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      <Name>
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        <State>NC</State>
        <ZIPCode>28711</ZIPCode>
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    <Officer>
      <Name>WILLIAM THIEMKEY</Name>
      <Title>TREASURER</Title>
      <Phone>8286694485</Phone>
      <DateSigned>2012-05-10</DateSigned>
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      <Name>TIMOTHY C KELLNER CPA</Name>
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        <TaxDue>44</TaxDue>
        <AmountCreditedToNextYear>0</AmountCreditedToNextYear>
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        <LegislativePoliticalActivities>false</LegislativePoliticalActivities>
        <MoreThan100Spent>false</MoreThan100Spent>
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        <ApplicableInsuranceContract>false</ApplicableInsuranceContract>
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        <WebsiteAddress>N/A</WebsiteAddress>
        <BooksInCareOfPersonName>WILLIAM THIEMKEY</BooksInCareOfPersonName>
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          <AddressLine1>44 HUNTING LODGE</AddressLine1>
          <City>BLACK MOUNTAIN</City>
          <State>NC</State>
          <ZIPCode>28711</ZIPCode>
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        <SaleOrExchangeWithDsqflyPerson>false</SaleOrExchangeWithDsqflyPerson>
        <BorrowOrLendWithDsqflyPerson>false</BorrowOrLendWithDsqflyPerson>
        <FurnishedGoodsWithDsqflyPerson>false</FurnishedGoodsWithDsqflyPerson>
        <PayCompensationToDsqflyPerson>false</PayCompensationToDsqflyPerson>
        <TransferAssetsToDsqflyPerson>false</TransferAssetsToDsqflyPerson>
        <PaymentToGovernmentOffical>false</PaymentToGovernmentOffical>
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        <BusinessHoldings>false</BusinessHoldings>
        <JeopardyInvestments>false</JeopardyInvestments>
        <InfluenceLegislation>false</InfluenceLegislation>
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        <GrantsToIndividuals>false</GrantsToIndividuals>
        <GrantsToOrganizations>false</GrantsToOrganizations>
        <NoncharitablePurpose>false</NoncharitablePurpose>
        <RcvFundsToPayPrsnlBnftContract>false</RcvFundsToPayPrsnlBnftContract>
        <PayPremiumsPrsnlBnftContract>false</PayPremiumsPrsnlBnftContract>
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          <PersonName referenceDocumentId="RetDoc3">RICHARD THIEMKEY</PersonName>
          <USAddress>
            <AddressLine1>44 HUNTING LODGE</AddressLine1>
            <City>BLACK MOUNTAIN</City>
            <State>NC</State>
            <ZIPCode>28711</ZIPCode>
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          <Title>PRESIDENT</Title>
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        <OfcrDirTrusteesOrKeyEmployee>
          <PersonName referenceDocumentId="RetDoc3">PETER MUTCH</PersonName>
          <USAddress>
            <AddressLine1>381 N SAGINAW ST</AddressLine1>
            <City>LAPEER</City>
            <State>MI</State>
            <ZIPCode>48446</ZIPCode>
          </USAddress>
          <Title>SCHLR CHAIR</Title>
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          <Compensation>0</Compensation>
          <ContriToEmplBenefitPlansEtc>0</ContriToEmplBenefitPlansEtc>
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        <OfcrDirTrusteesOrKeyEmployee>
          <PersonName referenceDocumentId="RetDoc3">WILLIAM THIEMKEY</PersonName>
          <USAddress>
            <AddressLine1>44 HUNTING LODGE</AddressLine1>
            <City>BLACK MOUNTAIN</City>
            <State>NC</State>
            <ZIPCode>28711</ZIPCode>
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          <Title>SEC/TREAS</Title>
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          <ExpenseAccountOtherAllowances>0</ExpenseAccountOtherAllowances>
        </OfcrDirTrusteesOrKeyEmployee>
        <CompOfHighestPaidEmplNONE>NONE</CompOfHighestPaidEmplNONE>
        <CompOfHghstPaidCntrctNONE>NONE</CompOfHghstPaidCntrctNONE>
      </OfcrDirTrusteesKeyEmployeeInfo>
      <SumOfProgramRelatedInvestments>
        <Description1>N/A</Description1>
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        <AvgMonthlyFMVOfSecurities>73573</AvgMonthlyFMVOfSecurities>
        <AvgMonthlyCashBalances>7411</AvgMonthlyCashBalances>
        <FMVAllOtherNoncharitableAssets>0</FMVAllOtherNoncharitableAssets>
        <TotalFMVOfUnusedAssets>80984</TotalFMVOfUnusedAssets>
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        <CashDeemedCharitable>1215</CashDeemedCharitable>
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        <MinimumInvestmentReturn>3988</MinimumInvestmentReturn>
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        <MinimumInvestmentReturn>3988</MinimumInvestmentReturn>
        <TaxBasedOnInvestmentIncome>44</TaxBasedOnInvestmentIncome>
        <TotalTax>44</TotalTax>
        <DistributableAmountBeforeAdj>3944</DistributableAmountBeforeAdj>
        <DistributableAmountBeforeDed>3944</DistributableAmountBeforeDed>
        <DistributableAmountAsAdjusted>3944</DistributableAmountAsAdjusted>
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      <QualifyingDistributions>
        <ExpensesAndContributions>3000</ExpensesAndContributions>
        <QualifyingDistributions>3000</QualifyingDistributions>
        <AdjQualifyingDistributions>3000</AdjQualifyingDistributions>
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        <QualifyingDistributions>3000</QualifyingDistributions>
        <AppliedToYear1>2221</AppliedToYear1>
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        <UndistributedIncomeCY>3165</UndistributedIncomeCY>
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        <ContributingManager>WILLIAM AND ROBERTA THIEMKEY</ContributingManager>
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          <RecipientName>WILLIAM THIEMKEY</RecipientName>
          <RecipientUSAddress>
            <AddressLine1>44 HUNTING LODGE</AddressLine1>
            <City>BLACK MOUNTAIN</City>
            <State>NC</State>
            <ZIPCode>28711</ZIPCode>
          </RecipientUSAddress>
          <RecipientPhoneNumber>8286694485</RecipientPhoneNumber>
          <FormAndInfoAndMaterials>NO STANDARD FORMAT HAD BEEN ESTABLISHED.</FormAndInfoAndMaterials>
          <SubmissionDeadlines>NO DEADLINES HAVE BEEN ESTABLISHED.</SubmissionDeadlines>
          <RestrictionsOnAwards>AWARDS ARE GIVEN TO SENIOR STUDENTS AT LAPEER WEST SCHOOL WITH A STRONG INTEREST IN PURSUING TEACHING AS A CAREER. A STRONG PREFERENCE WILL BE GIVEN TO STUDENTS WHO ARE ACCEPTED TO EASTERN MICHIGAN UNIVERSITY, THE UNIVERSITY OF MICHIGAN OR ALMA COLLEGE. A 3.0 GPA AND A 22 OR BETTER ACT (OR ITS EQUIVALENT) SHALL BE USED FOR ACADEMIC STANDARDS.</RestrictionsOnAwards>
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        <GrantOrContriPaidDuringYear>
          <RecipientPersonName>SCHOLARSHIPS</RecipientPersonName>
          <RecipientUSAddress>
            <AddressLine1>LAPEER MICHIGAN</AddressLine1>
            <City>LAPEER</City>
            <State>MI</State>
            <ZIPCode>48446</ZIPCode>
          </RecipientUSAddress>
          <RecipientRelationship>NONE</RecipientRelationship>
          <RecipientFoundationStatus>PAID</RecipientFoundationStatus>
          <PurposeOfGrantOrContribution>SCHOLARSHIPS</PurposeOfGrantOrContribution>
          <Amount>3000</Amount>
        </GrantOrContriPaidDuringYear>
        <TotGrantOrContriPaidDuringYear>3000</TotGrantOrContriPaidDuringYear>
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        <IntOnSavingsAndTempCashInvst>
          <ExclusionCode>14</ExclusionCode>
          <ExclusionAmount>4</ExclusionAmount>
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          <RelationshipStatement>INTEREST INCOME HELPS INCREASE ASSET VALUE WHICH IS USED</RelationshipStatement>
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          <RelationshipStatement>DIVIDEND INCOME HELPS INCREASE ASSET VALUE WHICH IS USED</RelationshipStatement>
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