2022-05-03T14:28:45-05:00 2021-12-31 201717681 SOMERSET CPAS AND ADVISORS 3925 RIVER CROSSING PKWY STE 100 INDIANAPOLIS IN 46240 990PF 2021-01-01 203523866 THE SEMLER FAMILY FOUNDATION INC SEML 3179971615 7920 BEAUMONT GREEN WEST DR INDIANAPOLIS IN 462501651 JERRY SEMLER OFFICER 3179971615 2022-05-02 1 JERRY SEMLER 999009999 SUSIE M KEATON CPA P00765420 3174722200 2022-05-02 3 AAL1 IAL1 2021 2022-09-23 18:48:47Z X 2317510 X X 4577 4577 42477 42477 112394 457368 112394 159448 159448 0 0 0 3155 3155 0 21326 21326 0 637 637 0 25118 25118 0 127800 127800 152918 25118 127800 6530 134330 237 17411 17411 111691 54085 54085 376604 454280 645002 342808 306962 318980 870014 877866 1281134 1112 898 898 1702466 1711502 2317510 0 0 X 1642061 1642061 0 0 60405 69441 1702466 1711502 1702466 1711502 1702466 6530 2506 1711502 0 1711502 FIDELITY - 2997 P 2020-01-01 2021-07-01 133802 101514 32288 32288 FIDELITY - 2997 P 2021-01-01 2021-07-01 132469 131501 968 968 FIDELITY - 3003 P 2020-01-01 2021-07-01 141714 101994 39720 39720 FIDELITY - 3003 P 2021-01-01 2021-07-01 19614 9965 9649 9649 CAPITAL GAINS DIVIDENDS P 29769 29769 29769 112394 1867 0 1867 0 1867 1040 0 0 0 1040 0 827 0 0 0 0 0 0 0 0 0 0 1 1 IN 1 0 0 0 0 1 N/A JERRY SEMLER 3179971615 7920 BEAUMONT GREEN WEST DR INDIANAPOLIS IN 46250 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 JERRY D SEMLER 7920 BEAUMONT GREEN WEST DR INDIANAPOLIS IN 46250 PRESIDENT 1.00 0 0 0 ROSEMARY R SEMLER 7920 BEAUMONT GREEN WEST DR INDIANAPOLIS IN 46250 VICE-PRESIDENT 1.00 0 0 0 MICHAEL R SEMLER 7920 BEAUMONT GREEN WEST DR INDIANAPOLIS IN 46250 TREASURER 1.00 0 0 0 KIMBERLY D HAMILTON 7920 BEAUMONT GREEN WEST DR INDIANAPOLIS IN 46250 SECRETARY 1.00 0 0 0 MARY D DODSON 7920 BEAUMONT GREEN WEST DR INDIANAPOLIS IN 46250 DIRECTOR 1.00 0 0 0 JOHN R SEMLER 7920 BEAUMONT GREEN WEST DR INDIANAPOLIS IN 46250 DIRECTOR 1.00 0 0 0 KRISTIN D TERRELL 7920 BEAUMONT GREEN WEST DR INDIANAPOLIS IN 46250 DIRECTOR 1.00 0 0 0 JEFFREY R SEMLER 7920 BEAUMONT GREEN WEST DR INDIANAPOLIS IN 46250 DIRECTOR 1.00 0 0 0 SALLY D BUTLER 7920 BEAUMONT GREEN WEST DR INDIANAPOLIS IN 46250 DIRECTOR 1.00 0 0 0 NONE 0 NONE 0 CONTRIBUTIONS TO VARIOUS PUBLIC CHARITIES TO CARRY OUT CHARITABLE GOALS. SEE LIST OF CHARITIES ATTACHED TO TAX RETURN. 127800 0 2206803 22590 0 2229393 0 0 2229393 33441 2195952 109798 109798 1867 1867 107931 0 107931 0 107931 127800 0 127800 107931 0 0 22584 5924 31917 36053 96478 127800 0 0 0 107931 19869 0 0 116347 0 0 0 0 0 0 22584 93763 5924 31917 36053 19869 JERRY D SEMLER 7920 BEAUMONT GREEN WEST DR INDIANAPOLIS IN 46250 3172851615 SUBMIT LETTER DESCRIBING NEED FOR AND PURPOSE OF REQUESTED CONTRIBUTION. N/A N/A AMERICAN HEART ASSOCIATION 6100 W 96TH ST STE 200 INDIANAPOLIS IN 46278 NO RELATION PUBLIC CHARITY PROGRAM SUPPORT 100 BISHOP CHATARD HIGH SCHOOL-KYLE GUYTON MEMORIAL 5885 N CRITTENDEN AVE INDIANAPOLIS IN 46220 NO RELATION PUBLIC CHARITY PROGRAM SUPPORT 25000 CLD 2425 MARTIN LUTHER KING JR ST INDIANAPOLIS IN 46208 NO RELATION PUBLIC CHARITY PROGRAM SUPPORT 10000 CONNOR PRAIRIE 13400 ALLISONVILLE RD FISHERS IN 46038 NO RELATION PUBLIC CHARITY PROGRAM SUPPORT 3500 CROSSROADS OF AMERICA COUNCIL 7125 FALL CREEK RD INDIANAPOLIS IN 46256 NO RELATION PUBLIC CHARITY PROGRAM SUPPORT 300 CULVER BOYS & GIRLS CLUB 401 SCHOOL ST CULVER IN 46511 NO RELATION PUBLIC CHARITY PROGRAM SUPPORT 1000 FIRST TEE OF INDIANA 2625 HURRICANE RD FRANKLIN IN 46131 NO RELATION PUBLIC CHARITY PROGRAM SUPPORT 100 GLEANERS FOOD BANK 3737 WALDEMERE AVE INDIANAPOLIS IN 46241 NO RELATION PUBLIC CHARITY PROGRAM SUPPORT 1000 HOOSIER SALON PATRONS ASSOC 1060 N CAPITOL AVE C365 INDIANAPOLIS IN 46204 NO RELATION PUBLIC CHARITY PROGRAM SUPPORT 6500 INDIANA HISTORICAL SOCIETY 450 W OHIO ST INDIANAPOLIS IN 46202 NO RELATION PUBLIC CHARITY PROGRAM SUPPORT 10500 JOSEPH MALEY FOUNDATION 7128 LAKEVIEW PKWY W DR INDIANAPOLIS IN 46268 NO RELATION PUBLIC CHARITY PROGRAM SUPPORT 300 KATE'S KART 10376 LEO RD STE A FT WAYNE IN 46825 NO RELATION PUBLIC CHARITY PROGRAM SUPPORT 200 KIDNEY CANCER FOUNDATION PO BOX 803338 38269 CHICAGO IL 60680 NO RELATION PUBLIC CHARITY PROGRAM SUPPORT 100 LAKE MAX ENVIROMENTAL FUND 116 N MAIN ST CULVER IN 46511 NO RELATION PUBLIC CHARITY PROGRAM SUPPORT 2500 MAKE A WISH 6201 CORPORATE DR STE 100 INDIANAPOLIS IN 46278 NO RELATION PUBLIC CHARITY PROGRAM SUPPORT 200 MARIAN UNIVERSITY 3200 COLD SPRING RD INDIANAPOLIS IN 46222 NO RELATION PUBLIC CHARITY DAVISON PROJECT/GALA/HELPING HANDS 10000 MDRT 3258 W TOUHY AVE PARK RIDGE IL 60068 NO RELATION PUBLIC CHARITY PROGRAM SUPPORT 5000 NATIONAL EATING DISORDERS ASSOCIATION 1500 BROADWAY STE 1101 NEW YORK NY 10036 NO RELATION PUBLIC CHARITY PROGRAM SUPPORT 100 RILEY CHILDRENS FOUNDATION 30 S MERIDIAN ST STE 200 INDIANAPOLIS IN 46204 NO RELATION PUBLIC CHARITY PROGRAM SUPPORT 2000 SEEDS OF HOPE 1425 MICKLEY AVE INDIANAPOLIS IN 46241 NO RELATION PUBLIC CHARITY PROGRAM SUPPORT 100 ST MEINRAD 200 HILL DR ST MEINRED IN 47577 NO RELATION PUBLIC CHARITY PROGRAM SUPPORT 1000 SYCAMORE FOUNDATION 101 WEST OHIO ST INDIANAPOLIS IN 46204 NO RELATION PUBLIC CHARITY PROGRAM SUPPORT 2000 UNITED CATHOLIC APPEAL (ARCH OF INDIANAPOLIS) PO BOX 6043 INDIANAPOLIS IN 46206 NO RELATION PUBLIC CHARITY PROGRAM SUPPORT 10000 CONNOR PRAIRIE (CAPITAL CAMPAIGN) 13400 ALLISONVILLE RD FISHERS IN 46038 NO RELATION PUBLIC CHARITY PROGRAM SUPPORT 10000 LAKE MAXINKUCKEE ASSOCIATION 116 N MAIN ST CULVER IN 46511 NO RELATION PUBLIC CHARITY PROGRAM SUPPORT (FIREWORKS) 1000 UNITED WAY OF MARSHALL COUNTY 2680 MILLER DR PLYMOUTH IN 46563 NO RELATION PUBLIC CHARITY PROGRAM SUPPORT 1000 ST AGNES CATHOLIC SCHOOL-GRANT 1501 CHICAGO RD CHICAGO HEIGHTS IL 60411 NO RELATION PUBLIC CHARITY PROGRAM SUPPORT 100 PURDUE UNIVERSITY - LEROY KEYES FELLOWSHIP 610 PURDUE MALL WEST LAFAYETTE IN 47907 NO RELATION PUBLIC CHARITY PROGRAM SUPPORT 1000 SECOND HELPINGS-GRANT 1121 SOUTHEASTERN AVE INDIANAPOLIS IN 46202 NO RELATION PUBLIC CHARITY PROGRAM SUPPORT 100 PHI GAMMA DELTA FOUNDATION-GRANT 640 RUSSELL ST LEXINGTON KY 40502 NO RELATION PUBLIC CHARITY PROGRAM SUPPORT 100 PROVIDENCE CRISTO REY HIGH SCHOOL-GRANT 75 N BELLEVUE AVE INDIANAPOLIS IN 46222 NO RELATION PUBLIC CHARITY PROGRAM SUPPORT 400 MERCIFUL HELP CENTER-GRANT 1045 W 146TH ST SUITE A CARMEL IN 46032 NO RELATION PUBLIC CHARITY PROGRAM SUPPORT 400 500 FESTIVAL FOUNDATION 21 VIRGINIA AVE INDIANAPOLIS IN 46204 NO RELATION PUBLIC CHARITY PROGRAM SUPPORT 1000 ARCHDIOCESE OF INDIANAPOLIS PO BOX 6043 INDIANAPOLIS IN 46206 NO RELATION PUBLIC CHARITY PROGRAM SUPPORT 5000 BARSTOOL FUND-30 DAY FUND-GRANT 1314 RUGBY ROAD CHARLOTTESVILLE VA 22903 NO RELATION PUBLIC CHARITY PROGRAM SUPPORT 100 EARLY LEARNING INDIANA 10 WEST MARKET ST SUITE 1990 INDIANAPOLIS IN 46204 NO RELATION PUBLIC CHARITY PROGRAM SUPPORT 1000 EITELJORG MUSEUM 500 WEST WASHINGTON INDIANAPOLIS IN 46204 NO RELATION PUBLIC CHARITY PROGRAM SUPPORT 1000 FREEMAN ARMY AIRFIELD MUSEUM 1035 A AVENUE SEYMOUR IN 47274 NO RELATION PUBLIC CHARITY PROGRAM SUPPORT 2000 INDIANAPOLIS SYMPHONY ORCHESTRA 45 MONUMENT CIRCLE INDIANAPOLIS IN 46204 NO RELATION PUBLIC CHARITY PROGRAM SUPPORT 1000 IRT 140 W WASHINGTON ST INDIANAPOLIS IN 46204 NO RELATION PUBLIC CHARITY PROGRAM SUPPORT 10000 IU FOUNDATION 420 UNIVERSITY BLVD INDIANAPOLIS IN 46202 NO RELATION PUBLIC CHARITY PROGRAM SUPPORT 1000 JUVENILE DIABETES RESEARCH FOUNDATION-GRANT 225 S EAST ST SUITE 280 INDIANAPOLIS IN 46202 NO RELATION PUBLIC CHARITY PROGRAM SUPPORT 100 127800 0 14 4577 14 42477 18 112394 0 159448 0 159448 0 0 0 0 0 0 0 0 0 0 ACCOUNTING FEES 3155 3155 0 VANGUARD HI YIELD CORPORATE ADMIRAL 13927 15194 MAINSTAY MACKAY CONVERTIBLE CL I 21644 27916 JACKSON ST UNIV EDL BLDG CORP MISS REV 24070 25953 NEW HAMPSHIRE ST GO CAP IMPT BDS 30099 30216 JPMORGAN MORTGAGE BACKED SEC CLASS I 37282 37542 ALLSPRING SHORT TERM HIGH YIELD BD INST 37687 38062 CARILLON REAMS UNCONSTRAINED BOND I 40284 45342 STONE RIDGE HIGH YLD REINSRNCE RSK PREM I 46704 44430 FEDERAL FARM CR BKS BOND 55265 54325 ALPHABET INC CAP STK CL C 3003 17362 STARBUCKS CORP COM USD 0.001 3556 6784 IQVIA HLDGS INC COM 4128 14107 APPLE INC COM USD 0.00001 4326 28766 COLFAX CORP 4600 6941 LEVI STRAUSS & CO NEW CL A COM STK 5156 9637 AMERICAN EXPRESS CO COM USD0.20 5328 13252 MCKESSON CORP 5466 12429 ENBRIDGE INC COM ISIN 5626 6644 CACI INTERNATIONAL INC 5901 6461 EDISON INTERNATIONAL 5943 7303 VONTIER CORPORATION 6116 6054 SCHLUMBERGER LIMITED COM USD 0.01 6161 12070 INTEL CORP COM USD0.001 6467 6232 VALVOLINE INC COM 6481 7085 META PLATFORMS INC CLASS A COMMON 6489 5718 DOMINION ENERGY INC COM 6503 7699 HONEYWELL INTERNATIONAL INC 6578 14596 JOHNSON CONTROLS INTERNATIONAL PLC 7006 15693 UNITED HEALTH GROUP INC 7180 14562 QUALCOMM INC 7241 24687 RAYTHEON TECHNOLOGIES 7281 11188 CORTEVA INC COM 7301 12151 KRAFT HEINZ CO COM 7404 9837 FIRST SOLAR INC 7663 12813 VMWARE INC 7689 5910 BERKSHIRE HATHAWAY INC COM USD 0.0033 8223 12259 WELLS FARGO CO NEW COM 8232 12139 ZIMMER BIOMET HOLDINGS INC COM 8332 10290 DISCOVERY INC COM SER C 8392 6481 FIFTH THIRD BANCORP 8425 14851 CRANE CO 8600 8138 VERIZON COMMUNICATIONS INC 9481 9820 BROADRIDGE FINANCIAL SOLUTION INC 9491 14808 MICROSOFT CORP 9600 23542 AMAZON.COM INC 9708 10003 CAPITAL ONE FINANCIAL CORP COM 9861 14219 MERCK & CO. INC COM 9918 13259 CVS HEALTH CORPORATION COM 9971 15371 BORG WARNER INC COM USD 0.01 10389 13566 VIATRIS INC COM 10497 8416 TJX COMPANIES INC 10514 14197 PURDENTIAL FINANCIAL INC 11012 12772 FREEPORT-MCMORAN INC COM USD0.10 11559 13813 AMERICAN INTERNATIONAL GROUP 11723 13533 COMCAST CORP 11736 11022 HANESBRANDS INC COM USD 0.01 11758 10968 CHEVRON CORP NEW COM 11846 12909 HOSTESS BRANDS INC CL A 12211 15090 FISHERV INC 13724 11936 ALTRA INDUSTRIAL MOTION CORP 14179 11706 EXXON MOBIL CORP 14967 12728 VANGUARD COMMODITY STRATEGY FD ADMIRAL 23338 21185 OMEGA HEALTHCARE INVESTORS INC AT COST 7305 8552 SIMON PROPERTY GROUP AT COST 8431 8947 ISHARES TR EXPANDED TECH AT COST 10354 20678 JP MORGAN MID CAP VALUE FUND CLASS L AT COST 12018 14865 DBX ETF TR XTRACK MSCI EAFE AT COST 12936 18732 VANGUARD EMERG MKTS SELECT STOCK INVSTR AT COST 14863 17013 DIAMOND HILL LONG/SHRT FUND CL I AT COST 17928 22078 ISHARES S&P 500 AT COST 26318 52469 ISHARES S&P MIDCAP 400 INDEX FUND AT COST 28620 42462 ISHARES CORE S&P SMALL-CAP E AT COST 34573 73859 ISHARES TR ISHS 1-5YR INVS AT COST 41924 43267 CALAMOS MARKET NEUTRAL INCOME CL I AT COST 43322 47965 FIDELITY ADVISOR REAL ESTATE INCOME Z AT COST 44584 50640 BLACKROCK SYSTEMATIC MULTI-STRATEGY INSTL AT COST 45994 47119 SPDR SERIES TRUST S&P 600 SMCP VAL AT COST 55602 101664 JANUS HENDERSON ENTERPRISES AT COST 61490 79947 FEDERATED HERMES INTL EQ CL IS AT COST 65181 83224 ISHARES TR ISHS 5-10YR INVS AT COST 80180 80227 FIDELITY TOTAL INTL INDEX FUND AT COST 85447 95094 ISHARES S&P 500 GROWTH ETF AT COST 180796 372332 ACCRUED INTEREST 1112 898 898 NONDIVIDEND DISTRIBUTIONS 697 ADJUSTMENT 1809 FIDELITY FEES 21326 21326 0 FOREIGN TAX 637 637 0