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
2022
Open to Public Inspection
For calendar year 2022, or tax year beginning 01-01-2022 , and ending 12-31-2022
Name of foundation
LAVERN T BUSSE & AUDREY BUSSE FOUNDATION
 
Number and street (or P.O. box number if mail is not delivered to street address)2129 NORTH TOWNE LANE NE STE B
  Room/suite
City or town, state or province, country, and ZIP or foreign postal code
CEDAR RAPIDS, IA52402
A Employer identification number

75-2342746
B Telephone number (see instructions)

(319) 395-9636
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$36,883,559J 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) 704,103
2 Check right arrow.............
3 Interest on savings and temporary cash investments 497 497  
4 Dividends and interest from securities... 532,960 509,807  
5a Gross rents............      
b Net rental income or (loss)  
6a Net gain or (loss) from sale of assets not on line 10 316,798
b Gross sales price for all assets on line 6a 527,096
7 Capital gain net income (from Part IV, line 2)... 316,798
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........ 1,554,358 827,102  
Operating and Administrative Expenses 13 Compensation of officers, directors, trustees, etc. 0 0   0
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
4,260 2,130   2,130
c Other professional fees (attach schedule).... Click to see attachment
List of Attached Documents:
// Content
97,155 97,155   0
17 Interest...............        
18 Taxes (attach schedule) (see instructions)... Click to see attachment
List of Attached Documents:
// Content
2,100 2,100   0
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
13,254 13,254   0
24 Total operating and administrative expenses.
Add lines 13 through 23.......... 116,769 114,639   2,130
25 Contributions, gifts, grants paid....... 1,429,170 1,429,170
26 Total expenses and disbursements. Add lines 24 and 25 1,545,939 114,639   1,431,300
27 Subtract line 26 from line 12:
a Excess of revenue over expenses and disbursements 8,419
b Net investment income (if negative, enter -0-) 712,463
c Adjusted net income (if negative, enter -0-)...  
For Paperwork Reduction Act Notice, see instructions.
Cat. No. 11289X Form 990-PF (2022)
Form 990-PF (2022)
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............. 785,095 332,408 332,408
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)....... 13,475,333 Click to see attachment
List of Attached Documents:
// Content
13,893,526 		36,551,151
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)..........      
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) 14,260,428 14,225,934 36,883,559
Liabilities 17 Accounts payable and accrued expenses..........    
18 Grants payable.................    
19 Deferred revenue.................    
20 Loans from officers, directors, trustees, and other disqualified persons    
21 Mortgages and other notes payable (attach schedule)......    
22 Other liabilities (describe right arrow) Click to see attachment
List of Attached Documents:
// Content
79,079 		Click to see attachment
List of Attached Documents:
// Content
33,278
23 Total liabilities (add lines 17 through 22)......... 79,079 33,278
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...........    
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........ 0 0
27 Paid-in or capital surplus, or land, bldg., and equipment fund 0 0
28 Retained earnings, accumulated income, endowment, or other funds 14,181,349 14,192,656
29 Total net assets or fund balances (see instructions)..... 14,181,349 14,192,656
30 Total liabilities and net assets/fund balances (see instructions). 14,260,428 14,225,934
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
14,181,349
2
Enter amount from Part I, line 27a .....................
2
8,419
3
Other increases not included in line 2 (itemize) right arrowClick to see attachment
List of Attached Documents:
// Content
3
332,426
4
Add lines 1, 2, and 3 ..........................
4
14,522,194
5
Decreases not included in line 2 (itemize) right arrowClick to see attachment
List of Attached Documents:
// Content
5
329,538
6
Total net assets or fund balances at end of year (line 4 minus line 5)—Part II, column (b), line 29 .
6
14,192,656
Form 990-PF (2022)
Form 990-PF (2022)
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 TD AMERITRADE SHORT-TERM   2022-01-01 2022-12-31
b TD AMERITRADE LONG-TERM   2021-01-01 2022-12-31
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 102,872     102,872
b 424,224   210,298 213,926
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       102,872
b       213,926
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 2 316,798
3 Net short-term capital gain or (loss) as defined in sections 1222(5) and (6):
If gain, also enter in Part I, line 8, column (c) (see instructions). If (loss), enter -0-
in Part I, line 8 ................... 		Bracket 3  
Form 990-PF (2022)
Form 990-PF (2022)
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 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 9,903
b All other domestic foundations enter 1.39% (0.0139) of line 27b. Exempt foreign organizations enter 4% (0.04) of Part I, line 12, col. (b)
2 Tax under section 511 (domestic section 4947(a)(1) trusts and taxable foundations only. Others enter -0-) 2 0
3 Add lines 1 and 2........................... 3 9,903
4 Subtitle A (income) tax (domestic section 4947(a)(1) trusts and taxable foundations only. Others enter -0-) 4 0
5 Tax based on investment income. Subtract line 4 from line 3. If zero or less, enter -0- ..... 5 9,903
6 Credits/Payments:
a 2022 estimated tax payments and 2021 overpayment credited to 2022 6a 15,601
b Exempt foreign organizations—tax withheld at source...... 6b 0
c Tax paid with application for extension of time to file (Form 8868)... 6c 0
d Backup withholding erroneously withheld ........... 6d 0
7 Total credits and payments. Add lines 6a through 6d.............. 7 15,601
8 Enter any penalty for underpayment of estimated tax. Check here if Form 2221 is attached. Click to see attachment
List of Attached Documents:
// Content
8 0
9 Tax due. If the total of lines 5 and 8 is more than line 7, enter amount owed.......right arrow 9  
10 Overpayment. If line 7 is more than the total of lines 5 and 8, enter the amount overpaid...right arrow 10 5,698
11 Enter the amount of line 10 to be: Credited to 2023 estimated taxright arrow5,698 Refundedright arrow 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. right arrow$ 0(2) On foundation managers.right arrow$ 0
e
Enter the reimbursement (if any) paid by the foundation during the year for political expenditure tax imposed
on foundation managers.right arrow$ 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)
right arrowTX
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 2022 or the taxable year beginning in 2022? See the instructions for Part XIII.
If "Yes," complete Part XIII .............................
9
 
No
10
Did any persons become substantial contributors during the tax year? If "Yes," attach a schedule listing their names
and addresses. ...............................
10
 
No
Form 990-PF (2022)
Form 990-PF (2022)
Page 5
Part VI-A
Statements Regarding Activities (continued)
11
At any time during the year, did the foundation, directly or indirectly, own a controlled entity within the
meaning of section 512(b)(13)? If "Yes," attach schedule. See instructions .............
11
 
No
12
Did the foundation make a distribution to a donor advised fund over which the foundation or a disqualified person had
advisory privileges? If "Yes," attach statement. See instructions.................
12
 
No
13
Did the foundation comply with the public inspection requirements for its annual returns and exemption application?
13
Yes
 
Website addressright arrowN/A
14
The books are in care ofright arrowJEFFREY BUSSE Telephone no.right arrow (319) 395-9636

Located atright arrow2129 NORTH TOWNE LANE NE STE BCEDAR RAPIDSIA ZIP+4right arrow52402
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 2022, 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
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)
Yes
 
(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
 
No
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 2022? .............
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 2022, did the foundation have any undistributed income (Part XII, lines 6d
and 6e) for tax year(s) beginning before 2022?....................
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 2022 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 2022.) .....................
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 2022? ..
4b
 
No
Form 990-PF (2022)
Form 990-PF (2022)
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
LAVERN T BUSSE PRESIDENT/TRUSTEE
6.00 		0 0 0
2310 HERITAGE GREEN DRIVE
HIAWATHA,IA52233
AUDREY BUSSE TREASURER/TRUSTEE
3.00 		0 0 0
2310 HERITAGE GREEN DRIVE
HIAWATHA,IA52233
JEFFREY BUSSE EXECUTIVE DIRECTOR/SECRETARY/TRUSTEE
10.00 		0 0 0
6718 COTTAGE HILL LANE NE
CEDAR RAPIDS,IA52411
MONICA BUSSE VICE PRESIDENT/TRUSTEE
2.00 		0 0 0
6718 COTTAGE HILL LANE NE
CEDAR RAPIDS,IA52411
ANNA BUSSE ASST SECRETARY/TRUSTEE
2.00 		0 0 0
6718 COTTAGE HILL LANE NE
CEDAR RAPIDS,IA52411
GRACE BUSSE ASST TREASURER/TRUSTEE
2.00 		0 0 0
6718 COTTAGE HILL LANE NE
CEDAR RAPIDS,IA52411
MICHELE BUSSE TRUSTEE
3.00 		0 0 0
6718 COTTAGE HILL LANE NE
CEDAR RAPIDS,IA52411
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 0
Form 990-PF (2022)
Form 990-PF (2022)
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
KEYSTONE INVESTMENT ADVISORS INC INVESTMENT ADVISORY - SEE STATEMENT 12 97,155
2129 NORTH TOWNE LN NE
CEDAR RAPIDS,IA52402
Total number of others receiving over $50,000 for professional services.............right arrow0
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.........................right arrow0
Form 990-PF (2022)
Form 990-PF (2022)
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
39,967,624
b
Average of monthly cash balances.......................
1b
402,071
c
Fair market value of all other assets (see instructions)................
1c
0
d
Total (add lines 1a, b, and c).........................
1d
40,369,695
e
Reduction claimed for blockage or other factors reported on lines 1a and
1c (attach detailed explanation) .............
1e
0
2
Acquisition indebtedness applicable to line 1 assets..................
2
0
3
Subtract line 2 from line 1d.........................
3
40,369,695
4
Cash deemed held for charitable activities. Enter 1.5% (0.015) of line 3 (for greater amount, see
instructions) .............................
4
605,545
5
Net value of noncharitable-use assets. Subtract line 4 from line 3. ............
5
39,764,150
6
Minimum investment return. Enter 5% (0.05) of line 5................
6
1,988,208
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
1,988,208
2a
Tax on investment income for 2022 from Part V, line 5.......
2a
9,903
b
Income tax for 2022. (This does not include the tax from Part V.) ...
2b
 
c
Add lines 2a and 2b............................
2c
9,903
3
Distributable amount before adjustments. Subtract line 2c from line 1............
3
1,978,305
4
Recoveries of amounts treated as qualifying distributions................
4
0
5
Add lines 3 and 4............................
5
1,978,305
6
Deduction from distributable amount (see instructions).................
6
0
7
Distributable amount as adjusted. Subtract line 6 from line 5. Enter here and on Part XII, line 1 ...
7
1,978,305
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
1,431,300
b
Program-related investments—total from Part VIII-B..................
1b
0
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
1,431,300
Form 990-PF (2022)
Form 990-PF (2022)
Page 9
Part XII
Undistributed Income (see instructions)
(a)
Corpus 		(b)
Years prior to 2021 		(c)
2021 		(d)
2022
1 Distributable amount for 2022 from Part X, line 7 1,978,305
2 Undistributed income, if any, as of the end of 2022:
a Enter amount for 2021 only....... 1,349,871
b Total for prior years:20, 20, 20 0
3 Excess distributions carryover, if any, to 2022:
a From 2017......  
b From 2018......  
c From 2019......  
d From 2020......  
e From 2021......  
f Total of lines 3a through e ........ 0
4Qualifying distributions for 2022 from Part
XI, line 4: right arrow$ 1,431,300
a Applied to 2021, but not more than line 2a 1,349,871
b Applied to undistributed income of prior years
(Election required—see instructions)..... 		0
c Treated as distributions out of corpus (Election
required—see instructions)........ 		0
d Applied to 2022 distributable amount..... 81,429
e Remaining amount distributed out of corpus 0
5 Excess distributions carryover applied to 2022. 0 0
(If an amount appears in column (d), the
same amount must be shown in column (a).)
6Enter the net total of each column as
indicated below:
a Corpus. Add lines 3f, 4c, and 4e. Subtract line 5 0
b Prior years’ undistributed income. Subtract
line 4b from line 2b .......... 		0
c Enter the amount of prior years’ undistributed
income for which a notice of deficiency has
been issued, or on which the section 4942(a)
tax has been previously assessed...... 		0
d Subtract line 6c from line 6b. Taxable amount
—see instructions ........... 		0
e Undistributed income for 2021. Subtract line
4a from line 2a. Taxable amount—see
instructions ............. 		0
f Undistributed income for 2022. Subtract
lines 4d and 5 from line 1. This amount must
be distributed in 2023 .......... 		1,896,876
7 Amounts treated as distributions out of
corpus to satisfy requirements imposed by
section 170(b)(1)(F) or 4942(g)(3) (Election may
be required - see instructions) ....... 		0
8 Excess distributions carryover from 2017 not
applied on line 5 or line 7 (see instructions) ... 		0
9 Excess distributions carryover to 2023.
Subtract lines 7 and 8 from line 6a ...... 		0
10 Analysis of line 9:
a Excess from 2018....  
b Excess from 2019....  
c Excess from 2020....  
d Excess from 2021....  
e Excess from 2022....  
Form 990-PF (2022)
Form 990-PF (2022)
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 2022, 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) 2022 (b) 2021 (c) 2020 (d) 2019
         
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).)
LAVERN T BUSSE
JEFFREY BUSSE
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 right arrow
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 (2022)
Form 990-PF (2022)
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

ANIMAL RESCUE LEAGUE OF IA INC

5452 NE 22ND ST
DES MOINES,IA50313 		  PUBLIC CHARITY GENERAL OPERATING BUDGET 2,500

BOYS & GIRLS CLUB OF CEDAR RAPIDS

420 6TH ST SE 240
CEDAR RAPIDS,IA52401 		  PUBLIC CHARITY GENERAL OPERATING BUDGET 540,878

CALTECH ALUMNI ASSOCIATION

1200 E CALIFORNIA BOULEVARD
PASADENA,CA91125 		  PUBLIC CHARITY GENERAL OPERATING BUDGET 5,000

CAMP COURAGEOUS

12007 190TH STREET PO BOX 418
MONTICELLO,IA52310 		  PUBLIC CHARITY GENERAL OPERATING BUDGET 10,000

CATHERINE MCCAULEY CENTER

1220 5TH AVE SE
CEDAR RAPIDS,IA52403 		  PUBLIC CHARITY GENERAL OPERATING BUDGET 24,000

COE COLLEGE

1220 1ST AVENUE NE
CEDAR RAPIDS,IA52402 		  PUBLIC CHARITY GENERAL OPERATING BUDGET 50,316

COMMUNITY HEALTH CLINIC

947 14TH AVE SE
CEDAR RAPIDS,IA52401 		  PUBLIC CHARITY GENERAL OPERATING BUDGET 27,500

CORNERSTONE CHURCH

1000 N STUDEBAKER RD
LONG BEACH,CA90815 		  PUBLIC CHARITY GENERAL OPERATING BUDGET 3,000

FOOD BANK OF IOWA

PO BOX 1517
DES MOINES,IA50305 		  PUBLIC CHARITY GENERAL OPERATING BUDGET 2,500

FOUR OAKS

5400 KIRKWOOD BLVD
CEDAR RAPIDS,IA52404 		  PUBLIC CHARITY GENERAL OPERATING BUDGET 6,000

HIAWATHA LIBRARY FOUNDATION

150 W WILLMAN ST
HIAWATHA,IA52233 		  PUBLIC CHARITY GENERAL OPERATING BUDGET 5,000

HOUSE OF HOPE

845 W 4TH ST
WATERLOO,IA50702 		  PUBLIC CHARITY GENERAL OPERATING BUDGET 2,500

IOWA STATE UNIVERSITY FOUNDATION

2505 UNIVERSITY BLVD
AMES,IA50010 		  PUBLIC CHARITY GENERAL OPERATING BUDGET 500

JUDICAL WATCH

425 THIRD ST SW STE 800
WASHINGTON,DC20024 		  PUBLIC CHARITY GENERAL OPERATING BUDGET 24,000

KIDS FIRST LAW CENTER

420 6TH ST SE
CEDAR RAPIDS,IA52401 		  PUBLIC CHARITY GENERAL OPERATING BUDGET 6,000

LA CASA DE CRISTO CHURCH

6300 E BELL RD
SCOTTSDALE,AZ85254 		  PUBLIC CHARITY GENERAL OPERATING BUDGET 31,113

LINN COUNTY CONSERVATION BOARD

10260 MORRIS HILLS ROAD
TODDVILLE,IA52341 		  PUBLIC CHARITY GENERAL OPERATING BUDGET 10,000

MERCY MEDICAL CENTER FOUNDATION

701 10TH STREET SE
CEDAR RAPIDS,IA52403 		  PUBLIC CHARITY GENERAL OPERATING BUDGET 13,000

MONARCH RESEARCH PROJECT

4970 LAKESIDE ROAD
MARION,IA52302 		  PUBLIC CHARITY GENERAL OPERATING BUDGET 2,396

MOUNT MERCY UNIVERSITY

1330 ELMHURST DR NE
CEDAR RAPIDS,IA52402 		  PUBLIC CHARITY GENERAL OPERATING BUDGET 55,206

NORTHEAST IOWA FOOD BANK

1605 LAFAYETTE ST
WATERLOO,IA50703 		  PUBLIC CHARITY GENERAL OPERATING BUDGET 2,500

NOTRE DAME ACE

107 CAROLE SANDNER HALL
NOTRE DAME,IN46556 		  PUBLIC CHARITY GENERAL OPERATING BUDGET 15,000

OASIS CHURCH

PO BOX 55
MARION,IA52302 		  PUBLIC CHARITY GENERAL OPERATING BUDGET 20,000

OWEN GRADUATE SCHOOL OF MGMT

401 21ST AVENUE SOUTH
NASHVILLE,TN37203 		  PUBLIC CHARITY GENERAL OPERATING BUDGET 100

PRAGER UNIVERSITY

15021 VENTURA BLVD 552
SHERMAN OAKS,CA91403 		  PUBLIC CHARITY GENERAL OPERATING BUDGET 24,000

PURPLE HEART TOUR

11536 SPRING AVE
CLARKSVILLE,IA506199348 		  PUBLIC CHARITY GENERAL OPERATING BUDGET 2,500

ST MARK'S LUTHERAN CHURCH

8300 C AVENUE NE
MARION,IA52302 		  PUBLIC CHARITY GENERAL OPERATING BUDGET 10,000

ST MARK'S LUTHERAN CHURCH FOUNDATION

8300 C AVENUE NE
MARION,IA52302 		  PUBLIC CHARITY GENERAL OPERATING BUDGET 20,000

ST PIUS X CHURCH

4949 COUNCIL ST NE
CEDAR RAPIDS,IA52402 		  PUBLIC CHARITY GENERAL OPERATING BUDGET 5,000

ST JOHNS LUTHERAN CHURCH

301 4TH AVE
FREDERIKA,IA50631 		  PUBLIC CHARITY GENERAL OPERATING BUDGET 5,000

ST JUDES CHILDREN'S RESEARCH HOSPITAL

501 ST JUDE PLACE
MEMPHIS,TN38105 		  PUBLIC CHARITY GENERAL OPERATING BUDGET 6,000

TANAGER PLACE

2309 C STREET SW
CEDAR RAPIDS,IA52404 		  PUBLIC CHARITY GENERAL OPERATING BUDGET 101,444

THE HERITAGE FOUNDATION

214 MASSACHUSETTS AVE NE
WASHINGTON,DC200024999 		  PUBLIC CHARITY GENERAL OPERATING BUDGET 24,000

THE SALVATION ARMY

PO BOX 8056
CEDAR RAPIDS,IA524088056 		  PUBLIC CHARITY GENERAL OPERATING BUDGET 14,000

TURNING POINT USA

4940 EAST BEVERLY ROAD
PHOENIX,AZ85044 		  PUBLIC CHARITY GENERAL OPERATING BUDGET 24,000

UNITED WAY OF EAST CENTRAL IOWA

317 7TH AVE SE UNIT 401
CEDAR RAPIDS,IA52401 		  PUBLIC CHARITY GENERAL OPERATING BUDGET 20,000

UNIVERSITY OF IOWA CENTER FOR ADVANCEMENT

ONE WEST PARK RD
IOWA CITY,IA52242 		  PUBLIC CHARITY GENERAL OPERATING BUDGET 71,417

WARTBURG COLLEGE

100 WARTBURG BLVD
WAVERLY,IA50677 		  PUBLIC CHARITY GENERAL OPERATING BUDGET 35,000

XAVIER FOUNDATION

PO BOX 10956
CEDAR RAPIDS,IA524100956 		  PUBLIC CHARITY GENERAL OPERATING BUDGET 5,000

YOUNG AMERICAS FOUNDATION

11480 COMMERCE PARK DR 600
RESTON,VA20191 		  PUBLIC CHARITY GENERAL OPERATING BUDGET 24,000

ALL SAINTS CHURCH

720 29TH ST SE
CEDAR RAPIDS,IA52403 		  PUBLIC CHARITY GENERAL OPERATING BUDGET 1,800

ARC OF EASTERN IOWA

680 2ND ST SE
CEDAR RAPIDS,IA52401 		  PUBLIC CHARITY GENERAL OPERATING BUDGET 6,000

ARCHDIOCISE OF DUBUQUE

1229 MOUNT LORETTA AVE
DUBUQUE,IA52003 		  PUBLIC CHARITY GENERAL OPERATING BUDGET 4,000

BENTON COMMUNITY FOUNDATION

PO BOX 129
VAN HORNE,IA52346 		  PUBLIC CHARITY GENERAL OPERATING BUDGET 10,000

BLESSMAN INTERNATIONAL INC

2557 106TH ST
URBANDALE,IA50322 		  PUBLIC CHARITY GENERAL OPERATING BUDGET 4,000

CARENET - WACO TX

7110 SANGER AVE
WACO,TX76712 		  PUBLIC CHARITY GENERAL OPERATING BUDGET 5,000

CHALLENGED ATHLETES FOUNDATION

9591 WAPLES ST
SAN DIEGO,CA92121 		  PUBLIC CHARITY GENERAL OPERATING BUDGET 2,000

CHURCH OF THE LIVING WORLD

420 1ST AVE NE
HAMPTON,IA50266 		  PUBLIC CHARITY GENERAL OPERATING BUDGET 5,000

FREEDOM FOUNDATION

609 CENTER POINT RD
CEDAR RAPIDS,IA52402 		  PUBLIC CHARITY GENERAL OPERATING BUDGET 30,000

GRACE LUTHERAN CHURCH

1515 S 15TH ST
PRAIRIE DU CHIEN,WI53821 		  PUBLIC CHARITY GENERAL OPERATING BUDGET 3,500

HEDRICK FIRE DEPARTMENT

PO BOX 65
HEDRICK,IA52563 		  PUBLIC CHARITY GENERAL OPERATING BUDGET 7,500

HIGHLAND BAPTIST CHURCH

3014 MAPLE AVE
WACO,TX76707 		  PUBLIC CHARITY GENERAL OPERATING BUDGET 5,000

KANSAS UNIVERSITY ENDOWMENT ASSOCIATION

PO BOX 928
LAWRENCE,KS660440928 		  PUBLIC CHARITY GENERAL OPERATING BUDGET 5,000

LINN-MAR SCHOOL FOUNDATION

2999 10TH ST
MARION,IA52302 		  PUBLIC CHARITY GENERAL OPERATING BUDGET 2,500

LUTHERAN CHURCH OF HOPE

925 JORDAN CREEK PKWY
WEST DES MOINES,IA50266 		  PUBLIC CHARITY GENERAL OPERATING BUDGET 2,500

MAYO HOSPITAL

5779 E MAYO BLVD
PHOENIX,AZ580544502 		  PUBLIC CHARITY GENERAL OPERATING BUDGET 35,000

MERCY HOSPITAL FOUNDATION

701 10TH STREET SE
CEDAR RAPIDS,IA524031292 		  PUBLIC CHARITY GENERAL OPERATING BUDGET 15,000

PNC BANK CO FIRST BOOK

LOCKBOX NUMBER 8
MOORESTOWN,NJ08057 		  PUBLIC CHARITY GENERAL OPERATING BUDGET 5,000

PURPLE HEART OUTDOOR TOUR INC

PO BOX 148
EDISON,GA39846 		  PUBLIC CHARITY GENERAL OPERATING BUDGET 2,500

SCORE MINISTRIES

PO BOX 99026
TROY,MI480999026 		  PUBLIC CHARITY GENERAL OPERATING BUDGET 5,000

SEEDS OF FAITH EARLY LEARNING CENTER

10395 UNIVERSITY AVE
CLIVE,IA50325 		  PUBLIC CHARITY GENERAL OPERATING BUDGET 2,500

STEADY RUN TOWNSHIP TRUSTEES

17654 315TH ST
HEDRICK,IA52563 		  PUBLIC CHARITY GENERAL OPERATING BUDGET 2,500

THEATRE OF CEDAR RAPIDS

102 3RD ST SE
CEDAR RAPIDS,IA52401 		  PUBLIC CHARITY GENERAL OPERATING BUDGET 2,500

TRIPOLI-FREDERIKA DOLLARS FOR SCHOLARS

PO BOX 304
TRIPOLI,IA50676 		  PUBLIC CHARITY GENERAL OPERATING BUDGET 5,000

UNITY CENTER OF CEDAR RAPIDS

3791 BLAIRS FERRY RD NE
CEDAR RAPIDS,IA52402 		  PUBLIC CHARITY GENERAL OPERATING BUDGET 5,000

UT AUSTIN FOUNDATION

PO BOX 7458
AUSTIN,TX787137458 		  PUBLIC CHARITY GENERAL OPERATING BUDGET 5,000
Total .................................right arrow 3a 1,429,170
bApproved for future payment
Total ................................. right arrow 3b 0
Form 990-PF (2022)
Form 990-PF (2022)
Page 12
Part XV-A
Analysis of Income-Producing Activities
Enter gross amounts unless otherwise indicated. Unrelated business income Excluded by section 512, 513, or 514 (e)
Related or exempt
function income
(See instructions.)
1Program service revenue: (a)
Business code 		(b)
Amount 		(c)
Exclusion code 		(d)
Amount
a
b
c
d
e
f
gFees and contracts from government agencies          
2 Membership dues and assessments ....          
3 Interest on savings and temporary cash
investments ........... 		    14 497  
4 Dividends and interest from securities ....     14 532,960  
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 ............ 		    18 316,798  
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) .. 0 850,255 0
13Total. Add line 12, columns (b), (d), and (e)..................
13
850,255
(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 (2022)
Form 990-PF (2022)
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 (2022)
Additional Data


Software ID:  
Software Version:  


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

Arrow Bullet Attach to Form 990, 990-EZ, or 990-PF.
Arrow Bullet Go to www.irs.gov/Form990 for the latest information.
OMB No. 1545-0047
2022
Name of the organization
LAVERN T BUSSE & AUDREY BUSSE FOUNDATION
 
Employer identification number

75-2342746
Organization type (check one):
Filers of:
Section:
Form 990 or 990-EZ






Form 990-PF




Check if your organization is covered by the General Rule or a Special Rule.  
Note: Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.
General Rule
Special Rules
......... Arrow Bullet $  
Caution: An organization that isn't covered by the General Rule and/or the Special Rules doesn't file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its Form 990-EZ
or on its Form 990PF, Part I, line 2, to certify that it doesn't meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).
For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.
Cat. No. 30613XSchedule B (Form 990) (2022)
Schedule B (Form 990) (2022) Page 2
Name of organization
LAVERN T BUSSE & AUDREY BUSSE FOUNDATION
  		Employer identification number
75-2342746
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
JEFFREY BUSSE
 
2129 N TOWNE LANE NE SUITE B
 
CEDAR RAPIDS, IA52402

$ 223,223


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
2
LAVERN BUSSE
 
2310 HERITAGE GREEN DR
 
HIAWATHA, IA52233

$ 384,704


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
3
LAVERN BUSSE
 
2310 HERITAGE GREEN DR
 
HIAWATHA, IA52233

$ 96,176


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

$  


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

$  


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

$  


(Complete Part II for noncash contributions.)
Schedule B (Form 990) (2022)
Schedule B (Form 990) (2022)
Page 3
Name of organization
LAVERN T BUSSE & AUDREY BUSSE FOUNDATION
  		Employer identification number

75-2342746
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
 1,500 SHARES OF APPLE STOCK (APPL) $ 223,223 2022-11-17
(a)
No. from Part I 		(b)
Description of noncash property given 		(c)
FMV (or estimate)
(See instructions) 		(d)
Date received
2
 1,600 SHARES OF MICROSOFT STOCK (MSFT) $ 384,704 2022-11-17
(a)
No. from Part I 		(b)
Description of noncash property given 		(c)
FMV (or estimate)
(See instructions) 		(d)
Date received
3
 400 SHARES OF MICROSOFT STOCK (MSFT) $ 96,176 2022-11-17
(a)
No. from Part I 		(b)
Description of noncash property given 		(c)
FMV (or estimate)
(See instructions) 		(d)
Date received
 
$    
(a)
No. from Part I 		(b)
Description of noncash property given 		(c)
FMV (or estimate)
(See instructions) 		(d)
Date received
 
$    
(a)
No. from Part I 		(b)
Description of noncash property given 		(c)
FMV (or estimate)
(See instructions) 		(d)
Date received
 
$    
Schedule B (Form 990) (2022)
Schedule B (Form 990) (2022)
Page 4
Name of organization
LAVERN T BUSSE & AUDREY BUSSE FOUNDATION
  		Employer identification number

75-2342746
Part III
Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10) that total more than $1,000 for the year from any one contributor. Complete columns (a) through (e) and the following line entry. For organizations completing Part III, enter the total of exclusively religious, charitable, etc., contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet$  
Use duplicate copies of Part III if additional space is needed.
(a)
No. from Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
     
 
(a)
No. from Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
     
 
(a)
No. from Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
     
 
(a)
No. from Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
     
 
Schedule B (Form 990) (2022)
Additional Data


Software ID:  
Software Version:  

TY 2022 AccountingFeesSchedule
Name:
LAVERN T BUSSE & AUDREY BUSSE FOUNDATION
EIN:
75-2342746
Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
ACCOUNTING FEE 4,260 2,130   2,130

TY 2022 GeneralExplanationAttachment
Name:
LAVERN T BUSSE & AUDREY BUSSE FOUNDATION
EIN:
75-2342746
Identifier Return Reference Explanation
  PART VI-B LINE 1(A)(4) THE INVESTMENT ADVISORY FEE WAS ENTIRELY PAID TO KEYSTONE INVESTMENT ADVISORS, INC. KEYSTONE INVESTMENT ADVISORS, INC. IS ENTIRELY OWNED BY DISQUALIFIED PERSONS. THE INVESTMENT ADVISORY FEE IS FOR PROFESSIONAL SERVICES THAT ARE REASONABLE AND NECESSARY, AS DETERMINED BY AN ENTIRELY INDEPENDENT FOUNDATION COMMITTEE AFTER REVIEW OF CORRESPONDING DATA FROM TEN COMPARABLE PRIVATE FOUNDATIONS.

TY 2022 InvestmentsCorpStockSchedule
Name:
LAVERN T BUSSE & AUDREY BUSSE FOUNDATION
EIN:
75-2342746
Name of Stock End of Year Book Value End of Year Fair Market Value
TD AMERITRADE 13,893,526 36,551,151

TY 2022 OtherDecreasesSchedule
Name:
LAVERN T BUSSE & AUDREY BUSSE FOUNDATION
EIN:
75-2342746
Description Amount
NON-DIVIDEND DISTRIBUTIONS 13,835
FMV OF CONTRIBUTION VERSUS COST BASIS 255,218
MISC. ADJUSTMENTS 485
CHECK RETURNED AND NOT ISSUED UNTIL 2023 60,000


TY 2022 OtherExpensesSchedule
Name:
LAVERN T BUSSE & AUDREY BUSSE FOUNDATION
EIN:
75-2342746
Description Revenue and Expenses per Books Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
ADVISOR FEE 100 100   0
OTHER EXPENSES 13,154 13,154   0


TY 2022 OtherIncreasesSchedule
Name:
LAVERN T BUSSE & AUDREY BUSSE FOUNDATION
EIN:
75-2342746
Description Amount
OVERSTATEMENT OF PROCEEDS ON SALE 213,708
TTE CALLS 118,718


TY 2022 OtherLiabilitiesSchedule
Name:
LAVERN T BUSSE & AUDREY BUSSE FOUNDATION
EIN:
75-2342746
Description Beginning of Year - Book Value End of Year - Book Value
STOCK OPTIONS 79,079 33,278


TY 2022 OtherProfessionalFeesSchedule
Name:
LAVERN T BUSSE & AUDREY BUSSE FOUNDATION
EIN:
75-2342746
Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
INVESTMENT ADVISORY FEE 97,155 97,155   0


TY 2022 TaxesSchedule
Name:
LAVERN T BUSSE & AUDREY BUSSE FOUNDATION
EIN:
75-2342746
Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
TD AMERITRADE FOREIGN TAX PAID 2,100 2,100   0