SURPLUS LINE ASSOCIATION OF ARIZONA FOUNDATION TR: Form 990PF, tax year 2021
View the entire original 990 at ProPublica ↗
- Organization
- SURPLUS LINE ASSOCIATION OF ARIZONA FOUNDATION TR (EIN 86-6320000)
- Tax period
- 2021-01-01 to 2021-12-31
- Filed
- 2022-09-15
- IRS object ID
- 202212589349101401
- Schema version
- 2021v4.2
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990-PF
- Schedule B
- Compensation Explanation
- Depreciation Schedule
- Investments Corp Bonds Schedule
- Investments Govt Obligations Sch
- Investments Other Schedule2
- Other Expenses Schedule
- Other Income Schedule2
- Taxes Schedule
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2022-09-15T14:54:09-05:00 | ReturnTs |
| Tax Period End | 2021-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | FOUNDATION SOURCE | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | ONE HOLLOW LN STE 212 | AddressLine1Txt |
| City | LAKE SUCCESS | CityNm |
| State Abbreviation | NY | StateAbbreviationCd |
| ZIP | 11042 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990PF | ReturnTypeCd |
| Tax Period Begin | 2021-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 866320000 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | The Surplus Line Association of Arizona | BusinessNameLine1Txt |
| Business Name Line2 | Foundation | BusinessNameLine2Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| In Care Of | % Foundation Source | InCareOfNm |
| Business Name Control | SURP | BusinessNameControlTxt |
| Phone | 8008391754 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | Foundation Source 501 Silverside Rd | AddressLine1Txt |
| City | Wilmington | CityNm |
| State Abbreviation | DE | StateAbbreviationCd |
| ZIP | 198091377 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | JON SCOTT WEDE | PersonNm |
| Person Title | TRUSTEE | PersonTitleTxt |
| Phone | 8008391754 | PhoneNum |
| Signature | 2022-08-31 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | JON SCOTT | PersonFirstNm |
| Person Last | WEDE | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Jeffrey D Haskell | PreparerPersonNm |
| PTIN | P01345770 | PTIN |
| Phone | 8008391754 | PhoneNum |
Additional Filer Information AdditionalFilerInformation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | TrustedCustomerGrp |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2021 | TaxYr |
| Build TS | 2023-04-26 12:10:37Z | BuildTS |
Form 990-PF IRS990PF
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization501c3 Exempt PF | Yes (X) | Organization501c3ExemptPFInd |
| FMV Assets EOY | $7,396,873 | FMVAssetsEOYAmt |
| Method Of Accounting Cash | Yes (X) | MethodOfAccountingCashInd |
Analysis Of Revenue And Expenses AnalysisOfRevenueAndExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contri Rcvd Rev And Expnss | $1,200,000 | ContriRcvdRevAndExpnssAmt |
| Interest On Sav Rev And Expnss | $50 | InterestOnSavRevAndExpnssAmt |
| Interest On Sav Net Invst Incm | $50 | InterestOnSavNetInvstIncmAmt |
| Dividends Rev And Expnss | $11,178 | DividendsRevAndExpnssAmt |
| Dividends Net Invst Incm | $11,178 | DividendsNetInvstIncmAmt |
| Net Gain Sale Ast Rev And Expnss | -$878 | NetGainSaleAstRevAndExpnssAmt |
| Gross Sales Price | $55,000 | GrossSalesPriceAmt |
| Cap Gain Net Incm Net Invst Incm | $0 | CapGainNetIncmNetInvstIncmAmt |
| Other Income Rev And Expnss | $202,930 | OtherIncomeRevAndExpnssAmt |
| Other Income Net Invst Incm | $202,930 | OtherIncomeNetInvstIncmAmt |
| Total Rev And Expnss | $1,413,280 | TotalRevAndExpnssAmt |
| Total Net Invst Incm | $214,158 | TotalNetInvstIncmAmt |
| Comp Ofcr Dir Trst Rev And Expnss | $0 | CompOfcrDirTrstRevAndExpnssAmt |
| Taxes Rev And Expnss | $550 | TaxesRevAndExpnssAmt |
| Other Expenses Rev And Expnss | $32,049 | OtherExpensesRevAndExpnssAmt |
| Other Expenses Net Invst Incm | $300 | OtherExpensesNetInvstIncmAmt |
| Other Expenses Dsbrs Chrtbl | $31,749 | OtherExpensesDsbrsChrtblAmt |
| Tot Opr Expenses Rev And Expnss | $32,599 | TotOprExpensesRevAndExpnssAmt |
| Tot Opr Expenses Net Invst Incm | $300 | TotOprExpensesNetInvstIncmAmt |
| Tot Opr Expenses Dsbrs Chrtbl | $31,749 | TotOprExpensesDsbrsChrtblAmt |
| Contri Paid Rev And Expnss | $1,126,000 | ContriPaidRevAndExpnssAmt |
| Contri Paid Dsbrs Chrtbl | $1,126,000 | ContriPaidDsbrsChrtblAmt |
| Total Expenses Rev And Expnss | $1,158,599 | TotalExpensesRevAndExpnssAmt |
| Total Expenses Net Invst Incm | $300 | TotalExpensesNetInvstIncmAmt |
| Total Expenses Dsbrs Chrtbl | $1,157,749 | TotalExpensesDsbrsChrtblAmt |
| Excess Revenue Over Expenses | $254,681 | ExcessRevenueOverExpensesAmt |
| Net Investment Income | $213,858 | NetInvestmentIncomeAmt |
Form990 PF Balance Sheets Form990PFBalanceSheetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Sav And Temp Cash Invst BOY | $809,130 | SavAndTempCashInvstBOYAmt |
| Sav And Temp Cash Invst EOY | $923,088 | SavAndTempCashInvstEOYAmt |
| Sav And Temp Cash Invst EOYFMV | $923,088 | SavAndTempCashInvstEOYFMVAmt |
| US Government Obligations BOY | $96,905 | USGovernmentObligationsBOYAmt |
| US Government Obligations EOY | $34,699 | USGovernmentObligationsEOYAmt |
| US Govt Obligations EOYFMV | $30,849 | USGovtObligationsEOYFMVAmt |
| Corporate Bonds BOY | $326,251 | CorporateBondsBOYAmt |
| Corporate Bonds EOY | $326,251 | CorporateBondsEOYAmt |
| Corporate Bonds EOYFMV | $338,108 | CorporateBondsEOYFMVAmt |
| Other Investments BOY | $6,093,896 | OtherInvestmentsBOYAmt |
| Other Investments EOY | $6,296,825 | OtherInvestmentsEOYAmt |
| Other Investments EOYFMV | $6,104,828 | OtherInvestmentsEOYFMVAmt |
| Total Assets BOY | $7,326,182 | TotalAssetsBOYAmt |
| Total Assets EOY | $7,580,863 | TotalAssetsEOYAmt |
| Total Assets EOYFMV | $7,396,873 | TotalAssetsEOYFMVAmt |
| Total Liabilities BOY | $0 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $0 | TotalLiabilitiesEOYAmt |
| Org Does Not Follow FASB117 | Yes (X) | OrgDoesNotFollowFASB117Ind |
| Retained Earning BOY | $7,326,182 | RetainedEarningBOYAmt |
| Retained Earning EOY | $7,580,863 | RetainedEarningEOYAmt |
| Tot Net Ast Or Fund Balances BOY | $7,326,182 | TotNetAstOrFundBalancesBOYAmt |
| Tot Net Ast Or Fund Balances EOY | $7,580,863 | TotNetAstOrFundBalancesEOYAmt |
| Total Liabilities Net Ast BOY | $7,326,182 | TotalLiabilitiesNetAstBOYAmt |
| Total Liabilities Net Ast EOY | $7,580,863 | TotalLiabilitiesNetAstEOYAmt |
Chg In Net Assets Fund Balances ChgInNetAssetsFundBalancesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tot Net Ast Or Fund Balances BOY | $7,326,182 | TotNetAstOrFundBalancesBOYAmt |
| Excess Revenue Over Expenses | $254,681 | ExcessRevenueOverExpensesAmt |
| Subtotal | $7,580,863 | SubtotalAmt |
| Tot Net Ast Or Fund Balances EOY | $7,580,863 | TotNetAstOrFundBalancesEOYAmt |
Cap Gains Loss Tx Invst Incm Detail CapGainsLossTxInvstIncmDetail
Cap Gains Loss Tx Invst Incm CapGainsLossTxInvstIncmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Property | Publicly-traded Securities | PropertyDesc |
| Gross Sales Price | $55,000 | GrossSalesPriceAmt |
| Cost Or Other Basis | $55,878 | CostOrOtherBasisAmt |
| Gain Or Loss | -$878 | GainOrLossAmt |
| Gains Minus Excess Or Losses | -$878 | GainsMinusExcessOrLossesAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Capital Gain Net Income | -$878 | CapitalGainNetIncomeAmt |
Excise Tax Based On Invst Incm ExciseTaxBasedOnInvstIncmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Income Excise Tax | $2,973 | InvestmentIncomeExciseTaxAmt |
| Subtotal | $2,973 | SubtotalAmt |
| Tax Based On Investment Income | $2,973 | TaxBasedOnInvestmentIncomeAmt |
| Estimated Plus Ovpmt Incm Tx | $10 | EstimatedPlusOvpmtIncmTxAmt |
| Exempt Frgn Org Tax Wthld At Srce | $0 | ExemptFrgnOrgTaxWthldAtSrceAmt |
| Extsn Request Income Tax Paid | $300 | ExtsnRequestIncomeTaxPaidAmt |
| Total Payments And Credits | $310 | TotalPaymentsAndCreditsAmt |
| Form2220 Attached | Yes (X) | Form2220AttachedInd |
| Es Penalty | $0 | EsPenaltyAmt |
| Tax Due | $2,663 | TaxDueAmt |
Statements Regarding Acty StatementsRegardingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Legislative Political Acty | false | LegislativePoliticalActyInd |
| More Than100 Spent | false | MoreThan100SpentInd |
| Form1120 POL Filed | false | Form1120POLFiledInd |
| Activities Not Previously Rpt | false | ActivitiesNotPreviouslyRptInd |
| Changes To Articles Or Bylaws | false | ChangesToArticlesOrBylawsInd |
| Unrelated Bus Incm Over Limit | false | UnrelatedBusIncmOverLimitInd |
| Organization Dissolved Etc | false | OrganizationDissolvedEtcInd |
| Section508e Rqr Satisfied | Yes (true) | Section508eRqrSatisfiedInd |
| At Least5000 In Assets | Yes (true) | AtLeast5000InAssetsInd |
| Org Report Or Register State | AZ | OrgReportOrRegisterStateCd |
| Form990 PF Filed With Atty Gen | Yes (true) | Form990PFFiledWithAttyGenInd |
| Private Operating Foundation | false | PrivateOperatingFoundationInd |
| New Substantial Contributors | false | NewSubstantialContributorsInd |
| Own Controlled Entity | false | OwnControlledEntityInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Comply With Public Insp Rqr | Yes (true) | ComplyWithPublicInspRqrInd |
Persons With Books Name PersonsWithBooksName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Foundation Source | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 8008391754 | PhoneNum |
Location Of Books US Address LocationOfBooksUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 501 Silverside Road Suite 123 | AddressLine1Txt |
| City | Wilmington | CityNm |
| State Abbreviation | DE | StateAbbreviationCd |
| ZIP | 198091377 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Foreign Accounts Question | false | ForeignAccountsQuestionInd |
Statements Regarding Acty4720 StatementsRegardingActy4720Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Sale Or Exch Disqualified Prsn | false | SaleOrExchDisqualifiedPrsnInd |
| Brrw Or Lend Disqualified Prsn | false | BrrwOrLendDisqualifiedPrsnInd |
| Furn Goods Disqualified Prsn | false | FurnGoodsDisqualifiedPrsnInd |
| Pay Comp Disqualified Prsn | false | PayCompDisqualifiedPrsnInd |
| Transfer Ast Disqualified Prsn | false | TransferAstDisqualifiedPrsnInd |
| Payment To Government Official | false | PaymentToGovernmentOfficialInd |
| Uncorrected Prior Acts | false | UncorrectedPriorActsInd |
| Undistributed Income PY | false | UndistributedIncomePYInd |
| Business Holdings | false | BusinessHoldingsInd |
| Jeopardy Investments | false | JeopardyInvestmentsInd |
| Uncorrected PY Jeopardy Invst | false | UncorrectedPYJeopardyInvstInd |
| Influence Legislation | false | InfluenceLegislationInd |
| Influence Election | false | InfluenceElectionInd |
| Grants To Individuals | false | GrantsToIndividualsInd |
| Grants To Organizations | false | GrantsToOrganizationsInd |
| Noncharitable Purpose | false | NoncharitablePurposeInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | false | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | false | PayPremiumsPrsnlBnftCntrctInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | false | SubjToTaxRmnrtnExPrchtPymtInd |
Officer Dir Trst Key Empl Info OfficerDirTrstKeyEmplInfoGrp
Officer Dir Trst Key Empl OfficerDirTrstKeyEmplGrp (9 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | TitleTitleTxt | Average Hrs Per Wk Devoted To PosAverageHrsPerWkDevotedToPosRt | CompensationCompensationAmt | Employee Benefit ProgramEmployeeBenefitProgramAmt | Expense Account Other AllwncExpenseAccountOtherAllwncAmt |
|---|---|---|---|---|---|---|---|---|
| Marc Adler | ||||||||
| Foundation Source 501 Silverside Rd | Wilmington | DE | 198091377 | Trustee, Sec, Treas | 1.0 | $0 | $0 | $0 |
| Timothy Downey | ||||||||
| Foundation Source 501 Silverside Rd | Wilmington | DE | 198091377 | Pres | 1.0 | $0 | $0 | $0 |
| Ed Dresselhuys | ||||||||
| Foundation Source 501 Silverside Rd | Wilmington | DE | 198091377 | Trustee, Sec*, Treas*, VP | 1.0 | $0 | $0 | $0 |
| Lanny Hair | ||||||||
| Foundation Source 501 Silverside Rd | Wilmington | DE | 198091377 | Trustee | 1.0 | $0 | $0 | $0 |
| Erick L Johnson CPCU | ||||||||
| Foundation Source 501 Silverside Rd | Wilmington | DE | 198091377 | Trustee | 1.0 | $0 | $0 | $0 |
| Konnie Keaschall-Kiser | ||||||||
| Foundation Source 501 Silverside Rd | Wilmington | DE | 198091377 | Trustee, VP*, Pres | 1.0 | $0 | $0 | $0 |
| James Mann | ||||||||
| Foundation Source 501 Silverside Rd | Wilmington | DE | 198091377 | Trustee | 1.0 | $0 | $0 | $0 |
| Teresa Quale | ||||||||
| Foundation Source 501 Silverside Rd | Wilmington | DE | 198091377 | Trustee | 1.0 | $0 | $0 | $0 |
| J Scott Wede | ||||||||
| Foundation Source 501 Silverside Rd | Wilmington | DE | 198091377 | Trustee, exec dir | 1.0 | $0 | $0 | $0 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Summary Of Direct Chrtbl Acty | SummaryOfDirectChrtblActyGrp | |
| Sum Of Program Related Invst | SumOfProgramRelatedInvstGrp |
Minimum Investment Return MinimumInvestmentReturnGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Average Monthly FMV Of Sec | $401,806 | AverageMonthlyFMVOfSecAmt |
| Average Monthly Cash Balances | $521,541 | AverageMonthlyCashBalancesAmt |
| FMV All Other Noncharitable Ast | $6,104,828 | FMVAllOtherNoncharitableAstAmt |
| Total FMV Of Unused Assets | $7,028,175 | TotalFMVOfUnusedAssetsAmt |
| Acquisition Indebtedness | $0 | AcquisitionIndebtednessAmt |
| Adjusted Total FMV Of Unused Ast | $7,028,175 | AdjustedTotalFMVOfUnusedAstAmt |
| Cash Deemed Charitable | $105,423 | CashDeemedCharitableAmt |
| Net Vl Noncharitable Assets | $6,922,752 | NetVlNoncharitableAssetsAmt |
| Minimum Investment Return | $346,138 | MinimumInvestmentReturnAmt |
Distributable Amount DistributableAmountGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Minimum Investment Return | $346,138 | MinimumInvestmentReturnAmt |
| Tax Based On Investment Income | $2,973 | TaxBasedOnInvestmentIncomeAmt |
| Total Tax | $2,973 | TotalTaxAmt |
| Distributable Before Adj | $343,165 | DistributableBeforeAdjAmt |
| Distributable Before Ded | $343,165 | DistributableBeforeDedAmt |
| Distributable As Adjusted | $343,165 | DistributableAsAdjustedAmt |
PF Qualifying Distributions PFQualifyingDistributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expenses And Contributions | $1,157,749 | ExpensesAndContributionsAmt |
| Program Related Invst Total | $0 | ProgramRelatedInvstTotalAmt |
| Charitable Assets Acquis Paid | $0 | CharitableAssetsAcquisPaidAmt |
| Set Aside Suitability Test | $0 | SetAsideSuitabilityTestAmt |
| Set Aside Cash Distri Test | $0 | SetAsideCashDistriTestAmt |
| Qualifying Distributions | $1,157,749 | QualifyingDistributionsAmt |
Undistributed Income UndistributedIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Distributable As Adjusted | $343,165 | DistributableAsAdjustedAmt |
| Prior Year1 | 2019 | PriorYear1Yr |
| Prior Year2 | 2018 | PriorYear2Yr |
| Prior Year3 | 2017 | PriorYear3Yr |
| Excess Distribution Cyov Yr5 | $435,618 | ExcessDistributionCyovYr5Amt |
| Excess Distribution Cyov Yr4 | $465,417 | ExcessDistributionCyovYr4Amt |
| Excess Distribution Cyov Yr3 | $465,393 | ExcessDistributionCyovYr3Amt |
| Excess Distribution Cyov Yr2 | $453,604 | ExcessDistributionCyovYr2Amt |
| Excess Distribution Cyov Yr1 | $864,895 | ExcessDistributionCyovYr1Amt |
| Total Excess Distribution Cyov | $2,684,927 | TotalExcessDistributionCyovAmt |
| Qualifying Distributions | $1,157,749 | QualifyingDistributionsAmt |
| Applied To Current Year | $343,165 | AppliedToCurrentYearAmt |
| Remaining Distri From Corpus | $814,584 | RemainingDistriFromCorpusAmt |
| Total Corpus | $3,499,511 | TotalCorpusAmt |
| Undistributed Income CY | $0 | UndistributedIncomeCYAmt |
| Excess Distri Cyov From Yr5 | $435,618 | ExcessDistriCyovFromYr5Amt |
| Excess Distri Cyov To Next Yr | $3,063,893 | ExcessDistriCyovToNextYrAmt |
| Excess From Year4 | $465,417 | ExcessFromYear4Amt |
| Excess From Year3 | $465,393 | ExcessFromYear3Amt |
| Excess From Year2 | $453,604 | ExcessFromYear2Amt |
| Excess From Year1 | $864,895 | ExcessFromYear1Amt |
| Excess From Current Year | $814,584 | ExcessFromCurrentYearAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Private Operating Foundations | PrivateOperatingFoundationsGrp |
Supplementary Information SupplementaryInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributing Manager | NONE | ContributingManagerNm |
| Only Contri To Preselected | Yes (X) | OnlyContriToPreselectedInd |
Grant Or Contribution Pd Dur Yr GrantOrContributionPdDurYrGrp (37 entries)
| Address Line1RecipientUSAddress/AddressLine1Txt | CityRecipientUSAddress/CityNm | State AbbreviationRecipientUSAddress/StateAbbreviationCd | ZIPRecipientUSAddress/ZIPCd | Recipient RelationshipRecipientRelationshipTxt | Recipient Foundation StatusRecipientFoundationStatusTxt | Grant Or Contribution PurposeGrantOrContributionPurposeTxt | AmtAmt |
|---|---|---|---|---|---|---|---|
| 100 CLUB OF ARIZONA | |||||||
| 333 N 44TH ST STE 100 | PHOENIX | AZ | 85008 | N/A | PC | General & Unrestricted | $20,000 |
| ABILITY360 INC | |||||||
| 5025 EAST WASHINGTON ST NO 20 | PHOENIX | AZ | 85034 | N/A | PC | General & Unrestricted | $5,000 |
| AID TO WOMEN CENTER | |||||||
| 1328 E APACHE BLVD | TEMPE | AZ | 85281 | N/A | PC | General & Unrestricted | $5,000 |
| AMERICAN CANCER SOCIETY - GREAT WEST DIVISION | |||||||
| 6270 E HAWTHORNE ST | TUCSON | AZ | 85711 | N/A | PC | General & Unrestricted | $5,000 |
| AMYOTROPHIC LATERAL SCLEROSIS ASSOCIATION | |||||||
| 360 E CORONADO RD STE 140 | PHOENIX | AZ | 85004 | N/A | PC | General & Unrestricted | $3,000 |
| ANDRE HOUSE OF ARIZONA INC | |||||||
| PO BOX 2014 | PHOENIX | AZ | 85001 | N/A | PC | General & Unrestricted | $65,000 |
| ARIZONA ART ALLIANCE | |||||||
| 4327 E LEWIS AVE | PHOENIX | AZ | 85008 | N/A | PC | General & Unrestricted | $10,000 |
| ARIZONA COMMUNITY FOUNDATION | |||||||
| 2201 E CAMELBACK RD STE 405B | PHOENIX | AZ | 85016 | N/A | PC | General & Unrestricted | $3,000 |
| ARIZONA DIABETES FOUNDATION INC | |||||||
| GREENWAY PROFESSIONAL BLDG | PHOENIX | AZ | 85032 | N/A | PC | General & Unrestricted | $5,000 |
| ARTHRITIS FOUNDATION INC - PHOENIX CHAPTER | |||||||
| 5009 E WASHINGTON ST STE 125 | PHOENIX | AZ | 85034 | N/A | PC | General & Unrestricted | $5,000 |
| AUTISM SOCIETY OF GREATER PHOENIX | |||||||
| PO BOX 10543 | PHOENIX | AZ | 85064 | N/A | PC | General & Unrestricted | $10,000 |
| BARROW NEUROLOGICAL FOUNDATION | |||||||
| 2910 N 3RD AVE SUITE 450 | PHOENIX | AZ | 85013 | N/A | PC | General & Unrestricted | $10,000 |
| BOY SCOUTS OF AMERICA | |||||||
| 8840 E CHAPARRAL RD STE 200 | SCOTTSDALE | AZ | 85250 | N/A | PC | General & Unrestricted | $10,000 |
| COMMUNITY FOOD BANK INC | |||||||
| 3003 S COUNTRY CLUB RD | TUCSON | AZ | 85713 | N/A | PC | General & Unrestricted | $65,000 |
| CYSTIC FIBROSIS FOUNDATION | |||||||
| 2777 E CAMELBACK RD STE 330 | PHOENIX | AZ | 85016 | N/A | PC | General & Unrestricted | $5,000 |
| GOMPERS | |||||||
| 6601 N 27TH AVE | PHOENIX | AZ | 85017 | N/A | PC | General & Unrestricted | $5,000 |
| HACIENDA SNF INC | |||||||
| 1402 E S MOUNTAIN AVE | PHOENIX | AZ | 85042 | N/A | PC | General & Unrestricted | $15,000 |
| HONORHEALTH FOUNDATION | |||||||
| 8125 N HAYDEN RD | SCOTTSDALE | AZ | 85258 | N/A | PC | Desert Mission fund | $40,000 |
| HONORHEALTH FOUNDATION | |||||||
| 8125 N HAYDEN RD | SCOTTSDALE | AZ | 85258 | N/A | PC | General & Unrestricted | $25,000 |
| INSURANCE TRAINING AND EDUCATION CENTER INC | |||||||
| 333 E FLOWER ST | PHOENIX | AZ | 85012 | N/A | PC | General & Unrestricted | $90,000 |
| JUVENILE DIABETES RESEARCH FOUNDATION INTERNATIONA | |||||||
| 4343 E CAMELBACK ROAD STE 230 | PHOENIX | AZ | 85018 | N/A | PC | General & Unrestricted | $5,000 |
| KITCHEN ON THE STREET INC | |||||||
| 2650 E MOHAWK BLDG 3 | PHOENIX | AZ | 85050 | N/A | PC | General & Unrestricted | $65,000 |
| MAKE A WISH FOUNDATION OF ARIZONA INC | |||||||
| 2901 N 78TH ST | SCOTTSDALE | AZ | 85251 | N/A | PC | General & Unrestricted | $10,000 |
| NEW CITY BARRIO NUEVO PHOENIX | |||||||
| 2030 W BASELINE RD NO 182-212 | PHOENIX | AZ | 85041 | N/A | PC | General & Unrestricted | $5,000 |
| ORAL EDUCATIONAL OPPORTUNITIES FOR THE HEARING IMP | |||||||
| 3426 E SHEA BLVD | PHOENIX | AZ | 85028 | N/A | PC | General & Unrestricted | $15,000 |
| PAZ DE CRISTO COMMUNITY CENTER | |||||||
| 424 W BROADWAY RD | MESA | AZ | 85210 | N/A | PC | General & Unrestricted | $65,000 |
| PLUS FOUNDATION | |||||||
| 5353 WAYZATA BLVD STE 600 | MINNEAPOLIS | MN | 55416 | N/A | SO I | General & Unrestricted | $15,000 |
| SHRINERS HOSPITALS FOR CHILDREN - SALT LAKE CITY | |||||||
| FAIRFAX ROAD AT VIRGINIA ST | SALT LAKE CITY | UT | 84103 | N/A | PC | General & Unrestricted | $5,000 |
| SOJOURNER CENTER | |||||||
| PO BOX 20156 | PHOENIX | AZ | 85036 | N/A | PC | General & Unrestricted | $15,000 |
| SOUTHWEST DISTRICT KIWANIS FOUNDATION | |||||||
| 5318 KINGS ROW NE | ALBUQUERQUE | AZ | 87109 | N/A | PC | General & Unrestricted | $15,000 |
| SOUTHWEST HUMAN DEVELOPMENT | |||||||
| 2850 N 24TH ST | PHOENIX | AZ | 85008 | N/A | PC | General & Unrestricted | $5,000 |
| ST MARYS FOOD BANK ALLIANCE | |||||||
| 2831 N 31ST AVE | PHOENIX | AZ | 85009 | N/A | PC | General & Unrestricted | $65,000 |
| THE UNIVERSITY OF TEXAS MD ANDERSON CANCER CENTER | |||||||
| PO BOX 4486 | HOUSTON | TX | 77210 | N/A | GOV | General & Unrestricted | $5,000 |
| THE WSIA EDUCATION FOUNDATION | |||||||
| 4131 N MULBERRY DR STE 200 | KANSAS CITY | MO | 64116 | N/A | PC | General & Unrestricted | $350,000 |
| UNITED SERVICE ORGANIZATIONS INC | |||||||
| PO BOX 96860 | WASHINGTON | DC | 20077 | N/A | PC | General & Unrestricted | $10,000 |
| WASTE NOT INC | |||||||
| 1700 N GRANITE REEF RD | SCOTTSDALE | AZ | 85257 | N/A | PC | General & Unrestricted | $65,000 |
| YOUTH RISING | |||||||
| 6808 E INDIGOBAY DR | GILBERT | AZ | 85234 | N/A | PC | General & Unrestricted | $10,000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Grant Or Contri Pd Dur Yr | $1,126,000 | TotalGrantOrContriPdDurYrAmt |
Analysis Income Producing Acty AnalysisIncomeProducingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fees Contracts From Govt Ag | FeesContractsFromGovtAgGrp | |
| Membership Dues And Assmnt | MembershipDuesAndAssmntGrp |
Int On Sav And Temp Cash Invst IntOnSavAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Exclusion | 14 | ExclusionCd |
| Exclusion | $50 | ExclusionAmt |
Dividends And Interest From Sec Dtl DividendsAndInterestFromSecDtl
| Field | Value | IRS element (for citing) |
|---|---|---|
| Exclusion | 14 | ExclusionCd |
| Exclusion | $11,178 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Rntl Incm Re Debt Fincd Prop | NetRntlIncmReDebtFincdPropGrp | |
| Net Rntl Incm Re Not Debt Fincd Prop | NetRntlIncmReNotDebtFincdProp | |
| Net Rental Income Personal Prop | NetRentalIncomePersonalPropGrp | |
| Other Investment Income | OtherInvestmentIncomeGrp |
Gain Sales Ast Oth Than Invntry GainSalesAstOthThanInvntryGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Exclusion | 18 | ExclusionCd |
| Exclusion | -$878 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Income Loss From Special Evt | NetIncomeLossFromSpecialEvtGrp | |
| Gross Profit Loss Sls Of Invntry | GrossProfitLossSlsOfInvntryGrp |
Other Revenue Described OtherRevenueDescribedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | ANNUITY INCOME | Desc |
| Exclusion | 14 | ExclusionCd |
| Exclusion | $202,930 | ExclusionAmt |
Subtotals Incm Producing Acty SubtotalsIncmProducingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Exclusion | $213,280 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Income Producing Acty | $213,280 | TotalIncomeProducingActyAmt |
Trnsfr Trans Rln Nonchrtbl EO TrnsfrTransRlnNonchrtblEOGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trnsfr Of Cash To Nonchrtbl EO | false | TrnsfrOfCashToNonchrtblEOInd |
| Trnsfr Other Asset Nonchrtbl EO | false | TrnsfrOtherAssetNonchrtblEOInd |
| Sales Or Exchanges Of Assets | false | SalesOrExchangesOfAssetsInd |
| Purchase Of Assets Nonchrtbl EO | false | PurchaseOfAssetsNonchrtblEOInd |
| Rental Of Facilities Oth Assets | false | RentalOfFacilitiesOthAssetsInd |
| Reimbursement Arrangements | false | ReimbursementArrangementsInd |
| Loans Or Loan Guarantees | false | LoansOrLoanGuaranteesInd |
| Performance Of Services Etc | false | PerformanceOfServicesEtcInd |
| Sharing Of Facilities Etc | false | SharingOfFacilitiesEtcInd |
| Relationships Nonchrtbl EO | false | RelationshipsNonchrtblEOInd |
Schedule B IRS990ScheduleB
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization501c3 Exempt PF | Yes (X) | Organization501c3ExemptPFInd |
| General Rule | Yes (X) | GeneralRuleInd |
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | 1 | ContributorNum |
| Contributor Person | The Surplus Line Association of Ari | ContributorPersonNm |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 15849 N 71st Street ste 100 | AddressLine1Txt |
| City | Scottsdale | CityNm |
| State Abbreviation | AZ | StateAbbreviationCd |
| ZIP | 85254 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | $1,200,000 | TotalContributionsAmt |
| Person Contribution | Yes (X) | PersonContributionInd |
Compensation Explanation CompensationExplanation
Compensation Explanation CompensationExplanationGrp (3 entries)
| Short ExplanationShortExplanationTxt |
|---|
| Timothy Downey |
| * deceased in 2021 |
| Ed Dresselhuys |
| * removed from positions in 2021 |
| Konnie Keaschall-Kiser |
| * removed from position in 2021 |
Depreciation Schedule DepreciationSchedule
Investments Corp Bonds Schedule InvestmentsCorpBondsSchedule
Investments Corporate Bonds InvestmentsCorporateBondsGrp (12 entries)
| BondBondNm | EOY Book ValueEOYBookValueAmt | EOYFMVEOYFMVAmt |
|---|---|---|
| CATERPILLAR FINANCIAL SE MTN - | $27,118 | $28,888 |
| CITIGROUP INC - 5.500% - 09/13 | $28,857 | $28,283 |
| CITIGROUP INC SUB NT - 3.500% | $24,065 | $25,846 |
| GE CAPITAL CORP - 4.500% - 11/ | $27,075 | $26,863 |
| GENERAL ELECTRIC CAPITAL CORP | $25,722 | $26,369 |
| GENERAL ELECTRIC CO - 5.000% - | $55,230 | $55,451 |
| GOLDMAN SACHS GP INC - 5.950% | $32,164 | $35,382 |
| GOLDMAN SACHS GROUP INC - 3.50 | $11,770 | $12,837 |
| GOLDMAN SACHS GRP INC MTN BE - | $25,249 | $25,770 |
| HANCOCK JOHN LIFE INS CO - 5.0 | $17,689 | $18,458 |
| JPMORGAN CHASE & CO - 4.125% - | $25,267 | $27,590 |
| STATOIL ASA NT - 3.700% - 03/0 | $26,045 | $26,371 |
Investments Govt Obligations Sch InvestmentsGovtObligationsSch
| Field | Value | IRS element (for citing) |
|---|---|---|
| State Local Sec Book Vl EOY | $34,699 | StateLocalSecBookVlEOYAmt |
| State Local Sec EOYFMV | $30,849 | StateLocalSecEOYFMVAmt |
Investments Other Schedule2 InvestmentsOtherSchedule2
Investments Other InvestmentsOtherGrp (11 entries)
| Category Or ItemCategoryOrItemTxt | Book ValueBookValueAmt | EOYFMVEOYFMVAmt |
|---|---|---|
| COLUMBUS LIFE # CM5064902A | $168,045 | $168,045 |
| COLUMBUS LIFE # CM5108868A | $1,745,181 | $1,666,647 |
| INTEGRITY LIFE INSURANCE # 210 | $1,117,798 | $1,073,831 |
| JACKSON NATIONAL LIFE # 100355 | $336,965 | $336,965 |
| JACKSON NATIONAL LIFE # 100471 | $423,479 | $423,479 |
| JACKSON NATIONAL LIFE # 100498 | $407,897 | $407,897 |
| NEW YORK LIFE # 52132702 | $292,458 | $292,458 |
| NORTH AMERICAN LIFE 8000460723 | $665,463 | $643,096 |
| PRINCIPAL # 8944779 | $429,695 | $407,705 |
| PRINCIPAL # 8951445 | $315,789 | $300,603 |
| UNITED OF OMAHA # U01139674 | $394,055 | $384,102 |
Other Expenses Schedule OtherExpensesSchedule
Other Expenses Schedule OtherExpensesScheduleGrp (2 entries)
| DescDesc | Revenue And Expenses Per BooksRevenueAndExpensesPerBooksAmt | Disbursements Charitable PrpsDisbursementsCharitablePrpsAmt | Net Investment IncomeNetInvestmentIncomeAmt |
|---|---|---|---|
| Administrative Fees | $31,749 | $31,749 | |
| Bank Charges | $300 | $300 |
Other Income Schedule2 OtherIncomeSchedule2
Other Income Detail OtherIncomeDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | Annuity Income | Desc |
| Revenue And Expenses Per Books | $202,930 | RevenueAndExpensesPerBooksAmt |
| Net Investment Income | $202,930 | NetInvestmentIncomeAmt |
Taxes Schedule TaxesSchedule
Taxes Detail TaxesDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Category | 990-PF Extension for 2020 | CategoryTxt |
| Amt | $550 | Amt |
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