Centurion Foundation Form 990
Centurion Foundation Form 990
Centurion Foundation Form 990
For calendar year 2021, or tax year beginning 10-26-2021 , and ending 12-31-2021
Name of foundation A Employer identification number
CENTURION FOUNDATION
87-3351799
Number and street (or P.O. box number if mail is not delivered to street address) Room/suite B Telephone number (see instructions)
3155 BLUESTEM DRIVE SUITE 174
(847) 317-5051
City or town, state or province, country, and ZIP or foreign postal code
WEST FARGO, ND 58078 C If exemption application is pending, check here
G Check all that apply: Initial return Initial return of a former public charity D 1. Foreign organizations, check here.............
5a Gross rents . . . . . . . . . . . .
9 Income modifications . . . . . . . . . . .
Page 2
3 Accounts receivable
4 Pledges receivable
5 Grants receivable . . . . . . . . . . . . . . . . .
12 Investments—mortgage loans . . . . . . . . . . . . .
18 Grants payable . . . . . . . . . . . . . . . . .
19 Deferred revenue . . . . . . . . . . . . . . . . .
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Exempt operating foundations described in section 4940(d)(2), check here and enter “N/A" on line
1. Bracket
for line
1a 1a
Date of ruling or determination letter: (attach copy of letter if necessary–see instructions)
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)
b
Tax under section 511 (domestic section 4947(a)(1) trusts and taxable foundations only. Others enter -0-) 2
2 0
Add lines 1 and 2. . . . . . . . . . . . . . . . . . . . . . . . . . . 3
3 2 80
3 2,804
Subtitle A (income) tax (domestic section 4947(a)(1) trusts and taxable foundations only. Others enter -0-) 4
4 0
Tax based on investment income. Subtract line 4 from line 3. If zero or less, enter -0- . . . . . 5
5 2,804
Credits/Payments:
6
a 2021 estimated tax payments and 2020 overpayment credited to 2021 6a 0
b Exempt foreign organizations—tax withheld at source . . . . . . 6b 0
c Tax paid with application for extension of time to file (Form 8868) . . . 6c 10,000
d Backup withholding erroneously withheld 6d 0
. . . . . . . . . . .
7 Total credits and payments. Add lines 6a through 6d. . . . . . . . . . . . . . 7 10,000
8 38
8 Enter any penalty for underpayment of estimated tax. Check here if Form 2220 is attached.
9 Tax due. If the total of lines 5 and 8 is more than line 7, enter amount owed . . . . . . . 9
10 Overpayment. If line 7 is more than the total of lines 5 and 8, enter the amount overpaid . . . 10 7,158
11 Enter the amount of line 10 to be: Credited to 2022 estimated tax 7,158 Refunded 11 0
Part VI-A Statements Regarding Activities
1a During the tax year, did the foundation attempt to influence any national, state, or local legislation or did Yes No
it participate or intervene in any political campaign? . . . . . . . . . . . . . . . . . . . . 1a No
b Did it spend more than $100 during the year (either directly or indirectly) for political purposes? See the instructions
for the definition. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1b No
If the answer is "Yes" to 1a or 1b, attach a detailed description of the activities and copies of any materials
published or distributed by the foundation in connection with the activities.
c Did the foundation file Form 1120-POL for this year?. . . . . . . . . . . . . . . . . . . . . 1c No
d Enter the amount (if any) of tax on political expenditures (section 4955) imposed during the year:
(1) On the foundation. $ 0 (2) On foundation managers. $ 0
e Enter the reimbursement (if any) paid by the foundation during the year for political expenditure tax imposed
on foundation managers. $ 0
2 Has the foundation engaged in any activities that have not previously been reported to the IRS? . . . . . . . 2 No
If "Yes," attach a detailed description of the activities.
3 Has the foundation made any changes, not previously reported to the IRS, in its governing instrument, articles
of incorporation, or bylaws, or other similar instruments? If "Yes," attach a conformed copy of the changes . . . . 3 No
4a Did the foundation have unrelated business gross income of $1,000 or more during the year?. . . . . . . . . 4a No
b If "Yes," has it filed a tax return on Form 990-T for this year?. . . . . . . . . . . . . . . . . . . 4b
5 Was there a liquidation, termination, dissolution, or substantial contraction during the year? . . . . . . . . . 5 No
If "Yes," attach the statement required by General Instruction T.
6 Are the requirements of section 508(e) (relating to sections 4941 through 4945) satisfied either:
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)
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 Yes
Form 990-PF (2021)
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14 The books are in care of THE AYCO COMMPANY Telephone no. (847) 317-5051
15 Section 4947(a)(1) nonexempt charitable trusts filing Form 990-PF in lieu of Form 1041 —check here . . . . . . . . .
and enter the amount of tax-exempt interest received or accrued during the year . . . . . . . . 15
16 At any time during calendar year 2021, did the foundation have an interest in or a signature or other authority over Yes No
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
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. . . . . . . .
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 (Part XII, lines 6d
and 6e) for tax year(s) beginning before 2021?. . . . . . . . . . . . . . . . . . . . 2a No
If "Yes," list the years 20 , 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.
20 , 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)
Page 6
Information About Officers, Directors, Trustees, Foundation Managers, Highly Paid Employees,
Part VII
and Contractors
1 List all officers, directors, trustees, foundation managers and their compensation. See instructions
(b) Title, and average (c) Compensation (If (d) Contributions to
(e) Expense account,
(a) Name and address hours per week not paid, enter employee benefit plans and
other allowances
devoted to position -0-) deferred compensation
MICHAEL CHAMBERS TRUSTEE 0 0 0
2.00
3155 BLUESTEM DR 174
WEST FARGO, ND 58078
VICTORIA CHAMBERS TRUSTEE 0 0 0
2.00
3155 BLUESTEM DR 174
WEST FARGO, ND 58078
2 Compensation of five highest-paid employees (other than those included on line 1—see instructions). If none, enter “NONE."
(d) Contributions to
(b) Title, and average
(a) Name and address of each employee paid employee benefit (e) Expense account,
hours per week (c) Compensation
more than $50,000 plans and deferred other allowances
devoted to position
compensation
NONE
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3
4
2
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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.)
1 Information Regarding Foundation Managers:
a List 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).)
MICHAEL CHAMBERS
VICTORIA CHAMBERS
b List 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.
Check here if the foundation only makes contributions to preselected charitable organizations and does not accept
unsolicited requests for funds. If the foundation makes gifts, grants, etc. to individuals or organizations under
other conditions, complete items 2a, b, c, and d. See instructions
a The name, address, and telephone number or email address of the person to whom applications should be addressed:
b The form in which applications should be submitted and information and materials they should include:
d Any restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other
factors:
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Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3a 0
b Approved for future payment
Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3b 0
Form 990-PF (2021)
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(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? . . . . . . . . . . . Yes No
b If "Yes," complete the following schedule.
(a) Name of organization (b) Type of organization (c) Description of relationship
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
Sign which preparer has any knowledge.
Software ID:
Software Version:
(Form 990)
Department of the Treasury
Internal Revenue Service
Attach to Form 990, 990-EZ, or 990-PF.
Go to www.irs.gov/Form990 for the latest information. 2021
Name of the organization Employer identification number
CENTURION FOUNDATION
87-3351799
Organization type (check one):
General Rule
For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, contributions totaling $5,000 or more (in
money or other property) from any one contributor. Complete Parts I and II. See instructions for determining a contributor's total
contributions.
Special Rules
For an organization described in section 501(c)(3) filing Form 990 or 990-EZ that met the 331/3% support test of the regulations
under sections 509(a)(1) and 170(b)(1)(A)(vi), that checked Schedule A (Form 990 or 990-EZ), Part II, line 13, 16a, or 16b, and that
received from any one contributor, during the year, total contributions of the greater of (1) $5,000 or (2) 2% of the amount on (i) Form
990, Part VIII, line 1h, or (ii) Form 990-EZ, line 1. Complete Parts I and II.
For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, total contributions of more than $1,000 exclusively for religious, charitable, scientific, literary, or educational
purposes, or for the prevention of cruelty to children or animals. Complete Parts I, II, and III.
For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, contributions exclusively for religious, charitable, etc., purposes, but no such contributions totaled more than $1,000.
If this box is checked, enter here the total contributions that were received during the year for an exclusively religious, charitable, etc.,
purpose. Don't complete any of the parts unless the General Rule applies to this organization because it received nonexclusively
religious, charitable, etc., contributions totaling $5,000 or more during the year . . . . . . . . . $
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 Cat. No. 30613X Schedule B (Form 990) (2021)
for Form 990, 990-EZ, or 990-PF.
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1
PUBLICLY TRADED SECURITIES $ 160,612,173 2021-12-22
1
(a) (c)
(b) (d)
No. from FMV (or estimate)
Description of noncash property given Date received
Part I (See instructions)
$
(a) (c)
(b) (d)
No. from FMV (or estimate)
Description of noncash property given Date received
Part I (See instructions)
$
(a) (c)
(b) (d)
No. from FMV (or estimate)
Description of noncash property given Date received
Part I (See instructions)
$
(a) (c)
(b) (d)
No. from FMV (or estimate)
Description of noncash property given Date received
Part I (See instructions)
$
(a) (c)
(b) (d)
No. from FMV (or estimate)
Description of noncash property given Date received
Part I (See instructions)
$
Page 4
(a)
No. from (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
Part I
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
(a)
No. from (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
Part I
Software ID:
Software Version:
efile Public Visual Render ObjectId: 202213199349102151 - Submission: 2022-11-15 TIN: 87-3351799
TY 2021 IRS 990 e-File Render
Name of Stock End of Year Book Value End of Year Fair Market Value
efile Public Visual Render ObjectId: 202213199349102151 - Submission: 2022-11-15 TIN: 87-3351799
TY 2021 IRS 990 e-File Render
Description Amount
efile Public Visual Render ObjectId: 202213199349102151 - Submission: 2022-11-15 TIN: 87-3351799
TY 2021 IRS 990 e-File Render
Name Address
MICHAEL CHAMBERS 3155 BLUESTEM DR 174
WEST FARGO, ND 58078