Form990-PF


Department of the Treasury
Internal Revenue Service

Return of Private Foundation
or Section 4947(a)(1) Trust Treated as Private Foundation
bulletDo not enter social security numbers on this form as it may be made public.
bulletGo to www.irs.gov/Form990PF for instructions and the latest information.
OMB No. 1545-0047
2021
Open to Public Inspection
For calendar year 2021, or tax year beginning 12-01-2021 , and ending 11-30-2022
Name of foundation
THE COFFEY FOUNDATION INC
 
Number and street (or P.O. box number if mail is not delivered to street address)PO BOX 1161
  Room/suite
City or town, state or province, country, and ZIP or foreign postal code
LENOIR, NC28645
A Employer identification number

56-6047501
B Telephone number (see instructions)

(828) 754-9479
C bullet
G Check all that apply:

D 1. Foreign organizations, check here............. bullet
2. Foreign organizations meeting the 85%
test, check here and attach computation ... bullet
E bullet
H Check type of organization:
F bullet
I Fair market value of all assets at end
of year (from Part II, col. (c),
line 16)bullet$7,976,593J Accounting method:
 
(Part I, column (d) must be on cash basis.)
Part I Analysis of Revenue and Expenses (The total of amounts in columns (b), (c), and (d) may not necessarily equal the amounts in column (a) (see instructions).) (a) Revenue and
expenses per
books 		(b) Net investment
income 		(c) Adjusted net
income 		(d) Disbursements
for charitable
purposes
(cash basis only)
Revenue 1 Contributions, gifts, grants, etc., received (attach schedule)  
2 Check bullet.............
3 Interest on savings and temporary cash investments      
4 Dividends and interest from securities... 221,178 221,178  
5a Gross rents............      
b Net rental income or (loss)  
6a Net gain or (loss) from sale of assets not on line 10 348,664
b Gross sales price for all assets on line 6a 3,765,799
7 Capital gain net income (from Part IV, line 2)... 348,664
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)....... Click to see attachment 50 50  
12 Total. Add lines 1 through 11........ 569,892 569,892  
Operating and Administrative Expenses 13 Compensation of officers, directors, trustees, etc. 11,900 0   11,900
14 Other employee salaries and wages......        
15 Pension plans, employee benefits.......        
16a Legal fees (attach schedule).........        
b Accounting fees (attach schedule)....... Click to see attachment 11,000 11,000   0
c Other professional fees (attach schedule).... Click to see attachment 12,819 12,819   0
17 Interest...............        
18 Taxes (attach schedule) (see instructions)...        
19 Depreciation (attach schedule) and depletion...      
20 Occupancy..............        
21 Travel, conferences, and meetings.......        
22 Printing and publications..........        
23 Other expenses (attach schedule)....... Click to see attachment 60,949 56,554   4,395
24 Total operating and administrative expenses.
Add lines 13 through 23.......... 96,668 80,373   16,295
25 Contributions, gifts, grants paid....... 430,000 430,000
26 Total expenses and disbursements. Add lines 24 and 25 526,668 80,373   446,295
27 Subtract line 26 from line 12:
a Excess of revenue over expenses and disbursements 43,224
b Net investment income (if negative, enter -0-) 489,519
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 Attached schedules and amounts in the description column
should be for end-of-year amounts only. (See instructions.) 		Beginning of year End of year
(a) Book Value (b) Book Value (c) Fair Market Value
Assets 1 Cash—non-interest-bearing............. 927,974 574,405 574,405
2 Savings and temporary cash investments.........      
3 Accounts receivable bullet4,752
Less: allowance for doubtful accounts bullet   3,276 4,752 4,752
4 Pledges receivable bullet  
Less: allowance for doubtful accounts bullet        
5 Grants receivable.................      
6 Receivables due from officers, directors, trustees, and other
disqualified persons (attach schedule) (see instructions).....      
7 Other notes and loans receivable (attach schedule) bullet  
Less: allowance for doubtful accounts bullet        
8 Inventories for sale or use..............      
9 Prepaid expenses and deferred charges..........      
10a Investments—U.S. and state government obligations (attach schedule)      
b Investments—corporate stock (attach schedule).......      
c Investments—corporate bonds (attach schedule).......      
11 Investments—land, buildings, and equipment: basis bullet  
Less: accumulated depreciation (attach schedule) bullet        
12 Investments—mortgage loans.............      
13 Investments—other (attach schedule).......... 6,958,305 Click to see attachment7,339,854 7,397,436
14 Land, buildings, and equipment: basis bullet  
Less: accumulated depreciation (attach schedule) bullet        
15 Other assets (describe bullet)      
16 Total assets (to be completed by all filers—see the
instructions. Also, see page 1, item I) 7,889,555 7,919,011 7,976,593
Liabilities 17 Accounts payable and accrued expenses..........    
18 Grants payable.................    
19 Deferred revenue.................    
20 Loans from officers, directors, trustees, and other disqualified persons    
21 Mortgages and other notes payable (attach schedule)......    
22 Other liabilities (describe bullet)    
23 Total liabilities (add lines 17 through 22)......... 0 0
Net Assets or Fund Balances Foundations that follow FASB ASC 958, check here bullet
and complete lines 24, 25, 29 and 30.
24 Net assets without donor restrictions........... 7,889,555 7,919,011
25 Net assets with donor restrictions............    
Foundations that do not follow FASB ASC 958, check here bullet
and complete lines 26 through 30.
26 Capital stock, trust principal, or current funds........    
27 Paid-in or capital surplus, or land, bldg., and equipment fund    
28 Retained earnings, accumulated income, endowment, or other funds    
29 Total net assets or fund balances (see instructions)..... 7,889,555 7,919,011
30 Total liabilities and net assets/fund balances (see instructions). 7,889,555 7,919,011
Part III
Analysis of Changes in Net Assets or Fund Balances
1
Total net assets or fund balances at beginning of year—Part II, column (a), line 29 (must agree with end-of-year figure reported on prior year’s return) ...............
1
7,889,555
2
Enter amount from Part I, line 27a .....................
2
43,224
3
Other increases not included in line 2 (itemize) bullet
3
0
4
Add lines 1, 2, and 3 ..........................
4
7,932,779
5
Decreases not included in line 2 (itemize) bulletClick to see attachment
5
13,768
6
Total net assets or fund balances at end of year (line 4 minus line 5)—Part II, column (b), line 29 .
6
7,919,011
Form 990-PF (2021)
Form 990-PF (2021)
Page 3
Part IV
Capital Gains and Losses for Tax on Investment Income
(a) List and describe the kind(s) of property sold (e.g., real estate,
2-story brick warehouse; or common stock, 200 shs. MLC Co.)		 (b)
How acquired
P—Purchase
D—Donation 		(c)
Date acquired
(mo., day, yr.) 		(d)
Date sold
(mo., day, yr.)
1 a PUBLICALLY TRADED SECURITIES      
b PUBLICALLY TRADED SECURITIES      
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 672,259   734,006 -61,747
b 3,093,540   2,683,129 410,411
c
d
e
Complete only for assets showing gain in column (h) and owned by the foundation on 12/31/69 (l)
Gains (Col. (h) gain minus
col. (k), but not less than -0-) or
Losses (from col.(h))
(i)
F.M.V. as of 12/31/69 		(j)
Adjusted basis
as of 12/31/69 		(k)
Excess of col. (i)
over col. (j), if any
a       -61,747
b       410,411
c
d
e
2 Capital gain net income or (net capital loss) Bracket If gain, also enter in Part I, line 7
If (loss), enter -0- in Part I, line 7		 Bracket 2 348,664
3 Net short-term capital gain or (loss) as defined in sections 1222(5) and (6):
If gain, also enter in Part I, line 8, column (c) (see instructions). If (loss), enter -0-
in Part I, line 8 ................... 		Bracket 3  
Form 990-PF (2021)
Form 990-PF (2021)
Page 4
Part V
Excise Tax Based on Investment Income (Section 4940(a), 4940(b), 4940(e), or 4948—see instructions)
1a Exempt operating foundations described in section 4940(d)(2), check here Bullet and enter “N/A" on line 1. Bracket for line 1a
Date of ruling or determination letter:   (attach copy of letter if necessary–see instructions)
b All other domestic foundations enter 1.39% (0.0139) of line 27b. Exempt foreign organizations enter 4% (0.04) of Part I, line 12, col. (b)
2 Tax under section 511 (domestic section 4947(a)(1) trusts and taxable foundations only. Others enter -0-) 2 0
3 Add lines 1 and 2........................... 3 6,804
4 Subtitle A (income) tax (domestic section 4947(a)(1) trusts and taxable foundations only. Others enter -0-) 4 0
5 Tax based on investment income. Subtract line 4 from line 3. If zero or less, enter -0- ..... 5 6,804
6 Credits/Payments:
a 2021 estimated tax payments and 2020 overpayment credited to 2021 6a 9,840
b Exempt foreign organizations—tax withheld at source...... 6b 0
c Tax paid with application for extension of time to file (Form 8868)... 6c 0
d Backup withholding erroneously withheld ........... 6d 0
7 Total credits and payments. Add lines 6a through 6d.............. 7 9,840
8 Enter any penalty for underpayment of estimated tax. Check here if Form 2220 is attached. 8 0
9 Tax due. If the total of lines 5 and 8 is more than line 7, enter amount owed.......Bullet 9  
10 Overpayment. If line 7 is more than the total of lines 5 and 8, enter the amount overpaid...Bullet 10 3,036
11 Enter the amount of line 10 to be: Credited to 2022 estimated taxBullet3,036 RefundedBullet 11 0
Part VI-A
Statements Regarding Activities
1a
During the tax year, did the foundation attempt to influence any national, state, or local legislation or did
Yes
No
it participate or intervene in any political campaign? ....................
1a
 
No
b
Did it spend more than $100 during the year (either directly or indirectly) for political purposes? See the instructions
for the definition.................................
1b
 
No
If the answer is "Yes" to 1a or 1b, attach a detailed description of the activities and copies of any materials
published or distributed by the foundation in connection with the activities.
c
Did the foundation file Form 1120-POL for this year?.....................
1c
 
No
d
Enter the amount (if any) of tax on political expenditures (section 4955) imposed during the year:
(1) On the foundation. bullet$ 0(2) On foundation managers.bullet$ 0
e
Enter the reimbursement (if any) paid by the foundation during the year for political expenditure tax imposed
on foundation managers.bullet$ 0
2
Has the foundation engaged in any activities that have not previously been reported to the IRS?.......
2
 
No
If "Yes," attach a detailed description of the activities.
3
Has the foundation made any changes, not previously reported to the IRS, in its governing instrument, articles
of incorporation, or bylaws, or other similar instruments? If "Yes," attach a conformed copy of the changes....
3
 
No
4a
Did the foundation have unrelated business gross income of $1,000 or more during the year?.........
4a
 
No
b
If "Yes," has it filed a tax return on Form 990-T for this year?...................
4b
 
 
5
Was there a liquidation, termination, dissolution, or substantial contraction during the year?.........
5
 
No
If "Yes," attach the statement required by General Instruction T.
6
Are the requirements of section 508(e) (relating to sections 4941 through 4945) satisfied either:
  • By language in the governing instrument, or
  • By state legislation that effectively amends the governing instrument so that no mandatory directions
    • that conflict with the state law remain in the governing instrument?................
    6
    Yes
     
    7
    Did the foundation have at least $5,000 in assets at any time during the year? If "Yes," complete Part II, col. (c),
    and Part XIV..................................
    7
    Yes
     
    8a
    Enter the states to which the foundation reports or with which it is registered (see instructions)
    bulletNC
    b
    If the answer is "Yes" to line 7, has the foundation furnished a copy of Form 990-PF to the Attorney
    General (or designate) of each state as required by General Instruction G? If "No," attach explanation .
    8b
    Yes
     
    9
    Is the foundation claiming status as a private operating foundation within the meaning of section 4942(j)(3)
    or 4942(j)(5) for calendar year 2021 or the taxable year beginning in 2021? See the instructions for Part XIII.
    If "Yes," complete Part XIII .............................
    9
     
    No
    10
    Did any persons become substantial contributors during the tax year? If "Yes," attach a schedule listing their names
    and addresses. ...............................
    10
     
    No
    Form 990-PF (2021)
    Form 990-PF (2021)
    Page 5
    Part VI-A
    Statements Regarding Activities (continued)
    11
    At any time during the year, did the foundation, directly or indirectly, own a controlled entity within the
    meaning of section 512(b)(13)? If "Yes," attach schedule. See instructions .............
    11
     
    No
    12
    Did the foundation make a distribution to a donor advised fund over which the foundation or a disqualified person had
    advisory privileges? If "Yes," attach statement. See instructions.................
    12
     
    No
    13
    Did the foundation comply with the public inspection requirements for its annual returns and exemption application?
    13
    Yes
     
    Website addressbulletN/A
    14
    The books are in care ofbulletHARRIET HINES Telephone no.bullet (828) 754-9479

    Located atbullet512 STONECROFT COURT SELENOIRNC ZIP+4bullet28645
    15
    Section 4947(a)(1) nonexempt charitable trusts filing Form 990-PF in lieu of Form 1041 —check here .........bullet
    and enter the amount of tax-exempt interest received or accrued during the year ........bullet
    15
     
    16 At any time during calendar year 2021, did the foundation have an interest in or a signature or other authority over YesNo
    a bank, securities, or other financial account in a foreign country? .................
    16   No
    See the instructions for exceptions and filing requirements for FinCEN Form 114. If "Yes", enter the name of the foreign
    country bullet
    Part VI-B
    Statements Regarding Activities for Which Form 4720 May Be Required
    File Form 4720 if any item is checked in the "Yes" column, unless an exception applies.
    Yes
    No
    1a
    During the year did the foundation (either directly or indirectly):
    (1) Engage in the sale or exchange, or leasing of property with a disqualified person? ...........
    1a(1)
     
    No
    (2) Borrow money from, lend money to, or otherwise extend credit to (or accept it from)
    a disqualified person? ..............................
    1a(2)
     
    No
    (3) Furnish goods, services, or facilities to (or accept them from) a disqualified person? ...........
    1a(3)
     
    No
    (4) Pay compensation to, or pay or reimburse the expenses of, a disqualified person? ............
    1a(4)
     
    No
    (5) Transfer any income or assets to a disqualified person (or make any of either available
    for the benefit or use of a disqualified person)? ......................
    1a(5)
     
    No
    (6) Agree to pay money or property to a government official? (Exception. Check "No"
    if the foundation agreed to make a grant to or to employ the official for a period
    after termination of government service, if terminating within 90 days.) ...............
    1a(6)
     
    No
    b
    If any answer is "Yes" to 1a(1)–(6), did any of the acts fail to qualify under the exceptions described in Regulations
    section 53.4941(d)-3 or in a current notice regarding disaster assistance? See instructions ..........
    1b
     
     
    c
    ........bullet
    d
    Did the foundation engage in a prior year in any of the acts described in 1a, other than excepted acts,
    that were not corrected before the first day of the tax year beginning in 2021? .............
    1d
     
    No
    2
    Taxes on failure to distribute income (section 4942) (does not apply for years the foundation was a private
    operating foundation defined in section 4942(j)(3) or 4942(j)(5)):
    a
    At the end of tax year 2021, did the foundation have any undistributed income (lines 6d
    and 6e, Part XII) for tax year(s) beginning before 2021?....................
    2a
     
    No
    If "Yes," list the years bullet20, 20, 20, 20
    b
    Are there any years listed in 2a for which the foundation is not applying the provisions of section 4942(a)(2)
    (relating to incorrect valuation of assets) to the year’s undistributed income? (If applying section 4942(a)(2)
    to all years listed, answer "No" and attach statement—see instructions.) ..............
    2b
     
     
    c
    If the provisions of section 4942(a)(2) are being applied to any of the years listed in 2a, list the years here.
    bullet20, 20, 20, 20
    3a
    Did the foundation hold more than a 2% direct or indirect interest in any business enterprise at
    any time during the year? ..............................
    3a
     
    No
    b
    If "Yes," did it have excess business holdings in 2021 as a result of (1) any purchase by the foundation
    or disqualified persons after May 26, 1969; (2) the lapse of the 5-year period (or longer period approved
    by the Commissioner under section 4943(c)(7)) to dispose of holdings acquired by gift or bequest; or (3)
    the lapse of the 10-, 15-, or 20-year first phase holding period? (Use Schedule C, Form 4720, to determine
    if the foundation had excess business holdings in 2021.) .....................
    3b
     
     
    4a
    Did the foundation invest during the year any amount in a manner that would jeopardize its charitable purposes?
    4a
     
    No
    b
    Did the foundation make any investment in a prior year (but after December 31, 1969) that could jeopardize its
    charitable purpose that had not been removed from jeopardy before the first day of the tax year beginning in 2021? ..
    4b
     
    No
    Form 990-PF (2021)
    Form 990-PF (2021)
    Page 6
    Part VI-B
    Statements Regarding Activities for Which Form 4720 May Be Required (continued)
    5a
    During the year did the foundation pay or incur any amount to:
    Yes
    No
    (1) Carry on propaganda, or otherwise attempt to influence legislation (section 4945(e))? ..........
    5a(1)
     
    No
    (2) Influence the outcome of any specific public election (see section 4955); or to carry
    on, directly or indirectly, any voter registration drive? ....................
    5a(2)
     
    No
    (3) Provide a grant to an individual for travel, study, or other similar purposes? .............
    5a(3)
    Yes
     
    (4) Provide a grant to an organization other than a charitable, etc., organization described
    in section 4945(d)(4)(A)? See instructions ........................
    5a(4)
     
    No
    (5) Provide for any purpose other than religious, charitable, scientific, literary, or
    educational purposes, or for the prevention of cruelty to children or animals? .............
    5a(5)
     
    No
    b
    If any answer is "Yes" to 5a(1)–(5), did any of the transactions fail to qualify under the exceptions described in
    Regulations section 53.4945 or in a current notice regarding disaster assistance? See instructions ........
    5b
     
    No
    c
    .........bullet
    d
    If the answer is "Yes" to question 5a(4), does the foundation claim exemption from the
    tax because it maintained expenditure responsibility for the grant? .................
    5d
     
     
    If "Yes," attach the statement required by Regulations section 53.4945–5(d).
    6a
    Did the foundation, during the year, receive any funds, directly or indirectly, to pay premiums on
    a personal benefit contract? .............................
    6a
     
    No
    b
    Did the foundation, during the year, pay premiums, directly or indirectly, on a personal benefit contract? ....
    6b
     
    No
    If "Yes" to 6b, file Form 8870.
    7a
    At any time during the tax year, was the foundation a party to a prohibited tax shelter transaction?
    7a
     
    No
    b
    If "Yes", did the foundation receive any proceeds or have any net income attributable to the transaction? .....
    7b
     
     
    8
    Is the foundation subject to the section 4960 tax on payment(s) of more than $1,000,000 in remuneration or
    excess parachute payment during the year? .........................
    8
     
    No
    Part VII
    Information About Officers, Directors, Trustees, Foundation Managers, Highly Paid Employees,
    and Contractors
    1 List all officers, directors, trustees, foundation managers and their compensation. See instructions
    (a) Name and address (b) Title, and average
    hours per week
    devoted to position     		(c) Compensation
     (If not paid, enter
    -0-)     		(d) Contributions to employee benefit plans and deferred compensation (e) Expense account,
    other allowances
    BETTY LOU MILLER TRUSTEE
    2.00     		1,200 0 0
    414 HIGHLAND AVENUE SW
    LENOIR,NC28645
    BRUCE VANDERBLOEMEN TRUSTEE
    2.00     		1,000 0 0
    PO BOX 1320
    LENOIR,NC28645
    JENNIE GOODMAN DEAL TRUSTEE
    2.00     		2,500 0 0
    3950 WILLOWBROOK ROAD
    LENOIR,NC28645
    DEBORAH ASHLEY SMITH TRUSTEE
    2.00     		1,300 0 0
    1415 NC HIGHWAY 268
    LENIOR,NC28645
    RAHN CHASE TRUSTEE
    2.00     		1,000 0 0
    813 BEVERLY CIRCLE NE
    LENIOR,NC28645
    ROBERT O FLOYD JR TRUSTEE
    2.00     		1,000 0 0
    PO BOX 309
    LENIOR,NC28645
    LAUREN BROOKS CLARK TRUSTEE
    2.00     		2,500 0 0
    1020 CAMBRIDGE CT
    LENOIR,NC28645
    ELIZABETH SHULL FOX TRUSTEE
    2.00     		1,200 0 0
    973 SOMMERSET CT NE
    LENOIR,NC28645
    LESLIE D HINES JR TRUSTEE
    2.00     		200 0 0
    512 STONECROFT COURT SE
    LENIOR,NC28645
    2 Compensation of five highest-paid employees (other than those included on line 1—see instructions). If none, enter “NONE."
    (a) Name and address of each employee paid more than $50,000 (b) Title, and average
    hours per week
    devoted to position     		(c) Compensation (d) Contributions to
    employee benefit
    plans and deferred
    compensation     		(e) Expense account,
    other allowances
    NONE
    Total number of other employees paid over $50,000...................bullet 0
    Form 990-PF (2021)
    Form 990-PF (2021)
    Page 7
    Part VII
    Information About Officers, Directors, Trustees, Foundation Managers, Highly Paid Employees,
    and Contractors (continued)
    3 Five highest-paid independent contractors for professional services (see instructions). If none, enter "NONE".
    (a) Name and address of each person paid more than $50,000 (b) Type of service (c) Compensation
    NONE
    Total number of others receiving over $50,000 for professional services.............bullet0
    Part VIII-A
    Summary of Direct Charitable Activities
    List the foundation’s four largest direct charitable activities during the tax year. Include relevant statistical information such as the number of organizations and other beneficiaries served, conferences convened, research papers produced, etc. Expenses
    1 SCHOLARSHIPS- SEE ATTACHED SCHEDULE OF RECIPIENTS 244,000
    2 CHARITABLE CONTRIBUTIONS- SEE ATTACHED SCHEDULE OF RECIPIENTS 186,000
    3  
    4  
    Part VIII-B
    Summary of Program-Related Investments (see instructions)
    Describe the two largest program-related investments made by the foundation during the tax year on lines 1 and 2. Amount
    1  
    2  
    All other program-related investments. See instructions.
    3  
    Total. Add lines 1 through 3.........................bullet0
    Form 990-PF (2021)
    Form 990-PF (2021)
    Page 8
    Part IX
    Minimum Investment Return (All domestic foundations must complete this part. Foreign foundations, see instructions.)
    1
    Fair market value of assets not used (or held for use) directly in carrying out charitable, etc.,
    purposes:
    a
    Average monthly fair market value of securities...................
    1a
    7,545,306
    b
    Average of monthly cash balances.......................
    1b
    833,125
    c
    Fair market value of all other assets (see instructions)................
    1c
    0
    d
    Total (add lines 1a, b, and c).........................
    1d
    8,378,431
    e
    Reduction claimed for blockage or other factors reported on lines 1a and
    1c (attach detailed explanation) .............
    1e
    0
    2
    Acquisition indebtedness applicable to line 1 assets..................
    2
    0
    3
    Subtract line 2 from line 1d.........................
    3
    8,378,431
    4
    Cash deemed held for charitable activities. Enter 1.5% (0.015) of line 3 (for greater amount, see
    instructions) .............................
    4
    125,676
    5
    Net value of noncharitable-use assets. Subtract line 4 from line 3. .......
    5
    8,252,755
    6
    Minimum investment return. Enter 5% (0.05) of line 5................
    6
    412,638
    Part X
    Distributable Amount (see instructions) (Section 4942(j)(3) and (j)(5) private operating foundations and certain foreign organizations check here right arrow and do not complete this part.)
    1
    Minimum investment return from Part IX, line 6..................
    1
    412,638
    2a
    Tax on investment income for 2021 from Part V, line 5.......
    2a
    6,804
    b
    Income tax for 2021. (This does not include the tax from Part V.) ...
    2b
     
    c
    Add lines 2a and 2b............................
    2c
    6,804
    3
    Distributable amount before adjustments. Subtract line 2c from line 1............
    3
    405,834
    4
    Recoveries of amounts treated as qualifying distributions................
    4
    0
    5
    Add lines 3 and 4............................
    5
    405,834
    6
    Deduction from distributable amount (see instructions).................
    6
    0
    7
    Distributable amount as adjusted. Subtract line 6 from line 5. Enter here and on Part XII, line 1 ...
    7
    405,834
    Part XI
    Qualifying Distributions (see instructions)
    1
    Amounts paid (including administrative expenses) to accomplish charitable, etc., purposes:
    a
    Expenses, contributions, gifts, etc.—total from Part I, column (d), line 26 ..........
    1a
     
    b
    Program-related investments—total from Part VIII-B..................
    1b
     
    2
    Amounts paid to acquire assets used (or held for use) directly in carrying out charitable, etc.,
    purposes...............................
    2
     
    3
    Amounts set aside for specific charitable projects that satisfy the:
    a
    Suitability test (prior IRS approval required)....................
    3a
     
    b
    Cash distribution test (attach the required schedule) .................
    3b
     
    4
    Qualifying distributions. Add lines 1a through 3b. Enter here and on Part XII, line 4.
    4
     
    Form 990-PF (2021)
    Form 990-PF (2021)
    Page 9
    Part XII
    Undistributed Income (see instructions)
    (a)
    Corpus     		(b)
    Years prior to 2020     		(c)
    2020     		(d)
    2021
    1 Distributable amount for 2021 from Part X, line 7 405,834
    2 Undistributed income, if any, as of the end of 2021:
    a Enter amount for 2020 only....... 442,386
    b Total for prior years:20, 20, 20 0
    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 ........ 0
    4Qualifying distributions for 2021 from Part
    XI, line 4: bullet$ 446,295
    a Applied to 2020, but not more than line 2a 442,386
    b Applied to undistributed income of prior years
    (Election required—see instructions).....     		0
    c Treated as distributions out of corpus (Election
    required—see instructions)........     		0
    d Applied to 2021 distributable amount..... 3,909
    e Remaining amount distributed out of corpus 0
    5 Excess distributions carryover applied to 2021. 0 0
    (If an amount appears in column (d), the
    same amount must be shown in column (a).)
    6Enter the net total of each column as
    indicated below:
    a Corpus. Add lines 3f, 4c, and 4e. Subtract line 5 0
    b Prior years’ undistributed income. Subtract
    line 4b from line 2b ..........     		0
    c Enter the amount of prior years’ undistributed
    income for which a notice of deficiency has
    been issued, or on which the section 4942(a)
    tax has been previously assessed......     		0
    d Subtract line 6c from line 6b. Taxable amount
    —see instructions ...........     		0
    e Undistributed income for 2019. Subtract line
    4a from line 2a. Taxable amount—see
    instructions .............     		0
    f Undistributed income for 2021. Subtract
    lines 4d and 5 from line 1. This amount must
    be distributed in 2022 ..........     		401,925
    7 Amounts treated as distributions out of
    corpus to satisfy requirements imposed by
    section 170(b)(1)(F) or 4942(g)(3) (Election may
    be required - see instructions) .......     		0
    8 Excess distributions carryover from 2016 not
    applied on line 5 or line 7 (see instructions) ...     		0
    9 Excess distributions carryover to 2022.
    Subtract lines 7 and 8 from line 6a ......     		0
    10 Analysis of line 9:
    a Excess from 2017....  
    b Excess from 2018....  
    c Excess from 2019....  
    d Excess from 2020....  
    e Excess from 2021....  
    Form 990-PF (2021)
    Form 990-PF (2021)
    Page 10
    Part XIII
    Private Operating Foundations (see instructions and Part VI-A, question 9)
    1a If the foundation has received a ruling or determination letter that it is a private operating
    foundation, and the ruling is effective for 2021, enter the date of the ruling ....... bullet
     
    b Check box to indicate whether the organization is a private operating foundation described in section or
    2a Enter the lesser of the adjusted net
    income from Part I or the minimum
    investment return from Part X for each
    year listed ..........     		Tax year Prior 3 years (e) Total
    (a) 2021 (b) 2020 (c) 2019 (d) 2018
             
    b 85% (0.85) of line 2a .........          
    c Qualifying distributions from Part XI,
    line 4 for each year listed .....     		         
    d Amounts included in line 2c not used directly
    for active conduct of exempt activities ..........     		         
    e Qualifying distributions made directly
    for active conduct of exempt activities.
    Subtract line 2d from line 2c ....     		         
    3 Complete 3a, b, or c for the
    alternative test relied upon:
    a “Assets" alternative test—enter:
    (1) Value of all assets ......          
    (2) Value of assets qualifying
    under section 4942(j)(3)(B)(i)    		          
    b “Endowment" alternative test— enter 2/3
    of minimum investment return shown in
    Part IX, line 6 for each year listed ..     		         
    c “Support" alternative test—enter:
    (1) Total support other than gross
    investment income (interest,
    dividends, rents, payments
    on securities loans (section
    512(a)(5)), or royalties) ....     		         
    (2) Support from general public
    and 5 or more exempt
    organizations as provided in
    section 4942(j)(3)(B)(iii)....     		         
    (3) Largest amount of support
    from an exempt organization    		          
    (4) Gross investment income          
    Part XIV
    Supplementary Information (Complete this part only if the foundation had $5,000 or more in
    assets at any time during the year—see instructions.)
    1Information Regarding Foundation Managers:
    aList any managers of the foundation who have contributed more than 2% of the total contributions received by the foundation
    before the close of any tax year (but only if they have contributed more than $5,000). (See section 507(d)(2).)
    bList any managers of the foundation who own 10% or more of the stock of a corporation (or an equally large portion of the
    ownership of a partnership or other entity) of which the foundation has a 10% or greater interest.
    2Information Regarding Contribution, Grant, Gift, Loan, Scholarship, etc., Programs:
    Check here bullet
    aThe name, address, and telephone number or e-mail address of the person to whom applications should be addressed:
    MRS HARRIET HINES
    512 STONECROFT COURT SE
    LENOIR,NC28645
    (828) 754-9479
    bThe form in which applications should be submitted and information and materials they should include:
    THE COFFEY FOUNDATION SCHOLARSHIP FORM, SCHOOL IDENTIFCATION, COMPLETE TRANSCRIPT OF APPLICANT'S HIGH SCHOOL COURSES AND GRADES, RESULTS OF SUPPLEMENTAL TEST, ORGINAL WRITTEN PAPER STATING WHY A PARTICULAR COURSE OF STUDY AND FUTURE WORK WAS CHOSEN.
    cAny submission deadlines:
    APRIL 15
    dAny restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other
    factors:
    THE AWARDS ARE INTENDED TO ASSIST QUALIFIED STUDENTS WHO ARE RESIDENTS OF CALDWELL COUNTY, NC. THE AWARDS WILL BE MADE ONLY FOR ATTENDANCE AT AN ACCREDITED COLLEGE OR UNIVERSITY OF THE APPLICANT'S CHOICE PROVIDED IT IS A MEMBER OF THE SOUTHERN ASSOCIATION OF COLLEGES AND SECONDARY SCHOOLS OR THE EQUIVALENT. THE PURPOSE OF THIS REQUIREMENT IS TO SELECT STUDENTS WHO WISH TO ATTEND, AND ARE CAPABLE OF ATTENDING, BONA FIDE ACCREDITED COLLEGES AND UNIVERSITIES. THE COFFEY FOUNDATION AWARDS ARE SCHOLARSHIPS AND LOANS TO PAY FOR DIRECTLY RELATED EDUCATIONAL EXPENSES OF ATTENDING SUCH COLLEGES AND UNIVERSITIES. IT IS THE INTENTION OF THE FOUNDATION THAT THESE AWARDS WILL BE MADE IN AN AMOUNT TO PAY TUITION AND OTHER DIRECT EDUCATIONAL EXPENSES NECESSARY FOR A STUDENT TO COMPLETE HIS FOUR YEARS OF COLLEGE EDUCATION. HOWEVER, EACH AWARD IS SUBJECT TO AN ANNUAL REVIEW BY THE SELECTION COMMITTEE.
    Form 990-PF (2021)
    Form 990-PF (2021)
    Page 11
    Part XIV
    Supplementary Information (continued)
    3 Grants and Contributions Paid During the Year or Approved for Future Payment
    Recipient If recipient is an individual,
    show any relationship to
    any foundation manager
    or substantial contributor
    		 Foundation
    status of
    recipient     		Purpose of grant or
    contribution     		Amount
    Name and address (home or business)
    aPaid during the year
    UNC CHAPEL HILL - ABIGAIL SOPHIA FLERI
    223 TAYLOR CR
    GRANITE FALLS,NC28630     		N/A N/A COLLEGE SCHOLARSHIPS 6,000
    UNC CHAPEL HILL - ADDYSON PAIGE THOMAS
    412 NORWOOD ST SW
    LENOIR,NC28645     		N/A N/A COLLEGE SCHOLARSHIPS 8,000
    APPALACHIAN STATE UNIVERSITY - ALYSSA DANIELLE MCMASTERS
    2594 PISGAH CHURCH RD
    LENOIR,NC28645     		N/A N/A COLLEGE SCHOLARSHIPS 8,000
    BRYN MAWR COLLEGE - AUTUMN ELIZABETH SOOTS
    1743 STILL MEADOW LN
    LENOIR,NC28645     		N/A N/A COLLEGE SCHOLARSHIPS 4,000
    APPALACHIAN STATE UNIVERSITY - BRODY MICHAEL MILLER
    4090 NAVAJO WAY
    LENOIR,NC28645     		N/A N/A COLLEGE SCHOLARSHIPS 4,000
    GARDNER-WEBB UNIVERSITY - CALEB LEE COOK
    3386 HARVARD PI
    HUDSON,NC28638     		N/A N/A COLLEGE SCHOLARSHIPS 4,000
    UNC WILMINGTON - ELISE ARIEL MITCHELL
    5042 TAYLOR FARM RD
    LENOIR,NC28645     		N/A N/A COLLEGE SCHOLARSHIPS 4,000
    DUKE UNIVERSITY - ELYSE CAROLINE DEMAS
    5567 SERENE PLACE
    GRANITE FALLS,NC28630     		N/A N/A COLLEGE SCHOLARSHIPS 4,000
    WESTERN CAROLINA UNIVERSITY - FRANKLIN LEE HAAS
    917 PENNELL ST
    LENOIR,NC28645     		N/A N/A COLLEGE SCHOLARSHIPS 6,000
    UNC CHAPEL HILL - HAYLEA ALEXIS LEDBETTER
    4083 BURL ST
    HUDSON,NC28638     		N/A N/A COLLEGE SCHOLARSHIPS 8,000
    APPALACHIAN STATE UNIVERSITY - INDIA MARIE HORN
    409 HIBRITEN AVE SW
    LENOIR,NC28645     		N/A N/A COLLEGE SCHOLARSHIPS 4,000
    WESTERN CAROLINA UNIVERSITY - JACQUELYN ZELAYA
    3 CIRCLE ST APT 4
    GRANITE FALLS,NC28630     		N/A N/A COLLEGE SCHOLARSHIPS 4,000
    APPALACHIAN STATE UNIVERSITY - JAMES OWEN INGRAM
    5344 LAKEWOOD DR
    GRANITE FALLS,NC28630     		N/A N/A COLLEGE SCHOLARSHIPS 8,000
    UNC CHARLOTTE - JORDAN DALTON BOWMAN
    3290 CAPITAL CT
    LENOIR,NC28645     		N/A N/A COLLEGE SCHOLARSHIPS 8,000
    UNC CHAPEL HILL - JUSTIN RILEY SMITH
    1781 BUSHWOOD CT
    LENOIR,NC28645     		N/A N/A COLLEGE SCHOLARSHIPS 8,000
    EMBRY RIDDLE AERONAUTICAL UNIVERSITY - KATHERINE ELIZABETH CLARK
    101 FOOTHILLS DR
    LENOIR,NC28645     		N/A N/A COLLEGE SCHOLARSHIPS 8,000
    UNC CHAPEL HILL - KATHRYN DIANE WHISNANT
    723 SEVERT CIRCLE
    LENOIR,NC28645     		N/A N/A COLLEGE SCHOLARSHIPS 8,000
    UNC CHAPEL HILL - KENLEY MAUREN YOUNT
    414 PENWOOD ST
    LENOIR,NC28645     		N/A N/A COLLEGE SCHOLARSHIPS 6,000
    BALDWIN WALLACE UNIVERSITY - LILLIA JEWEL CHAPMAN
    5804 ELLENWOOD RD
    GRANITE FALLS,NC28630     		N/A N/A COLLEGE SCHOLARSHIPS 8,000
    UNC WILMINGTON - MARY CATHERINE FORD
    2971 MORGANTON BLVD SW
    LENOIR,NC28645     		N/A N/A COLLEGE SCHOLARSHIPS 8,000
    NC STATE UNIVERSITY - MASON CARTER LEWIS
    6238 MOUNTAINSIDE DR
    HICKORY,NC28601     		N/A N/A COLLEGE SCHOLARSHIPS 4,000
    APPALACHIAN STATE UNIVERSITY - MATTHEW CHRISTOPHER GROGAN
    4729 HORSESHOE BEND RD
    HUDSON,NC28638     		N/A N/A COLLEGE SCHOLARSHIPS 8,000
    UNC WILMINGTON - MOLLIE GRACE CHURCH
    5296 MOORE ACRES DR
    GRANITE FALLS,NC28630     		N/A N/A COLLEGE SCHOLARSHIPS 4,000
    UNC CHAPEL HILL - NATALIE LAUREN CLARK
    1734 ORCHARD DRIVE
    LENOIR,NC28645     		N/A N/A COLLEGE SCHOLARSHIPS 8,000
    APPALACHIAN STATE UNIVERSITY - NICHOLAS RICHARD PILATO
    16 TIMOTHY LANE
    GRANITE FALLS,NC28630     		N/A N/A COLLEGE SCHOLARSHIPS 4,000
    APPALACHIAN STATE UNIVERSITY - PAUL JACOB NORWOOD
    1012 WOODBINE PL NE
    LENOIR,NC28645     		N/A N/A COLLEGE SCHOLARSHIPS 8,000
    UNC CHAPEL HILL - QUINTEN WALKER CURTIS
    147 WINWOOD CIRCLE
    GRANITE FALLS,NC28630     		N/A N/A COLLEGE SCHOLARSHIPS 8,000
    UNC CHAPEL HILL - RACHEL KRIPNER
    1844 CONNELLY SPRINGS RD
    LENOIR,NC28645     		N/A N/A COLLEGE SCHOLARSHIPS 8,000
    NC STATE UNIVERSITY - RACHEL STEPHANIE HAGEN
    410 PENNTON AVE SW
    LENOIR,NC28645     		N/A N/A COLLEGE SCHOLARSHIPS 4,000
    ST JOHN'S UNIVERSITY - RILEY JAMES HOUCK
    606 IVY ST
    HUDSON,NC28638     		N/A N/A COLLEGE SCHOLARSHIPS 6,000
    APPALACHIAN STATE UNIVERSITY - SAVANNAH DAWN STEWART
    2321 GOOD SHEPARD CT
    LENOIR,NC28645     		N/A N/A COLLEGE SCHOLARSHIPS 6,000
    WAKE FOREST UNIVERSITY - SAVANNAH MACKENZIE LONGO
    9041 ARNEY ESTATE
    CONNELLY SPRINGS,NC28621     		N/A N/A COLLEGE SCHOLARSHIPS 8,000
    UNC CHAPEL HILL - SIMON TIMOTHY HAWKINS
    1206 QUEEN ANNE CT
    LENOIR,NC28645     		N/A N/A COLLEGE SCHOLARSHIPS 4,000
    UNC CHAPEL HILL - SYDNEY TAYLOR PROPST
    5357 BEACON RIDGE DR
    GRANITE FALLS,NC28630     		N/A N/A COLLEGE SCHOLARSHIPS 8,000
    NC STATE UNIVERSITY - ZARINA SANTOS VILLACORTE
    5365 BEACON RIDGE DR
    GRANITE FALLS,NC28630     		N/A N/A COLLEGE SCHOLARSHIPS 4,000
    INDIVIDUAL GRANT - MCKENNA ALYSE LOWE
    2105 PIPER RIDGE DR
    LENOIR,NC28645     		N/A N/A COLLEGE SCHOLARSHIPS 1,000
    INDIVIDUAL GRANT - JACK THOMAS HILLIS
    2113 PIPER RIDGE DR
    LENOIR,NC28645     		N/A N/A COLLEGE SCHOLARSHIPS 1,000
    INDIVIDUAL GRANT - AVERY LYNETTE GILBERT
    603 STONECROFT CT SE
    LENOIR,NC28645     		N/A N/A COLLEGE SCHOLARSHIPS 1,000
    INDIVIDUAL GRANT - ADDISON LAINE BURNS
    4011 MEADOW CIRCLE
    LENOIR,NC28645     		N/A N/A COLLEGE SCHOLARSHIPS 1,000
    INDIVIDUAL GRANT - KEIRA MORGAN ANDREWS
    914 BARRINGTON DR
    LENOIR,NC28645     		N/A N/A COLLEGE SCHOLARSHIPS 1,000
    INDIVIDUAL GRANT - LANA GRACE MCCALL
    3231 CHRISTIE ROAD
    HUDSON,NC28638     		N/A N/A COLLEGE SCHOLARSHIPS 1,000
    INDIVIDUAL GRANT - WILLIAM ASHER MEARNS
    31 FALLS AVE
    GRANITE FALLS,NC28630     		N/A N/A COLLEGE SCHOLARSHIPS 1,000
    INDIVIDUAL GRANT - MICHAEL MESA
    166 EASTVIEW ST
    HUDSON,NC28638     		N/A N/A COLLEGE SCHOLARSHIPS 1,000
    INDIVIDUAL GRANT - ABIGAIL GRACE BRASWELL
    3185 COVINGTON WAY
    LENOIR,NC28645     		N/A N/A COLLEGE SCHOLARSHIPS 2,000
    INDIVIDUAL GRANT - MEREDITH LEIGH PENNELL
    4385 GROVER PLACE
    GRANITE FALLS,NC28630     		N/A N/A COLLEGE SCHOLARSHIPS 2,000
    INDIVIDUAL GRANT - SARAH GRACE ARNOLD
    17 TIMOTHY LANE
    GRANITE FALLS,NC28630     		N/A N/A COLLEGE SCHOLARSHIPS 2,000
    INDIVIDUAL GRANT - LEAH JIAO BOFF
    5781 KAYLEE ANN DRIVE
    GRANITE FALLS,NC28630     		N/A N/A COLLEGE SCHOLARSHIPS 2,000
    INDIVIDUAL GRANT - CHARLES JEFFREY HAGAMAN
    4703 MCCALL TOWN RD
    GRANITE FALLS,NC28630     		N/A N/A COLLEGE SCHOLARSHIPS 2,000
    INDIVIDUAL GRANT - ANNA KATHERINE HOWARD
    5311 BEACON RIDGE DR
    GRANITE FALLS,NC28630     		N/A N/A COLLEGE SCHOLARSHIPS 2,000
    INDIVIDUAL GRANT - CASSIDY MARIE LOWE
    2105 PIPER RIDGE DRIVE
    LENOIR,NC28645     		N/A N/A COLLEGE SCHOLARSHIPS 2,000
    INDIVIDUAL GRANT - NOAH ROBERT POWELL
    863 CHEROKEE PL SW
    LENOIR,NC28645     		N/A N/A COLLEGE SCHOLARSHIPS 2,000
    INDIVIDUAL GRANT - NATHANIEL NEWBURY WRIGHT
    1177 EMMANUEL BARN LANE
    LENOIR,NC28645     		N/A N/A COLLEGE SCHOLARSHIPS 2,000
    CALDWELL ARTS COUNCIL
    PO BOX 1613
    LENOIR,NC28645     		N/A 501(C)(3) THE CONTRIBUTIONS ARE NOT CONTROLLED BY THE FOUNDATION BUT BY THE RECIPIENTS 5,000
    CALDWELL COUNTY HABITAT FOR HUMANITY
    PO BOX 1341
    LENOIR,NC28645     		N/A 501(C)(3) THE CONTRIBUTIONS ARE NOT CONTROLLED BY THE FOUNDATION BUT BY THE RECIPIENTS 19,770
    CALDWELL COUNTY YOKEFELLOW
    PO BOX 2422
    LENOIR,NC28645     		N/A 501(C)(3) THE CONTRIBUTIONS ARE NOT CONTROLLED BY THE FOUNDATION BUT BY THE RECIPIENTS 26,350
    CALDWELL COUNTY YOKEFELLOW - LEO'S PLACE
    PO BOX 2422
    LENOIR,NC28645     		N/A 501(C)(3) THE CONTRIBUTIONS ARE NOT CONTROLLED BY THE FOUNDATION BUT BY THE RECIPIENTS 13,140
    CALDWELL FRIENDS
    PO BOX 2784
    LENOIR,NC28645     		N/A 501(C)(3) THE CONTRIBUTIONS ARE NOT CONTROLLED BY THE FOUNDATION BUT BY THE RECIPIENTS 2,000
    CALDWELL HERITAGE MUSEUM
    112 VAIDEN ST SW
    LENOIR,NC28645     		N/A 501(C)(3) THE CONTRIBUTIONS ARE NOT CONTROLLED BY THE FOUNDATION BUT BY THE RECIPIENTS 6,600
    CALDWELL HOUSE INC
    951 KENHAM PLACE
    LENOIR,NC28645     		N/A 501(C)(3) THE CONTRIBUTIONS ARE NOT CONTROLLED BY THE FOUNDATION BUT BY THE RECIPIENTS 7,925
    CALDWELL PEOPLE
    1010 FROSTY LANE
    LENOIR,NC28645     		N/A 501(C)(3) THE CONTRIBUTIONS ARE NOT CONTROLLED BY THE FOUNDATION BUT BY THE RECIPIENTS 3,975
    CALDWELL SENIOR CENTER
    PO BOX 933
    LENOIR,NC28645     		N/A 501(C)(3) THE CONTRIBUTIONS ARE NOT CONTROLLED BY THE FOUNDATION BUT BY THE RECIPIENTS 3,000
    COMMUNITIES IN SCHOOLS
    PO BOX 959
    LENOIR,NC28645     		N/A 501(C)(3) THE CONTRIBUTIONS ARE NOT CONTROLLED BY THE FOUNDATION BUT BY THE RECIPIENTS 11,860
    CROSSNORE SCHOOL INC
    PO BOX 249
    CROSSNORE,NC28616     		N/A 501(C)(3) THE CONTRIBUTIONS ARE NOT CONTROLLED BY THE FOUNDATION BUT BY THE RECIPIENTS 2,635
    FOUNDATION OF CALDWELL COMMUNITY COLLEGE
    PO BOX 600
    LENOIR,NC28645     		N/A 501(C)(3) THE CONTRIBUTIONS ARE NOT CONTROLLED BY THE FOUNDATION BUT BY THE RECIPIENTS 25,000
    HELPING HANDS CLINIC
    810 HARPER AVE
    LENOIR,NC28645     		N/A 501(C)(3) THE CONTRIBUTIONS ARE NOT CONTROLLED BY THE FOUNDATION BUT BY THE RECIPIENTS 13,180
    JAMES C HARPER SCHOOL OF PERFORMING ARTS
    PO BOX 390
    LENOIR,NC28645     		N/A 501(C)(3) THE CONTRIBUTIONS ARE NOT CONTROLLED BY THE FOUNDATION BUT BY THE RECIPIENTS 7,000
    LEES-MCRAE COLLEGE
    PO BOX 128
    BANNER ELK,NC28604     		N/A 501(C)(3) THE CONTRIBUTIONS ARE NOT CONTROLLED BY THE FOUNDATION BUT BY THE RECIPIENTS 3,000
    LENOIR SOUP KITCHEN
    PO BOX 1054
    LENOIR,NC28645     		N/A 501(C)(3) THE CONTRIBUTIONS ARE NOT CONTROLLED BY THE FOUNDATION BUT BY THE RECIPIENTS 10,550
    ROBIN'S NEST
    PO BOX 646
    LENOIR,NC28645     		N/A 501(C)(3) THE CONTRIBUTIONS ARE NOT CONTROLLED BY THE FOUNDATION BUT BY THE RECIPIENTS 5,275
    SHELTER HOME OF CALDWELL COUNTY
    PO BOX 426
    LENOIR,NC28645     		N/A 501(C)(3) THE CONTRIBUTIONS ARE NOT CONTROLLED BY THE FOUNDATION BUT BY THE RECIPIENTS 6,600
    SOUTH CALDWELL CHRISTIAN MINISTRIES
    PO BOX 359
    GRANITE FALLS,NC28630     		N/A 501(C)(3) THE CONTRIBUTIONS ARE NOT CONTROLLED BY THE FOUNDATION BUT BY THE RECIPIENTS 13,140
    Total .................................bullet 3a 430,000
    bApproved for future payment
    Total .................................bullet 3b 0
    Form 990-PF (2021)
    Form 990-PF (2021)
    Page 12
    Part XV-A
    Analysis of Income-Producing Activities
    Enter gross amounts unless otherwise indicated. Unrelated business income Excluded by section 512, 513, or 514 (e)
    Related or exempt
    function income
    (See instructions.)
    1Program service revenue: (a)
    Business code     		(b)
    Amount     		(c)
    Exclusion code     		(d)
    Amount
    a
    b
    c
    d
    e
    f
    gFees and contracts from government agencies          
    2 Membership dues and assessments ....          
    3 Interest on savings and temporary cash
    investments ...........     		         
    4 Dividends and interest from securities ....          
    5 Net rental income or (loss) from real estate:
    aDebt-financed property......          
    bNot debt-financed property.....          
    6 Net rental income or (loss) from personal property          
    7 Other investment income .....          
    8 Gain or (loss) from sales of assets other than
    inventory ............     		    18 348,664  
    9 Net income or (loss) from special events:          
    10 Gross profit or (loss) from sales of inventory          
    11 Other revenue:
    aMISCELLANEOUS     		    01 50  
    b
    c
    d
    e
    12 Subtotal. Add columns (b), (d), and (e) .. 0 569,892 0
    13Total. Add line 12, columns (b), (d), and (e)..................
    13
    569,892
    (See worksheet in line 13 instructions to verify calculations.)
    Part XV-B
    Relationship of Activities to the Accomplishment of Exempt Purposes
    Line No.
    DownArrow     		Explain below how each activity for which income is reported in column (e) of Part XV-A contributed importantly to
    the accomplishment of the foundation’s exempt purposes (other than by providing funds for such purposes). (See
    instructions.)
    8 PROVIDES INCOME FOR PROGRAM ACTIVITIES
    Form 990-PF (2021)
    Form 990-PF (2021)
    Page 13
    Part XVI
    Information Regarding Transfers To and Transactions and Relationships With Noncharitable Exempt Organizations
    1
    Did the organization directly or indirectly engage in any of the following with any other organization described in section 501(c) (other than section 501(c)(3) organizations) or in section 527, relating to political organizations?
    Yes
    No
    a
    Transfers from the reporting foundation to a noncharitable exempt organization of:
    (1) Cash...................................
    1a(1)
     
    No
    (2) Other assets.................................
    1a(2)
     
    No
    b
    Other transactions:
    (1) Sales of assets to a noncharitable exempt organization....................
    1b(1)
     
    No
    (2) Purchases of assets from a noncharitable exempt organization..................
    1b(2)
     
    No
    (3) Rental of facilities, equipment, or other assets.......................
    1b(3)
     
    No
    (4) Reimbursement arrangements...........................
    1b(4)
     
    No
    (5) Loans or loan guarantees.............................
    1b(5)
     
    No
    (6) Performance of services or membership or fundraising solicitations................
    1b(6)
     
    No
    c
    Sharing of facilities, equipment, mailing lists, other assets, or paid employees..............
    1c
     
    No
    d
    If the answer to any of the above is "Yes," complete the following schedule. Column (b) should always show the fair market value
    of the goods, other assets, or services given by the reporting foundation. If the foundation received less than fair market value
    in any transaction or sharing arrangement, show in column (d) the value of the goods, other assets, or services received.
    (a) Line No. (b) Amount involved (c) Name of noncharitable exempt organization (d) Description of transfers, transactions, and sharing arrangements
    2a
    Is the foundation directly or indirectly affiliated with, or related to, one or more tax-exempt organizations
    described in section 501(c) (other than section 501(c)(3)) or in section 527? ...........
    b
    If "Yes," complete the following schedule.

    (a) Name of organization (b) Type of organization (c) Description of relationship
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    Signature of officer or trustee Date Title
    Paid Preparer Use Only Print/Type preparer's name Preparer's Signature Date PTIN
    Firm's name SmallBullet
    		 Firm's EIN SmallBullet
    Firm's address SmallBullet


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


    Software ID:  
    Software Version:  


    Form 990PF - Special Condition Description:
    Special Condition Description

    TY 2021 AccountingFeesSchedule
    Name:
    THE COFFEY FOUNDATION INC
    EIN:
    56-6047501
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    ACCOUNTING FEES 11,000 11,000   0

    TY 2021 InvestmentsOtherSchedule2
    Name:
    THE COFFEY FOUNDATION INC
    EIN:
    56-6047501
    Category/ Item Listed at Cost or FMV Book Value End of Year Fair Market Value
    MERRILL LYNCH FMV 7,339,854 7,397,436

    TY 2021 OtherDecreasesSchedule
    Name:
    THE COFFEY FOUNDATION INC
    EIN:
    56-6047501
    Description Amount
    NET ASSET ADJUSTMENT 13,768


    TY 2021 OtherExpensesSchedule
    Name:
    THE COFFEY FOUNDATION INC
    EIN:
    56-6047501
    Description Revenue and Expenses per Books Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    COMMISSIONS AND FEES 56,554 56,554   0
    SCHOLARSHIP DINNER 1,873 0   1,873
    OFFICE EXPENSES 404 0   404
    MISCELLANEOUS 2,118 0   2,118


    TY 2021 OtherIncomeSchedule2
    Name:
    THE COFFEY FOUNDATION INC
    EIN:
    56-6047501
    Description Revenue And Expenses Per Books Net Investment Income Adjusted Net Income
    MISCELLANEOUS 50 50 50


    TY 2021 OtherProfessionalFeesSchedule
    Name:
    THE COFFEY FOUNDATION INC
    EIN:
    56-6047501
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    BOOKKEEPING SERVICES 11,850 11,850   0
    OTHER PROFESSIONAL FEES 969 969   0