TY 2021 Form 990PF

- TIN:

Form990-PF

Department of the Treasury
Internal Revenue Service

Return of Private Foundation

or Section 4947(a)(1) Trust Treated as Private Foundation

Do not enter social security numbers on this form as it may be made public.
bullet

Go 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 01-01-2021 , and ending 12-31-2021

Name of foundation
CAROLINA MOTOR CLUB FOUNDATION FOR
TRAFFIC SAFETY

Number and street (or P.O. box number if mail is not delivered to street address)6600 AAA DRIVE
Room/suite

City or town, state or province, country, and ZIP or foreign postal code
CHARLOTTE, NC28212

A Employer identification number

56-2139475

B Telephone number (see instructions)

(704) 569-7732

C If exemption application is pending, check here bullet

G Check all that apply: Initial returnInitial return of a former public charity
Final returnAmended return
Address change Name change

D 1. Foreign organizations, check here............. bullet

2. Foreign organizations meeting the 85%
test, check here and attach computation ... bullet

E If private foundation status was terminated
under section 507(b)(1)(A), check here ....... bullet

H Check type of organization: Section 501(c)(3) exempt private foundation
Section 4947(a)(1) nonexempt charitable trust Other taxable private foundation

F If the foundation is in a 60-month termination
under section 507(b)(1)(B), check here ....... bullet

I Fair market value of all assets at end
of year (from Part II, col. (c),
line 16) bullet

$2,069,302J Accounting method: Cash Accrual
Other (specify)
(Part I, column (d) must be on cash basis.)

	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	(d) Disbursements for charitable purposes (cash basis only)


1	Contributions, gifts, grants, etc., received (attach schedule)
2	Check .............
3	Interest on savings and temporary cash investments
4	Dividends and interest from securities...	64,845		60,330
5a	Gross rents............
b	Net rental income or (loss)
6a	Net gain or (loss) from sale of assets not on line 10		64,307
b	Gross sales price for all assets on line 6a 650,071
7	Capital gain net income (from Part IV, line 2)...			64,402
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).......
12	Total. Add lines 1 through 11........	129,152		124,732
13	Compensation of officers, directors, trustees, etc.	0		0	0
14	Other employee salaries and wages......
15	Pension plans, employee benefits.......
16a	Legal fees (attach schedule).........
b	Accounting fees (attach schedule).......		2,150	0	4,200
c	Other professional fees (attach schedule)....		11,207	9,626	936
17	Interest...............
18	Taxes (attach schedule) (see instructions)...		44	44	0
19	Depreciation (attach schedule) and depletion...
20	Occupancy..............
21	Travel, conferences, and meetings.......
22	Printing and publications..........
23	Other expenses (attach schedule).......		162,927	101	219,864
24	Total operating and administrative expenses.
	Add lines 13 through 23..........	176,328		9,771	225,000
25	Contributions, gifts, grants paid.......	0			0
26	Total expenses and disbursements. Add lines 24 and 25	176,328		9,771	225,000
27	Subtract line 26 from line 12:
a	Excess of revenue over expenses and disbursements	-47,176
b	Net investment income (if negative, enter -0-)			114,961
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	Beginning of year	End of year
Part II		Balance Sheets	(a) Book Value	(b) Book Value	(c) Fair Market Value
	1	Cash—non-interest-bearing.............	98,284	98,284	98,284
	2	Savings and temporary cash investments.........	32,936	54,003	54,003
	3	Accounts receivable
		Less: allowance for doubtful accounts
	4	Pledges receivable
		Less: allowance for doubtful accounts
	5	Grants receivable.................
	6	Receivables due from officers, directors, trustees, and other
		disqualified persons (attach schedule) (see instructions).....
	7	Other notes and loans receivable (attach schedule)
		Less: allowance for doubtful accounts
	8	Inventories for sale or use..............
	9	Prepaid expenses and deferred charges..........
	10a	Investments—U.S. and state government obligations (attach schedule)	34,040	56,268	56,268
	b	Investments—corporate stock (attach schedule).......	1,883,146	1,859,747	1,859,747
	c	Investments—corporate bonds (attach schedule).......
	11	Investments—land, buildings, and equipment: basis
		Less: accumulated depreciation (attach schedule)
	12	Investments—mortgage loans.............
	13	Investments—other (attach schedule)..........
	14	Land, buildings, and equipment: basis
		Less: accumulated depreciation (attach schedule)
	15	Other assets (describe )	1,000	1,000	1,000
	16	Total assets (to be completed by all filers—see the
		instructions. Also, see page 1, item I)	2,049,406	2,069,302	2,069,302
	17	Accounts payable and accrued expenses..........	188,148	128,881
	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 )
	23	Total liabilities (add lines 17 through 22).........	188,148	128,881
		Foundations that follow FASB ASC 958, check here
		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
		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	1,861,258	1,940,421
	29	Total net assets or fund balances (see instructions).....	1,861,258	1,940,421
	30	Total liabilities and net assets/fund balances (see instructions).	2,049,406	2,069,302

Part III

Analysis of Changes in Net Assets or Fund Balances

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) ...............

1,861,258

Enter amount from Part I, line 27a .....................

-47,176

Other increases not included in line 2 (itemize) bullet

126,339

Add lines 1, 2, and 3 ..........................

1,940,421

Decreases not included in line 2 (itemize) bullet

Total net assets or fund balances at end of year (line 4 minus line 5)—Part II, column (b), line 29 .

1,940,421

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
1 a	PUBLICLY TRADED SECURITIES	P
b
c
d
e

(e) Gross sales price		(g) Cost or other basis plus expense of sale	(h) Gain or (loss) (e) plus (f) minus (g)
a	650,071	585,669	64,402
b
c
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			64,402
b
c
d
e

2	Capital gain net income or (net capital loss)	If gain, also enter in Part I, line 7 If (loss), enter -0- in Part I, line 7	2	64,402
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 ...................		3

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 and enter “N/A" on line 1.
	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	1,598
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	1,598
6	Credits/Payments:

a	2021 estimated tax payments and 2020 overpayment credited to 2021	6a	2,026
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	2,026
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.......		9
10	Overpayment. If line 7 is more than the total of lines 5 and 8, enter the amount overpaid...		10	428
11	Enter the amount of line 10 to be: Credited to 2022 estimated tax428	Refunded	11	0

Part VI-A

Statements Regarding Activities

During the tax year, did the foundation attempt to influence any national, state, or local legislation or did

Yes

it participate or intervene in any political campaign? ....................

Did it spend more than $100 during the year (either directly or indirectly) for political purposes? See the instructions

for the definition.................................

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.

Did the foundation file Form 1120-POL for this year?.....................

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

Enter the reimbursement (if any) paid by the foundation during the year for political expenditure tax imposed

on foundation managers. bullet

$ 0

Has the foundation engaged in any activities that have not previously been reported to the IRS?.......

If "Yes," attach a detailed description of the activities.

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....

Did the foundation have unrelated business gross income of $1,000 or more during the year?.........

If "Yes," has it filed a tax return on Form 990-T for this year?...................

Was there a liquidation, termination, dissolution, or substantial contraction during the year?.........

If "Yes," attach the statement required by General Instruction T.

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?................

Yes

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..................................

Yes

Enter the states to which the foundation reports or with which it is registered (see instructions)

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 .

Yes

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 .............................

Did any persons become substantial contributors during the tax year? If "Yes," attach a schedule listing their names

and addresses. ...............................

Form 990-PF (2021)

Page 5

Part VI-A

Statements Regarding Activities (continued)

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 .............

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.................

Did the foundation comply with the public inspection requirements for its annual returns and exemption application?

Yes

Website address bullet

N/A

The books are in care of bullet

LINDA RETTIG Telephone no. bullet

(704) 569-7732

Located at bullet

6600 AAA DRIVECHARLOTTENC ZIP+4 bullet

28212

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

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

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)

(2) Borrow money from, lend money to, or otherwise extend credit to (or accept it from)

a disqualified person? ..............................

1a(2)

(3) Furnish goods, services, or facilities to (or accept them from) a disqualified person? ...........

1a(3)

(4) Pay compensation to, or pay or reimburse the expenses of, a disqualified person? ............

1a(4)

(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)

(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)

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 ..........

Organizations relying on a current notice regarding disaster assistance check here........ bullet

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? .............

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)):

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?....................

If "Yes," list the years bullet

20, 20, 20, 20

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.) ..............

If the provisions of section 4942(a)(2) are being applied to any of the years listed in 2a, list the years here.

20, 20, 20, 20

Did the foundation hold more than a 2% direct or indirect interest in any business enterprise at

any time during the year? ..............................

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.) .....................

Did the foundation invest during the year any amount in a manner that would jeopardize its charitable purposes?

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? ..

Form 990-PF (2021)

Page 6

Part VI-B

Statements Regarding Activities for Which Form 4720 May Be Required (continued)

During the year did the foundation pay or incur any amount to:

Yes

(1) Carry on propaganda, or otherwise attempt to influence legislation (section 4945(e))? ..........

5a(1)

(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)

(3) Provide a grant to an individual for travel, study, or other similar purposes? .............

5a(3)

(4) Provide a grant to an organization other than a charitable, etc., organization described

in section 4945(d)(4)(A)? See instructions ........................

5a(4)

(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)

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 ........

Organizations relying on a current notice regarding disaster assistance check here ......... bullet

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).

Did the foundation, during the year, receive any funds, directly or indirectly, to pay premiums on

a personal benefit contract? .............................

Did the foundation, during the year, pay premiums, directly or indirectly, on a personal benefit contract? ....

If "Yes" to 6b, file Form 8870.

At any time during the tax year, was the foundation a party to a prohibited tax shelter transaction?

If "Yes", did the foundation receive any proceeds or have any net income attributable to the transaction? .....

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? .........................

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
ROBERT WILSON III	CHAIRMAN 0.20	0	0	0
6600 AAA DRIVE CHARLOTTE,NC28212	CHAIRMAN 0.20	0	0	0
JOHN BRUNO	EXECUTIVE VP,SECRETARY, & CHIEF HR OFF 0.20	0	0	0
6600 AAA DRIVE CHARLOTTE,NC28212	EXECUTIVE VP,SECRETARY, & CHIEF HR OFF 0.20	0	0	0
SEAN H MALONEY	EXECUTIVE VP & TREASURER 0.20	0	0	0
6600 AAA DRIVE CHARLOTTE,NC28212	EXECUTIVE VP & TREASURER 0.20	0	0	0
MICHAEL S CHERRY	SENIOR VP & CFO 0.20	0	0	0
6600 AAA DRIVE CHARLOTTE,NC28212	SENIOR VP & CFO 0.20	0	0	0
MARCIA L HANNEWALD	VP, ASSISTANT CORP. SECRETARY 0.20	0	0	0
6600 AAA DRIVE CHARLOTTE,NC28212	VP, ASSISTANT CORP. SECRETARY 0.20	0	0	0
DION D STEVENS	ASSISTANT TREASURER 0.20	0	0	0
6600 AAA DRIVE CHARLOTTE,NC28212	ASSISTANT TREASURER 0.20	0	0	0
JIM MCCAFFERTY	BOARD MEMBER 0.20	0	0	0
6600 AAA DRIVE CHARLOTTE,NC28212	BOARD MEMBER 0.20	0	0	0
TIFFANY M WRIGHT	PRESIDENT 5.00	0	0	0
6600 AAA DRIVE CHARLOTTE,NC28212	PRESIDENT 5.00	0	0	0

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...................				0

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............. bullet

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	DISTRACTED DRIVINGIN 2021, OUR DISCONNECT AND DRIVE CAMPAIGN CONTINUED TO BE THE BIGGEST INITIATIVE. WE CREATED A BRAND NEW PSA FOR DISCONNECT AND DRIVE, COMPLETE WITH A MUSIC VIDEO AND ORIGINAL SONG DONE BY A LOCAL NC CHOIR. THIS YEAR WE HAD A "TAKE THE PLEDGE" PIECE WHERE MOTORISTS WHO VISITED DISCONNECTANDDRIVE.COM ENTERED THEIR INFO AND COMMITMENT TO DRIVE DISTRACTION FREE. MESSAGING WAS ALSO DISPLAYED IN PAID ADS AT GAS STATIONS AND PUMP TOPPERS. DIGITAL ADS ON FACEBOOK, INSTAGRAM AND TIKTOK WERE ALSO PURCHASED. DUE TO THE PANDEMIC, DISTRACTED DRIVING AWARENESS MONTH WAS MOVED FROM APRIL TO OCTOBER, SO THE MAJORITY OF THE SPEND HAPPENED IN THE FALL. ANOTHER BIG CAMPAIGN WAS SLOW DOWN, MOVE OVER (SDMO) THAT WE USED TO RAISE AWARENESS FOR THE MOVE OVER LAW WHICH PROTECTS LAW ENFORCEMENT AND FIRST RESPONDERS, INCLUDING OUR TOW OPERATORS. WE HAD PAID ADS ON SOCIAL MEDIA PLATFORMS, WHICH RAN OUR SDMO PSA.	141,458
2	EDUCATION/RESEARCH/PROFESSIONAL FEES:COMMISSIONED NC STATE'S TRANSPORTATION DEPARTMENT TO CONDUCT A STUDY ON THE MOST DANGEROUS INTERSECTIONS IN NORTH AND SOUTH CAROLINA IN AN EFFORT TO RAISE AWARENESS OF THE DANGERS AT THESE LOCATIONS IN AN EFFORT TO REDUCE COLLISIONS AND SAVE LIVES. OTHER EDUCATION EFFORTS INCLUDED A CAMPAIGN CENTERED AROUND TEENS DURING PROM. THE FOUNDATION WAS A SPONSOR OF PROM PROMISE, A CAMPAIGN AIMED TO RAISE AWARENESS OF THE DANGERS OF DRINKING ALCOHOL AND USING DRUGS DURING PROM. WE PRODUCED AND BOUGHT RADIO ADS AND SPOTS ACROSS THE CAROLINAS FOR THE WEEKS SURROUNDING PROMS, SPONSORED BIKE EVENTS AND PURCHASED REFLECTORS FOR SAFETY TO BE HANDED OUT AT THE EVENTS, AND HELPED SPONSOR VIP FOR VIP, AN ORGANIZATION THAT TRAVELS THE CAROLINAS HOLDING DEMONSTRATIONS USING CAR CRASH REENACTMENTS. WE ALSO PURCHASED BROCHURES AND MATERIALS FOR SENIORS TO BE HANDED OUT AT EVENTS AND ASSISTED LIVING FACILITIES AIMED AT KEEPING SENIORS SAFE BEHIND THE WHEEL.	21,368
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


2


All other program-related investments. See instructions.
3

Total. Add lines 1 through 3......................... bullet

Form 990-PF (2021)

Page 8

Part IX

Minimum Investment Return (All domestic foundations must complete this part. Foreign foundations, see instructions.)

Fair market value of assets not used (or held for use) directly in carrying out charitable, etc.,

purposes:

Average monthly fair market value of securities...................

2,045,344

Average of monthly cash balances.......................

168,493

Fair market value of all other assets (see instructions)................

1,000

Total (add lines 1a, b, and c).........................

2,214,837

Reduction claimed for blockage or other factors reported on lines 1a and

1c (attach detailed explanation) .............

Acquisition indebtedness applicable to line 1 assets..................

Subtract line 2 from line 1d.........................

2,214,837

Cash deemed held for charitable activities. Enter 1.5% (0.015) of line 3 (for greater amount, see

instructions) .............................

33,223

Net value of noncharitable-use assets. Subtract line 4 from line 3. .......

2,181,614

Minimum investment return. Enter 5% (0.05) of line 5................

109,081

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.)

Minimum investment return from Part IX, line 6..................

109,081

Tax on investment income for 2021 from Part V, line 5.......

1,598

Income tax for 2021. (This does not include the tax from Part V.) ...

Add lines 2a and 2b............................

1,598

Distributable amount before adjustments. Subtract line 2c from line 1............

107,483

Recoveries of amounts treated as qualifying distributions................

Add lines 3 and 4............................

107,483

Deduction from distributable amount (see instructions).................

Distributable amount as adjusted. Subtract line 6 from line 5. Enter here and on Part XII, line 1 ...

107,483

Part XI

Qualifying Distributions (see instructions)

Amounts paid (including administrative expenses) to accomplish charitable, etc., purposes:

Expenses, contributions, gifts, etc.—total from Part I, column (d), line 26 ..........

Program-related investments—total from Part VIII-B..................

Amounts paid to acquire assets used (or held for use) directly in carrying out charitable, etc.,

purposes...............................

Amounts set aside for specific charitable projects that satisfy the:

Suitability test (prior IRS approval required)....................

Cash distribution test (attach the required schedule) .................

Qualifying distributions. Add lines 1a through 3b. Enter here and on Part XII, line 4.

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					107,483
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......
b From 2017......	193,776
c From 2018......
d From 2019......	342,127
e From 2020......	103,753
f Total of lines 3a through e ........		639,656
4Qualifying distributions for 2021 from Part
XI, line 4: $ 225,000
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.....					107,483
e Remaining amount distributed out of corpus		117,517
5 Excess distributions carryover applied to 2021.		0			0
(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		757,173
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) ...		0
9 Excess distributions carryover to 2022. Subtract lines 7 and 8 from line 6a ......		757,173
10 Analysis of line 9:
a Excess from 2017....	193,776
b Excess from 2018....
c Excess from 2019....	342,127
d Excess from 2020....	103,753
e Excess from 2021....	117,517

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 4942(j)(3) or4942(j)(5)

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	(e) Total

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.

2Information Regarding Contribution, Grant, Gift, Loan, Scholarship, etc., Programs:

Check here bullet

if the foundation only makes contributions to preselected charitable organizations and does not accept
unsolicited requests for funds. If the foundation makes gifts, grants, etc. to individuals or organizations under
other conditions, complete items 2a, b, c, and d. See instructions

aThe name, address, and telephone number or email address of the person to whom applications should be addressed:

bThe form in which applications should be submitted and information and materials they should include:

cAny submission deadlines:

dAny restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other
factors:

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)		Foundation status of recipient	Purpose of grant or contribution	Amount
aPaid during the year

Total ................................. 3a				0

bApproved for future payment

Total ................................. 3b				0

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	(e) Related or exempt function income (See instructions.)
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 ....
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 ............			18	64,307
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) ..		0		129,152	0

13Total. Add line 12, columns (b), (d), and (e)..................

129,152

(See worksheet in line 13 instructions to verify calculations.)

Part XV-B

Relationship of Activities to the Accomplishment of Exempt Purposes

Line No.	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)

Page 13

Part XVI

Information Regarding Transfers To and Transactions and Relationships With Noncharitable Exempt Organizations

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

Transfers from the reporting foundation to a noncharitable exempt organization of:

(1) Cash...................................

1a(1)

(2) Other assets.................................

1a(2)

Other transactions:

(1) Sales of assets to a noncharitable exempt organization....................

1b(1)

(2) Purchases of assets from a noncharitable exempt organization..................

1b(2)

(3) Rental of facilities, equipment, or other assets.......................

1b(3)

(4) Reimbursement arrangements...........................

1b(4)

(5) Loans or loan guarantees.............................

1b(5)

(6) Performance of services or membership or fundraising solicitations................

1b(6)

Sharing of facilities, equipment, mailing lists, other assets, or paid employees..............

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

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? ...........Yes No

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.
				May the IRS discuss this return with the preparer shown below? See instructions. Yes No
	Signature of officer or trustee	Date	Title

Paid Preparer Use Only	Print/Type preparer's name	Preparer's Signature	Date	Check if self- employed	PTIN
	Firm's name				Firm's EIN
	Firm's address				Phone no.

Form 990-PF (2021)

Additional Data

Software ID:
Software Version:

Form 990PF - Special Condition Description:

Special Condition Description

- TIN:

TY 2021 AccountingFeesSchedule

Name:

CAROLINA MOTOR CLUB FOUNDATION FOR

TRAFFIC SAFETY

EIN:

56-2139475

Category	Amount	Net Investment Income	Adjusted Net Income	Disbursements for Charitable Purposes
RETURN PREPARATION FEES	2,150	0		4,200

- TIN:

TY 2021 InvestmentsCorpStockSchedule

Name:

CAROLINA MOTOR CLUB FOUNDATION FOR

TRAFFIC SAFETY

EIN:

56-2139475

Name of Stock	End of Year Book Value	End of Year Fair Market Value
AIR PRODUCTS & CHEMICALS INC	38,337	38,337
AMERICAN ELECTRIC POWER INC	29,805	29,805
ANALOG DEVICES INC	5,273	5,273
AXA-ADR	6,639	6,639
BANK NEW YORK MELLON CORP	57,499	57,499
BASF SE SPONSORED ADR	2,805	2,805
BRITISH AMERN TOB PLC SPON ADR	5,163	5,163
CHEVRON CORPORATION	24,761	24,761
CISCO SYSTEMS INC	53,864	53,864
COCA-COLA COMPANY	9,474	9,474
COCA-COLA EUROPEAN PARTNERS PLC	9,620	9,620
COMCAST CORP NEW CL A	7,902	7,902
CVS HEALTH CORPORATION	9,800	9,800
DEUTSCHE BOERSE AG-UNSPO ADR	4,086	4,086
DEUTSCHE POST AG SPONSORED ADR	6,216	6,216
DUKE ENERGY CORP COM NEW	3,567	3,567
EDISON INTL	20,202	20,202
GOLDMAN SACHS GROUP INC	5,738	5,738
HASBRO INC	7,939	7,939
HOME DEPOT INC	39,011	39,011
HONEYWELL INTERNATIONAL INC	3,962	3,962
ILLINOIS TOOL WORKS INC	23,199	23,199
INTL FLAVOR & FRAGRANCES	6,026	6,026
INVESCO TR II	61,290	61,290
INVESCO TR II ETF TAXABLE MUN BD	40,145	40,145
ISHARES MBS ETF	81,862	81,862
ISHARES TR ETF BROAD USD HIGH YIELD CORPORATE BD ETF	126,206	126,206
JOHNSON & JOHNSON	9,751	9,751
JPMORGAN CHASE & CO	4,592	4,592
LAMAR ADVERTISING CO NEW CLASS A	43,789	43,789
LOCKHEED MARTIN CORP	9,951	9,951
LOWES COMPANIES INC	5,945	5,945
LVMH MOET HENNESSY LOUIS VUITTON ADR	3,475	3,475
MEDTRONIC PLC	3,621	3,621
MERCK & CO INC NEW	9,427	9,427
MICROSOFT CORP	5,045	5,045
MONDELEZ INTL INC	7,029	7,029
MOTOROLA SOLUTIONS INC	3,804	3,804
NATIONAL RETAIL PPTYS INC	35,428	35,428
NESTLE S A REG ADR	7,018	7,018
NEXTERA ENERGY INC	9,243	9,243
NOVARTIS AG SPON ADR	8,135	8,135
ORIX CORP SPONSORED ADR	4,071	4,071
PEOPLE'S UNITED FINANCIAL	27,265	27,265
PFIZER INCORPORATED	37,969	37,969
PHILIP MORRIS INTERNATIONAL INC	4,560	4,560
PHILLIPS 66	39,853	39,853
PNC FINANCIAL VAR PERP-SER P-CALL 5/1/22 FIXED TO FLOAT	11,532	11,532
PNC FINANCIAL SERVICES GROUP	50,130	50,130
PROCTER & GAMBLE CO	37,624	37,624
PROGRESSIVE CORP OHIO	36,954	36,954
PUBLIC SVC ENTERPRISE	3,937	3,937
QUALCOMM INC	8,046	8,046
REINSURANCE GROUP 6.2% PFD AMER-10YR FIXED TO FLOAT MTY 9/15/42 CALL 9/15/22	7,916	7,916
RESTAURANT BRANDS INTL INC	4,733	4,733
ROCHE HOLDINGS LTD ADR	6,410	6,410
RPM INTERNATIONAL INC	10,302	10,302
SANOFI ADR	3,507	3,507
SIEMENS A G - ADR	8,833	8,833
SMITH & NEPHEW PLC ADR	3,739	3,739
SNAP-ON INC	3,661	3,661
SPIRE INC	21,131	21,131
SUMITOMO MITSUI FINL GROUP INC	5,357	5,357
TAKEA ADR PHARMACEUTICAL CO LTD SPONSORED ADR	3,721	3,721
TC ENERGY CORP	9,075	9,075
TOKYO ELECTRON LTD-UNSPN ADR	4,317	4,317
UNILEVER PLC SPONS ADR	7,423	7,423
UNION PACIFIC CORP	5,542	5,542
US BANCORP NEW	47,688	47,688
US BANCORP PERPETUAL/CALLABLE VARIABLE	10,625	10,625
VANGUARD LONG TERM CORP BD	41,913	41,913
VERIZON COMMUNICATIONS COM	21,512	21,512
VF CORPORATION	12,301	12,301
WALMART STORES INC	23,150	23,150
WATSCO INC	35,981	35,981
WILLIAMS COMPANIES INC	9,687	9,687
XCEL ENERGY INC	33,105	33,105
STRACKERS USD HIGH ETF YIELD CORPORATE BOND	152,786	152,786
DEUTSCHE TELEKOM AG SPON ADR	4,627	4,627
ING GROEP N V SPON ADR	5,888	5,888
NORDEA BANK ABP SPON ADR	6,257	6,257
RECKITT BECNCHISER ADR	4,637	4,637
SAP SE-SPONSORED ADR	3,503	3,503
STANLEY BLACK & DECKER INC	5,470	5,470
TJX COS INC NEW	8,199	8,199
TOTAL ENERGIES SE	8,162	8,162
VINCI SA - ADR	5,920	5,920
ISHARES SELECT ETF DIVIDEND	67,057	67,057
ISHARES TR ETF FALLEN ANGELS USD BD	42,677	42,677
SPDR PORTFOLIO SHORT ETF TERM CORP	11,149	11,149
UNITEDHEALTH GROUP INC	33,141	33,141
VANECK EMERGING MARKETS HIGH YIELD ETF	18,936	18,936
VANGUARD WHITE HALL ETF	21,124	21,124

- TIN:

TY 2021 InvestmentsGovtObligationsSch

Name:

CAROLINA MOTOR CLUB FOUNDATION FOR

TRAFFIC SAFETY

EIN:

56-2139475

US Government Securities - End of Year Book Value:

56,268

US Government Securities - End of Year Fair Market Value:

56,268

State & Local Government Securities - End of Year Book Value:

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

- TIN:

TY 2021 OtherAssetsSchedule

Name:

CAROLINA MOTOR CLUB FOUNDATION FOR

TRAFFIC SAFETY

EIN:

56-2139475

Description	Beginning of Year - Book Value	End of Year - Book Value	End of Year - Fair Market Value
DEPOSIT	1,000	1,000	1,000

- TIN:

TY 2021 OtherExpensesSchedule

Name:

CAROLINA MOTOR CLUB FOUNDATION FOR

TRAFFIC SAFETY

EIN:

56-2139475

Description	Revenue and Expenses per Books	Net Investment Income	Disbursements for Charitable Purposes
DISTRACTED DRIVING PROGRAM	141,458	0	212,038
SPONSORSHIPS	0	0	2,500
EDUCATION	11,924	0	3,527
POSTAGE AND SHIPPING	444	0	299
TRANSACTION FEES	101	101	0
TRAFFIC SAFETY RESEARCH	9,000	0	1,500

- TIN:

TY 2021 OtherIncreasesSchedule

Name:

CAROLINA MOTOR CLUB FOUNDATION FOR

TRAFFIC SAFETY

EIN:

56-2139475

Description	Amount
CHANGE IN UNREALIZED GAINS/LOSSES	126,339

- TIN:

TY 2021 OtherProfessionalFeesSchedule

Name:

CAROLINA MOTOR CLUB FOUNDATION FOR

TRAFFIC SAFETY

EIN:

56-2139475

Category	Amount	Net Investment Income	Adjusted Net Income	Disbursements for Charitable Purposes
INVESTMENT FEES	9,626	9,626		0
CORPORATE REGISTRATION AND OTHER FEES	1,581	0		936

- TIN:

TY 2021 TaxesSchedule

Name:

CAROLINA MOTOR CLUB FOUNDATION FOR

TRAFFIC SAFETY

EIN:

56-2139475

Category	Amount	Net Investment Income	Adjusted Net Income	Disbursements for Charitable Purposes
FOREIGN TAXES	44	44		0