990-PF ReturnofPrivate Foundation...
Transcript of 990-PF ReturnofPrivate Foundation...
Form 990-PF Return of Private Foundationor Section 4947(a)(1) Nonexempt Charitable Trust
Department of the Treasury Treated as a Private FoundationInternal Revenue Service
Note : The foundation may be able to use a copyy of this return to satisfy state report
OMB No 1545-0052
2006For calendar year 2008 , or tax year beginning , and ending
G Check all that aoDM. E-1 Initial return n Final return n Amended return n Address chanoe n Name rhanna
Use the IRS Name of foundation A Employer identification number
label.Otherwise , ROY CHAMBERS FOUNDATION 55-6113902
print Number and street (or P 0 box number if mail is not delivered to street address) Room/swte B Telephone numberortype . 1358 NATIONAL ROAD 304.242.8410
See SpecificInstructions .
City or town, state, and ZIP code C if exemption application is pending , check here
WHEELING , WV 2 6 0 0 3 D 1. Foreign organizations, check here ►H Check type of organization: ® Section 501 (c)(3) exempt private foundation an
drzahons meeting the 85% test,
h2. Foreign o
h hc tt t t
0 Section 4947(a)(1) nonexempt charitable trust 0 Other taxable private foundation
ere compuc e k ane a ac a ion
I Fair market value of all assets at end of year J Accounting method: ® Cash LI AccrualE If private foundation status was terminated
under section 507(b)(1)(A), check here ►(from Part 11, col. (c), line 16) 0 Other (specify) F If the foundation is in a 60-month termination
$ 14 0 4 3 8 2 . (Part 1, column (d) must be on cash basis.) under section 507 ( b )( 1 B ), check herePart I Analysis of Revenue and Expenses
(The total of amounts in columns (b). (c), and (d) may not(a) Revenue andex enses er books
(b) Net investmentincome
(c) Adjusted net ( d) Disbursementsfor charitable purposes
necessarily equal the amounts in column (a)) p p income (cash basis only)
1 Contributions, gifts, grants, etc., received N/A2 Check►® it the foundation Is not required to attach Sch B
Interest on savings and temporary3 cash investments 19 . 19 . Statement 14 Dividends and interest from securities 16475. 16475. Statement 25a Gross rents
b Net rental income or (loss) -
6a Net gam or Qoss) from sale of assets not on Ime 10 2970.7c
Gross sales puce for allb assets on line ea 2979.
m 7 Capital gain net income (from Part IV, line 2) 2970. -IM
8 Net short-term capital gain
9 Income modifications L)Gross sales less returns
108 and allowances
b Less Cost of goods sold MAY U ti I-Uuf jn
c Gross profit or (loss) V - . -
11 Other income GGDr-12 Total . Add lines 1 through 11 19464. 19464.13 Compensation of officers , directors , trustees , etc 0. 0. 0.
14 Other employee salaries and wages
15 Pension plans, employee benefits
16a Legal fees
b Accounting fees $ tmt 3 850. 0. 0.X c Other professional fees Stmt 4 50000. 0. 0.9 17 Interest
18 Taxes Stmt 5 6062. 0. 0.2E 19 Depreciation and depletion
E 20 Occupancy
21 Travel, conferences, and meetings
t C 22 Printing and publications
c 23 Other expenses Stmt 6 10. 0. 0.0 24 Total operating and administrative
expenses . Add lines 13 through 23 56922. 0. 0.0 25 Contributions, gifts, grants paid 46614. 46614.
26 Total expenses and disbursements.
Add lines 24 and 25 103536. 0. 46614.27 Subtract line 26 from line 12:
a Excess of revenue over expenses and disbursements - 8 4 0 7 2 .
b Net investment income (if negative, enter -0-) 19464. 1c Adjusted net income (if negative , enter -0-) N /A
L
22
82350101-29-07
LHA For Privacy Act and Paperwork Reduction Act Notice , see the instructions. Form 990-PF (2006)
C\
Form 990-PF (20061 R[)V r"HnMRRR G FfT1NTI.TT(1AT RR-91 1 1 Q f12 Paae 2
schedules and amounts In the descriptionBalance Sheets 'u""'Beginning of year End of year
Part II column should be for end -o fiearamounts only (a) Book Value (b) Book Value (c Fair Market Value
1 Cash - non-interest-bearing
2 Savings and temporary cash investments -219. 19023. 19023.3 Accounts receivable ►
Less: allowance for doubtful accounts ►4 Pledges receivable ►
Less: allowance for doubtful accounts ►5 Grants receivable
6 Receivables due from officers, directors, trustees, and other
disqualified persons
7 Other notes and loans receivable ►
Less: allowance for doubtful accounts ►
8 Inventories for sale or use
M 9 Prepaid expenses and deferred charges
a 10a Investments - U.S. and state government obligations
b Investments - corporate stock $ tmt 7 260094. 156780. 360479.c Investments - corporate bonds $ tmt 8 100000. 100000. 9 6595.
11 Investments - land, buildings , and equipment basis ►
Less accumulated depreciation
12 Investments - mortgage loans
13 Investments - other $tmt 9 700000. 700000. 928285.14 Land, buildings, and equipment basis ►
Less accumulated deprecation ►
15 Other assets (describe ►
16 Total assets to be com p leted b all filers 1059875. 975803. 1404382.17 Accounts payable and accrued expenses
18 Grants payable
u) 19 Deferred revenue
20 Loans from officers , directors , trustees , and other disqualified persons
21 Mortgages and other notes payable
22 Other liabilities (describe ►
23 Total liabilities (add lines 17 throw h 22 ) 0. 0.
Foundations that follow SFAS 117, check here ►and complete lines 24 through 26 and lines 30 and 31.
24 Unrestricted
25 Temporarily restricted
m 26 Permanently restricted
Foundations that do not follow SFAS 117 , check here ►and complete lines 27 through 31.
27 Capital stock, trust principal, or current funds 521664 . 521664.j 28 Paid-1n or capital surplus, or land, bldg., and equipment fund 0. 0. -
a 29 Retained earnings, accumulated income, endowment, or other funds 538211. 454139aZ 30 Total net assets or fund balances 10 59 8 75. 975803.
31 Total liabilities and net assets/fund balances 1059875. 1 975803.
Part Ill Analysis of Changes in Net Assets or Fund Balances
1 Total net assets or fund balances at beginning of year - Part II, column (a), line 30
(must agree with end-of-year figure reported on prior year's return) 1 1059875 .
2 Enter amount from Part I, line 27a 2 - 8 4 0 7 2 .
3 Other increases not included in line 2 (itemize) ► 3 0 .
4 Add lines 1, 2, and 3 4 975803.
5 Decreases not included in line 2 (itemize) ► 5 0 .
6 Total net assets or fun d balan ces at end of year (line 4 minus line 5) - Part II, column (b), line 30 _ 6 9 7 5 8 0 3 .
823511Form 990-PF (2006)
01-29-07
Form 990-PF 2006 ROY CHAMBERS FOUNDATION 55-6113902 Page 3Part IV Capital Gains and Losses for Tax on Investment Income
(a) List and describe the kind(s) of property sold (e. g., real estate ,2-story brick warehouse; or common stock, 200 shs. MLC Co.)
(b How acquired- Purchase
D - Donation(c( Date acquired
mo., day, yr.)(d) Date sold(mo., day, yr.)
to CASH IN LIEU-IDEARC INC D 09 / 14 / 90 11 / 17 / 06b Capital Gains Dividendsc
d
e
(e) Gross sales price (f) Depreciation allowed(or allowable)
(p) Cost or other basisplus expense of sale
(h) Gain or (loss)(e) plus (f) minus (g)
a 9. 9. 0.b 2970. 2970.C
d
eComplete only for assets showing gain in column (h) and owned by the foundation on 12/31/69 (I) Gains (Col. (h) gain minus
(i) FF.M.V. as of 12/31/69(j) Adjusted basisas of 12/31/69
(k) Excess of col. (i)over col. (j), if any
c ol. (k),but not
less than -0-) orLosses (from col. (h))
a 0.b 2970.Cd
e
2 C Iflain, also
enter -0enter
-inin
PartPart
II, lineline
77 }Capital gain net income or (net capital loss).
If?loss) 2 2 9 7 0 .
3
, ,
Net short-term capital gain or (loss) as defined in sections 1222(5) and (6):If gain, also enter in Part I, line 8, column (c).If (loss), enter -0- in Part I, line 8 3 N /A
I Part v - 1 ouaIftcation under section 4940(e) for Reduced Tax on Net Investment Income
(For optional use by domestic private foundations subject to the section 4940(a) tax on net investment income.)
If section 4940(d)(2) applies, leave this part blank.
Was the foundation liable for the section 4942 tax on the distributable amount of any year in the base period? ® Yes 0 No
If 'Yes, the foundation does not qualify 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.
Base perod yearsCalendar year or tax year be g innin g in ) (b)qualifying distributions (c)Net value of nonchardable-use assets
Distribution ratio(col. (b) divided by col. (c))
2005
2004
2003
2002
2001
2 Total of line 1, column (d) 2
3 Average distribution ratio for the 5-year base period - divide the total on line 2 by 5, or by the number of years
the foundation has been in existence if less than 5 years 3
4 Enter the net value of noncharitable-use assets for 2006 from Part X, line 5 4
5 Multiply line 4 by line 3 5
6 Enter 1% of net investment income (1% of Part I, line 27b) 6
7 Add lines 5 and 6 7
8 Enter qualifying distributions from Part XII, line 4 8
If line 8 is equal to or greater than line 7, check the box in Part VI, line 1b, and complete that part using a 1% tax rate.See the Part VI instructions.
623521/01-29-07 Form 990-PF (2006)
Form 990-PF (2006) ROY CHAMBERS FOUNDATION 55-611Part VI Excise Tax Based on Investment Income (Section 4940(a). 4940(b). 4940(e). or 4948 - seeto Exempt operating foundations described in section 4940(d)(2), check here ►U and enter'WA' on line 1.
Date of ruling letter. ( attach copy of ruling letter if necessary -see instructions)
b Domestic foundations that meet the section 4940(e) requirements in Part V, check here ►0 and enter 1%
of Part I, line 27b
c All other domestic foundations enter 2% of line 27b. Exempt foreign organizations enter 4% of Part I, line 12, col. (b)2 Tax under section 511 (domestic section 4947(a)(1) trusts and taxable foundations only. Others enter -0-) 2
3 Add lines 1 and 2 3
4 Subtitle A (income) tax (domestic section 4947(a)(1) trusts and taxable foundations only. Others enter -0-) 4
5 Tax based on investment income . Subtract line 4 from line 3. If zero or less, enter -0- 5
6 Credits/Payments:
a 2006 estimated tax payments and 2005 overpayment credited to 2006 6a 826.b Exempt foreign organizations - tax withheld at source 6bc Tax paid with application for extension of time to file (Form 8868) 6c
d Backup withholding erroneously withheld 6d
7 Total credits and payments. Add lines 6a through 6d 7 826.8 Enter any penalty for underpayment of estimated tax Check here Elf Form 2220 is attached 8
9 Tax due. If the total of lines 5 and 8 is more than line 7, enter amount owed ► 910 Overpayment . If line 7 is more than the total of lines 5 and 8, enter the amount overpaid ► 10 437.11 Enter the amount of line 10 to be: Credited to 2007 estimated tax 110, 4 3 7 . Refunded lop. 11 0.Part VII-A Statements Regarding Activities
Is During the tax year, did the foundation attempt to influence any national, state, or local legislation or did it participate or intervene inany political campaign? is
b Did it spend more than $100 during the year (either directly or indirectly) for political purposes (see instructions for definition)? lbIf the answer is "Yes" to 1a or 1b, attach a detailed description of the activities and copies of any matenals published ordistributed by the foundation in connection with the activities.
c Did the foundation file Form 1120-POL for this year? 1c
d Enter the amount (if any) of tax on political expenditures (section 4955) imposed during the year.
(1) On the foundation. ► $ 0. (2) On foundation managers.► $ 0.
e Enter the reimbursement (if any) paid by the foundation during the year for political expenditure tax imposed on foundation
managers. ► $ 0.
2 Has the foundation engaged in any activities that have not previously been reported to the IRS? 2 XIf 'Yes,' attach a detailed description of the activities.
3 Has the foundation made any changes, not previously reported to the IRS, in its governing instrument, articles of incorporation, or
bylaws, or other similar instruments? If "Yes," attach a conformed copy of the changes 3 X4a Did the foundation have unrelated business gross income of $1,000 or more during the year? 4a Xb If 'Yes, has it 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 XIf "Yes," attach the statement required by General Instruction T.
6 Are the requirements of section 508(e) (relating to sections 4941 through 4945) satisfied either:
• By language in the governing instrument, or
• By state legislation that effectively amends the governing instrument so that no mandatory directions that conflict with the state law
remain in the governing instrument? 6 X
7 Did the foundation have at least $5,000 in assets at any time during the years 7 XIf "Yes," complete Part II, col. (c), and Part XV
8a Enter the states to which the foundation reports or with which it is registered (see instructions) ►WV
b If the answer is 'Yes' to line 7, has the foundation furnished a copy of Form 990-PF to the Attorney General (or designate)
of each state as required by General Instruction G? If "No,' attach explanation
Is the foundation claiming status as a private operating foundation within the meaning of section 4942(j)(3) or 4942(1)(5) for calendar
year 2006 or the taxable year beginning in 2006 (see instructions for Part XIV)? If "Yes, " complete Part XIV
Form 990-PF (2006)
62353101-29-07
Form 990-PF
Activities Continued
11a At any time during the year, did the foundation, directly or indirectly, own a controlled entity within the meaning of section 512(b)(13)?
If 'Yes, attach schedule. (see instructions)
b If 'Yes, did the foundation have a binding written contract in effect on August 17, 2006, covering the interest, rents, royalties, and
annuities described in the attachment for line 1 la? N/A
12 Did the foundation acquire a direct or indirect interest in any applicable insurance contract?
Page 5
13 Did the foundation comply with the public inspection requirements for its annual returns and exemption application? 13 I XWeb site address ► N/A
14 The books are in care of ► LINDA M BORDAS , TRUSTEE Telephone no. ► 3 0 4. 2 4 2. 8 410Located at ' 1358 NATIONAL ROAD , WHEELING , WV ZIP+4 '26003-5742
15 Section 4947( a)(1) nonexempt charitable trusts filing Form 990-PF in lieu of Form 1041 - Check here ►=
Part VII-B I Statements Regarding Activities for Which Form 4720 May Be RequiredFile Form 4720 if any item is checked in the "Yes" column , unless an exception applies. Yes No
1a During the year did the foundation (either directly or indirectly):
(1) Engage in the sale or exchange, or leasing of property with a disqualified person? L1 Yes ® No
(2) Borrow money from, lend money to, or otherwise extend credit to (or accept it from)
a disqualified person? =Yes ® No
(3) Furnish goods, services, or facilities to (or accept them from) a disqualified person? Yes No(4) Pay compensation to, or pay or reimburse the expenses of, a disqualified person? Yes ® No(5) Transfer any income or assets to a disqualified person (or make any of either available
for the benefit or use of a disqualified person)? Yes No(6) Agree to pay money or property to a government official? ( Exception. Check 'No'
if the foundation agreed to make a grant to or to employ the official for a period after
termination of government service, if terminating within 90 days.) Yes ® No
b If any answer is Yes' to la ( 1)-(6), did any of the acts fail to qualify under the exceptions described in Regulations
section 53.4941(d )-3 or in a current notice regarding disaster assistance ( see page 22 of the instructions)?
Organizations relying on a current notice regarding disaster assistance check here ►0c Did the foundation 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 2006?
Taxes on failure to distribute income (section 4942 ) ( does not apply for years the foundation was a private operating foundation
defined in section 4942(l)(3) or 4942 (l)(5)):
a At the end of tax year 2006 , did the foundation have any undistributed income ( lines 6d and 6e, Part XIII ) for tax year( s) beginningbefore 2006? ® Yes No
If 'Yes,* list the years ► 2005 ,
b Are there any years listed in 2a for which the foundation is not applying the provisions of section 4942(a)(2) (relating to incorrect
valuation of assets ) to the year's undistributed income? ( If applying section 4942(a)(2) to all years listed, answer ' No'and attach
statement - see instructions.)
c If the provisions of section 4942 ( a)(2) are being applied to any of the years listed in 2a, list the years here.
3a Did the foundation hold more than a 2% direct or indirect interest in any business enterprise at any timeduring the year? LI Yes ® No
b It 'Yes,' did it have excess business holdings in 2006 as a result of (1) any purchase by the foundation or disqualified persons after
May 26, 1969 ; ( 2) the lapse of the 5-year period ( or longer period approved by the Commissioner under section 4943 (c)(7)) to dispose
of holdings acquired by gift or bequest; or (3) the lapse of the 10 -, 15-, or 20 -year first phase holding period? (Use Schedule C,
Form 4720, to determine if the foundation had excess business holdings in 2006) N/A
4a Did the foundation invest during the year any amount in a manner that would jeopardize its charitable purposes?
b Did the foundation make any investment in a prior year (but after December 31, 1969 ) that could jeopardize its charitable purpose that
had not been removed from ieopardv before the first day of the tax year beaimmno in 20069
Form 990-PF (2006)
62354101-29-07
ulreI Continued
5a During the year did the foundation pay or incur any amount to:
(1) Carry on propaganda, or otherwise attempt to influence legislation ( section 4945(e))? 0 Yes ® No
(2) Influence the outcome of any specific public election (see section 4955); or to carry on, directly or indirectly,
any voter registration drive? 0 Yes ® No
(3) Provide a grant to an individual for travel, study, or other similar purposes? 0 Yes ® No
(4) Provide a grant to an organization other than a charitable, etc., organization described in section
509(a)(1), (2), or ( 3), or section 4940(d)(2)? 0 Yes ® No
(5) Provide for any purpose other than religious, charitable, scientific, literary, or educational purposes, or for
the prevention of cruelty to children or animals? 0 Yes ® No
b If any answer is 'Yes' to 5a(1)-(5), did any of the transactions fail to qualify under the exceptions described in Regulationssection 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 0c If the answer is'Yes' to question 5a(4), does the foundation claim exemption from the tax because it maintained
expenditure responsibility for the grant? N/A L1 Yes [l No
If 'Yes,' attach the statement required by Regulations section 53 . 4945-5(d).
6a Did the foundation , during the year , receive any funds , directly or indirectly , to pay premiums on
a personal benefit contract? 0 Yes ® No
b Did the foundation , during the year, pay premiums, directly or indirectly , on a personal benefit contract?
If you answered " Yes" to 6b, also file Form 8870.
7a At any time during the tax year, was the foundation a party to a prohibited tax shelter transaction ? O Yes ® No
pwr wu Information About Officers , Directors, Trustees, Foundation Managers , HighlyPaid Employees , and Contractors
I List all officers , directors , trustees , foundation managers and their compensation.
(a) Name and address(b) Title, and average
hours per week devotedto p osition
(c) Compensation(If not paid,enter -0-
(md' Contdbutionsto
° anddefeedPianscompensation
(e) Ex enseaccount otherallowances
LINDA M BORDAS TRUSTEE1358 NATIONAL ROADWHEELING WV 26003 0.00 0. 0. 0.JAMES G BORDAS TRUSTEE1358 NATIONAL ROADWHEELING WV 26003 0.00 0. 0. 0.
2 Compensation of five highest-paid employees (other than those included on line 1). If none, enter "NONE.°
(a) Name and address of each employee paid more than $50,000(b) Title and average
hours per weekdevoted to p osition
(c) Compensationd) Contnbubons to
e D anddeferrned^^nscompensation
(e) Expenseaccount, otherallowances
None
Total number of other employees paid over $50,000 1 0Form 990-PF (2006)
82355101-29-07
Form 990-PF (2006) ROY CHAMBERS FOUNDATION 55-6113902 Page 7
Part VIII Information About Officers , Directors , Trustees , Foundation Managers, HighlyPaid Employees, and Contractors continued
3 Five highest-paid independent contractors for professional services . If none, enter °NONE.°
(a) Name and address of each person paid more than $50,000 (b) Type of service (c) Compensation
None
Total number of others receivin g over $50,000 for p rofessional services ► 0
Part IX-A I 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 I Expensesnumber of organizations and other beneficiaries served, conferences convened, research papers produced, etc.
Part IX-B I Summary of Program-Related InvestmentsDescribe the two largest program-related investments made by the foundation during the tax year on lines 1 and 2. Amount
1N A
2
All other program-related investments. See instructions.
3
Total. Add lines 1 through 3 ► 0.
Form 990-PF (2006)
62358101-29-07
Form 990-PF (2006) ROY CHAMBERS FOUNDATION 55-6113902 Page 8
Part X Minimum Investment Return (All domestic foundations must complete this part. Foreign foundations, see instructions.)
1 Fair market value of assets not used (or held for use) directly in carrying out charitable, etc., purposes:
a Average monthly fair market value of securities
b Average of monthly cash balances
c Fair market value of all other assets
d Total (add lines la, b, and c)
e Reduction claimed for blockage or other factors reported on lines la and
1c (attach detailed explanation)
2 Acquisition indebtedness applicable to line 1 assets
3 Subtract line 2 from line 1d
4 Cash deemed held for charitable activities. Enter 1112% of line 3 (for greater amount, see instructions)
5 Net value of noncharitable - use assets . Subtract line 4 from line 3. Enter here and on Part V, line 4
6 Minimum investment return . Enter 5% of line 51.
Part X1Distributable Amount (see instructions) (Section 4942(j)(3) and (i)(5) private operating foundations and certainforeign organizations check here ► and do not complete this part.)
2
1 Minimum investment return from Part X, line 6 1 67355.2a Tax on investment income for 2006 from Part VI, line 5 2a 389.
b Income tax for 2006. (This does not include the tax from Part VI.) 2b
c Add lines 2a and 2b 2c 389 .3 Distributable amount before adjustments. Subtract line 2c from line 1 3 6 6 9 6 6 .4 Recoveries of amounts treated as qualifying distributions 4 0 .
5 Add lines 3 and 4 5 66966.6 Deduction from distributable amount (see instructions) 6 0 .7 Distributable amount as adjusted. Subtract line 6 from line 5. Enter here and on Part XIII, line 1 7 6 6 9 6 6 .
Part XII , Qualifying Distributions (see instructions)
Amounts paid (including administrative expenses) to accomplish charitable, etc., purposes:
Expenses, contributions, gifts, etc. - total from Part I, column (d), line 26
Program-related investments - total from Part IX-B
2 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 la through 3b. Enter here and on Part V, line 8, and Part XIII, line 4 4 46614.
5 Foundations that qualify under section 4940(e) for the reduced rate of tax on net investment
income. Enter 1% of Part I, line 27b 5 0.
6 Adjusted qualifying distributions . Subtract line 5 from line 4 6 46614.
Note: The amount on line 6 will be used in Part V, column (b), in subsequent years when calculating whether the foundation qualifies for the section
4940(e) reduction of tax in those years.
Form 990-PF (2006)
82367101-29-07
Form 990-PF (2006) ROY CHAMBERS FOUNDATION 55-6113902 Page 9
Part XIII Undistributed Income (see instructions)
(a) (b) (c) (d)Corpus Years prior to 2005 2005 2006
1 Distributable amount for 2006 from Part XI,
line? 66966.2 Undistributed income , if any , as of the and of 2005 . - -- y-. - -
a Enter amount for 2005 only 64424.b Total for prior years:
2004 , 40416.3 Excess distributions carryover, if any, to 2006:
a From 2001
b From 2002
c From 2003
d From 2004
e From 2005
f Total of lines 3a throu gh e 0.
4 Qualifying distributions for 2006 fromPart X I line 4: ► $ 46614.
a Applied to 2005, but not more than line 2a 46614.b Applied to undistributed income of prioryears (Election required - see instructions) 0.
c Treated as distributions out of corpus
(Election required - see instructions) 0.
d Applied to 2006 distributable amount - 0e Remaining amount distributed out of corpus 0.
5 Excess distributions carryover applied to 2008 0 0Of an amount appears in column (d), the same amount -must be shown in column (a).)
6 Enter the net total of each column as .indicated below:
a Corpus Add lines 3f , 4c, and 4e Subtract line 5 0.
b Prior years' undistributed income. Subtract
line 4b from line 2b 40416.c Enter the amount of prior years'undistributed income for which a notice of -deficiency has been issued, or on whichthe section 4942(a) tax has been previouslyassessed 40416.
d Subtract line 6c from line 6b. Taxableamount - see instructions 0
e Undistributed income for 2005. Subtract line4a from line 2a. Taxable amount - see instr. 17810.
f Undistributed income for 2006. Subtractlines 4d and 5 from line 1. This amount must
be distributed in 2007 66966.7 Amounts treated as distributions out of
corpus to satisfy requirements imposed by
section 170(b)(1)(E) or 4942(g)(3) 0.8 Excess distributions carryover from 2001
not applied on line 5 or line 7 0 .
9 Excess distributions carryover to 2007.Subtract lines 7 and 8 from line 6a 0
10 Analysis of line 9:
a Excess from 2002
b Excess from 2003
c Excess from 2004
d Excess from 2005
e Excess from 2006
Form 990-PF (2006)82358101-20-07
Form 990-PF 10Part XIV I Private Operating Foundations (see instructions and Part VII-A. question 9) N/A1 a If the foundation has received a ruling or determination letter that it is a private operating
foundation, and the ruling is effective for 2006, enter the date of the ruling 101.b Check box to indicate whether the foundation is a private operating foundation described in section
2 a Enter the lesser of the adjusted net Tax year
income from Part I or the minimum ( a) 2006
investment return from Part X for
each year listed
b 85% of line 2a
c Qualifying distributions from Part XII,
line 4 for each year listed
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 2cComplete 3a, b, or c for thealternative test relied upon:
a 'Assets' alternative test - enter(1) Value of all assets
(2) Value of assets qualifyingunder section 4942(I)(3)(B)(i)
b 'Endowment alternative test - enter2/3 of minimum investment returnshown in Part X, line 6 for each yearlisted
c 'Support' alternative test - enter:
(1) Total support other than grossinvestment income (interest,dividends, rents, payments onsecurities loans (section512(a)(5)), or royalties)
(2) Support from general publicand 5 or more exemptorganizations as provided insection 4942(j)(3)(B)(iii)
(3) Largest amount of support from
an exempt organization
Prior 3 yeas(b)2005 (c)2004
3 ) or 0 4942 (j)( 5 )
(d) 2003 ( e) Total
Part XV Supplementary Information (Complete this part only if the foundation had $5,000 or more in assetsat any time during the year-see page 28 of the instructions.)
I 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 taxyear (but only if they have contributed more than $5,000). (See section 507(d)(2).)
None
b List any managers of the foundation who own 10% or more of the stock of a corporation (or an equally large portion of the ownership of a partnership orother entity) of which the foundation has a 10% or greater interest
2 Information Regarding Contribution , Grant, Gift, Loan , Scholarship , etc., Programs:
Check here ►0 if the foundation only makes contributions to preselected charitable organizations and does not accept unsolicited requests for funds. If
the foundation 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:
See Statement 10b The form in which applications should be submitted and information and materials they should include:
c Any submission deadlines:
d Any restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other factors:
823601/01-29-07 Form 990-PF (2006)
Form 990-PF
3 Grants and Contributions Paid During the Year or Approved for Future Payment
Recipient If recipient is an individual,show any relationship to Foundation Purpose of grant or
f d t status of contribution AmountName and address (home or business) ion managerany oun a
or substantial contributor recipient
a Paid dung the year
EE ATTACHEDSEE ATTACHED STATEMENT ONE ONE STATEMENT 46614.
Total ► 3a 46614.b Approved for future payment
None
Total ► 3b I U.
823811/01-29-07 Form 990-PF (2006)
Form 990-PF (2006) ROY CHAMBERS FOUNDATION 55-6113902 Pane 12
Part XVI-A Analysis of Income-Producing Activities
Enter gross amounts unless otherwise indicated. Unrelated business income FxGuded by section 512 , 513 , «514 (e)
(a) (b) Ei „_ (d) Related or exempt
1 Program service revenue: BcodersAmount s Amount function income
a
b
Cd
ef
g Fees and contracts from government agencies
2 Membership dues and assessments
3 Interest on savings and temporary cash
investments 14 19.4 Dividends and interest from securities 14 16475.5 Net rental income or (loss) from real estate:
a Debt-financed property
b Not debt-financed property
6 Net rental income or (loss) from personal
property
7 Other investment income
8 Gain or (loss) from sales of assets otherthan inventory 14 2 9 7 0 .
9 Net income or (loss) from special events
10 Gross profit or (loss) from sales of inventory
11 Other revenue:
a
b
Cd
e
12 Subtotal. Add columns (b), (d), and (e) 0. 1 19464. 0.13 Total. Add line 12, columns (b), (d), and (e) 13 19464.(See worksheet in line 13 instructions to verify calculations.)
Part XVI-B Relationship of Activities to the Accomplishment of Exempt Purposes
Line No .y
Explain below how each activity for which income is reported in column (e) of Part XVI-A contributed importantly to the accomplishment ofthe foundation's exempt purposes (other than by providing funds for such purposes).
Form 990-PF (2006)
Form 990-PF (2006) ROY CHAMBERS FOUNDATION 55-6113902 Page 13Part XVII Information Regarding Transfers To and Transactions and Relationships With Noncharitable
Did the organization directly or indirectly engage in any of the following with any other organization described in section 501(c) of Yes No
the Code (other than section 501(c)(3) organizations) or in section 527, relating to political organizations?
Transfers from the reporting foundation to a noncharltable exempt organization of
(1) Cash
_
la" ) X
(2) Other assets 1a(2 ) X
Other transactions:
(1) Sales of assets to a noncharitable exempt organization lb ( l ) X
(2) Purchases of assets from a noncharitable exempt organization U12) X
(3) Rental of facilities, equipment, or other assets lb ( 3 ) X
(4) Reimbursement arrangements 1b 4 X
(5) Loans or loan guarantees 1b 5 X
(6) Performance of services or membership or fundraising solicitations lb 6 X
Sharing of facilities, equipment, mailing lists, other assets, or paid employees 1c X
If the answer to any of the above is 'Yes, complete the following schedule. Column (b) should always show the fair market value of the goods, other assets,
or services given by the reporting foundation. If the foundation received less than fair market value in any transaction or sharing arrangement, show in
(a) Name of organization (b) Type of organization (c) Description of relationship
N/A
Under penalties of perjury, I declare that I have examined this return , including accompanying schedules and statements, and to the best of my knowledge and belief , it is true, correct.
and complet Declaration of preparer ( t er than taxpayer or fiduciary) is based on all inform
1,1111.4
SI ature of officer or t tee
Preparer's.9 -2a signature 4154a I rrm'sname ( oryours ABRAHAIC & COMPANY CPA
n sen-mployed ) , ' 4 0 0 MORTON AVENUEaddress , and ZIP code MOUNDSVILLE WV 26041
62362201-29-07
2a Is the foundation 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? 0 Yes 0 No
b If 'Yes .' comp lete the followin schedule.
ROY CHAMBERS FOUNDATION 55-6113902
Form 990-PF Interest on Savings and Temporary Cash Investments Statement 1
Source
WESBANCO
Total to Form 990-PF, Part I, line 3, Column A
19.
19.
Form 990-PF Dividends and Interest from Securities Statement 2
Source Gross Amount
WACHOVIA SECURITIES 19445.
Total to Fm 990 -PF, Part I, In 4 19445.
Capital Gains Column (A)Dividends Amount
2970. 16475.
2970. 16475.
Form 990-PF Accounting Fees Statement 3
Description
ABRAHAM & COMPANY
(a)ExpensesPer Books
850.
To Form 990-PF, Pg 1, In 16b 850.
Amount
(b) (c) (d)Net Invest- Adjusted Charitablement Income Net Income Purposes
0. 0.
0. 0.
Form 990-PF Other Professional Fees Statement 4
Description
BORDAS & BORDAS PLLC -
(a)ExpensesPer Books
(b)Net Invest-ment Income
(c)Adjusted
Net Income
(d)CharitablePurposes
ADMINISTATION EXPENSE 50000. 0. 0.
To Form 990-PF, Pg 1, In 16c 50000. 0. 0.
Statement(s) 1, 2, 3, 4
ROY CHAMBERS FOUNDATION 55-6113902
Form 990- PF Taxes Statement 5
Description
TAX ON INVESTMENT INCOMETAX ON UNDISTRUBUTEDINCOME
To Form 990-PF, Pg 1, In 18
(c)Adjusted
Net Income
(d)CharitablePurposes
0.
0.
0.
(a)ExpensesPer Books
0.
6062. 0.
6062. 0.
(b)Net Invest-ment Income
0.
Form 990-PF Other Expenses Statement 6
Description
WACHOVIA SECURITIES -
(a)ExpensesPer Books
(b) (c) (d)Net Invest- Adjusted Charitablement Income Net Income Purposes
0. 0.
0. 0.
SERVICE FEES 10.
To Form 990 - PF, Pg 1, In 23 10.
Form 990-PF Corporate Stock Statement 7
DescriptionFair Market
Book Value Value
3578.4 SHS AFFILIATED FUND 38830. 54678.330 SHS AMERICAN ELETRIC POWER 8724. 14051.2000 SHS WYETH CORP 23719. 101840.832 SHS EXXON CORPORATION 10621 . 63756.347 SHS VERIZON COMMUNICATIONS 7396. 12922.800 SHS KIMBERLY CLARK 15162. 54360.
6 SHS WHX CORPORATION 185. 0.
400 SHS VERIZON CORPORATION 9167. 14896.
354 SHS QUEST COMMUNICATIONS INT'L 7579. 2963.33017.92 SHS EVERGREEN MONEY MARKET FUND 34752. 34752.
24 SHS NEENAH PAPER INC 0. 848.
68 SHS SCHWEITZER-MAUDUIT INT 0. 1771.
61 SHS COMCAST CORP 0. 2582.37 SHS IDEARC INC 645. 1060.
Total to Form 990 - PF, Part II, line 10b 156780 . 360479.
Statement(s) 5, 6, 7
ROY CHAMBERS FOUNDATION 55-6113902
Form 990-PF Corporate Bonds Statement 8
Fair MarketDescription Book Value Value
100000 GMAC SMART NOTES,4.75% DUE 10/15/08
Total to Form 990-PF, Part II, line 10c
100000. 96595.
100000. 96595.
Form 990-PF Other Investments Statement 9
Description
PACIFIC INNOVATIONS SELECT ANNUITY
Total to Form 990-PF, Part II, line 13
Fair MarketBook Value Value
700000. 928285.
700000. 928285.
Statement(s) 8, 9
.ROY CHAMBERS FOUNDATION 55-6113902
Form 990-PF Grant Application Submission Information Statement 10Part XV, Lines 2a through 2d
Name and Address of Person to Whom Applications Should be Submitted
LINDA M BORDAS,TRUSTEE, 1358 NATIONAL ROAD,WHEELING WV 26003-5742
Telephone Number
Form and Content of Applications
SEE ATTACHED
Any Submission Deadlines
APPLICATIONS ARE ACCEPTED AT ANY TIME
Restrictions and Limitations on Awards
THE PURPOSE OF THIS TRUST IS TO DEVOTE THE PROPERTY AND INCOME DERIVED
THEREFROM EXCLUSIVELY FOR CHARITABLE AND EDUCATIONAL PURPOSES FOR THE
BENEFIT OF THE FINANCIALLY DEPRIVED CHILDREN OF OHIO COUNTY WEST VIRGINIA.
Statement(s) 10
ROY CHAMBERS FOUNDATION2006 Recipients
Ohio County DHHRPO Box 6165Wheeling, WV 26003
1 Shaniqua Davis $92.88
Marie Amos125 Knorr LaneWheeling, WV 26003
2 Jay Amos $94613 Robbie Amos $97.68
Rebecca Armstrong104 Graham CourtWheeling , WV 26003
4 Nate Armstrong $96 36
Thomas Armstrong157 Idabell AveneueWheeling, WV 26003
5 Tommy Armstrong $96 366 Sean Armstrong $96.36
Shaya A. Augenstein1092 Hil-DarWheeling, WV 26003
7 Kristopher Augenstein $98.258 Annalise Augenstein $97.739 Damian Augenstein $98.96
10 Gage Augenstein $95.79
Darlena BalerRR 2 Box 312AChapel Hill RoadTriadelphia , WV 26059
11 Maggie Dillie $99.8112 Cody Baier $100.00
Rachel BaierRR 2 Box 312BChapel Hill RoadTriadelphia, WV 26059
13 Emily Baier $98 36
14 Mark Baier III $98.85
Page 1 of 16
Mickey & Karen BallardRR1 Box 133Valley Grove, WV 26060
15 Allison Ballard
Cortni Beasley90 New Jersey StreetWheeling , WV 26003
16 Christopher Stadler
17 Camren Beasley
Beth Beran258 Kruger Street Apt. 1Wheeling , WV 26003
18 Dylan Beran
Mary Biery5 Bae Mar PlaceWheeling , WV 26003
19 LaKeisha Jackson
Lisa Biggs421 N. WabashWheeling , WV 26003
20 Alleyah Hill
21 Jyair Biggs-McGhee
22 Anashia Hill
Kimberly Bird166 Station LaneWheeling , WV 26003
23 Alec Smith
Eliza Bowman112 N . 17th StreetWheeling , WV 26003
24 Wyatt Leppert
25 Max Leppert III
26 Alex Bowman
27 Skye Leppert
28 Eric Bowman
Eugene & Debra Brown40 Lounez AvenueWheeling, WV 26003
29 Nicholas Brown
$100.00
$100.00
$96.54
$96.36
$100.00
$98.47
$98.37
$96.06
$96.36
$100.00
$99.11
$99.30
$99.98
$98.46
$100.00
Page 2 of 16
Kyle Brown128 Grant AvenueWheeling, WV 26003
30 Austin Brown $99.43
Sharon Burkhalter2127 Marshall AvenueWheeling , WV 26003
31 Josh Dent $96.36
Brandie Burton445 Broadway StreetWheeling , WV 26003
32 DeVauna Burton $100.00
33 DeJauna Burton $100.00
Steven William CaldwellRD #1 Box 7Dallas, WV 26036
34 Tyler Caldwell $56.55
Janice Carenbauer2532 Lincoln AvenueWheeling , WV 26003
35 Janelle Carenbauer $98.91
36 Jaclyn Carenbauer $100.00
Carrie Chapman412 Sligar AvenueWheeling , WV 26003
37 Dana Becket $100.00
38 Chappy Chapman $100.00
39 Rebecca Chapman $100.00
Amanda Cole15 N. Penn StreetWheeling , WV 26003
40 Donevan Cole $10000
Carolyn Cooper20 Ohio StreetWheeling , WV 26003
41 Tre' Cooper $94 45
42 Kaneashia Cooper $94.41
Page 3 of 16
Kathleen CrockardRD I Box 107AValley Grove, WV 26060
43 Shailen Barnhart $110.00
44 Kylie Crockard $110.00
Bonnie Culp45 Virginia Park RoadWheeling , WV 26003
45 Ray Asbury $9636
Bobbi Danhart120 Peters Run RoadWheeling , WV 26003
46 Sean Danhart $96.36
Diana Darnley4354 Wood StreetWheeling , WV 26003
47 Davon Goudy $100.00
48 Destyne' Murry $99.04
Evelyn DeGennaroRR I Box 286Triadelphia , WV 26059
49 Emily DeGennaro $100.00
50 Jenna DeGennaro $100.00
51 Ryan Stewart $99.83
52 Jason Stewart $100.00
Sharon GillRR #2 Box 13BTriadelphia , WV 26059
53 Tequila Gill $99.28
Jamie GomezRR 2 Box 45 Apartment 2DTriadelphia, WV 26059
54 Trenton Heath $100.00
Carlotta Gooch118 Station LaneWheeling, WV 26003
55 Joshua Gooch $10000
Page 4 of 16
Timiska Grandstaff1090 Hildar StreetWheeling , WV 26003
56 Samadki Grandstaff $98.91
Zackary Griffith114 Baltimore StreetWheeling, WV 26003
57 Justice Brown $100.00
Edward GrouxRD #2 Box 36Valley Grove, WV 26060
58 Suzanne Groux $100.0059 Edward Groux III $96.36
Helen HallBox 31 Atkinson CrossingValley Grove, WV 26060
60 Kiya Kurri $98.2361 Alex Little $97 8962 Damieean Whiddon $98.6963 Samantha Brewer $100.0064 Kadie Whiddon $98.9665 Savon Morrison $99.25
Patty Hall17 Mt Wood RoadWheeling, WV 26003
66 Amanda Hall $98.7367 Joanna Hall $98.3568 Diane Hall $98.0569 Cheyanne Hall $95.2970 Sabrina Hall $98.21
Andrea Hartong12 Ark AvenueWheeling, WV 26003
71 Dakota Cintron $100.0072 Timothy Hartong $99.8173 Montana Hartong $100.0074 Sierra McNeil $100 00
Page 5 of 16
Michelle HeathPO Box 4Valley Grove, WV 26060
75 Ashton Heath $100.00
76 Devin Danehart $98.57
Amy Henderson520 South York StreetWheeling, WV 26003
77 Aiden Henderson $100.00
78 Nathaniel Henderson $100.00
79 Alexis Henderson $100.00
Erica Hicks517 Warwood AvenueWheeling, WV 26003
80 Jeremy Hicks $99.39
81 Allison Hall $100.00
82 Lexie Hall $100 00
Betty Jenkins405 Kenny StreetWheeling , WV 26003
83 Na-Kwaun Phillips $100.00
84 Na-Kwasia Phillips $100.00
Molly Kammer9 Maple LaneWheeling , WV 26003
85 Ciera Kammer $96.36
86 Cheyanne Kammer $96.36
Crystal KeirsRR 2 Box 55BTriadelphia , WV 26059
87 Garrett Keirs $100.00
88 Justin Keirs $100.00
Kathie King130 1 12 Grant AvenueWheeling , WV 26003
89 Jasmyn King $100 00
William KnightPO Box 244Dallas , WV 26036
90 Jonathon Knight $96.36
Page 6 of 16
Rosemarie Lally138 Serig DriveWheeling , WV 26003
91 Danyelle Williams $99.64
92 Loren Lally $100.00
93 Mary Lally $99.67
Alberta Lee23 Hawk CourtWheeling , WV 26003
94 Megan Palmer $100.00
Jennifer LeshukRD 2 Box 88Valley Grove, WV 26060
95 Blake Bailer $94.22
April Littleton1068 Hil-Dar StreetWheeling , WV 26003
96 Brittany Littleton $96.3897 Kayla Littleton $96.36
Stephanie Lyn LoewRD 2 Box 249 A-1Valley Grove , WV 26060
98 Amber Loew $100.00
99 Audrey Loew $100.00100 Andrea Loew $116.41101 Austin Loew $11067
Michell LuckettPO Box 474Triadelphia , WV 26059
102 Ashley Hoskins $96.36
Mellicha Mayfield111 1/2 Ohio StreetWheeling , WV 26003
103 Darjaiia Mayfield $100.00
Sharon McCarthy4043 Jacob StreetWheeling , WV 26003
104 Addison McCarthy $96.82
105 Casey McCarthy $10054
Page 7 of 16
Isaac McCombsRR#2Box157ATriadelphia, WV 26059
106 Doug Bonnell $100.00
Kara MeadorRD #1 Box 240Wheeling , WV 26003
107 Olivia Caldwell $98.08108 Karla Caldwell $96.35
Becky MencerRD I Box 208Triadelphia , WV 26059
109 Greg Mencer $96.36
Pam MilikenRt. #1 Box 143Valley Grove, WV 26060
110 Raelynn Milliken $100.00
Carl MillerRD 2 Box 267DValley Grove , WV 26060
111 Jomana Miller $96.36
Dawn Miller92 Lane 15Wheeling, WV 26003
112 Isaiah Selmon-Miller $98.61
113 Maurice Miller $100.00114 Davon Miller $98.18115 Bruce Selmon $100.00
Martha MillerRD 2 Box 267AValley Grove , WV 26059
116 Chris Shaler $96.36
117 Maxine Shaler $96 36
Paula Morris217 S. BroadwayWheeling, WV 26003
118 Matt Morris $200.00
119 Tim Morris $200.00
Page 8 of 16
Bessie Nash96 11215th StreetWheeling, WV 26003
120 Shelly Lynn Nash $98.90121 Santana Nash $98.02122 Cody Alan Nash $98.92
Jamie Neer13919th StreetWheeling, WV 26003
123 Mercedes Shirley $97.54
Jamie Neff40 Monroe AvenueWheeling , WV 26003
124 Jessica Sheets $96.36
Ericka Nickerson3413 Chapline StreetWheeling, WV 26003
125 Hayden Meeker $97.46
Helena O'BrienRD 1 Box 374Triadelphia, WV 26059
126 Eryk O'Brien $104.33
Richard Passarello844 Cherry Hill RoadWheeling, WV 26003
127 Makenna Passarello $100.00128 Seth Miridokis $100.00129 Victor Miridokis $99.78130 Jake Passarello $100.00131 Olivia Miridokis $100.00132 Josh Passarello $100.00
Crystal Peterman16th StreetWheeling, WV 26003
133 Carmensita Peterman $99.33
Page 9 of 16
Freda Plummer15 Baker StreetWheeling , WV 26003
134 Daniel Nightingale $100.00
135 Moesha Nightingale $98.08
136 Lance Plummer $100.00
Nicole Ponko146 East Bethlehem BoulevardWheeling , WV 26003
137 Zach Foster $98.49
Liz Porter128 Grant AvenueWheeling , WV 26003
138 Bailey Porter $95.30
Renee PostelwaitRD I Box 23 Lot 21Wheeling, WV 26003
139 Brandon Postelwait $100.00
140 Jennifer Postelwait $99 54
141 Kyle Posteiwait $100 00
142 Kelly Postelwait $100.00
143 Emily Postelwait $100.00
Heather Prager60 Indiana StreetWheeling , WV 26003
144 Heidi Prager $100 00
145 Dominic Prager $100.00
146 Christopher Dennison $100.00
Connie Prayear150 14th StreetWheeling, WV 26003
147 Lagara Prayear $10000
Starlet Prayear150 14th StreetWheeling , WV 26003
148 Ja'Lynn Prayear $100.00
149 Stormie Prayear $99.76
Page 10 of 16
Carol Rector2230 Eoff StreetWheeling , WV 26003
150 Shane Rector
Johnnie Reynolds1100 Chapline StreetWheeling , WV 26003
151 James Reynolds
152 Sarah Reynolds
Teresa Riggs105 Ohio StreetWheeling , WV 26003
153 Lindsey Mann
Cheryl Ripley375 West StreetWheeling, WV 26003
154 Erik Ripley
155 April Ripley
156 Jeremiah Ripley
Pandora Rodgers12 Maple LaneWheeling , WV 26003
157 Casey Rodgers
158 Katnna Rodgers
159 Brandon Rodgers
Lisa Rutan2387 Lumber AvenueWheeling , WV 26003
160 Corbin Rutan
Cathy Safreed492 1/2 Fairmont AvenueWheeling , WV 26003
161 Melissa Safreed
162 Earl Safreed
Becky ScarberryRD 2 Box 463DWheeling , WV 26003
163 Amanda Scarberry
$100.00
$99.03$98.21
$100.00
$103.70
$106.30
$101.29
$100.00
$99.78
$99.24
$99.41
$99 81
$100.00
$96.36
Page 11 of 16
Stephanie N. SeymourRD #3 Box 105112Wheeling , WV 26003
164 Kaylee Church $96.41
Wendy Shaw1010 Hil DarWheeling , WV 26003
165 Austin Shaw $99.70
Erin Shelek-Bachman2 Brookside DriveWheeling , WV 26003
166 Camdyn Bachman $99.76
Linda Showalter107 15th StreetWheeling , WV 26003
167 Shanice Showalter $100.00
Lorrie Snyder917 Main Street Apartment 12Wheeling , WV 26003
168 Jobey Snyder $10000
St. John's Home141 Key AvenueWheeling , WV 26003
169 David $99.90
170 Mike $98.03
171 Decoda $98.58
172 VaShean $8833
173 Austin $98.25
174 Chase $98.92
175 John Paul $98.03
176 Marc $10000
Candace Starcher415 Kenney StreetWheeling , WV 26003
177 Ayrik Starcher $100.00
Page 12 of 16
Debbie Steele' 60 Indiana Street
Wheeling , WV 26003
178 Kameron Prager
179 Brittany Prager
Nichole Sterling127 N . 17th StreetWheeling , WV 26003
180 Serenity Ward
181 Jacob Sterling
Jennifer Timko129 South Huron StreetWheeling , WV 26003
182 Ehtan Timko
183 Nicholas Timko
184 Elizabeth Timko185 Nya Timko
Susie Tolliver Hall133 Station LaneWheeling, WV 26003
186 Jonesha Tolliver
187 MacKenzie Tolliver
Ann Marie Vaughan1100 Chapline StreetWheeling, WV 26003
188 Chelsea Vaughan
189 Joel Vaughan
Laurey A. Vetanze121 North 19th StreetWheeling , WV 26003
190 Alyssa Vetanze
191 MichaVetanze
192 Laura' Lee Vetanze
Susan Watts2629 Eoff StreetWheeling , WV 26003
193 Antonio Miller
$100.00
$100.00
$100.00
$98.90
$101.83
$109.12
$91.12
$98.50
$99.50
$99.37
$100.00
$100.00
$100.00
$97.08
$98.43
$96.36
Page 13 of 16
Stephanie & Albert Wheeler30 Lava AvenueWheeling , WV 26003
194 Dominique Estep $99.81195 Jonah Nathaniel Estep $98.64196 Maiya Wheeler $96.23197 Orion Patrick Wheeler $96.74
Mellissa Wildem403 Kruger StreetWheeling, WV 26003
198 Carlie E.R. Terrell $99.94
199 Edgar Dunn $100.00
Ted & Sonja Williams1009 Vine StreetWheeling , WV 26003
200 Carolyn Williams $95.87
201 Tyler Williams $98.94
Hubert & Tina Woods441 Jones StreetWheeling , WV 26003
202 Adaline Woods $96.36
Jacquelynn Woods87 Virginia StreetWheeling , WV 26003
203 Mariah Aldridge $99.28
204 Christian Aldridge $99.84
205 Steven Aldridge $99.30
206 Jordan Aldridge $99.94
YMCA of Wheeling
Mike Panes
55 Lounez AvenueWheeling , WV 26003
206 Keiser M3 Indoor Cycle
8 Cycles, Freight & Training $9,000.00
St John Children's HomeKey AvenueWheeling , WV 26003
207 Television and Stand for children $630 00
$768.00
Page 14 of 16
• Wendy's RestaurantElm Grove CrossingWheeling , WV 26003
208 Lunch for Children on Bridge Street Trip $230.24
Betty Jenkins
209 Pizza Party for North Wheeling Children $100.00
Youth Services System, Inc.1000 Chapline Street
Wheeling , WV 26003
210 $2,760.00
Jeanne Dedo
211 Reimbursement for Candy for Children $565.75
Easter Seals Rehabilitation Center
1305 National Road
Wheeling , WV 26003
212 $11,200.13
Connie Woods
President Councel HiI-Dar
1069 Hil-Dar Street
Wheeling, WV 26003
213 Book bags $300.00
Alberta Lee
43 Hawk Court
Wheeling , WV 26003
214 Megan Palmer $105.48
Lorne Snyder1305 National Road
Wheeling , WV 26003
215 Jobey Snyder $101 89
Page 15 of 16
Terri ConawayRD I Box 408Wheeling , WV 26003
216 Shiann Conaway $100.00217 Nicole Conaway 89 85
Jamie Neer
13919th Street
Wheeling, WV 26003
218 Mercades Shirley $91.57
Total: $46,614.35
Page 16 of 16
ROY CHAMBERS FOUNDATION
APPLICATION FOR BENEFITS
Date of Application
NAME
ADDRESS
TELEPHONE NUMBER
BIRTH DATE
GRADE
SCHOOL
TEACHER
PARENT OR GUARDIAN'S NAME
WHAT YOU NEED
APPROXIMATE COST
WERE YOU & EFERRED BY ANY JNE? _ YES NO
IF YES, BY WHOM
The ROY CHAMBERS FOUNDATION is a charitable trust. Therefore,it is necessary that a parent or guardian of the child indicatethat the parent or guardian does not have the financial resourcesto purchase the requested item for the child at the present time.
I am financially unable to purchase the above requested itemat the present time.
NAME DATE
REIATIONSHIP TO CHILD
DO NOT WRITE BELOW LINE------------------ ------------------------------------------------
ACTION TAKEN