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.
bulletGo to www.irs.gov/Form990PF for instructions and the latest information.
OMB No. 1545-0047
2021
Open to Public Inspection
For calendar year 2021, or tax year beginning 07-01-2021 , and ending 06-30-2022
Name of foundation
MAX AND HELEN GUERNSEY
CHARITABLE FOUNDATION
Number and street (or P.O. box number if mail is not delivered to street address)PO BOX 1172
  Room/suite
City or town, state or province, country, and ZIP or foreign postal code
WATERLOO, IA507041172
A Employer identification number

42-1460664
B Telephone number (see instructions)

(319) 226-3434
C bullet
G Check all that apply:

D 1. Foreign organizations, check here............. bullet
2. Foreign organizations meeting the 85%
test, check here and attach computation ... 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$42,706,607J 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) 5,000
2 Check bullet.............
3 Interest on savings and temporary cash investments 97,650 94,938  
4 Dividends and interest from securities... 726,272 725,166  
5a Gross rents............      
b Net rental income or (loss)  
6a Net gain or (loss) from sale of assets not on line 10 935,151
b Gross sales price for all assets on line 6a 12,520,711
7 Capital gain net income (from Part IV, line 2)... 935,151
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 1,480,175 0  
12 Total. Add lines 1 through 11........ 3,244,248 1,755,255  
Operating and Administrative Expenses 13 Compensation of officers, directors, trustees, etc. 52,520 6,010   46,510
14 Other employee salaries and wages...... 67,191 0   67,191
15 Pension plans, employee benefits....... 2,400 0   2,400
16a Legal fees (attach schedule).........        
b Accounting fees (attach schedule)....... Click to see attachment 20,962 8,385   8,736
c Other professional fees (attach schedule)....        
17 Interest...............        
18 Taxes (attach schedule) (see instructions)... Click to see attachment 256,268 4,662   5,140
19 Depreciation (attach schedule) and depletion... Click to see attachment 6,961 0  
20 Occupancy.............. 16,758 0   16,758
21 Travel, conferences, and meetings....... 151 0   151
22 Printing and publications..........        
23 Other expenses (attach schedule)....... Click to see attachment 432,261 104,126   29,827
24 Total operating and administrative expenses.
Add lines 13 through 23.......... 855,472 123,183   176,713
25 Contributions, gifts, grants paid....... 1,820,000 1,820,000
26 Total expenses and disbursements. Add lines 24 and 25 2,675,472 123,183   1,996,713
27 Subtract line 26 from line 12:
a Excess of revenue over expenses and disbursements 568,776
b Net investment income (if negative, enter -0-) 1,632,072
c Adjusted net income (if negative, enter -0-)...  
For Paperwork Reduction Act Notice, see instructions.
Cat. No. 11289X Form 990-PF (2021)
Form 990-PF (2021)
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.............      
2 Savings and temporary cash investments......... 926,785 1,858,797 1,858,797
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) 14,650,834 Click to see attachment11,911,436 11,911,436
b Investments—corporate stock (attach schedule)....... 25,274,359 Click to see attachment20,662,633 20,662,633
c Investments—corporate bonds (attach schedule)....... 2,757,816 Click to see attachment3,288,784 3,288,784
11 Investments—land, buildings, and equipment: basis bullet  
Less: accumulated depreciation (attach schedule) bullet        
12 Investments—mortgage loans.............      
13 Investments—other (attach schedule).......... 4,903,270 Click to see attachment4,903,166 4,903,166
14 Land, buildings, and equipment: basis bullet44,974
Less: accumulated depreciation (attach schedule) bullet36,739 12,473 Click to see attachment8,235 8,235
15 Other assets (describe bullet) Click to see attachment115,778 Click to see attachment73,556 Click to see attachment73,556
16 Total assets (to be completed by all filers—see the
instructions. Also, see page 1, item I) 48,641,315 42,706,607 42,706,607
Liabilities 17 Accounts payable and accrued expenses.......... 11,266 10,679
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) Click to see attachment7,746 Click to see attachment53,601
23 Total liabilities (add lines 17 through 22)......... 19,012 64,280
Net Assets or Fund Balances Foundations that follow FASB ASC 958, check here bullet
and complete lines 24, 25, 29 and 30.
24 Net assets without donor restrictions...........    
25 Net assets with donor restrictions............    
Foundations that do not follow FASB ASC 958, check here bullet
and complete lines 26 through 30.
26 Capital stock, trust principal, or current funds........ 0 0
27 Paid-in or capital surplus, or land, bldg., and equipment fund 0 0
28 Retained earnings, accumulated income, endowment, or other funds 48,622,303 42,642,327
29 Total net assets or fund balances (see instructions)..... 48,622,303 42,642,327
30 Total liabilities and net assets/fund balances (see instructions). 48,641,315 42,706,607
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 29 (must agree with end-of-year figure reported on prior year’s return) ...............
1
48,622,303
2
Enter amount from Part I, line 27a .....................
2
568,776
3
Other increases not included in line 2 (itemize) bulletClick to see attachment
3
867,461
4
Add lines 1, 2, and 3 ..........................
4
50,058,540
5
Decreases not included in line 2 (itemize) bulletClick to see attachment
5
7,416,213
6
Total net assets or fund balances at end of year (line 4 minus line 5)—Part II, column (b), line 29 .
6
42,642,327
Form 990-PF (2021)
Form 990-PF (2021)
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 PUBLICLY TRADED SECURITIES P    
b PUBLICLY TRADED SECURITIES P    
c CAPITAL GAINS DIVIDENDS P    
d
e
(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 3,407,108   2,903,448 503,660
b 8,382,770   8,682,112 -299,342
c 730,833     730,833
d
e
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       503,660
b       -299,342
c       730,833
d
e
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 2 935,151
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  
Form 990-PF (2021)
Form 990-PF (2021)
Page 4
Part V
Excise Tax Based on Investment Income (Section 4940(a), 4940(b), 4940(e), or 4948—see instructions)
1a Exempt operating foundations described in section 4940(d)(2), check here Bullet and enter “N/A" on line 1. Bracket for line 1a
Date of ruling or determination letter:   (attach copy of letter if necessary–see instructions)
b All other domestic foundations enter 1.39% (0.0139) of line 27b. Exempt foreign organizations enter 4% (0.04) 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 22,686
4 Subtitle A (income) tax (domestic section 4947(a)(1) trusts and taxable foundations only. Others enter -0-) 4 0
5 Tax based on investment income. Subtract line 4 from line 3. If zero or less, enter -0- ..... 5 22,686
6 Credits/Payments:
a 2021 estimated tax payments and 2020 overpayment credited to 2021 6a 28,920
b Exempt foreign organizations—tax withheld at source...... 6b 0
c Tax paid with application for extension of time to file (Form 8868)... 6c 0
d Backup withholding erroneously withheld ........... 6d 0
7 Total credits and payments. Add lines 6a through 6d.............. 7 28,920
8 Enter any penalty for underpayment of estimated tax. Check here if Form 2220 is attached. 8 0
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 6,234
11 Enter the amount of line 10 to be: Credited to 2022 estimated taxBullet6,234 RefundedBullet 11 0
Part VI-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 the instructions
for the 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$ 0(2) On foundation managers.bullet$ 0
e
Enter the reimbursement (if any) paid by the foundation during the year for political expenditure tax imposed
on foundation managers.bullet$ 0
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 changesClick to see attachment....
3
Yes
 
4a
Did the foundation have unrelated business gross income of $1,000 or more during the year?.........
4a
Yes
 
b
If "Yes," has it filed a tax return on Form 990-T for this year?...................
4b
Yes
 
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 XIV..................................
    7
    Yes
     
    8a
    Enter the states to which the foundation reports or with which it is registered (see instructions)
    bulletIA
    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
    Yes
     
    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 2021 or the taxable year beginning in 2021? See the instructions for Part XIII.
    If "Yes," complete Part XIII .............................
    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 (2021)
    Form 990-PF (2021)
    Page 5
    Part VI-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
    Yes
     
    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 addressbulletWWW.GUERNSEYFOUNDATION.COM
    14
    The books are in care ofbulletBERGANKDV LTD Telephone no.bullet (319) 234-6885

    Located atbullet100 E PARK AVENUE STE 300WATERLOOIA ZIP+4bullet50704
    15
    Section 4947(a)(1) nonexempt charitable trusts filing Form 990-PF in lieu of Form 1041 —check here .........bullet
    and enter the amount of tax-exempt interest received or accrued during the year ........bullet
    15
     
    16 At any time during calendar year 2021, 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 the instructions for exceptions and filing requirements for FinCEN Form 114. If "Yes", enter the name of the foreign
    country bullet
    Part VI-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? ...........
    1a(1)
     
    No
    (2) Borrow money from, lend money to, or otherwise extend credit to (or accept it from)
    a disqualified person? ..............................
    1a(2)
     
    No
    (3) Furnish goods, services, or facilities to (or accept them from) a disqualified person? ...........
    1a(3)
     
    No
    (4) Pay compensation to, or pay or reimburse the expenses of, a disqualified person? ............
    1a(4)
    Yes
     
    (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)? ......................
    1a(5)
     
    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.) ...............
    1a(6)
     
    No
    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
     
    No
    c
    ........bullet
    d
    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 2021? .............
    1d
     
    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 2021, did the foundation have any undistributed income (lines 6d
    and 6e, Part XII) for tax year(s) beginning before 2021?....................
    2a
     
    No
    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? ..............................
    3a
    Yes
     
    b
    If "Yes," did it have excess business holdings in 2021 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 2021.) .....................
    3b
     
    No
    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 2021? ..
    4b
     
    No
    Form 990-PF (2021)
    Form 990-PF (2021)
    Page 6
    Part VI-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:
    Yes
    No
    (1) Carry on propaganda, or otherwise attempt to influence legislation (section 4945(e))? ..........
    5a(1)
     
    No
    (2) Influence the outcome of any specific public election (see section 4955); or to carry
    on, directly or indirectly, any voter registration drive? ....................
    5a(2)
     
    No
    (3) Provide a grant to an individual for travel, study, or other similar purposes? .............
    5a(3)
     
    No
    (4) Provide a grant to an organization other than a charitable, etc., organization described
    in section 4945(d)(4)(A)? See instructions ........................
    5a(4)
     
    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? .............
    5a(5)
     
    No
    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
     
     
    c
    .........bullet
    d
    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? .................
    5d
     
     
    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? .............................
    6a
     
    No
    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?
    7a
     
    No
    b
    If "Yes", did the foundation receive any proceeds or have any net income attributable to the transaction? .....
    7b
     
     
    8
    Is the foundation subject to the section 4960 tax on payment(s) of more than $1,000,000 in remuneration or
    excess parachute payment during the year? .........................
    8
     
    No
    Part VII
    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
    THOMAS R PAULSEN FINANCE COMMITTEE CHAIR
    1.00     		12,020 0 0
    PO BOX 1172
    WATERLOO,IA50704
    GARY NELSON TRUSTEE CHAIR
    1.00     		11,000 0 0
    PO BOX 1172
    WATERLOO,IA50704
    HAROLD B STREVER JR ADMIN COMMITTEE CHAIR
    1.00     		10,500 0 0
    PO BOX 1172
    WATERLOO,IA50704
    LOIS M JOHNSON SECRETARY
    1.00     		9,500 0 0
    PO BOX 1172
    WATERLOO,IA50704
    SOO GREIMAN TRUSTEE
    1.00     		9,500 0 0
    PO BOX 1172
    WATERLOO,IA50704
    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
    CASEY J REINTS EXECUTIVE DIRECTOR
    40.00     		57,630 0 0
    32254 250TH ST
    SHELL ROCK,IA50670
    Total number of other employees paid over $50,000...................bullet 0
    Form 990-PF (2021)
    Form 990-PF (2021)
    Page 7
    Part VII
    Information About Officers, Directors, Trustees, Foundation Managers, Highly Paid Employees,
    and Contractors (continued)
    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 VIII-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  
    2  
    3  
    4  
    Part VIII-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 N/A 0
    2  
    All other program-related investments. See instructions.
    3  
    Total. Add lines 1 through 3.........................bullet0
    Form 990-PF (2021)
    Form 990-PF (2021)
    Page 8
    Part IX
    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
    41,813,463
    b
    Average of monthly cash balances.......................
    1b
    1,323,678
    c
    Fair market value of all other assets (see instructions)................
    1c
    5,124,968
    d
    Total (add lines 1a, b, and c).........................
    1d
    48,262,109
    e
    Reduction claimed for blockage or other factors reported on lines 1a and
    1c (attach detailed explanation) .............
    1e
    0
    2
    Acquisition indebtedness applicable to line 1 assets..................
    2
    0
    3
    Subtract line 2 from line 1d.........................
    3
    48,262,109
    4
    Cash deemed held for charitable activities. Enter 1.5% (0.015) of line 3 (for greater amount, see
    instructions) .............................
    4
    723,932
    5
    Net value of noncharitable-use assets. Subtract line 4 from line 3. .......
    5
    47,538,177
    6
    Minimum investment return. Enter 5% (0.05) of line 5................
    6
    2,376,909
    Part X
    Distributable Amount (see instructions) (Section 4942(j)(3) and (j)(5) private operating foundations and certain foreign organizations check here right arrow and do not complete this part.)
    1
    Minimum investment return from Part IX, line 6..................
    1
    2,376,909
    2a
    Tax on investment income for 2021 from Part V, line 5.......
    2a
    22,686
    b
    Income tax for 2021. (This does not include the tax from Part V.) ...
    2b
    223,780
    c
    Add lines 2a and 2b............................
    2c
    246,466
    3
    Distributable amount before adjustments. Subtract line 2c from line 1............
    3
    2,130,443
    4
    Recoveries of amounts treated as qualifying distributions................
    4
    0
    5
    Add lines 3 and 4............................
    5
    2,130,443
    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 XII, line 1 ...
    7
    2,130,443
    Part XI
    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
     
    b
    Program-related investments—total from Part VIII-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 XII, line 4.
    4
     
    Form 990-PF (2021)
    Form 990-PF (2021)
    Page 9
    Part XII
    Undistributed Income (see instructions)
    (a)
    Corpus     		(b)
    Years prior to 2020     		(c)
    2020     		(d)
    2021
    1 Distributable amount for 2021 from Part X, line 7 2,130,443
    2 Undistributed income, if any, as of the end of 2021:
    a Enter amount for 2020 only....... 0
    b Total for prior years:20, 20, 20 0
    3 Excess distributions carryover, if any, to 2021:
    a From 2016...... 327,934
    b From 2017...... 271,579
    c From 2018......  
    d From 2019...... 28,759
    e From 2020......  
    f Total of lines 3a through e ........ 628,272
    4Qualifying distributions for 2021 from Part
    XI, line 4: bullet$ 1,999,437
    a Applied to 2020, but not more than line 2a 0
    b Applied to undistributed income of prior years
    (Election required—see instructions).....     		0
    c Treated as distributions out of corpus (Election
    required—see instructions)........     		0
    d Applied to 2021 distributable amount..... 1,999,437
    e Remaining amount distributed out of corpus 0
    5 Excess distributions carryover applied to 2021. 131,006 131,006
    (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 5 497,266
    b Prior years’ undistributed income. Subtract
    line 4b from line 2b ..........     		0
    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......     		0
    d Subtract line 6c from line 6b. Taxable amount
    —see instructions ...........     		0
    e Undistributed income for 2019. Subtract line
    4a from line 2a. Taxable amount—see
    instructions .............     		0
    f Undistributed income for 2021. Subtract
    lines 4d and 5 from line 1. This amount must
    be distributed in 2022 ..........     		0
    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) .......     		0
    8 Excess distributions carryover from 2016 not
    applied on line 5 or line 7 (see instructions) ...     		196,928
    9 Excess distributions carryover to 2022.
    Subtract lines 7 and 8 from line 6a ......     		300,338
    10 Analysis of line 9:
    a Excess from 2017.... 271,579
    b Excess from 2018....  
    c Excess from 2019.... 28,759
    d Excess from 2020....  
    e Excess from 2021....  
    Form 990-PF (2021)
    Form 990-PF (2021)
    Page 10
    Part XIII
    Private Operating Foundations (see instructions and Part VI-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 2021, 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) 2021 (b) 2020 (c) 2019 (d) 2018
             
    b 85% (0.85) of line 2a .........          
    c Qualifying distributions from Part XI,
    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 IX, 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 XIV
    Supplementary Information (Complete this part only if the foundation 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).)
    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.
    GARY NELSON
    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:
    MAX HELEN GUERNSEY CHARITABLE FOUND
    PO BOX 1172
    WATERLOO,IA507041172
    (319) 226-3434
    bThe form in which applications should be submitted and information and materials they should include:
    APPLICATIONS SHOULD BE SUBMITTED IN WRITING IDENTIFYING THE PURPOSE AND AMOUNT REQUESTED. THE APPLICATION SHOULD BE ACCOMPANIED BY FINANCIAL STATEMENTS AND PROOF OF 501(C)(3) ORGANIZATION STATUS OR VERIFICATION THAT THE ORGANIZATION WILL USE THE FUNDS EXCLUSIVELY FOR PUBLIC PURPOSES OR AS OTHERWISE DESCRIBED IN IRC SECTION 170(C)(1).
    cAny submission deadlines:
    NONE
    dAny restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other
    factors:
    ALL AWARDS MUST BE TO CHARITABLE, SCIENTIFIC, LITERARY, OR EDUCATIONAL ORGANIZATIONS WITHIN THE MEANING OF IRC SECTION 501(C)(3) OR EXCLUSIVELY FOR PUBLIC PURPOSES OR AS OTHERWISE DESCRIBED IN IRC SECTION 170(C)(1).
    Form 990-PF (2021)
    Form 990-PF (2021)
    Page 11
    Part XIV
    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
    AMANI COMMUNITY SERVICES
    2315 FALLS AVE SUITE 1
    WATERLOO,IA50701     		N/A OTHER PUBLIC CHARITY PROGRAM SUPPORT - I BELIEVE LEADERSHIP ACADEMY 22,000
    AMERICANS FOR INDEPENDENT LIVING
    904 W 4TH ST
    WATERLOO,IA50702     		N/A OTHER PUBLIC CHARITY FURNITURE FOR VETERANS PROGRAM 20,000
    BLACK HAWK SHERIFF'S DEPT
    225 E 6TH ST
    WATERLOO,IA50703     		N/A EXCLUSIVELY FOR PUBL K9 PROGRAM 1,500
    BOYS & GIRLS CLUB OF THE CEDAR VALLEY
    515 LIME ST
    WATERLOO,IA50703     		N/A OTHER PUBLIC CHARITY PROGRAM SUPPORT - PROJECT LEARN 30,000
    BREMER COUNTY HISTORICAL SOCIETY
    402 W BREMER AVE
    WAVERLY,IA50677     		N/A OTHER PUBLIC CHARITY CAPITAL - WALL & FOUNDATION RESTORATION 19,000
    BREMER COUNTY SHERIFF
    111 4TH ST NE
    WAVERLY,IA50677     		N/A EXCLUSIVELY FOR PUBL K9 PROGRAM 2,500
    BUCHANAN COUNTY ANIMAL SHELTER
    400 N 1ST ST
    HAZLETON,IA50641     		N/A OTHER PUBLIC CHARITY CAPITAL - WELL WATER RENEWAL - OTTER CREEK ANIMAL SHELTER 5,000
    CEDAR BEND HUMANE SOCIETY INC
    1166 W AIRLINE HWY
    WATERLOO,IA50701     		N/A OTHER PUBLIC CHARITY IN HOUSE SPAY & NEUTER PROGRAM 30,000
    CEDAR FALLS SCHOOLS FOUNDATION
    602 MAIN ST
    CEDAR FALLS,IA50613     		N/A OTHER PUBLIC CHARITY CAPITAL - SWIMMING POOL CONSTRUCTION 35,000
    CEDAR VALLEY ARBORETUM & BOTANIC GARDENS
    1927 E ORANGE RD
    WATERLOO,IA50701     		N/A OTHER PUBLIC CHARITY OPERATING SUPPORT 30,000
    CEDAR VALLEY BICYCLE COLLECTIVE
    219 W 4TH ST
    WATERLOO,IA50701     		N/A OTHER PUBLIC CHARITY OPERATING SUPPORT 6,000
    CEDAR VALLEY CRIMESTOPPERS INC
    715 MULBERRY ST
    WATERLOO,IA50703     		N/A OTHER PUBLIC CHARITY OPERATING SUPPORT 7,500
    CEDAR VALLEY GEARHEADS MINISTRIES INC
    3606 SKYVIEW DR
    CEDAR FALLS,IA50613     		N/A OTHER PUBLIC CHARITY OPERATING SUPPORT 20,000
    CEDAR VALLEY HOSPICE INC
    900 TOWER PARK DRIVE
    WATERLOO,IA50701     		N/A OTHER PUBLIC CHARITY PALLIATIVE CARE PROGRAM 30,000
    CEDAR VALLEY PRESCHOOL & CHILDCARE CENTER
    724 LANTZ AVE
    CEDAR FALLS,IA50613     		N/A OTHER PUBLIC CHARITY OPERATING SUPPORT 5,000
    CEDAR VALLEY PRESCHOOL & CHILDCARE CENTER
    724 LANTZ AVE
    CEDAR FALLS,IA50613     		N/A OTHER PUBLIC CHARITY BUILDING BRIGHT FUTURES PROGRAM 30,000
    CEDAR VALLEY UNITED WAY
    425 CEDAR ST STE 300
    WATERLOO,IA50701     		N/A OTHER PUBLIC CHARITY BOOKS FOR BABIES PROGRAM 5,000
    CEDAR VALLEY UNITED WAY
    425 CEDAR ST STE 300
    WATERLOO,IA50701     		N/A OTHER PUBLIC CHARITY OPERATING SUPPORT 3,500
    CHRISTIAN COMMUNITY DEVELOPMENT
    845 W 4TH ST
    WATERLOO,IA50702     		N/A OTHER PUBLIC CHARITY OPERATING SUPPORT FOR HOUSE OF HOPE 30,000
    CITY OF CLARKSVILLE
    115 W SUPERIOR ST PO BOX 309
    CLARKSVILLE,IA50619     		N/A EXCLUSIVELY FOR PUBL CAPITAL - VOLUNTEER PARK ADDITION 20,000
    CITY OF JANESVILLE
    227 MAIN ST PO BOX 328
    JANESVILLE,IA50647     		N/A EXCLUSIVELY FOR PUBL CAPITAL - PUBLIC LIBRARY CONSTRUCTION 50,000
    CITY OF JESUP
    791 6TH ST PO BOX 592
    JESUP,IA50648     		N/A EXCLUSIVELY FOR PUBL CAPITAL - LIBERTY PARK SPLASH PAD 30,000
    CITY OF LAPORTE CITY
    408 MAIN ST
    LA PORTE CITY,IA50651     		N/A EXCLUSIVELY FOR PUBL CAPITAL - WEB DESIGN & EXHIBIT DEVELOPMENT FOR FFA/AG MUSEUM 3,500
    CITY OF NEW HARTFORD
    PO BOX 212 503 PACKWAUKEE ST
    NEW HARTFORD,IA50660     		N/A EXCLUSIVELY FOR PUBL CAPITAL - SPLASH PAD CONSTRUCTION 30,000
    CITY OF TRIPOLI
    303 MAIN ST
    TRIPOLI,IA50676     		N/A EXCLUSIVELY FOR PUBL CAPITAL - WELCOME CENTER & TRAIL BRIDGE RENOVATIONS 4,500
    FAMILY & CHILDREN'S COUNCIL OF BLACK HAWK COUNTY
    316 W 5TH ST
    WATERLOO,IA50701     		N/A OTHER PUBLIC CHARITY PROGRAM SUPPORT - SEXUAL ABUSE PREVENTION 15,000
    GRIN & GROW LTD
    608 W 4TH ST
    WATERLOO,IA50702     		N/A OTHER PUBLIC CHARITY OPERATING SUPPORT - CHILDCARE GAP FUNDING FOR LOW INCOME 30,000
    GROUT MUSEUM INC
    503 SOUTH ST
    WATERLOO,IA50701     		N/A OTHER PUBLIC CHARITY OPERATING SUPPORT - SCIENCE OUTREACH 30,000
    HAWKEYE COMMUNITY COLLEGE FOUNDATION
    1501 E ORANGE RD PO BOX 8015
    WATERLOO,IA50704     		N/A OTHER PUBLIC CHARITY PROGRAM SUPPORT - HAWKEYE CELEBRATES THE ARTS 30,000
    INCLUSION CONNECTION INC
    1024 7TH AVE NW
    WAVERLY,IA50677     		N/A OTHER PUBLIC CHARITY OPERATING SUPPORT 7,000
    INDEPENDENCE POLICE DEPARTMENT
    2349 JAMESTOWN AVE 3
    INDEPENDENCE,IA50644     		N/A EXCLUSIVELY FOR PUBL K9 PROGRAM 2,500
    IOWA HEARTLAND HABITAT FOR HUMANITY
    803 W 5TH ST
    WATERLOO,IA50702     		N/A OTHER PUBLIC CHARITY AFFORDABLE HOME OWNERSHIP & CRITICAL REPAIRS PROGRAM 30,000
    IOWA JOBS FOR AMERICA'S GRADUATES INC
    1111 9TH ST STE 268
    DES MOINES,IA50314     		N/A OTHER PUBLIC CHARITY CAREER PATHS PROGRAM FOR UNDERSERVED YOUTH 15,000
    JUNIOR ACHIEVEMENT OF EASTERN IOWA
    425 CEDAR ST SUITE 320
    WATERLOO,IA50701     		N/A OTHER PUBLIC CHARITY PERSONAL FINANCE & STEM EDUCATION PROGRAMS 15,000
    LITTLE KNIGHTS LEARNING CENTER
    1102 CLARK ST
    DYSART,IA52224     		N/A OTHER PUBLIC CHARITY OPERATING SUPPORT 5,000
    LOVE INC OF THE CEDAR VALLEY
    2603 RAINBOW DRIVE SUITE 2
    CEDAR FALLS,IA50613     		N/A OTHER PUBLIC CHARITY WORK DYNAMICS PROGRAM 6,500
    METROPOLITAN CHORALE INC
    PO BOX 1616
    WATERLOO,IA50704     		N/A OTHER PUBLIC CHARITY OPERATING SUPPORT 5,000
    NAMI OF BLACK HAWK COUNTY
    C/O ALLEN HOSPITAL 1825 LOGAN AVE
    WATERLOO,IA50703     		N/A OTHER PUBLIC CHARITY OPERATING SUPPORT 5,000
    NE IOWA FOOD BANK
    1605 LAFAYETTE ST
    WATERLOO,IA50703     		N/A OTHER PUBLIC CHARITY FEEDING COMMUNITIES PROGRAM 30,000
    SENIOR CITIZENS GROUP OF WAVERLY
    506 E BREMER AVE
    WAVERLY,IA50677     		N/A OTHER PUBLIC CHARITY COMMUNITY OUTREACH PROGRAM 10,000
    SUCCESSLINK INC
    229 E PARK AVE
    WATERLOO,IA50703     		N/A OTHER PUBLIC CHARITY TOGETHER FOR YOUTH PROGRAMMING 30,000
    SUNRISE CHILDREN'S ZOO INC
    PO BOX 1102
    WATERLOO,IA50704     		N/A OTHER PUBLIC CHARITY OPERATING SUPPORT 1,000
    THE LARRABEE CENTER INC
    117 11TH ST NW
    WAVERLY,IA50677     		N/A OTHER PUBLIC CHARITY PROGRAM - EMPLOYMENT SUPPORT SERVICES 15,000
    TRANSFORMATIONS BY CEDAR VALLEY ANGELS
    PO BOX 11
    CEDAR FALLS,IA50613     		N/A OTHER PUBLIC CHARITY LOVE BOX & DARE TO DREAM PROGRAMS 30,000
    UNIVERSITY OF NORTHERN IOWA FOUNDATION
    204 COMMONS
    CEDAR FALLS,IA50613     		N/A OTHER PUBLIC CHARITY THEATER DEPT - CLASSIC UPWARD BOUND PROGRAM 5,000
    UNIVERSITY OF NORTHERN IOWA FOUNDATION
    204 COMMONS
    CEDAR FALLS,IA50613     		N/A OTHER PUBLIC CHARITY KALEIDOSCOPE & BLACK LIFE YOUTH CAMP PROGRAMS 30,000
    VOLUNTEER CENTER OF THE CEDAR VALLEY
    360 WESTFIELD AVE SUITE 201
    WATERLOO,IA50701     		N/A OTHER PUBLIC CHARITY OPERATING SUPPORT 10,000
    WARTBURG COMMUNITY SYMPHONY
    100 WARTBURG BLVD
    WAVERLY,IA50677     		N/A OTHER PUBLIC CHARITY PROGRAM SUPPORT - BLACK HISTORY CELEBRATION CONCERT 7,500
    WATERLOOCEDAR FALLS SYMPHONY ORCHESTRA ASSN
    8201 DAKOTA ST GALLAGHER BLUEDORN
    CEDAR FALLS,IA50614     		N/A OTHER PUBLIC CHARITY PROGRAMMING 10,000
    WATERLOO COMMUNITY FOUNDATION
    425 CEDAR ST 320
    WATERLOO,IA50704     		N/A OTHER PUBLIC CHARITY KOATS 4 KIDS PROGRAM 30,000
    WATERLOO COMMUNITY SCHOOLS FOUNDATION
    201 TOWER PARK DR
    WATERLOO,IA50701     		N/A OTHER PUBLIC CHARITY CAMP INVENTION PROGRAM 18,000
    WAVERLY SHELL ROCK UNITED WAY
    805 W BREMER AVE
    WAVERLY,IA50677     		N/A OTHER PUBLIC CHARITY OPERATING SUPPORT 3,500
    WILDWOOD HILLS INC
    2552 UNION LANE
    DES MOINES,IA50310     		N/A OTHER PUBLIC CHARITY NEXT STEPS PROGRAM 20,000
    YOUTH ART TEAM
    325 E PARK AVE 101
    WATERLOO,IA50703     		N/A OTHER PUBLIC CHARITY HIGH STAKES PROGRAM 30,000
    YWCA OF BLACK HAWK COUNTY
    425 LAFAYETTE ST
    WATERLOO,IA50703     		N/A OTHER PUBLIC CHARITY YOUTH & FAMILY SERVICES PROGRAMS 30,000
    ALL IN MENTORING
    PO BOX 260
    WAVERLY,IA50677     		N/A OTHER PUBLIC CHARITY ADULT TO YOUTH MENTORING PROGRAM 21,000
    AREA EMERGENCY & TRANSPORTATIONS SERVICES INC
    212 MAIN ST
    ELGIN,IA52141     		N/A OTHER PUBLIC CHARITY CAPITAL - COT & MONITOR FOR AMBULANCE 20,000
    BENTON COUNTY CONSERVATION BOARD
    5718 20TH AVE DR
    VINTON,IA52349     		N/A OTHER PUBLIC CHARITY CAPITAL - TRAILHEAD WATER SOURCE 8,000
    BLACK HAWK COUNTY EXTENSION SERVICE
    3420 UNIVERSITY AVE B
    WATERLOO,IA50701     		N/A OTHER PUBLIC CHARITY OPERATING SUPPORT - BLACK HAWK COUNTY 4H/FFA FAIR 20,000
    BLAIRSTOWN AMBULANCE SERVICE INC
    PO BOX 19
    BLAIRSTOWN,IA52209     		N/A OTHER PUBLIC CHARITY CAPITAL - CARDIAC MONITOR & IV PUMP 20,000
    BOSNIAN CULTURAL FOUNDATION INC
    209 FOREST AVE
    WATERLOO,IA50702     		N/A OTHER PUBLIC CHARITY PROGRAM SUPPORT - KOLO DANCE FESTIVAL 15,000
    BREMER COUNTY FAIR ASSOCIATION
    PO BOX 142
    WAVERLY,IA50677     		N/A OTHER PUBLIC CHARITY CAPITAL - PHASE 1 BUILDING PROGRAM 30,000
    BUTLER COUNTY CONSERVATION BOARD
    27887 195TH ST
    CLARKSVILLE,IA50619     		N/A OTHER PUBLIC CHARITY CAPITAL - FISHING HANDICAP RAMP 25,000
    CEDAR FALLS COMMUNITY FOUNDATION
    515 MAIN STREET
    CEDAR FALLS,IA50613     		N/A OTHER PUBLIC CHARITY OPERATING SUPPORT - CHILDREN & FAMILIES FUND 10,000
    CEDAR FALLS COMMUNITY FOUNDATION
    515 MAIN STREET
    CEDAR FALLS,IA50613     		N/A OTHER PUBLIC CHARITY OPERATING SUPPORT - HEALTH & WELLNESS FUND 5,000
    CEDAR FALLS HISTORICAL SOCIETY
    308 W 3RD ST
    CEDAR FALLS,IA50613     		N/A OTHER PUBLIC CHARITY CAPITAL - BUILDING PROGRAM 25,000
    CEDAR FALLS PUBLIC SCHOOLS
    1015 S DIVISION ST
    CEDAR FALLS,IA50613     		N/A OTHER PUBLIC CHARITY OPERATING SUPPORT - HIGH SCHOOL ROCKET CLUB 2,500
    CEDAR VALLEY ASSOCIATION FOR SOFT TRAILS
    217 WASHINGTON ST
    CEDAR FALLS,IA50613     		N/A OTHER PUBLIC CHARITY GRANT - UTV FOR TRAIL GROOMING 15,000
    CEDAR VALLEY IRISH CULTURAL ASSOCIATION INC
    315 E 5TH ST
    WATERLOO,IA50701     		N/A OTHER PUBLIC CHARITY IRISH FEST PROGRAMMING 20,000
    CHILDREN'S CANCER CONNECTION
    5701 GREENDALE RD
    JOHNSTON,IA50131     		N/A OTHER PUBLIC CHARITY SUMMER CAMP PROGRAM 5,000
    CLERMONT EMT'S INC
    808 STATE ST
    CLERMONT,IA52135     		N/A OTHER PUBLIC CHARITY CAPITAL - EQUIPMENT & TRAINING 3,500
    DENVER WRESTLING CLUB INC
    PO BOX 670
    DENVER,IA50622     		N/A OTHER PUBLIC CHARITY CAPITAL - WRESTLING ROOM CONSTRUCTION 30,000
    EASTSIDE MINISTERIAL ALLIANCE INC
    205 ADAMS ST SUITE 1
    WATERLOO,IA50703     		N/A OTHER PUBLIC CHARITY GETTING WORKERS BACK TO WORK PROGRAM 30,000
    EMS MD - COLLABORATIVE OF THE CEDAR VALLEY INC
    1702 BREMER RD
    WAVERLY,IA50677     		N/A OTHER PUBLIC CHARITY CAPITAL - PROTOCOL MOBILE APPLICATION DEVELOPMENT 12,000
    FAITH TEMPLE AMERICAN BAPTIST CHURCH
    234 S HACKETT RD
    WATERLOO,IA50701     		N/A OTHER PUBLIC CHARITY Y.E.S. YOUTH PROGRAM 6,000
    FAMILIES HELPING FAMILIES OF IOWA
    6000 7TH ST SW
    CEDAR RAPIDS,IA52404     		N/A OTHER PUBLIC CHARITY PROGRAM SUPPORT - SHOES FOR FOSTER CARE CHILDREN 5,000
    GROUT MUSEUM INC
    503 SOUTH ST
    WATERLOO,IA50701     		N/A OTHER PUBLIC CHARITY CAPITAL - MUSEUM RENOVATIONS 30,000
    HAWKEYE COMMUNITY COLLEGE FOUNDATION
    1501 E ORANGE RD PO BOX 8015
    WATERLOO,IA50704     		N/A OTHER PUBLIC CHARITY SHIRLEY KREGER SCHOLARSHIP FUND 5,000
    HAWKEYE COMMUNITY COLLEGE FOUNDATION
    1501 E ORANGE RD PO BOX 8015
    WATERLOO,IA50704     		N/A OTHER PUBLIC CHARITY WE BUILD WATERLOO PROGRAM 30,000
    HEALTHY CEDAR VALLEY COALITION
    5106 THYME RD
    CEDAR FALLS,IA50613     		N/A OTHER PUBLIC CHARITY COLOR ME HUMAN READING CHALLENGE PROGRAM 11,000
    IOWA GARDENING FOR GOOD
    2191 340TH ST
    MADRID,IA50156     		N/A OTHER PUBLIC CHARITY VOLUNTEER BASED GARDENING PROGRAM 9,000
    JOB FOUNDATION
    4600 UNIVERSITY AVE 1
    CEDAR FALLS,IA50613     		N/A OTHER PUBLIC CHARITY FINANCIAL STEWARDSHIP PROGRAM 15,000
    LEADER VALLEY FOUNDATION
    360 WESTFIELD AVE SUITE 200
    WATERLOO,IA50701     		N/A OTHER PUBLIC CHARITY LEADER IN ME PROGRAM 20,000
    LUTHERAN SERVICES IN IOWA
    304 SOUTH ST
    WATERLOO,IA50701     		N/A OTHER PUBLIC CHARITY BLACK HAWK COUNTY HOPES PROGRAM 20,000
    MARCHING AGAINST THE DARKNESS INC
    227 MOBILE ST
    WATERLOO,IA50703     		N/A OTHER PUBLIC CHARITY PROGRAM SUPPORT 30,000
    MAROON & WHITE INC
    C/O GRUNDY CITY HALL 703 F AVE 2
    GRUNDY CENTER,IA50638     		N/A OTHER PUBLIC CHARITY CAPITAL - GRUNDY CENTER CHILDCARE CENTER 60,000
    MERCY ONE FOUNDATION
    515 COLLEGE ST
    CEDAR FALLS,IA50613     		N/A OTHER PUBLIC CHARITY RED SLEIGH PROGRAM 1,500
    NO FOOT TOO SMALL
    405 GALWAY ST
    IOWA CITY,IA52246     		N/A OTHER PUBLIC CHARITY SUPPORT PROGRAM FOR BEREAVED PARENTS 5,000
    NORTH END CULTURAL CENTER
    1621 E 4TH ST
    WATERLOO,IA50703     		N/A OTHER PUBLIC CHARITY HIP HOP LITERACY PROGRAM 15,000
    NORTH STAR COMMUNITY SERVICES
    3420 UNIVERSITY AVE
    WATERLOO,IA50701     		N/A OTHER PUBLIC CHARITY PROGRAM SUPPORT - ADULT DAY CARE 30,000
    ONE CITY UNITED
    907 INDEPENDENCE AVE
    WATERLOO,IA50703     		N/A OTHER PUBLIC CHARITY ONE CITY MOMENTUM PROGRAM 30,000
    QUOTA CLUB OF WATERLOO CHARITABLE FOUNDATION
    PO BOX 1231
    WATERLOO,IA50704     		N/A OTHER PUBLIC CHARITY COPS N' KIDS LITERACY PROGRAM 5,000
    ROBERT D & BILLIE RAY CENTER
    DRAKE UNIVERSITY 2702 FOREST AVE
    DES MOINES,IA50311     		N/A OTHER PUBLIC CHARITY CHARACTER EDUCATION PROGRAMMING 29,500
    RONALD MCDONALD HOUSE CHARITIES
    730 HAWKINS DRIVE
    IOWA CITY,IA52246     		N/A OTHER PUBLIC CHARITY PROGRAM SUPPORT - SUPPORT FUND FOR FAMILIES 30,000
    ST TIMOTHY CHILDCARE & PRESCHOOL
    1 THELMA ST
    HUDSON,IA50643     		N/A OTHER PUBLIC CHARITY CAPITAL - PLAYGROUND CONSTRUCTION 15,000
    THE SALVATION ARMY OF WATERLOOCEDAR FALLS
    89 FRANKLIN ST
    WATERLOO,IA50703     		N/A OTHER PUBLIC CHARITY OPERATING SUPPORT 30,000
    THE SET ME FREE PROJECT
    11620 M CIRCLE
    OMAHA,NE68137     		N/A OTHER PUBLIC CHARITY PROGRAMMING 5,000
    WATERLOO COMMUNITY PLAYHOUSE
    224 COMMERCIAL ST
    WATERLOO,IA50701     		N/A OTHER PUBLIC CHARITY OPERATING SUPPORT - BH CHILDREN'S THEATER 30,000
    WATERLOO POLICE
    715 MULBERRY ST
    WATERLOO,IA50703     		N/A EXCLUSIVELY FOR PUBL K9 PROGRAM 10,000
    WAVERLY CHAMBER MUSIC SERIES
    315 3RD AVE SE
    WAVERLY,IA50677     		N/A OTHER PUBLIC CHARITY OPERATING SUPPORT 5,000
    WAVERLY PUBLIC LIBRARY FOUNDATION
    1500 W BREMER AVE
    WAVERLY,IA50677     		N/A OTHER PUBLIC CHARITY CAPITAL - BOOKMOBILE 5,000
    WINNEBAGO COUNCIL OF BOY SCOUTS
    2929 AIRPORT BLVD
    WATERLOO,IA50703     		N/A OTHER PUBLIC CHARITY ELIMINATING BARRIERS TO SUCCESS PROGRAM 10,000
    GIRL SCOUTS OF EASTERN IA AND WESTERN ILL
    510 MULBERRY ST
    WATERLOO,IA50703     		N/A OTHER PUBLIC CHARITY LEADERSHIP PROGRAM 30,000
    Total .................................bullet 3a 1,820,000
    bApproved for future payment
    Total .................................bullet 3b 0
    Form 990-PF (2021)
    Form 990-PF (2021)
    Page 12
    Part XV-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 ...........     		522100 2,712 14 94,938  
    4 Dividends and interest from securities ....          
    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 ............     		531390   18 935,151  
    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) .. 1,483,993 1,755,255 0
    13Total. Add line 12, columns (b), (d), and (e)..................
    13
    3,239,248
    (See worksheet in line 13 instructions to verify calculations.)
    Part XV-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 XV-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 (2021)
    Form 990-PF (2021)
    Page 13
    Part XVI
    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) (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) (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 instructions.
    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 (2021)
    Additional Data


    Software ID:  
    Software Version:  


    Form 990PF - Special Condition Description:
    Special Condition Description
    Schedule B
    (Form 990)
    Department of the Treasury
    Internal Revenue Service
    Schedule of Contributors

    Arrow Bullet Attach to Form 990, 990-EZ, or 990-PF.
    Arrow Bullet Go to www.irs.gov/Form990 for the latest information.
    OMB No. 1545-0047
    2021
    Name of the organization
    MAX AND HELEN GUERNSEY
    CHARITABLE FOUNDATION
    Employer identification number

    42-1460664
    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 isn't covered by the General Rule and/or the Special Rules doesn't 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 doesn't 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) (2021)
    Schedule B (Form 990) (2021) Page 2
    Name of organization
    MAX AND HELEN GUERNSEY
    CHARITABLE FOUNDATION         		Employer identification number
    42-1460664
    Part I
    Contributors
    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
    BPC PROPERTIES
     
    100 EAST PARK AVE
     
    WATERLOO, IA50703

    		$ 5,000


    (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) (2021)
    Schedule B (Form 990) (2021)
    Page 3
    Name of organization
    MAX AND HELEN GUERNSEY
    CHARITABLE FOUNDATION         		Employer identification number

    42-1460664
    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) (2021)
    Schedule B (Form 990) (2021)
    Page 4
    Name of organization
    MAX AND HELEN GUERNSEY
    CHARITABLE FOUNDATION         		Employer identification number

    42-1460664
    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) (2021)
    Additional Data


    Software ID:  
    Software Version:  

    TY 2021 AccountingFeesSchedule
    Name:
    MAX AND HELEN GUERNSEY
     
    CHARITABLE FOUNDATION
    EIN:
    42-1460664
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    LEGAL AND ACCOUNTING FEES 20,962 8,385   8,736

    Note: To capture the full content of this document, please select landscape mode (11" x 8.5") when printing.

    TY 2021 DepreciationSchedule
    Name:
    MAX AND HELEN GUERNSEY
     
    CHARITABLE FOUNDATION
    EIN:
    42-1460664
    Description of Property Date Acquired Cost or Other Basis Prior Years' Depreciation Computation Method Rate /
    Life (# of years)    		 Current Year's Depreciation Expense Net Investment Income Adjusted Net Income Cost of Goods Sold Not Included
    DESK/WORKSTATION 2000-09-01 310 310 200DB 7.000000000000 0 0    
    DESK CHAIR 2000-09-01 139 139 200DB 7.000000000000 0 0    
    OFFICE FURNITURE 2000-09-01 379 379 200DB 7.000000000000 0 0    
    REFRIGERATOR 2008-07-16 268 268 200DB 7.000000000000 0 0    
    CREDENZA, CONFERENCE TABLE 2008-07-30 882 882 200DB 7.000000000000 0 0    
    OFFICE FURNITURE 2008-08-26 6,925 6,925 200DB 7.000000000000 0 0    
    8 CHAIRS 2008-10-29 2,350 2,350 200DB 7.000000000000 0 0    
    OFFICE CONCEPTS - SIGNAGE 2008-11-05 1,394 1,394 200DB 7.000000000000 0 0    
    PHONE SYSTEM 2008-12-18 2,289 2,289 200DB 5.000000000000 0 0    
    COMPUTER NETWORK 2009-03-03 2,411 2,411 200DB 5.000000000000 0 0    
    COPY & FAX MACHINE 2010-03-04 1,605 1,605 200DB 5.000000000000 0 0    
    DELL COMPUTER 2011-02-07 979 979 200DB 5.000000000000 0 0    
    DELL OPTIPLEX 3046 2016-12-30 984 927 200DB 5.000000000000 57 0    
    DELL OPTIPLEX 3046 2016-12-30 984 927 200DB 5.000000000000 57 0    
    DELL 22" LED LCD MONITOR 2016-12-30 209 197 200DB 5.000000000000 12 0    
    COPIER 2018-02-27 2,087 1,726 200DB 5.000000000000 241 0    
    SAGE SOFTWARE COLLECTION 2019-07-24 2,371 1,580 SL 3.000000000000 791 0    
    DELL LATITUDE 15" 5000 2020-04-17 2,217 953 200DB 5.000000000000 506 0    
    RUCKUS R310 ACCESS POINT 2020-06-29 948 407 200DB 5.000000000000 216 0    
    FOUNDANT TECH - GRANT PROCESSING SOFTWARE 2020-10-12 12,519 3,130 SL 3.000000000000 4,173 0    
    SAGE SOFTWARE 2021-07-23 2,724   SL 3.000000000000 908 0    

    TY 2021 InvestmentsCorpBondsSchedule
    Name:
    MAX AND HELEN GUERNSEY
     
    CHARITABLE FOUNDATION
    EIN:
    42-1460664
    Name of Bond End of Year Book Value End of Year Fair Market Value
    CORPORATE BONDS 3,288,784 3,288,784

    TY 2021 InvestmentsCorpStockSchedule
    Name:
    MAX AND HELEN GUERNSEY
     
    CHARITABLE FOUNDATION
    EIN:
    42-1460664
    Name of Stock End of Year Book Value End of Year Fair Market Value
    CORPORATE STOCK-COMMON 20,662,633 20,662,633

    TY 2021 InvestmentsGovtObligationsSch
    Name:
    MAX AND HELEN GUERNSEY
     
    CHARITABLE FOUNDATION
    EIN:
    42-1460664
    US Government Securities - End of Year Book Value:

    11,911,436
    US Government Securities - End of Year Fair Market Value:

    11,911,436
    State & Local Government Securities - End of Year Book Value:


    0
    State & Local Government Securities - End of Year Fair Market Value:


    0


    TY 2021 InvestmentsOtherSchedule2
    Name:
    MAX AND HELEN GUERNSEY
     
    CHARITABLE FOUNDATION
    EIN:
    42-1460664
    Category/ Item Listed at Cost or FMV Book Value End of Year Fair Market Value
    CLOSELY HELD STOCK AT COST 4,903,166 4,903,166

    TY 2021 LandEtcSchedule2
    Name:
    MAX AND HELEN GUERNSEY
     
    CHARITABLE FOUNDATION
    EIN:
    42-1460664
    Category / Item Cost / Other Basis Accumulated Depreciation Book Value End of Year Fair Market Value
    DESK/WORKSTATION 310 310 0  
    DESK CHAIR 139 139 0  
    OFFICE FURNITURE 379 379 0  
    REFRIGERATOR 268 268 0  
    CREDENZA, CONFERENCE TABLE 882 882 0  
    OFFICE FURNITURE 6,925 6,925 0  
    8 CHAIRS 2,350 2,350 0  
    OFFICE CONCEPTS - SIGNAGE 1,394 1,394 0  
    PHONE SYSTEM 2,289 2,289 0  
    COMPUTER NETWORK 2,411 2,411 0  
    COPY & FAX MACHINE 1,605 1,605 0  
    DELL COMPUTER 979 979 0  
    DELL OPTIPLEX 3046 984 984 0  
    DELL OPTIPLEX 3046 984 984 0  
    DELL 22" LED LCD MONITOR 209 209 0  
    COPIER 2,087 1,967 120  
    SAGE SOFTWARE COLLECTION 2,371 2,371 0  
    DELL LATITUDE 15" 5000 2,217 1,459 758  
    RUCKUS R310 ACCESS POINT 948 623 325  
    FOUNDANT TECH - GRANT PROCESSING SOFTWARE 12,519 7,303 5,216  
    SAGE SOFTWARE 2,724 908 1,816  


    TY 2021 OtherAssetsSchedule
    Name:
    MAX AND HELEN GUERNSEY
     
    CHARITABLE FOUNDATION
    EIN:
    42-1460664
    Description Beginning of Year - Book Value End of Year - Book Value End of Year - Fair Market Value
    ACCRUED INCOME 76,350 67,322 67,322
    PREPAID UBTI INCOME TAX 13,603 6,234 6,234
    AMENDED EXCISE TAX RECEIVABLE 25,825 0 0


    TY 2021 OtherDecreasesSchedule
    Name:
    MAX AND HELEN GUERNSEY
     
    CHARITABLE FOUNDATION
    EIN:
    42-1460664
    Description Amount
    UNREALIZED INVESTMENT LOSS 6,229,699
    EVANS BANCSHARES - K-1 15,253
    WAVERLY PLASTICS COMPANY, INC - K-1 68,882
    RADA MANUFACTURING COMPANY, INC - K-1 1,102,379


    TY 2021 OtherExpensesSchedule
    Name:
    MAX AND HELEN GUERNSEY
     
    CHARITABLE FOUNDATION
    EIN:
    42-1460664
    Description Revenue and Expenses per Books Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    INVESTMENT FEES 104,126 104,126   0
    DUES AND NOTICES 1,465 0   1,465
    OFFICE EXPENSE 1,538 0   1,538
    MISCELLANEOUS 1,389 0   664
    INSURANCE 4,673 0   4,673
    UTILITIES 592 0   592
    REPAIRS AND MAINTENANCE 15,169 0   15,169
    TECHNOLOGY EXPENSE 5,726 0   5,726
    MISCELLANEOUS K-1 DEDUCTIONS 297,583 0   0


    TY 2021 OtherIncomeSchedule2
    Name:
    MAX AND HELEN GUERNSEY
     
    CHARITABLE FOUNDATION
    EIN:
    42-1460664
    Description Revenue And Expenses Per Books Net Investment Income Adjusted Net Income
    EVANS BANCSHARES, INC K-1 15,271 0 15,271
    CEDAR VALLEY VENTURE FUND NO.1, LC K-1 -105 0 -105
    WAVERLY PLASTICS COMPANY, INC K-1 -17,232 0 -17,232
    WAVERLY PLASTICS COMPANY, INC K-1 84,265 0 84,265
    RADA MANUFACTURING COMPANY, INC K-1 1,397,976 0 1,397,976


    TY 2021 OtherIncreasesSchedule
    Name:
    MAX AND HELEN GUERNSEY
     
    CHARITABLE FOUNDATION
    EIN:
    42-1460664
    Description Amount
    EVANS BANCSHARES - DISTRIBUTIONS 7,747
    WAVERLY PLASTICS COMPANY, INC - DISTRIBUTIONS 100,433
    RADA MANUFACTURING COMPANY, INC - DISTRIBUTIONS 759,177
    CEDAR VALLEY VENTURE FUND - K-1 104


    TY 2021 OtherLiabilitiesSchedule
    Name:
    MAX AND HELEN GUERNSEY
     
    CHARITABLE FOUNDATION
    EIN:
    42-1460664
    Description Beginning of Year - Book Value End of Year - Book Value
    EXCISE TAX PAYABLE 7,586 53,425
    CREDIT CARD PAYABLE 160 176


    TY 2021 TaxesSchedule
    Name:
    MAX AND HELEN GUERNSEY
     
    CHARITABLE FOUNDATION
    EIN:
    42-1460664
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    EXCISE TAX ON INVESTMENT INCOME 22,686 0   0
    PAYROLL TAXES 5,140 0   5,140
    FOREIGN TAXES WITHHELD 4,662 4,662   0
    NET UNRELATED BUSINESS TAX 223,780 0   0