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
MIDDLECOTT FOUNDATION
 
Number and street (or P.O. box number if mail is not delivered to street address)50 CONGRESS STREET ROOM 800
  Room/suite
City or town, state or province, country, and ZIP or foreign postal code
BOSTON, MA02109
A Employer identification number

04-6155699
B Telephone number (see instructions)

(617) 227-8660
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$4,049,918J 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) 28,688
2 Check bullet.............
3 Interest on savings and temporary cash investments      
4 Dividends and interest from securities... 51,180 51,180  
5a Gross rents............      
b Net rental income or (loss)  
6a Net gain or (loss) from sale of assets not on line 10 231,556
b Gross sales price for all assets on line 6a 285,886
7 Capital gain net income (from Part IV, line 2)... 231,556
8 Net short-term capital gain.........  
9 Income modifications...........  
10a Gross sales less returns and allowances  
b Less: Cost of goods sold....  
c Gross profit or (loss) (attach schedule).....    
11 Other income (attach schedule).......      
12 Total. Add lines 1 through 11........ 311,424 282,736 0
Operating and Administrative Expenses 13 Compensation of officers, directors, trustees, etc. 0 0 0 0
14 Other employee salaries and wages......        
15 Pension plans, employee benefits.......        
16a Legal fees (attach schedule).........        
b Accounting fees (attach schedule)....... Click to see attachment 44,073 35,258 0 8,815
c Other professional fees (attach schedule).... Click to see attachment 6,480 5,184 0 1,296
17 Interest...............        
18 Taxes (attach schedule) (see instructions)... Click to see attachment 1,300 1,265 0 35
19 Depreciation (attach schedule) and depletion...      
20 Occupancy..............        
21 Travel, conferences, and meetings.......        
22 Printing and publications..........        
23 Other expenses (attach schedule)....... Click to see attachment 2,234 2,234 0 0
24 Total operating and administrative expenses.
Add lines 13 through 23.......... 54,087 43,941 0 10,146
25 Contributions, gifts, grants paid....... 278,625 278,625
26 Total expenses and disbursements. Add lines 24 and 25 332,712 43,941 0 288,771
27 Subtract line 26 from line 12:
a Excess of revenue over expenses and disbursements -21,288
b Net investment income (if negative, enter -0-) 238,795
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......... 749,614 717,551 717,551
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)....... 1,652,112 Click to see attachment1,667,722 3,332,367
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 bullet  
Less: accumulated depreciation (attach schedule) bullet        
15 Other assets (describe bullet)      
16 Total assets (to be completed by all filers—see the
instructions. Also, see page 1, item I) 2,401,726 2,385,273 4,049,918
Liabilities 17 Accounts payable and accrued expenses..........    
18 Grants payable.................    
19 Deferred revenue.................    
20 Loans from officers, directors, trustees, and other disqualified persons    
21 Mortgages and other notes payable (attach schedule)......    
22 Other liabilities (describe bullet)    
23 Total liabilities (add lines 17 through 22)......... 0 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........ 0 0
27 Paid-in or capital surplus, or land, bldg., and equipment fund 0 0
28 Retained earnings, accumulated income, endowment, or other funds 2,401,726 2,385,273
29 Total net assets or fund balances (see instructions)..... 2,401,726 2,385,273
30 Total liabilities and net assets/fund balances (see instructions). 2,401,726 2,385,273
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
2,401,726
2
Enter amount from Part I, line 27a .....................
2
-21,288
3
Other increases not included in line 2 (itemize) bulletClick to see attachment
3
4,835
4
Add lines 1, 2, and 3 ..........................
4
2,385,273
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
2,385,273
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 LONG TERM CAPITAL GAIN/LOSS   1958-04-15 2021-12-31
b CAPITAL GAIN DISTRIBUTIONS   2021-01-01 2021-12-31
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 285,860   54,330 231,530
b 26     26
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       231,530
b       26
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 2 231,556
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 26
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 3,319
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 3,319
6 Credits/Payments:
a 2021 estimated tax payments and 2020 overpayment credited to 2021 6a 4,359
b Exempt foreign organizations—tax withheld at source...... 6b 0
c Tax paid with application for extension of time to file (Form 8868)... 6c 5,000
d Backup withholding erroneously withheld ........... 6d 0
7 Total credits and payments. Add lines 6a through 6d.............. 7 9,359
8 Enter any penalty for underpayment of estimated tax. Check here if Form 2220 is attached. 8 0
9 Tax due. If the total of lines 5 and 8 is more than line 7, enter amount owed.......Bullet 9  
10 Overpayment. If line 7 is more than the total of lines 5 and 8, enter the amount overpaid...Bullet 10 6,040
11 Enter the amount of line 10 to be: Credited to 2022 estimated taxBullet6,040 RefundedBullet 11 0
Part VI-A
Statements Regarding Activities
1a
During the tax year, did the foundation attempt to influence any national, state, or local legislation or did
Yes
No
it participate or intervene in any political campaign? ....................
1a
 
No
b
Did it spend more than $100 during the year (either directly or indirectly) for political purposes? See the instructions
for the definition.................................
1b
 
No
If the answer is "Yes" to 1a or 1b, attach a detailed description of the activities and copies of any materials
published or distributed by the foundation in connection with the activities.
c
Did the foundation file Form 1120-POL for this year?.....................
1c
 
No
d
Enter the amount (if any) of tax on political expenditures (section 4955) imposed during the year:
(1) On the foundation. bullet$ 0(2) On foundation managers.bullet$ 0
e
Enter the reimbursement (if any) paid by the foundation during the year for political expenditure tax imposed
on foundation managers.bullet$ 0
2
Has the foundation engaged in any activities that have not previously been reported to the IRS?.......
2
 
No
If "Yes," attach a detailed description of the activities.
3
Has the foundation made any changes, not previously reported to the IRS, in its governing instrument, articles
of incorporation, or bylaws, or other similar instruments? If "Yes," attach a conformed copy of the 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)
    bulletMA
    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 ofbulletSALTONSTALL CO Telephone no.bullet (617) 227-8660

    Located atbullet50 CONGRESS STREET ROOM 800BOSTONMA ZIP+4bullet02109
    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)
    Yes
     
    (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
     
    No
    c
    ........bullet
    d
    Did the foundation engage in a prior year in any of the acts described in 1a, other than excepted acts,
    that were not corrected before the first day of the tax year beginning in 2021? .............
    1d
     
    No
    2
    Taxes on failure to distribute income (section 4942) (does not apply for years the foundation was a private
    operating foundation defined in section 4942(j)(3) or 4942(j)(5)):
    a
    At the end of tax year 2021, did the foundation have any undistributed income (lines 6d
    and 6e, Part XII) for tax year(s) beginning before 2021?....................
    2a
     
    No
    If "Yes," list the years bullet20, 20, 20, 20
    b
    Are there any years listed in 2a for which the foundation is not applying the provisions of section 4942(a)(2)
    (relating to incorrect valuation of assets) to the year’s undistributed income? (If applying section 4942(a)(2)
    to all years listed, answer "No" and attach statement—see instructions.) ..............
    2b
     
     
    c
    If the provisions of section 4942(a)(2) are being applied to any of the years listed in 2a, list the years here.
    bullet20, 20, 20, 20
    3a
    Did the foundation hold more than a 2% direct or indirect interest in any business enterprise at
    any time during the year? ..............................
    3a
     
    No
    b
    If "Yes," did it have excess business holdings in 2021 as a result of (1) any purchase by the foundation
    or disqualified persons after May 26, 1969; (2) the lapse of the 5-year period (or longer period approved
    by the Commissioner under section 4943(c)(7)) to dispose of holdings acquired by gift or bequest; or (3)
    the lapse of the 10-, 15-, or 20-year first phase holding period? (Use Schedule C, Form 4720, to determine
    if the foundation had excess business holdings in 2021.) .....................
    3b
     
     
    4a
    Did the foundation invest during the year any amount in a manner that would jeopardize its charitable purposes?
    4a
     
    No
    b
    Did the foundation make any investment in a prior year (but after December 31, 1969) that could jeopardize its
    charitable purpose that had not been removed from jeopardy before the first day of the tax year beginning in 2021? ..
    4b
     
    No
    Form 990-PF (2021)
    Form 990-PF (2021)
    Page 6
    Part VI-B
    Statements Regarding Activities for Which Form 4720 May Be Required (continued)
    5a
    During the year did the foundation pay or incur any amount to:
    Yes
    No
    (1) Carry on propaganda, or otherwise attempt to influence legislation (section 4945(e))? ..........
    5a(1)
     
    No
    (2) Influence the outcome of any specific public election (see section 4955); or to carry
    on, directly or indirectly, any voter registration drive? ....................
    5a(2)
     
    No
    (3) Provide a grant to an individual for travel, study, or other similar purposes? .............
    5a(3)
     
    No
    (4) Provide a grant to an organization other than a charitable, etc., organization described
    in section 4945(d)(4)(A)? See instructions ........................
    5a(4)
     
    No
    (5) Provide for any purpose other than religious, charitable, scientific, literary, or
    educational purposes, or for the prevention of cruelty to children or animals? .............
    5a(5)
     
    No
    b
    If any answer is "Yes" to 5a(1)–(5), did any of the transactions fail to qualify under the exceptions described in
    Regulations section 53.4945 or in a current notice regarding disaster assistance? See instructions ........
    5b
     
     
    c
    .........bullet
    d
    If the answer is "Yes" to question 5a(4), does the foundation claim exemption from the
    tax because it maintained expenditure responsibility for the grant? .................
    5d
     
     
    If "Yes," attach the statement required by Regulations section 53.4945–5(d).
    6a
    Did the foundation, during the year, receive any funds, directly or indirectly, to pay premiums on
    a personal benefit contract? .............................
    6a
     
    No
    b
    Did the foundation, during the year, pay premiums, directly or indirectly, on a personal benefit contract? ....
    6b
     
    No
    If "Yes" to 6b, file Form 8870.
    7a
    At any time during the tax year, was the foundation a party to a prohibited tax shelter transaction?
    7a
     
    No
    b
    If "Yes", did the foundation receive any proceeds or have any net income attributable to the transaction? .....
    7b
     
     
    8
    Is the foundation subject to the section 4960 tax on payment(s) of more than $1,000,000 in remuneration or
    excess parachute payment during the year? .........................
    8
     
    No
    Part VII
    Information About Officers, Directors, Trustees, Foundation Managers, Highly Paid Employees,
    and Contractors
    1 List all officers, directors, trustees, foundation managers and their compensation. See instructions
    (a) Name and address (b) Title, and average
    hours per week
    devoted to position     		(c) Compensation
     (If not paid, enter
    -0-)     		(d) Contributions to employee benefit plans and deferred compensation (e) Expense account,
    other allowances
    JEFFREY L THOMPSON TRUSTEE
    1.00     		0 0 0
    50 CONGRESS STREET ROOM 800
    BOSTON,MA02109
    NEIL L THOMPSON TRUSTEE
    1.00     		0 0 0
    50 CONGRESS STREET ROOM 800
    BOSTON,MA02109
    G WEST SALTONSTALL TRUSTEE
    1.00     		0 0 0
    50 CONGRESS STREET ROOM 800
    BOSTON,MA02109
    2 Compensation of five highest-paid employees (other than those included on line 1—see instructions). If none, enter “NONE."
    (a) Name and address of each employee paid more than $50,000 (b) Title, and average
    hours per week
    devoted to position     		(c) Compensation (d) Contributions to
    employee benefit
    plans and deferred
    compensation     		(e) Expense account,
    other allowances
    NONE
    Total number of other employees paid over $50,000...................bullet 0
    Form 990-PF (2021)
    Form 990-PF (2021)
    Page 7
    Part VII
    Information About Officers, Directors, Trustees, Foundation Managers, Highly Paid Employees,
    and Contractors (continued)
    3 Five highest-paid independent contractors for professional services (see instructions). If none, enter "NONE".
    (a) Name and address of each person paid more than $50,000 (b) Type of service (c) Compensation
    NONE
    Total number of others receiving over $50,000 for professional services.............bullet0
    Part VIII-A
    Summary of Direct Charitable Activities
    List the foundation’s four largest direct charitable activities during the tax year. Include relevant statistical information such as the number of organizations and other beneficiaries served, conferences convened, research papers produced, etc. Expenses
    1  
    2  
    3  
    4  
    Part VIII-B
    Summary of Program-Related Investments (see instructions)
    Describe the two largest program-related investments made by the foundation during the tax year on lines 1 and 2. Amount
    1  
    2  
    All other program-related investments. See instructions.
    3  
    Total. Add lines 1 through 3.........................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
    3,111,779
    b
    Average of monthly cash balances.......................
    1b
    714,353
    c
    Fair market value of all other assets (see instructions)................
    1c
    0
    d
    Total (add lines 1a, b, and c).........................
    1d
    3,826,132
    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
    3,826,132
    4
    Cash deemed held for charitable activities. Enter 1.5% (0.015) of line 3 (for greater amount, see
    instructions) .............................
    4
    57,392
    5
    Net value of noncharitable-use assets. Subtract line 4 from line 3. .......
    5
    3,768,740
    6
    Minimum investment return. Enter 5% (0.05) of line 5................
    6
    188,437
    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
    188,437
    2a
    Tax on investment income for 2021 from Part V, line 5.......
    2a
    3,319
    b
    Income tax for 2021. (This does not include the tax from Part V.) ...
    2b
     
    c
    Add lines 2a and 2b............................
    2c
    3,319
    3
    Distributable amount before adjustments. Subtract line 2c from line 1............
    3
    185,118
    4
    Recoveries of amounts treated as qualifying distributions................
    4
    0
    5
    Add lines 3 and 4............................
    5
    185,118
    6
    Deduction from distributable amount (see instructions).................
    6
    0
    7
    Distributable amount as adjusted. Subtract line 6 from line 5. Enter here and on Part XII, line 1 ...
    7
    185,118
    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 7 185,118
    2 Undistributed income, if any, as of the end of 2021:
    a Enter amount for 2020 only....... 0
    b Total for prior years:20, 20, 20 0
    3 Excess distributions carryover, if any, to 2021:
    a From 2016...... 486,890
    b From 2017...... 571,030
    c From 2018...... 595,953
    d From 2019...... 349,220
    e From 2020...... 590,811
    f Total of lines 3a through e ........ 2,593,904
    4Qualifying distributions for 2021 from Part
    XI, line 4: bullet$ 288,771
    a Applied to 2020, but not more than line 2a 0
    b Applied to undistributed income of prior years
    (Election required—see instructions).....     		0
    c Treated as distributions out of corpus (Election
    required—see instructions)........     		0
    d Applied to 2021 distributable amount..... 185,118
    e Remaining amount distributed out of corpus 103,653
    5 Excess distributions carryover applied to 2021. 0 0
    (If an amount appears in column (d), the
    same amount must be shown in column (a).)
    6Enter the net total of each column as
    indicated below:
    a Corpus. Add lines 3f, 4c, and 4e. Subtract line 5 2,697,557
    b Prior years’ undistributed income. Subtract
    line 4b from line 2b ..........     		0
    c Enter the amount of prior years’ undistributed
    income for which a notice of deficiency has
    been issued, or on which the section 4942(a)
    tax has been previously assessed......     		0
    d Subtract line 6c from line 6b. Taxable amount
    —see instructions ...........     		0
    e Undistributed income for 2019. Subtract line
    4a from line 2a. Taxable amount—see
    instructions .............     		0
    f Undistributed income for 2021. Subtract
    lines 4d and 5 from line 1. This amount must
    be distributed in 2022 ..........     		0
    7 Amounts treated as distributions out of
    corpus to satisfy requirements imposed by
    section 170(b)(1)(F) or 4942(g)(3) (Election may
    be required - see instructions) .......     		0
    8 Excess distributions carryover from 2016 not
    applied on line 5 or line 7 (see instructions) ...     		486,890
    9 Excess distributions carryover to 2022.
    Subtract lines 7 and 8 from line 6a ......     		2,210,667
    10 Analysis of line 9:
    a Excess from 2017.... 571,030
    b Excess from 2018.... 595,953
    c Excess from 2019.... 349,220
    d Excess from 2020.... 590,811
    e Excess from 2021.... 103,653
    Form 990-PF (2021)
    Form 990-PF (2021)
    Page 10
    Part XIII
    Private Operating Foundations (see instructions and Part VI-A, question 9)
    1a If the foundation has received a ruling or determination letter that it is a private operating
    foundation, and the ruling is effective for 2021, enter the date of the ruling ....... bullet
     
    b Check box to indicate whether the organization is a private operating foundation described in section or
    2a Enter the lesser of the adjusted net
    income from Part I or the minimum
    investment return from Part X for each
    year listed ..........     		Tax year Prior 3 years (e) Total
    (a) 2021 (b) 2020 (c) 2019 (d) 2018
             
    b 85% (0.85) of line 2a .........          
    c Qualifying distributions from Part XI,
    line 4 for each year listed .....     		         
    d Amounts included in line 2c not used directly
    for active conduct of exempt activities ..........     		         
    e Qualifying distributions made directly
    for active conduct of exempt activities.
    Subtract line 2d from line 2c ....     		         
    3 Complete 3a, b, or c for the
    alternative test relied upon:
    a “Assets" alternative test—enter:
    (1) Value of all assets ......          
    (2) Value of assets qualifying
    under section 4942(j)(3)(B)(i)    		          
    b “Endowment" alternative test— enter 2/3
    of minimum investment return shown in
    Part IX, line 6 for each year listed ..     		         
    c “Support" alternative test—enter:
    (1) Total support other than gross
    investment income (interest,
    dividends, rents, payments
    on securities loans (section
    512(a)(5)), or royalties) ....     		         
    (2) Support from general public
    and 5 or more exempt
    organizations as provided in
    section 4942(j)(3)(B)(iii)....     		         
    (3) Largest amount of support
    from an exempt organization    		          
    (4) Gross investment income          
    Part XIV
    Supplementary Information (Complete this part only if the foundation had $5,000 or more in
    assets at any time during the year—see instructions.)
    1Information Regarding Foundation Managers:
    aList any managers of the foundation who have contributed more than 2% of the total contributions received by the foundation
    before the close of any tax year (but only if they have contributed more than $5,000). (See section 507(d)(2).)
    bList any managers of the foundation who own 10% or more of the stock of a corporation (or an equally large portion of the
    ownership of a partnership or other entity) of which the foundation has a 10% or greater interest.
    2Information Regarding Contribution, Grant, Gift, Loan, Scholarship, etc., Programs:
    Check here bullet
    aThe name, address, and telephone number or email address of the person to whom applications should be addressed:
    bThe form in which applications should be submitted and information and materials they should include:
    cAny submission deadlines:
    dAny restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other
    factors:
    Form 990-PF (2021)
    Form 990-PF (2021)
    Page 11
    Part XIV
    Supplementary Information (continued)
    3 Grants and Contributions Paid During the Year or Approved for Future Payment
    Recipient If recipient is an individual,
    show any relationship to
    any foundation manager
    or substantial contributor
    		 Foundation
    status of
    recipient     		Purpose of grant or
    contribution     		Amount
    Name and address (home or business)
    aPaid during the year
    ADVANCE TRANSIT
    PO BOX 1027
    WILDER,VT050881027     		NONE PC GENERAL SUPPORT 100
    ADVANCEMENT INFORMATION SYSTEMS NORTHEASTERN UNIVERSITY
    118 CUSHING HALL 360 HUNTINGTON
    AVENUE
    BOSTON,MA022159877     		NONE PC GENERAL SUPPORT 250
    ADVANCEMENT OFFICE THE RIVERS SCHOOL
    333 WINTER STREET
    WESTON,MA02493     		NONE PC GENERAL SUPPORT 200
    ALUMNI AND DEVELOPMENT SERVICES HARVARD UNIVERSITY
    PO BOX 419209
    BOSTON,MA022419209     		NONE PC GENERAL SUPPORT 250
    ALUTIIQ MUSEUM
    215 MISSION RD SUITE 101
    KODIAK,AK99615     		NONE PC GENERAL SUPPORT 1,000
    ALUTIIQ MUSEUM
    215 MISSION RD SUITE 101
    KODIAK,AK99615     		NONE PC GENERAL SUPPORT 250
    ALZHEIMER'S ASSOCIATION MASSACHUSETTSNEW HAMPSHIRE CHAPTER
    PO BOX 96011
    WASHINGTON,DC200906011     		NONE PC MA/NH CHAPTER 1,000
    AMERICAN BIRD CONSERVANCY
    PO BOX 249
    THE PLAINS,VA20198     		NONE PC GENERAL SUPPORT 500
    AMERICAN FARMLAND TRUST GIFT PROCESSING CENTER
    PO BOX 758603
    TOPEKA,KS666759961     		NONE PC GENERAL SUPPORT 100
    AMERICAN HEART ASSOCIATION
    11207 BLUE HERON BLVD NORTH
    ST PETERSBURG,FL33716     		NONE PC HANLON'S HEART OF THE FAMILY 100
    AMERICAN RED CROSS OF GREATER BOSTON DONATION PROCESSING CENTER
    PO BOX 55919
    BOSTON,MA022055919     		NONE PC GENERAL SUPPORT 100
    AMERICAN RED CROSS OF MAINE
    2401 CONGRESS STREET
    PORTLAND,ME04102     		NONE PC GENERAL SUPPORT 200
    AMERICAN RED CROSS NORTHERN NEW ENGLAND REGION
    PO BOX 9632
    MANCHESTER,NH031089632     		NONE PC NORTHERN NEW ENGLAND 1,000
    ANCHORAGE COALITION TO END HOMELESSNESS
    PO BOX 243041
    ANCHORAGE,AK99524     		NONE PC GENERAL SUPPORT 3,000
    ASSOCIATES OF THE BOSTON PUBLIC LIBRARY
    700 BOYLSTON STREET
    BOSTON,MA02116     		NONE PC GENERAL SUPPORT 500
    ASSOCIATES OF THE BOSTON PUBLIC LIBRARY
    700 BOYLSTON STREET
    BOSTON,MA02116     		NONE PC GENERAL SUPPORT 250
    ASTHMA AND ALLERGY FOUNDATION OF AMERICA
    PO BOX 424053
    WASHINGTON,DC200424053     		NONE PC GENERAL SUPPORT 500
    BABY STEPS CO EAST BAY COMMUNITY ACTION PROGRAM
    19 BROADWAY
    NEWPORT,RI02840     		NONE PC GENERAL SUPPORT 250
    BARBARA'S RED STOCKING
    118 INDIAN POND RD
    ORFORD,NH03777     		NONE PC GENERAL SUPPORT 200
    BIGELOW LABORATORY
    60 BIGELOW DR
    EAST BOOTHBAY,ME04544     		NONE PC GENERAL SUPPORT 2,000
    BONNELL COVE FOUNDATION
    124 CHESTNUT STREET
    CAMDEN,ME04843     		NONE PC GENERAL SUPPORT 500
    BOSTON CHILDREN'S HOSPITAL
    401 PARK DRIVE SUITE 602
    BOSTON,MA02215     		NONE PC KAPLAN CARDIOLOGY 1,000
    BOSTON CHILDREN'S HOSPITAL
    PO BOX 5016
    HAGERSTOWN,MD217415016     		NONE PC GENERAL SUPPORT 250
    BREHM SCHOOL FOUNDATION
    950 SOUTH BREHM LANE
    CARBONDALE,IL629019950     		NONE PC GENERAL SUPPORT 250
    BRIGHAM & WOMEN'S HOSPITAL
    116 HUNTINGTON AVE 3RD FL
    BOSTON,MA02116     		NONE PC ALBERT L SHEFFER PROFESSORSHIP 2,500
    BRIGHAM & WOMEN'S HOSPITAL
    116 HUNTINGTON AVE 3RD FL
    BOSTON,MA02116     		NONE PC ALBERT L SHEFFER PROFESSORSHIP 2,000
    BRIGHAM & WOMEN'S HOSPITAL
    116 HUNTINGTON AVE 3RD FL
    BOSTON,MA02116     		NONE PC ALBERT L SHEFFER PROFESSORSHIP 2,500
    BYRD POLAR & CLIMATE RESEARCH CENTER
    108 SCOTT HALL 1090 CARMACK RD
    COLUMBUS,OH43210     		NONE PC BYRD POLAR & CLIMATE RESEARCH 200
    CAMBRIDGE PUBLIC LIBRARY FOUNDATION
    449 BROADWAY
    CAMBRIDGE,MA02138     		NONE PC GENERAL SUPPORT 500
    CARE GIFT CENTER
    PO BOX 1870
    MERRIFIELD,VA221168070     		NONE PC GENERAL SUPPORT 1,500
    CARE GIFT CENTER
    PO BOX 1870
    MERRIFIELD,VA221168070     		NONE PC GENERAL SUPPORT 1,000
    CARE GIFT CENTER
    PO BOX 1870
    MERRIFIELD,VA221168070     		NONE PC GENERAL SUPPORT 1,000
    CARE GIFT CENTER
    PO BOX 1870
    MERRIFIELD,VA221168070     		NONE PC GENERAL SUPPORT 1,000
    CARE GIFT CENTER
    PO BOX 1870
    MERRIFIELD,VA221168070     		NONE PC GENERAL SUPPORT 1,000
    CASPAR
    PO BOX 45538
    SOMERVILLE,MA02145     		NONE PC GENERAL SUPPORT 500
    CENTRE STREET FOOD PANTRY
    11 HOMER STREET
    NEWTON CENTRE,MA02459     		NONE PC GENERAL SUPPORT 252
    CENTRE STREET FOOD PANTRY
    11 HOMER STREET
    NEWTON CENTRE,MA02459     		NONE PC GENERAL SUPPORT 1,000
    CENTRE STREET FOOD PANTRY
    11 HOMER STREET
    NEWTON CENTRE,MA02459     		NONE PC GENERAL SUPPORT 1,000
    CENTRE STREET FOOD PANTRY
    11 HOMER STREET
    NEWTON CENTRE,MA02459     		NONE PC GENERAL SUPPORT 500
    CENTRE STREET FOOD PANTRY
    11 HOMER STREET
    NEWTON CENTRE,MA02459     		NONE PC GENERAL SUPPORT 500
    CENTRE STREET FOOD PANTRY
    11 HOMER STREET
    NEWTON CENTRE,MA02459     		NONE PC GENERAL SUPPORT 500
    CENTRE STREET FOOD PANTRY
    11 HOMER STREET
    NEWTON CENTRE,MA02459     		NONE PC GENERAL SUPPORT 500
    CENTRE STREET FOOD PANTRY
    11 HOMER STREET
    NEWTON CENTRE,MA02459     		NONE PC GENERAL SUPPORT 1,000
    CHAPEL HAVEN INC
    1040 WHALLEY AVE
    NEW HAVEN,CT06515     		NONE PC GENERAL SUPPORT 5,000
    CHARLES RIVER SCHOOL
    6 OLD MEADOW ROAD PO BOX 339
    DOVER,MA02030     		NONE PC GENERAL SUPPORT 10,000
    CHARLES RIVER SCHOOL
    6 OLD MEADOW ROAD PO BOX 339
    DOVER,MA02030     		NONE PC GENERAL SUPPORT 250
    CHILD AND FAMILY SERVICES OF NEWPORT COUNTY
    31 JOHN CLARKE ROAD
    MIDDLETOWN,RI02842     		NONE PC GENERAL SUPPORT 250
    CHILTON CLUB - CHRISTMAS FUND
    152 COMMONWEALTH AVE
    BOSTON,MA02116     		NONE PC GENERAL SUPPORT 100
    COASTAL FAMILY HOSPICE VOLUNTEERS
    PO BOX 122
    ROCKPORT,ME04856     		NONE PC GENERAL SUPPORT 500
    COASTAL MOUNTAINS LAND TRUST
    101 MOUNT BATTIE STREET
    CAMDEN,ME04843     		NONE PC GENERAL SUPPORT 500
    CONSERVATION LAND FOUNDATION RI
    235 PROMENADE ST STE 560 MAILBOX 28
    PROVIDENCE,RI02908     		NONE PC GENERAL SUPPORT 250
    CONSERVATION LAW FOUNDATION
    62 SUMMER STREET
    BOSTON,MA02110     		NONE PC GENERAL SUPPORT 1,000
    CONSERVATION LAW FOUNDATION
    62 SUMMER STREET
    BOSTON,MA02110     		NONE PC GENERAL SUPPORT 5,000
    CONSERVATION LAW FOUNDATION
    62 SUMMER STREET
    BOSTON,MA02110     		NONE PC GENERAL SUPPORT 2,000
    CORNELL LAB OF ORNITHOLOGY
    159 SAPSUCKER WOODS ROAD
    ITHACA,NY14850     		NONE PC GENERAL SUPPORT 3,000
    CROSSCURRENTS INTERNATIONAL INSTITUTE
    7122 HARDIN-WAPAK ROAD
    SIDNEY,OH45365     		NONE PC GENERAL SUPPORT 20,000
    CROSSROADS ACADEMY
    95 DARTMOUTH COLLEGE HIGHWAY
    LYME,NH03768     		NONE PC GENERAL SUPPORT 100
    CUMMINGS SCHOOL OF VETERINARY MEDICINE AT TUFTS UNIVERSITY
    200 WESTBORO ROAD
    NORTH GRAFTON,MA01536     		NONE PC GENERAL SUPPORT 250
    DEDHAM COUNTRY DAY SCHOOL
    90 SANDY VALLEY ROAD
    DEDHAM,MA02026     		NONE PC GENERAL SUPPORT 200
    DELTA DELTA DELTA FOUNDATION
    14951 NORTH DALLAS PARKWAY SUITE
    500
    DALLAS,TX752546893     		NONE PC GENERAL SUPPORT 100
    DEXTER SOUTHFIELD
    20 NEWTON STREET
    BROOKLINE,MA02445     		NONE PC ANNUAL FUND 200
    DEXTER SOUTHFIELD
    20 NEWTON STREET
    BROOKLINE,MA02445     		NONE PC TEDDY THORNDIKE TEACHER FUND 1,000
    DEXTER SOUTHFIELD SCHOOL
    20 NEWTON STREET
    BROOKLINE,MA02445     		NONE PC GENERAL SUPPORT 250
    D-HGEISEL OFFICE OF DEVELOPMENT
    ONE MEDICAL CENTER DRIVE HB 7070
    LEBANON,NH037560001     		NONE PC CHILDREN'S HOSPITAL AT DARTMOUTH HITCHCOCK 250
    D-HGEISEL OFFICE OF DEVELOPMENT
    ONE MEDICAL CENTER DRIVE HB 7070
    LEBANON,NH037560001     		NONE PC NCCC 500
    DICKINSON COLLEGE
    PO BOX 1773
    CARLISLE,PA17013     		NONE PC GENERAL SUPPORT 500
    DOCTORS WITHOUT BORDERS
    PO BOX 5030
    HAGERSTOWN,MD217415030     		NONE PC GENERAL SUPPORT 1,000
    DR MARTIN LUTHER KING JR COMMUNITY CENTER
    20 DR MARCUS F WHEATLAND BLVD
    NEWPORT,RI02840     		NONE PC GENERAL SUPPORT 500
    ECORI NEWS
    10 DAVOL SQ SUITE 100
    PROVIDENCE,RI02903     		NONE PC GENERAL SUPPORT 250
    EPILEPSY FOUNDATION OF NEW ENGLAND
    650 SUFFOLK STREET 405
    LOWELL,MA01854     		NONE PC GENERAL SUPPORT 1,000
    EPIPHANY SCHOOL
    154 CENTRE STREET
    DORCHESTER,MA02124     		NONE PC SPRING GALA 1,500
    ESPLANADE ASSOCIATION
    575 BOYLSTON STREET SUITE 4R
    BOSTON,MA02116     		NONE PC GENERAL SUPPORT 500
    FAB NEWPORT
    1 YORK STREET
    NEWPORT,RI02840     		NONE PC GENERAL SUPPORT 250
    FIRST CHURCH IN CHESTNUT HILL
    26 SUFFOLK RD
    CHESTNUT HILL,MA02467     		NONE PC ANNUAL FUND 500
    FOUNDATION FOR ENERGY THERAPIES
    8 CLOUGH AVENUE
    WINDSOR,VT05089     		NONE PC GENERAL SUPPORT 1,000
    FRIENDS OF HARVARD FENCING
    65 NORTH HARVARD STREET
    BOSTON,MA021631012     		NONE PC GENERAL SUPPORT 1,000
    FRIENDS OF HARVARD HOCKEY
    65 NORTH HARVARD STREET
    BOSTON,MA021631012     		NONE PC GENERAL SUPPORT 200
    FRIENDS OF HARVARD HOCKEY
    65 N HARVARD ST
    BOSTON,MA02163     		NONE PC HARVARD HOCKEY GOLF TOURNAMENT 1,000
    FRIENDS OF ORFORD SOCIAL LIBRARY
    PO BOX 189
    ORFORD,NH03777     		NONE PC GENERAL SUPPORT 100
    FRIENDS OF THE BOSTON SYMPHONY ORCHESTRA
    301 MASSACHUSETTS AVENUE
    BOSTON,MA02115     		NONE PC GENERAL SUPPORT 5,500
    FRIENDS OF THE PUBLIC GARDEN
    69 BEACON STREET
    BOSTON,MA02108     		NONE PC GENERAL SUPPORT 1,000
    FRIENDS OF THE SHERBORN LIBRARY
    4 SANGER STREET
    SHERBORN,MA01770     		NONE PC GENERAL SUPPORT 500
    GRAFTON COUNTY SENIOR CITIZENS COUNCIL INC
    PO BOX 433
    LEBANON,NH037660433     		NONE PC GENERAL SUPPORT 100
    GRANITE UNITED WAY
    22 CONCORD ST FLOOR 2
    MANCHESTER,NH03101     		NONE PC GENERAL SUPPORT 500
    GULF OF MAINE RESEARCH INSTITUTE
    350 COMMERCIAL STREET
    PORTLAND,ME04101     		NONE PC GENERAL SUPPORT 500
    HARVARD COLLEGE FUND
    PO BOX 55997
    BOSTON,MA022059727     		NONE PC HARVARD COLLEGE FUND 2,500
    HARVARD COLLEGE FUND - MEMORIAL PROGRAM
    PO BOX 419209
    BOSTON,MA022419209     		NONE PC GENERAL SUPPORT 100
    HARVARD UNIVERSITY BOATHOUSE RENEWAL PROJECT
    PO BOX 419209
    BOSTON,MA022419209     		NONE PC HARVARD BOATHOUSE 20,000
    HEIFER INTERNATIONAL
    PO BOX 8058
    LITTLE ROCK,AR72203     		NONE PC GENERAL SUPPORT 150
    HEIFER INTERNATIONAL
    PO BOX 6021
    ALBERT LEA,MN560079831     		NONE PC GENERAL SUPPORT 250
    HIGH HORSES
    PO BOX 278
    SHARON,VT05065     		NONE PC GENERAL SUPPORT 100
    HISTORY CAMBRIDGE
    159 BRATTLE STREET
    CAMBRIDGE,MA02138     		NONE PC GENERAL SUPPORT 1,000
    HOME BASE
    125 NASHUA STREET STE 540
    BOSTON,MA02114     		NONE PC GENERAL SUPPORT 250
    HOUSING HOTLINE
    40 DR MARCUS WHEATLAND BLVD
    NEWPORT,RI02840     		NONE PC GENERAL SUPPORT 250
    HURRICANE ISLAND
    PO BOX 1280
    ROCKLAND,ME04841     		NONE PC GENERAL SUPPORT 200
    INTERNATIONAL RESCUE COMMITTEE
    PO BOX 6068
    ALBERT LEA,MN560076668     		NONE PC GENERAL SUPPORT 1,500
    INTERNATIONAL RESCUE COMMITTEE
    PO BOX 6068
    ALBERT LEA,MN560076668     		NONE PC GENERAL SUPPORT 1,000
    ISLAND COMMUNITY MEDICAL SERVICES
    15 MEDICAL CENTER LOOP
    VINALHAVEN,ME04863     		NONE PC GENERAL SUPPORT 500
    ISLAND COMMUNITY MEDICAL SERVICES
    15 MEDICAL CENTER LOOP
    VINALHAVEN,ME04863     		NONE PC GENERAL SUPPORT 100
    ISLAND COMMUNITY MEDICAL SERVICES
    15 MEDICAL CENTER LOOP
    VINALHAVEN,ME04863     		NONE PC GENERAL SUPPORT 500
    ISLAND INSTITUTE
    PO BOX 648
    ROCKLAND,ME048410648     		NONE PC GENERAL SUPPORT 250
    JOSLIN DIABETES CENTER
    ONE JOSLIN PLACE
    BOSTON,MA02215     		NONE PC FRANK R. RING, JR. FUND 500
    JOSLIN DIABETES CENTER
    ONE JOSLIN PLACE
    BOSTON,MA02215     		NONE PC GENERAL SUPPORT 500
    JUVENILE BIPOLAR RESEARCH FOUNDATION
    111 HEKILI STREET SUITE A-600
    KAILUA,HI96734     		NONE PC GENERAL SUPPORT 1,000
    JUVENILE BIPOLAR RESEARCH FOUNDATION
    111 HEKILI STREET SUITE A-600
    KAILUA,HI96734     		NONE PC GENERAL SUPPORT 500
    KIMBALL UNION ACADEMY ADVANCEMENT OFFICE
    PO BOX 188
    MERIDEN,NH03770     		NONE PC GENERAL SUPPORT 100
    KINGSWOOD OXFORD SCHOOL
    170 KINGSWOOD ROAD
    WEST HARTFORD,CT06119     		NONE PC GENERAL SUPPORT 500
    LISTEN COMMUNITY SERVICES
    60 HANOVER STREET
    LEBANON,NH03766     		NONE PC GENERAL SUPPORT 1,000
    LISTEN COMMUNITY SERVICES
    60 HANOVER STREET
    LEBANON,NH03766     		NONE PC GENERAL SUPPORT 1,500
    LUCY'S HEARTH
    19 VALLEY ROAD
    MIDDLETOWN,RI02842     		NONE PC GENERAL SUPPORT 500
    MA GOOD NEIGHBOR ENERGY FUND CO THE SALVATION ARMY
    25 SHAWMUT RD
    CANTON,MA020211408     		NONE PC GENERAL SUPPORT 1,000
    MAINE COAST HERITAGE TRUST
    1 BOWDOIN MILL ISLAND SUITE 201
    TOPSHAM,ME04086     		NONE PC GENERAL SUPPORT 2,000
    MAINE COMMUNITY FOUNDATION
    245 MAIN STREET
    ELLSWORTH,ME04605     		NONE PC GENERAL SUPPORT 5,000
    MAINE FAMILY PLANNING
    PO BOX 587
    AUGUSTA,ME043320587     		NONE PC GENERAL SUPPORT 500
    MAINE MEDIA WORKSHOPS & COLLEGE
    PO BOX 200
    ROCKPORT,ME04856     		NONE PC GENERAL SUPPORT 500
    MAINE MEDICAL CENTER
    22 BRAMHALL STREET
    PORTLAND,ME04102     		NONE PC GENERAL SUPPORT 500
    MAINE PUBLIC RADIO
    63 TEXAS AVE
    BANGOR,ME04401     		NONE PC GENERAL SUPPORT 3,000
    MAINE SEACOAST MISSION
    127 WEST STREET
    BAR HARBOR,ME04609     		NONE PC GENERAL SUPPORT 500
    MAKING COMMUNITY HAPPEN
    46 SUMMER STREET
    ROCKLAND,ME04841     		NONE PC GENERAL SUPPORT 1,000
    MANOMET CENTER FOR CONSERVATION SCIENCES
    PO BOX 1770
    MANOMET,MA02345     		NONE PC GENERAL SUPPORT 250
    MAPLEBROOK SCHOOL
    5142 ROUTE 22
    AMENIA,NY12501     		NONE PC GENERAL SUPPORT 5,000
    MASSACHUSETTS HISTORICAL SOCIETY
    1154 BOYLSTON STREET
    BOSTON,MA022153695     		NONE PC GENERAL SUPPORT 2,000
    MEGUNTICOOK ROWING
    PO BOX 855
    CAMDEN,ME04843     		NONE PC GENERAL SUPPORT 10,000
    MERRYSPRING
    PO BOX 893
    CAMDEN,ME04843     		NONE PC GENERAL SUPPORT 100
    MIDDLESEX SCHOOL
    1400 LOWELL ROAD
    CONCORD,MA01742     		NONE PC GENERAL SUPPORT 250
    MOUNT KEARSARGE PONY CLUB
    641 ROLLINS ROAD
    HOPKINTON,NH03229     		NONE PC GENERAL SUPPORT 100
    MSPCA
    350 SOUTH HUNTINGTON AVE
    BOSTON,MA02130     		NONE PC GENERAL SUPPORT 10,000
    NABB
    160 COMMONWEALTH AVE L-8
    BOSTON,MA021162749     		NONE PC GENERAL SUPPORT 250
    NATIONAL MULTIPLE SCLEROSIS SOCIETY
    PO BOX 91891
    WASHINGTON,DC200901891     		NONE PC GENERAL SUPPORT 2,000
    NATURAL RESOURCES COUNCIL OF MAINE
    3 WADE STREET
    AUGUSTA,ME04330     		NONE PC GENERAL SUPPORT 5,000
    NEW ENGLAND FORESTRY FOUNDATION
    PO BOX 1346
    LITTLETON,MA01460     		NONE PC GENERAL SUPPORT 500
    NEW HAMPSHIRE FOOD BANK DEPT F
    PO BOX 5000
    MANCHESTER,NH031085000     		NONE PC GENERAL SUPPORT 500
    NEWPORT ART MUSEUM
    76 BELLEVUE AVENUE
    NEWPORT,RI02840     		NONE PC GENERAL SUPPORT 500
    NEWPORT MENTAL HEALTH
    127 JOHNNY CAKE HILL ROAD
    MIDDLETOWN,RI02842     		NONE PC GENERAL SUPPORT 250
    NEWPORT PERFORMING ARTS CENTER & OPERA HOUSE
    29 TOURO STREET
    NEWPORT,RI02840     		NONE PC GENERAL SUPPORT 500
    NEWPORT PUBLIC EDUCATION FOUNDATION
    320 THAMES STREET 1237
    NEWPORT,RI028407268     		NONE PC GENERAL SUPPORT 250
    NEWPORT TREE CONSERVANCY
    PO BOX 863
    NEWPORT,RI02840     		NONE PC GENERAL SUPPORT 2,021
    NEWTON FOOD PANTRY
    1000 COMMONWEALTH AVENUE
    NEWTON,MA02459     		NONE PC GENERAL SUPPORT 252
    NEWTON FOOD PANTRY
    1000 COMMONWEALTH AVENUE
    NEWTON,MA02459     		NONE PC GENERAL SUPPORT 1,000
    NEWTON FOOD PANTRY
    1000 COMMONWEALTH AVENUE
    NEWTON,MA02459     		NONE PC GENERAL SUPPORT 1,000
    NEWTON FOOD PANTRY
    1000 COMMONWEALTH AVENUE
    NEWTON,MA02459     		NONE PC GENERAL SUPPORT 500
    NEWTON FOOD PANTRY
    1000 COMMONWEALTH AVENUE
    NEWTON,MA02459     		NONE PC GENERAL SUPPORT 500
    NEWTON FOOD PANTRY
    1000 COMMONWEALTH AVENUE
    NEWTON,MA02459     		NONE PC GENERAL SUPPORT 1,000
    NEWTON FOOD PANTRY
    1000 COMMONWEALTH AVENUE
    NEWTON,MA02459     		NONE PC GENERAL SUPPORT 500
    NEWTON FOOD PANTRY
    1000 COMMONWEALTH AVENUE
    NEWTON,MA02459     		NONE PC GENERAL SUPPORT 500
    NHPR
    PO BOX 9645
    MANCHESTER,NH031089645     		NONE PC GENERAL SUPPORT 250
    NOBLE & GREENOUGH SCHOOL
    10 CAMPUS DRIVE
    DEDHAM,MA020269906     		NONE PC GENERAL SUPPORT 200
    NOBLE AND GREENOUGH SCHOOL
    10 CAMPUS DRIVE
    DEDHAM,MA020269906     		NONE PC ANNUAL FUND 500
    NORMAN BIRD SANCTUARY
    583 THIRD BEACH ROAD
    MIDDLETOWN,RI02842     		NONE PC GENERAL SUPPORT 250
    NORTH HAVEN BAPTIST CHURCH
    PO BOX 435
    NORTH HAVEN,ME048530435     		NONE PC GENERAL SUPPORT 300
    NORTH HAVEN BAPTIST CHURCH
    PO BOX 435
    NORTH HAVEN,ME04853     		NONE PC FREEZER 1,000
    NORTH HAVEN BAPTIST CHURCH
    PO BOX 435
    NORTH HAVEN,ME04853     		NONE PC GENERAL SUPPORT 250
    NORTH HAVEN BAPTIST CHURCH
    PO BOX 435
    NORTH HAVEN,ME04853     		NONE PC GENERAL SUPPORT 1,000
    NORTH HAVEN CONSERVATION PARTNERS
    PO BOX 336
    NORTH HAVEN,ME04853     		NONE PC GENERAL SUPPORT 200
    NORTH HAVEN CONSERVATION PARTNERS
    PO BOX 336
    NORTH HAVEN,ME04853     		NONE PC GENERAL SUPPORT 500
    NORTH HAVEN FOUNDATION
    PO BOX 664
    NORTH HAVEN,ME048410664     		NONE PC GENERAL SUPPORT 500
    NORTH HAVEN LIBRARY
    PO BOX 486
    NORTH HAVEN,ME048530486     		NONE PC GENERAL SUPPORT 500
    NORTH HAVEN LIBRARY
    PO BOX 486
    NORTH HAVEN,ME048530486     		NONE PC GENERAL SUPPORT 250
    NORTH HAVEN SUMMER SERVICES
    111 SOUTH ORANGE GROVE BLVD UNIT
    209
    PASEDENA,CA91105     		NONE PC GENERAL SUPPORT 300
    NORWICH COMMUNITY NURSE
    PO BOX 852
    NORWICH,VT050550852     		NONE PC GENERAL SUPPORT 500
    NOTICEABILITY INC
    PO BOX 380617
    CAMBRIDGE,MA02238     		NONE PC GENERAL SUPPORT 500
    NRDC
    PO BOX 1830
    MERRIFIELD,VA221168030     		NONE PC GENERAL SUPPORT 1,000
    OFFICE OF ANNUAL GIVING UNIVERSITY ADVANCEMENT
    15 STRAFFORD AVENUE
    DURHAM,NH038249914     		NONE PC 4H FOUNDAITON OF NEW HAMPSHIRE 100
    OFFICE OF INSTITUTIONAL ADVANCEMENT FOXCROFT SCHOOL
    22407 FOXHOUND LANE
    MIDDLEBURG,VA20117     		NONE PC GENERAL SUPPORT 100
    PAWS ANIMAL ADOPTION CENTER
    PO BOX 707
    ROCKPORT,ME04856     		NONE PC CHRISTMAS FUND 100
    PARTNERS IN ISLAND EDUCATION
    BOX 664
    VINALHAVEN,ME04863     		NONE PC GENERAL SUPPORT 250
    PENOBSCOT MARINE MUSEUM
    PO BOX 498
    SEARSPORT,ME04974     		NONE PC GENERAL SUPPORT 1,000
    PENOBSCOT MARINE MUSEUM
    PO BOX 498
    SEARSPORT,ME049740498     		NONE PC GENERAL SUPPORT 100
    PHILANTHROPY DEPARTMENT
    180 HEMENWAY ROAD
    FRAMINGHAM,MA017012699     		NONE PC GENERAL SUPPORT 1,500
    PINE STREET INN
    PO BOX 55945
    BOSTON,MA022055945     		NONE PC GENERAL SUPPORT 400
    PLANNED PARENTHOOD OF NORTHERN NEW ENGLAND
    784 HERCULES DR STE 110
    COLCHESTER,VT054469943     		NONE PC GENERAL SUPPORT 500
    POSITIVE TRACKS
    35 SOUTH MAIN STREET
    HANOVER,NH03755     		NONE PC GENERAL SUPPORT 250
    REDWOOD LIBRARY & ATHENAEUM
    50 BELLEVUE AVENUE
    NEWPORT,RI02840     		NONE PC GENERAL SUPPORT 250
    REHEARSAL FOR LIFE
    670 CENTRE STREET SUITE 8
    JAMAICA PLAIN,MA02130     		NONE PC GENERAL SUPPORT 250
    RHODE ISLAND TREE COUNCIL
    PO BOX 6144
    PROVIDENCE,RI02940     		NONE PC GENERAL SUPPORT 250
    ROCKY MOUNTAIN INSTITUTE
    2490 JUNCTION PLACE STE 200
    BOULDER,CO803019806     		NONE PC GENERAL SUPPORT 100
    ROCKY MOUNTAIN INSTITUTE INNOVATION CENTER
    2490 JUNCTION PLACE SUITE 200
    BOULDER,CO80301     		NONE PC GENERAL SUPPORT 1,000
    ROTCH-JONES-DUFF HOUSE & GARDEN MUSEUM
    396 COUNTY STREET
    NEW BEDFORD,MA02740     		NONE PC GENERAL SUPPORT 500
    SCIENCENTER
    601 1ST STREET
    ITHACA,NY14850     		NONE PC GENERAL SUPPORT 20,000
    SELF-REALIZATION FELLOWSHIP
    3880 SAN RAFAEL AVENUE
    LOS ANGELES,CA900653219     		NONE PC GENERAL SUPPORT 1,000
    SELF-REALIZATION FELLOWSHIP
    3880 SAN RAFAEL AVENUE
    LOS ANGELES,CA900653219     		NONE PC GENERAL SUPPORT 1,000
    SHERBORN LIBRARY
    4 SANGER STREET
    SHERBORN,MA01770     		NONE PC GENERAL SUPPORT 500
    SHORE COUNTRY DAY SCHOOL
    545 CABOT STREET
    BEVERLY,MA01915     		NONE PC GENERAL SUPPORT 100
    SIERRA CLUB
    PO BOX 421044
    PALM COAST,FL321426423     		NONE PC GENERAL SUPPORT 1,000
    SOUTHERN HARBOR ELDERCARE SERVICES
    12 PULPIT HARBOR ROAD
    NORTH HAVEN,ME04853     		NONE PC GENERAL SUPPORT 1,000
    SPAULDING REHABILITATION HOSPITAL
    1575 CAMBRIDGE ST
    CAMBRIDGE,MA021384308     		NONE PC GENERAL SUPPORT 250
    SPAULDING REHABILITATION HOSPITAL
    301 1ST AVE
    CHARLESTOWN,MA02129     		NONE PC GENERAL SUPPORT 500
    ST FRANCIS HOUSE
    39 BOYLSTON STREET
    BOSTON,MA02116     		NONE PC GENERAL SUPPORT 200
    SYMPHONY ANNUAL FUND
    PO BOX 419124
    BOSTON,MA022419124     		NONE PC MUCH CIRCLE MEMBERSHIP 2,500
    THE APPRENTICESHOP
    655 MAIN STREET
    ROCKLAND,ME04841     		NONE PC GENERAL SUPPORT 500
    THE ARNOLD ARBORETUM OF HARVARD UNIVERSITY
    PO BOX 419209
    BOSTON,MA022419209     		NONE PC GENERAL SUPPORT 3,000
    THE ARTHRITIS RESEARCH INSTITUTE OF AMERICA
    2240 BELLEAIR ROAD SUITE 100
    CLEARWATER,FL33764     		NONE PC GENERAL SUPPORT 500
    THE FOREST SOCIETY OF MAINE
    115 FRANKLIN STREET 3RD FL
    BANGOR,ME04401     		NONE PC GENERAL SUPPORT 1,000
    THE MGH FUND
    125 NASHUA STREET SUITE 540
    BOSTON,MA02114     		NONE PC THE 1811 SOCIETY 1,000
    THE NATURE CONSERVANCY - MAINE
    14 MAINE STREET SUITE 401
    BRUNSWICK,ME04011     		NONE PC GENERAL SUPPORT 250
    THE NEEDHAM COMMUNITY COUNCIL
    570 HILLSIDE AVENUE
    NEEDHAM,MA02494     		NONE PC GENERAL SUPPORT 1,500
    THE NORTH HAVEN FOUNDATION
    10 SCHOOL STREET PO BOX 664
    NORTH HAVEN,ME048530664     		NONE PC GENERAL SUPPORT 200
    THE ROTCH-JONES-DUFF HOUSE & GARDEN MUSEUM
    396 COUNTY STREET
    NEW BEDFORD,MA02740     		NONE PC GENERAL SUPPORT 500
    THE TRUSTEES OF RESERVATIONS
    200 HIGH STREET 4TH FLOOR
    BOSTON,MA02110     		NONE PC CASTLE HILL ROSE GARDEN RESTORATION 250
    THE TRUSTEES OF RESERVATIONS
    4TH FLOOR
    BOSTON,MA02110     		NONE PC GENERAL SUPPORT 1,000
    THOMAS G CAVANAGH MEMORIAL FUND INC
    25 NATHANIEL GREENE DRIVE
    WARWICK,RI02818     		NONE PC GENERAL SUPPORT 250
    THOMPSON ISLAND OUTWARD BOUND
    PO BOX 127
    BOSTON,MA02127     		NONE PC GENERAL SUPPORT 1,000
    TWIN PINES HOUSING
    226 HOLIDAY DRIVE SUITE 20
    WHITE RIVER JUNCTION,VT05001     		NONE PC GENERAL SUPPORT 1,000
    UNION CHURCH
    PO BOX 249
    VINALHAVEN,ME04863     		NONE PC GENERAL SUPPORT 500
    UNION OF CONCERNED SCIENTISTS
    2 BRATTLE SQUARE SUITE 6
    CAMBRIDGE,MA02138     		NONE PC GENERAL SUPPORT 2,000
    UNION OF CONCERNED SCIENTISTS
    PO BOX 4123
    WOBURN,MA018884123     		NONE PC GENERAL SUPPORT 100
    UNITED WAY OF MASSACHUSETTS BAY AND MERRIMACK VALLEY
    PO BOX 51381
    BOSTON,MA022051381     		NONE PC ANNUAL FUND 10,000
    UNITED WAY OF MASSACHUSETTS BAY FAMILY FUND
    51 SLEEPER STREET
    BOSTON,MA021101205     		NONE PC GENERAL SUPPORT 500
    UNIVERSITY OF ALASKA ANCHORAGE CO UNIVERSITY OF ALASKA FOUNDATION
    1815 BRAGAW ST SUITE 206
    ANCHORAGE,AK99508     		NONE PC UAA HOCKEY 1,000
    UPPER VALLEY HAVEN
    713 HARTFORD AVENUE
    WHITE RIVER JUNCTION,VT05001     		NONE PC GENERAL SUPPORT 1,500
    UPPER VALLEY LAND TRUST
    19 BUCK ROAD
    HANOVER,NH037552714     		NONE PC GENERAL SUPPORT 100
    UPPER VALLEY ROWING FOUNDATION
    PO BOX 419
    HANOVER,NH03755     		NONE PC GENERAL SUPPORT 200
    USPEA
    966 PLUMSOCK RD
    NEWTON SQUARE,PA19073     		NONE PC GENERAL SUPPORT 250
    VINALHAVEN LAND TRUST
    PO BOX 268
    VINALHAVEN,ME048630268     		NONE PC GENERAL SUPPORT 200
    VINALHAVEN LAND TRUST
    PO BOX 268
    VINALHAVEN,ME048630268     		NONE PC DUES 250
    VINALHAVEN LAND TRUST
    PO BOX 268
    VINALHAVEN,ME048630268     		NONE PC WLS/BYRD 2,500
    VINALHAVEN LAND TRUST
    PO BOX 268
    VINALHAVEN,ME04863     		NONE PC GENERAL SUPPORT 1,000
    VINALHAVEN LAND TRUST
    PO BOX 268
    VINALHAVEN,ME04863     		NONE PC GENERAL SUPPORT 500
    VINALHAVEN LAND TRUST
    PO BOX 268
    VINALHAVEN,ME04863     		NONE PC GENERAL SUPPORT 250
    VITAL COMMUNITIES
    195 NORTH MAIN STREET
    WHITE RIVER JUNCITON,VT05001     		NONE PC GENERAL SUPPORT 100
    WATERMAN'S COMMUNITY CENTER
    12 MAIN STREET
    NORTH HAVEN,ME04853     		NONE PC GENERAL SUPPORT 1,000
    WATERMAN'S COMMUNITY CENTER
    PO BOX 526
    NORTH HAVEN,ME04853     		NONE PC GENERAL SUPPORT 250
    WBUR MEMBERSHIP
    890 COMMONWEALTH AVE 3RD FL
    BOSTON,MA02215     		NONE PC MEMBERSHIP 2,500
    WGBH
    PO BOX 55875
    BOSTON,MA02205     		NONE PC RALPH LOWELL SOCIETY 3,000
    WILLING HANDS
    198 CHURCH STREET
    NORWICH,VT05055     		NONE PC GENERAL SUPPORT 1,500
    WOMEN'S RESOURCE CENTER
    114 TOURO STREET
    NEWPORT,RI02840     		NONE PC GENERAL SUPPORT 150
    WOMENSWIMMIN' FOR HOSPICARE
    172 EAST KING ROAD
    ITHACA,NY14850     		NONE PC SWIMMER: ALICE SALTONSTALL 100
    WORLD OCEAN SCHOOL
    PO BOX 51091
    BOSTON,MA02205     		NONE PC SCHOONER ROSEWAY FRED EUSTIS 250
    Total .................................bullet 3a 278,625
    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 ...........     		         
    4 Dividends and interest from securities ....          
    5 Net rental income or (loss) from real estate:
    aDebt-financed property......          
    bNot debt-financed property.....          
    6 Net rental income or (loss) from personal property          
    7 Other investment income .....          
    8 Gain or (loss) from sales of assets other than
    inventory ............     		    18 231,556  
    9 Net income or (loss) from special events:          
    10 Gross profit or (loss) from sales of inventory          
    11 Other revenue: a
    b
    c
    d
    e
    12 Subtotal. Add columns (b), (d), and (e) .. 0 282,736 0
    13Total. Add line 12, columns (b), (d), and (e)..................
    13
    282,736
    (See worksheet in line 13 instructions to verify calculations.)
    Part XV-B
    Relationship of Activities to the Accomplishment of Exempt Purposes
    Line No.
    DownArrow     		Explain below how each activity for which income is reported in column (e) of Part XV-A contributed importantly to
    the accomplishment of the foundation’s exempt purposes (other than by providing funds for such purposes). (See
    instructions.)
    Form 990-PF (2021)
    Form 990-PF (2021)
    Page 13
    Part XVI
    Information Regarding Transfers To and Transactions and Relationships With Noncharitable Exempt Organizations
    1
    Did the organization directly or indirectly engage in any of the following with any other organization described in section 501(c) (other than section 501(c)(3) organizations) or in section 527, relating to political organizations?
    Yes
    No
    a
    Transfers from the reporting foundation to a noncharitable exempt organization of:
    (1) Cash...................................
    1a(1)
     
    No
    (2) Other assets.................................
    1a(2)
     
    No
    b
    Other transactions:
    (1) Sales of assets to a noncharitable exempt organization....................
    1b(1)
     
    No
    (2) Purchases of assets from a noncharitable exempt organization..................
    1b(2)
     
    No
    (3) Rental of facilities, equipment, or other assets.......................
    1b(3)
     
    No
    (4) Reimbursement arrangements...........................
    1b(4)
     
    No
    (5) Loans or loan guarantees.............................
    1b(5)
     
    No
    (6) Performance of services or membership or fundraising solicitations................
    1b(6)
     
    No
    c
    Sharing of facilities, equipment, mailing lists, other assets, or paid employees..............
    1c
     
    No
    d
    If the answer to any of the above is "Yes," complete the following schedule. Column (b) should always show the fair market value
    of the goods, other assets, or services given by the reporting foundation. If the foundation received less than fair market value
    in any transaction or sharing arrangement, show in column (d) the value of the goods, other assets, or services received.
    (a) Line No. (b) Amount involved (c) Name of noncharitable exempt organization (d) Description of transfers, transactions, and sharing arrangements
    2a
    Is the foundation directly or indirectly affiliated with, or related to, one or more tax-exempt organizations
    described in section 501(c) (other than section 501(c)(3)) or in section 527? ...........
    b
    If "Yes," complete the following schedule.

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


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


    Software ID:  
    Software Version:  


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

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

    04-6155699
    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
    MIDDLECOTT FOUNDATION
          		Employer identification number
    04-6155699
    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
    MARY SALTONSTALL
    C/O 50 CONGRESS ST ROOM 800
     
    BOSTON, MA02109

    		$ 5,382


    (Complete Part II for noncash contributions.)
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Total contributions    		 (d)
    Type of contribution
    2
    SUSAN VON STADE
    C/O 50 CONGRESS ST ROOM 800
     
    BOSTON, MA02109

    		$ 9,203


    (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
    MIDDLECOTT FOUNDATION
          		Employer identification number

    04-6155699
    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
    1
    		 PUBLICLY TRADED SECURITIES $ 31,396 2021-01-11
    (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
    MIDDLECOTT FOUNDATION
          		Employer identification number

    04-6155699
    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:
    MIDDLECOTT FOUNDATION
    EIN:
    04-6155699
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    ACCOUNTING & BOOKKEEPING SRVCS 44,073 35,258 0 8,815

    TY 2021 InvestmentsCorpStockSchedule
    Name:
    MIDDLECOTT FOUNDATION
    EIN:
    04-6155699
    Name of Stock End of Year Book Value End of Year Fair Market Value
    PUBLICLY TRADED STOCK 1,667,722 3,332,367

    TY 2021 OtherExpensesSchedule
    Name:
    MIDDLECOTT FOUNDATION
    EIN:
    04-6155699
    Description Revenue and Expenses per Books Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    BANK FEES 2,234 2,234 0 0


    TY 2021 OtherIncreasesSchedule
    Name:
    MIDDLECOTT FOUNDATION
    EIN:
    04-6155699
    Description Amount
    ADJUSTMENT TO COST BASIS 4,835


    TY 2021 OtherProfessionalFeesSchedule
    Name:
    MIDDLECOTT FOUNDATION
    EIN:
    04-6155699
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    PROFESSIONAL TAX SERVICES 6,480 5,184 0 1,296


    TY 2021 TaxesSchedule
    Name:
    MIDDLECOTT FOUNDATION
    EIN:
    04-6155699
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    MA FILING FEE 35 0 0 35
    FOREIGN TAXES 1,265 1,265 0 0