN'S CENTER - BUFFA
151 KLONDIKE	BUFFALO	WY	82834	NONE	EXEMPT ORG.	GENERAL OPERATIONS	$45,000
CLEARMONT COMMUNITY LIBRA
PO BOX 26	CLEARMONT	WY	82835	NONE	EXEMPT ORG.	GENERAL OPERATIONS	$5,000
GENESIS FOUNDATION
444 CRESCENT DR	SHERIDAN	WY	82801	NONE	EXEMPT ORG.	GENERAL OPERATIONS	$30,000
HABITAT FOR HUMANITY OF
PO BOX 6196	SHERIDAN	WY	82801	NONE	EXEMPT ORG.	GENERAL OPERATIONS	$10,000	THE EASTERN BIGHORNS INC
JOHNSON COUNTY LIBRARY
171 N ADAMS	BUFFALO	WY	82834	NONE	EXEMPT ORG.	GENERAL OPERATIONS	$10,000	FOUNDATION
JOHNSON COUNTY YMCA
101 SOUTH KLONDIKE	BUFFALO	WY	82834	NONE	EXEMPT ORG.	GENERAL OPERATIONS	$20,000
LUNCH TOGETHER SOUP KITCHEN
102 S CONNER ST	SHERIDAN	WY	82801	NONE	EXEMPT ORG.	GENERAL OPERATIONS	$5,000
METHODIST CHURCH
132 N ADAMS AVE	BUFFALO	WY	82834	NONE	EXEMPT ORG.	GENERAL OPERATIONS	$5,000	OF BUFFALO WYOMING
METHODIST CHURCH
215 W WORKS	SHERIDAN	WY	82801	NONE	EXEMPT ORG.	GENERAL OPERATIONS	$5,000	OF SHERIDAN WYOMING
MOUNTAIN PLAINS HERITAGE
PO BOX 27	BUFFALO	WY	82834	NONE	EXEMPT ORG.	GENERAL OPERATIONS	$3,000
SCOTTISH RITE CHILDHOOD
8 RIVERBEND COURT	SHERIDAN	WY	82801	NONE	EXEMPT ORG.	GENERAL OPERATIONS	$5,000	LANGUAGE CLINIC C/O TOM NEIGHBORS
SENIOR CITIZENS COUNCIL
211 SMITH STREET	SHERIDAN	WY	82801	NONE	EXEMPT ORG.	GENERAL OPERATIONS	$10,000
SHERIDAN COLLEGE
3059 COFFEEN AVE	SHERIDAN	WY	82801	NONE	EXEMPT ORG.	GENERAL OPERATIONS	$10,000	FOUNDATION
SHERIDAN COUNTY LIBRARY
335 W ALGER	SHERIDAN	WY	82801	NONE	EXEMPT ORG.	GENERAL OPERATIONS	$5,000	FOUNDATION INC
SHERIDAN COUNTY YMCA
417 NORTH JEFFERSON	SHERIDAN	WY	82801	NONE	EXEMPT ORG.	GENERAL OPERATIONS	$20,000
STORY BRANCH LIBRARY
PO BOX 188	STORY	WY	82842	NONE	EXEMPT ORG.	GENERAL OPERATIONS	$5,000
STORY COMMUNITY CHURCH
PO BOX 415	STORY	WY	82842	NONE	EXEMPT ORG.	GENERAL OPERATIONS	$5,000
TONGUE RIVER BRANCH
PO BOX 909	RANCHESTER	WY	82839	NONE	EXEMPT ORG.	GENERAL OPERATIONS	$5,000	LIBRARY
TONGUE RIVER CHILD'S
84 DAYTON STREET	RANCHESTER	WY	82839	NONE	EXEMPT ORG.	GENERAL OPERATIONS	$5,000	PLACE
VOLUNTEERS OF AMERICA OF
PO BOX 6291	SHERIDAN	WY	82801	NONE	EXEMPT ORG.	HOMELESS SHELTER	$5,000	WYOMING AND MONTANA

Field	Value	IRS element (for citing)
Tot Grant Or Contri Paid During Year	248500	TotGrantOrContriPaidDuringYear

Analysis Income Producing Acty AnalysisIncomeProducingActy

Int On Savings And Temp Cash Invst IntOnSavingsAndTempCashInvst

Field	Value	IRS element (for citing)
Exclusion Code	14	ExclusionCode
Exclusion	$25,063	ExclusionAmount

Dividends And Int From Sec Part VII DividendsAndIntFromSecPartVII

Field	Value	IRS element (for citing)
Exclusion Code	14	ExclusionCode
Exclusion	$120,041	ExclusionAmount

Gain Sales Assets Oth Than Invntry GainSalesAssetsOthThanInvntry

Field	Value	IRS element (for citing)
Exclusion Code	18	ExclusionCode
Exclusion	$312,207	ExclusionAmount

Subtotals Part XVIA SubtotalsPartXVIA

Field	Value	IRS element (for citing)
Exclusion	$457,311	ExclusionAmount

Field	Value	IRS element (for citing)
Total Part XVIA	457311	TotalPartXVIA

Trnsfr Tr Rln With Noncharitable EO TrnsfrTrRlnWithNoncharitableEO

Field	Value	IRS element (for citing)
Trnsfr Of Cash To Noncharitable EO	false	TrnsfrOfCashToNoncharitableEO
Trnsfr Oth Assets Noncharitable EO	false	TrnsfrOthAssetsNoncharitableEO
Sales Or Exchanges Of Assets	false	SalesOrExchangesOfAssets
Purchase Assets Noncharitable EO	false	PurchaseAssetsNoncharitableEO
Rental Of Facilities Etc	false	RentalOfFacilitiesEtc
Reimbursement Arrangements	false	ReimbursementArrangements
Loans Or Loan Guarantees	false	LoansOrLoanGuarantees
Performance Of Services Etc	false	PerformanceOfServicesEtc
Sharing Of Facilities Etc	false	SharingOfFacilitiesEtc
Relationships Noncharitable E Os	false	RelationshipsNoncharitableEOs

Accounting Fees Schedule AccountingFeesSchedule

Accounting Fees AccountingFees

Field	Value	IRS element (for citing)
Category	ACCOUNTING FEES	Category
Amount	$2,000	Amount
Net Investment Income	1500	NetInvestmentIncome
Disbursements Charitable Prps	500	DisbursementsCharitablePrps

Compensation Explanation CompensationExplanation

Compensation Compensation (3 entries)

RALPH C ROBINSON
JOHN PRADERE
ROBERT WYATT

Investments Corp Bonds Schedule InvestmentsCorpBondsSchedule

Investments Corp Bonds InvestmentsCorpBonds (15 entries)

Name Of BondNameOfBond	EOY Book ValueEOYBookValue	EOYFMVEOYFMV
BLACKROCK INC	50000	57298
CSX CORP 6.25%	50920	58646
DODGE & COX INCOME FUND	100000	101856
GENERAL ELECTRIC CAP 5.1%	100000	110666
LILLY ELI & CO	26963	28160
MORGAN STANLEY STR 4.0%
OPPENHEIMER INTERNATIONAL BOND FUND	100000	94027
PRUDENTIAL FINANCIAL INC 5.75%
ROYAL BANK OF SCOTLAND PLC 3.40%
TEMPLETON GLOBAL BOND FUND	100000	96241
US BANCORP	15725	15315
VANGUARD HIGH YIELD CORPORATE PORT	125000	136115
VANGUARD INTERMEDIATE-TERM INVEST	98000	98555
VANGUARD SHORT TERM CORP FUND	72400	71613
EASTON VANCE FLOATING RATE FUND	50000	50135

Investments Corp Stock Schedule InvestmentsCorpStockSchedule

Investments Corp Stock InvestmentsCorpStock (77 entries)

Name Of StockNameOfStock	EOY Book ValueEOYBookValue	EOYFMVEOYFMV
ABBOTT LABORATORIES
AMERICAN EXPRESS	68269	77053
AMGEN INC
APACHE CORPORATION	41032	40759
APPLE COMPUTER INC	74510	123880
BAKER HUGHES INC	62156	78828
BB&T CORPORATION	32877	35906
BERKSHIRE HATHAWAY INC - CL B	28212	41663
BHP BILLITON LIMITED ADR	58854	56411
BOEING CO	24398	52200
BRISTOL MYERS SQUIBB	64970	92330
CATERPILLAR INC	48190	55601
CALGENE	27318	49002
CHEVRON CORP	23337	57941
CISCO SYSTEMS	46883	49158
COCA COLA COMPANY
CONSOLIDATED EDISON INC
COSTCO WHOLESALE CORPORATION	22193	45784
DEERE & COMPANY	61710	63180
DISNEY WALT CO HOLDINGS	34847	73940
DU PONT E I DE NEMOURS & COMPANY	46841	60649
EMC CORPORATION	72441	81673
EMERSON ELECTRIC CO	29700	62014
EXELON CORPORATION	32514	25886
EXXON MOBIL CORP	16205	83526
FLUOR CORPORATION
FORD MOTOR COMPANY	32261	58876
FREEPORT MCMORAN COPPER AND GOLD CLA	42605	44186
GENERAL ELECTRIC CAPITAL CORP
GENERAL ELECTRIC CO	70025	96300
GENERAL MILLS
GILEAD SCIENCES INC.	19482	54662
HUNTINGTON BANCSHARES INC
ILLINOIS TOOL WORKS INC	21428	30886
INTEL CORP	41665	44486
INTERNATIONAL BUSINESS MACHINES CORP
JOHNSON CONTROLS INC	38996	53165
J.P. MORGAN CHASE & CO	96381	130087
KRAFT FOODS INC
MCDONALDS CORPORATION	64240	84455
MCKESSON CORPORATION	55043	97869
MDU RESOURCES GROUP
MERCK & CO INC
MICROSOFT CORPORATION	75999	87627
MONDELEZ INTERNATIONAL INC	37618	58215
NATIONAL OILWELL VARCO INC	42902	47166
NEXTERA ENERGY INC
NORTHERN TRUST CORPORATION	51388	53091
ORACLE CORPORATION
PEPSICO	22825	62395
PFIZER INC	1896	30685
PHILIP MORRIS INTERNATIONAL	42075	58284
PROCTOR & GAMBLE CO	33393	58302
PUBLIC STORAGE 6.50% PFD	25000	24690
QUALCOMM INC	33467	65043
SCHLUMBERGER LIMITED	41005	56794
SKYWORKS SOLUTIONS INC	62749	64371
SOUTHERN CO	6839	40910
TARGET CORP	36794	50990
TENN VALLEY AUTH 6/1/28	49980	43904
TERADATA CORP	62405	45084
TEVA PHARMACEUTICAL INDUSTRIES LIMIT
UNITEDHEALTH GROUP INC	62156	79932
ROUCHE HOLDINGS LTD	73486	97437
GS-INTERNATIONAL SML CAP INSIGHTS	50000	56310
OPPENHEIMER MAIN ST SMALL CAP	50000	70419
T ROWE PRICE MID CAP FUND	50000	72796
T ROWE PRICE MID CAP VALUE FUND	50000	69370
AMERICAN EUROPACIFIC GROWTH FUND	73447	99083
HARBOR INTERNATIONAL FUND	58089	97601
OPPENHEIMER DEVELOPING MARKETS FUND	125000	135070
EATON VANCE TAX-MANAGED EMERGING
VANGUARD EMERGIN MARKETS ETF	127211	125595
HARBOR COMMODITY REAL RETURN STRATEG	100000	85214
PRINCIPAL GOLBAL REAL ESTATE SEC	100000	107326
GENERAL MOTORS CO WARRANTS EXP 07/10		10178
GENERAL MOTORS CO WARRANTS EXP 07/10		7271

Investments Govt Obligations Sch InvestmentsGovtObligationsSch

Field	Value	IRS element (for citing)
US Govt Securities EOY Book Value	156553	USGovtSecuritiesEOYBookValue
US Govt Securities EOYFMV	156781	USGovtSecuritiesEOYFMV
State Local Securities EOY Book Val	50519	StateLocalSecuritiesEOYBookVal
State Local Securities EOYFMV	51263	StateLocalSecuritiesEOYFMV

Other Assets Schedule OtherAssetsSchedule

Other Assets OtherAssets

Field	Value	IRS element (for citing)
Description	MINERAL RIGHTS	Description
BOY Book Value	22982	BOYBookValue
EOY Book Value	22982	EOYBookValue
EOYFMV	22982	EOYFMV

Other Expenses Schedule OtherExpensesSchedule

Other Expenses OtherExpenses (2 entries)

DescriptionDescription	Revenue And Expenses Per BooksRevenueAndExpensesPerBooks	Net Investment IncomeNetInvestmentIncome
EXPENSES
WIRE TRANSFER FEES	43	43

Other Liabilities Schedule OtherLiabilitiesSchedule

Other Liabilities OtherLiabilities

Field	Value	IRS element (for citing)
Description	FEDERAL TAXES PAYABLE	Description
BOY Book Value	12	BOYBookValue
EOY Book Value	1546	EOYBookValue

Other Professional Fees Schedule OtherProfessionalFeesSchedule

Other Professional Fees OtherProfessionalFees

Field	Value	IRS element (for citing)
Category	INVESTMENT MANAGEMENT FEES	Category
Amount	$14,553	Amount
Net Investment Income	14553	NetInvestmentIncome

Taxes Schedule TaxesSchedule

Taxes Taxes (3 entries)

CategoryCategory	AmountAmount	Net Investment IncomeNetInvestmentIncome	Disbursements Charitable PrpsDisbursementsCharitablePrps
PAYROLL TAXES	$1,946	973	973
2012 990-PF EXCISE TAXES	$4,286
FOREIGN TAXES	$494	494