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
MAXWELL CORPENING JR MEMORIAL
FOUNDATION
Number and street (or P.O. box number if mail is not delivered to street address)PO BOX 2400
  Room/suite
City or town, state or province, country, and ZIP or foreign postal code
MARION, NC28752
A Employer identification number

23-7201488
B Telephone number (see instructions)

(828) 659-9622
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$524,798J 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) 654,842
2 Check bullet.............
3 Interest on savings and temporary cash investments 207 207 207
4 Dividends and interest from securities...      
5a Gross rents............      
b Net rental income or (loss)  
6a Net gain or (loss) from sale of assets not on line 10  
b Gross sales price for all assets on line 6a  
7 Capital gain net income (from Part IV, line 2)... 0
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)....... Click to see attachment 3,180 0 3,180
12 Total. Add lines 1 through 11........ 658,229 207 3,387
Operating and Administrative Expenses 13 Compensation of officers, directors, trustees, etc. 0 0 0 0
14 Other employee salaries and wages...... 12,165 0 0 12,165
15 Pension plans, employee benefits.......        
16a Legal fees (attach schedule)......... Click to see attachment 500 0 100 400
b Accounting fees (attach schedule)....... Click to see attachment 3,000 0 2,755 245
c Other professional fees (attach schedule)....        
17 Interest...............        
18 Taxes (attach schedule) (see instructions)... Click to see attachment 956 0 0 956
19 Depreciation (attach schedule) and depletion... Click to see attachment 363 0 363
20 Occupancy..............        
21 Travel, conferences, and meetings.......        
22 Printing and publications..........        
23 Other expenses (attach schedule)....... Click to see attachment 2,778 0 169 2,608
24 Total operating and administrative expenses.
Add lines 13 through 23.......... 19,762 0 3,387 16,374
25 Contributions, gifts, grants paid....... 502,440 502,440
26 Total expenses and disbursements. Add lines 24 and 25 522,202 0 3,387 518,814
27 Subtract line 26 from line 12:
a Excess of revenue over expenses and disbursements 136,027
b Net investment income (if negative, enter -0-) 207
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......... 387,733 524,284 524,284
3 Accounts receivable bullet  
Less: allowance for doubtful accounts bullet        
4 Pledges receivable bullet  
Less: allowance for doubtful accounts bullet        
5 Grants receivable.................      
6 Receivables due from officers, directors, trustees, and other
disqualified persons (attach schedule) (see instructions).....      
7 Other notes and loans receivable (attach schedule) bullet  
Less: allowance for doubtful accounts bullet        
8 Inventories for sale or use..............      
9 Prepaid expenses and deferred charges..........      
10a Investments—U.S. and state government obligations (attach schedule)      
b Investments—corporate stock (attach schedule).......      
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)..........      
14 Land, buildings, and equipment: basis bullet3,849
Less: accumulated depreciation (attach schedule) bullet3,335 877 Click to see attachment514 514
15 Other assets (describe bullet)      
16 Total assets (to be completed by all filers—see the
instructions. Also, see page 1, item I) 388,610 524,798 524,798
Liabilities 17 Accounts payable and accrued expenses.......... 560 721
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)......... 560 721
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............ 388,050 524,077
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........    
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)..... 388,050 524,077
30 Total liabilities and net assets/fund balances (see instructions). 388,610 524,798
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
388,050
2
Enter amount from Part I, line 27a .....................
2
136,027
3
Other increases not included in line 2 (itemize) bullet
3
0
4
Add lines 1, 2, and 3 ..........................
4
524,077
5
Decreases not included in line 2 (itemize) bullet
5
0
6
Total net assets or fund balances at end of year (line 4 minus line 5)—Part II, column (b), line 29 .
6
524,077
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.)
1a
b
c
d
e
(e)
Gross sales price 		(f)
Depreciation allowed
(or allowable) 		(g)
Cost or other basis
plus expense of sale 		(h)
Gain or (loss)
(e) plus (f) minus (g)
a
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
b
c
d
e
2 Capital gain net income or (net capital loss) Bracket If gain, also enter in Part I, line 7
If (loss), enter -0- in Part I, line 7		 Bracket 2  
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: 1989-02-23(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  
3 Add lines 1 and 2........................... 3  
4 Subtitle A (income) tax (domestic section 4947(a)(1) trusts and taxable foundations only. Others enter -0-) 4  
5 Tax based on investment income. Subtract line 4 from line 3. If zero or less, enter -0- ..... 5 0
6 Credits/Payments:
a 2021 estimated tax payments and 2020 overpayment credited to 2021 6a 0
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 0
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 0
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 taxBullet   RefundedBullet 11  
Part VI-A
Statements Regarding Activities
1a
During the tax year, did the foundation attempt to influence any national, state, or local legislation or did
Yes
No
it participate or intervene in any political campaign? ....................
1a
 
No
b
Did it spend more than $100 during the year (either directly or indirectly) for political purposes? See the instructions
for the definition.................................
1b
 
No
If the answer is "Yes" to 1a or 1b, attach a detailed description of the activities and copies of any materials
published or distributed by the foundation in connection with the activities.
c
Did the foundation file Form 1120-POL for this year?.....................
1c
 
No
d
Enter the amount (if any) of tax on political expenditures (section 4955) imposed during the year:
(1) On the foundation. bullet$ 0(2) On foundation managers.bullet$ 0
e
Enter the reimbursement (if any) paid by the foundation during the year for political expenditure tax imposed
on foundation managers.bullet$ 0
2
Has the foundation engaged in any activities that have not previously been reported to the IRS?.......
2
 
No
If "Yes," attach a detailed description of the activities.
3
Has the foundation made any changes, not previously reported to the IRS, in its governing instrument, articles
of incorporation, or bylaws, or other similar instruments? If "Yes," attach a conformed copy of the 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)
    bulletNC
    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
    Yes
     
    10
    Did any persons become substantial contributors during the tax year? If "Yes," attach a schedule listing their names
    and addresses. Click to see attachment...............................
    10
    Yes
     
    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 addressbulletN/A
    14
    The books are in care ofbulletMR DAVID WOOTEN Telephone no.bullet (828) 659-9622

    Located atbulletP O BOX 2400MARIONNC ZIP+4bullet28752
    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)
     
    No
    (5) Transfer any income or assets to a disqualified person (or make any of either available
    for the benefit or use of a disqualified person)? ......................
    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
     
     
    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
    DAVID WOOTEN SECRETARY/TREASURER
    2.00     		0 0 0
    P O BOX 2400
    MARION,NC28752
    RICKY BUCHANAN CHAIRMAN
    2.00     		0 0 0
    P O BOX 2400
    MARION,NC28752
    REV ROBERT WARREN VICE CHAIRMAN
    2.00     		0 0 0
    P O BOX 2400
    MARION,NC28752
    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 THE FOUNDATION SERVED 213 NEEDY INDIVIDUALS OF MCDOWELL COUNTY THROUGH DIRECT PAYMENT FOR SHELTER, UTILITIES, MEDICAL ASSISTANCE AND OTHER NECESSARY LIVING EXPENSES. 92,733
    2 GRANT TO MAXWELL M. CORPENING, JR. MEMORIAL CENTER, INC. TO CONSTRUCT AND SUPPORT OPERATIONS OF YMCA TO BENEFIT ALL RESIDENTS OF MCDOWELL COUNTY. 404,707
    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.........................bullet0
    Form 990-PF (2021)
    Form 990-PF (2021)
    Page 8
    Part IX
    Minimum Investment Return (All domestic foundations must complete this part. Foreign foundations, see instructions.)
    1
    Fair market value of assets not used (or held for use) directly in carrying out charitable, etc.,
    purposes:
    a
    Average monthly fair market value of securities...................
    1a
    0
    b
    Average of monthly cash balances.......................
    1b
    374,293
    c
    Fair market value of all other assets (see instructions)................
    1c
    0
    d
    Total (add lines 1a, b, and c).........................
    1d
    374,293
    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
    374,293
    4
    Cash deemed held for charitable activities. Enter 1.5% (0.015) of line 3 (for greater amount, see
    instructions) .............................
    4
    5,614
    5
    Net value of noncharitable-use assets. Subtract line 4 from line 3. .......
    5
    368,679
    6
    Minimum investment return. Enter 5% (0.05) of line 5................
    6
    18,434
    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
     
    2a
    Tax on investment income for 2021 from Part V, line 5.......
    2a
     
    b
    Income tax for 2021. (This does not include the tax from Part V.) ...
    2b
     
    c
    Add lines 2a and 2b............................
    2c
     
    3
    Distributable amount before adjustments. Subtract line 2c from line 1............
    3
     
    4
    Recoveries of amounts treated as qualifying distributions................
    4
     
    5
    Add lines 3 and 4............................
    5
     
    6
    Deduction from distributable amount (see instructions).................
    6
     
    7
    Distributable amount as adjusted. Subtract line 6 from line 5. Enter here and on Part XII, line 1 ...
    7
     
    Part XI
    Qualifying Distributions (see instructions)
    1
    Amounts paid (including administrative expenses) to accomplish charitable, etc., purposes:
    a
    Expenses, contributions, gifts, etc.—total from Part I, column (d), line 26 ..........
    1a
     
    b
    Program-related investments—total from Part VIII-B..................
    1b
     
    2
    Amounts paid to acquire assets used (or held for use) directly in carrying out charitable, etc.,
    purposes...............................
    2
     
    3
    Amounts set aside for specific charitable projects that satisfy the:
    a
    Suitability test (prior IRS approval required)....................
    3a
     
    b
    Cash distribution test (attach the required schedule) .................
    3b
     
    4
    Qualifying distributions. Add lines 1a through 3b. Enter here and on Part XII, line 4.
    4
     
    Form 990-PF (2021)
    Form 990-PF (2021)
    Page 9
    Part XII
    Undistributed Income (see instructions)
    (a)
    Corpus     		(b)
    Years prior to 2020     		(c)
    2020     		(d)
    2021
    1 Distributable amount for 2021 from Part X, line 7  
    2 Undistributed income, if any, as of the end of 2021:
    a Enter amount for 2020 only.......  
    b Total for prior years:20, 20, 20  
    3 Excess distributions carryover, if any, to 2021:
    a From 2016......  
    b From 2017......  
    c From 2018......  
    d From 2019......  
    e From 2020......  
    f Total of lines 3a through e ........  
    4Qualifying distributions for 2021 from Part
    XI, line 4: bullet$  
    a Applied to 2020, but not more than line 2a  
    b Applied to undistributed income of prior years
    (Election required—see instructions).....     		 
    c Treated as distributions out of corpus (Election
    required—see instructions)........     		 
    d Applied to 2021 distributable amount.....  
    e Remaining amount distributed out of corpus  
    5 Excess distributions carryover applied to 2021.    
    (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  
    b Prior years’ undistributed income. Subtract
    line 4b from line 2b ..........     		 
    c Enter the amount of prior years’ undistributed
    income for which a notice of deficiency has
    been issued, or on which the section 4942(a)
    tax has been previously assessed......     		 
    d Subtract line 6c from line 6b. Taxable amount
    —see instructions ...........     		 
    e Undistributed income for 2019. Subtract line
    4a from line 2a. Taxable amount—see
    instructions .............     		 
    f Undistributed income for 2021. Subtract
    lines 4d and 5 from line 1. This amount must
    be distributed in 2022 ..........     		 
    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) .......     		 
    8 Excess distributions carryover from 2016 not
    applied on line 5 or line 7 (see instructions) ...     		 
    9 Excess distributions carryover to 2022.
    Subtract lines 7 and 8 from line 6a ......     		 
    10 Analysis of line 9:
    a Excess from 2017....  
    b Excess from 2018....  
    c Excess from 2019....  
    d Excess from 2020....  
    e Excess from 2021....  
    Form 990-PF (2021)
    Form 990-PF (2021)
    Page 10
    Part XIII
    Private Operating Foundations (see instructions and Part VI-A, question 9)
    1a If the foundation has received a ruling or determination letter that it is a private operating
    foundation, and the ruling is effective for 2021, enter the date of the ruling ....... bullet
    1983-01-01
    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
    0 0 0 0 0
    b 85% (0.85) of line 2a ......... 0 0 0 0 0
    c Qualifying distributions from Part XI,
    line 4 for each year listed .....     		518,814 584,184 613,450 598,651 2,315,099
    d Amounts included in line 2c not used directly
    for active conduct of exempt activities ..........     		409,707 454,216 445,351 432,263 1,741,537
    e Qualifying distributions made directly
    for active conduct of exempt activities.
    Subtract line 2d from line 2c ....     		109,107 129,968 168,099 166,388 573,562
    3 Complete 3a, b, or c for the
    alternative test relied upon:
    a “Assets" alternative test—enter:
    (1) Value of all assets ...... 524,284 387,733 358,456 369,268 1,639,741
    (2) Value of assets qualifying
    under section 4942(j)(3)(B)(i)    		 524,284 387,733 358,456 369,268 1,639,741
    b “Endowment" alternative test— enter 2/3
    of minimum investment return shown in
    Part IX, line 6 for each year listed ..     		        0
    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) ....     		        0
    (2) Support from general public
    and 5 or more exempt
    organizations as provided in
    section 4942(j)(3)(B)(iii)....     		        0
    (3) Largest amount of support
    from an exempt organization    		         0
    (4) Gross investment income         0
    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 e-mail address of the person to whom applications should be addressed:
    MS TERRI LAWS
    PO BOX 2400
    MARION,NC28752
    (828) 659-9622
    bThe form in which applications should be submitted and information and materials they should include:
    APPLICANTS COMPLETE AN APPLICATION DESIGNED BY THE FOUNDATION. THE APPLICATION REQUESTS THE APPLICANT'S CONTACT INFORMAITON, INCOME, EXPENSES AND OTHER INFORMATION. THE APPLICANT CERTIFIES THAT THE INFORMATION PROVIDED TO THE FOUNDATION IS CORRECT.
    cAny submission deadlines:
    NONE
    dAny restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other
    factors:
    LIMITED TO RESIDENTS OF MCDOWELL COUNTY, NORTH CAROLINA
    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
    JOHN CAMPBELL PEPPERS
    45 EAST VIEW STREET APT 1
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 300
    STARLA WHEELER SPARKMAN
    130 DEER RUN DRIVE 22
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 400
    AUTUMN ANDREWS
    321 KATHY STREET
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 400
    ANITA BRIGGS SIXTO
    126 SOUTH MCDOWELL AVENUE
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 377
    ERIC BUSTOS SANTO
    386 YANCY STREET LOT 6
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 330
    NICHOLE FAYE BRADLEY
    299 CHAPEL HILL CHURCH LOOP
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 500
    DEVON BRAY HOFFMAN
    50 JOANNA DRIVE
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 400
    VESTA WISE ADKINS
    327 OLD CATAWBA RIVER ROAD
    OLD FORT,NC28762     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 221
    BRANDY MCKINNEY DUVEMAY
    255 VIRGINIA DRIVE
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 450
    JAMES KENNETH BRADLEY
    216 WILDWOOD TERRACE
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 335
    LLOYD RAY BROOME
    31 MEADOW LANE
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 250
    JOSE AMADOR LOPEZ
    167 CLARK STREET
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 400
    FORREST M SATTERFIELD
    145 E WILHEMENIA STREET
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 400
    MARLENE HUTCHINSON
    359 TATER TOT DRIVE
    NEBO,NC28761     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 352
    BRITTANY LASHEA WINCHESTER
    153 STROUD STREET
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 400
    CHARLES KEITH CLARK
    1882 N MAIN STREET
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 400
    DORIS DOLES MCKINNEY
    111 CRAWFORD STREET APT 36H
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 242
    MARK R LAMB
    165 BROOKE LANE
    OLD FORT,NC28762     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 453
    CRYSTAL MARIE REAL
    182 LILLIES DRIVE
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 440
    MICHAEL DOLPH TATE
    48 EAST HIGH STREET
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 400
    JUANITA JONES BARTLETT
    102 CANNON FARM DRIVE
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 430
    GREGORY THOMAS MILLER
    5429 VEIN MTN ROAD
    NEBO,NC28761     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 400
    DIANE BANNER FOX
    167 OVERLOOK DRIVE
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 280
    MA RODRIGUEZ-GARCIASELINA BUSTO-GAR
    31 OCTAVIA AVENUE
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 300
    NICHOLE ENGLISH
    77 CALIFORNIA AVENUE
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 400
    DANIEL P MEJIA JR
    2446 FAIRVIEW ROAD
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 400
    REBECCA EILEEN PARKER
    42 KELLERS COURT
    NEBO,NC28761     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 400
    BETINA RENEE HARWOOD
    690 LENTZ ROAD
    MARLON,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 400
    DORA L CALLE RENDON
    1615 US 70 W LOT 39
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 400
    JOHN TRINKS
    119 OVERLOOK PARK CIRCLE
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 390
    DEBRA BARNES TABOR
    106 MOORE DRIVE
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 400
    KRYSTAL BURNETTE STEVESON
    1894 LACKEYTOWN ROAD
    OLD FORT,NC28762     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 400
    NINA EDWARDS WILSON
    525 TONEY ROAD
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 500
    CONNIE KAY MILLER
    53 PILOT RIDGE ROAD
    NEBO,NC28761     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 300
    KATHY FORBES COOK
    857 NED MCGIMSEY ROAD
    NEBO,NC28761     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 389
    JAMES CRAIG BRISTOL
    1246 OLD NC 105
    NEBO,NC28761     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 400
    JERRY REEL
    52 MERCY LANE
    NEBO,NC28761     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 470
    DORIS ADAMS TRANTHAM
    928 OWL HOLLOW ROAD
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 325
    ANNETTE HINES
    20 VILLAGE CIRCLE
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 300
    FRANK WILBUR BRAY
    90 LIGHTING RIDGE DRIVE
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 500
    KYMBERLEE WHITESIDES
    98 GLORIA WAY
    NEBO,NC28761     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 525
    CHRIS BUIE
    96 MACES TRAILER PARK
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 400
    PAUL BENJAMIN AVERY
    174 BUMPY HILL DRIVE
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 477
    GARY DEAN AUTREY
    1890 OLD GREENLEE ROAD
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 232
    PAUL J CHAUEZ
    101 S MCDOWELL AVE
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 360
    AMBER RHYNE
    93 ELLIOTT ROAD
    MARLON,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 400
    JANIE BELL CHAMBERS
    1319 BETHEL CHURCH RD
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 301
    MARGARET LYNCH
    72 WEST HIGH STREET
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 265
    ANNA REEL GENTRY
    369 OLD MORGANTON RD
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 325
    HAZEL WHITESIDE TATE
    361 WEST HUDGINS ST
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 339
    DANIELLE HOGAN MADDEN
    53 RIDGECREST DRIVE
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 450
    CALVIN LINDSEY
    45 W YANCEY STREET
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 255
    WESLEY MATT DAVIS
    248 WALL POOL ROAD
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 400
    BOBBLE ZULLO BENGE
    56 LILAC ROAD
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 401
    CHRISTOPHER WAYNE CONNER
    299 ACORN LANE
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 400
    PAIGE LEIGH ANNE LEDBETTER
    5646 SUGAR HILL ROAD
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 450
    SHERRY HENDERSON GROVER
    144 LEWIS DRIVE
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 400
    EVELYN PATTY TOLHURST
    9689 MONTFORD COVE RD
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 400
    JON VUE
    260 RIVERVIEW DRIVE
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 400
    JANICE BAILEY
    90 HARRISON TERRACE APT 332C
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 500
    GRISELDA RODRIGUIZ DIAZ
    1615 US 70 W LOT 46
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 500
    JUSTIN DENTON
    60 LEACH STREET
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 400
    RENEE MOUSSEAU
    819 VIRGINIA ROAD
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 400
    MARY CONLEY WELLS
    349 STATE STREET APT 76
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 167
    FRANCES MCCALL FLANAGAN
    116 CARSON STREET APT 37
    MARLON,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 400
    DARRELL RAY WILSON
    197 WHITSON ROAD
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 272
    GINA LYNN PATE
    129 MACES PARK DRIVE
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 400
    STEPHANIE PATTERSON
    631 STATE STREET
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 220
    JACK DOUGLAS MCINTOSH JR
    70 ELIZABETH LOOP
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 400
    EMILY WORLEY RAY
    25 COMFY COVE ROAD
    OLD FORT,NC28762     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 450
    JUSTIN JO CROW
    79 GOOSEBERRY DRIVE
    OLD FORT,NC28762     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 210
    YVONNE JOHNSON MCDANIEL
    200 MCDOWELL HIGH DRIVE 313
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 481
    LAWRENCE ISSAC GENTRY
    4779 US HIGHWAY 70 E
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 400
    CRYSTAL DENNY MURRAY
    279 N CHURCH ROAD
    OLD FORT,NC28762     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 400
    MAKAYLA RENAE RUSSELL
    65 KINSBURY DRIVE
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 400
    RUBY WILLIAMS THOMPSON
    176 SCHOOL ST 2
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 400
    ROSEANNA RUSSELL
    349 STATE STREET APT 38
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 500
    RENELLE MELTON WRIGHT
    112 FOXWOOD DRIVE
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 447
    JORDAN BERRYHILL
    10 WILLOW STREET
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 400
    AMANDA TABOR
    349 STATE STREET APT 33
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 390
    AMBER NICOLE PHILLIPS
    204 OAKDALE ESTATES
    OLD FORT,NC28762     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 520
    BRIAN MICHAEL GOULD
    581 VALLEY STREET APT A
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 425
    STORME MARIE ADKINS
    544 SUGARHILL HEIGHTS DRIVE
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 3,000
    DEANNA HENSLEY
    172 FAIRVIEW ROAD
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 500
    FAITH PARROW
    115 LAMAR STREET
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 500
    MADISON OGLE
    PO BOX 194
    OLD FORT,NC28762     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 500
    TAYLOR BARRIER
    77 PORTER RIDGE RD
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 1,000
    JAKOB PITTMAN
    292 MCKINNEY ROAD
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 1,000
    KELESY SMITH
    5050 US HWV 70 E
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 500
    IESHA DIAMONIQUE CARSON
    26 REID STREET APT 7
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 400
    BARBARA HOLLIFIELD SURRETT
    107 OAKWELL DRIVE
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 269
    WESLEY MATTHEW WEBB
    2377 US 70 WEST
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 650
    MICHAEL SCOTT ROLAND
    150 MOCKING BIRD DR
    NEBO,NC28761     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 413
    SANDA GALLOWAY EVANS
    2305 RUTHERFORD RD
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 400
    ANITA NABERHOIS CLAYTON
    42 RAY ROLAND DRIVE
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 400
    JERRI REECE MCNEILLY
    6619 HWY 70 EAST
    NEBO,NC28761     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 450
    EDWARD WASELESKI III
    6640 US 70 WEST
    OLD FORT,NC28762     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 350
    WANDA LAWSON GREER
    6527 SUGAR HILL RD
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 435
    MELISSA BENZ CLARK
    838 SPAULDING ROAD APT 205B
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 450
    BRANDY BIDDIX MILLER
    90 HARRISON TERRACE APT 134A
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 450
    CHARLES A MCPHERSON
    80 LEACH STREET APT A
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 400
    TIMOTHY SCOTT SMITH
    250 AMILIA DRIVE LOT 1
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 300
    ANGELA KING
    157 W HIGH STREET
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 205
    JAMES EDWARD BARTLETT
    117 B DRIVE
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 300
    JENNIFER TIERCE
    249 STROUD STREET
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 400
    GRACE MELTON HOLLIFIELD
    6429 BAT CAVE ROAD
    OLD FORT,NC28762     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 500
    SHAREN MCELREATH POWELL
    3778 BETHLEHEM ROAD
    OLD FORT,NC28762     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 400
    JESSICA HUTCHINS PATRICK
    200 MCDOWELL HIGH DR 207
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 400
    BARBARA RADER BUCHANAN
    147 GREENWOOD DRIVE
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 390
    JACKIE SHETLEY HALL
    2290 TATERTOWN LOOP
    NEBO,NC28761     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 361
    SHANNON ROCHELL CARDEN
    2712 HWY 226 N
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 400
    DYLAN MONROE BLAIR
    30 LYTLE COVE ROAD
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 3,500
    WINDY GRINDSTAFF
    1674 MACKEY CREEK RD
    OLD FORT,NC28762     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 225
    RENEE TATE STEPTOE
    96 OAK DALE EST
    OLD FORT,NC28762     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 250
    FREDRICK ALEXANDER BROWN
    351 WEST HUDGINS ST
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 250
    TREVOR AUSTIN KETTLES
    1086 PINNACLE CHURCH RD
    NEBO,NC28761     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 3,500
    JESSICA AGOSTO BRIDGES
    200 SPRING STREET APT 4
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 350
    CHACARA LINDSEY
    30 JACKSON STREET
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 260
    APRIL BIZZARD
    720 HWY 126
    NEBO,NC28761     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 439
    JESSIE MCPETERS HENSLEY
    59 LAMB DRIVE
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 350
    ASHELY MARIE FRADY
    16 STILLHOUSE DRIVE
    OLD FORT,NC28762     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 300
    STACY HOUSE
    2408 OLD GREENLEE RD
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 500
    KATELYN N MACE
    296 TRIPLE J PARK
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 400
    NICHOLAS WILKERSON
    95 RENA STREET
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 400
    CATHY ANN RUFFLE
    5128 OLD LINVILLE RD
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 400
    STELLA MARIE PRATHER
    90 HARRISON TERRACE 212B
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 500
    GARY MONORE DAVIS
    315 NORTH CHURCH ST
    OLD FORT,NC28762     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 500
    RIEDA G NANNEY
    200 MCDOWELL HIGH DR 220
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 267
    CAROL KEITHLEY GOLDEN
    251 LUCKY STRIKE DR
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 400
    MICHELLE LEA LOGAN
    181 JOHN BYNUM RD
    OLD FORT,NC28762     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 403
    WILLIAM ERIC WOODS
    349 STATE STREET 37
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 263
    ANGELA DENISE JOLLY
    150 WEST MAIN STREET APT 4
    OLD FORT,NC28762     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 335
    MARY JO SILVER
    887 N SUNNY GROVE DR
    NEBO,NC28761     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 248
    STEPHEN ASLEY FERKO
    69 W CRAWFORD ST
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 350
    CHARLENE SHAMBLIN SOWERS
    258 LOG CABIN LANE
    NEBO,NC28761     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 200
    JUSTIN CALEB GRANT
    376 PARK AVENUE
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 400
    BRITTANY DAWN OWENSBY
    69 W YANCEY STREET
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 400
    TOYNA DAWN YORK
    3076 US 70 EAST
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 400
    MELISSA OWENSBY THORPE
    311 RED TOWN ROAD A
    OLD FORT,NC28762     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 400
    JONATHAN ALAN CARVER
    389 HILLTOP DRIVE
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 352
    JARED DALE ROBINSON
    483 CHEROKEE WAY
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 400
    JAMES RAY THOMPSON JR
    33 CHRIS DRIVE
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 400
    BENJAMIN F PRUITT III
    170 CARSON STREET
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 425
    CIERRA NICOLE JOHNSON
    977 OAKS PARK DR
    NEBO,NC28761     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 350
    THOMAS ROBERT WHITE
    4524 PARKER PADGETT RD
    OLD FORT,NC28762     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 400
    TRAVIS R WEBB
    41 JACK RABBIT DRIVE
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 500
    ANELIA ENGLISH
    218 PROCTOR KNOB RD
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 400
    SHEILA PADGETT DAVIS
    104 7TH STREET
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 500
    CHRISTOPHER M RUSH
    32 BOLDEN DRIVE
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 582
    MAGGIE FINCHER WALDROUP
    358 ZION HILL RD
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 435
    BOBBIE F WILSON
    205 WHITSON ROAD
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 373
    SOSHA NICOLE PETERS
    4238 US 221
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 400
    JUANITA METCALF BELL
    167 JOHNSONS TRAIL
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 400
    CAROLYN PARKER THOMAS
    50 BLACKHAWK DRIVE
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 400
    SANDA LEWIS CLINE
    479 CHEROKEE WAY
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 400
    KRISTINA MAE ADKINS
    74 BEN VIEW DRIVE
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 400
    BROOKLYN RYAN WILSON
    363 TAYLOR LAKE DR
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 450
    CHELSIE DANIELLE MOORE
    75 CARRAWAY DRIVE
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 450
    TRACY LYNN DUCKWORTH
    26 REID STREET APT 5
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 400
    LISSA CHRISAWN WARD
    247 BARTLETT ROAD
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 464
    GREGORY SCOTT JOHNSON
    1777 HWY 70 WEST
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 400
    MARION GWEN MCCULLERS
    50 RIDGE STREET
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 610
    CHARTOTTE MULLINS RICH
    33 WEST CROSS STREET
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 342
    LISA MARIE TORRES
    12 SWANN DRIVE
    OLD FORT,NC28762     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 392
    DOROTHY LYNN LUKAS
    58 COLE STREET
    OLD FORT,NC28762     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 450
    MARIOW JERMAINE MUNDY
    222 LUCKY STREET
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 387
    LAVERNE CONLEY
    340 WEST HUDGINS ST
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 400
    LINDA PATTON EDWARDS
    1752 AIRPORT ROAD
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 326
    PATRICA THOM
    4027 PARKER PADGETT RD
    OLD FORT,NC28762     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 700
    ANGEL LYNN HOWARD
    259 TIMBER ROAD
    MARLON,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 350
    BRADLEV JAY BROWN JR
    190 HOYLE STREET
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 470
    PATRICA RANDOLPH
    98 STATE STREET
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 477
    JAMES EDWARD LONON
    334 PARK AVENUE
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 358
    ERICA RAKESTRAW JENKINS
    325 HIDDEN ACRES
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 425
    MYRA REGINA BROWN
    42 FLINTROCK PASS DR
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 153
    KYLE DANIEL FOX
    3616 US 221 N APT 18
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 400
    MARGARET TUMER BAILEY
    154 HAMMERS CIRCLE
    OLD FORT,NC28762     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 406
    JUDY HARMON MCCULLERS
    40 RIDGE STREET
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 225
    STEVEN LD PENNELL JR
    47 VILLAGE TRAIL
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 400
    LARK DILLION PRINDLE
    40 BENT TWIG DRIVE
    OLD FORT,NC28762     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 375
    ROBERT NELSON SMITH JR
    21 COLUMBIA AVENUE
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 400
    JAY CHARLES LEE
    93 SEAGLE STREET
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 415
    ROSEWA ANN LYTLE
    145 SUNSET DRIVE
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 400
    TAMMY MERRILL BUCHANAN
    261 LUCKY STREET
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 400
    GERALDINE MAE CLARK
    188 LONESOME PINE DR
    NEBO,NC28761     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 585
    PEGGY SHELTON THOMPSON
    90 HARRISON TERRACE 111A
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 285
    STEPHEN J VETTRAINO
    26 REID STREET APT 2
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 350
    DEBORAH WHITEHEAD VANCE
    820 RUTHERFORD ROAD
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 450
    SANDRA CABLE LAWSON
    153 MACK CARR DRIVE
    OLD FORT,NC28762     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 400
    JESSICA ALEXANDRIA RENFRO
    65 SUMMERSET PARK
    OLD FORT,NC28762     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 220
    JENNIFER WEBB
    73 SUMMERSET PARK
    OLD FORT,NC28762     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 450
    BILLY BURRELL
    1155 VIRGINIA ROAD
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 406
    BOBBY TERRY JR
    95 STONEY END DRIVE
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 263
    TIMOTHY IVY
    77 TEAL STREET
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 274
    HEATHER CONNER THOMAS
    40 STATE STREET
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 500
    CRYSTAL WILSON
    245 KIDS WAY
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 400
    CHARLES DOUGLAS CAUSBY
    3411 FAIRVIEW ROAD
    NEBO,NC28761     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 400
    ELIZABETH KAPING
    678 CHEROKEE WAY
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 400
    ANNE STYLES ROBINSON
    445 CHEROKEE WAY
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 400
    LINDA TUTEN BOTHWELL
    591 HIDDEN FOREST DR
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 200
    JANE MILLS AHRENSTEDT
    66 PERRY STREET
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 405
    AMANDA BUCHANAN MARSHBURN
    194 REID STREET
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 400
    AMY JOHNSON HOLLIFIELD
    16 MEADOW BROOK LANE
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 325
    NATALIE BURGIN
    344 DAWN DRIVE 49
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 200
    GWEN HAMMOND MARETT
    390 E MAIN STREET
    OLD FORT,NC28762     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 350
    JASON TWITTY
    97 KEATON DRIVE
    OLD FORT,NC28762     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 400
    KEVIN SUMPTER
    838 SPAULDING ROAD APT 206A
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 587
    PROJECT CHRISTMAS
    PO BOX 2198
    MARION,NC28752     		NONE PRIVATE FOUNDATION PROVIDE CHRISTMAS GIFTS TO LOW INCOME CHILDREN 5,000
    MAXWELL M CORPENING JR MEMORIAL CENTER INC
    PO BOX 2400
    MARION,NC28752     		RELATED EXEMPT ORGANIZATION 501(C)(3) ORGANIZATI SEE PART VIII-A, STATEMENT 2 404,707
    SANDRA B JOHNSON
    76 CATAWBA STREET
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 400
    PAULA DENNISE WHEELER
    108 SADIE DRIVE
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 400
    RONALD FYLNN
    105 TUNNEL ROAD
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 132
    MELISSA MCKEE HEAFNER
    192 PINNICLE HEIGHTS DRIVE
    NEBO,NC28761     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 250
    AMANDA SHELTON BAILEY
    200 MCDOWELL HIGH DRIVE 211
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 500
    JESSICA LEE SEMRAU
    1674 POLLY SPROUT ROAD
    MARION,NC28752     		INDIVIDUAL N/A SEE STATEMENT VIII-A, STATEMENT 1 450
    Total .................................bullet 3a 502,440
    bApproved for future payment
    Total .................................bullet 3b 0
    Form 990-PF (2021)
    Form 990-PF (2021)
    Page 12
    Part XV-A
    Analysis of Income-Producing Activities
    Enter gross amounts unless otherwise indicated. Unrelated business income Excluded by section 512, 513, or 514 (e)
    Related or exempt
    function income
    (See instructions.)
    1Program service revenue: (a)
    Business code     		(b)
    Amount     		(c)
    Exclusion code     		(d)
    Amount
    a
    b
    c
    d
    e
    f
    gFees and contracts from government agencies          
    2 Membership dues and assessments ....          
    3 Interest on savings and temporary cash
    investments ...........     		    14 207  
    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 ............     		         
    9 Net income or (loss) from special events:          
    10 Gross profit or (loss) from sales of inventory          
    11 Other revenue:
    aPRIOR YEAR GRANT REFUNDS     		        3,180
    b
    c
    d
    e
    12 Subtotal. Add columns (b), (d), and (e) .. 0 207 3,180
    13Total. Add line 12, columns (b), (d), and (e)..................
    13
    3,387
    (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.)
    11A REFUNDS FROM PRIOR YEAR GRANTS THAT ARE AVAILABLE FOR USE TO PROVIDE NEW ASSISTANCE TO FAMILIES WITHIN MCDOWELL COUNTY
    Form 990-PF (2021)
    Form 990-PF (2021)
    Page 13
    Part XVI
    Information Regarding Transfers To and Transactions and Relationships With Noncharitable Exempt Organizations
    1
    Did the organization directly or indirectly engage in any of the following with any other organization described in section 501(c) (other than section 501(c)(3) organizations) or in section 527, relating to political organizations?
    Yes
    No
    a
    Transfers from the reporting foundation to a noncharitable exempt organization of:
    (1) Cash...................................
    1a(1)
     
    No
    (2) Other assets.................................
    1a(2)
     
    No
    b
    Other transactions:
    (1) Sales of assets to a noncharitable exempt organization....................
    1b(1)
     
    No
    (2) Purchases of assets from a noncharitable exempt organization..................
    1b(2)
     
    No
    (3) Rental of facilities, equipment, or other assets.......................
    1b(3)
     
    No
    (4) Reimbursement arrangements...........................
    1b(4)
     
    No
    (5) Loans or loan guarantees.............................
    1b(5)
     
    No
    (6) Performance of services or membership or fundraising solicitations................
    1b(6)
     
    No
    c
    Sharing of facilities, equipment, mailing lists, other assets, or paid employees..............
    1c
     
    No
    d
    If the answer to any of the above is "Yes," complete the following schedule. Column (b) should always show the fair market value
    of the goods, other assets, or services given by the reporting foundation. If the foundation received less than fair market value
    in any transaction or sharing arrangement, show in column (d) the value of the goods, other assets, or services received.
    (a) Line No. (b) Amount involved (c) Name of noncharitable exempt organization (d) Description of transfers, transactions, and sharing arrangements
    2a
    Is the foundation directly or indirectly affiliated with, or related to, one or more tax-exempt organizations
    described in section 501(c) (other than section 501(c)(3)) or in section 527? ...........
    b
    If "Yes," complete the following schedule.

    (a) Name of organization (b) Type of organization (c) Description of relationship
    Sign Here
    Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.
    Bullet Bullet
    May the IRS discuss this return
    with the preparer shown below?
    See instructions.
    Signature of officer or trustee Date Title
    Paid Preparer Use Only Print/Type preparer's name Preparer's Signature Date PTIN
    Firm's name SmallBullet
    		 Firm's EIN SmallBullet
    Firm's address SmallBullet


    		 Phone no.
    Form 990-PF (2021)
    Additional Data


    Software ID:  
    Software Version:  


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

    Arrow Bullet Attach to Form 990, 990-EZ, or 990-PF.
    Arrow Bullet Go to www.irs.gov/Form990 for the latest information.
    OMB No. 1545-0047
    2021
    Name of the organization
    MAXWELL CORPENING JR MEMORIAL
    FOUNDATION
    Employer identification number

    23-7201488
    Organization type (check one):
    Filers of:
    Section:
    Form 990 or 990-EZ






    Form 990-PF




    Check if your organization is covered by the General Rule or a Special Rule.  
    Note: Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.
    General Rule
    Special Rules
    ......... Arrow Bullet $  
    Caution: An organization that isn't covered by the General Rule and/or the Special Rules doesn't file Schedule B (Form 990,
    990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its Form 990-EZ
    or on its Form 990PF, Part I, line 2, to certify that it doesn't meet the filing requirements of Schedule B (Form 990,
    990-EZ, or 990-PF).
    For Paperwork Reduction Act Notice, see the Instructions
    for Form 990, 990-EZ, or 990-PF.
    Cat. No. 30613XSchedule B (Form 990) (2021)
    Schedule B (Form 990) (2021) Page 2
    Name of organization
    MAXWELL CORPENING JR MEMORIAL
    FOUNDATION         		Employer identification number
    23-7201488
    Part I
    Contributors
    Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Total contributions    		 (d)
    Type of contribution
    1
    DUKE ENERGY FOUNDATION
     
    PO BOX 35469
     
    CHARLOTTE, NC28254

    		$ 57,023


    (Complete Part II for noncash contributions.)
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Total contributions    		 (d)
    Type of contribution
    2
    MAXWELL M CORPENING JR MEMORIAL TRUST
     
    10 S DEARBORN IL 1-0111
     
    CHICAGO, IL60603

    		$ 591,254


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

    		$  


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

    		$  


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

    		$  


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

    		$  


    (Complete Part II for noncash contributions.)
    Schedule B (Form 990) (2021)
    Schedule B (Form 990) (2021)
    Page 3
    Name of organization
    MAXWELL CORPENING JR MEMORIAL
    FOUNDATION         		Employer identification number

    23-7201488
    Part II
    Noncash Property (see instructions). Use duplicate copies of Part II if additional space is needed.
    (a)
    No. from Part I    		 (b)
    Description of noncash property given    		 (c)
    FMV (or estimate)
    (See instructions)     		(d)
    Date received
     
    		$    
    (a)
    No. from Part I    		 (b)
    Description of noncash property given    		 (c)
    FMV (or estimate)
    (See instructions)     		(d)
    Date received
     
    		$    
    (a)
    No. from Part I    		 (b)
    Description of noncash property given    		 (c)
    FMV (or estimate)
    (See instructions)     		(d)
    Date received
     
    		$    
    (a)
    No. from Part I    		 (b)
    Description of noncash property given    		 (c)
    FMV (or estimate)
    (See instructions)     		(d)
    Date received
     
    		$    
    (a)
    No. from Part I    		 (b)
    Description of noncash property given    		 (c)
    FMV (or estimate)
    (See instructions)     		(d)
    Date received
     
    		$    
    (a)
    No. from Part I    		 (b)
    Description of noncash property given    		 (c)
    FMV (or estimate)
    (See instructions)     		(d)
    Date received
     
    		$    
    Schedule B (Form 990) (2021)
    Schedule B (Form 990) (2021)
    Page 4
    Name of organization
    MAXWELL CORPENING JR MEMORIAL
    FOUNDATION         		Employer identification number

    23-7201488
    Part III
    Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10) that total more than $1,000 for the year from any one contributor. Complete columns (a) through (e) and the following line entry. For organizations completing Part III, enter the total of exclusively religious, charitable, etc., contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet$  
    Use duplicate copies of Part III if additional space is needed.
    (a)
    No. from Part I    		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
     
    (e) Transfer of gift
    Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
     
     
         
     
    (a)
    No. from Part I    		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
     
    (e) Transfer of gift
    Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
     
     
         
     
    (a)
    No. from Part I    		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
     
    (e) Transfer of gift
    Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
     
     
         
     
    (a)
    No. from Part I    		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
     
    (e) Transfer of gift
    Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
     
     
         
     
    Schedule B (Form 990) (2021)
    Additional Data


    Software ID:  
    Software Version:  

    TY 2021 AccountingFeesSchedule
    Name:
    MAXWELL CORPENING JR MEMORIAL
     
    FOUNDATION
    EIN:
    23-7201488
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    ACCOUNTING FEES 3,000 0 2,755 245

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

    TY 2021 DepreciationSchedule
    Name:
    MAXWELL CORPENING JR MEMORIAL
     
    FOUNDATION
    EIN:
    23-7201488
    Description of Property Date Acquired Cost or Other Basis Prior Years' Depreciation Computation Method Rate /
    Life (# of years)    		 Current Year's Depreciation Expense Net Investment Income Adjusted Net Income Cost of Goods Sold Not Included
    PICTURES 2003-05-28 1,222 1,222 SL 7.000000000000 0 0 0  
    COMPUTER SYSTEM 2012-06-04 749 749 SL 5.000000000000 0 0 0  
    MICROWAVE 2012-08-27 64 64 SL 7.000000000000 0 0 0  
    MAC COMPUTER 2018-05-27 1,814 937 SL 5.000000000000 363 0 363  

    TY 2021 LandEtcSchedule2
    Name:
    MAXWELL CORPENING JR MEMORIAL
     
    FOUNDATION
    EIN:
    23-7201488
    Category / Item Cost / Other Basis Accumulated Depreciation Book Value End of Year Fair Market Value
    PICTURES 1,222 1,222 0  
    COMPUTER SYSTEM 749 749 0  
    MICROWAVE 64 64 0  
    MAC COMPUTER 1,814 1,300 514  


    TY 2021 LegalFeesSchedule
    Name:
    MAXWELL CORPENING JR MEMORIAL
     
    FOUNDATION
    EIN:
    23-7201488
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    LEGAL FEES 500 0 100 400


    TY 2021 OtherExpensesSchedule
    Name:
    MAXWELL CORPENING JR MEMORIAL
     
    FOUNDATION
    EIN:
    23-7201488
    Description Revenue and Expenses per Books Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    OFFICE EXPENSE 1,738 0 0 1,738
    INSURANCE AND BONDING 770 0 0 770
    AFFIDAVITS 100 0 0 100
    ANNUAL FEES 20 0 20 0
    POSTAGE 131 0 131 0
    BANK CHARGES 19 0 18 0


    TY 2021 OtherIncomeSchedule2
    Name:
    MAXWELL CORPENING JR MEMORIAL
     
    FOUNDATION
    EIN:
    23-7201488
    Description Revenue And Expenses Per Books Net Investment Income Adjusted Net Income
    PRIOR YEAR GRANT REFUNDS 3,180   3,180


    TY 2021 SubstantialContributorsSch
    Name:
    MAXWELL CORPENING JR MEMORIAL
     
    FOUNDATION
    EIN:
    23-7201488
    Name Address
    DUKE ENERGY FOUNDATION
          		PO BOX 35469
    CHARLOTTE,NC28254
    MAXWELL M CORPENING JR MEMORIAL TRUST
          		10 S DEARBORN IL 1-0111
    CHICAGO,IL60603


    TY 2021 TaxesSchedule
    Name:
    MAXWELL CORPENING JR MEMORIAL
     
    FOUNDATION
    EIN:
    23-7201488
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    PAYROLL TAXES 956 0 0 956