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 11-01-2021 , and ending 10-31-2022
Name of foundation
Dollens Family Foundation
 
% Ronald Dollens
Number and street (or P.O. box number if mail is not delivered to street address)9701 Soaring Hawk Circle
  Room/suite
City or town, state or province, country, and ZIP or foreign postal code
Zionsville, IN46077
A Employer identification number

35-2000508
B Telephone number (see instructions)

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$376,208J 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) 281,255
2 Check bullet.............
3 Interest on savings and temporary cash investments 146 146  
4 Dividends and interest from securities... 8,307 8,307  
5a Gross rents............      
b Net rental income or (loss)  
6a Net gain or (loss) from sale of assets not on line 10 Click to see attachment 3,305
b Gross sales price for all assets on line 6a 144,275
7 Capital gain net income (from Part IV, line 2)... 0
8 Net short-term capital gain.........  
9 Income modifications...........  
10a Gross sales less returns and allowances  
b Less: Cost of goods sold....  
c Gross profit or (loss) (attach schedule).....    
11 Other income (attach schedule).......      
12 Total. Add lines 1 through 11........ 293,013 8,453  
Operating and Administrative Expenses 13 Compensation of officers, directors, trustees, etc.        
14 Other employee salaries and wages......        
15 Pension plans, employee benefits.......        
16a Legal fees (attach schedule).........        
b Accounting fees (attach schedule).......        
c Other professional fees (attach schedule).... Click to see attachment 5,334 5,334 5,334  
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).......        
24 Total operating and administrative expenses.
Add lines 13 through 23.......... 5,334 5,334 5,334 0
25 Contributions, gifts, grants paid....... 172,389 172,389
26 Total expenses and disbursements. Add lines 24 and 25 177,723 5,334 5,334 172,389
27 Subtract line 26 from line 12:
a Excess of revenue over expenses and disbursements 115,290
b Net investment income (if negative, enter -0-) 3,119
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............. 14,428 19,729 19,729
2 Savings and temporary cash investments......... 7,542    
3 Accounts receivable bullet  
Less: allowance for doubtful accounts bullet        
4 Pledges receivable bullet  
Less: allowance for doubtful accounts bullet        
5 Grants receivable.................      
6 Receivables due from officers, directors, trustees, and other
disqualified persons (attach schedule) (see instructions).....      
7 Other notes and loans receivable (attach schedule) bullet  
Less: allowance for doubtful accounts bullet        
8 Inventories for sale or use..............      
9 Prepaid expenses and deferred charges..........      
10a Investments—U.S. and state government obligations (attach schedule)      
b Investments—corporate stock (attach schedule)....... 261,394 Click to see attachment379,330 356,479
c Investments—corporate bonds (attach schedule).......      
11 Investments—land, buildings, and equipment: basis bullet  
Less: accumulated depreciation (attach schedule) bullet        
12 Investments—mortgage loans.............      
13 Investments—other (attach schedule)..........      
14 Land, buildings, and equipment: basis bullet  
Less: accumulated depreciation (attach schedule) bullet        
15 Other assets (describe bullet)      
16 Total assets (to be completed by all filers—see the
instructions. Also, see page 1, item I) 283,364 399,059 376,208
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
Net Assets or Fund Balances Foundations that follow FASB ASC 958, check here bullet
and complete lines 24, 25, 29 and 30.
24 Net assets without donor restrictions...........    
25 Net assets with donor restrictions............    
Foundations that do not follow FASB ASC 958, check here bullet
and complete lines 26 through 30.
26 Capital stock, trust principal, or current funds........    
27 Paid-in or capital surplus, or land, bldg., and equipment fund    
28 Retained earnings, accumulated income, endowment, or other funds 283,364 399,059
29 Total net assets or fund balances (see instructions)..... 283,364 399,059
30 Total liabilities and net assets/fund balances (see instructions). 283,364 399,059
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
283,364
2
Enter amount from Part I, line 27a .....................
2
115,290
3
Other increases not included in line 2 (itemize) bulletClick to see attachment
3
405
4
Add lines 1, 2, and 3 ..........................
4
399,059
5
Decreases not included in line 2 (itemize) bullet
5
 
6
Total net assets or fund balances at end of year (line 4 minus line 5)—Part II, column (b), line 29 .
6
399,059
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.)
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 (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
b
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  
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  
3 Add lines 1 and 2........................... 3 43
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 43
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 200
d Backup withholding erroneously withheld ........... 6d  
7 Total credits and payments. Add lines 6a through 6d.............. Part VI Line 7 - Tax Paid with the Original Return: 200 7 200
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.......Bullet 9  
10 Overpayment. If line 7 is more than the total of lines 5 and 8, enter the amount overpaid...Bullet 10 157
11 Enter the amount of line 10 to be: Credited to 2022 estimated taxBullet157 RefundedBullet 11  
Part VI-A
Statements Regarding Activities
1a
During the tax year, did the foundation attempt to influence any national, state, or local legislation or did
Yes
No
it participate or intervene in any political campaign? ....................
1a
 
No
b
Did it spend more than $100 during the year (either directly or indirectly) for political purposes? See the instructions
for the definition.................................
1b
 
No
If the answer is "Yes" to 1a or 1b, attach a detailed description of the activities and copies of any materials
published or distributed by the foundation in connection with the activities.
c
Did the foundation file Form 1120-POL for this year?.....................
1c
 
No
d
Enter the amount (if any) of tax on political expenditures (section 4955) imposed during the year:
(1) On the foundation. bullet$   (2) On foundation managers.bullet$  
e
Enter the reimbursement (if any) paid by the foundation during the year for political expenditure tax imposed
on foundation managers.bullet$  
2
Has the foundation engaged in any activities that have not previously been reported to the IRS?.......
2
 
No
If "Yes," attach a detailed description of the activities.
3
Has the foundation made any changes, not previously reported to the IRS, in its governing instrument, articles
of incorporation, or bylaws, or other similar instruments? If "Yes," attach a conformed copy of the changes....
3
 
No
4a
Did the foundation have unrelated business gross income of $1,000 or more during the year?.........
4a
 
No
b
If "Yes," has it filed a tax return on Form 990-T for this year?...................
4b
 
 
5
Was there a liquidation, termination, dissolution, or substantial contraction during the year?.........
5
 
No
If "Yes," attach the statement required by General Instruction T.
6
Are the requirements of section 508(e) (relating to sections 4941 through 4945) satisfied either:
  • By language in the governing instrument, or
  • By state legislation that effectively amends the governing instrument so that no mandatory directions
    • that conflict with the state law remain in the governing instrument?................
    6
    Yes
     
    7
    Did the foundation have at least $5,000 in assets at any time during the year? If "Yes," complete Part II, col. (c),
    and Part XIV..................................
    7
    Yes
     
    8a
    Enter the states to which the foundation reports or with which it is registered (see instructions)
    bullet
    b
    If the answer is "Yes" to line 7, has the foundation furnished a copy of Form 990-PF to the Attorney
    General (or designate) of each state as required by General Instruction G? If "No," attach explanation .
    8b
    Yes
     
    9
    Is the foundation claiming status as a private operating foundation within the meaning of section 4942(j)(3)
    or 4942(j)(5) for calendar year 2021 or the taxable year beginning in 2021? See the instructions for Part XIII.
    If "Yes," complete Part XIII .............................
    9
     
    No
    10
    Did any persons become substantial contributors during the tax year? If "Yes," attach a schedule listing their names
    and addresses. ...............................
    10
     
    No
    Form 990-PF (2021)
    Form 990-PF (2021)
    Page 5
    Part VI-A
    Statements Regarding Activities (continued)
    11
    At any time during the year, did the foundation, directly or indirectly, own a controlled entity within the
    meaning of section 512(b)(13)? If "Yes," attach schedule. See instructions .............
    11
     
    No
    12
    Did the foundation make a distribution to a donor advised fund over which the foundation or a disqualified person had
    advisory privileges? If "Yes," attach statement. See instructions.................
    12
     
    No
    13
    Did the foundation comply with the public inspection requirements for its annual returns and exemption application?
    13
    Yes
     
    Website addressbullet  
    14
    The books are in care ofbulletRonald Dollens Telephone no.bullet (561) 389-7228

    Located atbullet9701 Soaring Hawk CircleZionsvilleIN ZIP+4bullet46077
    15
    Section 4947(a)(1) nonexempt charitable trusts filing Form 990-PF in lieu of Form 1041 —check here .........bullet
    and enter the amount of tax-exempt interest received or accrued during the year ........bullet
    15
     
    16 At any time during calendar year 2021, did the foundation have an interest in or a signature or other authority over YesNo
    a bank, securities, or other financial account in a foreign country? .................
    16   No
    See the instructions for exceptions and filing requirements for FinCEN Form 114. If "Yes", enter the name of the foreign
    country bullet
    Part VI-B
    Statements Regarding Activities for Which Form 4720 May Be Required
    File Form 4720 if any item is checked in the "Yes" column, unless an exception applies.
    Yes
    No
    1a
    During the year did the foundation (either directly or indirectly):
    (1) Engage in the sale or exchange, or leasing of property with a disqualified person? ...........
    1a(1)
     
    No
    (2) Borrow money from, lend money to, or otherwise extend credit to (or accept it from)
    a disqualified person? ..............................
    1a(2)
     
    No
    (3) Furnish goods, services, or facilities to (or accept them from) a disqualified person? ...........
    1a(3)
     
    No
    (4) Pay compensation to, or pay or reimburse the expenses of, a disqualified person? ............
    1a(4)
     
    No
    (5) Transfer any income or assets to a disqualified person (or make any of either available
    for the benefit or use of a disqualified person)? ......................
    1a(5)
     
    No
    (6) Agree to pay money or property to a government official? (Exception. Check "No"
    if the foundation agreed to make a grant to or to employ the official for a period
    after termination of government service, if terminating within 90 days.) ...............
    1a(6)
     
    No
    b
    If any answer is "Yes" to 1a(1)–(6), did any of the acts fail to qualify under the exceptions described in Regulations
    section 53.4941(d)-3 or in a current notice regarding disaster assistance? See instructions ..........
    1b
     
     
    c
    ........bullet
    d
    Did the foundation engage in a prior year in any of the acts described in 1a, other than excepted acts,
    that were not corrected before the first day of the tax year beginning in 2021? .............
    1d
     
    No
    2
    Taxes on failure to distribute income (section 4942) (does not apply for years the foundation was a private
    operating foundation defined in section 4942(j)(3) or 4942(j)(5)):
    a
    At the end of tax year 2021, did the foundation have any undistributed income (lines 6d
    and 6e, Part XII) for tax year(s) beginning before 2021?....................
    2a
     
    No
    If "Yes," list the years bullet20, 20, 20, 20
    b
    Are there any years listed in 2a for which the foundation is not applying the provisions of section 4942(a)(2)
    (relating to incorrect valuation of assets) to the year’s undistributed income? (If applying section 4942(a)(2)
    to all years listed, answer "No" and attach statement—see instructions.) ..............
    2b
     
     
    c
    If the provisions of section 4942(a)(2) are being applied to any of the years listed in 2a, list the years here.
    bullet20, 20, 20, 20
    3a
    Did the foundation hold more than a 2% direct or indirect interest in any business enterprise at
    any time during the year? ..............................
    3a
     
    No
    b
    If "Yes," did it have excess business holdings in 2021 as a result of (1) any purchase by the foundation
    or disqualified persons after May 26, 1969; (2) the lapse of the 5-year period (or longer period approved
    by the Commissioner under section 4943(c)(7)) to dispose of holdings acquired by gift or bequest; or (3)
    the lapse of the 10-, 15-, or 20-year first phase holding period? (Use Schedule C, Form 4720, to determine
    if the foundation had excess business holdings in 2021.) .....................
    3b
     
     
    4a
    Did the foundation invest during the year any amount in a manner that would jeopardize its charitable purposes?
    4a
     
    No
    b
    Did the foundation make any investment in a prior year (but after December 31, 1969) that could jeopardize its
    charitable purpose that had not been removed from jeopardy before the first day of the tax year beginning in 2021? ..
    4b
     
    No
    Form 990-PF (2021)
    Form 990-PF (2021)
    Page 6
    Part VI-B
    Statements Regarding Activities for Which Form 4720 May Be Required (continued)
    5a
    During the year did the foundation pay or incur any amount to:
    Yes
    No
    (1) Carry on propaganda, or otherwise attempt to influence legislation (section 4945(e))? ..........
    5a(1)
     
    No
    (2) Influence the outcome of any specific public election (see section 4955); or to carry
    on, directly or indirectly, any voter registration drive? ....................
    5a(2)
     
    No
    (3) Provide a grant to an individual for travel, study, or other similar purposes? .............
    5a(3)
     
    No
    (4) Provide a grant to an organization other than a charitable, etc., organization described
    in section 4945(d)(4)(A)? See instructions ........................
    5a(4)
     
    No
    (5) Provide for any purpose other than religious, charitable, scientific, literary, or
    educational purposes, or for the prevention of cruelty to children or animals? .............
    5a(5)
     
    No
    b
    If any answer is "Yes" to 5a(1)–(5), did any of the transactions fail to qualify under the exceptions described in
    Regulations section 53.4945 or in a current notice regarding disaster assistance? See instructions ........
    5b
     
     
    c
    .........bullet
    d
    If the answer is "Yes" to question 5a(4), does the foundation claim exemption from the
    tax because it maintained expenditure responsibility for the grant? .................
    5d
     
     
    If "Yes," attach the statement required by Regulations section 53.4945–5(d).
    6a
    Did the foundation, during the year, receive any funds, directly or indirectly, to pay premiums on
    a personal benefit contract? .............................
    6a
     
    No
    b
    Did the foundation, during the year, pay premiums, directly or indirectly, on a personal benefit contract? ....
    6b
     
    No
    If "Yes" to 6b, file Form 8870.
    7a
    At any time during the tax year, was the foundation a party to a prohibited tax shelter transaction?
    7a
     
    No
    b
    If "Yes", did the foundation receive any proceeds or have any net income attributable to the transaction? .....
    7b
     
     
    8
    Is the foundation subject to the section 4960 tax on payment(s) of more than $1,000,000 in remuneration or
    excess parachute payment during the year? .........................
    8
     
    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
    Ronald Dollens Director
    001.00     		0    
    9701 Soaring Hawk Circle
    Zionsville,IN46077
    Susan Dollens Director
    001.00     		0    
    9701 Soaring Hawk Circle
    Zionsville,IN46077
    Stephanie Pryor Director
    001.00     		0    
    9701 Soaring Hawk Circle
    Zionsville,IN46077
    W Grant Dollens Director
    001.00     		0    
    9701 Soaring Hawk Circle
    Zionsville,IN46077
    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
     
    Total number of other employees paid over $50,000...................bullet  
    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
     
    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  
    2  
    3  
    4  
    Part VIII-B
    Summary of Program-Related Investments (see instructions)
    Describe the two largest program-related investments made by the foundation during the tax year on lines 1 and 2. Amount
    1  
    2  
    All other program-related investments. See instructions.
    3  
    Total. Add lines 1 through 3.........................bullet  
    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
    401,479
    b
    Average of monthly cash balances.......................
    1b
    91,164
    c
    Fair market value of all other assets (see instructions)................
    1c
    0
    d
    Total (add lines 1a, b, and c).........................
    1d
    492,643
    e
    Reduction claimed for blockage or other factors reported on lines 1a and
    1c (attach detailed explanation) .............
    1e
     
    2
    Acquisition indebtedness applicable to line 1 assets..................
    2
     
    3
    Subtract line 2 from line 1d.........................
    3
    492,643
    4
    Cash deemed held for charitable activities. Enter 1.5% (0.015) of line 3 (for greater amount, see
    instructions) .............................
    4
    7,390
    5
    Net value of noncharitable-use assets. Subtract line 4 from line 3. .......
    5
    485,253
    6
    Minimum investment return. Enter 5% (0.05) of line 5................
    6
    24,263
    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
    24,263
    2a
    Tax on investment income for 2021 from Part V, line 5.......
    2a
    43
    b
    Income tax for 2021. (This does not include the tax from Part V.) ...
    2b
     
    c
    Add lines 2a and 2b............................
    2c
    43
    3
    Distributable amount before adjustments. Subtract line 2c from line 1............
    3
    24,220
    4
    Recoveries of amounts treated as qualifying distributions................
    4
     
    5
    Add lines 3 and 4............................
    5
    24,220
    6
    Deduction from distributable amount (see instructions).................
    6
     
    7
    Distributable amount as adjusted. Subtract line 6 from line 5. Enter here and on Part XII, line 1 ...
    7
    24,220
    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 24,220
    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...... 85,015
    b From 2017......  
    c From 2018...... 43,154
    d From 2019...... 90,400
    e From 2020...... 70,313
    f Total of lines 3a through e ........ 288,882
    4Qualifying distributions for 2021 from Part
    XI, line 4: bullet$ 172,389
    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..... 24,220
    e Remaining amount distributed out of corpus 148,169
    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 5 437,051
    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 ..........     		0
    7 Amounts treated as distributions out of
    corpus to satisfy requirements imposed by
    section 170(b)(1)(F) or 4942(g)(3) (Election may
    be required - see instructions) .......     		 
    8 Excess distributions carryover from 2016 not
    applied on line 5 or line 7 (see instructions) ...     		85,015
    9 Excess distributions carryover to 2022.
    Subtract lines 7 and 8 from line 6a ......     		352,036
    10 Analysis of line 9:
    a Excess from 2017....  
    b Excess from 2018.... 43,154
    c Excess from 2019.... 90,400
    d Excess from 2020.... 70,313
    e Excess from 2021.... 148,169
    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).)
    Ronald and Susan Dollens
    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.
    None
    2Information Regarding Contribution, Grant, Gift, Loan, Scholarship, etc., Programs:
    Check here bullet
    aThe name, address, and telephone number or email address of the person to whom applications should be addressed:
    bThe form in which applications should be submitted and information and materials they should include:
    cAny submission deadlines:
    dAny restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other
    factors:
    Form 990-PF (2021)
    Form 990-PF (2021)
    Page 11
    Part XIV
    Supplementary Information (continued)
    3 Grants and Contributions Paid During the Year or Approved for Future Payment
    Recipient If recipient is an individual,
    show any relationship to
    any foundation manager
    or substantial contributor
    		 Foundation
    status of
    recipient     		Purpose of grant or
    contribution     		Amount
    Name and address (home or business)
    aPaid during the year
    University Prep
    8000 25th Ave NE
    Seattle,WA98115     		None Publc General 40,000
    First Scotts Presbyterian
    53 Meeting St
    Charleston,SC29401     		None Publc General 1,375
    Salem Black River Presb
    1060 N Brick Church Rd
    Mayesville,SC29104     		None Publc General 5,000
    SCDS Annual Fund
    2619 4th Ave N
    Seattle,WA98109     		None Publc General 15,000
    American Red Cross
    PO Box 37839
    Boone,IA50037     		None Publc General 5,181
    Florence Henry Memorial
    181 NW Higland Drive
    Shoreline,WA98177     		None Publc General 1,000
    100 Bank Men of Indy
    1500 E Michigan St Room 8
    Indianapolis,IN46201     		None Publc General 1,000
    Samaritan's Purse
    PO Box 3000
    Boone,NC28607     		None Publc General 10,000
    Historic Charleston
    40 E Bay St
    Charleston,SC29401     		None Publc General 35,000
    Zionsville Presbyterian
    4775 W 116th St
    Zionsville,IN46077     		None Publc General 500
    Vision to learn Programs
    12100 Wilshire BLVD Suite 1275
    Los Angeles,CA90025     		None Publc General 33,333
    Stanford University
    450 Jane Stanford Way
    Stanford,CA94305     		None Publc General 5,000
    Trident Academy
    1455 Wakendaw Rd
    Mount Pleasant,SC29464     		None Publc General 20,000
    Total .................................bullet 3a 172,389
    bApproved for future payment
    Total .................................bullet 3b  
    Form 990-PF (2021)
    Form 990-PF (2021)
    Page 12
    Part XV-A
    Analysis of Income-Producing Activities
    Enter gross amounts unless otherwise indicated. Unrelated business income Excluded by section 512, 513, or 514 (e)
    Related or exempt
    function income
    (See instructions.)
    1Program service revenue: (a)
    Business code     		(b)
    Amount     		(c)
    Exclusion code     		(d)
    Amount
    a
    b
    c
    d
    e
    f
    gFees and contracts from government agencies          
    2 Membership dues and assessments ....          
    3 Interest on savings and temporary cash
    investments ...........     		    14 146  
    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 3,305  
    9 Net income or (loss) from special events:          
    10 Gross profit or (loss) from sales of inventory          
    11 Other revenue: a
    b
    c
    d
    e
    12 Subtotal. Add columns (b), (d), and (e) ..   11,758  
    13Total. Add line 12, columns (b), (d), and (e)..................
    13
    11,758
    (See worksheet in line 13 instructions to verify calculations.)
    Part XV-B
    Relationship of Activities to the Accomplishment of Exempt Purposes
    Line No.
    DownArrow     		Explain below how each activity for which income is reported in column (e) of Part XV-A contributed importantly to
    the accomplishment of the foundation’s exempt purposes (other than by providing funds for such purposes). (See
    instructions.)
    Form 990-PF (2021)
    Form 990-PF (2021)
    Page 13
    Part XVI
    Information Regarding Transfers To and Transactions and Relationships With Noncharitable Exempt Organizations
    1
    Did the organization directly or indirectly engage in any of the following with any other organization described in section 501(c) (other than section 501(c)(3) organizations) or in section 527, relating to political organizations?
    Yes
    No
    a
    Transfers from the reporting foundation to a noncharitable exempt organization of:
    (1) Cash...................................
    1a(1)
     
    No
    (2) Other assets.................................
    1a(2)
     
    No
    b
    Other transactions:
    (1) Sales of assets to a noncharitable exempt organization....................
    1b(1)
     
    No
    (2) Purchases of assets from a noncharitable exempt organization..................
    1b(2)
     
    No
    (3) Rental of facilities, equipment, or other assets.......................
    1b(3)
     
    No
    (4) Reimbursement arrangements...........................
    1b(4)
     
    No
    (5) Loans or loan guarantees.............................
    1b(5)
     
    No
    (6) Performance of services or membership or fundraising solicitations................
    1b(6)
     
    No
    c
    Sharing of facilities, equipment, mailing lists, other assets, or paid employees..............
    1c
     
    No
    d
    If the answer to any of the above is "Yes," complete the following schedule. Column (b) should always show the fair market value
    of the goods, other assets, or services given by the reporting foundation. If the foundation received less than fair market value
    in any transaction or sharing arrangement, show in column (d) the value of the goods, other assets, or services received.
    (a) Line No. (b) Amount involved (c) Name of noncharitable exempt organization (d) Description of transfers, transactions, and sharing arrangements
    2a
    Is the foundation directly or indirectly affiliated with, or related to, one or more tax-exempt organizations
    described in section 501(c) (other than section 501(c)(3)) or in section 527? ...........
    b
    If "Yes," complete the following schedule.

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


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


    Software ID: 21013554
    Software Version: 21.0.5.0
    Part VI Line 7 - Tax Paid with the Original Return: 200


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

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

    35-2000508
    Organization type (check one):
    Filers of:
    Section:
    Form 990 or 990-EZ






    Form 990-PF




    Check if your organization is covered by the General Rule or a Special Rule.  
    Note: Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.
    General Rule
    Special Rules
    ......... Arrow Bullet $  
    Caution: An organization that isn't covered by the General Rule and/or the Special Rules doesn't file Schedule B (Form 990,
    990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its Form 990-EZ
    or on its Form 990PF, Part I, line 2, to certify that it doesn't meet the filing requirements of Schedule B (Form 990,
    990-EZ, or 990-PF).
    For Paperwork Reduction Act Notice, see the Instructions
    for Form 990, 990-EZ, or 990-PF.
    Cat. No. 30613XSchedule B (Form 990) (2021)
    Schedule B (Form 990) (2021) Page 2
    Name of organization
    Dollens Family Foundation
          		Employer identification number
    35-2000508
    Part I
    Contributors
    Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Total contributions    		 (d)
    Type of contribution
     
     
     
     

    		$  


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

    		$  


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

    		$  


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

    		$  


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

    		$  


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

    		$  


    (Complete Part II for noncash contributions.)
    Schedule B (Form 990) (2021)
    Schedule B (Form 990) (2021)
    Page 3
    Name of organization
    Dollens Family Foundation
          		Employer identification number

    35-2000508
    Part II
    Noncash Property (see instructions). Use duplicate copies of Part II if additional space is needed.
    (a)
    No. from Part I    		 (b)
    Description of noncash property given    		 (c)
    FMV (or estimate)
    (See instructions)     		(d)
    Date received
     
    		$    
    (a)
    No. from Part I    		 (b)
    Description of noncash property given    		 (c)
    FMV (or estimate)
    (See instructions)     		(d)
    Date received
     
    		$    
    (a)
    No. from Part I    		 (b)
    Description of noncash property given    		 (c)
    FMV (or estimate)
    (See instructions)     		(d)
    Date received
     
    		$    
    (a)
    No. from Part I    		 (b)
    Description of noncash property given    		 (c)
    FMV (or estimate)
    (See instructions)     		(d)
    Date received
     
    		$    
    (a)
    No. from Part I    		 (b)
    Description of noncash property given    		 (c)
    FMV (or estimate)
    (See instructions)     		(d)
    Date received
     
    		$    
    (a)
    No. from Part I    		 (b)
    Description of noncash property given    		 (c)
    FMV (or estimate)
    (See instructions)     		(d)
    Date received
     
    		$    
    Schedule B (Form 990) (2021)
    Schedule B (Form 990) (2021)
    Page 4
    Name of organization
    Dollens Family Foundation
          		Employer identification number

    35-2000508
    Part III
    Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10) that total more than $1,000 for the year from any one contributor. Complete columns (a) through (e) and the following line entry. For organizations completing Part III, enter the total of exclusively religious, charitable, etc., contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet$  
    Use duplicate copies of Part III if additional space is needed.
    (a)
    No. from Part I    		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
     
    (e) Transfer of gift
    Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
     
     
         
     
    (a)
    No. from Part I    		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
     
    (e) Transfer of gift
    Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
     
     
         
     
    (a)
    No. from Part I    		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
     
    (e) Transfer of gift
    Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
     
     
         
     
    (a)
    No. from Part I    		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
     
    (e) Transfer of gift
    Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
     
     
         
     
    Schedule B (Form 990) (2021)
    Additional Data


    Software ID: 21013554
    Software Version: 21.0.5.0

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

    TY 2021 GainLossSaleOtherAssetsSch
    Name:
    Dollens Family Foundation
    EIN:
    35-2000508
    Software ID:
    21013554
    Software Version:
    21.0.5.0
    Name Date Acquired How Acquired Date Sold Purchaser Name Gross Sales Price Basis Basis Method Sales Expenses Total (net) Accumulated Depreciation
    CATERPILLAR INS 2021-01 P 2022-06   413 367     46  
    HESS CORP 2021-05 P 2022-06   601 408     193  
    HESS CORP 2021-05 P 2022-06   481 331     150  
    INVESCO TR II PFD ETF 2017-02 P 2022-06   156 192     -36  
    ISHARES INC CORE MSCI EMERGING MKTS ETF 2018-09 P 2022-06   1,235 1,303     -68  
    ISHARES INC MSCI CDA ETF 2021-05 P 2022-06   69 74     -5  
    ISHARES TR JPMORGAN USD EMERGING MKTS BD ETF 2018-12 P 2022-06   85 104     -19  
    ISHARES TR SP 500 VALUE ETF 2021-05 P 2022-06   274 294     -20  
    METLIFE 2021-04 P 2022-06   124 125     -1  
    PIONEER NAT RES 2021-03 P 2022-06   267 167     100  
    PIONEER NAT RES 2021-03 P 2022-06   267 163     104  
    SPDR TR MATLS 2020-12 P 2022-06   624 569     55  
    SPDR SER TR BLOOMBERG HIGH YIELD BD ETF 2019-07 P 2022-06   363 433     -70  
    T-MOBILE 2020-07 P 2022-06   376 317     59  
    VANGUARD SHORT TERM BD ETF 2021-03 P 2022-06   758 822     -64  
    VANGUARD TOTAL BD MARKET ETF 2020-10 P 2022-06   367 441     -74  
    VANGUARD FTSE EMERGING MKTS ETF 2017-02 P 2022-06   2,351 2,188     163  
    VANGUARD INTL DEVELOPED MKTS ETF 2018-12 P 2022-06   82 74     8  
    VANGUARD INTER-TERM CORP BOND INDEX ETF 2020-06 P 2022-06   314 375     -61  
    APPLE INC 2015-06 P 2022-06   275 64     211  
    EATON CORP 2021-02 P 2022-06   908 843     65  
    EATON CORP 2021-02 P 2022-06   778 724     54  
    EATON CORP 2021-01 P 2022-06   130 118     12  
    FIRST REP BK 2021-02 P 2022-06   147 166     -19  
    INVESCO TR II PFD ETF 2017-02 P 2022-06   49 59     -10  
    ISHARES INC MSCI FRANCE ETF 2021-05 P 2022-06   1,131 1,415     -284  
    ISHARES INC MSCI FRANCE ETF 2021-05 P 2022-06   825 1,017     -192  
    ISHARES INC MSCI SOUTH KOREA ETF 2021-02 P 2022-06   946 1,458     -512  
    ISHARES INC MSCI SOUTH KOREA ETF 2021-01 P 2022-06   769 1,154     -385  
    ISHARES INC MSCI TAIWAN ETF 2020-09 P 2022-06   1,658 1,414     244  
    ISHARES INC MSCI TAIWAN ETF 2020-09 P 2022-06   725 624     101  
    ISHARES TR CORE MSCI EAFE ETF 2019-07 P 2022-06   4,522 4,654     -132  
    ISHARES TR CORE MSCI EAFE ETF 2019-07 P 2022-06   1,428 1,474     -46  
    ISHARES TR RUSSELL 2000 ETF 2018-10 P 2022-06   346 295     51  
    ISHARES TR RUSSELL MID-CAP ETF 2019-05 P 2022-06   198 165     33  
    ISHARES TR RUSSELL MID-CAP GROWTH ETF 2019-01 P 2022-06   242 179     63  
    METLIFE 2021-04 P 2022-06   64 63     1  
    MORGAN STANLEY 2021-01 P 2022-06   78 68     10  
    PAYPAL 2021-02 P 2022-06   361 1,389     -1,028  
    PAYPAL 2021-02 P 2022-06   361 1,445     -1,084  
    SPDR TR COMMUNICATION SVCS 2020-01 P 2022-06   110 113     -3  
    SPDR TR TECHNOLOGY 2020-06 P 2022-06   3,606 2,783     823  
    SPDR TR TECHNOLOGY 2020-06 P 2022-06   4,379 3,341     1,038  
    T-MOBILE 2020-07 P 2022-06   133 106     27  
    UNITED RENTALS 2021-04 P 2022-06   1,244 1,641     -397  
    ADVANCED MICRO DEVICES INC 2020-07 P 2022-08   561 323     238  
    APPLE INC 2015-06 P 2022-08   1,846 350     1,496  
    APPLE INC 2015-07 P 2022-08   504 94     410  
    DEERE CO 2020-12 P 2022-08   376 258     118  
    FIRST REP BK 2021-02 P 2022-08   320 332     -12  
    FREEPORT-MCMORAN 2021-03 P 2022-08   63 71     -8  
    GOLDMAN SACHS 2021-03 P 2022-08   340 341     -1  
    HESS CORP 2021-05 P 2022-08   120 82     38  
    INVESCO TR II PFD ETF 2017-02 P 2022-08   50 59     -9  
    ISHARES INC MSCI CDA ETF 2021-05 P 2022-08   177 184     -7  
    ISHARES TR JPMORGAN USD EMERGING MKTS BD ETF 2018-12 P 2022-08   348 415     -67  
    ISHARES TR RUSSELL 2000 ETF 2018-10 P 2022-08   3,248 2,504     744  
    ISHARES TR RUSSELL 2000 ETF 2018-12 P 2022-08   2,484 1,734     750  
    ISHARES TR RUSSELL 2000 GROWTH ETF 2019-07 P 2022-08   236 202     34  
    ISHARES TR RUSSELL 2000 GROWTH ETF 2019-07 P 2022-08   1,181 1,007     174  
    ISHARES TR RUSSELL 2000 VALUE ETF 2021-03 P 2022-08   604 666     -62  
    ISHARES TR RUSSELL 2000 VALUE ETF 2021-03 P 2022-08   453 498     -45  
    ISHARES TR RUSSELL MID-CAP ETF 2019-05 P 2022-08   2,498 1,925     573  
    ISHARES TR RUSSELL MID-CAP ETF 2019-06 P 2022-08   2,355 1,763     592  
    ISHARES TR RUSSELL MID-CAP GROWTH ETF 2019-01 P 2022-08   1,343 894     449  
    ISHARES TR RUSSELL MID-CAP VALUE ETF 2021-04 P 2022-08   553 567     -14  
    ISHARES TR RUSSELL MID-CAP VALUE ETF 2021-04 P 2022-08   221 225     -4  
    ISHARES TR SP 500 VALUE ETF 2021-05 P 2022-08   586 588     -2  
    JOHNSON CTLS INTL 2021-05 P 2022-08   332 384     -52  
    LOWES 2020-07 P 2022-08   416 277     139  
    METLIFE 2021-04 P 2022-08   132 126     6  
    MICROSOFT 2018-12 P 2022-08   277 101     176  
    MORGAN STANLEY 2021-02 P 2022-08   442 339     103  
    MORGAN STANLEY 2021-01 P 2022-08   88 68     20  
    SCHWAB CHARLES CORP 2021-03 P 2022-08   219 197     22  
    SCHWAB CHARLES CORP 2021-03 P 2022-08   219 196     23  
    SPDR TR COMMUNICATION SVCS 2020-01 P 2022-08   446 454     -8  
    SPDR TR CONSUMER DISC 2021-01 P 2022-08   1,476 1,487     -11  
    SPDR TR CONSUMER DISC 2020-06 P 2022-08   328 257     71  
    SPDR TR MATLS 2020-12 P 2022-08   392 356     36  
    SPDR TR TECHNOLOGY 2020-06 P 2022-08   1,009 696     313  
    SPDR SP 500 ETF 2019-08 P 2022-08   826 585     241  
    SPDR BARCLAYS LT CORPORATE BD ETF 2021-07 P 2022-08   146 194     -48  
    SPDR SER TR BLOOMBERG HIGH YIELD BD ETF 2019-07 P 2022-08   377 433     -56  
    T-MOBILE 2020-07 P 2022-08   288 211     77  
    VANGUARD TOTAL BD MARKET ETF 2020-10 P 2022-08   226 265     -39  
    VANGUARD INTL DEVELOPED MKTS ETF 2018-12 P 2022-08   125 111     14  
    VANGUARD INTER-TERM CORP BOND INDEX ETF 2020-06 P 2022-08   243 281     -38  
    ABBOTT LABS 2019-02 P 2022-09   405 308     97  
    ABBOTT LABS 2019-02 P 2022-09   101 77     24  
    APPLE INC 2018-12 P 2022-09   152 39     113  
    APPLE INC 2016-09 P 2022-09   609 113     496  
    APPLE INC 2015-07 P 2022-09   152 31     121  
    CAPITAL ONE FINL CORP 2021-05 P 2022-09   191 315     -124  
    CATERPILLAR INS 2021-02 P 2022-09   171 184     -13  
    DEERE CO 2020-12 P 2022-09   348 258     90  
    FREEPORT-MCMORAN 2021-03 P 2022-09   199 248     -49  
    GOLDMAN SACHS 2021-03 P 2022-09   312 344     -32  
    HESS CORP 2021-05 P 2022-09   346 245     101  
    INVESCO TR II PFD ETF 2017-02 P 2022-09   633 782     -149  
    ISHARES INC CORE MSCI EMERGING MKTS ETF 2018-09 P 2022-09   2,411 2,763     -352  
    ISHARES INC MSCI CDA ETF 2021-05 P 2022-09   454 516     -62  
    ISHARES TR JPMORGAN USD EMERGING MKTS BD ETF 2018-12 P 2022-09   1,489 1,868     -379  
    ISHARES TR RUSSELL 2000 ETF 2018-12 P 2022-09   3,762 2,935     827  
    ISHARES TR RUSSELL 2000 GROWTH ETF 2019-07 P 2022-09   631 605     26  
    ISHARES TR RUSSELL 2000 VALUE ETF 2021-03 P 2022-09   815 997     -182  
    ISHARES TR RUSSELL MID-CAP ETF 2019-06 P 2022-09   1,684 1,406     278  
    ISHARES TR RUSSELL MID-CAP ETF 2019-06 P 2022-09   3,109 2,564     545  
    ISHARES TR RUSSELL MID-CAP GROWTH ETF 2019-01 P 2022-09   965 715     250  
    ISHARES TR RUSSELL MID-CAP VALUE ETF 2021-04 P 2022-09   404 451     -47  
    ISHARES TR RUSSELL MID-CAP VALUE ETF 2021-04 P 2022-09   707 793     -86  
    ISHARES TR SP 500 VALUE ETF 2021-05 P 2022-09   679 735     -56  
    ISHARES U S ETF TR BLACKROCK SHORT MATURITY BD ETF 2021-07 P 2022-09   838 852     -14  
    JOHNSON CTLS INTL 2021-05 P 2022-09   309 384     -75  
    LOWES 2020-07 P 2022-09   188 139     49  
    METLIFE 2021-04 P 2022-09   381 378     3  
    MICROSOFT 2018-12 P 2022-09   240 101     139  
    MORGAN STANLEY 2021-02 P 2022-09   594 474     120  
    PIONEER NAT RES 2021-03 P 2022-09   229 167     62  
    SCHWAB CHARLES CORP 2021-03 P 2022-09   504 460     44  
    SPDR TR COMMUNICATION SVCS 2020-02 P 2022-09   1,251 1,441     -190  
    SPDR TR COMMUNICATION SVCS 2020-01 P 2022-09   350 397     -47  
    SPDR TR CONSUMER DISC 2021-01 P 2022-09   598 672     -74  
    SPDR TR CONSUMER DISC 2021-01 P 2022-09   299 331     -32  
    SPDR TR MATLS 2021-01 P 2022-09   140 154     -14  
    SPDR TR MATLS 2020-12 P 2022-09   560 569     -9  
    SPDR TR TECHNOLOGY 2020-06 P 2022-09   375 298     77  
    SPDR SP 500 ETF 2020-09 P 2022-09   749 658     91  
    SPDR BARCLAYS LT CORPORATE BD ETF 2021-07 P 2022-09   564 807     -243  
    SPDR SER TR BLOOMBERG HIGH YIELD BD ETF 2020-04 P 2022-09   180 199     -19  
    SPDR SER TR BLOOMBERG HIGH YIELD BD ETF 2020-04 P 2022-09   1,440 1,606     -166  
    T-MOBILE 2020-07 P 2022-09   269 211     58  
    TRACTOR SUPPLY 2020-08 P 2022-09   188 154     34  
    TRACTOR SUPPLY 2020-08 P 2022-09   188 153     35  
    VANGUARD LONG TERM BD ETF 2019-04 P 2022-09   222 274     -52  
    VANGUARD SHORT TERM BD ETF 2021-03 P 2022-09   75 82     -7  
    VANGUARD SHORT TERM BD ETF 2021-03 P 2022-09   977 1,069     -92  
    VANGUARD TOTAL BD MARKET ETF 2020-10 P 2022-09   2,094 2,557     -463  
    VANGUARD FTSE EMERGING MKTS ETF 2018-08 P 2022-09   1,036 1,176     -140  
    VANGUARD FTSE EMERGING MKTS ETF 2017-02 P 2022-09   2,109 2,149     -40  
    VANGUARD INTL DEVELOPED MKTS ETF 2018-12 P 2022-09   764 742     22  
    VANGUARD INTER-TERM CORP BOND INDEX ETF 2020-06 P 2022-09   154 187     -33  
    VANGUARD INTER-TERM CORP BOND INDEX ETF 2020-06 P 2022-09   769 937     -168  
    ABBOTT LABS 2019-02 P 2022-10   202 154     48  
    CAPITAL ONE FINL CORP 2021-05 P 2022-10   94 158     -64  
    CATERPILLAR INS 2021-02 P 2022-10   360 369     -9  
    DEERE CO 2020-12 P 2022-10   360 258     102  
    FIRST REP BK 2021-02 P 2022-10   129 166     -37  
    FREEPORT-MCMORAN 2021-03 P 2022-10   142 176     -34  
    FREEPORT-MCMORAN 2021-03 P 2022-10   28 35     -7  
    HESS CORP 2021-05 P 2022-10   371 248     123  
    INVESCO TR II PFD ETF 2018-12 P 2022-10   58 67     -9  
    INVESCO TR II PFD ETF 2017-02 P 2022-10   138 177     -39  
    ISHARES INC CORE MSCI EMERGING MKTS ETF 2018-12 P 2022-10   85 95     -10  
    ISHARES INC CORE MSCI EMERGING MKTS ETF 2018-09 P 2022-10   427 521     -94  
    ISHARES INC MSCI CDA ETF 2021-05 P 2022-10   91 111     -20  
    ISHARES TR JPMORGAN USD EMERGING MKTS BD ETF 2018-12 P 2022-10   393 519     -126  
    ISHARES TR RUSSELL 2000 ETF 2018-12 P 2022-10   2,326 1,868     458  
    ISHARES TR RUSSELL 2000 GROWTH ETF 2019-07 P 2022-10   619 605     14  
    ISHARES TR RUSSELL 2000 VALUE ETF 2021-04 P 2022-10   392 483     -91  
    ISHARES TR RUSSELL 2000 VALUE ETF 2021-03 P 2022-10   131 166     -35  
    ISHARES TR RUSSELL MID-CAP ETF 2019-06 P 2022-10   2,376 2,055     321  
    ISHARES TR RUSSELL MID-CAP GROWTH ETF 2019-06 P 2022-10   471 406     65  
    ISHARES TR RUSSELL MID-CAP GROWTH ETF 2019-01 P 2022-10   78 60     18  
    ISHARES TR RUSSELL MID-CAP VALUE ETF 2021-04 P 2022-10   388 451     -63  
    ISHARES TR SP 500 VALUE ETF 2021-05 P 2022-10   392 441     -49  
    ISHARES U S ETF TR BLACKROCK SHORT MATURITY BD ETF 2021-07 P 2022-10   344 351     -7  
    JOHNSON CTLS INTL 2021-05 P 2022-10   154 194     -40  
    JOHNSON CTLS INTL 2021-05 P 2022-10   51 64     -13  
    LOWES 2020-07 P 2022-10   391 277     114  
    METLIFE 2021-04 P 2022-10   191 189     2  
    PIONEER NAT RES 2021-03 P 2022-10   245 167     78  
    SCHWAB CHARLES CORP 2021-03 P 2022-10   143 132     11  
    SPDR TR COMMUNICATION SVCS 2020-02 P 2022-10   620 749     -129  
    SPDR TR CONSUMER DISC 2021-01 P 2022-10   138 168     -30  
    SPDR TR MATLS 2021-01 P 2022-10   482 539     -57  
    SPDR TR TECHNOLOGY 2020-06 P 2022-10   117 99     18  
    SPDR SP 500 ETF 2020-09 P 2022-10   358 329     29  
    SPDR BARCLAYS LT CORPORATE BD ETF 2021-07 P 2022-10   106 161     -55  
    SPDR SER TR BLOOMBERG HIGH YIELD BD ETF 2020-04 P 2022-10   615 695     -80  
    T-MOBILE 2020-07 P 2022-10   271 211     60  
    TRACTOR SUPPLY 2020-08 P 2022-10   202 154     48  
    VANGUARD LONG TERM BD ETF 2019-04 P 2022-10   70 91     -21  
    VANGUARD SHORT TERM BD ETF 2021-03 P 2022-10   373 411     -38  
    VANGUARD TOTAL BD MARKET ETF 2021-01 P 2022-10   706 874     -168  
    VANGUARD TOTAL BD MARKET ETF 2020-10 P 2022-10   141 176     -35  
    VANGUARD FTSE EMERGING MKTS ETF 2018-12 P 2022-10   540 574     -34  
    VANGUARD FTSE EMERGING MKTS ETF 2018-08 P 2022-10   144 174     -30  
    VANGUARD INTL DEVELOPED MKTS ETF 2018-12 P 2022-10   218 223     -5  
    VANGUARD INTER-TERM CORP BOND INDEX ETF 2020-06 P 2022-10   299 375     -76  
    ISHARES U S ETF TR BLACKROCK SHORT MATURITY BD ETF 2021-07 P 2022-06   739 752     -13  
    EATON CORP 2022-03 P 2022-06   1,167 1,378     -211  
    ISHARES INC MSCI FRANCE ETF 2022-03 P 2022-06   1,375 1,577     -202  
    ISHARES INC MSCI SOUTH KOREA ETF 2022-03 P 2022-06   1,419 1,702     -283  
    ISHARES INC MSCI TAIWAN ETF 2022-03 P 2022-06   1,399 1,680     -281  
    ISHARES TR CORE MSCI EAFE ETF 2022-06 P 2022-06   60 68     -8  
    ISHARES TR CORE MSCI EAFE ETF 2022-03 P 2022-06   4,462 5,156     -685  
    PAYPAL 2022-06 P 2022-06   865 1,318     -453  
    PAYPAL 2022-03 P 2022-06   2,163 3,276     -668  
    UNITED RENTALS 2022-03 P 2022-06   747 1,033     -286  
    AMAZON 2022-06 P 2022-09   1,633 1,503     130  
    ILLINOIS TOOL WKS 2022-06 P 2022-09   566 549     17  
    ISHARES INC MSCI CHILE ETF 2022-06 P 2022-09   1,099 1,055     44  
    ISHARES INC MSCI MEXICO ETF 2022-06 P 2022-09   789 802     -13  
    ISHARES INC MSCI TURKEY ETF 2022-06 P 2022-09   1,804 1,519     285  
    ISHARES TR INDIA 50 ETF 2022-06 P 2022-09   1,268 1,181     87  
    SPDR TR INDL 2022-06 P 2022-09   1,297 1,317     -20  
    AMAZON 2022-06 P 2022-10   224 215     9  
    ILLINOIS TOOL WKS 2022-06 P 2022-10   188 183     5  
    ISHARES INC MSCI CHILE ETF 2022-06 P 2022-10   95 98     -3  
    ISHARES INC MSCI MEXICO ETF 2022-06 P 2022-10   275 283     -8  
    ISHARES INC MSCI TURKEY ETF 2022-06 P 2022-10   533 434     99  
    ISHARES TR INDIA 50 ETF 2022-06 P 2022-10   168 163     5  
    SPDR TR INDL 2022-06 P 2022-10   513 527     -14  

    TY 2021 InvestmentsCorpStockSchedule
    Name:
    Dollens Family Foundation
    EIN:
    35-2000508
    Software ID:
    21013554
    Software Version:
    21.0.5.0
    Name of Stock End of Year Book Value End of Year Fair Market Value
    Pershing brokerage account 379,330 356,479

    TY 2021 OtherIncreasesSchedule
    Name:
    Dollens Family Foundation
    EIN:
    35-2000508
    Software ID:
    21013554
    Software Version:
    21.0.5.0
    Description Amount
    Book Adjustment 405


    TY 2021 OtherProfessionalFeesSchedule
    Name:
    Dollens Family Foundation
    EIN:
    35-2000508
    Software ID:
    21013554
    Software Version:
    21.0.5.0
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    Investment Advisor fees 5,334 5,334 5,334