Form990-PF

Department of the Treasury
Internal Revenue Service

Return of Private Foundation
or Section 4947(a)(1) Trust Treated as Private Foundation
bulletDo not enter social security numbers on this form as it may be made public.
bulletInformation about Form 990-PF and its instructions is at www.irs.gov/form990pf.
OMB No. 1545-0052
2015
Open to Public Inspection
For calendar year 2015, or tax year beginning 01-01-2015 , and ending 12-31-2015
Name of foundation
FIRST CITIZENS CHARITABLE FOUNDATION INC
 
Number and street (or P.O. box number if mail is not delivered to street address)2601 4TH STREET SW PO BOX 1708
  Room/suite
City or town, state or province, country, and ZIP or foreign postal code
MASON CITY, IA504021708
A Employer identification number

42-1451615
B Telephone number (see instructions)

(641) 423-1600
C bullet
G Check all that apply:

D 1. bullet
2. bullet
E bullet
H Check type of organization:
F bullet
I Fair market value of all assets at end
of year (from Part II, col. (c),
line 16)bullet$1,254,088J Accounting method:
 
(Part I, column (d) must be on cash basis.)
Part I Analysis of Revenue and Expenses (The total of amounts in columns (b), (c), and (d) may not necessarily equal the amounts in column (a) (see instructions).) (a) Revenue and
expenses per
books 		(b) Net investment
income 		(c) Adjusted net
income 		(d) Disbursements
for charitable
purposes
(cash basis only)
Revenue 1 Contributions, gifts, grants, etc., received (attach schedule) 360,000
2 Check bullet Sch. B .............
3 Interest on savings and temporary cash investments      
4 Dividends and interest from securities... 42,229 42,229  
5a Gross rents............      
b Net rental income or (loss)  
6a Net gain or (loss) from sale of assets not on line 10  
b Gross sales price for all assets on line 6a  
7 Capital gain net income (from Part IV, line 2)... 23,809
8 Net short-term capital gain.........  
9 Income modifications...........  
10a Gross sales less returns and allowances  
b Less: Cost of goods sold....  
c Gross profit or (loss) (attach schedule).....    
11 Other income (attach schedule)....... Click to see attachment 190 190  
12 Total. Add lines 1 through 11........ 402,419 66,228  
Operating and Administrative Expenses 13 Compensation of officers, directors, trustees, etc. 6,000 3,000   3,000
14 Other employee salaries and wages......        
15 Pension plans, employee benefits.......        
16a Legal fees (attach schedule).........        
b Accounting fees (attach schedule)....... Click to see attachment 840 840    
c Other professional fees (attach schedule).... Click to see attachment 5,841 5,841    
17 Interest...............        
18 Taxes (attach schedule) (see instructions)... Click to see attachment 2,415 2,415    
19 Depreciation (attach schedule) and depletion...      
20 Occupancy..............        
21 Travel, conferences, and meetings.......        
22 Printing and publications..........        
23 Other expenses (attach schedule).......        
24 Total operating and administrative expenses.
Add lines 13 through 23.......... 15,096 12,096   3,000
25 Contributions, gifts, grants paid....... 398,839 398,839
26 Total expenses and disbursements. Add lines 24 and 25 413,935 12,096   401,839
27 Subtract line 26 from line 12:
a Excess of revenue over expenses and disbursements -11,516
b Net investment income (if negative, enter -0-) 54,132
c Adjusted net income (if negative, enter -0-)...  
For Paperwork Reduction Act Notice, see instructions.
Cat. No. 11289X Form 990-PF (2015)
Form 990-PF (2015)
Page 2
Part II Balance Sheets Attached schedules and amounts in the description column
should be for end-of-year amounts only. (See instructions.)		 Beginning of year End of year
(a) Book Value (b) Book Value (c) Fair Market Value
Assets 1 Cash—non-interest-bearing............. 9,199 9,764 9,764
2 Savings and temporary cash investments......... 10,064 31,933 31,933
3 Accounts receivable bullet  
Less: allowance for doubtful accounts bullet        
4 Pledges receivable bullet  
Less: allowance for doubtful accounts bullet        
5 Grants receivable.................      
6 Receivables due from officers, directors, trustees, and other
disqualified persons (attach schedule) (see instructions).....      
7 Other notes and loans receivable (attach schedule) bullet  
Less: allowance for doubtful accounts bullet        
8 Inventories for sale or use..............      
9 Prepaid expenses and deferred charges..........      
10a Investments—U.S. and state government obligations (attach schedule)      
b Investments—corporate stock (attach schedule)....... 429,363 Click to see attachment448,519 532,723
c Investments—corporate bonds (attach schedule)....... 196,914 Click to see attachment147,164 140,584
11 Investments—land, buildings, and equipment: basis bullet  
Less: accumulated depreciation (attach schedule) bullet        
12 Investments—mortgage loans.............      
13 Investments—other (attach schedule).......... 498,826 Click to see attachment519,279 539,084
14 Land, buildings, and equipment: basis bullet  
Less: accumulated depreciation (attach schedule) bullet        
15 Other assets (describe bullet)      
16 Total assets (to be completed by all filers—see the
instructions. Also, see page 1, item I) 1,144,366 1,156,659 1,254,088
Liabilities 17 Accounts payable and accrued expenses..........    
18 Grants payable..................    
19 Deferred revenue.................    
20 Loans from officers, directors, trustees, and other disqualified persons    
21 Mortgages and other notes payable (attach schedule)......    
22 Other liabilities (describe bullet)    
23 Total liabilities (add lines 17 through 22).........   0
Net Assets or Fund Balances bullet
and complete lines 24 through 26 and lines 30 and 31.
24 Unrestricted..................    
25 Temporarily restricted...............    
26 Permanently restricted...............    
bullet
and complete lines 27 through 31.
27 Capital stock, trust principal, or current funds........    
28 Paid-in or capital surplus, or land, bldg., and equipment fund 1,144,366 1,156,659
29 Retained earnings, accumulated income, endowment, or other funds    
30 Total net assets or fund balances (see instructions)..... 1,144,366 1,156,659
31 Total liabilities and net assets/fund balances (see instructions). 1,144,366 1,156,659
Part III
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
1,144,366
2
Enter amount from Part I, line 27a .....................
2
-11,516
3
Other increases not included in line 2 (itemize) bulletClick to see attachment
3
23,809
4
Add lines 1, 2, and 3 ..........................
4
1,156,659
5
Decreases not included in line 2 (itemize) bullet
5
 
6
Total net assets or fund balances at end of year (line 4 minus line 5)—Part II, column (b), line 30 .
6
1,156,659
Form 990-PF (2015)
Form 990-PF (2015)
Page 3
Part 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
P—Purchase
D—Donation 		(c) Date acquired
(mo., day, yr.) 		(d) Date sold
(mo., day, yr.)
1 a ALTRIA GROUP INC P 2011-09-13 2015-01-16
b CARE CAP PPTYS INC P 2013-09-16 2015-08-26
c CONOCO PHILLIPS COM P 2011-05-27 2015-01-06
d KINDER MORGAN INC P 2014-08-18 2015-12-07
e KRAFT HEINZ CO COM P 2012-10-11 2015-09-24
KRAFT FOODS GROUP INC P 2012-10-11 2015-07-06
REYNOLDS AMERICAN INC P 2011-08-24 2015-09-24
SENIOR HOUSING PPTYS P 2013-02-19 2015-06-09
TALEN ENERGY CORP P 2011-12-16 2015-06-09
S A SPONS ADR P 2011-12-16 2015-08-26
WILLIAMS CO INC P 2013-12-03 2015-06-25
TALEN ENERGY CORP P 2011-12-16 2015-06-12
ISHARE MSCI EAFE FUND P 2011-01-28 2015-03-06
ISHARE S&P MIDCAP 400 GROWTH INDEX FD P 2002-03-18 2015-03-06
ISHARE S&P MICAP 400 VALUE INDEX FUND P 2002-03-18 2015-03-06
ISHARES DJ US REAL ESTATE P 2013-03-06 2015-03-06
ISHARE S&P SMALLCAP 600 BARRA VALUE IND P 2002-03-18 2015-03-06
ISHARE S&P SMALLCAP 600 GROWTH INDEX P 2002-03-18 2015-03-06
ISHARE DOW JONES INTL SELECT DIV IDX P 2013-01-30 2015-03-06
ISHARE DOW JONES INTL SELECT DIV IDX P 2013-01-30 2015-10-09
ETF VANGUARD EMERGING MARKETS P 2011-02-03 2015-03-06
MORGAN STANLEY 3.45% BOND P 2011-01-31 2015-11-02
MUTUAL FUND CAPITAL GAIN DISTRIBUTIONS P 2010-01-01 2015-12-31
(e) Gross sales price (f) Depreciation allowed
(or allowable) 		(g) Cost or other basis
plus expense of sale 		(h) Gain or (loss)
(e) plus (f) minus (g)
a 2,104 0 1,260 844
b 799 0 836 -37
c 7,937 0 7,160 777
d 3,129 0 6,903 -3,774
e 2,186 0 1,497 689
15,653 0 11,726 3,927
4,331 0 2,195 2,136
3,508 0 4,850 -1,342
554 0 513 41
10,038 0 11,838 -1,800
11,207 0 7,670 3,537
14 0 13 1
4,843 0 4,562 281
8,388 0 2,933 5,455
7,201 0 2,685 4,516
12,217 0 10,703 1,514
7,088 0 2,782 4,306
7,636 0 2,374 5,262
2,988 0 3,050 -62
16,732 0 19,559 -2,827
3,095 0 3,327 -232
50,000 0 49,750 250
347 0 0 347
Complete only for assets showing gain in column (h) and owned by the foundation on 12/31/69 (l) Gains (Col. (h) gain minus
col. (k), but not less than -0-) or
Losses (from col.(h))
(i) F.M.V. as of 12/31/69 (j) Adjusted basis
as of 12/31/69 		(k) Excess of col. (i)
over col. (j), if any
a 0 0 0 844
b 0 0 0 -37
c 0 0 0 777
d 0 0 0 -3,774
e 0 0 0 689
0 0 0 3,927
0 0 0 2,136
0 0 0 -1,342
0 0 0 41
0 0 0 -1,800
0 0 0 3,537
0 0 0 1
0 0 0 281
0 0 0 5,455
0 0 0 4,516
0 0 0 1,514
0 0 0 4,306
0 0 0 5,262
0 0 0 -62
0 0 0 -2,827
0 0 0 -232
0 0 0 250
0 0 0 347
2 Capital gain net income or (net capital loss) Bracket If gain, also enter in Part I, line 7
If (loss), enter -0- in Part I, line 7		 Bracket 2 23,809
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) (see instructions). If (loss), enter -0-
in Part I, line 8 ................... 		Bracket 3  
Part V
Qualification Under Section 4940(e) for Reduced Tax on Net Investment Income
(For optional use by domestic private foundations subject to the section 4940(a) tax on net investment income.)
If section 4940(d)(2) applies, leave this part blank.
Was the foundation liable for the section 4942 tax on the distributable amount of any year in the base period?
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.
(a)
Base period years Calendar
year (or tax year beginning in) 		(b)
Adjusted qualifying distributions 		(c)
Net value of noncharitable-use assets 		(d)
Distribution ratio
(col. (b) divided by col. (c))
2014 335,400 1,309,718 0.256086
2013 404,350 1,122,660 0.360171
2012 329,546 847,337 0.388920
2011 376,153 822,052 0.457578
2010 349,095 827,464 0.421885
2
Total of line 1, column (d) .....................
21.884640
3
Average distribution ratio for the 5-year base period—divide the total on line 2 by 5, or by
the number of years the foundation has been in existence if less than 5 years . . .
3
0.376928
4
Enter the net value of noncharitable-use assets for 2015 from Part X, line 5.....
4
1,318,872
5
Multiply line 4 by line 3......................
5
497,120
6
Enter 1% of net investment income (1% of Part I, line 27b)...........
6
541
7
Add lines 5 and 6........................
7
497,661
8
Enter qualifying distributions from Part XII, line 4.............
8
401,839
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.
Form 990-PF (2015)
Form 990-PF (2015)
Page 4
Part VI
Excise Tax Based on Investment Income (Section 4940(a), 4940(b), 4940(e), or 4948—see page 18 of the instructions)
1a Bullet and enter “N/A" on line 1. Bracket
Date of ruling or determination letter:   (attach copy of letter if necessary–see instructions)
b 1 1,083
hereBulletand 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 0
3 Add lines 1 and 2........................... 3 1,083
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 1,083
6 Credits/Payments:
a 2015 estimated tax payments and 2014 overpayment credited to 2015 6a 1,560
b Exempt foreign organizations—tax withheld at source...... 6b
c 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.............. Part VI Line 7 - Original Return Overpayment: -1560 7 1,560
8 Enter any penalty for underpayment of estimated tax. if Form 2220 is attached. 8  
9 Tax due. If the total of lines 5 and 8 is more than line 7, enter amount owed.......Bullet 9  
10 Overpayment. If line 7 is more than the total of lines 5 and 8, enter the amount overpaid...Bullet 10 477
11 Enter the amount of line 10 to be: Credited to 2015 estimated taxBullet477 RefundedBullet 11  
Part VII-A
Statements Regarding Activities
1a
During the tax year, did the foundation attempt to influence any national, state, or local legislation or did
Yes
No
it participate or intervene in any political campaign? ....................
1a
 
No
b
Did it spend more than $100 during the year (either directly or indirectly) for political purposes (see Instructions
for definition)?.................................
1b
 
No
If the answer is "Yes" to 1a or 1b, attach a detailed description of the activities and copies of any materials
published or distributed by the foundation in connection with the activities.
c
Did the foundation file Form 1120-POL for this year?.....................
1c
 
No
d
Enter the amount (if any) of tax on political expenditures (section 4955) imposed during the year:
(1) On the foundation. bullet$   (2) On foundation managers.bullet$  
e
Enter the reimbursement (if any) paid by the foundation during the year for political expenditure tax imposed
on foundation managers.bullet$  
2
Has the foundation engaged in any activities that have not previously been reported to the IRS?.......
2
 
No
If "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
 
No
4a
Did the foundation have unrelated business gross income of $1,000 or more during the year?........
4a
 
No
b
If "Yes," has it filed a tax return on Form 990-T for this year?...................
4b
 
No
5
Was there a liquidation, termination, dissolution, or substantial contraction during the year?.........
5
 
No
If "Yes," attach the statement required by General Instruction T.
6
Are the requirements of section 508(e) (relating to sections 4941 through 4945) satisfied either:
  • By language in the governing instrument, or
  • By state legislation that effectively amends the governing instrument so that no mandatory directions
    • that conflict with the state law remain in the governing instrument?................
    6
    Yes
     
    7
    Did the foundation have at least $5,000 in assets at any time during the year? If "Yes," complete Part II, col. (c),
    and Part XV..................................
    7
    Yes
     
    8a
    Enter the states to which the foundation reports or with which it is registered (see instructions)
    bullet
    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 .
    8b
     
    No
    9
    Is the foundation claiming status as a private operating foundation within the meaning of section 4942(j)(3)
    or 4942(j)(5) for calendar year 2015 or the taxable year beginning in 2015 (see instructions for Part XIV)?
    If "Yes," complete Part XIV.............................
    9
     
    No
    10
    Did any persons become substantial contributors during the tax year? If "Yes," attach a schedule listing their names
    and addresses. ...............................
    10
     
    No
    Form 990-PF (2015)
    Form 990-PF (2015)
    Page 5
    Part VII-A
    Statements Regarding Activities (continued)
    11
    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) .............
    11
     
    No
    12
    Did the foundation make a distribution to a donor advised fund over which the foundation or a disqualified person had
    advisory privileges? If "Yes," attach statement (see instructions).................
    12
     
    No
    13
    Did the foundation comply with the public inspection requirements for its annual returns and exemption application?
    13
    Yes
     
    Website addressbulletN/A
    14
    The books are in care ofbulletFIRST CITIZENS TRUST COMPANY Telephone no.bullet (641) 422-1600

    Located atbullet2601 4TH STREET SWMASON CITYIA ZIP+4bullet50401
    15
    Section 4947(a)(1) nonexempt charitable trusts filing Form 990-PF in lieu of Form 1041.......bullet
    and enter the amount of tax-exempt interest received or accrued during the year ......bullet
    15  
    16 At any time during calendar year 2015, did the foundation have an interest in or a signature or other authority over YesNo
    a bank, securities, or other financial account in a foreign country?
    16   No
    See instructions for exceptions and filing requirements for FinCEN Form 114, Report of Foreign Bank and Financial Accounts (FBAR). If "Yes", enter the name of the foreign country bullet  
    Part VII-B
    Statements Regarding Activities for Which Form 4720 May Be Required
    File 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?
    (2) Borrow money from, lend money to, or otherwise extend credit to (or accept it from)
    a disqualified person?......................
    (3) Furnish goods, services, or facilities to (or accept them from) a disqualified person?
    (4) Pay compensation to, or pay or reimburse the expenses of, a disqualified person?
    (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)?...............
    (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.).......
    b
    If any answer is "Yes" to 1a(1)–(6), did any of the acts fail to qualify under the exceptions described in Regulations
    section 53.4941(d)-3 or in a current notice regarding disaster assistance (see instructions)? ........
    1b
     
     
    ........bullet
    c
    Did the foundation engage in a prior year in any of the acts described in 1a, other than excepted acts,
    that were not corrected before the first day of the tax year beginning in 2015?.............
    1c
     
    No
    2
    Taxes on failure to distribute income (section 4942) (does not apply for years the foundation was a private
    operating foundation defined in section 4942(j)(3) or 4942(j)(5)):
    a
    At the end of tax year 2015, did the foundation have any undistributed income (lines 6d
    and 6e, Part XIII) for tax year(s) beginning before 2015?.............
    If "Yes," list the years bullet20, 20, 20, 20
    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.) ..............
    2b
     
     
    c
    If the provisions of section 4942(a)(2) are being applied to any of the years listed in 2a, list the years here.
    bullet20, 20, 20, 20
    3a
    Did the foundation hold more than a 2% direct or indirect interest in any business enterprise at
    any time during the year?......................
    b
    If "Yes," did it have excess business holdings in 2015 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 2015.)..................
    3b
     
     
    4a
    Did the foundation invest during the year any amount in a manner that would jeopardize its charitable purposes?
    4a
     
    No
    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 jeopardy before the first day of the tax year beginning in 2015?
    4b
     
    No
    Form 990-PF (2015)
    Form 990-PF (2015)
    Page 6
    Part VII-B
    Statements Regarding Activities for Which Form 4720 May Be Required (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))?
    (2) Influence the outcome of any specific public election (see section 4955); or to carry
    on, directly or indirectly, any voter registration drive?.............
    (3) Provide a grant to an individual for travel, study, or other similar purposes?
    (4) Provide a grant to an organization other than a charitable, etc., organization described
    in section 4945(d)(4)(A)? (see instructions)................
    (5) Provide for any purpose other than religious, charitable, scientific, literary, or
    educational purposes, or for the prevention of cruelty to children or animals?.....
    b
    If any answer is "Yes" to 5a(1)–(5), did any of the transactions fail to qualify under the exceptions described in
    Regulations section 53.4945 or in a current notice regarding disaster assistance (see instructions)? ......
    5b
     
     
    .........bullet
    c
    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?..........
    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?.....................
    b
    Did the foundation, during the year, pay premiums, directly or indirectly, on a personal benefit contract?....
    6b
     
    No
    If "Yes" to 6b, file Form 8870.
    7a
    At any time during the tax year, was the foundation a party to a prohibited tax shelter transaction?
    b
    If yes, did the foundation receive any proceeds or have any net income attributable to the transaction? ....
    7b
     
     
    Form 990-PF (2015)
    Form 990-PF (2015)
    Page 7
    Part VIII
    Information About Officers, Directors, Trustees, Foundation Managers, Highly Paid Employees,
    and Contractors
    1 List all officers, directors, trustees, foundation managers and their compensation (see instructions).
    (a) Name and address (b) Title, and average
    hours per week
    devoted to position     		(c) Compensation
     (If not paid, enter
    -0-)     		(d) Contributions to employee benefit plans and deferred compensation (e) Expense account,
    other allowances
    PATRICIA A TOMSON EXEC DIRECTOR
    2.00     		6,000 0 0
    PO BOX 1708
    MASON CITY,IA50402
    O JAY TOMSON PRESIDENT
    1.00     		0 0 0
    PO BOX 1708
    MASON CITY,IA50402
    GORDON ANDERSON DIRECTOR
    1.00     		0 0 0
    501 MAIN ST
    OSAGE,IA50461
    CATHERINE ROTTINGHAUS DIRECTOR
    1.00     		0 0 0
    300 MAIN ST
    CHARLES CITY,IA50616
    MARTI RODAMAKER DIRECTOR
    1.00     		0 0 0
    PO BOX 1708
    MASON CITY,IA50402
    KRISTINE SCHULTZ DIRECTOR
    1.00     		0 0 0
    PO BOX 1708
    MASON CITY,IA50402
    2 Compensation of five highest-paid employees (other than those included on line 1—see instructions). If none, enter “NONE."
    (a) Name and address of each employee paid more than $50,000 (b) Title, and average
    hours per week
    devoted to position     		(c) Compensation (d) Contributions to
    employee benefit
    plans and deferred
    compensation     		(e) Expense account,
    other allowances
    NONE
    Total number of other employees paid over $50,000...................bullet 0
    3 Five highest-paid independent contractors for professional services (see instructions). 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 receiving over $50,000 for professional services.............bullet0
    Part IX-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 number of organizations and other beneficiaries served, conferences convened, research papers produced, etc. Expenses
    1 GRANTS PAID TO NONPROFIT ORGANIZATIONS THAT MEETESTABLSIHED CRITERIA. SEE LISTING ON PAGE 11, PART XV. 398,839
    2  
    3  
    4  
    Part IX-B
    Summary of Program-Related Investments (see instructions)
    Describe the two largest program-related investments made by the foundation during the tax year on lines 1 and 2. Amount
    1  
    2  
    All other program-related investments. See instructions.
    3  
    Total. Add lines 1 through 3.........................bullet  
    Form 990-PF (2015)
    Form 990-PF (2015)
    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...................
    1a
    1,255,042
    b
    Average of monthly cash balances.......................
    1b
    83,914
    c
    Fair market value of all other assets (see instructions)................
    1c
    0
    d
    Total (add lines 1a, b, and c).........................
    1d
    1,338,956
    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..................
    2
     
    3
    Subtract line 2 from line 1d.........................
    3
    1,338,956
    4
    Cash deemed held for charitable activities. Enter 1 1/2% of line 3 (for greater amount, see
    instructions) .............................
    4
    20,084
    5
    Net value of noncharitable-use assets. Subtract line 4 from line 3. Enter here and on Part V, line 4
    5
    1,318,872
    6
    Minimum investment return. Enter 5% of line 5..................
    6
    65,944
    Part XI
    Distributable Amount bullet
    1
    Minimum investment return from Part X, line 6....................
    1
    65,944
    2a
    Tax on investment income for 2015 from Part VI, line 5......
    2a
    1,083
    b
    Income tax for 2015. (This does not include the tax from Part VI.)...
    2b
     
    c
    Add lines 2a and 2b............................
    2c
    1,083
    3
    Distributable amount before adjustments. Subtract line 2c from line 1............
    3
    64,861
    4
    Recoveries of amounts treated as qualifying distributions................
    4
     
    5
    Add lines 3 and 4............................
    5
    64,861
    6
    Deduction from distributable amount (see instructions).................
    6
     
    7
    Distributable amount as adjusted. Subtract line 6 from line 5. Enter here and on Part XIII, line 1 ...
    7
    64,861
    Part XII
    Qualifying Distributions (see instructions)
    1
    Amounts paid (including administrative expenses) to accomplish charitable, etc., purposes:
    a
    Expenses, contributions, gifts, etc.—total from Part I, column (d), line 26 ..........
    1a
    401,839
    b
    Program-related investments—total from Part IX-B..................
    1b
     
    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 1a through 3b. Enter here and on Part V, line 8, and Part XIII, line 4
    4
    401,839
    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 (see instructions).................
    5
     
    6
    Adjusted qualifying distributions. Subtract line 5 from line 4..............
    6
    401,839
    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 (2015)
    Form 990-PF (2015)
    Page 9
    Part XIII
    Undistributed Income (see instructions)
    (a)
    Corpus     		(b)
    Years prior to 2014     		(c)
    2014     		(d)
    2015
    1 Distributable amount for 2015 from Part XI, line 7 64,861
    2 Undistributed income, if any, as of the end of 2015:
    a Enter amount for 2014 only....... 63,939
    b Total for prior years:20, 20, 20  
    3 Excess distributions carryover, if any, to 2015:
    a From 2010...... 349,511
    b From 2011...... 376,350
    c From 2012...... 288,387
    d From 2013...... 348,930
    e From 2014...... 335,400
    fTotal of lines 3a through e........ 1,698,578
    4Qualifying distributions for 2015 from Part
    XII, line 4: bullet$ 401,839
    a Applied to 2014, but not more than line 2a  
    b Applied to undistributed income of prior years
    (Election required—see instructions).....     		 
    c Treated as distributions out of corpus (Election
    required—see instructions)........     		 
    d Applied to 2015 distributable amount.....  
    e Remaining amount distributed out of corpus 401,839
    5 Excess distributions carryover applied to 2015.    
    (If an amount appears in column (d), the
    same amount must be shown in column (a).)
    6Enter the net total of each column as
    indicated below:
    a Corpus. Add lines 3f, 4c, and 4e. Subtract line 5 2,100,417
    b Prior years’ undistributed income. Subtract
    line 4b from line 2b ..........     		 
    c Enter the amount of prior years’ undistributed
    income for which a notice of deficiency has
    been issued, or on which the section 4942(a)
    tax has been previously assessed......     		 
    d Subtract line 6c from line 6b. Taxable amount
    —see instructions ...........     		 
    e Undistributed income for 2014. Subtract line
    4a from line 2a. Taxable amount—see
    instructions .............     		63,939
    f Undistributed income for 2016. Subtract
    lines 4d and 5 from line 1. This amount must
    be distributed in 2015 ..........     		64,861
    7 Amounts treated as distributions out of
    corpus to satisfy requirements imposed by
    section 170(b)(1)(F) or 4942(g)(3) (Election may
    be required - see instructions) .......     		 
    8Excess distributions carryover from 2010 not
    applied on line 5 or line 7 (see instructions) ...     		349,511
    9Excess distributions carryover to 2016.
    Subtract lines 7 and 8 from line 6a ......     		1,750,906
    10 Analysis of line 9:
    a Excess from 2011.... 376,350
    b Excess from 2012.... 288,387
    c Excess from 2013.... 348,930
    d Excess from 2014.... 335,400
    e Excess from 2015.... 401,839
    Form 990-PF (2015)
    Form 990-PF (2015)
    Page 10
    Part XIV
    Private Operating Foundations (see instructions and Part VII-A, question 9)
    1a If the foundation has received a ruling or determination letter that it is a private operating
    foundation, and the ruling is effective for 2015, enter the date of the ruling.......bullet
     
    b Check box to indicate whether the organization is a private operating foundation described in section or
    2a Enter the lesser of the adjusted net
    income from Part I or the minimum
    investment return from Part X for each
    year listed ..........     		Tax year Prior 3 years (e) Total
    (a) 2015 (b) 2014 (c) 2013 (d) 2012
             
    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 2c ....     		         
    3 Complete 3a, b, or c for the
    alternative test relied upon:
    a “Assets" alternative test—enter:
    (1) Value of all assets ......          
    (2) Value of assets qualifying
    under section 4942(j)(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 “Support" alternative test—enter:
    (1) Total support other than gross
    investment income (interest,
    dividends, rents, payments
    on securities loans (section
    512(a)(5)), or royalties) ....     		         
    (2) Support from general public
    and 5 or more exempt
    organizations as provided in
    section 4942(j)(3)(B)(iii)....     		         
    (3) Largest amount of support
    from an exempt organization    		          
    (4) Gross investment income          
    Part XV
    Supplementary Information (Complete this part only if the organization had $5,000 or more in
    assets at any time during the year—see instructions.)
    1Information Regarding Foundation Managers:
    aList any managers of the foundation who have contributed more than 2% of the total contributions received by the foundation
    before the close of any tax year (but only if they have contributed more than $5,000). (See section 507(d)(2).)
    O JAY TOMSON
    bList any managers of the foundation who own 10% or more of the stock of a corporation (or an equally large portion of the
    ownership of a partnership or other entity) of which the foundation has a 10% or greater interest.
    NOT APPLICABLE
    2Information Regarding Contribution, Grant, Gift, Loan, Scholarship, etc., Programs:
    Check here bullet
    aThe name, address, and telephone number or e-mail address of the person to whom applications should be addressed:
    PATRICIA A TOMSON
    FIRST CITIZENS CHARITABLE FOUNDATIO
    MASON CITY,IA50402
    (641) 422-1600
    bThe form in which applications should be submitted and information and materials they should include:
    SEE ATTACHED APPLICATION FORMS.
    cAny submission deadlines:
    APPLICATIONS ARE REVIEWED QUARTERLY.
    dAny restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other
    factors:
    SEE CRITERIA INCLUDED IN THE APPLICATION FORM ATTACHED.
    Form 990-PF (2015)
    Form 990-PF (2015)
    Page 11
    Part XV
    Supplementary Information (continued)
    3 Grants and Contributions Paid During the Year or Approved for Future Payment
    Recipient If recipient is an individual,
    show any relationship to
    any foundation manager
    or substantial contributor
    		 Foundation
    status of
    recipient     		Purpose of grant or
    contribution     		Amount
    Name and address (home or business)
    aPaid during the year
    CASA OF NORTH IOWA
    220 N WASHINGTON
    MASON CITY,IA50401     		  PUBLICCHARITY TRAINING OFRETENTION ANDVOLUNTEERS 1,000
    CHARLES CITY CIVIC FOUNDATION
    117 N JACKSON ST
    CHARLES CITY,IA50616     		  PUBLICCHARITY REPAINT STREETLIGHT POLES 2,000
    COMMUNITY KITCHEN OF NORTH IOWA
    606 NORTH MONROE
    MASON CITY,IA50401     		  PUBLICCHARITY FOOD FOR NEEDYFAMILIES 1,250
    COMMUNITY POLICING ADVISORY BOARD
    78 SOUTH GEORGIA
    MASON CITY,IA50401     		  PUBLICCHARITY MATIONAL NIGHT OUT 1,000
    COMPREHENSIVE SYSTEMS INC
    1453 4TH STREET SE
    MASON CITY,IA50401     		  PUBLICCHARITY RENOVATIONS 5,000
    FRANCIS LAUER YOUTH SERVICES
    50 NORTH EISENHOWER
    MASON CITY,IA50401     		  PUBLICCHARITY CHARACTER COUNTSEDUCATION PROGRAM 5,250
    FRANKLIN GENERAL HOSPITAL FDN
    1720 CENTRAL AVENUE EAST
    HAMPTON,IA50441     		  PUBLICCHARITY REMODELINGHOSPITALPROJECT 6,000
    GOOD SHEPHERD HEALTH CENTER
    304 3RD STREET NE
    MASON CITY,IA50401     		  PUBLICCHARITY TELEPHONEREASSURANCE 1,000
    IOWA COLLEGE FOUNDATION
    505 5TH AVE STE 1034
    DES MOINES,IA50309     		  PUBLICCHARITY SCHOLARSHIPPROGRAM 6,500
    LUTHER COLLEGE
    700 COLLEGE DRIVE
    DECORAH,IA52101     		  PUBLICCHARITY SCHOLARSHIP FUND 10,000
    LUTHERAN SOCIAL SERVICES
    2502 SOUTH JEFFERSON
    MASON CITY,IA50401     		  PUBLICCHARITY FAMILIES TOGETHERPROGRAM 1,000
    LUTHERAN SUMMER MUSIC PROGRAM
    122 W FRANKLIN AVE
    MINNEAPOLIS,MN55404     		  PUBLICCHARITY MATCHINGGIFT 1,000
    MASON CITY YMCA
    1840 S MONROE
    MASON CITY,IA50401     		  PUBLICCHARITY CAPITAL FUND 15,000
    MASON CITY YMCA
    1840 S MONROE
    MASON CITY,IA50401     		  PUBLICCHARITY OPERATINGSCHOLARSHIPSDEBT REDUCTION 4,000
    MERCY MEDICAL CENTER FOUNDATION
    1000 4TH STREET SW
    MASON CITY,IA50401     		  PUBLICCHARITY MATCHINGGIFT 3,000
    NORTHERN LIGHTS ALLIANCE FOR HOMELESS
    2 SOUTH ADAMS
    MASON CITY,IA50401     		  PUBLICCHARITY RENOVATIONS 25,500
    NO IOWA AREA COMM COLLEGE FDN
    500 COLLEGE
    MASON CITY,IA50401     		  PUBLICCHARITY PERFORMING ARTSSCHOLARSHIPSSPONSORSHIP 56,950
    NORTH IA AREA COUNCIL OF GOVTS
    525 6TH STREET SE
    MASON CITY,IA50401     		  PUBLICCHARITY EMERGENCY HOUSINGREPAIRS 5,500
    NORTH IOWA BAND FESTIVAL
    9 NORTH FEDERAL
    MASON CITY,IA50401     		  PUBLICCHARITY SPONSORPARADE 5,000
    PHEASANTS FOREVER
    INDUSTRIAL DRIVE
    FOREST CITY,IA50436     		  PUBLICCHARITY OUTDOORCLASSROOM 1,000
    ROCKWELL AQUATIC CENTER
    PO BOX 446
    ROCKWELL,IA50469     		  PUBLICCHARITY BATH HOUSEIMPROVEMENTS 2,000
    THE WORLD FOOD PRIZE FOUNDATION
    666 GRAND AVENUE PO BOX 1700
    DES MOINES,IA50309     		  PUBLICCHARITY RESTORATIONHALL OF LAUREATES 10,000
    YOUTH FOR CHRIST
    2210 SOUTH FEDERAL
    MASON CITY,IA50401     		  PUBLICCHARITY BASIC FINANCIALEDUCATION PROJECT 2,400
    WRIGHT CO CONSERVATION BOARD
    1768 OBRIEN AVE
    CLARION,IA50525     		  PUBLICCHARITY TORNADO SHELTER 5,000
    FRANKLIN COUNTY RACE
    1008 CENTRAL AVE WEST
    HAMPTON,IA50441     		  PUBLICCHARITY DEBTREDUCTION 10,000
    CHICKASAW TOWNSHIP FIRE DISTRICT
    205 SW ST
    IONIA,IA50645     		  PUBLICCHARITY REPLACE FIREEQUIPMENT 1,000
    KINNEY PIONEER MUSEUM
    MUNICIPAL AIRPORT HWY 122 W
    MASON CITY,IA50401     		  PUBLICCHARITY RESTORATION 1,000
    THE SALVATION ARMY
    747 VILLAGE GREEN DR
    MASON CITY,IA50401     		  PUBLICCHARITY DAY CARECENTER 1,000
    CLEAR LAKE CHAMBER OF COMMERCE
    205 MAIN AVE
    CLEAR LAKE,IA50428     		  PUBLICCHARITY THURSDAYS ON MAINSPONSORSHIP 2,500
    OPPORTUNITY VILLAGE
    1200 N 9TH STREET W
    CLEAR LAKE,IA50428     		  PUBLICCHARITY GENERALOPERATING 5,000
    FOUR OAKS
    980 S IOWA AVE
    MASON CITY,IA50401     		  PUBLICCHARITY CAPITALIMPROVEMENTS 25,000
    NORTH IOWA VOCATIONAL CENTER
    1225 S HARRISON AVE
    MASON CITY,IA50401     		  PUBLICCHARITY VAN PURCHASE 5,000
    CHARLES CITY BOOSTER CLUB
    1 COMET LANE
    CHARLES CITY,IA50616     		  PUBLICCHARITY MATCHINGGIFT 1,000
    KCMR RADIO
    316 N FEDERAL AVE
    MASON CITY,IA50401     		  PUBLICCHARITY GENERALOPERATING 2,500
    NORTH IOWA EVENTS CENTER
    3700 4TH ST SW
    MASON CITY,IA50401     		  PUBLICCHARITY SPONSORSHIP 7,500
    SPECIAL KIDS SPECIAL LOVE INC
    2137 336TH ST
    OSAGE,IA50461     		  PUBLICCHARITY GENERALOPERATING 1,000
    MORA EDUCATION FOUNDATION
    730 FOREST AVE E PO BOX 323
    MORA,MN55051     		  PUBLICCHARITY MATCHING GIFT 12,500
    FLOYD FIRE DEPARTMENT
    615 MONROE ST
    FLOYD,IA50435     		  PUBLICCHARITY NEW STATION 12,500
    ED FDN OF THE CAL COMMUNITY SCHOOLS
    1441 GULL AVE PO BOX 459
    LATIMER,IA50452     		  PUBLICCHARITY ELECTRONICMESSAGE BOARD 5,000
    MITCHELL COUNTY AG SOCIETY
    2597 410TH ST
    LITTLE CEDAR,IA50454     		  PUBLICCHARITY HANDICAPACCESSIBILITY 1,000
    SUNRISE PRESCHOOL
    216 N BROADWAY AVE
    NEW HAMPTON,IA50659     		  PUBLICCHARITY EQUIPMENT 1,000
    JORDON RIVER INC
    102 N MAIN ST
    CHARLES CITY,IA50616     		  PUBLICCHARITY FOOD FORNEEDY FAMILIES 1,000
    CITY OF NORA SPRINGS SWIMMING POOL
    605 E CONGRESS ST
    NORA SPRINGS,IA50458     		  EXEMPT SWIMMINGPOOL 5,000
    WINNEBAGO COUNCIL OF BOY SCOUTS
    1631 4TH ST SW STE 125A
    MASON CITY,IA50401     		  EXEMPT YOUTH PROGRAM 5,000
    KANAWHA FIREFIGHTERS ASSN
    35 MAIN AVE S PO BOX 301
    BRITT,IA50423     		  PUBLICCHARITY TANKER TRUCK 7,000
    HAWKEYE HARVEST FOOD BANK
    22 M GEORGIA
    MASON CITY,IA50401     		  PUBLICCHARITY REMODELING 5,000
    COMMUNITY BANKERS OF IOWA ED FDN
    1603 22ND ST STE 102
    WEST DES MOINES,IA50266     		  PUBLICCHARITY SCHOLASHIPS 6,000
    KANAWHA COMMUNITY POOL
    112 E 2ND ST
    KANAWHA,IA50447     		  PUBLICCHARITY DEBT REDUCTION 5,000
    MACNIDER ART MUSEUM FDN
    303 22N ST SE
    MASON CITY,IA50401     		  EXEMPT EXHIBITS/REMODELING 3,000
    GIRL SCOUT CAMP TANGLEFOOT
    14948 DOGWOOD AVE
    CLEAR LAKE,IA50428     		  EXEMPT CRAFT HOUSEREPAIRS 2,000
    BRIDGE OF HOPE- NORTH CENTRAL IA
    420 1ST AVE NE PO BOX 623
    HAMPTON,IA50441     		  EXEMPT RENTALASSISTANCE 1,000
    COMMUNITY FDN OF NE IOWA
    3117 GREENHILL CIRCLE
    CEDAR FALLS,IA50613     		  EXEMPT CLEAR LAKE FIREWORKSCERRO GORDO COMM FDNENDOWMENT 5,000
    ELDERBRIDGE AGENCY ON AGING
    22 N GEORGIA AVE 216
    MASON CITY,IA50401     		  EXEMPT ELDERBIRDGE ENDOW FDCOMM FDN OF NE IACLIENT CHAIRS 1,239
    LATIMER FIRE DEPT
    115 S DONOVAN
    LATIMER,IA50452     		  EXEMPT FACILITYEXPANSION 2,000
    WEST HANCOCK CO AMBULANCE SERV INC
    20 1ST AVE SW
    BRITT,IA50423     		  EXEMPT EMERGENCYEQUIPMENT 2,500
    INDUSTRIES INC
    500 S WALNUT ST
    MORA,MN55051     		  EXEMPT PORTABLEDEFIBRILATOR KITS 5,500
    BELMOND AREA ARTS COUNCIL
    1179 TAYLOR AVE
    BELMOND,IA50421     		  EXEMPT CONSTRUCTION 1,000
    CHARLES THEATER INC
    409 N MAIN ST
    CHARLES CITY,IA50616     		  EXEMPT RESTORATION 4,000
    NORTH IOWA FIGURE SKATING CLUB
    3700 4TH ST SW PO BOX 1381
    MASON CITY,IA50402     		  EXEMPT SCHOLARSHIPS 1,000
    MORA PUBLIC SCHOOLS
    400 EAST MAPLE AVE
    MORA,MN55051     		  EXEMPT LEARNPADS 15,000
    MORA AREA YOUTH RECREATION ASSN
    701 SOUTH UNION ST
    MORA,MN55051     		  EXEMPT DEHUMIDIFICATIONSYSTEM 10,000
    ISU EXTENSION- CERRO GORDO CO
    2023 S FEDERAL AVE
    MASON CITY,IA50401     		  EXEMPT GREENHOUSE 5,000
    IOOF HOME AND COMMUNITY THERAPY CNTR
    1037 19TH ST SW
    MASON CITY,IA50401     		  EXEMPT BUS PAYMENT 10,000
    HOMES FOR HAITI FDN INC
    113 E HALLANDALE BEACH BLVD STE C
    HALLANDALE,FL33009     		  EXEMPT RELEIF FUNDING 5,000
    GREAT PLAYS INC
    485 S LINN AVE
    NEW HAMPTON,IA50659     		  EXEMPT GENERALOPERATING 1,000
    CONSUMER CREDIT COUNSELING SVCS OF NE IA
    1003 W 4ST ST
    WATERLOO,IA50702     		  EXEMPT COUNSELINGSERVICES 1,000
    THE CHORAL MUSIC GUILD INC
    11 4TH ST NE
    MASON CITY,IA50401     		  EXEMPT NEW CHOIRROBE BOXES 10,000
    IMMACULATE CONCEPTION CHURCH
    106 CHAPEL LN
    CHARLES CITY,IA50616     		  EXEMPT MATCHINGGIFT 1,000
    STEBEN'S CHILDREN'S THEATRE
    616 N DELAWARE
    MASON CITY,IA50401     		  EXEMPT MATCHINGGIFT 500
    CEDAR VALLEY SEMINARY FDN INC
    2365 370TH ST
    OSAGE,IA50461     		  EXEMPT MATCHINGGIFT 1,000
    HOSPICE OF NORTH IOWA
    232 2NS ST SE
    MASON CITY,IA50401     		  EXEMPT MATCHINGGIFT 250
    UNIVERSITY OF NORTHERN IA FDN
    204 COMMONS
    CEDAR FALLS,IA50614     		  EXEMPT MATCHINGGIFT 1,000
    IOWA MEDIATION SERVICE INC
    1415 S MONROE AVE
    MASON CITY,IA50401     		  EXEMPT TRAINING 5,000
    Total .................................bullet 3a 398,839
    bApproved for future payment
    Total .................................bullet 3b  
    Form 990-PF (2015)
    Form 990-PF (2015)
    Page 12
    Part XVI-A
    Analysis of Income-Producing Activities
    Enter gross amounts unless otherwise indicated. Unrelated business income Excluded by section 512, 513, or 514 (e)
    Related or exempt
    function income
    (See instructions.)
    1Program service revenue: (a)
    Business code     		(b)
    Amount     		(c)
    Exclusion code     		(d)
    Amount
    a
    b
    c
    d
    e
    f
    gFees and contracts from government agencies          
    2 Membership dues and assessments....          
    3
    Interest on savings and temporary cash investments ...........     		         
    4 Dividends and interest from securities....     14 42,229  
    5 Net rental income or (loss) from real estate:
    aDebt-financed property......          
    bNot debt-financed property.....          
    6
    Net rental income or (loss) from personal property     		         
    7 Other investment income.....          
    8
    Gain or (loss) from sales of assets other than inventory ............     		         
    9 Net income or (loss) from special events:          
    10 Gross profit or (loss) from sales of inventory..          
    11 Other revenue: a
    b
    c
    d
    e
    12 Subtotal. Add columns (b), (d), and (e)..   42,229  
    13Total. Add line 12, columns (b), (d), and (e)..................
    1342,229
    (See worksheet in line 13 instructions to verify calculations.)
    Part XVI-B
    Relationship of Activities to the Accomplishment of Exempt Purposes
    Line No.
    DownArrow     		Explain below how each activity for which income is reported in column (e) of Part XVI-A contributed importantly to
    the accomplishment of the foundation’s exempt purposes (other than by providing funds for such purposes). (See
    instructions.)
    Form 990-PF (2015)
    Form 990-PF (2015)
    Page 13
    Part XVII
    Information Regarding Transfers To and Transactions and Relationships With Noncharitable Exempt Organizations
    1
    Did the organization directly or indirectly engage in any of the following with any other organization described in section 501(c) of the Code (other than section 501(c)(3) organizations) or in section 527, relating to political organizations?
    Yes
    No
    a
    Transfers from the reporting foundation to a noncharitable exempt organization of:
    (1) Cash...................................
    1a(1)
     
    No
    (2) Other assets.................................
    1a(2)
     
    No
    b
    Other transactions:
    (1) Sales of assets to a noncharitable exempt organization....................
    1b(1)
     
    No
    (2) Purchases of assets from a noncharitable exempt organization..................
    1b(2)
     
    No
    (3) Rental of facilities, equipment, or other assets.......................
    1b(3)
     
    No
    (4) Reimbursement arrangements...........................
    1b(4)
     
    No
    (5) Loans or loan guarantees.............................
    1b(5)
     
    No
    (6) Performance of services or membership or fundraising solicitations................
    1b(6)
     
    No
    c
    Sharing of facilities, equipment, mailing lists, other assets, or paid employees..............
    1c
     
    No
    d
    If the answer to any of the above is "Yes," complete the following schedule. Column (b) should always show the fair market value
    of the goods, other assets, or services given by the reporting foundation. If the foundation received less than fair market value
    in any transaction or sharing arrangement, show in column (d) the value of the goods, other assets, or services received.

    (a) Line No. (b) Amount involved (c) Name of noncharitable exempt organization (d) Description of transfers, transactions, and sharing arrangements
    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?...........
    b
    If "Yes," complete the following schedule.

    (a) Name of organization (b) Type of organization (c) Description of relationship
    Sign Here
    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 complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.
    Bullet Bullet
    May the IRS discuss this return
    with the preparer shown below
    (see instr.)?
    Signature of officer or trustee Date Title
    Paid Preparer Use Only Print/Type preparer's name Preparer's Signature Date PTIN
    Firm's name SmallBullet
    		 Firm's EIN SmallBullet
    Firm's address SmallBullet


    		 Phone no.
    Form 990-PF (2015)
    Additional Data


    Software ID:  
    Software Version:  
    Part VI Line 7 -Original Return Overpayment: -1,560


    Form 990PF - Special Condition Description:
    Special Condition Description
    Schedule B
    (Form 990, 990-EZ,
    or 990-PF)
    Department of the Treasury
    Internal Revenue Service
    Schedule of Contributors
    Arrow Bullet Attach to Form 990, 990-EZ, or 990-PF.
    Arrow Bullet Information about Schedule B (Form 990, 990-EZ, or 990-PF) and its instructions is at www.irs.gov/form990.
    OMB No. 1545-0047
    2015
    Name of the organization
    FIRST CITIZENS CHARITABLE FOUNDATION INC
     
    Employer identification number

    42-1451615
    Organization type (check one):
    Filers of:
    Section:
    Form 990 or 990-EZ





    Form 990-PF




    Check if 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 and a Special Rule. See instructions.
    General Rule
    Special Rules
    ......... Arrow Bullet $  
    Caution. An organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990,
    990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its
    Form 990-EZ or on its Form 990PF, Part I, line 2, to certify that it does not meet the filing requirements of Schedule B (Form 990,
    990-EZ, or 990-PF).
    For Paperwork Reduction Act Notice, see the Instructions
    for Form 990, 990-EZ, or 990-PF.
    Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2015)
    Schedule B (Form 990, 990-EZ, or 990-PF) (2015) Page 2
    Name of organization
    FIRST CITIZENS CHARITABLE FOUNDATION INC
          		Employer identification number
    42-1451615
    Part I
    Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Total contributions    		 (d)
    Type of contribution
    1
    FIRST CITIZENS BANK
     

       
    2601 4TH ST SW
     
    MASON CITY, IA50401

    		$ 360,000


    (Complete Part II for noncash contributions.)
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Total contributions    		 (d)
    Type of contribution
     
     
     

       
     
     

    		$  


    (Complete Part II for noncash contributions.)
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Total contributions    		 (d)
    Type of contribution
     
     
     

       
     
     

    		$  


    (Complete Part II for noncash contributions.)
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Total contributions    		 (d)
    Type of contribution
     
     
     

       
     
     

    		$  


    (Complete Part II for noncash contributions.)
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Total contributions    		 (d)
    Type of contribution
     
     
     

       
     
     

    		$  


    (Complete Part II for noncash contributions.)
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Total contributions    		 (d)
    Type of contribution
     
     
     

       
     
     

    		$  


    (Complete Part II for noncash contributions.)
    Schedule B (Form 990, 990-EZ, or 990-PF) (2015)
    Schedule B (Form 990, 990-EZ, or 990-PF) (2015)
    Page 3
    Name of organization
    FIRST CITIZENS CHARITABLE FOUNDATION INC
          		Employer identification number

    42-1451615
    Part II
    Noncash Property (see instructions). Use duplicate copies of Part II if additional space is needed.
    (a)
    No.from Part I    		 (b)
    Description of noncash property given    		 (c)
    FMV (or estimate)
    (see instructions)     		(d)
    Date received
     
    		$    
    (a)
    No.from Part I    		 (b)
    Description of noncash property given    		 (c)
    FMV (or estimate)
    (see instructions)     		(d)
    Date received
     
    		$    
    (a)
    No.from Part I    		 (b)
    Description of noncash property given    		 (c)
    FMV (or estimate)
    (see instructions)     		(d)
    Date received
     
    		$    
    (a)
    No.from Part I    		 (b)
    Description of noncash property given    		 (c)
    FMV (or estimate)
    (see instructions)     		(d)
    Date received
     
    		$    
    (a)
    No.from Part I    		 (b)
    Description of noncash property given    		 (c)
    FMV (or estimate)
    (see instructions)     		(d)
    Date received
     
    		$    
    (a)
    No.from Part I    		 (b)
    Description of noncash property given    		 (c)
    FMV (or estimate)
    (see instructions)     		(d)
    Date received
     
    		$    
    Schedule B (Form 990, 990-EZ, or 990-PF) (2015)
    Schedule B (Form 990, 990-EZ, or 990-PF) (2015)
    Page 4
    Name of organization
    FIRST CITIZENS CHARITABLE FOUNDATION INC
          		Employer identification number

    42-1451615
    Part III
    Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10) that total more than $1,000 for the year from any one contributor. Complete columns (a) through (e) and the following line entry. For organizations completing Part III, enter the total of exclusively religious, charitable, etc., contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet$  
    Use duplicate copies of Part III if additional space is needed.
    (a)
    No.from Part I    		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
     
    (e) Transfer of gift
    Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
     
     
         
     
    (a)
    No.from Part I    		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
     
    (e) Transfer of gift
    Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
     
     
         
     
    (a)
    No.from Part I    		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
     
    (e) Transfer of gift
    Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
     
     
         
     
    (a)
    No.from Part I    		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
     
    (e) Transfer of gift
    Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
     
     
         
     
    Schedule B (Form 990, 990-EZ, or 990-PF) (2015)

    Additional Data


    Software ID:  
    Software Version:  

    TY 2015 AccountingFeesSchedule
    Name:
    FIRST CITIZENS CHARITABLE FOUNDATION INC
    EIN:
    42-1451615
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    SCHUPICK & ASSOC, PC TAX PREPARATION 840 840    

    TY 2015 InvestmentsCorpBondsSchedule
    Name:
    FIRST CITIZENS CHARITABLE FOUNDATION INC
    EIN:
    42-1451615
    Name of Bond End of Year Book Value End of Year Fair Market Value
    ROYAL BANK OF CANADA 75,000 75,197
    VANGUARD HIGH YIELD CORPORATE FUND 72,164 65,387

    TY 2015 InvestmentsCorpStockSchedule
    Name:
    FIRST CITIZENS CHARITABLE FOUNDATION INC
    EIN:
    42-1451615
    Name of Stock End of Year Book Value End of Year Fair Market Value
    AT&T INC 14,143 14,796
    ALTRIA GROUP INC 9,530 17,172
    AMERICAN ELEC PWR INC 2,959 4,137
    BCE INC COM 12,731 11,045
    BERKSHIRE HATHAWAY INC 21,823 33,010
    CHEVRON CORPORATION 7,107 6,117
    COCA COLA 5,502 6,358
    DOMINION RESOURCES INC 6,084 7,440
    DUKE ENERGY HOLDINGS 10,828 11,637
    EXXON MOBIL CORP 11,448 12,472
    GENERAL MILLS INC 5,845 6,343
    HCP INC 7,173 6,921
    JOHNSON & JOHNSON 5,680 7,909
    KIMBERLY CLARK CORP 5,872 9,675
    KRAFT FOODS GROUP 10,891 15,789
    MCDONALDS CORP 13,392 16,421
    MERCK & CO 10,020 12,519
    NATIONAL GRID PLC 12,847 16,342
    OMEGA HEALTHCARE INVESTORS INC 4,392 4,373
    PNC FINANCIAL SVCS CORP 24,975 28,593
    PPL CORP 6,970 8,601
    PEPSICO INC 2,992 4,197
    PHILLIP MORRIS INTL INC 16,373 17,494
    PROCTOR & GAMBLE CO 15,438 16,041
    REALTY INCOME CORP 4,194 5,008
    REYNOLDS AMERICAN 8,124 17,306
    SANOFI-AVENTIS SPONS ADR 3,598 3,369
    SOUTHERN CO 10,973 11,604
    VENTAS INC 6,003 6,151
    VERIZON COMMUNICATIONS INC 13,737 13,866
    WELLS FARGO & CO 34,192 59,796
    WELLTOWER INC 6,073 7,007
    BANK OF AMERICA PREFERRED 49,784 60,130
    B P AMOCO SPONSORED ADR 14,636 10,753
    GLAXOSMITHKLINE PLC 17,871 15,414
    ROYAL DUTCH SHELL PLC 12,531 8,011
    UNILEVER PLC 8,602 9,228
    VODAFONE GROUP PLC 13,186 9,678

    TY 2015 InvestmentsOtherSchedule2
    Name:
    FIRST CITIZENS CHARITABLE FOUNDATION INC
    EIN:
    42-1451615
    Category/ Item Listed at Cost or FMV Book Value End of Year Fair Market Value
    ISHARE S&P MIDCAP 400 GROWTH   54,117 67,603
    ISHARE S&P MIDCAP 400 VALUE   54,692 66,804
    ISHARE S&P SMALLCAP 600 BARRA VALUE   36,239 48,131
    ISHARE S&P SMALLCAP 600 GROWTH   31,087 48,481
    ETF VANGUARD EMERGING MARKETS   72,749 53,644
    ISHARE MSCI EAFE FUND   106,817 103,347
    ISHARE DOW JONES INTL SELECT DIV IDX   103,851 86,130
    ISHARES DJ US REAL ESTATE   59,727 64,944

    TY 2015 OtherIncomeSchedule2
    Name:
    FIRST CITIZENS CHARITABLE FOUNDATION INC
    EIN:
    42-1451615
    Description Revenue And Expenses Per Books Net Investment Income Adjusted Net Income
    OTHER INVESTMENT INCOME 190 190  


    TY 2015 OtherIncreasesSchedule
    Name:
    FIRST CITIZENS CHARITABLE FOUNDATION INC
    EIN:
    42-1451615
    Description Amount
    CAPITAL GAIN 23,809


    TY 2015 OtherProfessionalFeesSchedule
    Name:
    FIRST CITIZENS CHARITABLE FOUNDATION INC
    EIN:
    42-1451615
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    FIRST CITIZENS TRUST CO. TRUSTEE 5,841 5,841    


    TY 2015 TaxesSchedule
    Name:
    FIRST CITIZENS CHARITABLE FOUNDATION INC
    EIN:
    42-1451615
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    FOREIGN TAXES 28 28    
    FEDERAL EXCISE TAXES 2,387 2,387