TY 2021 Form 990PF

- TIN:

Form990-PF

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.
bullet

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 07-01-2021 , and ending 06-30-2022

Name of foundation
BOILING SPRING LAKES FIRE RESCUE

Number and street (or P.O. box number if mail is not delivered to street address)PO BOX 10718
Room/suite

City or town, state or province, country, and ZIP or foreign postal code
SOUTHPORT, NC28461

A Employer identification number

23-7350442

B Telephone number (see instructions)

(910) 845-2818

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

$1,905,135J 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	(c) Adjusted net income	(d) Disbursements for charitable purposes (cash basis only)


1	Contributions, gifts, grants, etc., received (attach schedule)	12,193
2	Check .............
3	Interest on savings and temporary cash investments	70			70
4	Dividends and interest from securities...
5a	Gross rents............
b	Net rental income or (loss)
6a	Net gain or (loss) from sale of assets not on line 10		7,100
b	Gross sales price for all assets on line 6a 7,100
7	Capital gain net income (from Part IV, line 2)...
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).......		817,170		817,170
12	Total. Add lines 1 through 11........	836,533		0	817,240
13	Compensation of officers, directors, trustees, etc.
14	Other employee salaries and wages......	187,744				187,744
15	Pension plans, employee benefits.......	17,801				17,801
16a	Legal fees (attach schedule).........
b	Accounting fees (attach schedule).......		18,250			18,250
c	Other professional fees (attach schedule)....
17	Interest...............	26,456				26,456
18	Taxes (attach schedule) (see instructions)...
19	Depreciation (attach schedule) and depletion...		181,084
20	Occupancy..............	23,956				23,956
21	Travel, conferences, and meetings.......
22	Printing and publications..........
23	Other expenses (attach schedule).......		207,067			207,067
24	Total operating and administrative expenses.
	Add lines 13 through 23..........	662,358		0		481,274
25	Contributions, gifts, grants paid.......	0				0
26	Total expenses and disbursements. Add lines 24 and 25	662,358		0		481,274
27	Subtract line 26 from line 12:
a	Excess of revenue over expenses and disbursements	174,175
b	Net investment income (if negative, enter -0-)			0
c	Adjusted net income (if negative, enter -0-)...				817,240

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.............
	2	Savings and temporary cash investments.........	123,948	250,816	250,816
	3	Accounts receivable 5,699
		Less: allowance for doubtful accounts	4,542	5,699	5,699
	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)
	b	Investments—corporate stock (attach schedule).......
	c	Investments—corporate bonds (attach schedule).......
	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 3,033,251
		Less: accumulated depreciation (attach schedule) 1,670,019	1,205,886	1,363,232	1,648,620
	15	Other assets (describe )
	16	Total assets (to be completed by all filers—see the
		instructions. Also, see page 1, item I)	1,334,376	1,619,747	1,905,135
	17	Accounts payable and accrued expenses..........	7,399	11,555
	18	Grants payable.................
	19	Deferred revenue.................
	20	Loans from officers, directors, trustees, and other disqualified persons
	21	Mortgages and other notes payable (attach schedule)......	793,694	927,574
	22	Other liabilities (describe )	26,840
	23	Total liabilities (add lines 17 through 22).........	827,933	939,129
		Foundations that follow FASB ASC 958, check here
		and complete lines 24, 25, 29 and 30.
	24	Net assets without donor restrictions...........	506,443	680,618
	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
	29	Total net assets or fund balances (see instructions).....	506,443	680,618
	30	Total liabilities and net assets/fund balances (see instructions).	1,334,376	1,619,747

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) ...............

506,443

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

174,175

Other increases not included in line 2 (itemize) bullet

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

680,618

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 .

680,618

Form 990-PF (2021)

Page 3

Part IV

Capital Gains and Losses for Tax on Investment Income

(a) List and describe the kind(s) of property sold (e.g., real estate, 2-story brick warehouse; or common stock, 200 shs. MLC Co.)		(b) How acquired P—Purchase D—Donation	(c) Date acquired (mo., day, yr.)	(d) Date sold (mo., day, yr.)
1a
b
c
d
e

(e) Gross sales price		(f) Depreciation allowed (or allowable)	(g) Cost or other basis plus expense of sale	(h) Gain or (loss) (e) plus (f) minus (g)
a
b
c
d
e

Complete only for assets showing gain in column (h) and owned by the foundation on 12/31/69
(i) F.M.V. as of 12/31/69	(j) Adjusted basis as of 12/31/69	(k) Excess of col. (i) over col. (j), if any
a
b
c
d
e

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

a	2021 estimated tax payments and 2020 overpayment credited to 2021	6a
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
8	Enter any penalty for underpayment of estimated tax. Check here if Form 2220 is attached.		8
9	Tax due. If the total of lines 5 and 8 is more than line 7, enter amount owed.......		9
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 tax	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?................

Yes

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

Yes

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

N/A

The books are in care of bullet

RAY FARWELL Telephone no. bullet

(910) 845-2818

Located at bullet

PO BOX 10718SOUTHPORTNC ZIP+4 bullet

28461

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-)	(d) Contributions to employee benefit plans and deferred compensation	(e) Expense account, other allowances
DARRELL BRYANT	PRESIDENT 000.00	0	0	0
3059 GEORGE II HWY SOUTHPORT,NC28461	PRESIDENT 000.00	0	0	0
NATHAN MCCONNELL	VICE-PRESIDE 000.00	0	0	0
3059 GEORGE II HWY SOUTHPORT,NC28461	VICE-PRESIDE 000.00	0	0	0
DANIEL EDGE	TREASURER 000.00	0	0	0
3059 GEORGE II HWY SOUTHPORT,NC28461	TREASURER 000.00	0	0	0
DEB FARRIS	SECRETARY 000.00	0	0	0
3059 GEORGE II HWY SOUTHPORT,NC28461	SECRETARY 000.00	0	0	0

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	PROVIDE FIRE AND RESCUE SERVICES TO BOILING SPRING LAKES, NC AND SURROUNDING AREAS	662,358
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	N/A
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...................

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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	(b) Years prior to 2020	(c) 2020	(d) 2021
1 Distributable amount for 2021 from Part X, line 7
2 Undistributed income, if any, as of the end of 2021:
a Enter amount for 2020 only.......
b Total for prior years:20, 20, 20
3 Excess distributions carryover, if any, to 2021:
a From 2016......
b From 2017......
c From 2018......
d From 2019......
e From 2020......
f Total of lines 3a through e ........
4Qualifying distributions for 2021 from Part
XI, line 4: $ 481,274
a Applied to 2020, but not more than line 2a
b Applied to undistributed income of prior years (Election required—see instructions).....
c Treated as distributions out of corpus (Election required—see instructions)........
d Applied to 2021 distributable amount.....
e Remaining amount distributed out of corpus		481,274
5 Excess distributions carryover applied to 2021.
(If an amount appears in column (d), the same amount must be shown in column (a).)
6Enter the net total of each column as indicated below:
a Corpus. Add lines 3f, 4c, and 4e. Subtract line 5		481,274
b Prior years’ undistributed income. Subtract line 4b from line 2b ..........
c Enter the amount of prior years’ undistributed income for which a notice of deficiency has been issued, or on which the section 4942(a) tax has been previously assessed......
d Subtract line 6c from line 6b. Taxable amount —see instructions ...........
e Undistributed income for 2019. Subtract line 4a from line 2a. Taxable amount—see instructions .............
f Undistributed income for 2021. Subtract lines 4d and 5 from line 1. This amount must be distributed in 2022 ..........
7 Amounts treated as distributions out of corpus to satisfy requirements imposed by section 170(b)(1)(F) or 4942(g)(3) (Election may be required - see instructions) .......
8 Excess distributions carryover from 2016 not applied on line 5 or line 7 (see instructions) ...
9 Excess distributions carryover to 2022. Subtract lines 7 and 8 from line 6a ......
10 Analysis of line 9:
a Excess from 2017....
b Excess from 2018....
c Excess from 2019....
d Excess from 2020....
e Excess from 2021....

Form 990-PF (2021)

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
	0				0
b 85% (0.85) of line 2a .........
c Qualifying distributions from Part XI, line 4 for each year listed .....	481,274	470,461	555,288	407,034	1,914,057
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 ....	481,274	470,461	555,288	407,034	1,914,057
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 ..					0
c “Support" alternative test—enter:
(1) Total support other than gross investment income (interest, dividends, rents, payments on securities loans (section 512(a)(5)), or royalties) ....
(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 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)

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

Total ................................. 3a

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			25	752,667
2 Membership dues and assessments ....
3 Interest on savings and temporary cash investments ...........			14	70
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 ............					7,100
9 Net income or (loss) from special events:
10 Gross profit or (loss) from sales of inventory
11 Other revenue: aSPECIAL EVENT REVENUE					9,733
bFIRE RECOVERY					2,852
cINSURANCE CLAIMS					2,709
dMOTOR FUEL TAX REIMBURSEMEN					863
eOTHER					18,659
fPPP LOAN FORGIVENESS					26,840
gFIREMENS RELIEF FUND INCOME					2,847
12 Subtotal. Add columns (b), (d), and (e) ..				752,737	71,603

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

824,340

(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:
Software Version:

Form 990PF - Special Condition Description:

Special Condition Description

- TIN:

TY 2021 AccountingFeesSchedule

Name:

BOILING SPRING LAKES FIRE RESCUE

EIN:

23-7350442

Category	Amount	Net Investment Income	Adjusted Net Income	Disbursements for Charitable Purposes
INDIRECT ACCOUNTING FEES	18,250			18,250

- TIN:

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

TY 2021 DepreciationSchedule

Name:

BOILING SPRING LAKES FIRE RESCUE

EIN:

23-7350442

Description of Property	Date Acquired	Cost or Other Basis	Prior Years' Depreciation	Computation Method	Rate / Life (# of years)	Current Year's Depreciation Expense
LOT - 900 FIFTY LAKES RD	2001-06-20	8,811	18
LOT - 920 FIFTY LAKES RD	2001-06-20	5,411
LOT NEXT TO STATION 2	2004-07-16	11,417
STATION 1 - HDQ	1975-03-01	31,673	31,673	S/L	25.0000
STATION 2	1976-03-01	13,780	13,780	S/L	25.0000
STATION 1	1990-03-30	30,973	30,973	S/L	25.0000
STATION 3	2004-10-18	175,693	73,205	S/L	40.0000	4,393
FLOATING DOCK	1996-10-12	418	418	S/L	5.0000
REFRIG & KITCHEN SINK	1997-01-17	774	774	S/L	5.0000
KITCHEN FIXTURES	1997-02-08	1,101	1,101	S/L	5.0000
PAVING STATIONS	1998-12-02	4,992	4,992	S/L	10.0000
ROFF ON ACTIVITY CENTER	1999-01-14	7,800	7,800	S/L	15.0000
INTERIOR IMPROVEMENTS-STA 2	2002-05-14	3,100	3,100	S/L	10.0000
WELL - STA 3	2004-10-18	1,600	1,600	S/L	10.0000
CARPET - STA 3	2004-10-18	1,483	1,483	S/L	10.0000
LANDSCAPING - STA 3	2004-10-18	15,800	15,800	S/L	15.0000
PAVING - STA 3	2004-10-18	42,465	42,465	S/L	15.0000
FENCING - STA 3	2004-10-18	6,454	6,454	S/L	15.0000
BUILDING GENERATOR - HDQ'S	2009-08-10	39,911	11,890	S/L	40.0000	998
GUTTERS - STA 2	2012-01-06	3,000	2,700	S/L	10.0000	300
TRANE 5 TON SPLIT HEAT PUMP	2013-07-24	5,391	4,268	S/L	10.0000	539
TRUCK 473 (2002 E-ONE)	2002-11-11	243,817	243,817	S/L	15.0000
TRUCK 481 (2001 CHEVY)	2005-06-02	5,200	5,200	S/L	5.0000
TRUCK 479 (2007 FORD F-350)	2007-06-20	64,000	59,733	S/L	15.0000	4,267
TRUCK 478 (2009 FORD F-350)	2009-01-20	70,000	58,333	S/L	15.0000	4,667
TRUCK 472 (2010 PIERCE)	2009-11-18	195,756	152,255	S/L	15.0000	13,050
TRUCK 471 (2012 PIERCE INTL)	2011-12-15	420,946	269,165	S/L	15.0000	28,063
TRUCK 476 (1991 INTERNATIONAL)	2012-02-06	15,000	15,000	S/L	5.0000
TRUCK 480 (2012 FORD EXP)	2012-06-18	32,820	29,811	S/L	10.0000	3,009
TRUCK 484 NEW (2006 FORD EXP)	2013-06-05	8,260	8,260	S/L	5.0000
TRUCK 461 (1987 SIMON-LADDER)	2013-10-25	65,000	65,000	S/L	5.0000
SHELVING, FIXTURES, CAGE	2001-03-31	722	722	S/L	5.0000
COMPUTER PROJECTOR	2001-05-07	3,672	3,672	S/L	3.0000
CABINETS - STA 3	2004-10-18	2,701	2,701	S/L	15.0000
FURNITURE - STA 3	2004-10-18	1,614	1,614	S/L	15.0000
ICE MAKER - KITCHEN	2013-08-21	2,965	2,965	S/L	5.0000
AMKUS-JAWS OF LIFE	1997-01-10	14,408	14,408	S/L	10.0000
HOSE TESTER & GUAGE	1998-10-12	2,216	2,216	S/L	5.0000
MONITER	2003-03-21	2,115	2,115	S/L	10.0000
AMX 25 C EXTRACTOR	2004-06-30	3,571	3,571	S/L	10.0000
MINI POWER UNIT	2004-08-26	3,455	3,455	S/L	10.0000
INFRARED CAMERA	2006-12-19	10,171	10,171	S/L	10.0000
AMKUS CUTTER	2007-01-23	3,139	3,139	S/L	10.0000
MOTOROLA MINITOR PAGERS (3)	2007-10-11	1,215	1,215	S/L	5.0000
TURNOUT GEAR (35 SETS)	2008-03-25	57,494	57,494	S/L	10.0000
HOSES	2008-06-10	1,034	1,034	S/L	5.0000
COMMAND COMM EQUIP 480	2008-06-13	8,625	8,625	S/L	7.0000
SCBA & SPARE CYLINDERS (25)	2008-06-23	114,480	114,480	S/L	10.0000
MOTOROLA MINITOR PAGERS (5)	2008-07-23	2,025	2,025	S/L	5.0000
RESCUE BAGS	2008-09-25	3,697	3,697	S/L	5.0000
MOTOROLA MINITOR PAGERS (3)	2008-11-20	1,215	1,215	S/L	5.0000
MOTOROLA MINITOR PAGERS (3)	2008-12-19	1,215	1,215	S/L	5.0000
TRUCK ACCESSORIES & TOOLS	2009-02-10	2,363	2,363	S/L	5.0000
MOTOROLA MINITOR PAGERS (6)	2009-06-04	2,430	2,430	S/L	5.0000
ARGUS THERMAL IMAGING CAMERA (1)	2013-06-21	7,006	6,188	S/L	10.0000	701
ARGUS THERMAL IMAGING CAMERA (1)	2013-07-24	5,560	4,402	S/L	10.0000	556
ADJUSTMENT	2014-06-30		104
SCOTT SCBA UNITS (5)	2014-10-21	33,559	22,373	S/L	10.0000	3,356
1991 SUTPHEN ENG/TANK	2015-11-10	55,000	55,000	S/L	5.0000
FLAT MARSH BOAT & TRLR 5A4GC	2017-05-25	5,523	4,510	S/L	5.0000	1,013
TURN-OUT GEAR	2017-11-06	9,224	3,382	S/L	10.0000	922
SCBA UNITS	2017-11-09	38,106	13,972	S/L	10.0000	3,811
BOAT MOTOR	2018-04-13	4,694	3,051	S/L	5.0000	939
TURNOUT GEAR (5 SETS)	2018-01-23	8,587	2,934	S/L	10.0000	858
TURNOUT GEAR (5 SETS)	2018-05-29	8,765	2,703	S/L	10.0000	876
5 SCBA UNITS	2019-03-11	37,175	8,674	S/L	10.0000	3,718
2019 FORD EXPEDITION	2019-02-14	42,953	20,760	S/L	5.0000	8,591
LAWN MOWER	2018-09-21	1,899	1,044	S/L	5.0000	380
STATION 2 SIGN	2020-04-28	13,045	3,044	S/L	5.0000	2,609
POLY TANK & HALE PTO PUMP	2019-07-24	3,000	1,917	S/L	3.0000	1,000
TOYNE FIRE TRUCK	2019-12-23	773,500	116,025	S/L	10.0000	77,350
DIGITAL SIGN	2020-08-25	12,795	1,066	S/L	10.0000	1,280
2021 FORD F250	2021-03-18	43,973	2,199	S/L	5.0000	8,794
ICE MACHINE	2020-09-23	3,500	525	S/L	5.0000	700
GUTTERS STATION 1 & 3	2022-01-20	7,744		S/L	27.5000	117
MOTOROLA RADIOS	2022-04-27	31,823		S/L	5.0000	1,061
SECURITY SYSTEM	2021-09-06	16,938		S/L	7.0000	2,016
ICE MACHINE STATION 3	2021-10-13	5,103		S/L	5.0000	765
SUPER VAC 18" MILWAUKEE FAN	2022-06-01	6,404		S/L	5.0000	107
TURN OUT GEAR (3)	2022-03-18	5,878		S/L	10.0000	147
GUTTERS 1 & 3	2021-09-21	4,789		S/L	27.5000	131
LAND - DONATED	2022-06-30	15,000
3172 GEORGE II HIGHWAY	2022-04-05	244,750

- TIN:

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TY 2021 GainLossSaleOtherAssetsSch

Name:

BOILING SPRING LAKES FIRE RESCUE

EIN:

23-7350442

Name	Date Acquired	How Acquired	Date Sold	Gross Sales Price	Basis	Total (net)	Accumulated Depreciation
1991 SUTPHEN ENG/TANK	2015-11	PURCHASE	2022-04	7,100	55,000	7,100	55,000
FLOATING DOCK	1996-10	PURCHASE	2021-12		418		418
TRUCK 461 (1987 SIMON-LADDER)	2013-10	PURCHASE	2022-06		65,000		65,000
COMPUTER PROJECTOR	2001-05	PURCHASE	2021-12		3,672		3,672
HOSE TESTER & GUAGE	1998-10	PURCHASE	2021-12		2,216		2,216
TURNOUT GEAR (35 SETS)	2008-03	PURCHASE	2021-12		57,494		57,494
COMMAND COMM EQUIP 480	2008-06	PURCHASE	2021-12		8,625		8,625

- TIN:

TY 2021 LandEtcSchedule2

Name:

BOILING SPRING LAKES FIRE RESCUE

EIN:

23-7350442

Category / Item	Cost / Other Basis	Accumulated Depreciation	Book Value	End of Year Fair Market Value
	2,747,863	1,670,019	1,077,844	1,363,232
	285,388		285,388	285,388

- TIN:

TY 2021 MortgagesAndNotesPayableSch

Name:

BOILING SPRING LAKES FIRE RESCUE

EIN:

23-7350442

Total Mortgage Amount:

Item No.	1
Lender's Name	LGFCU-TRK 471
Lender's Title
Relationship to Insider
Original Amount of Loan	323,000
Balance Due	105,222
Date of Note	2011-12
Maturity Date	2026-12
Repayment Terms	QTRLY PYMNTS OF 7,434
Interest Rate	0.0450
Security Provided by Borrower	FIRE TRUCK
Purpose of Loan	TO PURCHASE FIRE TRUCK
Description of Lender Consideration
Consideration FMV

Item No.	2
Lender's Name	LGFCU-CONSOLIDATED
Lender's Title
Relationship to Insider
Original Amount of Loan	442,324
Balance Due
Date of Note	2013-02
Maturity Date	2023-02
Repayment Terms	QTRLY PYMNTS OF 12,810
Interest Rate	0.0295
Security Provided by Borrower	REAL ESTATE AND TWO FIRE TRUCKS
Purpose of Loan	TO CONSOLIDATE THREE LOANS INTO ONE
Description of Lender Consideration
Consideration FMV

Item No.	3
Lender's Name	CIVIC FCU-TOYNE FIRE TRUCK
Lender's Title
Relationship to Insider
Original Amount of Loan	695,500
Balance Due	587,352
Date of Note	2019-12
Maturity Date	1934-12
Repayment Terms	QRTRLY PYMNETS OF 14,951
Interest Rate	0.0350
Security Provided by Borrower	TOYNE FIRE TRUCK
Purpose of Loan	TO PURCHASE TOYNE FIRE TRUCK
Description of Lender Consideration
Consideration FMV

Item No.	4
Lender's Name	NP CIVIC 3172 GEORGE HIGHWAY II
Lender's Title
Relationship to Insider
Original Amount of Loan	235,000
Balance Due	235,000
Date of Note	2022-04
Maturity Date	2027-06
Repayment Terms
Interest Rate
Security Provided by Borrower
Purpose of Loan	LAND PURCHASE
Description of Lender Consideration
Consideration FMV

- TIN:

TY 2021 OtherAssetsSchedule

Name:

BOILING SPRING LAKES FIRE RESCUE

EIN:

23-7350442

Description	Beginning of Year - Book Value	End of Year - Book Value	End of Year - Fair Market Value
RESTRICTED CASH
TAX REFUNDS RECEIVABLE

- TIN:

TY 2021 OtherExpensesSchedule

Name:

BOILING SPRING LAKES FIRE RESCUE

EIN:

23-7350442

Description	Revenue and Expenses per Books	Disbursements for Charitable Purposes
EXPENSES
ADMINISTRATION	6,146	6,146
MISCELLANEOUS	8,555	8,555
FUEL & OIL	18,497	18,497
INSURANCE	41,683	41,683
REPAIRS & MAINTENANCE-BLDGS	15,873	15,873
REPAIRS & MAINTENANCE-VEHIC	45,399	45,399
TRAINING & RELATED TRAVEL	10,985	10,985
UNIFORMS	3,914	3,914
SAFETY & FIRE PREVENTION	3,598	3,598
EQUIPMENT REPLACEMENT	33,459	33,459
OFFICE SUPPLIES & EQUIPMENT	2,804	2,804
MEMBERSHIP & DUES	3,592	3,592
PERSONNEL RECOGNITION	3,697	3,697
PHYSICALS	8,865	8,865

- TIN:

TY 2021 OtherIncomeSchedule2

Name:

BOILING SPRING LAKES FIRE RESCUE

EIN:

23-7350442

Description	Revenue And Expenses Per Books	Adjusted Net Income
FIRE DISTRICT FEES	752,667	752,667
SPECIAL EVENT REVENUE	9,733	9,733
FIRE RECOVERY	2,852	2,852
INSURANCE CLAIMS	2,709	2,709
MOTOR FUEL TAX REIMBURSEMENTS	863	863
OTHER	18,659	18,659
PPP LOAN FORGIVENESS	26,840	26,840
FIREMENS RELIEF FUND INCOME	2,847	2,847

- TIN:

TY 2021 OtherLiabilitiesSchedule

Name:

BOILING SPRING LAKES FIRE RESCUE

EIN:

23-7350442

Description	Beginning of Year - Book Value	End of Year - Book Value
PPP LOAN	26,840