Form990-PF

Department of the Treasury
Internal Revenue Service

Return of Private Foundation
or Section 4947(a)(1) Trust Treated as Private Foundation
right arrowDo not enter social security numbers on this form as it may be made public.
right arrowGo to www.irs.gov/Form990PF for instructions and the latest information.
OMB No. 1545-0047
2023
Open to Public Inspection
For calendar year 2023, or tax year beginning 07-01-2023 , and ending 06-20-2024
Name of foundation
CIVISTA CHARITABLE FOUNDATION
FKA UCB CHARITABLE FOUNDATION
Number and street (or P.O. box number if mail is not delivered to street address)92 WALNUT STREET
  Room/suite
City or town, state or province, country, and ZIP or foreign postal code
LAWRENCEBURG, IN47025
A Employer identification number

20-4604858
B Telephone number (see instructions)

(812) 537-4822
C right arrow
G Check all that apply:

D 1. Foreign organizations, check here............. right arrow
2. Foreign organizations meeting the 85%
test, check here and attach computation ... right arrow
E right arrow
H Check type of organization:
F right arrow
I Fair market value of all assets at end
of year (from Part II, col. (c),
line 16)right arrow$873,345J 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 right arrow.............
3 Interest on savings and temporary cash investments      
4 Dividends and interest from securities... 36,650 36,650 36,650
5a Gross rents............      
b Net rental income or (loss)  
6a Net gain or (loss) from sale of assets not on line 10 6,146
b Gross sales price for all assets on line 6a 6,146
7 Capital gain net income (from Part IV, line 2)... 6,146
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........ 42,796 42,796 36,650
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)....... Click to see attachment
List of Attached Documents:
// Content
1,950      
c Other professional fees (attach schedule)....        
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
List of Attached Documents:
// Content
2,721      
24 Total operating and administrative expenses.
Add lines 13 through 23.......... 4,671 0   0
25 Contributions, gifts, grants paid....... 151,617 151,617
26 Total expenses and disbursements. Add lines 24 and 25 156,288 0   151,617
27 Subtract line 26 from line 12:
a Excess of revenue over expenses and disbursements -113,492
b Net investment income (if negative, enter -0-) 42,796
c Adjusted net income (if negative, enter -0-)... 36,650
For Paperwork Reduction Act Notice, see instructions.
Cat. No. 11289X Form 990-PF (2023)
Form 990-PF (2023)
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............. 49,891 44,599 44,599
2 Savings and temporary cash investments.........      
3 Accounts receivable right arrow  
Less: allowance for doubtful accounts right arrow        
4 Pledges receivable right arrow  
Less: allowance for doubtful accounts right arrow        
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) right arrow  
Less: allowance for doubtful accounts right arrow        
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 right arrow  
Less: accumulated depreciation (attach schedule) right arrow        
12 Investments—mortgage loans.............      
13 Investments—other (attach schedule).......... 896,035 Click to see attachment
List of Attached Documents:
// Content
828,746 		828,746
14 Land, buildings, and equipment: basis right arrow  
Less: accumulated depreciation (attach schedule) right arrow        
15 Other assets (describe right arrow)      
16 Total assets (to be completed by all filers—see the
instructions. Also, see page 1, item I) 945,926 873,345 873,345
Liabilities 17 Accounts payable and accrued expenses.......... 15,231 21,500
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 right arrow)    
23 Total liabilities (add lines 17 through 22)......... 15,231 21,500
Net Assets or Fund Balances Foundations that follow FASB ASC 958, check here right arrow
and complete lines 24, 25, 29 and 30.
24 Net assets without donor restrictions........... 930,695 851,845
25 Net assets with donor restrictions............    
Foundations that do not follow FASB ASC 958, check here right arrow
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)..... 930,695 851,845
30 Total liabilities and net assets/fund balances (see instructions). 945,926 873,345
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
930,695
2
Enter amount from Part I, line 27a .....................
2
-113,492
3
Other increases not included in line 2 (itemize) right arrowClick to see attachment
List of Attached Documents:
// Content
3
34,642
4
Add lines 1, 2, and 3 ..........................
4
851,845
5
Decreases not included in line 2 (itemize) right arrow
5
 
6
Total net assets or fund balances at end of year (line 4 minus line 5)—Part II, column (b), line 29 .
6
851,845
Form 990-PF (2023)
Form 990-PF (2023)
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 6,146
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  
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 right arrow 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) 1 595
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........................... 3 595
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- ..... 5 595
6 Credits/Payments:
a 2023 estimated tax payments and 2022 overpayment credited to 2023 6a  
b Exempt foreign organizations—tax withheld at source...... 6b  
c Tax paid with application for extension of time to file (Form 8868)... 6c  
d Backup withholding erroneously withheld .......... 6d  
7 Total credits and payments. Add lines 6a through 6d.............. 7  
8 Enter any penalty for underpayment of estimated tax. Check here if Form 2220 is attached. Click to see attachment
List of Attached Documents:
// Content
8 30
9 Tax due. If the total of lines 5 and 8 is more than line 7, enter amount owed.......right arrow 9 625
10 Overpayment. If line 7 is more than the total of lines 5 and 8, enter the amount overpaid...right arrow 10  
11 Enter the amount of line 10 to be: Credited to 2024 estimated taxright arrow   Refundedright arrow 11  
Form 990-PF (2023)
Form 990-PF (2023)
Page 4
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. right arrow$   (2) On foundation managers.right arrow$  
e
Enter the reimbursement (if any) paid by the foundation during the year for political expenditure tax imposed
on foundation managers.right arrow$  
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:
round bullet By language in the governing instrument, or
round bullet 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)
right arrow
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 2023 or the taxable year beginning in 2023? 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
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 addressright arrowN/A
14
The books are in care ofright arrowAMANADA COSMEIER Telephone no.right arrow (812) 537-4822

Located atright arrow19954 LONGVIEW DRLAWRENCEBURGIN ZIP+4right arrow47025
15
Section 4947(a)(1) nonexempt charitable trusts filing Form 990-PF in lieu of Form 1041 —check here .........right arrow
and enter the amount of tax-exempt interest received or accrued during the year ........right arrow
15
 
16 At any time during calendar year 2023, 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 right arrow
Form 990-PF (2023)
Form 990-PF (2023)
Page 5
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
Organizations relying on a current notice regarding disaster assistance check here ........right arrow
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 2023? .............
1d
 
 
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 2023, did the foundation have any undistributed income (Part XII, lines 6d
and 6e) for tax year(s) beginning before 2023?....................
2a
 
No
If "Yes," list the years right arrow20, 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.
right arrow20, 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 2023 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 2023.) .....................
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 2023? ..
4b
 
No
Form 990-PF (2023)
Form 990-PF (2023)
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
Organizations relying on a current notice regarding disaster assistance check .........right arrow
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
EG MCLAUGHLIN PRESIDENT
1.00 		0 0 0
PO BOX 3792
LAWRENCEBURG,IN47025
MARK SAMS SECRETARY
1.00 		0 0 0
92 WALNUT ST
LAWRENCEBURG,IN47025
AMANADA COSMEIER TREASURER
1.00 		0 0 0
19954 LONGVIEW DR
LAWRENCEBURG,IN47025
DENNIS SHAFFER MEMBER
1.00 		0 0 0
100 EAST WATER STREET
SANDUSKY,OH44870
WILLIAM RITZMANN DIRECTOR
1.00 		0 0 0
19815 LAKEVIEW DR
LAWRENCEBURG,IN47025
ROBERT EWBANK DIRECTOR
1.00 		0 0 0
114 W HIGH ST
LAWRENCEBURG,IN47025
JERRY HACKER DIRECTOR
1.00 		0 0 0
1136 HOLLYHEDGE LAND
LAWRENCEBURG,IN47025
FRED MCCARTER DIRECTOR
1.00 		0 0 0
322 WALNUT ST
LAWRENCEBURG,IN47025
CHIP PERFECT MEMBER
1.00 		0 0 0
92 WALNUT ST
LAWRENCEBURG,IN47025
JULIE MATLIN MEMBER
1.00 		0 0 0
6368 COOC RD
GUILFORD,IN47022
JAMES KITTLE MEMBER
1.00 		0 0 0
640 TANNER AVE
GREENDALE,IN47025
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...................right arrow  
Form 990-PF (2023)
Form 990-PF (2023)
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.............right arrow  
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 N/A  
2  
All other program-related investments. See instructions.
3  
Total. Add lines 1 through 3.........................right arrow  
Form 990-PF (2023)
Form 990-PF (2023)
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
900,071
b
Average of monthly cash balances.......................
1b
0
c
Fair market value of all other assets (see instructions)................
1c
0
d
Total (add lines 1a, b, and c).........................
1d
900,071
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
900,071
4
Cash deemed held for charitable activities. Enter 1.5% (0.015) of line 3 (for greater amount, see
instructions) .............................
4
13,501
5
Net value of noncharitable-use assets. Subtract line 4 from line 3. ............
5
886,570
6
Minimum investment return. Enter 5% (0.05) of line 5................
6
44,329
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
44,329
2a
Tax on investment income for 2022 from Part V, line 5.......
2a
595
b
Income tax for 2022. (This does not include the tax from Part V.) ...
2b
 
c
Add lines 2a and 2b............................
2c
595
3
Distributable amount before adjustments. Subtract line 2c from line 1............
3
43,734
4
Recoveries of amounts treated as qualifying distributions................
4
 
5
Add lines 3 and 4............................
5
43,734
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
43,734
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
151,617
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
151,617
Form 990-PF (2023)
Form 990-PF (2023)
Page 9
Part XII
Undistributed Income (see instructions)
(a)
Corpus 		(b)
Years prior to 2022 		(c)
2022 		(d)
2023
1 Distributable amount for 2023 from Part X, line 7 43,734
2 Undistributed income, if any, as of the end of 2022:
a Enter amount for 2022 only.......  
b Total for prior years:20 , 20, 20  
3 Excess distributions carryover, if any, to 2022:
a From 2018...... 74,297
b From 2019...... 116,131
c From 2020...... 11,244
d From 2021...... 17,687
e From 2022...... 123,746
f Total of lines 3a through e ........ 343,105
4Qualifying distributions for 2023 from Part
XI, line 4: right arrow$ 151,617
a Applied to 2022, 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 2023 distributable amount..... 43,734
e Remaining amount distributed out of corpus 107,883
5 Excess distributions carryover applied to 2023.    
(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 5 450,988
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 2022. Subtract line
4a from line 2a. Taxable amount—see
instructions ............. 		 
f Undistributed income for 2023. Subtract
lines 4d and 5 from line 1. This amount must
be distributed in 2024 .......... 		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 2018 not
applied on line 5 or line 7 (see instructions) ... 		74,297
9 Excess distributions carryover to 2024.
Subtract lines 7 and 8 from line 6a ...... 		376,691
10 Analysis of line 9:
a Excess from 2019.... 116,131
b Excess from 2020.... 11,244
c Excess from 2021.... 17,687
d Excess from 2022.... 123,746
e Excess from 2023.... 107,883
Form 990-PF (2023)
Form 990-PF (2023)
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 2023, enter the date of the ruling ...... right arrow
 
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 IX for each
year listed .......... 		Tax year Prior 3 years (e) Total
(a) 2023 (b) 2022 (c) 2021 (d) 2020
         
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).)
NONE
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 right arrow
aThe name, address, and telephone number or e-mail address of the person to whom applications should be addressed:
CIVISTA CHARITABLE FOUNDATION
92 WALNUT STREET
LAWRENCEBURG,IN47025
(817) 537-4822
bThe form in which applications should be submitted and information and materials they should include:
ONE TO TWO PAGE LETTER
cAny submission deadlines:
NONE
dAny restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other
factors:
501(C)(3) CHARITIES, NO FUNDING TO POLITICAL OR FRATERNAL ORGANIZATIONS OR INDIVIDUALS
Form 990-PF (2023)
Form 990-PF (2023)
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

1 VOICE

111 5TH ST
AURORA,IN47001 		NONE PUBLIC UNRESTRICTED CONTRIBUTION 200

A COMMUNITY BRIDGE INC

8018 STATE RD 48
AURORA,IN47001 		NONE PUBLIC UNRESTRICTED CONTRIBUTION 5,600

ALL SAINTS PARISH

25743 STATE ROUTE 1
GUILGORD,IN47022 		NONE PUBLIC UNRESTRICTED CONTRIBUTION 3,000

ALS ASSOCIATION INDIANA CHARTER

7202 E 87TH STREET
INDIANAPOLIS,IN46256 		NONE PUBLIC UNRESTRICTED CONTRIBUTION 1,000

AMERICAN CANCER SOCIETY

5635 W 96TH ST SUITE 100
INDIANAPOLIS,IN46278 		NONE PUBLIC UNRESTRICTED CONTRIBUTION 2,000

AMY IRONS MEYER FOUNDATION INC

305 HILLVIEW DR
AURORA,IN47001 		NONE PRIVATE UNRESTRICTED CONTRIBUTION 1,000

ASG FOUNDATION

543 BIELBY RD
LAWRENCEBURG,IN47025 		NONE PUBLIC UNRESTRICTED CONTRIBUTION 600

AURORA ELEMENTARY SCHOOL

6098 SQUIRE PL
AURORA,IN47001 		NONE PUBLIC UNRESTRICTED CONTRIBUTION 250

BIG BROTHERS BIG SISTERS OF GTR CIN

2412 PICNIC WOODS
LAWRENCEBURG,IN47025 		NONE PUBLIC UNRESTRICTED CONTRIBUTION 1,500

CAC OF SOUTHEASTERN INDIANA

12211 RULLMAN DR
DILLSBORO,IN47018 		NONE PUBLIC UNRESTRICTED CONTRIBUTION 6,000

CASA

423 WALNUT ST
LAWRENCEBURG,IN47025 		NONE PUBLIC UNRESTRICTED CONTRIBUTION 1,000

CHARACTER COUNCIL OF GRTR CINCI &NK

3874 PAXTON AVE
CINCINNATI,OH45209 		NONE PUBLIC UNRESTRICTED CONTRIBUTION 1,000

CHILD EVANGELISM FELLOWSHIP INC

PO BOX 276
WESTFIELD,IN46074 		NONE PUBLIC UNRESTRICTED CONTRIBUTION 250

CINCINNATI MARATHON INC

PO BOX 6068
CINCINNATI,OH45206 		    UNRESTRICTED CONTRIBUTION 293

CINCINNATI ZOO & BOTANICAL GARDEN

3400 VINE STREET
CINCINNATI,OH45220 		NONE PUBLIC UNRESTRICTED CONTRIBUTION 2,500

CITY OF AURORA

PO BOX 156
AURORA,IN47001 		NONE GOVERNMENT UNRESTRICTED CONTRIBUTON 5,500

CITY OF GREENDALE

500 RIDGE AVE
GREENDALE,IN47025 		NONE GOVERNMENT UNRESTRICTED CONTRIBUTION 2,620

CITY OF LAWRENCEBURG

349 WALNUT ST
LAWRENCEBURG,IN47025 		NONE GOVERNMENT UNRESTRICTED CONTRIBUTION 2,500

CITY OF RISING SUN

200 NORTH WALNUT ST
RISING SUN,IN47040 		NONE GOVERNMENT UNRESTRICTED CONTRIBUTION 250

DEARBORN COUNTY 4-H

233 MAIN STREET
AURORA,IN47001 		NONE PUBLIC UNRESTRICTED CONTRIBUTION 2,700

DEARBORN COUNTY CLEARINGHOUSE

411 GEORGE ST
AURORA,IN47001 		NONE PUBLIC UNRESTRICTED CONTRIBUTION 1,500

DEARBORN COUNTY COMMUNITY FOUNDATIO

622 WALNUT ST
LAWRENCEBURG,IN47025 		NONE PUBLIC UNRESTRICTED CONTRIBUTION 20,000

DEARBORN COUNTY GIRLS SOFTBALL INC

PO BOX 4165
LAWRENCEBURG,IN47025 		NONE PUBLIC UNRESTRICTED CONTRIBUTION 400

DELAWARE COMMUNITY VOLUNTEER FIRE D

5452 N ST RD 129
OSGOOD,IN47037 		NONE PUBLIC UNRESTRICTED CONTRIBUTION 100

DILLSBORO HOME COMING

9824 CENTRAL AVE
DILLSBORO,IN47018 		NONE PUBLIC UNRESTRICTED CONTRIBUTON 200

EAST CENTRAL HIGH SCHOOL

1 TROJAN PL BROOVILLE
ST LEON,IN47012 		NONE PUBLIC UNRESTRICTED CONTRIBUTION 1,800

HARRISON HIGH SCHOOL

9860 WEST RD
HARRISON,OH45030 		NONE PUBLIC UNRESTRICTED CONTRIBUTION 100

HILLFOREST

213 5TH ST
AURORA,IN47001 		NONE PUBLIC UNRESTRICTED CONTRIBUTION 1,500

IVY TECH FOUNDATION

50 WALNUT STREET
LAWRENCEBURG,IN47025 		NONE PUBLIC UNRESTRICTED CONTRIBUTION 3,000

JAC CEN DEL HIGH SCHOOL

4586 N US HIGHWAY 421
OSGOOD,IN47037 		NONE PUBLIC UNRESTRICTED CONTRIBUTION 3,600

JAC CEN DEL SCHOLARSHIP FOUNDATION

4586 N US HIGHWAY 421
OSGOOD,IN47037 		NONE PUBLIC UNRESTRICTED CONTRIUTION 750

JAC CEN DEL SCHOOL CORP

723 N BUCKEYE STREET
OSGOOD,IN47037 		NONE PUBLIC UNRESTRICTED CONTRIBUTION 200

JERRY ABBOTT MEMORIAL SCHOLARSHIP

309 DIEHL DR
GREENDALE,IN47025 		NONE PUBLIC UNRESTRICTED CONTRIBUTION 1,000

LA SOCIETE OF QUARANTE HOMMES

25542 ST RT 1
GUILFORD,IN47022 		NONE PUBLIC UNRESTRICTED CONTRIBUTION 200

LAURENS FIGHT FOR CURE

933 PRIBBLE CIRCLE
LAWRENCEBURG,IN47025 		NONE PUBLIC UNRESTRICTED CONTRIBUTION 1,000

LAWRENCEBURG ELKS LODGE 1836

13 W HIGH ST
LAWRENCEBURG,IN47025 		NONE PUBLIC UNRESTRICTED CONTRIBUTION 200

LAWRENCEBURG HIGH SCHOOL

100 TIGER BLVD
LAWRENCEBURG,IN47025 		NONE PUBLIC UNRESTRICTED CONTRIBUTION 2,274

LAWRENCEBURG MAIN STREET

320 MAIN STREET
LAWRENCEBURG,IN47025 		NONE PUBLIC UNRESTRICTED CONTRIBUTION 5,500

LOHMILLER FOUNDATION

325 WALNUT ST
LAWRENCEBURG,IN47025 		NONE QUALIFED UNRESTRICTED CONTRIBUTION 500

MAIN STREET AURORA

309 THIRD ST
AURORA,IN47001 		NONE PUBLIC UNRESTRICTED CONTRIBUTION 10,000

MILAN 54 INC

201 W CAR ST
MILAN,IN47031 		NONE PUBLIC UNRESTRICTED CONTRIBUTION 250

MILAN COMMUNITY DOLLARS FOR SCHOLAR

609 N WARPATH DR
MILAN,IN47031 		NONE PUBLIC UNRESTRICTED CONTRIBUTION 950

MILAN COMMUNITY SCHOOLS

412 E CARR ST
MILAN,IN47031 		NONE PUBLIC UNRESTRICTED CONTRIBUTION 2,650

MILAN HIGH SCHOOL

609 N WARPATH DR
MILAN,IN47031 		NONE PUBLIC UNRESTRICTED CONTRIBUTION 1,091

MILAN MIDDLE SCHOOL

609 NORTH WARPATH DR
MILAN,IN47031 		NONE PUBLIC UNRESTRICTED CONTRIBUTION 907

MILAN SUMMER BASKETBALL

P O BOX 782
MILAN,IN47031 		NONE PUBLIC UNRESTRICTED CONTRIBUTION 150

MILAN VOLUNTEER FIRE DEPARTMENT

201 N RIPLEY ST
MILAN,IN47031 		NONE GOVERNMENT UNRESTRICTED CONTRIBUTION 150

MOORES HILL RECREATION

PO BOX 62
MOORES HILL,IN47032 		NONE PUBLIC UNRESTRICTED CONTRIBUTION 250

NATIONAL CHILD SAFETY COUNCIL

PO BOX 1368
JACKSON,MI49204 		NONE PUBLIC UNRESTRICTED CONTRIBUTION 100

NORTH DEARBORN COMMUNITY PARK INC

26222 WHEAT LN
GUILFORD,IN47022 		NONE PUBLIC UNRESTRICTED CONTRIBUTION 500

OAK HERITAGE CONSERVANCY

PO BOX 335
HANOVER,IN47243 		NONE PUBLIC UNRESTRICTED CONTRIBUTION 1,000

OHIO VALLEY SCREEN PRINTING

139 W TATE ST STE 3
LAWRENCEBURG,IN47025 		NONE PUBLIC UNRESTRICTED CONTRIBUTION 2,500

OSGOOD BEUTIFICATION & MAIN ST DEVE

2335 W COUNTY ROAD 525 N
OSGOOD,IN47037 		NONE PUBLIC UNRESTRICTED CONTRIBUTION 1,250

PARTNERS FOR ANIMAL WELFARE SOCIETY

200 CHARLES A LIDDLE DR
LAWRENCEBURG,IN47025 		NONE PUBLIC UNRESTRICTED CONTRIBUTION 1,000

PEOPLE HELPING PEOPLE

582 W EADS PARKWAY
LAWRENCEBURG,IN47025 		NONE PUBLIC UNRESTRICTED CONTRIBUTION 100

PHI BETA PSI

PO BOX 3536
LAWRENCEBURG,IN47025 		NONE PUBLIC UNRESTRICTED CONTRIBUTION 1,500

RIPLEY COUNTY COMMUNITY FOUNDATION

13 E GEORGE ST
BATESVILLE,IN47006 		NONE PUBLIC UNRESTRICTED CONTRIBUTION 1,000

RIPLEY COUNTY INDIANA 4-H

525 W BEECH ST
OSGOOD,IN47037 		NONE PUBLIC UNRESTRICTED CONTRIBUTION 1,700

RISING SUN HIGH SCHOOL

3449 BELLVIEW LN
RISING SUN,IN47040 		NONE PUBLIC UNRESTRICTED CONTRIBUTION 750

SAFE PASSAGE INC

1000 S MICHIGAN ST
SOUTH BEND,IN46601 		NONE PUBLIC UNRESTRICTED CONTRIBUTION 1,500

SOCCER ASSOC FOR YOUTH

11490 SPRINGFIELD PIKE
CINCINNATI,OH45246 		NONE PUBLIC UNRESTRICTED CONTRIBUTION 750

SOUTH DEARBORN COMMUNITY SCHOOL COR

6109 SQUIRE PL
AURORA,IN47001 		NONE PUBLIC UNRESTIRCTED CONTRIBUTION 250

SOUTH DEARBORN DOLLARS FOR SCHOLLAR

PO BOX 396
AURORA,IN47001 		NONE PUBLIC UNRESTRICTED CONTRIBUTION 250

SOUTH DEARBORN HIGH SCHOOL

5770 HIGHLANDER DR
AURORA,IN47001 		NONE PUBLIC UNRESTRICTED CONTRIBUTION 3,050

SOUTH DEARBORN MIDDLE SCHOOL

6109 SQUIRE PL
AURORA,IN47001 		NONE PUBLIC UNRESTRICTED CONTRIBUTION 100

SOUTH DEARBORN YOUTH BASEBALL

PO BOX 324
AURORA,IN47001 		NONE PUBLIC UNRESTRICTED CONTRIBUTION 300

SOUTH RIPLEY HIGH SCHOOL

1589 S BENHAM RD
VERSAILLE,IN47042 		NONE PUBLIC UNRESTRICTED CONTRIBUTION 1,395

SOUTHEAST INDIANA YOUTH ORCHASTRA

PO BOX 225
AURORA,IN47001 		NONE PUBLIC UNRESTRICTED CONTRIBUTION 1,757

SOUTHEASTERN INDIANA ART GUILD

302 SECOND ST
AURORA,IN47025 		NONE PUBLIC UNRESTRICTED CONTRIBUTION 1,000

SOUTHEASTERN INDIANA MUSICAL ASSOCI

17758 BIGNEY RD
MOORES HILL,IN47032 		NONE PUBLIC UNRESTRICTED CONTRIBUTION 250

SOUTHEASTERN INDIANA SHRINE CLUB

15626 US HWY 50
DILLSBORO,IN47018 		NONE PUBLIC UNRESTRICTED CONTRIBUTION 300

SOUTHEASTERN INDIANA YMCA

50 STATE RD 129
SOUTH BATESVILLE,IN47006 		NONE PUBLIC UNRESTRICTED CONTRIBUTION 500

SPECIAL OLYMPICS INDIANA

429 MANCHESTER ST
AURORA,IN47001 		NONE PUBLIC UNRESTRICTED CONTRIBUTION 1,000

ST ELIZABETH MEDICAL CENTER INC

PO BOX 7501
LAFAYETTE,IN47903 		NONE PUBLIC UNRESTRICTED CONTRIBUTION 13,000

ST JOHN LUTHERAN CHURCH AND SCHOOL

222 MECHANIC ST
AURORA,IN47001 		NONE PUBLIC UNRESTRICTED CONTRIBUTION 2,130

ST LAWRENCE CATHOLIC SCHOOL

524 WALNUT ST
LAWRENCEBURG,IN47025 		NONE PUBLIC UNRESTICTED CONTRIBUTION 5,500

ST LEON VOLUNTEER FIRE DEPARTMENT

28870 ST JOE DR
WEST HARRISON,IN47060 		NONE PUBLIC UNRESTRICTED CONTRIBUTION 250

ST TERESA BENEDICTA OF THE CROSS PA

23345 GAVIN LN
LAWRENCEBURG,IN47025 		NONE PUBLIC UNRESTRICTED CONTRIBUTION 500

SUNMAN ELEMENTARY

925 N MERIDIAN ST
SUNMAN,IN47041 		NONE PUBLIC UNRESTRICTED CONTRIBUTION 250

THE ARCHAEOLOGICAL RESEARCH INSTITU

424 WALNUT ST
LAWRENCEBURG,IN47025 		NONE PUBLIC UNRESTRICTED CONTRIBUTION 2,000

TOWN OF MILAN

211 W CARR ST
MILAN,IN47031 		NONE GOVERNMENT UNRESTRICTED CONTRIBUTION 500

UNITED WAY OF GREATER CINCINNATI SE

2400 READING RD
CINCINNATI,OH45202 		NONE PUBLIC UNRESTRICTED CONTRIBUTION 2,400

YOUNG LIFE

2182 2ND ST
LAWRENCEBURG,IN47025 		NONE PUBLIC UNRESTRICTED CONTRIBUTION 1,000

YOUTH ENCOURAGEMENT SERVCIES INC

11636 COUNTY FARM RD
AURORA,IN47001 		NONE PUBLIC UNRESTRICTED CONTRIBUTION 100

YOUTH TO YOUTH STONE OF RIPLEY CO

3773 NORTH STATE RD 129
MILAN,IN47031 		NONE PUBLIC UNRESTRICTED CONTRIBUTION 200
Total .................................right arrow 3a 151,617
bApproved for future payment
Total ................................. right arrow 3b  
Form 990-PF (2023)
Form 990-PF (2023)
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       18    
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 ....     14 36,650  
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 ............ 		        6,146
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) ..   36,650 6,146
13Total. Add line 12, columns (b), (d), and (e)..................
13
42,796
(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 (2023)
Form 990-PF (2023)
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.
right arrow right arrow
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 Check if self-
employed right arrow		 PTIN
Firm's name SmallBullet
 Firm's EIN SmallBullet
Firm's address SmallBullet


 Phone no.
Form 990-PF (2023)
Additional Data


Software ID:  
Software Version:  


Form 990PF - Special Condition Description:
Special Condition Description

TY 2023 AccountingFeesSchedule
Name:
CIVISTA CHARITABLE FOUNDATION
 
FKA UCB CHARITABLE FOUNDATION
EIN:
20-4604858
Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
ACCOUNTING 1,950      

TY 2023 InvestmentsOtherSchedule2
Name:
CIVISTA CHARITABLE FOUNDATION
 
FKA UCB CHARITABLE FOUNDATION
EIN:
20-4604858
Category/ Item Listed at Cost or FMV Book Value End of Year Fair Market Value
CIVISTA BANCORP STOCK AT COST 828,746 828,746

TY 2023 OtherExpensesSchedule
Name:
CIVISTA CHARITABLE FOUNDATION
 
FKA UCB CHARITABLE FOUNDATION
EIN:
20-4604858
Description Revenue and Expenses per Books Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
EXPENSES        
INSURANCE 1,644      
ENTITY FILINGS 193      
MEALS 502      
SUPPLIES 382      


TY 2023 OtherIncreasesSchedule
Name:
CIVISTA CHARITABLE FOUNDATION
 
FKA UCB CHARITABLE FOUNDATION
EIN:
20-4604858
Description Amount
PRIOR YEAR ADJUSTMENT 34,642