TY 2021 Form 990PF

- TIN:

Form990-PF
Click to see attachment

Department of the Treasury
Internal Revenue Service

Return of Private Foundation

or Section 4947(a)(1) Trust Treated as Private Foundation

Do not enter social security numbers on this form as it may be made public.
bullet

Go to www.irs.gov/Form990PF for instructions and the latest information.

OMB No. 1545-0047

2021

Open to Public Inspection

For calendar year 2021, or tax year beginning 01-01-2021 , and ending 12-31-2021

Name of foundation
Lane Werner Family Foundation

% Foundation Source

Number and street (or P.O. box number if mail is not delivered to street address)Foundation Source 501 Silverside Rd
Room/suite

City or town, state or province, country, and ZIP or foreign postal code
Wilmington, DE198091377

A Employer identification number

20-5429087

B Telephone number (see instructions)

(800) 839-1754

C If exemption application is pending, check here bullet

G Check all that apply: Initial returnInitial return of a former public charity
Final returnAmended return
Address change Name change

D 1. Foreign organizations, check here............. bullet

2. Foreign organizations meeting the 85%
test, check here and attach computation ... bullet

E If private foundation status was terminated
under section 507(b)(1)(A), check here ....... bullet

H Check type of organization: Section 501(c)(3) exempt private foundation
Section 4947(a)(1) nonexempt charitable trust Other taxable private foundation

F If the foundation is in a 60-month termination
under section 507(b)(1)(B), check here ....... bullet

I Fair market value of all assets at end
of year (from Part II, col. (c),
line 16) bullet

$963,521J Accounting method: Cash Accrual
Other (specify)
(Part I, column (d) must be on cash basis.)

	Analysis of Revenue and Expenses (The total of amounts in columns (b), (c), and (d) may not necessarily equal the amounts in column (a) (see instructions).)	(a) Revenue and expenses per books		(b) Net investment income	(d) Disbursements for charitable purposes (cash basis only)


1	Contributions, gifts, grants, etc., received (attach schedule)	125,317
2	Check .............
3	Interest on savings and temporary cash investments	7		7
4	Dividends and interest from securities...	15,230		15,230
5a	Gross rents............
b	Net rental income or (loss)
6a	Net gain or (loss) from sale of assets not on line 10		248,147
b	Gross sales price for all assets on line 6a 1,031,486
7	Capital gain net income (from Part IV, line 2)...			330,651
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........	388,701		345,888
13	Compensation of officers, directors, trustees, etc.	0
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)....		5,805	5,805
17	Interest...............
18	Taxes (attach schedule) (see instructions)...		2,950	150
19	Depreciation (attach schedule) and depletion...
20	Occupancy..............
21	Travel, conferences, and meetings.......
22	Printing and publications..........
23	Other expenses (attach schedule).......		6,066	41	6,025
24	Total operating and administrative expenses.
	Add lines 13 through 23..........	14,821		5,996	6,025
25	Contributions, gifts, grants paid.......	75,170			75,170
26	Total expenses and disbursements. Add lines 24 and 25	89,991		5,996	81,195
27	Subtract line 26 from line 12:
a	Excess of revenue over expenses and disbursements	298,710
b	Net investment income (if negative, enter -0-)			339,892
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	Beginning of year	End of year
Part II		Balance Sheets	(a) Book Value	(b) Book Value	(c) Fair Market Value
	1	Cash—non-interest-bearing.............
	2	Savings and temporary cash investments.........	45,857	136,227	136,227
	3	Accounts receivable
		Less: allowance for doubtful accounts
	4	Pledges receivable
		Less: allowance for doubtful accounts
	5	Grants receivable.................
	6	Receivables due from officers, directors, trustees, and other
		disqualified persons (attach schedule) (see instructions).....
	7	Other notes and loans receivable (attach schedule)
		Less: allowance for doubtful accounts
	8	Inventories for sale or use..............
	9	Prepaid expenses and deferred charges..........
	10a	Investments—U.S. and state government obligations (attach schedule)
	b	Investments—corporate stock (attach schedule).......	532,738	741,078	827,294
	c	Investments—corporate bonds (attach schedule).......
	11	Investments—land, buildings, and equipment: basis
		Less: accumulated depreciation (attach schedule)
	12	Investments—mortgage loans.............
	13	Investments—other (attach schedule)..........
	14	Land, buildings, and equipment: basis
		Less: accumulated depreciation (attach schedule)
	15	Other assets (describe )
	16	Total assets (to be completed by all filers—see the
		instructions. Also, see page 1, item I)	578,595	877,305	963,521
	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 )
	23	Total liabilities (add lines 17 through 22).........	0	0
		Foundations that follow FASB ASC 958, check here
		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
		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	578,595	877,305
	29	Total net assets or fund balances (see instructions).....	578,595	877,305
	30	Total liabilities and net assets/fund balances (see instructions).	578,595	877,305

Part III

Analysis of Changes in Net Assets or Fund Balances

Total net assets or fund balances at beginning of year—Part II, column (a), line 29 (must agree with end-of-year figure reported on prior year’s return) ...............

578,595

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

298,710

Other increases not included in line 2 (itemize) bullet

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

877,305

Decreases not included in line 2 (itemize) bullet

Total net assets or fund balances at end of year (line 4 minus line 5)—Part II, column (b), line 29 .

877,305

Form 990-PF (2021)

Page 3

Part IV

Capital Gains and Losses for Tax on Investment Income

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

(e) Gross sales price		(g) Cost or other basis plus expense of sale	(h) Gain or (loss) (e) plus (f) minus (g)
a	1,031,486	700,835	330,651
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			330,651
b
c
d
e

2	Capital gain net income or (net capital loss)	If gain, also enter in Part I, line 7 If (loss), enter -0- in Part I, line 7	2	330,651
3	Net short-term capital gain or (loss) as defined in sections 1222(5) and (6):
	If gain, also enter in Part I, line 8, column (c) (see instructions). If (loss), enter -0- in Part I, line 8 ...................		3

Form 990-PF (2021)

Page 4

Part V

Excise Tax Based on Investment Income (Section 4940(a), 4940(b), 4940(e), or 4948—see instructions)

1a	Exempt operating foundations described in section 4940(d)(2), check here and enter “N/A" on line 1.
	Date of ruling or determination letter: (attach copy of letter if necessary–see instructions)
b	All other domestic foundations enter 1.39% (0.0139) of line 27b. Exempt foreign organizations enter 4% (0.04) of Part I, line 12, col. (b)
2	Tax under section 511 (domestic section 4947(a)(1) trusts and taxable foundations only. Others enter -0-)	2
3	Add lines 1 and 2...........................	3	4,724
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	4,724
6	Credits/Payments:

a	2021 estimated tax payments and 2020 overpayment credited to 2021	6a	3,351
b	Exempt foreign organizations—tax withheld at source......	6b	0
c	Tax paid with application for extension of time to file (Form 8868)...	6c	1,373
d	Backup withholding erroneously withheld ...........	6d

7	Total credits and payments. Add lines 6a through 6d..............		7	4,724
8	Enter any penalty for underpayment of estimated tax. Check here if Form 2220 is attached.		8	0
9	Tax due. If the total of lines 5 and 8 is more than line 7, enter amount owed.......		9
10	Overpayment. If line 7 is more than the total of lines 5 and 8, enter the amount overpaid...		10
11	Enter the amount of line 10 to be: Credited to 2022 estimated tax	Refunded	11

Part VI-A

Statements Regarding Activities

During the tax year, did the foundation attempt to influence any national, state, or local legislation or did

Yes

it participate or intervene in any political campaign? ....................

Did it spend more than $100 during the year (either directly or indirectly) for political purposes? See the instructions

for the definition.................................

If the answer is "Yes" to 1a or 1b, attach a detailed description of the activities and copies of any materials

published or distributed by the foundation in connection with the activities.

Did the foundation file Form 1120-POL for this year?.....................

Enter the amount (if any) of tax on political expenditures (section 4955) imposed during the year:

(1) On the foundation. bullet

$ (2) On foundation managers. bullet

Enter the reimbursement (if any) paid by the foundation during the year for political expenditure tax imposed

on foundation managers. bullet

Has the foundation engaged in any activities that have not previously been reported to the IRS?.......

If "Yes," attach a detailed description of the activities.

Has the foundation made any changes, not previously reported to the IRS, in its governing instrument, articles

of incorporation, or bylaws, or other similar instruments? If "Yes," attach a conformed copy of the changes....

Did the foundation have unrelated business gross income of $1,000 or more during the year?.........

If "Yes," has it filed a tax return on Form 990-T for this year?...................

Was there a liquidation, termination, dissolution, or substantial contraction during the year?.........

If "Yes," attach the statement required by General Instruction T.

Are the requirements of section 508(e) (relating to sections 4941 through 4945) satisfied either:

By language in the governing instrument, or

By state legislation that effectively amends the governing instrument so that no mandatory directions

that conflict with the state law remain in the governing instrument?................

Yes

Did the foundation have at least $5,000 in assets at any time during the year? If "Yes," complete Part II, col. (c),

and Part XIV..................................

Yes

Enter the states to which the foundation reports or with which it is registered (see instructions)

If the answer is "Yes" to line 7, has the foundation furnished a copy of Form 990-PF to the Attorney

General (or designate) of each state as required by General Instruction G? If "No," attach explanation .

Yes

Is the foundation claiming status as a private operating foundation within the meaning of section 4942(j)(3)

or 4942(j)(5) for calendar year 2021 or the taxable year beginning in 2021? See the instructions for Part XIII.

If "Yes," complete Part XIII .............................

Did any persons become substantial contributors during the tax year? If "Yes," attach a schedule listing their names

and addresses. ...............................

Form 990-PF (2021)

Page 5

Part VI-A

Statements Regarding Activities (continued)

At any time during the year, did the foundation, directly or indirectly, own a controlled entity within the

meaning of section 512(b)(13)? If "Yes," attach schedule. See instructions .............

Did the foundation make a distribution to a donor advised fund over which the foundation or a disqualified person had

advisory privileges? If "Yes," attach statement. See instructions.................

Did the foundation comply with the public inspection requirements for its annual returns and exemption application?

Yes

Website address bullet

The books are in care of bullet

Foundation Source Telephone no. bullet

(800) 839-1754

Located at bullet

501 SILVERSIDE ROAD SUITE 123WilmingtonDE ZIP+4 bullet

198091377

Section 4947(a)(1) nonexempt charitable trusts filing Form 990-PF in lieu of Form 1041 —check here ......... bullet

and enter the amount of tax-exempt interest received or accrued during the year ........ bullet

16 At any time during calendar year 2021, did the foundation have an interest in or a signature or other authority over YesNo

a bank, securities, or other financial account in a foreign country? .................

16 No

See the instructions for exceptions and filing requirements for FinCEN Form 114. If "Yes", enter the name of the foreign
country bullet

Part VI-B

Statements Regarding Activities for Which Form 4720 May Be Required

File Form 4720 if any item is checked in the "Yes" column, unless an exception applies.

Yes

During the year did the foundation (either directly or indirectly):

(1) Engage in the sale or exchange, or leasing of property with a disqualified person? ...........

1a(1)

(2) Borrow money from, lend money to, or otherwise extend credit to (or accept it from)

a disqualified person? ..............................

1a(2)

(3) Furnish goods, services, or facilities to (or accept them from) a disqualified person? ...........

1a(3)

(4) Pay compensation to, or pay or reimburse the expenses of, a disqualified person? ............

1a(4)

(5) Transfer any income or assets to a disqualified person (or make any of either available

for the benefit or use of a disqualified person)? ......................

1a(5)

(6) Agree to pay money or property to a government official? (Exception. Check "No"

if the foundation agreed to make a grant to or to employ the official for a period

after termination of government service, if terminating within 90 days.) ...............

1a(6)

If any answer is "Yes" to 1a(1)–(6), did any of the acts fail to qualify under the exceptions described in Regulations

section 53.4941(d)-3 or in a current notice regarding disaster assistance? See instructions ..........

Organizations relying on a current notice regarding disaster assistance check here........ bullet

Did the foundation engage in a prior year in any of the acts described in 1a, other than excepted acts,

that were not corrected before the first day of the tax year beginning in 2021? .............

Taxes on failure to distribute income (section 4942) (does not apply for years the foundation was a private

operating foundation defined in section 4942(j)(3) or 4942(j)(5)):

At the end of tax year 2021, did the foundation have any undistributed income (lines 6d

and 6e, Part XII) for tax year(s) beginning before 2021?....................

If "Yes," list the years bullet

20, 20, 20, 20

Are there any years listed in 2a for which the foundation is not applying the provisions of section 4942(a)(2)

(relating to incorrect valuation of assets) to the year’s undistributed income? (If applying section 4942(a)(2)

to all years listed, answer "No" and attach statement—see instructions.) ..............

If the provisions of section 4942(a)(2) are being applied to any of the years listed in 2a, list the years here.

20, 20, 20, 20

Did the foundation hold more than a 2% direct or indirect interest in any business enterprise at

any time during the year? ..............................

If "Yes," did it have excess business holdings in 2021 as a result of (1) any purchase by the foundation

or disqualified persons after May 26, 1969; (2) the lapse of the 5-year period (or longer period approved

by the Commissioner under section 4943(c)(7)) to dispose of holdings acquired by gift or bequest; or (3)

the lapse of the 10-, 15-, or 20-year first phase holding period? (Use Schedule C, Form 4720, to determine

if the foundation had excess business holdings in 2021.) .....................

Did the foundation invest during the year any amount in a manner that would jeopardize its charitable purposes?

Did the foundation make any investment in a prior year (but after December 31, 1969) that could jeopardize its

charitable purpose that had not been removed from jeopardy before the first day of the tax year beginning in 2021? ..

Form 990-PF (2021)

Page 6

Part VI-B

Statements Regarding Activities for Which Form 4720 May Be Required (continued)

During the year did the foundation pay or incur any amount to:

Yes

(1) Carry on propaganda, or otherwise attempt to influence legislation (section 4945(e))? ..........

5a(1)

(2) Influence the outcome of any specific public election (see section 4955); or to carry

on, directly or indirectly, any voter registration drive? ....................

5a(2)

(3) Provide a grant to an individual for travel, study, or other similar purposes? .............

5a(3)

(4) Provide a grant to an organization other than a charitable, etc., organization described

in section 4945(d)(4)(A)? See instructions ........................

5a(4)

(5) Provide for any purpose other than religious, charitable, scientific, literary, or

educational purposes, or for the prevention of cruelty to children or animals? .............

5a(5)

If any answer is "Yes" to 5a(1)–(5), did any of the transactions fail to qualify under the exceptions described in

Regulations section 53.4945 or in a current notice regarding disaster assistance? See instructions ........

Organizations relying on a current notice regarding disaster assistance check here ......... bullet

If the answer is "Yes" to question 5a(4), does the foundation claim exemption from the

tax because it maintained expenditure responsibility for the grant? .................

If "Yes," attach the statement required by Regulations section 53.4945–5(d).

Did the foundation, during the year, receive any funds, directly or indirectly, to pay premiums on

a personal benefit contract? .............................

Did the foundation, during the year, pay premiums, directly or indirectly, on a personal benefit contract? ....

If "Yes" to 6b, file Form 8870.

At any time during the tax year, was the foundation a party to a prohibited tax shelter transaction?

If "Yes", did the foundation receive any proceeds or have any net income attributable to the transaction? .....

Is the foundation subject to the section 4960 tax on payment(s) of more than $1,000,000 in remuneration or

excess parachute payment during the year? .........................

Part VII

Information About Officers, Directors, Trustees, Foundation Managers, Highly Paid Employees,
and Contractors

1 List all officers, directors, trustees, foundation managers and their compensation. See instructions

(a) Name and address	(b) Title, and average hours per week devoted to position	(c) Compensation (If not paid, enter -0-)	(d) Contributions to employee benefit plans and deferred compensation	(e) Expense account, other allowances
Jennifer Lane Werner	Pres, Dir 1.0	0	0	0
Foundation Source 501 Silverside Rd Wilmington,DE198091377	Pres, Dir 1.0	0	0	0
Blaine Werner	Dir, Sec 1.0	0	0	0
Foundation Source 501 Silverside Rd Wilmington,DE198091377	Dir, Sec 1.0	0	0	0
Margo Werner	Dir 1.0	0	0	0
Foundation Source 501 Silverside Rd Wilmington,DE198091377	Dir 1.0	0	0	0
Tierney Werner	Dir 1.0	0	0	0
Foundation Source 501 Silverside Rd Wilmington,DE198091377	Dir 1.0	0	0	0
Blaine Patrick Werner Jr	Dir 1.0	0	0	0
Foundation Source 501 Silverside Rd Wilmington,DE198091377	Dir 1.0	0	0	0

2 Compensation of five highest-paid employees (other than those included on line 1—see instructions). If none, enter “NONE."


(a) Name and address of each employee paid more than $50,000	(b) Title, and average hours per week devoted to position	(c) Compensation	(d) Contributions to employee benefit plans and deferred compensation	(e) Expense account, other allowances










Total number of other employees paid over $50,000...................

Form 990-PF (2021)

Page 7

Part VII

Information About Officers, Directors, Trustees, Foundation Managers, Highly Paid Employees,
and Contractors (continued)

3 Five highest-paid independent contractors for professional services (see instructions). If none, enter "NONE".
(a) Name and address of each person paid more than $50,000	(b) Type of service	(c) Compensation

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)

Page 8

Part IX

Minimum Investment Return (All domestic foundations must complete this part. Foreign foundations, see instructions.)

Fair market value of assets not used (or held for use) directly in carrying out charitable, etc.,

purposes:

Average monthly fair market value of securities...................

770,517

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

79,347

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

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

849,864

Reduction claimed for blockage or other factors reported on lines 1a and

1c (attach detailed explanation) .............

Acquisition indebtedness applicable to line 1 assets..................

Subtract line 2 from line 1d.........................

849,864

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

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

12,748

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

837,116

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

41,856

Part X

Distributable Amount (see instructions) (Section 4942(j)(3) and (j)(5) private operating foundations and certain foreign organizations check here right arrow

and do not complete this part.)

Minimum investment return from Part IX, line 6..................

41,856

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

4,724

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

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

4,724

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

37,132

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

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

37,132

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

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

37,132

Part XI

Qualifying Distributions (see instructions)

Amounts paid (including administrative expenses) to accomplish charitable, etc., purposes:

Expenses, contributions, gifts, etc.—total from Part I, column (d), line 26 ..........

Program-related investments—total from Part VIII-B..................

Amounts paid to acquire assets used (or held for use) directly in carrying out charitable, etc.,

purposes...............................

Amounts set aside for specific charitable projects that satisfy the:

Suitability test (prior IRS approval required)....................

Cash distribution test (attach the required schedule) .................

Qualifying distributions. Add lines 1a through 3b. Enter here and on Part XII, line 4.

Form 990-PF (2021)

Page 9

Part XII

Undistributed Income (see instructions)

		(a) Corpus	(d) 2021
1 Distributable amount for 2021 from Part X, line 7			37,132
2 Undistributed income, if any, as of the end of 2021:
a Enter amount for 2020 only.......
b Total for prior years:2019, 2018, 2017
3 Excess distributions carryover, if any, to 2021:
a From 2016......	58,064
b From 2017......	21,132
c From 2018......	8,228
d From 2019......	39,687
e From 2020......	39,469
f Total of lines 3a through e ........		166,580
4Qualifying distributions for 2021 from Part
XI, line 4: $ 81,195
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.....			37,132
e Remaining amount distributed out of corpus		44,063
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		210,643
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) ...		58,064
9 Excess distributions carryover to 2022. Subtract lines 7 and 8 from line 6a ......		152,579
10 Analysis of line 9:
a Excess from 2017....	21,132
b Excess from 2018....	8,228
c Excess from 2019....	39,687
d Excess from 2020....	39,469
e Excess from 2021....	44,063

Form 990-PF (2021)

Page 10

Part XIII

Private Operating Foundations (see instructions and Part VI-A, question 9)

1a If the foundation has received a ruling or determination letter that it is a private operating
foundation, and the ruling is effective for 2021, enter the date of the ruling ....... bullet

b Check box to indicate whether the organization is a private operating foundation described in section 4942(j)(3) or4942(j)(5)

2a Enter the lesser of the adjusted net income from Part I or the minimum investment return from Part X for each year listed ..........	Tax year	Prior 3 years			(e) Total
	(a) 2021	(b) 2020	(c) 2019	(d) 2018	(e) Total

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).)

Blaine Werner

Jennifer Lane Werner

bList any managers of the foundation who own 10% or more of the stock of a corporation (or an equally large portion of the
ownership of a partnership or other entity) of which the foundation has a 10% or greater interest.

2Information Regarding Contribution, Grant, Gift, Loan, Scholarship, etc., Programs:

Check here bullet

if the foundation only makes contributions to preselected charitable organizations and does not accept
unsolicited requests for funds. If the foundation makes gifts, grants, etc. to individuals or organizations under
other conditions, complete items 2a, b, c, and d. See instructions

aThe name, address, and telephone number or email address of the person to whom applications should be addressed:

bThe form in which applications should be submitted and information and materials they should include:

cAny submission deadlines:

dAny restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other
factors:

Form 990-PF (2021)

Page 11

Part XIV

Supplementary Information (continued)

3 Grants and Contributions Paid During the Year or Approved for Future Payment
Recipient	If recipient is an individual, show any relationship to any foundation manager or substantial contributor	Foundation status of recipient	Purpose of grant or contribution	Amount
Name and address (home or business)		Foundation status of recipient	Purpose of grant or contribution	Amount
aPaid during the year
ABBEY FOUNDATION OF OREGON 1 ABBEY DR ST BENEDICT,OR97373	N/A	SO I	General & Unrestricted	2,500
AIRPORT ROTARY FOUNDATION 1574 COBURG RD 188 EUGENE,OR97401	N/A	PC	General & Unrestricted	2,000
BOY SCOUTS OF AMERICA 2525 MARTIN LUTHER KING JR BLVD EUGENE,OR97401	N/A	PC	General & Unrestricted	7,000
CENTRAL CATHOLIC HIGH SCHOOL 2401 SE STARK ST PORTLAND,OR97214	N/A	PC	Msgr. Tim Murphy Scholarship Fund for needy studends	5,000
FAITH IN PRACTICE 7500 BEECHNUT ST STE 208 HOUSTON,TX77074	N/A	PC	General & Unrestricted	1,500
GREATER EUGENE AREA RIDERS CYCLING CLUB INC PO BOX 10244 EUGENE,OR97440	N/A	PC	General & Unrestricted	1,000
OSLC DEVELOPMENTS INC 10 SHELTON MCMURPHEY BLVD EUGENE,OR97401	N/A	PC	The 15th Night Fund	1,500
OSLC DEVELOPMENTS INC 10 SHELTON MCMURPHEY BLVD EUGENE,OR97401	N/A	PC	The 15th Night Fund	1,000
QUEEN OF PEACE FOUNDATION 2618 VIA VERDE WALNUT CREEK,CA94598	N/A	PC	General & Unrestricted	12,500
ROMAN CATHOLIC ARCHDIOCESE OF NASSAU FOUNDATION IN 110 MERRICK WAY NO 3-B CORAL GABLES,FL33134	N/A	SO I	Grade school tuition Scholarship Fund	2,170
ST ANTHONY CHURCH PO BOX 770 WALDPORT,OR97394	N/A	PC	General & Unrestricted	2,000
ST MARK CATHOLIC CHURCH 1760 ECHO HOLLOW RD EUGENE,OR97402	N/A	PC	General & Unrestricted	2,000
ST PATRICK CATHEDRAL 1206 THROCKMORTON ST FORT WORTH,TX76102	N/A	PC	General & Unrestricted	10,000
ST ROSE OF LIMA CATHOLIC CHURCH 2727 NE 54TH AVE PORTLAND,OR97213	N/A	PC	General & Unrestricted	20,000
WILLAMETTE FAMILY INC 687 CHESHIRE AVE EUGENE,OR97402	N/A	PC	Cheshire Mother/Child assistance fund	5,000
Total ................................. 3a				75,170

bApproved for future payment

Total ................................. 3b

Form 990-PF (2021)

Page 12

Part XV-A

Analysis of Income-Producing Activities

Enter gross amounts unless otherwise indicated.	Unrelated business income		Excluded by section 512, 513, or 514		(e) Related or exempt function income (See instructions.)
1Program service revenue:	(a) Business code	(b) Amount	(c) Exclusion code	(d) Amount	(e) Related or exempt function income (See instructions.)
a
b
c
d
e
f
gFees and contracts from government agencies
2 Membership dues and assessments ....
3 Interest on savings and temporary cash investments ...........			14	7
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	248,147
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) ..				263,384

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

263,384

(See worksheet in line 13 instructions to verify calculations.)

Part XV-B

Relationship of Activities to the Accomplishment of Exempt Purposes

Line No.	Explain below how each activity for which income is reported in column (e) of Part XV-A contributed importantly to the accomplishment of the foundation’s exempt purposes (other than by providing funds for such purposes). (See instructions.)

Form 990-PF (2021)

Page 13

Part XVI

Information Regarding Transfers To and Transactions and Relationships With Noncharitable Exempt Organizations

Did the organization directly or indirectly engage in any of the following with any other organization described in section 501(c) (other than section 501(c)(3) organizations) or in section 527, relating to political organizations?

Yes

Transfers from the reporting foundation to a noncharitable exempt organization of:

(1) Cash...................................

1a(1)

(2) Other assets.................................

1a(2)

Other transactions:

(1) Sales of assets to a noncharitable exempt organization....................

1b(1)

(2) Purchases of assets from a noncharitable exempt organization..................

1b(2)

(3) Rental of facilities, equipment, or other assets.......................

1b(3)

(4) Reimbursement arrangements...........................

1b(4)

(5) Loans or loan guarantees.............................

1b(5)

(6) Performance of services or membership or fundraising solicitations................

1b(6)

Sharing of facilities, equipment, mailing lists, other assets, or paid employees..............

If the answer to any of the above is "Yes," complete the following schedule. Column (b) should always show the fair market value
of the goods, other assets, or services given by the reporting foundation. If the foundation received less than fair market value
in any transaction or sharing arrangement, show in column (d) the value of the goods, other assets, or services received.

(a) Line No.	(b) Amount involved	(c) Name of noncharitable exempt organization	(d) Description of transfers, transactions, and sharing arrangements

Is the foundation directly or indirectly affiliated with, or related to, one or more tax-exempt organizations
described in section 501(c) (other than section 501(c)(3)) or in section 527? ...........Yes No

If "Yes," complete the following schedule.

(a) Name of organization	(b) Type of organization	(c) Description of relationship

Sign Here

Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.
				May the IRS discuss this return with the preparer shown below? See instructions. Yes No
	Signature of officer or trustee	Date	Title

Paid Preparer Use Only	Print/Type preparer's name	Preparer's Signature	Date	Check if self- employed	PTIN
	Firm's name				Firm's EIN
	Firm's address				Phone no.

Form 990-PF (2021)

Additional Data

Software ID:
Software Version:

Form 990PF - Special Condition Description:

Special Condition Description

- TIN:

Schedule B
(Form 990)

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

Attach to Form 990, 990-EZ, or 990-PF.

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2021

Name of the organization

Lane Werner Family Foundation

Employer identification number

20-5429087

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

4947(a)(1) nonexempt charitable trust not treated as a private foundation

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

4947(a)(1) nonexempt charitable trust treated as a private foundation

501(c)(3) taxable private foundation

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

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 ......... 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 Lane Werner Family Foundation

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
1	Lane Werner Jennifer PO Box 8188 Coburg, OR97408	$ 125,317	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
Schedule B (Form 990) (2021)

Schedule B (Form 990) (2021)

Page 3

Name of organization Lane Werner Family Foundation		Employer identification number 20-5429087

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
1	MATCH GROUP INC MTCH, 174 sh.	$ 25,383	2021-05-24
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
1	3M CO MMM, 44 sh.	$ 8,592	2021-08-19
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
1	COSTCO WHOLESALE CORPORATION COST, 100 sh.	$ 47,017	2021-10-20
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
1	AMERICAN INVESTMENT CO OF AMERICA AIVSX, 825.564 sh.	$ 44,325	2021-11-19
(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 Lane Werner Family Foundation			Employer identification number 20-5429087
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.) $ Use duplicate copies of Part III if additional space is needed.

(a)
No. from Part I

(b) Purpose 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

(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

(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

(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:
Software Version:

- TIN:

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

TY 2021 DepreciationSchedule

Name:

Lane Werner Family Foundation

EIN:

20-5429087

Description of Property	Date Acquired	Cost or Other Basis	Prior Years' Depreciation	Computation Method	Rate / Life (# of years)	Current Year's Depreciation Expense	Net Investment Income	Adjusted Net Income	Cost of Goods Sold Not Included

- TIN:

TY 2021 InvestmentsCorpStockSchedule

Name:

Lane Werner Family Foundation

EIN:

20-5429087

Name of Stock	End of Year Book Value	End of Year Fair Market Value
ACTIVISION BLIZZARD INC	1,102	798
ADIDAS AG	1,057	864
ADOBE SYSTEMS, INC	2,827	2,835
ADVANCED MICRO DEVICES INC	927	1,727
AIA GROUP LTD ADR	4,462	3,427
AIRBUS GROUP	2,008	2,106
ALBERTSONS COMPANIES INC	672	1,238
ALPHABET INC CL C	4,625	5,787
AMADEUS IT HLDS SA	970	880
AMAZON COM	6,421	6,669
AMERICA MOVIL SA	1,730	2,428
AMERICAN TOWER REIT INC	1,235	1,463
AMGEN INC	23,257	20,697
ANHEUSER BUSCH COS INC	1,111	908
APPLE INC	2,891	4,794
APPLIED MATERIALS INC	7,700	11,173
ASAHI KAISAI CP ADR	1,810	1,522
ASBURY AUTOMOTIVE GR	1,567	2,764
ASML HOLDING NV NY REG SHS	6,038	7,961
ASSA ABLOY UNSP/ADR	1,841	1,863
ASSOCIATED BRITISH FOODS PLC	832	714
ASTRAZENECA	2,485	2,738
AT&T, INC	23,212	17,786
BEIGENE LTD	1,600	1,355
BEST BUY INC	2,787	2,438
BLACKROCK INC	919	1,831
BRITISH AMERICAN TOBACCO PLC	2,520	2,394
BROADCOM INC	2,971	4,658
CALRSBERG AS SP ADR REP B	1,371	1,285
CARRIER GLOBAL	2,510	2,549
CDW CORP	2,823	4,096
CELLNEX TELECOM ADR	978	924
CHUBB LIMITED	2,281	2,900
CISCO SYSTEMS INC	23,220	28,518
CME GROUP, INC	1,601	2,056
COSTCO WHOLESALE CORPORATION	761	1,135
CROWN HOLDINGS INC	6,365	7,522
DNB BANK ASA	2,668	2,731
DSV UNSP ADR EACH REPR 0.5 ORD	2,260	2,348
EMERSON ELECTRIC CO	23,190	22,871
EQUIFAX INC	1,193	1,464
EQUINIX, INC	1,454	1,692
GAZPROM PJSC SPON ADR EA REP 2	1,384	1,810
GEN DYNAMICS CP	23,107	25,433
GODADDY INC	1,206	1,273
GOLDMAN SACHS GROUP	736	765
HERMES INTL 10 ADR	1,573	2,106
HILTON WORLDWIDE HOLDINGS, INC	2,204	2,652
HOME DEPOT INC	3,360	6,225
HONEYWELL INTL	1,668	2,502
HONG KONG EX&CL UNSP/ADR	1,851	1,896
HUBSPOT INC	1,589	1,318
HUNTINGTON INGALLS INDUSTRIES	1,855	1,867
ICICI BK LTD ADS	1,492	1,761
IDEX CP	1,579	1,654
IDEXX CORP	4,426	5,268
INSULET CORPORATION	1,165	1,330
INTERCONTINENTAL EXCHANGE, INC	1,020	1,231
INTERNATIONAL BUSINESS MACHINE	22,208	21,787
INTUITIVE SURGICAL	1,395	1,797
JOHNSON & JOHNSON	23,181	23,437
JP MORGAN CHASE	26,549	28,029
KELLOGG CO	26,031	25,381
KERING UNSPON ADR EA REPR 0.1	2,216	2,093
KIMBERLY CLARK CORP	23,219	24,725
KOMATSU LTD	1,648	1,309
KONINKLIJKE DSM NV ADR	2,417	3,000
KOSE CORPORATION UNSP ADR	979	771
KYNDRYL HOLDINGS INC	952	579
LAM RESEARCH CORP	2,361	6,472
LINDE PLC COM	1,352	1,732
LOCKHEED MARTIN CORP	23,127	21,325
LONDON STK EXCHANGE GROUP	2,638	2,406
LOWES COMPANIES INC	2,385	4,394
LVMH MOET HENN UNSP	3,357	3,641
LYONDELLBASELL INDUSTRIES NV	1,402	1,383
MASTERCARD INC	2,541	2,515
MCDONALD'S CORP	23,189	27,075
META PLATFORMS INC	7,450	8,072
MICROSOFT CORP	5,038	10,762
MOODYS CORP	2,336	2,734
NESTLE S.A	2,606	3,088
NETAPP, INC	1,828	1,932
NETFLIX INC	3,434	4,217
NIDEC CORPORATION ADR	1,795	1,918
NIKE INC-CL B	2,603	3,167
NOVARTIS AG ADR	1,331	1,312
NOVO NORDISK A S	1,525	2,128
NOVOCURE LTD	774	526
ORSTED A S	1,952	1,795
PAYPAL HOLDINGS, INC	5,012	3,772
PENSKE AUTOMOTIVE GROUP, INC	1,856	2,037
PEPSICO INC	23,339	27,967
PERNOD RICARD S A SPONSORED AD	2,236	2,521
PFIZER INC	23,299	34,604
PROCTER GAMBLE CO	23,254	27,809
PROSUS NV ADR	2,521	2,093
PUBLIC STORAGE INC	23,195	31,839
REGENERON PHARMACEUTICALS INC	1,032	1,263
RENAULT SA	1,319	1,125
RESTAURANT BRANDS INTL	1,281	1,153
ROCKWELL AUTOMATION INC	2,563	4,186
ROYAL CARRIBEAN CRUISE	1,890	1,692
RYANAIR HOLDINGS PLC-ADR COM	1,155	1,023
SAFRAN SA - UNSPON ADR	3,106	2,631
SAP AKTIENGESELL ADS	1,731	1,681
SCHLUMBERGER LTD	1,476	1,348
SEA LTD	1,508	1,566
SEAGEN INC	1,032	1,082
SERVICE NOW	922	1,298
SHERWIN-WILLIAMS CO	1,429	1,761
SHIN-ETSU CHEMICAL C	1,822	1,910
SHOPIFY INC	2,152	2,755
SIKA AG BEARER SHS	2,718	3,325
SMARTSHEET INC	818	1,162
SMC CORPORATION	1,221	1,423
STMICROELECTRONICS	2,192	2,835
TAIWAN SEMICONDUCTOR MFG CO LT	7,515	8,061
TEMPUR PEDIC INTERNATIONAL INC	3,030	7,055
TESLA MOTORS INC	11,214	20,079
TEXAS INSTRUMENTS INC	3,424	3,392
THE COCA-COLA CO	23,284	25,401
THE HERSHEY COMPANY	347	387
THERMO FISHER SCIENTIFIC INC	2,300	3,336
TOTALENERGIES SE	1,710	1,731
TRIMBLE NAV LTD	1,300	1,482
ULTRAGENYX PHARMACEUTICAL INC	1,099	841
UNILEVER PLC AMER	23,234	20,817
UNITED PARCEL SERVICE	23,479	23,792
UNITED RENTALS INC	3,105	3,987
USD TRONOX LTD	1,863	1,922
VALE SA	3,611	2,496
VERIZON COMMUNICATIONS	23,244	20,576
VERTEX PHARMCTLS INC	1,521	1,537
VISA INC	2,142	2,167
VONTIER CORPORATION	1,842	1,659
WHIRLPOOL CORP	3,354	3,285
ZOETIS INC	2,095	2,928

- TIN:

TY 2021 OtherExpensesSchedule

Name:

Lane Werner Family Foundation

EIN:

20-5429087

Description	Revenue and Expenses per Books	Net Investment Income	Disbursements for Charitable Purposes
Administrative Fees	6,000		6,000
Bank Charges	41	41
State or Local Filing Fees	25		25

- TIN:

TY 2021 OtherProfessionalFeesSchedule

Name:

Lane Werner Family Foundation

EIN:

20-5429087

Category	Amount	Net Investment Income	Adjusted Net Income	Disbursements for Charitable Purposes
Investment Management Services	5,805	5,805

- TIN:

TY 2021 ReasonableCauseExplanation

Name:

Lane Werner Family Foundation

EIN:

20-5429087

Explanation:

The Foundation's tax preparer is located in Nassau County, NY, which, per IRS release NY-2021-01 announced on September 9, 2021, is included in the list of localities that constitute a covered disaster area for purposes of Treas. Reg. Sec. 301.7508A-1(d)(2) and are entitled to tax relief due to Hurricane Ida. Additional time was needed to calculate and transmit the tax payment. Therefore, Form 2220 indicates that the Q3 or Q4 estimated tax payment made on or before the extended deadline of February 15, 2022 was, in fact, made timely on the original due date of such payment. We respectfully request that no late payment penalties be assessed in connection with such payment(s) per Treas. Reg. Sec. 301.7508A-1(c)(1).

- TIN:

TY 2021 TaxesSchedule

Name:

Lane Werner Family Foundation

EIN:

20-5429087

Category	Amount	Net Investment Income	Adjusted Net Income	Disbursements for Charitable Purposes
990-PF Estimated Tax for 2021	2,800
Foreign Tax Paid	150	150