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 01-01-2021 , and ending 12-31-2021
Name of foundation
CHARLOTTE B FORESTIER PRIVATE FOUNDATION
 
Number and street (or P.O. box number if mail is not delivered to street address)1100 NORTH MARKET STREET
  Room/suite
City or town, state or province, country, and ZIP or foreign postal code
WILMINGTON, DE198900001
A Employer identification number

51-6568003
B Telephone number (see instructions)

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$1,169,927J 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)  
2 Check bullet.............
3 Interest on savings and temporary cash investments      
4 Dividends and interest from securities... 23,105 23,105  
5a Gross rents............      
b Net rental income or (loss)  
6a Net gain or (loss) from sale of assets not on line 10 121,656
b Gross sales price for all assets on line 6a 457,022
7 Capital gain net income (from Part IV, line 2)... 121,656
8 Net short-term capital gain......... 0
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........ 144,761 144,761  
Operating and Administrative Expenses 13 Compensation of officers, directors, trustees, etc. 11,516     11,516
14 Other employee salaries and wages......   0 0 0
15 Pension plans, employee benefits.......   0 0  
16a Legal fees (attach schedule).........       0
b Accounting fees (attach schedule)....... Click to see attachment 1,500 0 0 1,500
c Other professional fees (attach schedule).... Click to see attachment 7,678 3,838   0
17 Interest...............       0
18 Taxes (attach schedule) (see instructions)... Click to see attachment 631 580   0
19 Depreciation (attach schedule) and depletion... 0 0  
20 Occupancy..............        
21 Travel, conferences, and meetings.......   0 0  
22 Printing and publications..........   0 0  
23 Other expenses (attach schedule).......        
24 Total operating and administrative expenses.
Add lines 13 through 23.......... 21,325 4,418 0 13,016
25 Contributions, gifts, grants paid....... 35,915 35,915
26 Total expenses and disbursements. Add lines 24 and 25 57,240 4,418 0 48,931
27 Subtract line 26 from line 12:
a Excess of revenue over expenses and disbursements 87,521
b Net investment income (if negative, enter -0-) 140,343
c Adjusted net income (if negative, enter -0-)... 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......... 33,958 65,525 65,525
3 Accounts receivable bullet  
Less: allowance for doubtful accounts bullet     0 0
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 bullet0      
8 Inventories for sale or use..............      
9 Prepaid expenses and deferred charges..........      
10a Investments—U.S. and state government obligations (attach schedule)      
b Investments—corporate stock (attach schedule)....... 666,155 721,760 1,104,402
c Investments—corporate bonds (attach schedule).......      
11 Investments—land, buildings, and equipment: basis bullet  
Less: accumulated depreciation (attach schedule) bullet        
12 Investments—mortgage loans.............      
13 Investments—other (attach schedule)..........     0
14 Land, buildings, and equipment: basis bullet  
Less: accumulated depreciation (attach schedule) bullet        
15 Other assets (describe bullet)      
16 Total assets (to be completed by all filers—see the
instructions. Also, see page 1, item I) 700,113 787,285 1,169,927
Liabilities 17 Accounts payable and accrued expenses..........    
18 Grants payable.................    
19 Deferred revenue.................    
20 Loans from officers, directors, trustees, and other disqualified persons    
21 Mortgages and other notes payable (attach schedule)......    
22 Other liabilities (describe bullet)    
23 Total liabilities (add lines 17 through 22).........   0
Net Assets or Fund Balances 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........ 700,113 787,285
27 Paid-in or capital surplus, or land, bldg., and equipment fund    
28 Retained earnings, accumulated income, endowment, or other funds    
29 Total net assets or fund balances (see instructions)..... 700,113 787,285
30 Total liabilities and net assets/fund balances (see instructions). 700,113 787,285
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
700,113
2
Enter amount from Part I, line 27a .....................
2
87,521
3
Other increases not included in line 2 (itemize) bullet
3
0
4
Add lines 1, 2, and 3 ..........................
4
787,634
5
Decreases not included in line 2 (itemize) bulletClick to see attachment
5
349
6
Total net assets or fund balances at end of year (line 4 minus line 5)—Part II, column (b), line 29 .
6
787,285
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 126.724 AMG RIVER RD SM-CAP VALUE FD CL I   2021-02-01 2021-03-01
b 187.262 AMG RIVER RD SM-CAP VALUE FD CL I   2020-03-31 2021-04-09
c 4. AT&T INC   2016-12-14 2021-03-01
d 10. AT&T INC   2016-12-14 2021-04-09
e 2. ACTIVISION BLIZZARD INC   2020-09-10 2021-03-01
4. ACTIVISION BLIZZARD INC   2020-09-10 2021-04-09
1. AIR PRODUCTS & CHEMICALS INC   2020-03-26 2021-03-01
2. AIR PRODUCTS & CHEMICALS INC   2020-03-26 2021-04-09
35.199 AB CONCENTRATED GR FD CL ADV   2021-03-26 2021-04-09
2. AMERICAN ELECTRIC POWER INCORPORATED   2017-03-24 2021-03-01
4. AMERICAN ELECTRIC POWER INCORPORATED   2020-03-26 2021-04-09
1. AMERICAN TOWER CORP CL A   2014-01-02 2021-03-01
3. AMERICAN TOWER CORP CL A   2020-03-26 2021-04-09
1. AMGEN INC COMMON   2014-04-11 2021-03-01
2. AMGEN INC COMMON   2020-03-26 2021-04-09
.03 ANALOG DEVICES INCORPORATED   2009-04-30 2021-09-24
12. APPLE COMPUTER INC COMMON   2017-02-28 2021-02-01
22. APPLE COMPUTER INC COMMON   2020-03-26 2021-04-09
91.166 ARTISAN SMALL CAP FUND CL INST   2020-03-31 2021-02-01
6.198 ARTISAN SMALL CAP FUND CL INST   2020-03-31 2021-03-01
85.312 BAILLIE GIFFORD EMERG MKTS CL K   2020-03-26 2021-06-03
1. BECTON DICKINSON & CO COM   2020-03-26 2021-03-01
1. BLACKROCK INCORPORATED CLASS A   2015-10-16 2021-03-01
1. BLACKROCK INCORPORATED CLASS A   2020-03-26 2021-04-09
30.663 BLACKROCK EVENT DRIVEN EQ FD CL I     2021-04-09
2. BROADCOM INC     2021-04-09
1. CME GROUP INC   2017-04-03 2021-03-01
2. CME GROUP INC   2017-04-03 2021-04-09
2. CMS ENERGY CORP COM   2020-03-26 2021-03-01
1. CHEVRONTEXACO CORP   2009-04-20 2021-03-01
3. CHEVRONTEXACO CORP   2020-03-26 2021-04-09
5. CISCO SYS INC COM   2014-08-14 2021-03-01
13. CISCO SYS INC COM     2021-04-09
3. CITIGROUP INC   2017-08-07 2021-03-01
6. CITIGROUP INC   2017-08-07 2021-04-09
89.141 COLUMBIA OVERSEAS VALUE-I3   2021-02-01 2021-03-01
294.312 COLUMBIA OVERSEAS VALUE-I3   2021-02-01 2021-04-09
5. COMCAST CORP NEW A   2017-02-28 2021-03-01
10. COMCAST CORP NEW A   2017-02-28 2021-04-09
1. COSTCO WHOLESALE CORPORATION   2016-12-14 2021-03-01
2. COSTCO WHOLESALE CORPORATION   2020-03-26 2021-04-09
1. DANAHER CORPORATION   2010-12-22 2021-03-01
3. DANAHER CORPORATION   2020-03-26 2021-04-09
1. WALT DISNEY CO COM   2020-03-26 2021-03-01
2. WALT DISNEY CO COM   2020-03-26 2021-04-09
3. EOG RESOURCES INCORPORATED   2016-07-12 2021-03-01
6. EOG RESOURCES INCORPORATED   2016-07-12 2021-04-09
1. EXPEDIA GROUP INC.   2017-03-24 2021-03-01
2. EXPEDIA GROUP INC.   2017-03-24 2021-04-09
1. FEDEX CORPORATION   2014-09-16 2021-03-01
2. FEDEX CORPORATION   2014-09-16 2021-04-09
217.503 T ROWE PRICE LG-CAP GR FD CL I   2020-05-14 2021-02-01
18.711 T ROWE PRICE LG-CAP GR FD CL I   2020-05-14 2021-03-01
222.901 T ROWE PRICE LG-CAP GR FD CL I     2021-03-26
128.924 T ROWE PRICE LG-CAP GR FD CL I   2020-03-26 2021-04-09
230.076 T ROWE PRICE LG-CAP GR FD CL I   2020-03-26 2021-06-03
104.73 WCM FOCUSED INTL GROWTH FD   2015-12-10 2021-02-01
77.088 WCM FOCUSED INTL GROWTH FD   2015-12-10 2021-04-09
72.468 WCM FOCUSED INTL GROWTH FD   2015-12-10 2021-06-03
47. ISHARES S&P SMALL-CAP 600 VALUE ETF   2020-09-04 2021-02-01
12. ISHARES S&P SMALL-CAP 600 VALUE ETF   2020-09-04 2021-03-01
13. ISHARES S&P SMALL-CAP 600 VALUE ETF   2021-03-26 2021-04-09
20. ISHARES S&P SMALL-CAP 600 VALUE ETF   2021-03-26 2021-06-03
33. ISHARES S&P SM-CAP 600 GROWTH ETF   2020-03-26 2021-02-01
3. ISHARES S&P SM-CAP 600 GROWTH ETF   2020-03-26 2021-03-01
102. ISHARES S&P SM-CAP 600 GROWTH ETF   2020-03-26 2021-03-26
28. ISHARES MSCI EAFE VALUE ETF   2021-03-26 2021-04-09
16. ISHARES MSCI USA QUALITY FACTOR ETF   2020-03-26 2021-02-01
4. ISHARES MSCI USA QUALITY FACTOR ETF   2020-03-26 2021-03-01
262. ISHARES MSCI USA QUALITY FACTOR ETF   2020-03-26 2021-03-26
10. ISHARES MSCI USA VALUE FACTOR   2021-03-26 2021-04-09
626. ISHARES CORE MSCI EAFE ETF     2021-02-01
416. ISHARES CORE MSCI EAFE ETF     2021-03-26
42. ISHARES CORE MSCI EAFE ETF   2020-03-26 2021-04-09
35. ISHARES CORE MSCI EAFE ETF   2020-03-26 2021-06-03
50. ISHARES CORE MSCI EMERGING   2016-12-14 2021-02-01
10. ISHARES CORE MSCI EMERGING   2016-12-14 2021-04-09
711. ISHARES GLOBAL REIT ETF     2021-02-01
3. J P MORGAN CHASE & CO COM   2009-09-04 2021-03-01
7. J P MORGAN CHASE & CO COM   2020-03-26 2021-04-09
1. JOHNSON & JOHNSON COMMON ~   1995-08-25 2021-03-01
3. JOHNSON & JOHNSON COMMON ~   2020-03-26 2021-04-09
1. ESTEE LAUDER COMPANIES INC   2017-05-11 2021-03-01
2. ESTEE LAUDER COMPANIES INC     2021-04-09
1. LOCKHEED MARTIN CORP COMMON   2020-03-26 2021-04-09
2. LOWES COMPANIES INCORPORATED   2013-06-28 2021-03-01
5. LOWES COMPANIES INCORPORATED   2020-03-26 2021-04-09
2. MASTERCARD INC CL A   2017-03-17 2021-03-01
4. MASTERCARD INC CL A   2020-03-26 2021-04-09
4. MAXIM INTEGRATED PRODUCTS INC   2009-04-30 2021-03-01
8. MAXIM INTEGRATED PRODUCTS INC   2020-03-26 2021-04-09
1. MERCK & CO INC   2012-01-30 2021-03-01
4. MERCK & CO INC   2020-03-26 2021-04-09
3. METLIFE INCORPORATED   2011-09-09 2021-03-01
6. MICROSOFT CORP COMMON   2017-02-28 2021-02-01
11. MICROSOFT CORP COMMON   2020-03-26 2021-04-09
2. MORGAN STANLEY GROUP INC   2020-03-26 2021-03-01
7. MORGAN STANLEY GROUP INC   2020-03-26 2021-04-09
1. NIKE INC CL B   2020-03-26 2021-03-01
3. NIKE INC CL B   2020-03-26 2021-04-09
3. OMNICOM GROUP INC COM   2010-03-25 2021-03-01
6. OMNICOM GROUP INC COM   2020-03-26 2021-04-09
2. ORACLE CORPORATION   2014-09-26 2021-03-01
4. ORACLE CORPORATION   2020-03-26 2021-04-09
.8 ORGANON & CO     2021-06-14
3. ORGANON & CO   2012-01-30 2021-06-17
2. PEPSICO INC COMMON ~   2010-08-10 2021-03-01
3. PEPSICO INC COMMON ~   2020-03-26 2021-04-09
1. PHILIP MORRIS INTL INC   2009-04-20 2021-03-01
3. PHILIP MORRIS INTL INC   2020-03-26 2021-04-09
1. PROCTER & GAMBLE CO COM   2017-02-28 2021-03-01
5. PROCTER & GAMBLE CO COM   2020-03-26 2021-04-09
2. QUALCOMM INCORPORATED   2010-01-28 2021-03-01
4. QUALCOMM INCORPORATED   2020-03-26 2021-04-09
3. RAYTHEON TECHNOLOGIES CORP   2020-04-17 2021-03-01
7. RAYTHEON TECHNOLOGIES CORP   2020-04-06 2021-04-09
82. SPDR GOLD SHARES   2020-07-24 2021-02-01
2. SHERWIN-WILLIAMS CO COMMON   2017-04-27 2021-04-09
2. STARBUCKS CORP COM   2020-04-17 2021-03-01
4. STARBUCKS CORP COM   2020-03-26 2021-04-09
3. TJX COMPANIES COM   2017-03-24 2021-03-01
7. TJX COMPANIES COM   2020-03-26 2021-04-09
3. US BANCORP NEW   2017-08-07 2021-03-01
7. US BANCORP NEW   2017-08-07 2021-04-09
2. UNION PACIFIC CORPORATION   2012-04-18 2021-03-01
3. UNION PACIFIC CORPORATION   2020-03-26 2021-04-09
1. UNITEDHEALTH GROUP INC   2017-03-17 2021-03-01
2. UNITEDHEALTH GROUP INC   2020-03-26 2021-04-09
3. VALERO ENERGY CORPORATION NEW     2021-03-01
6. VALERO ENERGY CORPORATION NEW   2020-03-26 2021-04-09
188.585 VANGUARD COMMODITY STRAT FD CL ADM   2020-03-26 2021-02-01
1695.012 VANGUARD HIGH YIELD CORP CL ADML   2019-09-17 2021-04-22
984.497 WILMINGTON GLOBAL ALPHA EQUITIES FD   2021-02-01 2021-03-01
120.449 WILMINGTON GLOBAL ALPHA EQUITIES FD   2021-02-01 2021-04-09
65.94 WILMINGTON GLOBAL ALPHA EQUITIES FD   2021-02-01 2021-10-28
130.285 WILMINGTON REAL ASSET FUND-I   2021-03-01 2021-04-09
280.452 WILMINGTON REAL ASSET FUND-I   2021-03-01 2021-06-03
712.225 WILMINGTON REAL ASSET FUND-I     2021-10-29
1055.775 WILMINGTON INTERNATIONAL FUND-I     2021-02-01
111.261 WILMINGTON INTERNATIONAL FUND-I   2020-03-26 2021-03-01
669.668 WILMINGTON INTERNATIONAL FUND-I   2020-03-26 2021-04-09
424.907 WILMINGTON INTERNATIONAL FUND-I   2020-03-26 2021-06-03
6929.496 WILMINGTON INTERMEDIATE-TERM BOND -I     2021-04-22
1. XYLEM INC-W/I   2020-11-12 2021-03-01
4. XYLEM INC-W/I   2020-09-03 2021-04-09
2. ZOETIS INC   2017-04-27 2021-03-01
3. ZOETIS INC   2017-04-27 2021-04-09
2. ACCENTURE PLC- CL A   2020-03-26 2021-04-09
1. MEDTRONIC PLC   2020-03-26 2021-03-01
3. MEDTRONIC PLC   2020-03-26 2021-04-09
2. TRANE TECHNOLOGIES PLC   2017-04-03 2021-03-01
3. TRANE TECHNOLOGIES PLC   2020-03-26 2021-04-09
1. WILLIS TOWERS WATSON PLC   2020-03-26 2021-03-01
2. WILLIS TOWERS WATSON PLC   2020-03-26 2021-04-09
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(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 1,911   1,749 162
b 2,940   1,685 1,255
c 113   166 -53
d 301   415 -114
e 196   161 35
381   322 59
262   193 69
569   387 182
1,981   1,910 71
154   136 18
346   296 50
217   79 138
721   604 117
227   114 113
492   392 100
5   1 4
1,606   411 1,195
2,857   1,382 1,475
4,933   2,678 2,255
347   182 165
2,486   1,408 1,078
244   205 39
713   329 384
804   410 394
310   307 3
959   464 495
206   117 89
409   234 175
110   106 4
103   65 38
310   209 101
229   123 106
676   468 208
206   207 -1
437   414 23
903   853 50
3,105   2,817 288
270   186 84
529   373 156
335   160 175
722   570 152
226   36 190
691   399 292
196   102 94
374   204 170
196   257 -61
437   514 -77
162   128 34
344   256 88
261   155 106
568   310 258
13,781   9,607 4,174
1,214   826 388
14,074   9,606 4,468
8,674   4,955 3,719
15,231   8,842 6,389
2,657   1,275 1,382
1,975   938 1,037
1,932   882 1,050
4,072   3,047 1,025
1,178   778 400
1,315   1,310 5
2,157   2,016 141
4,028   2,229 1,799
389   203 186
12,985   6,890 6,095
1,448   1,435 13
1,823   1,265 558
476   316 160
31,536   20,718 10,818
1,045   1,019 26
43,445   30,816 12,629
30,069   22,539 7,530
3,105   2,055 1,050
2,691   1,713 978
3,257   2,193 1,064
645   439 206
16,850   13,329 3,521
449   126 323
1,097   667 430
160   17 143
488   368 120
293   94 199
594   263 331
389   330 59
326   82 244
985   438 547
728   227 501
1,509   1,035 474
375   55 320
765   399 366
73   39 34
304   277 27
178   80 98
1,409   383 1,026
2,782   1,664 1,118
157   69 88
563   240 323
138   82 56
403   246 157
214   120 94
467   319 148
132   77 55
302   187 115
24   18 6
91   55 36
263   133 130
428   343 85
86   37 49
270   203 67
125   91 34
685   523 162
277   77 200
556   257 299
225   196 29
551   399 152
14,331   14,647 -316
509   223 286
218   153 65
449   271 178
203   118 85
482   312 170
153   159 -6
401   371 30
420   110 310
662   413 249
337   171 166
737   476 261
234   142 92
438   247 191
5,277   3,866 1,411
10,085   10,001 84
11,558   11,489 69
1,449   1,406 43
817   770 47
1,966   1,940 26
4,591   4,176 415
12,293   10,486 1,807
10,695   7,659 3,036
1,156   783 373
7,065   4,714 2,351
4,589   2,991 1,598
69,780   67,911 1,869
102   92 10
427   332 95
316   113 203
481   170 311
570   302 268
119   91 28
364   274 90
316   125 191
504   262 242
224   165 59
476   329 147
      13,235
      13,235
      13,235
      13,235
      13,235
      13,235
      13,235
      13,235
      13,235
      13,235
      13,235
      13,235
      13,235
      13,235
      13,235
      13,235
      13,235
      13,235
      13,235
      13,235
      13,235
      13,235
      13,235
      13,235
      13,235
      13,235
      13,235
      13,235
      13,235
      13,235
      13,235
      13,235
      13,235
      13,235
      13,235
      13,235
      13,235
      13,235
      13,235
      13,235
      13,235
      13,235
      13,235
      13,235
      13,235
      13,235
      13,235
      13,235
      13,235
      13,235
      13,235
      13,235
      13,235
      13,235
      13,235
      13,235
      13,235
      13,235
      13,235
      13,235
      13,235
      13,235
      13,235
      13,235
      13,235
      13,235
      13,235
      13,235
      13,235
      13,235
      13,235
      13,235
      13,235
      13,235
      13,235
      13,235
      13,235
      13,235
      13,235
      13,235
      13,235
      13,235
      13,235
      13,235
      13,235
      13,235
      13,235
      13,235
      13,235
      13,235
      13,235
      13,235
      13,235
      13,235
      13,235
      13,235
      13,235
      13,235
      13,235
      13,235
      13,235
      13,235
      13,235
      13,235
      13,235
      13,235
      13,235
      13,235
      13,235
      13,235
      13,235
      13,235
      13,235
      13,235
      13,235
      13,235
      13,235
      13,235
      13,235
      13,235
      13,235
      13,235
      13,235
      13,235
      13,235
      13,235
      13,235
      13,235
      13,235
      13,235
      13,235
      13,235
      13,235
      13,235
      13,235
      13,235
      13,235
      13,235
      13,235
      13,235
      13,235
      13,235
      13,235
      13,235
      13,235
      13,235
      13,235
      13,235
      13,235
      13,235
      13,235
      13,235
      13,235
      13,235
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       162
b       1,255
c       -53
d       -114
e       35
      59
      69
      182
      71
      18
      50
      138
      117
      113
      100
      4
      1,195
      1,475
      2,255
      165
      1,078
      39
      384
      394
      3
      495
      89
      175
      4
      38
      101
      106
      208
      -1
      23
      50
      288
      84
      156
      175
      152
      190
      292
      94
      170
      -61
      -77
      34
      88
      106
      258
      4,174
      388
      4,468
      3,719
      6,389
      1,382
      1,037
      1,050
      1,025
      400
      5
      141
      1,799
      186
      6,095
      13
      558
      160
      10,818
      26
      12,629
      7,530
      1,050
      978
      1,064
      206
      3,521
      323
      430
      143
      120
      199
      331
      59
      244
      547
      501
      474
      320
      366
      34
      27
      98
      1,026
      1,118
      88
      323
      56
      157
      94
      148
      55
      115
      6
      36
      130
      85
      49
      67
      34
      162
      200
      299
      29
      152
      -316
      286
      65
      178
      85
      170
      -6
      30
      310
      249
      166
      261
      92
      191
      1,411
      84
      69
      43
      47
      26
      415
      1,807
      3,036
      373
      2,351
      1,598
      1,869
      10
      95
      203
      311
      268
      28
      90
      191
      242
      59
      147
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
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 2 121,656
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 1,951
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 1,951
6 Credits/Payments:
a 2021 estimated tax payments and 2020 overpayment credited to 2021 6a 183
b Exempt foreign organizations—tax withheld at source...... 6b 0
c Tax paid with application for extension of time to file (Form 8868)... 6c 949
d Backup withholding erroneously withheld ........... 6d  
7 Total credits and payments. Add lines 6a through 6d.............. 7 1,132
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 9 819
10 Overpayment. If line 7 is more than the total of lines 5 and 8, enter the amount overpaid...Bullet 10  
11 Enter the amount of line 10 to be: Credited to 2022 estimated taxBullet0 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$   (2) On foundation managers.bullet$  
e
Enter the reimbursement (if any) paid by the foundation during the year for political expenditure tax imposed
on foundation managers.bullet$  
2
Has the foundation engaged in any activities that have not previously been reported to the IRS?.......
2
 
No
If "Yes," attach a detailed description of the activities.
3
Has the foundation made any changes, not previously reported to the IRS, in its governing instrument, articles
of incorporation, or bylaws, or other similar instruments? If "Yes," attach a conformed copy of the changes....
3
 
No
4a
Did the foundation have unrelated business gross income of $1,000 or more during the year?.........
4a
 
No
b
If "Yes," has it filed a tax return on Form 990-T for this year?...................
4b
 
 
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)
    bullet
    b
    If the answer is "Yes" to line 7, has the foundation furnished a copy of Form 990-PF to the Attorney
    General (or designate) of each state as required by General Instruction G? If "No," attach explanation .
    8b
    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
     
    No
    12
    Did the foundation make a distribution to a donor advised fund over which the foundation or a disqualified person had
    advisory privileges? If "Yes," attach statement. See instructions.................
    12
     
    No
    13
    Did the foundation comply with the public inspection requirements for its annual returns and exemption application?
    13
    Yes
     
    Website addressbullet  
    14
    The books are in care ofbulletWILMINTON TRUST COMPANY Telephone no.bullet (302) 651-1000

    Located atbullet1100 NORTH MARKET STREETWILMINGTONDE ZIP+4bullet19890
    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
     
    No
    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
     
     
    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
    WILMINGTON TRUST TRUSTEE
    1     		11,516    
    1100 NORTH MARKET STREET
    WILMINGTON,DE19890
    2 Compensation of five highest-paid employees (other than those included on line 1—see instructions). If none, enter “NONE."
    (a) Name and address of each employee paid more than $50,000 (b) Title, and average
    hours per week
    devoted to position     		(c) Compensation (d) Contributions to
    employee benefit
    plans and deferred
    compensation     		(e) Expense account,
    other allowances
    NONE
    Total number of other employees paid over $50,000...................bullet 0
    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  
    2  
    All other program-related investments. See instructions.
    3  
    Total. Add lines 1 through 3.........................bullet  
    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
    1,084,534
    b
    Average of monthly cash balances.......................
    1b
    42,579
    c
    Fair market value of all other assets (see instructions)................
    1c
    1,127,113
    d
    Total (add lines 1a, b, and c).........................
    1d
    2,254,226
    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
    2,254,226
    4
    Cash deemed held for charitable activities. Enter 1.5% (0.015) of line 3 (for greater amount, see
    instructions) .............................
    4
    33,813
    5
    Net value of noncharitable-use assets. Subtract line 4 from line 3. .......
    5
    2,220,413
    6
    Minimum investment return. Enter 5% (0.05) of line 5................
    6
    111,021
    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
    111,021
    2a
    Tax on investment income for 2021 from Part V, line 5.......
    2a
    1,951
    b
    Income tax for 2021. (This does not include the tax from Part V.) ...
    2b
     
    c
    Add lines 2a and 2b............................
    2c
    1,951
    3
    Distributable amount before adjustments. Subtract line 2c from line 1............
    3
    109,070
    4
    Recoveries of amounts treated as qualifying distributions................
    4
    0
    5
    Add lines 3 and 4............................
    5
    109,070
    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
    109,070
    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 7 109,070
    2 Undistributed income, if any, as of the end of 2021:
    a Enter amount for 2020 only....... 35,914
    b Total for prior years:20, 20, 20 0
    3 Excess distributions carryover, if any, to 2021:
    a From 2016...... 0
    b From 2017...... 0
    c From 2018...... 0
    d From 2019...... 0
    e From 2020...... 0
    f Total of lines 3a through e ........ 0
    4Qualifying distributions for 2021 from Part
    XI, line 4: bullet$ 48,931
    a Applied to 2020, but not more than line 2a 35,914
    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..... 13,017
    e Remaining amount distributed out of corpus 0
    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 0
    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 ..........     		96,053
    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 ......     		0
    10 Analysis of line 9:
    a Excess from 2017.... 0
    b Excess from 2018.... 0
    c Excess from 2019.... 0
    d Excess from 2020.... 0
    e Excess from 2021.... 0
    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.
    2Information Regarding Contribution, Grant, Gift, Loan, Scholarship, etc., Programs:
    Check here bullet
    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)
    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
    HOSPICE FND OF MARTIN & ST LUCIE INC
    1201 SE INDIAN STREET
    STUART,FL34997     		NONE PC GENERAL 7,183
    HUMANE SOCIETY OF THE TREASURE COAST
    4100 LEIGHTON FARM AVE
    PALM CITY,FL34990     		NONE PC GENERAL 7,183
    INDIAN RIVER STATE COLLEGE FDN INC
    3209 VIRGINIA AVENUE
    FORT PIERCE,FL34981     		NONE PC GENERAL 7,183
    TREASURE COAST WILDLIFE HOSPITAL INC
    8438 SW 48TH AVENUE
    PALM CITY,FL34990     		NONE PC GENERAL 7,183
    AMERICAN CANCER SOCIETY
    3709 W JETTON AVENUE
    TAMPA,FL33629     		NONE PC GENERAL 7,183
    Total .................................bullet 3a 35,915
    bApproved for future payment
    Total .................................bullet 3b  
    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 ...........     		         
    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 ............     		    18 121,656  
    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) ..   144,761  
    13Total. Add line 12, columns (b), (d), and (e)..................
    13
    144,761
    (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

    TY 2021 AccountingFeesSchedule
    Name:
    CHARLOTTE B FORESTIER PRIVATE FOUNDATION
    EIN:
    51-6568003
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    TAX PREPARATION FEE (NON-ALLOC 1,500     1,500

    TY 2021 OtherDecreasesSchedule
    Name:
    CHARLOTTE B FORESTIER PRIVATE FOUNDATION
    EIN:
    51-6568003
    Description Amount
    MUTUAL FUND 2021 INCOME RECEIVED IN 2022 124
    FOREIGN TAX WITHHELD 67
    TAX ADJUSTMENT 158


    TY 2021 OtherProfessionalFeesSchedule
    Name:
    CHARLOTTE B FORESTIER PRIVATE FOUNDATION
    EIN:
    51-6568003
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    TRUSTEE FEES - INCOME (NON-DED 3,839 1,919    
    TRUSTEE FEES-PRIN (NON-DEDUCTI 3,839 1,919    


    TY 2021 TaxesSchedule
    Name:
    CHARLOTTE B FORESTIER PRIVATE FOUNDATION
    EIN:
    51-6568003
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    FEDERAL ESTIMATES - PRINCIPAL 51 0   0
    FOREIGN TAXES ON QUALIFIED FOR 512 512   0
    FOREIGN TAXES ON NONQUALIFIED 68 68   0