2022-10-31T08:09:01-05:00 2021-12-31 390859910 BAKER TILLY US LLP 205 N MICHIGAN AVE 2800 CHICAGO IL 606015927 990 2021-01-01 474842422 M3 INSURANCE FOUNDATION INC M3IN 8002722443 828 JOHN NOLEN DRIVE MADISON WI 53713 BETH DETTMAN PRESIDENT 8002722443 2022-10-28 1 BETH DETTMAN 999009999 MARK HEROUX P00959793 3127298000 2022-10-28 3 AAL1 IAL1 2021 2022-09-23 18:48:47Z BETH DETTMAN 828 JOHN NOLEN DRIVE MADISON WI 53713 404915 0 X HTTPS://M3INS.COM/M3-FOUNDATION/ X 2015 WI (SEE SCHEDULE O)THE FOUNDATION WAS ORGANIZED TO PROMOTE THE CHARITABLE ATTITUDES OF THE EMPLOYEES AT M3 SOLUTIONS, INC. THE FOUNDATION WILL FOCUS ON THE AREAS OF HEALTH CARE, SAFETY IMPROVEMENT, CATASTROPHIC EVENT RELIEF, FINANCIAL EDUCATION AND LITERACY, AND THE PROMOTION OF CAREERS IN THE INSURANCE INDUSTRY. 9 9 0 11 0 0 339789 372520 0 0 204 14003 0 0 339993 386523 328000 192500 0 0 0 0 0 0 0 9840 21101 337840 213601 2153 172922 522233 676549 0 206000 522233 470549 X (SEE SCHEDULE O)THE FOUNDATION WAS ORGANIZED TO PROMOTE THE CHARITABLE ATTITUDES OF THE EMPLOYEES AT M3 SOLUTIONS, INC. THE FOUNDATION WILL FOCUS ON THE AREAS OF HEALTH CARE, SAFETY IMPROVEMENT, CATASTROPHIC EVENT RELIEF, FINANCIAL EDUCATION AND LITERACY, AND THE PROMOTION OF CAREERS IN THE INSURANCE INDUSTRY. 0 0 192500 192500 THE FOUNDATION DONATES TO LOCAL ORGANIZATIONS FOCUSING ON HEALTH CARE, SAFETY IMPROVEMENT, CATASTROPHIC EVENT RELIEF, FINANCIAL EDUCATION AND LITERACY, AND THE PROMOTION OF CAREERS IN THE INSURANCE INDUSTRY. 192500 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 9 9 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 0 0 0 WI X BRIAN DONARSKI 6082882732 828 JOHN NOLEN DR MADISON WI 53713 X BEC KURZYNSKE DIRECTOR 0.60 X 0 0 0 CANDICE ROTH DIRECTOR 0.60 X 0 0 0 JESSE MAAS DIRECTOR 0.60 X 0 0 0 KELSEY STACKS DIRECTOR 0.60 X 0 0 0 DANAE DORSEY DIRECTOR 0.60 X 0 0 0 MELISSA SEYFFER DIRECTOR 0.60 X 0 0 0 ELIZABETH DETTMAN PRESIDENT 0.60 X 0 0 0 KEVIN MILLER SECRETARY 0.60 X 0 0 0 LINDSEY HAMIELEC TREASURER 0.60 X 0 0 0 0 0 0 0 0 0 0 0 372520 372520 5053 5053 27342 18392 8950 8950 8950 386523 0 0 14003 191500 191500 1000 1000 17933 17933 1738 1738 594 594 SOFTWARE 755 755 BANK FEES 81 81 213601 192500 21101 0 282233 362731 9636 240000 304182 522233 676549 0 206000 0 206000 X 522233 470549 522233 470549 522233 676549 X 172922 20163 -244769 X X 1 X 0 0 0 X 123676 543828 325473 339789 372250 1705016 123676 543828 325473 339789 372250 1705016 1519296 185720 126 784 586 204 5053 6753 1711769 0.10850 0.07290 X PART II, SECTION C, LINE 17B, FACTS AND CIRCUMSTANCES TEST: M3 INSURANCE FOUNDATION RECEIVED A MAJORITY OF START UP SUPPORT FROM M3 INSURANCE SOLUTION. THE ORGANIZATION PROVIDES A WIDE RANGE OF CONTRIBUTIONS TO THE COMMUNITY IT CALLS HOME AND WORKS TO ENRICH THE COMMUNITY IT CONDUCTS BUSINESS IN. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 DONATIONS PAYABLE 206000 206000 X 407335 20163 649 20812 386523 0 386523 214250 649 649 213601 0 213601 PART X, LINE 2: THE FOUNDATION IS A NOT-FOR-PROFIT ORGANIZATION THAT IS EXEMPT FROM FEDERAL AND STATE INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. ACCORDINGLY, NO PROVISION FOR INCOME TAXES IS REFLECTED IN THE FOUNDATION'S FINANCIAL STATEMENTS. THE FOUNDATION IS CLASSIFIED AS A PUBLIC CHARITY ON INTERNAL REVENUE CODE 170(B)(1)(A)(VI). THE FOUNDATION DOES NOT BELIEVE THAT IT HAS ANY UNCERTAIN TAX POSITIONS AT DECEMBER 31, 2021. 1 DOMESTIC ABUSE INTERVENTION SERVICES (DAIS) 2102 FORDEM AVENUE MADISON WI 53704 411382134 501(C)(3) 7000 0 GENERAL ASSISTANCE LUTHERAN SOCIAL SERVICES 6737 W WASHING ST 2275 MILWAUKEE WI 53214 390816846 501(C)(3) 20000 0 GENERAL ASSISTANCE MADISON COLLEGE FOUNDATION 3591 ANDERSON ST SUITE 203A MADISON WI 53704 237265867 501(C)(3) 16500 0 GENERAL ASSISTANCE SECOND HARVEST FOODBANK OF SOUTHERN WISCONSIN 2802 DAIRY DR MADISON WI 53718 391490691 501(C)(3) 10000 0 GENERAL ASSISTANCE UNITED WAY OF DANE COUNTY PO BOX 7548 MADISON WI 53707 390817532 501(C)(3) 32000 0 GENERAL ASSISTANCE UNITED WAY OF GREATER MILWAUKEE & WAUKESHA COUNTY BOX 88110 MILWAUKEE WI 53288 390806190 501(C)(3) 6000 0 GENERAL ASSISTANCE UNITED WAY OF MARATHON COUNTY 705 S 24TH AVE SUITE 400B WAUSAU WI 54401 390935496 501(C)(3) 6000 0 GENERAL ASSISTANCE CHIPPEWA VALLEY HEALTH CLINIC INC 1030 OAK RIDGE DRIVE EAU CLAIRE WI 54701 391840231 501(C)(3) 6000 0 GENERAL ASSISTANCE 79 SCHOLARSHIP - DIANE WILKINSON SCHOLARSHIP 1 1000 PART I, LINE 2: M3 INSURANCE FOUNDATION HAS A FORMAL APPLICATION PROCESS FOR GRANT REQUESTS. MOST GRANTS ARE APPLICATION BASED. THE BOARD MEMBERS HAVE THE ABILITY TO RECOMMEND GRANTEES BASED ON THEIR COMMUNITY CONTRIBUTIONS. FORM 990, PART VI, SECTION B, LINE 11B A COPY OF THE FORM 990 IS REVIEWED BY THE BOARD AND APPROVED BEFORE IT IS FILED. FORM 990, PART VI, SECTION B, LINE 12C IN CONNECTION WITH ANY ACTUAL OR POSSIBLE CONFLICT OF INTEREST, AN INTERESTED PERSON MUST DISCLOSE THE EXISTENCE OF THE FINANCIAL INTEREST AND BE GIVEN THE OPPORTUNITY TO DISCLOSE ALL MATERIAL FACTS TO THE DIRECTORS AND MEMBERS OF COMMITTEES WITH GOVERNING BOARD DELEGATED POWERS CONSIDERING THE PROPOSED TRANSACTION OR ARRANGEMENT. FORM 990, PART VI, SECTION C, LINE 19 UPON REQUEST, THE ORGANIZATION WILL PROVIDE CERTAIN DOCUMENTS INCLUDING OUR FINANCIAL STATEMENTS, CONFLICT OF INTEREST POLICY, AND GOVERNING DOCUMENTS THAT SUPPORT OUR TAX EXEMPT STATUS, INCLUDING, BUT NOT LIMITED TO, ARTICLES OF INCORPORATION AND BYLAWS. FORM 990, PART XI, LINE 9: ADJUSTMENT DUE TO CHANGE IN ACCOUNTING METHODS -244,769. FORM 990, PART XII, LINE 1: IN 2021, THE FOUNDATION CHANGED ACCOUNTING METHODS FROM THE MODIFIED CASH BASIS TO ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA (U.S. GAAP), WHICH REQUIRE THE ACCRUAL BASIS OF ACCOUNTING. THE FOUNDATION PREFERRED U.S. GAAP TO THE MODIFIED CASH BASIS OF ACCOUNTING AS IT ALIGNS WITH THE ACCOUNTING POLICIES USED BY ITS RELATED PARTY, M3 INSURANCE SOLUTIONS, INC. THIS CHANGE IN ACCOUNTING PRINCIPLE IMPACTS THE PRESENTATION OF INVESTMENTS WHICH ARE RECOGNIZED AT FAIR VALUE, PUBLIC SUPPORT WHICH IS RECOGNIZED WHEN THE UNCONDITIONAL OBLIGATION IS INCURRED. THE FOUNDATION ADJUSTED ITS FINANCIAL STATEMENTS FOR ALL PERIODS PRESENTED, AND THE CHANGE IN ACCOUNTING METHOD DID HAVE A MATERIAL IMPACT ON THE STATEMENT OF FINANCIAL POSITION AS OF DECEMBER 31, 2020, AND THE STATEMENTS OF ACTIVITIES AND CASH FLOWS FOR THE YEAR THEN ENDED. FORM 990, PART XII, LINE 2C: THE ORGANIZATION HAS NEITHER CHANGED ITS OVERSIGHT PROCESS OR SELECTION PROCESS DURING THE TAX YEAR.