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
FIRST CITIZENS CHARITABLE FOUNDATION INC
 
Number and street (or P.O. box number if mail is not delivered to street address)2601 4TH STREET SW PO BOX 1708
  Room/suite
City or town, state or province, country, and ZIP or foreign postal code
MASON CITY, IA504021708
A Employer identification number

42-1451615
B Telephone number (see instructions)

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

D 1. 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$1,693,553J 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) 300,000
2 Check bullet.............
3 Interest on savings and temporary cash investments 56 56  
4 Dividends and interest from securities... 36,763 36,763  
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)... 66,731
8 Net short-term capital gain......... 12,015
9 Income modifications...........  
10a Gross sales less returns and allowances  
b Less: Cost of goods sold....  
c Gross profit or (loss) (attach schedule)..... 0  
11 Other income (attach schedule)....... 0    
12 Total. Add lines 1 through 11........ 336,819 103,550 12,015
Operating and Administrative Expenses 13 Compensation of officers, directors, trustees, etc. 10,000 5,000 0 5,000
14 Other employee salaries and wages......        
15 Pension plans, employee benefits.......        
16a Legal fees (attach schedule)......... 0      
b Accounting fees (attach schedule)....... Click to see attachment 960 960 0 0
c Other professional fees (attach schedule).... Click to see attachment 4,687 4,687 0 0
17 Interest...............        
18 Taxes (attach schedule) (see instructions)... Click to see attachment 801 801 0 0
19 Depreciation (attach schedule) and depletion... 0    
20 Occupancy..............        
21 Travel, conferences, and meetings.......        
22 Printing and publications..........        
23 Other expenses (attach schedule)....... 0      
24 Total operating and administrative expenses.
Add lines 13 through 23.......... 16,448 11,448 0 5,000
25 Contributions, gifts, grants paid....... 440,450 440,450
26 Total expenses and disbursements. Add lines 24 and 25 456,898 11,448 0 445,450
27 Subtract line 26 from line 12:
a Excess of revenue over expenses and disbursements -120,079
b Net investment income (if negative, enter -0-) 92,102
c Adjusted net income (if negative, enter -0-)... 12,015
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............. 1,390 776 776
2 Savings and temporary cash investments......... 82,909 87,016 87,016
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).....   0  
7 Other notes and loans receivable (attach schedule) bullet  
Less: allowance for doubtful accounts bullet     0  
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)....... 281,875 Click to see attachment82,317 169,253
c Investments—corporate bonds (attach schedule)....... 231,944    
11 Investments—land, buildings, and equipment: basis bullet  
Less: accumulated depreciation (attach schedule) bullet     0  
12 Investments—mortgage loans.............      
13 Investments—other (attach schedule).......... 731,261 Click to see attachment1,105,357 1,436,508
14 Land, buildings, and equipment: basis bullet  
Less: accumulated depreciation (attach schedule) bullet     0  
15 Other assets (describe bullet) 0 0 0
16 Total assets (to be completed by all filers—see the
instructions. Also, see page 1, item I) 1,329,379 1,275,466 1,693,553
Liabilities 17 Accounts payable and accrued expenses..........    
18 Grants payable.................    
19 Deferred revenue.................    
20 Loans from officers, directors, trustees, and other disqualified persons   0
21 Mortgages and other notes payable (attach schedule)......   0
22 Other liabilities (describe bullet) 0 0
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........    
27 Paid-in or capital surplus, or land, bldg., and equipment fund 1,329,379 1,275,466
28 Retained earnings, accumulated income, endowment, or other funds    
29 Total net assets or fund balances (see instructions)..... 1,329,379 1,275,466
30 Total liabilities and net assets/fund balances (see instructions). 1,329,379 1,275,466
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
1,329,379
2
Enter amount from Part I, line 27a .....................
2
-120,079
3
Other increases not included in line 2 (itemize) bulletClick to see attachment
3
66,731
4
Add lines 1, 2, and 3 ..........................
4
1,276,031
5
Decreases not included in line 2 (itemize) bulletClick to see attachment
5
565
6
Total net assets or fund balances at end of year (line 4 minus line 5)—Part II, column (b), line 29 .
6
1,275,466
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 AT&T INC COM P 2011-12-16 2021-01-25
b EATON CORP PLC P 2020-08-10 2021-01-25
c EATON CORP PLC P 2020-08-21 2021-01-25
d AT&T INC COM P 2011-12-16 2021-02-02
e BRISTOL MYERS SQUIBB CO COM P 2020-06-22 2021-02-02
BRISTOL MYERS SQUIBB CO COM P 2020-09-22 2021-02-02
PNC FINANCIAL SERVICES CORP P 2018-11-13 2021-02-22
JP MORGAN CHASE & CO COM P 2020-09-17 2021-03-04
JP MORGAN CHASE & CO COM P 2020-11-19 2021-03-04
JP MORGAN CHASE & CO COM P 2021-01-25 2021-03-04
REGIONS FINL CORP NEW P 2019-04-23 2021-03-04
AT&T INC P 2011-12-16 2021-03-23
ABBVIE INC P 2016-01-06 2021-03-23
AMERICAN ELEC PWR INC P 2020-04-29 2021-03-23
AMERICAN ELEC PWR INC P 2020-05-04 2021-03-23
AMERICAN ELEC PWR INC P 2020-09-22 2021-03-23
AMERICAN ELEC PWR INC P 2020-10-13 2021-03-23
AMERICAN ELEC PWR INC P 2021-01-25 2021-03-23
AMGEN INC P 2020-03-18 2021-03-23
AMGEN INC P 2020-03-24 2021-03-23
BCE INC COM NEW P 2011-12-16 2021-03-23
BRITISH AMERICAN TOBACCO PLC SPONS ADR P 2017-11-16 2021-03-23
CDN IMPERIAL BK COMM TORONTO O COM P 2017-07-13 2021-03-23
CHEVRON CORPORATION P 2017-03-22 2021-03-23
CHEVRON CORPORATION P 2017-04-26 2021-03-23
CHEVRON CORPORATION P 2017-05-02 2021-03-23
CHEVRON CORPORATION P 2017-08-03 2021-03-23
CHEVRON CORPORATION P 2017-08-07 2021-03-23
CHEVRON CORPORATION P 2017-10-13 2021-03-23
CHEVRON CORPORATION P 2018-03-01 2021-03-23
CHEVRON CORPORATION P 2018-08-06 2021-03-23
CHEVRON CORPORATION P 2018-12-26 2021-03-23
CHEVRON CORPORATION P 2019-02-04 2021-03-23
CHEVRON CORPORATION P 2019-06-11 2021-03-23
CHEVRON CORPORATION P 2019-11-18 2021-03-23
CHEVRON CORPORATION P 2020-01-08 2021-03-23
CHEVRON CORPORATION P 2020-04-17 2021-03-23
CHEVRON CORPORATION P 2020-07-13 2021-03-23
CHEVRON CORPORATION P 2020-10-22 2021-03-23
CHEVRON CORPORATION P 2021-01-25 2021-03-23
CISCO SYSTEMS INC P 2019-11-18 2021-03-23
COCA COLA COMMON STOCK P 2010-07-28 2021-03-23
CROWN CASTLE INTERNATIONAL CORP P 2020-09-22 2021-03-23
CROWN CASTLE INTERNATIONAL CORP P 2020-11-16 2021-03-23
CROWN CASTLE INTERNATIONAL CORP P 2021-01-25 2021-03-23
CROWN CASTLE INTERNATIONAL CORP P 2021-02-02 2021-03-23
CROWN CASTLE INTERNATIONAL CORP P 2021-03-04 2021-03-23
DIGITAL REALTY TRUST INC P 2021-03-04 2021-03-23
DOMINION ENERGY INC P 2011-12-16 2021-03-23
DUKE ENERGY HLDG P 2013-01-31 2021-03-23
DUKE ENERGY HLDG P 2013-08-08 2021-03-23
DUKE ENERGY HLDG P 2013-12-23 2021-03-23
DUKE ENERGY HLDG P 2015-03-31 2021-03-23
DUKE ENERGY HLDG P 2015-07-08 2021-03-23
DUKE ENERGY HLDG P 2015-10-02 2021-03-23
DUKE ENERGY HLDG P 2016-05-05 2021-03-23
DUKE ENERGY HLDG P 2017-08-17 2021-03-23
DUKE ENERGY HLDG P 2018-03-01 2021-03-23
DUKE ENERGY HLDG P 2018-04-05 2021-03-23
DUKE ENERGY HLDG P 2018-08-06 2021-03-23
DUKE ENERGY HLDG P 2018-12-26 2021-03-23
DUKE ENERGY HLDG P 2019-02-04 2021-03-23
DUKE ENERGY HLDG P 2019-06-11 2021-03-23
DUKE ENERGY HLDG P 2019-11-18 2021-03-23
DUKE ENERGY HLDG P 2020-01-08 2021-03-23
DUKE ENERGY HLDG P 2020-07-13 2021-03-23
DUKE ENERGY HLDG P 2020-10-22 2021-03-23
ENBRIDGE INC COM P 2019-04-23 2021-03-23
EXXON MOBIL CORP P 2015-08-26 2021-03-23
EXXON MOBIL CORP P 2016-05-05 2021-03-23
EXXON MOBIL CORP P 2017-06-06 2021-03-23
EXXON MOBIL CORP P 2017-08-17 2021-03-23
EXXON MOBIL CORP P 2017-11-16 2021-03-23
EXXON MOBIL CORP P 2018-03-01 2021-03-23
EXXON MOBIL CORP P 2018-08-06 2021-03-23
EXXON MOBIL CORP P 2018-12-26 2021-03-23
EXXON MOBIL CORP P 2019-02-04 2021-03-23
EXXON MOBIL CORP P 2019-06-11 2021-03-23
EXXON MOBIL CORP P 2019-07-23 2021-03-23
EXXON MOBIL CORP P 2019-10-03 2021-03-23
EXXON MOBIL CORP P 2019-11-18 2021-03-23
EXXON MOBIL CORP P 2019-12-10 2021-03-23
EXXON MOBIL CORP P 2020-01-08 2021-03-23
EXXON MOBIL CORP P 2020-07-13 2021-03-23
EXXON MOBIL CORP P 2020-10-22 2021-03-23
EXXON MOBIL CORP P 2021-01-25 2021-03-23
EXXON MOBIL CORP P 2021-02-02 2021-03-23
GENERAL MILLS INC P 2020-09-30 2021-03-23
GENERAL MILLS INC P 2020-11-16 2021-03-23
GENERAL MILLS INC P 2021-01-25 2021-03-23
GILEAD SCIENCES INC P 2019-07-23 2021-03-23
HUNTINGTON BANCSHARES INC COM P 2018-11-14 2021-03-23
INTL BUSINESS MACHINES P 2020-04-24 2021-03-23
INTL BUSINESS MACHINES P 2020-04-29 2021-03-23
INTL BUSINESS MACHINES P 2020-05-04 2021-03-23
INTL BUSINESS MACHINES P 2020-10-22 2021-03-23
KIMBERLY CLARK CORP P 2020-11-16 2021-03-23
MERCK & CO INC COM P 2020-03-02 2021-03-23
MERCK & CO INC COM P 2020-03-12 2021-03-23
MERCK & CO INC COM P 2020-05-11 2021-03-23
MERCK & CO INC COM P 2020-07-13 2021-03-23
MERCK & CO INC COM P 2020-08-14 2021-03-23
MERCK & CO INC COM P 2020-10-15 2021-03-23
MERCK & CO INC COM P 2020-10-21 2021-03-23
MERCK & CO INC COM P 2020-10-22 2021-03-23
MERCK & CO INC COM P 2021-01-25 2021-03-23
NATIONAL GRID PLC SPONSORED ADR NEW P 2017-05-19 2021-03-23
PNC FINANCIAL SERVICES CORP P 2018-11-13 2021-03-23
PPL CORP P 2011-12-16 2021-03-23
PEPSICO INC COM P 2011-12-16 2021-03-23
PFIZER INC COMMON STOCK P 2019-06-24 2021-03-23
PHILLIP MORRIS INTL INC P 2011-12-16 2021-03-23
PUBLIC SERVICE ENTERPRISE GR P 2020-05-18 2021-03-23
PUBLIC SERVICE ENTERPRISE GR P 2020-05-27 2021-03-23
PUBLIC SERVICE ENTERPRISE GR P 2020-10-22 2021-03-23
REGIONS FINL CORP NEW P 2019-04-23 2021-03-23
SOUTHERN CO COM P 2018-01-30 2021-03-23
SOUTHERN CO COM P 2018-03-01 2021-03-23
SOUTHERN CO COM P 2018-08-06 2021-03-23
SOUTHERN CO COM P 2018-12-26 2021-03-23
SOUTHERN CO COM P 2019-01-07 2021-03-23
SOUTHERN CO COM P 2019-02-04 2021-03-23
SOUTHERN CO COM P 2019-06-11 2021-03-23
SOUTHERN CO COM P 2019-11-18 2021-03-23
SOUTHERN CO COM P 2020-01-08 2021-03-23
SOUTHERN CO COM P 2020-04-24 2021-03-23
SOUTHERN CO COM P 2020-05-08 2021-03-23
SOUTHERN CO COM P 2020-07-13 2021-03-23
SOUTHERN CO COM P 2020-10-21 2021-03-23
SOUTHERN CO COM P 2020-10-22 2021-03-23
SOUTHERN CO COM P 2021-01-25 2021-03-23
TC ENERGY CORP COM P 2019-08-27 2021-03-23
3M CO P 2020-05-18 2021-03-23
3M CO P 2020-07-13 2021-03-23
3M CO P 2021-02-02 2021-03-23
TRUIST FINANCIAL CORP ORD SHS P 2021-01-25 2021-03-23
TRUIST FINANCIAL CORP ORD SHS P 2021-02-02 2021-03-23
US BANCORP DEL COM P 2021-03-04 2021-03-23
UNILEVER PLC AMER ADR P 2020-01-22 2021-03-23
VERIZON COMM INC P 2017-05-18 2021-03-23
VERIZON COMM INC P 2017-07-13 2021-03-23
VERIZON COMM INC P 2017-08-17 2021-03-23
VERIZON COMM INC P 2018-03-01 2021-03-23
VERIZON COMM INC P 2018-08-06 2021-03-23
VERIZON COMM INC P 2018-12-26 2021-03-23
VERIZON COMM INC P 2019-02-04 2021-03-23
VERIZON COMM INC P 2019-06-11 2021-03-23
VERIZON COMM INC P 2019-10-07 2021-03-23
VERIZON COMM INC P 2019-11-18 2021-03-23
VERIZON COMM INC P 2020-01-08 2021-03-23
VERIZON COMM INC P 2020-02-20 2021-03-23
VERIZON COMM INC P 2020-07-13 2021-03-23
VERIZON COMM INC P 2020-10-22 2021-03-23
VERIZON COMM INC P 2021-01-25 2021-03-23
VODAFONE GROUP PLC ADR P 2011-12-16 2021-03-23
ISHARE MSCI EAFE FUND P 2011-01-28 2021-01-06
ISHARE S&P MIDCAP 400/GROWTH INDEX FUND P 2014-04-04 2021-01-06
ISHARE DOW JONES TELECOM P 2020-02-13 2021-01-06
ISHARE DOW JONES TECH P 2020-02-13 2021-01-06
ISHARE DOW JONES INDUSTRIAL P 2020-02-13 2021-01-06
ISHARE DOW JONES HEALTHCARE P 2020-02-13 2021-01-06
ISHARE DOW JONES CONSUMER GOODS P 2020-02-13 2021-01-06
ISHARE S&P SMALL CAP 600 GROWTH INDEX P 2002-03-18 2021-01-06
ETF VANGUARD EMERGING MARKETS P 2011-02-03 2021-01-06
ISHARE DOW JONES ENERGY P 2020-02-13 2021-01-20
ISHARE DOW JONES INTL SELECT DIV IDX P 2013-01-30 2021-01-20
LORD ABBETT INVT TR SH DURA INCM I P 2020-02-13 2021-06-24
LORD ABBETT INVT TR SH DURA INCM I P 2020-02-13 2021-06-25
PNC FINANCIAL SERVICES CORP P 2014-01-23 2021-06-25
SHORT TERM CAPITAL GAIN DISTRIBUTIONS P 2021-01-01 2021-12-31
LONG TERM CAPITAL GAIN DISTRIBUTIONS P 2016-01-01 2021-12-31
(e)
Gross sales price 		(f)
Depreciation allowed
(or allowable) 		(g)
Cost or other basis
plus expense of sale 		(h)
Gain or (loss)
(e) plus (f) minus (g)
a 1,102 0 1,291 -189
b 1,341 0 1,092 249
c 1,341 0 1,110 231
d 1,404 0 1,664 -260
e 2,395 0 2,185 210
1,197 0 1,112 85
1,199 0 829 370
3,313 0 2,157 1,156
602 0 459 143
151 0 132 19
2,292 0 1,456 836
7,641 0 8,662 -1,021
11,002 0 8,578 2,424
1,267 0 1,247 20
929 0 900 29
1,098 0 1,047 51
1,267 0 1,339 -72
1,098 0 1,074 24
1,225 0 1,047 178
980 0 794 186
8,733 0 8,727 6
8,908 0 9,096 -188
12,151 0 10,306 1,845
1,227 0 1,295 -68
1,022 0 1,070 -48
1,022 0 1,063 -41
1,125 0 1,209 -84
920 0 989 -69
1,125 0 1,317 -192
204 0 224 -20
307 0 372 -65
307 0 304 3
102 0 118 -16
204 0 245 -41
307 0 355 -48
102 0 119 -17
1,738 0 1,441 297
102 0 85 17
102 0 71 31
102 0 90 12
8,493 0 6,836 1,657
2,460 0 2,151 309
2,362 0 2,249 113
1,012 0 994 18
1,181 0 1,130 51
1,012 0 1,002 10
1,856 0 1,642 214
2,785 0 2,592 193
4,589 0 4,096 493
1,968 0 1,437 531
281 0 214 67
281 0 209 72
281 0 229 52
281 0 225 56
281 0 213 68
281 0 240 41
562 0 518 44
375 0 302 73
1,312 0 1,086 226
281 0 245 36
281 0 250 31
281 0 262 19
281 0 259 22
281 0 268 13
94 0 90 4
94 0 82 12
94 0 92 2
8,483 0 8,660 -177
609 0 787 -178
332 0 533 -201
997 0 1,459 -462
166 0 231 -65
775 0 1,126 -351
886 0 1,209 -323
277 0 401 -124
166 0 196 -30
166 0 224 -58
166 0 226 -60
1,440 0 1,957 -517
2,049 0 2,509 -460
55 0 68 -13
1,052 0 1,322 -270
55 0 70 -15
166 0 128 38
111 0 66 45
55 0 47 8
1,218 0 1,007 211
2,134 0 2,162 -28
2,317 0 2,304 13
61 0 58 3
9,385 0 9,480 -95
6,598 0 5,828 770
2,215 0 2,078 137
1,173 0 1,159 14
912 0 843 69
130 0 113 17
2,294 0 2,406 -112
1,140 0 1,197 -57
1,444 0 1,429 15
1,216 0 1,249 -33
76 0 78 -2
760 0 843 -83
1,292 0 1,346 -54
988 0 1,021 -33
76 0 79 -3
76 0 81 -5
6,677 0 6,791 -114
4,727 0 3,315 1,412
4,041 0 4,216 -175
6,273 0 5,007 1,266
8,862 0 9,375 -513
11,948 0 11,203 745
1,276 0 1,095 181
1,218 0 1,038 180
58 0 59 -1
3,456 0 2,210 1,246
968 0 712 256
61 0 44 17
302 0 246 56
363 0 256 107
2,238 0 1,656 582
181 0 145 36
181 0 164 17
121 0 126 -5
60 0 63 -3
1,391 0 1,304 87
1,149 0 1,039 110
60 0 54 6
1,089 0 1,058 31
121 0 118 3
60 0 60 0
4,443 0 4,629 -186
2,639 0 2,078 561
188 0 155 33
942 0 880 62
1,345 0 1,231 114
1,401 0 1,260 141
2,554 0 2,432 122
7,455 0 7,247 208
1,593 0 1,263 330
2,162 0 1,650 512
171 0 145 26
512 0 435 77
512 0 472 40
171 0 158 13
114 0 108 6
228 0 227 1
2,503 0 2,660 -157
57 0 59 -2
114 0 120 -6
1,309 0 1,337 -28
57 0 55 2
114 0 114 0
114 0 117 -3
8,741 0 10,159 -1,418
11,284 0 9,189 2,095
8,637 0 4,463 4,174
2,317 0 2,304 13
13,459 0 10,354 3,105
14,820 0 13,090 1,730
3,752 0 3,314 438
7,026 0 5,580 1,446
9,061 0 1,484 7,577
9,036 0 7,648 1,388
11,050 0 12,243 -1,193
59,572 0 66,638 -7,066
20,000 0 20,087 -87
54,455 0 54,693 -238
38,328 0 16,650 21,678
1,344 0 0 1,344
16,411 0 0 16,411
Complete only for assets showing gain in column (h) and owned by the foundation on 12/31/69 (l)
Gains (Col. (h) gain minus
col. (k), but not less than -0-) or
Losses (from col.(h))
(i)
F.M.V. as of 12/31/69 		(j)
Adjusted basis
as of 12/31/69 		(k)
Excess of col. (i)
over col. (j), if any
a 0 0 0 -189
b 0 0 0 249
c 0 0 0 231
d 0 0 0 -260
e 0 0 0 210
0 0 0 85
0 0 0 370
0 0 0 1,156
0 0 0 143
0 0 0 19
0 0 0 836
0 0 0 -1,021
0 0 0 2,424
0 0 0 20
0 0 0 29
0 0 0 51
0 0 0 -72
0 0 0 24
0 0 0 178
0 0 0 186
0 0 0 6
0 0 0 -188
0 0 0 1,845
0 0 0 -68
0 0 0 -48
0 0 0 -41
0 0 0 -84
0 0 0 -69
0 0 0 -192
0 0 0 -20
0 0 0 -65
0 0 0 3
0 0 0 -16
0 0 0 -41
0 0 0 -48
0 0 0 -17
0 0 0 297
0 0 0 17
0 0 0 31
0 0 0 12
0 0 0 1,657
0 0 0 309
0 0 0 113
0 0 0 18
0 0 0 51
0 0 0 10
0 0 0 214
0 0 0 193
0 0 0 493
0 0 0 531
0 0 0 67
0 0 0 72
0 0 0 52
0 0 0 56
0 0 0 68
0 0 0 41
0 0 0 44
0 0 0 73
0 0 0 226
0 0 0 36
0 0 0 31
0 0 0 19
0 0 0 22
0 0 0 13
0 0 0 4
0 0 0 12
0 0 0 2
0 0 0 -177
0 0 0 -178
0 0 0 -201
0 0 0 -462
0 0 0 -65
0 0 0 -351
0 0 0 -323
0 0 0 -124
0 0 0 -30
0 0 0 -58
0 0 0 -60
0 0 0 -517
0 0 0 -460
0 0 0 -13
0 0 0 -270
0 0 0 -15
0 0 0 38
0 0 0 45
0 0 0 8
0 0 0 211
0 0 0 -28
0 0 0 13
0 0 0 3
0 0 0 -95
0 0 0 770
0 0 0 137
0 0 0 14
0 0 0 69
0 0 0 17
0 0 0 -112
0 0 0 -57
0 0 0 15
0 0 0 -33
0 0 0 -2
0 0 0 -83
0 0 0 -54
0 0 0 -33
0 0 0 -3
0 0 0 -5
0 0 0 -114
0 0 0 1,412
0 0 0 -175
0 0 0 1,266
0 0 0 -513
0 0 0 745
0 0 0 181
0 0 0 180
0 0 0 -1
0 0 0 1,246
0 0 0 256
0 0 0 17
0 0 0 56
0 0 0 107
0 0 0 582
0 0 0 36
0 0 0 17
0 0 0 -5
0 0 0 -3
0 0 0 87
0 0 0 110
0 0 0 6
0 0 0 31
0 0 0 3
0 0 0 0
0 0 0 -186
0 0 0 561
0 0 0 33
0 0 0 62
0 0 0 114
0 0 0 141
0 0 0 122
0 0 0 208
0 0 0 330
0 0 0 512
0 0 0 26
0 0 0 77
0 0 0 40
0 0 0 13
0 0 0 6
0 0 0 1
0 0 0 -157
0 0 0 -2
0 0 0 -6
0 0 0 -28
0 0 0 2
0 0 0 0
0 0 0 -3
0 0 0 -1,418
0 0 0 2,095
0 0 0 4,174
0 0 0 13
0 0 0 3,105
0 0 0 1,730
0 0 0 438
0 0 0 1,446
0 0 0 7,577
0 0 0 1,388
0 0 0 -1,193
0 0 0 -7,066
0 0 0 -87
0 0 0 -238
0 0 0 21,678
0 0 0 1,344
0 0 0 16,411
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 66,731
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 12,015
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 1,280
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 1,280
6 Credits/Payments:
a 2021 estimated tax payments and 2020 overpayment credited to 2021 6a 820
b Exempt foreign organizations—tax withheld at source...... 6b  
c Tax paid with application for extension of time to file (Form 8868)... 6c 1,200
d Backup withholding erroneously withheld ........... 6d  
7 Total credits and payments. Add lines 6a through 6d.............. Part VI Line 7 - Original Return Overpayment: -2020 7 2,020
8 Enter any penalty for underpayment of estimated tax. Check here if Form 2220 is attached. Click to see attachment 8 3
9 Tax due. If the total of lines 5 and 8 is more than line 7, enter amount owed.......Bullet 9  
10 Overpayment. If line 7 is more than the total of lines 5 and 8, enter the amount overpaid...Bullet 10 737
11 Enter the amount of line 10 to be: Credited to 2022 estimated taxBullet737 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$   (2) On foundation managers.bullet$  
e
Enter the reimbursement (if any) paid by the foundation during the year for political expenditure tax imposed
on foundation managers.bullet$  
2
Has the foundation engaged in any activities that have not previously been reported to the IRS?.......
2
 
No
If "Yes," attach a detailed description of the activities.
3
Has the foundation made any changes, not previously reported to the IRS, in its governing instrument, articles
of incorporation, or bylaws, or other similar instruments? If "Yes," attach a conformed copy of the changes....
3
 
No
4a
Did the foundation have unrelated business gross income of $1,000 or more during the year?.........
4a
 
No
b
If "Yes," has it filed a tax return on Form 990-T for this year?...................
4b
 
No
5
Was there a liquidation, termination, dissolution, or substantial contraction during the year?.........
5
 
No
If "Yes," attach the statement required by General Instruction T.
6
Are the requirements of section 508(e) (relating to sections 4941 through 4945) satisfied either:
  • By language in the governing instrument, or
  • By state legislation that effectively amends the governing instrument so that no mandatory directions
    • that conflict with the state law remain in the governing instrument?................
    6
    Yes
     
    7
    Did the foundation have at least $5,000 in assets at any time during the year? If "Yes," complete Part II, col. (c),
    and Part 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 addressbulletN/A
    14
    The books are in care ofbulletFIRST CITIZENS TRUST COMPANY Telephone no.bullet (641) 422-1600

    Located atbullet2601 4TH STREET SWMASON CITYIA ZIP+4bullet50401
    15
    Section 4947(a)(1) nonexempt charitable trusts filing Form 990-PF in lieu of Form 1041 —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
     
     
    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
    PATRICIA A TOMSON EXEC DIRECTOR
    2.00     		10,000 0 0
    PO BOX 1708
    MASON CITY,IA50402
    O JAY TOMSON PRESIDENT
    1.00     		0 0 0
    PO BOX 1708
    MASON CITY,IA50402
    GORDON ANDERSON DIRECTOR
    1.00     		0 0 0
    501 MAIN ST
    OSAGE,IA50461
    CATHERINE ROTTINGHAUS DIRECTOR
    1.00     		0 0 0
    300 MAIN ST
    CHARLES CITY,IA50616
    MARTI RODAMAKER VICE PRESIDENT
    1.00     		0 0 0
    PO BOX 1708
    MASON CITY,IA50402
    MARY NORDENSTROM DIRECTOR
    1.00     		0 0 0
    PO BOX 1708
    MASON CITY,IA50402
    AMY NELSON SECRETARY
    1.00     		0 0 0
    PO BOX 1708
    MASON CITY,IA50402
    JAMES ANDERSON TREASURER
    1.00     		0 0 0
    PO BOX 1708
    MASON CITY,IA50402
    2 Compensation of five highest-paid employees (other than those included on line 1—see instructions). If none, enter “NONE."
    (a) Name and address of each employee paid more than $50,000 (b) Title, and average
    hours per week
    devoted to position     		(c) Compensation (d) Contributions to
    employee benefit
    plans and deferred
    compensation     		(e) Expense account,
    other allowances
    NONE
    Total number of other employees paid over $50,000...................bullet 0
    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 GRANTS PAID TO NONPROFIT ORGANIZATIONS THAT MEET ESTABLSIHED CRITERIA. SEE LISTING ON PAGE 11, PART XV. 440,450
    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 NONE 0
    2  
    All other program-related investments. See instructions.
    3  
    Total. Add lines 1 through 3.........................bullet0
    Form 990-PF (2021)
    Form 990-PF (2021)
    Page 8
    Part IX
    Minimum Investment Return (All domestic foundations must complete this part. Foreign foundations, see instructions.)
    1
    Fair market value of assets not used (or held for use) directly in carrying out charitable, etc.,
    purposes:
    a
    Average monthly fair market value of securities...................
    1a
    1,510,768
    b
    Average of monthly cash balances.......................
    1b
    68,841
    c
    Fair market value of all other assets (see instructions)................
    1c
    0
    d
    Total (add lines 1a, b, and c).........................
    1d
    1,579,609
    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
     
    3
    Subtract line 2 from line 1d.........................
    3
    1,579,609
    4
    Cash deemed held for charitable activities. Enter 1.5% (0.015) of line 3 (for greater amount, see
    instructions) .............................
    4
    23,694
    5
    Net value of noncharitable-use assets. Subtract line 4 from line 3. .......
    5
    1,555,915
    6
    Minimum investment return. Enter 5% (0.05) of line 5................
    6
    77,796
    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
    77,796
    2a
    Tax on investment income for 2021 from Part V, line 5.......
    2a
    1,280
    b
    Income tax for 2021. (This does not include the tax from Part V.) ...
    2b
     
    c
    Add lines 2a and 2b............................
    2c
    1,280
    3
    Distributable amount before adjustments. Subtract line 2c from line 1............
    3
    76,516
    4
    Recoveries of amounts treated as qualifying distributions................
    4
     
    5
    Add lines 3 and 4............................
    5
    76,516
    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
    76,516
    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 76,516
    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...... 367,645
    b From 2017...... 228,938
    c From 2018...... 416,387
    d From 2019...... 364,587
    e From 2020...... 379,905
    f Total of lines 3a through e ........ 1,757,462
    4Qualifying distributions for 2021 from Part
    XI, line 4: bullet$ 445,450
    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)........     		0
    d Applied to 2021 distributable amount.....  
    e Remaining amount distributed out of corpus 445,450
    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 2,202,912
    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......     		 
    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 ..........     		76,516
    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) ...     		367,645
    9 Excess distributions carryover to 2022.
    Subtract lines 7 and 8 from line 6a ......     		1,835,267
    10 Analysis of line 9:
    a Excess from 2017.... 228,938
    b Excess from 2018.... 416,387
    c Excess from 2019.... 364,587
    d Excess from 2020.... 379,905
    e Excess from 2021.... 445,450
    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).)
    NONE
    bList any managers of the foundation who own 10% or more of the stock of a corporation (or an equally large portion of the
    ownership of a partnership or other entity) of which the foundation has a 10% or greater interest.
    NOT APPLICABLE
    2Information Regarding Contribution, Grant, Gift, Loan, Scholarship, etc., Programs:
    Check here bullet
    aThe name, address, and telephone number or e-mail address of the person to whom applications should be addressed:
    PATRICIA A TOMSON
    FIRST CITIZENS CHARITABLE FOUNDATIO
    MASON CITY,IA50402
    (641) 422-1600
    bThe form in which applications should be submitted and information and materials they should include:
    BUDGET, 501(c)3 IRS DETERMINATION LETTER, NAME & CONTACT INFO FOR BOARD OF DIRECTORS
    cAny submission deadlines:
    APPLICATIONS ARE REVIEWED JUNE 1 AND NOVEMBER 15
    dAny restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other
    factors:
    SEE CRITERIA INCLUDED IN THE APPLICATION FORM ATTACHED.
    Form 990-PF (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
    43 NORTH IOWA
    1225 S HARRISON AVE
    MASON CITY,IA50401     		  PC BECKER CENTERIMPROVEMENTPROJECT 25,000
    AVALON CENTER
    9 2ND ST NW
    MASON CITY,IA50401     		  PC SOCIAL SERVICESUPPORT 10,000
    BRIDGE OF HOPE NORTH CENTRAL IOWA
    420 1ST AVE NE
    HAMPTON,IA50441     		  PC RENTAL ASSISTANCE 1,000
    CARING PREGNANCY CENTER
    830 15TH ST SW SUITE 1
    MASON CITY,IA50401     		  PC SUPPORT 1,000
    CEDAR SUMMERSTOCK THEATRE
    809 SAWYER DR
    OSAGE,IA50461     		  PC SUPPORT 1,000
    CHARLES CITY ARTS CENTER
    301 N JACKSON ST
    CHARLES CITY,IA50616     		  PC 2021 ART-A-FEST 1,000
    CHARLES CITY COMMUNITY SCHOOLS
    500 NORTH GRAND AVE
    CHARLES CITY,IA50616     		  GOV CONSTRUCTION OF SOFTBALL& BASEBALL FIELD 10,000
    CHICKASAW TOWNSHIP FIRE DISTRICT
    403 S LINN AVE
    NEW HAMPTON,IA50659     		  GOV AIR PACK REPLACEMENT 2,500
    CHILDREN'S CANCER CONNECTION
    5701 GREENDALE RD
    JOHNSTON,IA50131     		  PC SUPPORT 2,000
    CITY OF ELMA
    319 OAK ST
    ELMA,IA50628     		  GOV ELMA LIBRARY FURNISHINGS 3,000
    CITY OF MASON CITY YOUTH TASK FORCE
    308 S PENNSYLVANIA AVE 2ND FLOOR
    MASON CITY,IA50401     		  GOV SUPPORT 2,500
    CITY OF OSAGE
    806 MAIN STREET
    OSAGE,IA50461     		  GOV PUBLIC RECREATIONAMENITIES 30,000
    COMMUNITY POLICING ADVISORY BOARD
    10 FIRST STREET NW
    MASON CITY,IA50401     		  PC NATIONAL NIGHT OUT 1,500
    COMPREHENSIVE SYSTEMS INC
    1316 18TH STREET SW
    MASON CITY,IA50401     		  PC AGING WHIRLPOOL 4,000
    ELDERBRIDGE AGENCY ON AGING
    22 N GEORGIA AVE 216
    MASON CITY,IA50401     		  PC PROVIDE MATERIALAID TO LOW-INCOMESENIORS 5,000
    FLOYD COUNTY FAIR SOCIETY
    2516 7 MILE RD
    CHARLES CITY,IA50616     		  PC CONSTRUCT BUILDINGFOR 4-H FOOD STANDAND INDOOR ENTERTAINMENT 12,500
    FLOYD COUNTY FAIR SOCIETY
    2516 7 MILE RD
    CHARLES CITY,IA50616     		  PC MATCHING GIFT 1,000
    FLOYD COUNTY HISTORICAL SOCIETY
    500 GILBERT ST
    CHARLES CITY,IA50616     		  PC MUSEUM BASEMENTELECTRICAL UPGRADES 5,000
    FOOD BANK OF IOWA
    2220 E 17TH ST
    DES MOINES,IA50316     		  PC PROVIDE FOOD ASSISTANCE 4,000
    FOUR OAKS FAMILY AND CHILDREN SERVICES
    80 N EISENHOWER
    MASON CITY,IA50401     		  PC SUPPORT 2,000
    FRANKLIN COUNTY FAIR FOUNDATION
    1008 CENTRAL AVE W
    HAMPTON,IA50441     		  PC RENOVATIONS OFCONVENTION CENTER 5,000
    GIRL SCOUTS OF GREATER IOWA INC
    10715 HICKMAN RD
    URBANDALE,IA50322     		  PC CAMP TANGLEFOOTALUMINUM DECKINGPROJECT 5,000
    GOOD SHEPHERD HEALTH CENTER INC
    302 2ND ST NE
    MASON CITY,IA50401     		  PC TELEPHONE REASSURANCEPROGRAM 1,000
    GREAT PLAYS DAYCARE
    485 S LINN AVE
    NEW HAMPTON,IA50659     		  PC SUPPORT 5,000
    IOOF HOME AND COMMUNITY THERAPY CENTER
    1037 19TH ST SW
    MASON CITY,IA50401     		  PC SOUTH HALLREMODELING 10,000
    IOOF HOME AND COMMUNITY THERAPY CENTER
    1037 19TH ST SW
    MASON CITY,IA50401     		  PC SUPPORT 1,000
    GREATER IOWA YOUTH FOR CHRIST
    2210 S FEDERAL AVE
    MASON CITY,IA50401     		  PC CAMPUS LIFEREWARDS EXPERIENTIALFISCAL LITERACY PROGRAM 10,000
    IOWA COLLEGE FOUNDATION
    505 5TH AVE STE 1034
    DES MOINES,IA50309     		  PC SCHOLARSHIPPROGRAM 5,000
    IOWA LEGAL AID
    202 1ST ST SE SUITE 112
    MASON CITY,IA50401     		  PC FREE LEGAL SERVICES FOR LOW-INCOMERESIDENTS 5,000
    IOWA SPECIALTY HOSPITAL HAMPTON
    700 2ND STREET SE STE 101
    HAMPTON,IA50441     		  PC BABY SCALEFOR CLINIC 1,000
    KANAWHA SWIMMING POOL
    220 W 6TH ST
    KANAWHA,IA50447     		  PC POOL DECKPROJECT 2,000
    LINN GROVE RECREATION CENTER INC
    610 1ST ST N
    ROCKWELL,IA50469     		  PC LINN GROVE RECREATIONPLAYGROUND PROJECT 5,000
    LUTHERAN MUSIC PROGRAM
    PO BOX 8687
    MINNEAPOLIS,MN55408     		  PC MATCHING GIFT 1,000
    MASON CITY CHAMBER OF COMMERCE
    9 N FEDERAL AVE
    MASON CITY,IA50401     		  PC 2021 BAND FESTIVALDRUM MAJORSCHOLARSHIP 5,000
    MASON CITY COMMUNITY SCHOOL DISTRICT
    1515 S PENNSYLVANIA
    MASON CITY,IA50401     		  GOV FUTURE IS NOWCAPITAL CAMPAIGNATHLETIC FACILITY 50,000
    MASON CITY FAMILY YMCA
    1840 S MONROE
    MASON CITY,IA50401     		  PC MATCHING GIFT 750
    MASON CITY FIRE DEPARTMENT
    350 5TH ST SW
    MASON CITY,IA50401     		  GOV SUPPORT 4,500
    MERCYONE NORTH IOWA FOUNDATION
    1000 4TH ST SW
    MASON CITY,IA50401     		  PC MATCHING GIFT 1,000
    MITCHELL COUNTY MEMORIAL FDN
    616 N 8TH ST
    OSAGE,IA50461     		  PC EXPANSION/RENOVATIONOF MITCHELL COUNTYREGIONAL HEALTH CENTER 25,000
    NEW HAMPTON INDUSTRIAL DEVELOPMENT CORPORATION
    112 E SPRING ST
    NEW HAMPTON,IA50659     		  PC NEW HAMPTONHOUSING PROJECT 10,000
    NIACC FOUNDATION
    500 COLLEGE DR
    MASON CITY,IA50401     		  PC 3 $1000 SCHOLARSHIPS 3,000
    NIACC FOUNDATION
    500 COLLEGE DR
    MASON CITY,IA50401     		  PC SPONSORSHIPPERFORMING ARTS SERIES 3,950
    NIACC FOUNDATION
    500 COLLEGE DR
    MASON CITY,IA50401     		  PC MATCHING GIFT 1,000
    NORTHERN LIGHTS ALLIANCE FOR THE HOMELESS
    2 SOUTH ADAMS
    MASON CITY,IA50401     		  PC MATCHINGGIFT 1,000
    NORTHERN LIGHTS ALLIANCE FOR HOMELESS
    2 SOUTH ADAMS
    MASON CITY,IA50401     		  PC PROVIDE SHELTERAND SERVICES FORTHE HOMELESS 15,000
    NIACOG HOUSING TRUST FUND
    525 6TH ST SW
    MASON CITY,IA50401     		  PC HOMEREPAIR PROGRAM 5,000
    NORTH IOWA AREA COMM COLLEGE FDN
    500 COLLEGE DR
    MASON CITY,IA50401     		  PC SPONSORSHIP OFLIFELONG LEARNINGINSTITUTE PROGRAM 10,000
    NORTH IOWA FAIR ASSOCIATION
    3700 4TH ST SW
    MASON CITY,IA50401     		  PC NORTH IOWARECREATION ARENABUILDING 10,000
    NORTHEAST IOWA FOOD BANK
    1605 LAFAYETTE ST
    WATERLOO,IA50703     		  PC BACKPACK ANDMOBILE FOOD PANTRYPROGRAMS 5,000
    NORTHWOOD-KENSETT BOOSTER CLUB
    1200 1ST AVE N
    NORTHWOOD,IA50459     		  PC FITNESS AND ACTIVITYCENTER ADDITION TOGYMNASIUM 5,000
    ONE VISION
    1200 N 9TH ST W
    CLEAR LAKE,IA50428     		  PC OVERNIGHT MONITORINGSYSTEM 3,000
    OUR DAILY BREAD FOOD PANTRY
    201 9TH ST NE
    ALTOONA,IA50009     		  PC MATCHING GIFT 1,000
    OUR SAVIORS LUTHERAN CHURCH
    833 ASH ST
    OSAGE,IA50461     		  PC MATCHING GIFT 1,000
    PHEASANTS FOREVER
    805 PENN BLVD
    OSKALOOSA,IA52577     		  PC MATCHING GIFT 1,000
    PROJECT FLO ASSOCIATION
    PO BOX 604
    SHELL ROCK,IA50670     		  PC REPAIRING/SHINGLING/RENOVATINGFAMILY RESIDENCES 2,000
    PROTIVIN FIREFIGHTERS INC
    217 N ELM STREET
    CRESCO,IA52136     		  PC SUPPORT 10,000
    ROCKWELL LIONS CLUB
    PO BOX 57
    ROCKWELL,IA50469     		  PC LIONS ANNUALTRUCK PULL 2,000
    CHARLES H MACNIDER ART MUSEUM
    303 2ND ST SE
    MASON CITY,IA50401     		  PC PATIO UMBRELLASWHITEBOARD 1,500
    THE WORLD FOOD PRIZE FOUNDATION
    666 GRAND AVENUE PO BOX 1700
    DES MOINES,IA50309     		  PC SUSTAINABILITYFUND 10,000
    SALVATION ARMY OF NORTH IOWA
    747 VILLAGE GREEN DR
    MASON CITY,IA50401     		  PC MATCHING GIFT 1,000
    SALVATION ARMY ADULT DAY HEALTH CENTER
    747 VILLAGE GREEN DR
    MASON CITY,IA50401     		  PC HANDS-ON ACTIVITIES 5,000
    STEBENS CHILDREN'S THEATER
    616 N DELAWARE
    MASON CITY,IA50401     		  PC SUPPORT 4,000
    UNA VOCIS CHORAL ENSEMBLE
    115 10TH ST NW
    MASON CITY,IA50401     		  PC CD DEVELOPMENT 1,000
    WEST FORK FOOD PANTRY
    106 GILMAN ST
    SHEFFIELD,IA50475     		  PC SUPPORT 5,000
    YMCA MASON CITY
    1840 S MONROE AVE
    MASON CITY,IA50401     		  PC SUPPORT 7,500
    YSS FRANCIS LAUER
    50 N EISENHOWER AVE
    MASON CITY,IA50401     		  PC RECOVERY CENTER 40,000
    YSS FRANCIS LAUER
    50 N EISENHOWER AVE
    MASON CITY,IA50401     		  PC YSS RAPID REHOUSINGPROGRAM 5,000
    LUTHERAN SERVICES IN IOWA
    2502 S JEFFERSON AVE
    MASON CITY,IA50401     		  PC CHILD ABUSEPREVENTION PROGRAM 5,000
    COMMUNITY KITCHEN OF NORTH IOWA
    606 N MONROE AVE
    MASON CITY,IA50401     		  PC MATCHING GIFT 250
    Total .................................bullet 3a 440,450
    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 ...........     		    14 56  
    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: a
    b
    c
    d
    e
    12 Subtotal. Add columns (b), (d), and (e) ..   36,819  
    13Total. Add line 12, columns (b), (d), and (e)..................
    13
    36,819
    (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:  
    Part VI Line 7 -Original Return Overpayment: -2,020


    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
    FIRST CITIZENS CHARITABLE FOUNDATION INC
     
    Employer identification number

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






    Form 990-PF




    Check if your organization is covered by the General Rule or a Special Rule.  
    Note: Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.
    General Rule
    Special Rules
    ......... Arrow Bullet $  
    Caution: An organization that 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
    FIRST CITIZENS CHARITABLE FOUNDATION INC
          		Employer identification number
    42-1451615
    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
    FIRST CITIZENS BANK
     
    2601 4TH STREET SW
     
    MASON CITY, IA50401

    		$ 300,000


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

    		$  


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

    		$  


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

    		$  


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

    		$  


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

    		$  


    (Complete Part II for noncash contributions.)
    Schedule B (Form 990) (2021)
    Schedule B (Form 990) (2021)
    Page 3
    Name of organization
    FIRST CITIZENS CHARITABLE FOUNDATION INC
          		Employer identification number

    42-1451615
    Part II
    Noncash Property (see instructions). Use duplicate copies of Part II if additional space is needed.
    (a)
    No. from Part I    		 (b)
    Description of noncash property given    		 (c)
    FMV (or estimate)
    (See instructions)     		(d)
    Date received
     
    		$    
    (a)
    No. from Part I    		 (b)
    Description of noncash property given    		 (c)
    FMV (or estimate)
    (See instructions)     		(d)
    Date received
     
    		$    
    (a)
    No. from Part I    		 (b)
    Description of noncash property given    		 (c)
    FMV (or estimate)
    (See instructions)     		(d)
    Date received
     
    		$    
    (a)
    No. from Part I    		 (b)
    Description of noncash property given    		 (c)
    FMV (or estimate)
    (See instructions)     		(d)
    Date received
     
    		$    
    (a)
    No. from Part I    		 (b)
    Description of noncash property given    		 (c)
    FMV (or estimate)
    (See instructions)     		(d)
    Date received
     
    		$    
    (a)
    No. from Part I    		 (b)
    Description of noncash property given    		 (c)
    FMV (or estimate)
    (See instructions)     		(d)
    Date received
     
    		$    
    Schedule B (Form 990) (2021)
    Schedule B (Form 990) (2021)
    Page 4
    Name of organization
    FIRST CITIZENS CHARITABLE FOUNDATION INC
          		Employer identification number

    42-1451615
    Part III
    Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10) that total more than $1,000 for the year from any one contributor. Complete columns (a) through (e) and the following line entry. For organizations completing Part III, enter the total of exclusively religious, charitable, etc., contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet$  
    Use duplicate copies of Part III if additional space is needed.
    (a)
    No. from Part I    		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
     
    (e) Transfer of gift
    Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
     
     
         
     
    (a)
    No. from Part I    		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
     
    (e) Transfer of gift
    Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
     
     
         
     
    (a)
    No. from Part I    		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
     
    (e) Transfer of gift
    Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
     
     
         
     
    (a)
    No. from Part I    		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
     
    (e) Transfer of gift
    Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
     
     
         
     
    Schedule B (Form 990) (2021)
    Additional Data


    Software ID:  
    Software Version:  

    TY 2021 AccountingFeesSchedule
    Name:
    FIRST CITIZENS CHARITABLE FOUNDATION INC
    EIN:
    42-1451615
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    SCHUPICK & ASSOC, PC TAX PREPARATION 960      

    TY 2021 InvestmentsCorpStockSchedule
    Name:
    FIRST CITIZENS CHARITABLE FOUNDATION INC
    EIN:
    42-1451615
    Name of Stock End of Year Book Value End of Year Fair Market Value
    BERKSHIRE HATHAWAY INC 32,533 89,700
    BANK OF AMERICA 49,784 79,553

    TY 2021 InvestmentsOtherSchedule2
    Name:
    FIRST CITIZENS CHARITABLE FOUNDATION INC
    EIN:
    42-1451615
    Category/ Item Listed at Cost or FMV Book Value End of Year Fair Market Value
    ISHARES DJ US REAL ESTATE   67,268 107,430
    T ROWE PRICE BLUE CHIP GROWTH FUND   94,150 116,251
    VANGUARD EQUITY INCOME FUND   108,350 115,195
    COHEN & STEERS PREFERRED SECURITIES & INCOME   10,000 9,658
    ISHARE S&P MIDCAP 400 VALUE INDEX FUND   38,597 69,728
    ISHARE S&P MIDCAP 400 GROWTH INDEX FUND   30,552 65,224
    ISHARE S&P SMALLCAP 600 BARRA VALUE FUND   31,602 72,098
    ISHARE S&P SMALLCAP 600 GROWTH INDEX FUND   25,051 65,930
    ISHARE DOW JONES - BASIC MATERIALS   7,639 11,217
    ISHARE DOW JONES - CONSUMER DISCRETIONARY   45,110 55,440
    ISHARE DOW JONES - UTILITIES   10,986 11,496
    ISHARE DOW JONES - FINANCIAL SECTOR   24,874 30,342
    ISHARE DOW JONES - HEALTHCARE   44,565 55,569
    ISHARE DOW JONES - INDUSTRIAL   17,453 22,548
    ISHARE DOW JONES - TECH   52,204 80,374
    ISHARE DOW JONES - TELECOM   9,982 10,696
    ISHARE DOW JONES - CONSUMER STAPLES   8,370 12,011
    ISHARE MSCI EAFE FUND   192,907 236,040
    ETF VANGUARD EMERGING MARKETS   53,533 60,589
    FEDERATED HERMES TOTAL RETURN BONS INSTL   80,000 79,210
    PIMCO FUNDS INCOME INSTL   80,000 79,235
    VANGUARD HIGH YIELD CORP ADM   72,164 70,227

    TY 2021 OtherDecreasesSchedule
    Name:
    FIRST CITIZENS CHARITABLE FOUNDATION INC
    EIN:
    42-1451615
    Description Amount
    COST BASIS ADJUSTMENT 565


    TY 2021 OtherIncreasesSchedule
    Name:
    FIRST CITIZENS CHARITABLE FOUNDATION INC
    EIN:
    42-1451615
    Description Amount
    CAPITAL GAIN 66,731


    TY 2021 OtherProfessionalFeesSchedule
    Name:
    FIRST CITIZENS CHARITABLE FOUNDATION INC
    EIN:
    42-1451615
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    FIRST CITIZENS TRUST CO. TRUSTEE 4,687 4,687 0 0


    TY 2021 TaxesSchedule
    Name:
    FIRST CITIZENS CHARITABLE FOUNDATION INC
    EIN:
    42-1451615
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    FOREIGN TAXES 92 92 0 0
    FEDERAL EXCISE TAXES 700 700 0 0
    INVESTMENT EXPENSES 9 9 0 0