TY 2021 Form 990PF

- TIN:

Form990-PF
Click to see attachment

Department of the Treasury
Internal Revenue Service

Return of Private Foundation

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

Do not enter social security numbers on this form as it may be made public.
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Go to www.irs.gov/Form990PF for instructions and the latest information.

OMB No. 1545-0047

2021

Open to Public Inspection

For calendar year 2021, or tax year beginning 10-01-2021 , and ending 09-30-2022

Name of foundation
Carl and Camilla Rietman Charitable
Foundation

Number and street (or P.O. box number if mail is not delivered to street address)3690 Broadway
Room/suite

City or town, state or province, country, and ZIP or foreign postal code
North Bend, OR97459

A Employer identification number

93-1221623

B Telephone number (see instructions)

(541) 269-9338

C If exemption application is pending, check here bullet

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

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

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

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

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

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

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

$6,538,695J Accounting method: Cash Accrual
Other (specify)
(Part I, column (d) must be on cash basis.)

	Analysis of Revenue and Expenses (The total of amounts in columns (b), (c), and (d) may not necessarily equal the amounts in column (a) (see instructions).)	(a) Revenue and expenses per books		(b) Net investment income	(d) Disbursements for charitable purposes (cash basis only)


1	Contributions, gifts, grants, etc., received (attach schedule)
2	Check .............
3	Interest on savings and temporary cash investments
4	Dividends and interest from securities...	232,226		232,226
5a	Gross rents............
b	Net rental income or (loss)
6a	Net gain or (loss) from sale of assets not on line 10		200,168
b	Gross sales price for all assets on line 6a 1,873,523
7	Capital gain net income (from Part IV, line 2)...			200,168
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........	432,394		432,394
13	Compensation of officers, directors, trustees, etc.	17,600			17,600
14	Other employee salaries and wages......
15	Pension plans, employee benefits.......
16a	Legal fees (attach schedule).........
b	Accounting fees (attach schedule).......		5,478		5,478
c	Other professional fees (attach schedule)....		43,426	39,826	3,600
17	Interest...............
18	Taxes (attach schedule) (see instructions)...		892		892
19	Depreciation (attach schedule) and depletion...
20	Occupancy..............	5,805			5,805
21	Travel, conferences, and meetings.......
22	Printing and publications..........
23	Other expenses (attach schedule).......
24	Total operating and administrative expenses.
	Add lines 13 through 23..........	73,201		39,826	33,375
25	Contributions, gifts, grants paid.......	303,233			303,233
26	Total expenses and disbursements. Add lines 24 and 25	376,434		39,826	336,608
27	Subtract line 26 from line 12:
a	Excess of revenue over expenses and disbursements	55,960
b	Net investment income (if negative, enter -0-)			392,568
c	Adjusted net income (if negative, enter -0-)...

For Paperwork Reduction Act Notice, see instructions.

Cat. No. 11289X Form 990-PF (2021)

Form 990-PF (2021)

Page 2

Part II		Balance Sheets	Beginning of year	End of year
Part II		Balance Sheets	(a) Book Value	(b) Book Value	(c) Fair Market Value
	1	Cash—non-interest-bearing.............	15,075	241,661	241,661
	2	Savings and temporary cash investments.........
	3	Accounts receivable
		Less: allowance for doubtful accounts
	4	Pledges receivable
		Less: allowance for doubtful accounts
	5	Grants receivable.................
	6	Receivables due from officers, directors, trustees, and other
		disqualified persons (attach schedule) (see instructions).....
	7	Other notes and loans receivable (attach schedule)
		Less: allowance for doubtful accounts
	8	Inventories for sale or use..............
	9	Prepaid expenses and deferred charges..........
	10a	Investments—U.S. and state government obligations (attach schedule)	716,683	740,948	649,102
	b	Investments—corporate stock (attach schedule).......	4,341,222	4,163,708	4,948,028
	c	Investments—corporate bonds (attach schedule).......	842,235	822,052	694,904
	11	Investments—land, buildings, and equipment: basis
		Less: accumulated depreciation (attach schedule)
	12	Investments—mortgage loans.............
	13	Investments—other (attach schedule)..........
	14	Land, buildings, and equipment: basis
		Less: accumulated depreciation (attach schedule)
	15	Other assets (describe )	2,194	5,000	5,000
	16	Total assets (to be completed by all filers—see the
		instructions. Also, see page 1, item I)	5,917,409	5,973,369	6,538,695
	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 )
	23	Total liabilities (add lines 17 through 22).........		0
		Foundations that follow FASB ASC 958, check here
		and complete lines 24, 25, 29 and 30.
	24	Net assets without donor restrictions...........
	25	Net assets with donor restrictions............
		Foundations that do not follow FASB ASC 958, check here
		and complete lines 26 through 30.
	26	Capital stock, trust principal, or current funds........
	27	Paid-in or capital surplus, or land, bldg., and equipment fund
	28	Retained earnings, accumulated income, endowment, or other funds	5,917,409	5,973,369
	29	Total net assets or fund balances (see instructions).....	5,917,409	5,973,369
	30	Total liabilities and net assets/fund balances (see instructions).	5,917,409	5,973,369

Part III

Analysis of Changes in Net Assets or Fund Balances

Total net assets or fund balances at beginning of year—Part II, column (a), line 29 (must agree with end-of-year figure reported on prior year’s return) ...............

5,917,409

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

55,960

Other increases not included in line 2 (itemize) bullet

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

5,973,369

Decreases not included in line 2 (itemize) bullet

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

5,973,369

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	40 Capital One FC: COF	P	2021-03-30	2021-10-22
b	30 Fortive Corp Disc 00500: FTV	P	2021-09-08	2021-10-22
c	20 Kingfisher PLC	P	2020-07-29	2021-10-12
d	1270 Kingfisher PLC	P	2020-09-08	2021-10-12
e	4 Alphabet, Inc	P	2019-11-04	2021-10-22
	25 JP Morgan Chase & Co: JPM	P	2018-02-09	2021-10-22
	10 Microsoft Corp: MSFT	P	2015-01-15	2021-10-22
	20 Parker Hannifin Corp: PH	P	2020-08-19	2021-10-22
	10 Union Pacific Corp: UNP	P	2020-08-19	2021-10-22
	380 VIVENDI SE	P	2021-08-03	2021-11-23
	95 Mutual Shares	P	2015-01-15	2021-10-28
	130 Totalenergies SE	P	2015-08-05	2021-11-03
	30 Totalenergies SE	P	2020-09-08	2021-11-03
	25000.00 Verizon Communications	P	2014-07-14	2021-11-12
	260 Electronic Arts Inc: EA	P	2018-12-24	2021-11-24
	70 Exchange from American Inc	P	2019-01-10	2021-11-24
	910 UMICORE Group	P	2021-09-16	2021-12-20
	400 ALLSTATE CORP: ALL	P	2016-02-08	2021-12-03
	260 Medtronic PLC	P	2019-08-21	2021-12-09
	720 Leggett & Platt Inc: LEG	P	2020-07-30	2021-12-17
	100 Leggett & Platt Inc: LEG	P	2020-08-19	2021-12-17
	380 Leggett & Platt Inc: LEG	P	2020-08-21	2021-12-17
	25 Applied Materials: AMAT	P	2021-03-25	2022-01-10
	20 Brown & Brown Inc: BRO	P	2021-12-03	2022-01-10
	3 Charter Communications	P	2021-04-20	2022-01-10
	60 CISCO Systems Inc: CSCO	P	2021-02-09	2022-01-10
	110 Coterra Energy Inc: CTRA	P	2021-02-25	2022-01-10
	140 First Horizon Corp: FHN	P	2021-02-09	2022-01-10
	15 Fortinet Inc: FTNT	P	2021-06-23	2022-01-10
	50 Fortive Corp Disc 00500: FTV	P	2021-09-08	2022-01-10
	5 Mastercard Inc	P	2021-04-14	2022-01-10
	25 Oshkosh Truck Corp: OSK	P	2021-02-22	2022-01-10
	120 Pfizer Inc: PFE	P	2021-07-21	2022-01-10
	15 Salesforce Com: CRM	P	2021-10-28	2022-01-10
	50 Warner Music Group Corp	P	2021-04-20	2022-01-10
	70 LKQ Corp: LKQ	P	2021-03-11	2022-01-24
	920 Universal Music Group	P	2021-11-23	2022-01-26
	3 Alphabet, Inc	P	2019-11-04	2022-01-10
	30 Analog Devices Inc: ADI	P	2019-09-13	2022-01-10
	90 Apple Inc: AAPL	P	2020-08-19	2022-01-10
	15 Avery Dennison Corp: AVY	P	2020-09-28	2022-01-10
	25 Boston Properties REIT: BXP	P	2020-06-09	2022-01-10
	14 Broadcam Inc: AVGO	P	2020-08-19	2022-01-10
	40 Carrier Global Corp: CARR	P	2020-04-23	2022-01-10
	10 Celanese Corp: CE	P	2019-08-14	2022-01-10
	30 Chevron Corp: CVX	P	2020-01-30	2022-01-10
	20 Digital Realty Trust	P	2019-01-29	2022-01-10
	15 Entergy Corp: ETR	P	2016-02-19	2022-01-10
	40 Entergy Corp: ETR	P	2020-08-19	2022-01-10
	20 Honeywell Intl Inc: HON	P	2020-08-19	2022-01-10
	25 Johnson & Johnson: JNJ	P	2018-07-17	2022-01-10
	30 Masco Corp: MAS	P	2020-08-04	2022-01-10
	40 Masco Corp: MAS	P	2020-08-19	2022-01-10
	15 Meta Platforms Inc	P	2020-02-26	2022-01-10
	45 Microsoft Corp: MSFT	P	2015-01-15	2022-01-10
	55 Morgan Stanley: MS	P	2020-06-05	2022-01-10
	20 Motorola Solutions: MSI	P	2019-12-04	2022-01-10
	10 Stryker Corp: SYK	P	2019-02-11	2022-01-10
	4 Thermo Fisher Scntfc: TMO	P	2016-05-12	2022-01-10
	90 Truist FINL Corp: TFC	P	2020-11-11	2022-01-10
	10 Union Pacific Corp: UNP	P	2020-08-19	2022-01-10
	15 Unitedhealth Group Inc: UNH	P	2019-07-15	2022-01-10
	20 Visa Inc	P	2018-02-26	2022-01-10
	60 Voya Finl Inv: VOYA	P	2019-12-17	2022-01-10
	4 Amazon.com Inc	P	2020-04-30	2022-01-13
	50 Autonation Inc: AN	P	2021-01-19	2022-01-24
	60 Best Buy Inc: BBY	P	2020-08-21	2022-01-24
	90 CISCO Systems Inc: CSCO	P	2021-01-14	2022-01-24
	15 Home Depot Inc: HD	P	2020-03-04	2022-01-24
	35 JP Morgan Chase & Co: JPM	P	2018-02-09	2022-01-24
	80 TJX Companies Inc: TJX	P	2020-12-18	2022-01-24
	10 Unitedhealth Group Inc: UNH	P	2019-07-15	2022-01-24
	90 Fortinet Inc: FTNT	P	2021-06-23	2022-02-25
	45 Mastercard Inc	P	2021-04-14	2022-03-10
	179 Dana Holding Corp 00500: DAN	P	2020-12-21	2022-02-25
	436 Dana Holding Corp 00500: DAN	P	2020-12-22	2022-02-25
	16 Ferguson PLC New	P	2020-09-08	2022-02-25
	59 Ferguson PLC New	P	2020-11-19	2022-02-25
	750 Recruit Co. LTD	P	2020-10-09	2022-02-25
	742 Dana Holding Corp 00500: DAN	P	2020-12-21	2022-02-28
	170 Ametek Inc: AME	P	2020-01-14	2022-03-01
	120 Ametek Inc: AME	P	2020-06-03	2022-03-01
	420 Masco Corp: MAS	P	2020-08-04	2022-03-01
	130 Union Pacific Corp: UNP	P	2018-09-19	2022-03-09
	20 Union Pacific Corp: UNP	P	2020-08-19	2022-03-09
	90 Mastercard Inc	P	2020-08-28	2022-03-10
	5 Sony Group Corp	P	2017-05-02	2022-03-21
	90 Sony Group Corp	P	2020-09-08	2022-03-21
	810 Pfizer Inc: PFE	P	2021-07-21	2022-04-19
	1310 First Horizon Corp: FHN	P	2021-02-09	2022-03-30
	1260 First Horizon Corp: FHN	P	2021-02-09	2022-04-22
	40 Canadaian Natural Res F: CNQ	P	2021-03-05	2022-04-29
	160 Canadaian Natural Res F: CNQ	P	2021-03-31	2022-04-29
	45 Abbvie Inc: ABBV	P	2020-03-06	2022-05-05
	40 Abbvie Inc: ABBV	P	2020-08-19	2022-05-05
	150 Abbvie Inc: ABBV	P	2020-09-03	2022-05-05
	435 Oshkosh Truck Corp: OSK	P	2021-02-22	2022-05-16
	310 Nike Inc	P	2019-02-28	2022-05-24
	710 Ing Groep ADR Rep 1 OR	P	2020-11-30	2022-05-25
	74 Intercontl HTLS	P	2014-02-04	2022-05-26
	70 Intercontl HTLS	P	2020-09-08	2022-05-26
	.21 Woodside Energy Group	P	2022-03-21	2022-06-02
	54 Woodside Energy Group	P	2022-03-21	2022-06-08
	42 Charter Communications	P	2021-04-20	2022-06-08
	286 Air Liquide	P	2021-12-20	2022-07-21
	240 Deutsche Post Ag	P	2021-04-28	2022-07-01
	450 Erste Group Bank	P	2021-05-18	2022-07-01
	100 IShares MSCI JAPAN ETF	P	2018-02-12	2022-07-01
	60 Nutrien LTD	P	2021-02-25	2022-07-01
	30 NXP Semiconductors	P	2020-09-08	2022-07-01
	60 Abbvie Inc: ABBV	P	2019-06-27	2022-07-19
	135 Abbvie Inc: ABBV	P	2020-03-06	2022-07-19
	20000 US Treasury Note	P	2018-09-19	2022-07-27
	30000 US Treasury	P	1996-12-20	2022-07-27
	25000 US Treasury	P	2020-01-31	2022-07-27
	35000 US Treasury Note	P	2022-01-19	2022-08-02
	15 Abbott Laboratories: ABT	P	2021-12-09	2022-08-25
	60 Alphabet, Inc	P	2022-06-08	2022-08-25
	10 Amerisourcebergen Corp: ABC	P	2022-05-05	2022-08-25
	15 Blackstone Inc: BX	P	2021-11-24	2022-08-25
	30 Brown & Brown Inc: BRO	P	2021-12-03	2022-08-25
	15 CF Industries Hldg	P	2022-02-25	2022-08-25
	30 Fortive Corp Disc 00500: FTV	P	2021-09-08	2022-08-25
	80 Leslies Inc: LESL	P	2022-03-01	2022-08-25
	5 Lockheed Martin Corp: LMT	P	2022-03-09	2022-08-25
	15 McDonalds Corp: MCD	P	2021-12-17	2022-08-25
	10 Nvidia Corp: NVDA	P	2022-02-14	2022-08-25
	20 Raytheon Technologies Co: RTX	P	2022-03-01	2022-08-25
	10 Salesforce Inc: CRM	P	2021-10-28	2022-08-25
	20 Western Alliance BNC: WAL	P	2022-02-11	2022-08-25
	170 Salesforce Inc: CRM	P	2021-09-13	2022-08-29
	80 Salesforce Inc: CRM	P	2021-10-28	2022-08-29
	50000 Intel Corp	P	2013-06-12	2022-08-02
	760 Carrier Global Corp: CARR	P	2020-04-23	2022-08-03
	165 Celanese Corp: CE	P	2019-08-14	2022-08-03
	270 Capital One FC: COF	P	2021-03-30	2022-08-05
	160 Legrand SA	P	2020-06-01	2022-08-10
	380 Legrand SA	P	2020-09-08	2022-08-10
	290 Voya Finl Inv: VOYA	P	2019-12-17	2022-08-22
	15 Amazon.com Inc	P	2020-04-30	2022-08-25
	15 Analog Devices Inc: ADI	P	2019-09-13	2022-08-25
	30 Apple Inc: AAPL	P	2020-08-19	2022-08-25
	15 Applied Materials: AMAT	P	2021-03-25	2022-08-25
	10 Avery Dennison Corp: AVY	P	2020-09-28	2022-08-25
	55000 Bank of America	P	2018-10-17	2022-08-25
	15 Best Buy Inc: BBY	P	2020-08-21	2022-08-25
	20 Boston Properties REIT: BXP	P	2021-04-30	2022-08-25
	3 Broadcom Inc: AVGO	P	2020-05-21	2022-08-25
	15 Chevron Corp: CVX	P	2015-12-07	2022-08-25
	70 Coterra Energy Inc: CTRA	P	2021-02-25	2022-08-25
	10 Digital Realty Trust	P	2021-04-30	2022-08-25
	10 Entergy Corp: ETR	P	2016-02-19	2022-08-25
	60 Fortinet Inc: FTNT	P	2021-06-23	2022-08-25
	5 Home Depot Inc: HD	P	2020-03-04	2022-08-25
	10 Honeywell Intl Inc: HON	P	2020-08-19	2022-08-25
	10 Johnson & Johnson: JNJ	P	2021-02-09	2022-08-25
	20 JP Morgan Chase & Co: JPM	P	2018-02-09	2022-08-25
	40 LKQ Corp: LKQ	P	2021-03-11	2022-08-25
	60 Masco Corp: MAS	P	2020-08-04	2022-08-25
	5 Microsoft Corp: MSFT	P	2015-01-15	2022-08-25
	35 Microsoft Corp: MSFT	P	2015-07-09	2022-08-25
	30 Morgan Stanley: MS	P	2020-06-05	2022-08-25
	15 Motorola Solutions: MSI	P	2021-06-23	2022-08-25
	5 Parker Hannifin Corp: PH	P	2020-08-07	2022-08-25
	30 Pfizer Inc: PFE	P	2021-07-21	2022-08-25
	120 Schlumberger LTD	P	2020-12-09	2022-08-25
	5 Stryker Corp: SYK	P	2019-02-11	2022-08-25
	2 Thermo Fisher Scntfc: TMO	P	2016-05-12	2022-08-25
	30 TJX Companies Inc: TJX	P	2020-12-18	2022-08-25
	60 Truist FINL Corp: TFC	P	2020-11-11	2022-08-25
	5 Union Pacific Corp: UNP	P	2021-06-15	2022-08-25
	2 Unifiedhealth Grp Inc: UNH	P	2021-04-28	2022-08-25
	10 Visa Inc	P	2018-02-26	2022-08-25
	110 Warner Music Group Corp	P	2021-04-20	2022-08-25
	10 Zoetis Inc	P	2020-08-19	2022-08-25
	87 Boston Properties REIT: BXP	P	2020-06-09	2022-08-26
	180 Boston Properties REIT: BXP	P	2021-04-30	2022-08-26
	283 Warner Music Group Corp	P	2021-04-20	2022-08-26
	148 Boston Properties REIT: BXP	P	2020-06-09	2022-08-29
	54 Warner Music Group Corp	P	2021-04-20	2022-08-29
	160 Nvidia Corp: NVDA	P	2022-02-14	2022-09-08
	5 Nvidia Corp: NVDA	P	2022-03-10	2022-09-08
	8 Nvidia Corp: NVDA	P	2022-03-10	2022-09-08
	330 Masco Corp: MAS	P	2020-10-29	2022-09-21
	8 Nvidia Corp: NVDA	P	2022-03-10	2022-09-08
	8 Nvidia Corp: NVDA	P	2022-03-10	2022-09-08
	8 Nvidia Corp: NVDA	P	2022-03-10	2022-09-08
	8 Nvidia Corp: NVDA	P	2022-03-10	2022-09-08
	8 Nvidia Corp: NVDA	P	2022-03-10	2022-09-08
	8 Nvidia Corp: NVDA	P	2022-03-10	2022-09-08
	8 Nvidia Corp: NVDA	P	2022-03-10	2022-09-08
	116 Nvidia Corp: NVDA	P	2022-03-10	2022-09-08
	293 Warner Music Group Corp	P	2021-04-20	2022-08-30
	1430 Kingfisher PLC	P	2020-07-29	2022-09-09
	125 Canadian Pac Railway	P	2020-10-09	2022-09-21
	30 Canadian Pac Railway	P	2020-11-18	2022-09-21
	60 Masco Corp: MAS	P	2020-08-04	2022-09-21
	280 Masco Corp: MAS	P	2020-09-28	2022-09-21
	10 AON PLC	P	2020-04-16	2022-01-28
	20 AON PLC	P	2020-09-08	2022-01-28
	40 Meta Platforms Inc	P	2017-03-03	2022-02-10
	80 Meta Platforms Inc	P	2017-08-17	2022-02-10
	55 Meta Platforms Inc	P	2019-03-05	2022-02-10
	120 Meta Platforms Inc	P	2020-02-26	2022-02-10
	55 Broadcom Inc: AVGO	P	2020-02-11	2022-02-14
	17 Broadcom Inc: AVGO	P	2020-05-21	2022-02-14
	6 Broadcom Inc: AVGO	P	2020-08-19	2022-02-14
	50000 US Treasury	P	2018-10-10	2022-02-15
	426 Dana Holding Corp 00500: DAN	P	2020-12-22	2022-02-24

(e) Gross sales price		(g) Cost or other basis plus expense of sale	(h) Gain or (loss) (e) plus (f) minus (g)
a	6,680	5,127	1,553
b	2,249	2,228	21
c	176	130	46
d	11,162	9,091	2,071
e	11,132	5,149	5,983
	4,247	2,693	1,554
	3,107	457	2,650
	6,001	4,119	1,882
	2,331	1,913	418
	4,777	13,023	-8,246
	30,739	4,338	26,401
	6,442	6,410	32
	1,487	1,157	330
	26,944	26,072	872
	32,785	19,773	13,012
	8,827	6,326	2,501
	8,917	13,431	-4,514
	43,357	25,186	18,171
	29,330	28,050	1,280
	28,435	28,677	-242
	3,949	3,953	-4
	15,007	15,178	-171
	3,683	2,978	705
	1,355	1,302	53
	1,815	1,961	-146
	3,687	2,920	767
	2,341	2,091	250
	2,535	2,193	342
	4,751	3,598	1,153
	3,597	3,713	-116
	1,819	1,889	-70
	2,969	2,574	395
	6,721	4,934	1,787
	3,413	4,474	-1,061
	1,942	1,811	131
	3,728	2,986	742
	11,182	12,753	-1,571
	8,302	3,861	4,441
	5,112	3,500	1,612
	15,347	10,413	4,934
	3,120	1,845	1,275
	3,118	2,600	518
	8,574	4,601	3,973
	2,079	628	1,451
	1,697	1,089	608
	3,744	3,303	441
	3,193	2,134	1,059
	1,681	929	752
	4,484	3,775	709
	4,264	3,145	1,119
	4,329	3,229	1,100
	1,997	1,717	280
	2,663	2,341	322
	4,892	2,959	1,933
	14,026	2,055	11,971
	5,703	2,763	2,940
	5,081	3,305	1,776
	2,628	1,832	796
	2,490	596	1,894
	5,835	4,381	1,454
	2,494	1,913	581
	6,967	3,983	2,984
	4,214	2,486	1,728
	4,310	3,523	787
	13,120	9,683	3,437
	5,249	3,735	1,514
	5,830	6,802	-972
	5,032	4,081	951
	5,280	3,513	1,767
	4,921	3,771	1,150
	5,336	5,413	-77
	4,549	2,655	1,894
	28,867	21,589	7,278
	14,553	17,005	-2,452
	3,475	3,444	31
	8,989	9,114	-125
	2,431	1,514	917
	8,964	6,280	2,684
	6,322	6,057	265
	13,886	14,276	-390
	21,605	17,184	4,421
	15,251	11,408	3,843
	22,918	24,042	-1,124
	32,838	21,201	11,637
	5,052	3,827	1,225
	29,105	32,768	-3,663
	521	173	348
	9,387	6,892	2,495
	41,054	33,304	7,750
	30,791	20,524	10,267
	28,838	19,741	9,097
	2,507	1,228	1,279
	10,027	4,922	5,105
	6,829	3,986	2,843
	6,070	3,915	2,155
	22,764	13,831	8,933
	38,055	44,784	-6,729
	33,235	26,666	6,569
	7,519	6,946	573
	4,532	3,374	1,158
	4,287	4,087	200
	5		5
	1,361		1,361
	20,448	27,452	-7,004
	7,456	8,808	-1,352
	8,958	14,185	-5,227
	5,598	9,446	-3,848
	5,245	6,013	-768
	4,745	3,368	1,377
	4,391	3,670	721
	8,960	4,197	4,763
	20,160	11,958	8,202
	19,906	19,803	103
	30,991	28,444	2,547
	25,826	29,258	-3,432
	32,304	34,451	-2,147
	1,579	1,994	-415
	6,906	7,056	-150
	1,489	1,552	-63
	1,561	2,216	-655
	1,972	1,953	19
	1,737	1,190	547
	1,997	2,228	-231
	1,173	1,697	-524
	2,175	2,246	-71
	3,920	3,938	-18
	1,713	2,404	-691
	1,889	2,067	-178
	1,672	2,983	-1,311
	1,643	1,973	-330
	27,580	43,006	-15,426
	12,979	23,863	-10,884
	49,884	48,034	1,850
	30,910	11,937	18,973
	18,277	17,962	315
	28,688	34,608	-5,920
	2,622	2,172	450
	6,226	6,285	-59
	18,288	17,026	1,262
	2,029	1,816	213
	2,485	1,750	735
	5,081	3,471	1,610
	1,553	1,787	-234
	1,953	1,230	723
	53,906	52,591	1,315
	1,176	1,701	-525
	1,675	2,175	-500
	1,619	832	787
	2,469	1,305	1,164
	2,195	1,331	864
	1,267	1,531	-264
	1,191	620	571
	3,040	2,878	162
	1,542	1,171	371
	1,992	1,572	420
	1,653	1,659	-6
	2,340	2,155	185
	2,199	1,706	493
	3,164	3,435	-271
	1,383	228	1,155
	9,679	1,567	8,112
	2,690	1,507	1,183
	3,765	3,209	556
	1,446	978	468
	1,421	1,234	187
	4,885	2,801	2,084
	1,077	916	161
	1,152	298	854
	1,939	2,030	-91
	2,972	2,921	51
	1,198	1,116	82
	1,067	791	276
	2,082	1,243	839
	3,111	3,985	-874
	1,630	1,588	42
	7,147	9,038	-1,891
	14,786	19,571	-4,785
	7,874	10,251	-2,377
	11,946	15,374	-3,428
	1,477	1,956	-479
	22,137	38,464	-16,327
	692	1,095	-403
	1,107	1,756	-649
	15,884	17,681	-1,797
	1,107	1,756	-649
	1,107	1,756	-649
	1,107	1,756	-649
	1,107	1,760	-653
	1,107	1,772	-665
	1,107	1,773	-666
	1,107	1,774	-667
	16,049	25,842	-9,793
	7,940	10,614	-2,674
	8,012	9,296	-1,284
	9,040	7,853	1,187
	2,170	2,028	142
	2,888	3,435	-547
	13,477	15,902	-2,425
	2,649	1,840	809
	5,297	4,022	1,275
	9,111	5,479	3,632
	18,221	13,455	4,766
	12,527	9,347	3,180
	27,332	23,672	3,660
	31,551	17,585	13,966
	9,752	4,716	5,036
	3,442	1,972	1,470
	50,000	48,508	1,492
	8,054	8,386	-332

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			1,553
b			21
c			46
d			2,071
e			5,983
			1,554
			2,650
			1,882
			418
			-8,246
			26,401
			32
			330
			872
			13,012
			2,501
			-4,514
			18,171
			1,280
			-242
			-4
			-171
			705
			53
			-146
			767
			250
			342
			1,153
			-116
			-70
			395
			1,787
			-1,061
			131
			742
			-1,571
			4,441
			1,612
			4,934
			1,275
			518
			3,973
			1,451
			608
			441
			1,059
			752
			709
			1,119
			1,100
			280
			322
			1,933
			11,971
			2,940
			1,776
			796
			1,894
			1,454
			581
			2,984
			1,728
			787
			3,437
			1,514
			-972
			951
			1,767
			1,150
			-77
			1,894
			7,278
			-2,452
			31
			-125
			917
			2,684
			265
			-390
			4,421
			3,843
			-1,124
			11,637
			1,225
			-3,663
			348
			2,495
			7,750
			10,267
			9,097
			1,279
			5,105
			2,843
			2,155
			8,933
			-6,729
			6,569
			573
			1,158
			200
			5
			1,361
			-7,004
			-1,352
			-5,227
			-3,848
			-768
			1,377
			721
			4,763
			8,202
			103
			2,547
			-3,432
			-2,147
			-415
			-150
			-63
			-655
			19
			547
			-231
			-524
			-71
			-18
			-691
			-178
			-1,311
			-330
			-15,426
			-10,884
			1,850
			18,973
			315
			-5,920
			450
			-59
			1,262
			213
			735
			1,610
			-234
			723
			1,315
			-525
			-500
			787
			1,164
			864
			-264
			571
			162
			371
			420
			-6
			185
			493
			-271
			1,155
			8,112
			1,183
			556
			468
			187
			2,084
			161
			854
			-91
			51
			82
			276
			839
			-874
			42
			-1,891
			-4,785
			-2,377
			-3,428
			-479
			-16,327
			-403
			-649
			-1,797
			-649
			-649
			-649
			-653
			-665
			-666
			-667
			-9,793
			-2,674
			-1,284
			1,187
			142
			-547
			-2,425
			809
			1,275
			3,632
			4,766
			3,180
			3,660
			13,966
			5,036
			1,470
			1,492
			-332

2	Capital gain net income or (net capital loss)	If gain, also enter in Part I, line 7 If (loss), enter -0- in Part I, line 7	2	200,168
3	Net short-term capital gain or (loss) as defined in sections 1222(5) and (6):
	If gain, also enter in Part I, line 8, column (c) (see instructions). If (loss), enter -0- in Part I, line 8 ...................		3

Form 990-PF (2021)

Page 4

Part V

Excise Tax Based on Investment Income (Section 4940(a), 4940(b), 4940(e), or 4948—see instructions)

1a	Exempt operating foundations described in section 4940(d)(2), check here and enter “N/A" on line 1.
	Date of ruling or determination letter: (attach copy of letter if necessary–see instructions)
b	All other domestic foundations enter 1.39% (0.0139) of line 27b. Exempt foreign organizations enter 4% (0.04) of Part I, line 12, col. (b)
2	Tax under section 511 (domestic section 4947(a)(1) trusts and taxable foundations only. Others enter -0-)	2
3	Add lines 1 and 2...........................	3	5,457
4	Subtitle A (income) tax (domestic section 4947(a)(1) trusts and taxable foundations only. Others enter -0-)	4
5	Tax based on investment income. Subtract line 4 from line 3. If zero or less, enter -0- .....	5	5,457
6	Credits/Payments:

a	2021 estimated tax payments and 2020 overpayment credited to 2021	6a	2,175
b	Exempt foreign organizations—tax withheld at source......	6b
c	Tax paid with application for extension of time to file (Form 8868)...	6c
d	Backup withholding erroneously withheld ...........	6d

7	Total credits and payments. Add lines 6a through 6d..............		7	2,175
8	Enter any penalty for underpayment of estimated tax. Check here if Form 2220 is attached.		8	114
9	Tax due. If the total of lines 5 and 8 is more than line 7, enter amount owed.......		9	3,396
10	Overpayment. If line 7 is more than the total of lines 5 and 8, enter the amount overpaid...		10
11	Enter the amount of line 10 to be: Credited to 2022 estimated tax0	Refunded	11

Part VI-A

Statements Regarding Activities

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

Yes

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

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

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

If the answer is "Yes" to 1a or 1b, attach a detailed description of the activities and copies of any materials

published or distributed by the foundation in connection with the activities.

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

Enter the amount (if any) of tax on political expenditures (section 4955) imposed during the year:

(1) On the foundation. bullet

$ (2) On foundation managers. bullet

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

on foundation managers. bullet

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

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

Has the foundation made any changes, not previously reported to the IRS, in its governing instrument, articles

of incorporation, or bylaws, or other similar instruments? If "Yes," attach a conformed copy of the changes....

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

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

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

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

Are the requirements of section 508(e) (relating to sections 4941 through 4945) satisfied either:

By language in the governing instrument, or

By state legislation that effectively amends the governing instrument so that no mandatory directions

that conflict with the state law remain in the governing instrument?................

Did the foundation have at least $5,000 in assets at any time during the year? If "Yes," complete Part II, col. (c),

and Part XIV..................................

Yes

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

If the answer is "Yes" to line 7, has the foundation furnished a copy of Form 990-PF to the Attorney

General (or designate) of each state as required by General Instruction G? If "No," attach explanation .

Yes

Is the foundation claiming status as a private operating foundation within the meaning of section 4942(j)(3)

or 4942(j)(5) for calendar year 2021 or the taxable year beginning in 2021? See the instructions for Part XIII.

If "Yes," complete Part XIII .............................

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

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

Form 990-PF (2021)

Page 5

Part VI-A

Statements Regarding Activities (continued)

At any time during the year, did the foundation, directly or indirectly, own a controlled entity within the

meaning of section 512(b)(13)? If "Yes," attach schedule. See instructions .............

Did the foundation make a distribution to a donor advised fund over which the foundation or a disqualified person had

advisory privileges? If "Yes," attach statement. See instructions.................

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

Yes

Website address bullet

www.rietmanscholarship.org

The books are in care of bullet

Jayson F Wartnik Telephone no. bullet

(541) 269-9338

Located at bullet

3690 BroadwayNorth BendOR ZIP+4 bullet

97459

Section 4947(a)(1) nonexempt charitable trusts filing Form 990-PF in lieu of Form 1041 —check here ......... bullet

and enter the amount of tax-exempt interest received or accrued during the year ........ bullet

16 At any time during calendar year 2021, did the foundation have an interest in or a signature or other authority over YesNo

a bank, securities, or other financial account in a foreign country? .................

16 No

See the instructions for exceptions and filing requirements for FinCEN Form 114. If "Yes", enter the name of the foreign
country bullet

Part VI-B

Statements Regarding Activities for Which Form 4720 May Be Required

File Form 4720 if any item is checked in the "Yes" column, unless an exception applies.

Yes

During the year did the foundation (either directly or indirectly):

(1) Engage in the sale or exchange, or leasing of property with a disqualified person? ...........

1a(1)

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

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

1a(2)

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

1a(3)

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

1a(4)

(5) Transfer any income or assets to a disqualified person (or make any of either available

for the benefit or use of a disqualified person)? ......................

1a(5)

(6) Agree to pay money or property to a government official? (Exception. Check "No"

if the foundation agreed to make a grant to or to employ the official for a period

after termination of government service, if terminating within 90 days.) ...............

1a(6)

If any answer is "Yes" to 1a(1)–(6), did any of the acts fail to qualify under the exceptions described in Regulations

section 53.4941(d)-3 or in a current notice regarding disaster assistance? See instructions ..........

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

Did the foundation engage in a prior year in any of the acts described in 1a, other than excepted acts,

that were not corrected before the first day of the tax year beginning in 2021? .............

Taxes on failure to distribute income (section 4942) (does not apply for years the foundation was a private

operating foundation defined in section 4942(j)(3) or 4942(j)(5)):

At the end of tax year 2021, did the foundation have any undistributed income (lines 6d

and 6e, Part XII) for tax year(s) beginning before 2021?....................

If "Yes," list the years bullet

20, 20, 20, 20

Are there any years listed in 2a for which the foundation is not applying the provisions of section 4942(a)(2)

(relating to incorrect valuation of assets) to the year’s undistributed income? (If applying section 4942(a)(2)

to all years listed, answer "No" and attach statement—see instructions.) ..............

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

20, 20, 20, 20

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

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

If "Yes," did it have excess business holdings in 2021 as a result of (1) any purchase by the foundation

or disqualified persons after May 26, 1969; (2) the lapse of the 5-year period (or longer period approved

by the Commissioner under section 4943(c)(7)) to dispose of holdings acquired by gift or bequest; or (3)

the lapse of the 10-, 15-, or 20-year first phase holding period? (Use Schedule C, Form 4720, to determine

if the foundation had excess business holdings in 2021.) .....................

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

Did the foundation make any investment in a prior year (but after December 31, 1969) that could jeopardize its

charitable purpose that had not been removed from jeopardy before the first day of the tax year beginning in 2021? ..

Form 990-PF (2021)

Page 6

Part VI-B

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

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

Yes

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

5a(1)

(2) Influence the outcome of any specific public election (see section 4955); or to carry

on, directly or indirectly, any voter registration drive? ....................

5a(2)

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

5a(3)

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

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

5a(4)

(5) Provide for any purpose other than religious, charitable, scientific, literary, or

educational purposes, or for the prevention of cruelty to children or animals? .............

5a(5)

If any answer is "Yes" to 5a(1)–(5), did any of the transactions fail to qualify under the exceptions described in

Regulations section 53.4945 or in a current notice regarding disaster assistance? See instructions ........

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

If the answer is "Yes" to question 5a(4), does the foundation claim exemption from the

tax because it maintained expenditure responsibility for the grant? .................

If "Yes," attach the statement required by Regulations section 53.4945–5(d).

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

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

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

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

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

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

Is the foundation subject to the section 4960 tax on payment(s) of more than $1,000,000 in remuneration or

excess parachute payment during the year? .........................

Part VII

Information About Officers, Directors, Trustees, Foundation Managers, Highly Paid Employees,
and Contractors

1 List all officers, directors, trustees, foundation managers and their compensation. See instructions

(a) Name and address	(b) Title, and average hours per week devoted to position	(c) Compensation (If not paid, enter -0-)
Al Walsh	Trustee 2.00	8,300
280 N Collier Coquille,OR97423	Trustee 2.00	8,300
John Burles	Trustee 3.00	2,900
1784 Koosbay Blvd Coos Bay,OR97420	Trustee 3.00	2,900
Jayson F Wartnik	Trustee 2.00	3,200
3690 Broadway North Bend,OR97459	Trustee 2.00	3,200
Amy Muenchrath	Trustee 1.00	3,200
830 Signal Way Coos Bay,OR97420	Trustee 1.00	3,200

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

Form 990-PF (2021)

Page 7

Part VII

Information About Officers, Directors, Trustees, Foundation Managers, Highly Paid Employees,
and Contractors (continued)

3 Five highest-paid independent contractors for professional services (see instructions). If none, enter "NONE".
(a) Name and address of each person paid more than $50,000	(b) Type of service	(c) Compensation
NONE

Total number of others receiving over $50,000 for professional services............. bullet

Part VIII-A

Summary of Direct Charitable Activities

List the foundation’s four largest direct charitable activities during the tax year. Include relevant statistical information such as the number of organizations and other beneficiaries served, conferences convened, research papers produced, etc.	Expenses
1	Charitable Contributions Per the Trust Instrument to St James Episcopal Church in Coquille, OR	76,983
2	Charitable Contribution Per the Trust Instrument to Coquille Valley Hospital, Coquille, OR	38,492
3	48 Scholarships of $4,700 Each Awarded to Students and Former Students of Coquille High School, Coquille, OR, for the School Year Beginning 9/2022. Refunds by Schools for Unused Scholarship Funds are Included in Total.	187,758
4

Part VIII-B

Summary of Program-Related Investments (see instructions)

Describe the two largest program-related investments made by the foundation during the tax year on lines 1 and 2.	Amount
1


2


All other program-related investments. See instructions.
3

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

Form 990-PF (2021)

Page 8

Part IX

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

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

purposes:

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

7,577,274

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

141,478

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

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

7,718,752

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

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

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

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

7,718,752

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

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

115,781

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

7,602,971

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

380,149

Part X

Distributable Amount (see instructions) (Section 4942(j)(3) and (j)(5) private operating foundations and certain foreign organizations check here right arrow

and do not complete this part.)

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

380,149

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

5,457

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

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

5,457

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

374,692

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

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

374,692

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

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

374,692

Part XI

Qualifying Distributions (see instructions)

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

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

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

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

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

Amounts set aside for specific charitable projects that satisfy the:

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

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

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

Form 990-PF (2021)

Page 9

Part XII

Undistributed Income (see instructions)

		(a) Corpus	(d) 2021
1 Distributable amount for 2021 from Part X, line 7			374,692
2 Undistributed income, if any, as of the end of 2021:
a Enter amount for 2020 only.......
b Total for prior years:20, 20, 20
3 Excess distributions carryover, if any, to 2021:
a From 2016......
b From 2017......	4,038
c From 2018......
d From 2019......
e From 2020......	31,506
f Total of lines 3a through e ........		35,544
4Qualifying distributions for 2021 from Part
XI, line 4: $ 336,608
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.....			336,608
e Remaining amount distributed out of corpus
5 Excess distributions carryover applied to 2021.		35,544	35,544
(If an amount appears in column (d), the same amount must be shown in column (a).)
6Enter the net total of each column as indicated below:
a Corpus. Add lines 3f, 4c, and 4e. Subtract line 5
b Prior years’ undistributed income. Subtract line 4b from line 2b ..........
c Enter the amount of prior years’ undistributed income for which a notice of deficiency has been issued, or on which the section 4942(a) tax has been previously assessed......
d Subtract line 6c from line 6b. Taxable amount —see instructions ...........
e Undistributed income for 2019. Subtract line 4a from line 2a. Taxable amount—see instructions .............
f Undistributed income for 2021. Subtract lines 4d and 5 from line 1. This amount must be distributed in 2022 ..........			2,540
7 Amounts treated as distributions out of corpus to satisfy requirements imposed by section 170(b)(1)(F) or 4942(g)(3) (Election may be required - see instructions) .......
8 Excess distributions carryover from 2016 not applied on line 5 or line 7 (see instructions) ...
9 Excess distributions carryover to 2022. Subtract lines 7 and 8 from line 6a ......
10 Analysis of line 9:
a Excess from 2017....
b Excess from 2018....
c Excess from 2019....
d Excess from 2020....
e Excess from 2021....

Form 990-PF (2021)

Page 10

Part XIII

Private Operating Foundations (see instructions and Part VI-A, question 9)

1a If the foundation has received a ruling or determination letter that it is a private operating
foundation, and the ruling is effective for 2021, enter the date of the ruling ....... bullet

b Check box to indicate whether the organization is a private operating foundation described in section 4942(j)(3) or4942(j)(5)

2a Enter the lesser of the adjusted net income from Part I or the minimum investment return from Part X for each year listed ..........	Tax year	Prior 3 years			(e) Total
	(a) 2021	(b) 2020	(c) 2019	(d) 2018	(e) Total

b 85% (0.85) of line 2a .........
c Qualifying distributions from Part XI, line 4 for each year listed .....
d Amounts included in line 2c not used directly for active conduct of exempt activities ..........
e Qualifying distributions made directly for active conduct of exempt activities. Subtract line 2d from line 2c ....
3 Complete 3a, b, or c for the alternative test relied upon:
a “Assets" alternative test—enter:
(1) Value of all assets ......
(2) Value of assets qualifying under section 4942(j)(3)(B)(i)
b “Endowment" alternative test— enter 2/3 of minimum investment return shown in Part IX, line 6 for each year listed ..
c “Support" alternative test—enter:
(1) Total support other than gross investment income (interest, dividends, rents, payments on securities loans (section 512(a)(5)), or royalties) ....
(2) Support from general public and 5 or more exempt organizations as provided in section 4942(j)(3)(B)(iii)....
(3) Largest amount of support from an exempt organization
(4) Gross investment income

Part XIV

Supplementary Information (Complete this part only if the foundation had $5,000 or more in
assets at any time during the year—see instructions.)

1Information Regarding Foundation Managers:

aList any managers of the foundation who have contributed more than 2% of the total contributions received by the foundation
before the close of any tax year (but only if they have contributed more than $5,000). (See section 507(d)(2).)

bList any managers of the foundation who own 10% or more of the stock of a corporation (or an equally large portion of the
ownership of a partnership or other entity) of which the foundation has a 10% or greater interest.

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

Check here bullet

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

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

JOYCE SCOLARI
280 N Collier
Coquille,OR97423
(541) 404-0449
info@rietmanscholarship.org

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

SCHOLARSHIP APPLICATION FORM COMPLETELY FILLED OUT WITH REFERENCES ATTACHED.

cAny submission deadlines:

APRIL 15TH OF THE YEAR TO BE AWARDED

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

SCHOLARSHIP RECIPIENTS MUST BE GRADUATES OF COQUILLE HIGH SCHOOL, COQUILLE, OREGON. 62.5% OF ANNUAL DISTRIBUTIONS GO TO SCHOLARSHIPS. ALL SCHOLARSHIP FUNDS ARE PAID FBO AWARDED STUDENT DIRECTLY TO THE INSTITUTION TO BE ATTENDED. INSTITUTIONS DIRECTLY REFUND ANY UNUSED SCHOLARSHIP FUNDS DUE TO NON ATTENDANCE.25% OF ANNUAL DISTRIBUTIONS GO TO ST JAMES EPISCOPAL CHURCH IN COQUILLE. 12.5% OF ANNUAL DISTRIBUTIONS GO TO COQUILLE VALLEY HOSPITAL IN COQUILLE.

Form 990-PF (2021)

Page 11

Part XIV

Supplementary Information (continued)

3 Grants and Contributions Paid During the Year or Approved for Future Payment
Recipient	If recipient is an individual, show any relationship to any foundation manager or substantial contributor	Foundation status of recipient	Purpose of grant or contribution	Amount
Name and address (home or business)		Foundation status of recipient	Purpose of grant or contribution	Amount
aPaid during the year
Benedictine University 5700 College Rd Lisle,IL60532	none		College Scholarship paid fbo student directly to Institution	4,700
Cedarville University 251 N Main Street Cedarville,OH45314	none		College Scholarship paid fbo student directly to Institution	4,700
College of Coastal Georgia One College Drive Brunswick,GA31520	none		College Scholarship paid fbo student directly to Institution	4,700
Coquille Valley Hospital 940 E 5th Coquille,OR97423	none		Charitable Donation for Medical purposes	38,492
George Fox University 414 N Meridian St Newberg,OR97132	none		College Scholarship paid fbo student directly to Institution	4,700
Lane Community College 4000 E 30th Avenue Eugene,OR97405	none		College Scholarship paid fbo student directly to Institution	9,400
New St Andrews University 400 S Main St Moscow,ID83843	none		College Scholarship paid fbo student directly to Institution	4,700
Oregon Institute of Technology 3201 Campus Dr Klamath Falls,OR97601	none		College Scholarship paid fbo student directly to Institution	14,100
Oregon State University PO Box 1086 Corvallis,OR97339	none		College Scholarship paid fbo student directly to Institution	42,300
Portland Community College PO Box 19000 Portland,OR97280	none		College Scholarship paid fbo student directly to Institution	4,700
Portland State University PO Box 751 Portland,OR97207	none		College Scholarship paid fbo student directly to Institution	9,400
Southern Oregon University 1250 Siskiyou Blvd Ashland,OR97520	none		College Scholarship paid fbo student directly to Institution	14,100
Southwest Oregon Community College 1988 Newmark Ave Coos Bay,OR97420	none		College Scholarship paid fbo student directly to Institution	32,900
St James Episcopal 210 E 3rd Coquille,OR97423	none		Charitable Donation For Religious purposes	76,983
Umpqua Community College 1140 Umpqua College Rd Roseburg,OR97470	none		College Scholarship paid fbo student directly to Institution	4,700
University of Oregon 1278 Univ of Oregon St Eugene,OR97403	none		College Scholarship paid fbo student directly to Institution	14,100
Western Oregon Govenors University PO Box 30015 Salt Lake City,UT84130	none		College Scholarship paid fbo student directly to Institution	4,700
Western Oregon University 345 N Monmouth Ave Monmouth,OR97361	none		College Scholarship paid fbo student directly to Institution	14,100
OHSU 3181 SW Jackson Park Road Portland,OR97239	none		College Scholarship paid fbo student directly to Institution	4,700
University of Texas at Dallas 800 W Cambell Road Richardson,TX75080	none		College Scholarship paid fbo student directly to Institution	4,700
Western New England University 1215 Wilbraham Road Springfield,MA01119	none		College Scholarship paid fbo student directly to Institution	4,700
Grand Canyon University 3300 West Camelback Rd Phoenix,AZ85017	none		College Scholarship paid fbo student directly to Institution	4,700
Imani Institute of Cosmetology 516 Crater Lake Ave Medford,OR97504	none		College Scholarship paid fbo student directly to Institution	4,700
Rocky Mountain College 1511 Poly Drive Billings,MT59102	none		College Scholarship paid fbo student directly to Institution	4,700
Oregon State University-Cascades 1500 SW Chandler Avenue Bend,OR97702	none		College Scholarship paid fbo student directly to Institution	4,700
Northwest College of Beauty 3150 Gateway Loop Springfield,OR97477	none		College Scholarship paid fbo student directly to Institution	4,700
Northwest Lineman School 7600 S Meridian Rd Meridian,ID83642	none		College Scholarship paid fbo student directly to Institution	4,700
Southern Oregon University Refund Financial Aid Dept - 1250 Siskiyou Ahsland,OR97520	none		College Scholarship paid fbo student directly to Institution	-3,750
Linn Benton CC - Refund 6500 Pacific Blvd SW Albany,OR97321	none		College Scholarship paid fbo student directly to Institution	-3,750
Southwestern Oregon CC-Refund 1988 Newmark Coos Bay,OR97420	none		College Scholarship paid fbo student directly to Institution	-7,500
Think Big NW Program Refund 545 One Five Oaks Dr Hillsboro,OR97124	none		College Scholarship paid fbo student directly to Institution	-3,750
Oregon State University - Refund PO Box 1086 Corvallis,OR97339	none		College Scholarship paid fbo student directly to Institution	-10,000
Oregon Tech - Refund 3201 Campus Drive Klamath Falls,OR97601	none		College Scholarship paid fbo student directly to Institution	-1,592
Lane Community - Refund 4000 E 30th Avenue Eugene,OR97405	none		College Scholarship paid fbo student directly to Institution	-6,250
OHSU - Refund 3455 SW US Veterans Hospital Rd Portland,OR97239	none		College Scholarship paid fbo student directly to Institution	-1,250
Oregon Institute of Technology - Re 3201 Campus Drive Klamath Falls,OR97601	none		College Scholarship paid fbo student directly to Institution	-4,700
Total ................................. 3a				303,233

bApproved for future payment

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

Form 990-PF (2021)

Page 12

Part XV-A

Analysis of Income-Producing Activities

Enter gross amounts unless otherwise indicated.	Unrelated business income		Excluded by section 512, 513, or 514		(e) Related or exempt function income (See instructions.)
1Program service revenue:	(a) Business code	(b) Amount	(c) Exclusion code	(d) Amount	(e) Related or exempt function income (See instructions.)
a
b
c
d
e
f
gFees and contracts from government agencies
2 Membership dues and assessments ....
3 Interest on savings and temporary cash investments ...........
4 Dividends and interest from securities ....
5 Net rental income or (loss) from real estate:
aDebt-financed property......
bNot debt-financed property.....
6 Net rental income or (loss) from personal property
7 Other investment income .....
8 Gain or (loss) from sales of assets other than inventory ............			14	200,168
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) ..				432,394

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

432,394

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

Part XV-B

Relationship of Activities to the Accomplishment of Exempt Purposes

Line No.	Explain below how each activity for which income is reported in column (e) of Part XV-A contributed importantly to the accomplishment of the foundation’s exempt purposes (other than by providing funds for such purposes). (See instructions.)

Form 990-PF (2021)

Page 13

Part XVI

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

Did the organization directly or indirectly engage in any of the following with any other organization described in section 501(c) (other than section 501(c)(3) organizations) or in section 527, relating to political organizations?

Yes

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

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

1a(1)

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

1a(2)

Other transactions:

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

1b(1)

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

1b(2)

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

1b(3)

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

1b(4)

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

1b(5)

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

1b(6)

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

If the answer to any of the above is "Yes," complete the following schedule. Column (b) should always show the fair market value
of the goods, other assets, or services given by the reporting foundation. If the foundation received less than fair market value
in any transaction or sharing arrangement, show in column (d) the value of the goods, other assets, or services received.

(a) Line No.	(b) Amount involved	(c) Name of noncharitable exempt organization	(d) Description of transfers, transactions, and sharing arrangements

Is the foundation directly or indirectly affiliated with, or related to, one or more tax-exempt organizations
described in section 501(c) (other than section 501(c)(3)) or in section 527? ...........Yes No

If "Yes," complete the following schedule.

(a) Name of organization	(b) Type of organization	(c) Description of relationship

Sign Here

Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.
				May the IRS discuss this return with the preparer shown below? See instructions. Yes No
	Signature of officer or trustee	Date	Title

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

Form 990-PF (2021)

Additional Data

Software ID:	21013475
Software Version:	2021v4.1

Form 990PF - Special Condition Description:

Special Condition Description

- TIN:

TY 2021 AccountingFeesSchedule

Name:

Carl and Camilla Rietman Charitable

Foundation

EIN:

93-1221623

Software ID:

21013475

Software Version:

2021v4.1

Category	Amount	Net Investment Income	Adjusted Net Income	Disbursements for Charitable Purposes
Accounting & Tax Preparation Fees	5,478	0	0	5,478

- TIN:

TY 2021 InvestmentsCorpStockSchedule

Name:

Carl and Camilla Rietman Charitable

Foundation

EIN:

93-1221623

Software ID:

21013475

Software Version:

2021v4.1

Name of Stock	End of Year Book Value	End of Year Fair Market Value
	4,163,708	4,948,028

- TIN:

TY 2021 OtherAssetsSchedule

Name:

Carl and Camilla Rietman Charitable

Foundation

EIN:

93-1221623

Software ID:

21013475

Software Version:

2021v4.1

Description	Beginning of Year - Book Value	End of Year - Book Value	End of Year - Fair Market Value
Stoel Rives Retainer		5,000	5,000

- TIN:

TY 2021 OtherProfessionalFeesSchedule

Name:

Carl and Camilla Rietman Charitable

Foundation

EIN:

93-1221623

Software ID:

21013475

Software Version:

2021v4.1

Category	Amount	Net Investment Income	Adjusted Net Income	Disbursements for Charitable Purposes
Investment Management	39,826	39,826	0	0
Judging Fees	3,600	0	0	3,600

- TIN:

TY 2021 TaxesSchedule

Name:

Carl and Camilla Rietman Charitable

Foundation

EIN:

93-1221623

Software ID:

21013475

Software Version:

2021v4.1

Category	Amount	Net Investment Income	Adjusted Net Income	Disbursements for Charitable Purposes
Oregon Department of Justice	892			892