SURPLUS LINE ASSOCIATION OF ARIZONA FOUNDATION TR: Form 990PF, tax year 2017
View the entire original 990 at ProPublica ↗
- Organization
- SURPLUS LINE ASSOCIATION OF ARIZONA FOUNDATION TR (EIN 86-6320000)
- Tax period
- 2017-01-01 to 2017-12-31
- Filed
- 2018-10-25
- IRS object ID
- 201822989349100117
- Schema version
- 2017v2.3
- 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
- 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 | 2018-10-25T13:39:47-05:00 | ReturnTs |
| Tax Period End | 2017-12-31 | 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 | 2017-01-01 | 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 | TIMOTHY DOWNEY | PersonNm |
| Person Title | president | PersonTitleTxt |
| Phone | 8008391754 | PhoneNum |
| Signature | 2018-10-09 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Jeffrey D Haskell | PreparerPersonNm |
| PTIN | P01345770 | PTIN |
| Phone | 8008391754 | PhoneNum |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 108.6.198.126 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Federal Original Submission Id | 06391520182985000000 | FederalOriginalSubmissionId |
| Federal Original Submission Id | 2018-10-25 | FederalOriginalSubmissionIdDt |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | 54CCAE8F7BC02385263C2CCCA723B6609AD4C170 | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | 259C731B7C7CCB55DA46458F0098BC0D5A2501CB | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2017 | TaxYr |
| Build TS | 2018-06-14 16:35:46Z | BuildTS |
Form 990-PF IRS990PF
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization501c3 Exempt PF | Yes (X) | Organization501c3ExemptPFInd |
| FMV Assets EOY | $6,417,720 | 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 | $450,000 | ContriRcvdRevAndExpnssAmt |
| Interest On Sav Rev And Expnss | $37 | InterestOnSavRevAndExpnssAmt |
| Interest On Sav Net Invst Incm | $37 | InterestOnSavNetInvstIncmAmt |
| Dividends Rev And Expnss | $38,172 | DividendsRevAndExpnssAmt |
| Dividends Net Invst Incm | $38,172 | DividendsNetInvstIncmAmt |
| Gross Sales Price | $50,000 | GrossSalesPriceAmt |
| Cap Gain Net Incm Net Invst Incm | $0 | CapGainNetIncmNetInvstIncmAmt |
| Other Income Rev And Expnss | $93,334 | OtherIncomeRevAndExpnssAmt |
| Other Income Net Invst Incm | $93,334 | OtherIncomeNetInvstIncmAmt |
| Total Rev And Expnss | $581,543 | TotalRevAndExpnssAmt |
| Total Net Invst Incm | $131,543 | TotalNetInvstIncmAmt |
| Comp Ofcr Dir Trst Rev And Expnss | $0 | CompOfcrDirTrstRevAndExpnssAmt |
| Taxes Rev And Expnss | $4,165 | TaxesRevAndExpnssAmt |
| Other Expenses Rev And Expnss | $30,962 | OtherExpensesRevAndExpnssAmt |
| Other Expenses Net Invst Incm | $480 | OtherExpensesNetInvstIncmAmt |
| Other Expenses Dsbrs Chrtbl | $30,482 | OtherExpensesDsbrsChrtblAmt |
| Tot Opr Expenses Rev And Expnss | $35,127 | TotOprExpensesRevAndExpnssAmt |
| Tot Opr Expenses Net Invst Incm | $480 | TotOprExpensesNetInvstIncmAmt |
| Tot Opr Expenses Dsbrs Chrtbl | $30,482 | TotOprExpensesDsbrsChrtblAmt |
| Contri Paid Rev And Expnss | $753,500 | ContriPaidRevAndExpnssAmt |
| Contri Paid Dsbrs Chrtbl | $753,500 | ContriPaidDsbrsChrtblAmt |
| Total Expenses Rev And Expnss | $788,627 | TotalExpensesRevAndExpnssAmt |
| Total Expenses Net Invst Incm | $480 | TotalExpensesNetInvstIncmAmt |
| Total Expenses Dsbrs Chrtbl | $783,982 | TotalExpensesDsbrsChrtblAmt |
| Excess Revenue Over Expenses | -$207,084 | ExcessRevenueOverExpensesAmt |
| Net Investment Income | $131,063 | NetInvestmentIncomeAmt |
Form990 PF Balance Sheets Form990PFBalanceSheetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Sav And Temp Cash Invst BOY | $273,506 | SavAndTempCashInvstBOYAmt |
| Sav And Temp Cash Invst EOY | $25,881 | SavAndTempCashInvstEOYAmt |
| Sav And Temp Cash Invst EOYFMV | $25,881 | SavAndTempCashInvstEOYFMVAmt |
| US Government Obligations BOY | $317,273 | USGovernmentObligationsBOYAmt |
| US Government Obligations EOY | $317,882 | USGovernmentObligationsEOYAmt |
| US Govt Obligations EOYFMV | $300,980 | USGovtObligationsEOYFMVAmt |
| Corporate Bonds BOY | $646,849 | CorporateBondsBOYAmt |
| Corporate Bonds EOY | $593,447 | CorporateBondsEOYAmt |
| Corporate Bonds EOYFMV | $587,492 | CorporateBondsEOYFMVAmt |
| Other Investments BOY | $5,538,349 | OtherInvestmentsBOYAmt |
| Other Investments EOY | $5,631,683 | OtherInvestmentsEOYAmt |
| Other Investments EOYFMV | $5,503,367 | OtherInvestmentsEOYFMVAmt |
| Total Assets BOY | $6,775,977 | TotalAssetsBOYAmt |
| Total Assets EOY | $6,568,893 | TotalAssetsEOYAmt |
| Total Assets EOYFMV | $6,417,720 | TotalAssetsEOYFMVAmt |
| Total Liabilities BOY | $0 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $0 | TotalLiabilitiesEOYAmt |
| Org Does Not Follow SFAS117 | Yes (X) | OrgDoesNotFollowSFAS117Ind |
| Retained Earning BOY | $6,775,977 | RetainedEarningBOYAmt |
| Retained Earning EOY | $6,568,893 | RetainedEarningEOYAmt |
| Tot Net Ast Or Fund Balances BOY | $6,775,977 | TotNetAstOrFundBalancesBOYAmt |
| Tot Net Ast Or Fund Balances EOY | $6,568,893 | TotNetAstOrFundBalancesEOYAmt |
| Total Liabilities Net Ast BOY | $6,775,977 | TotalLiabilitiesNetAstBOYAmt |
| Total Liabilities Net Ast EOY | $6,568,893 | TotalLiabilitiesNetAstEOYAmt |
Chg In Net Assets Fund Balances ChgInNetAssetsFundBalancesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tot Net Ast Or Fund Balances BOY | $6,775,977 | TotNetAstOrFundBalancesBOYAmt |
| Excess Revenue Over Expenses | -$207,084 | ExcessRevenueOverExpensesAmt |
| Subtotal | $6,568,893 | SubtotalAmt |
| Tot Net Ast Or Fund Balances EOY | $6,568,893 | 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 | $50,000 | GrossSalesPriceAmt |
| Cost Or Other Basis | $50,000 | CostOrOtherBasisAmt |
Qlfy Und Sect4940e Reduced Tax QlfyUndSect4940eReducedTaxGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Liable Section4942 Tax | false | LiableSection4942TaxInd |
| Adjusted Qlfy Distri Yr1 | $746,546 | AdjustedQlfyDistriYr1Amt |
| Net Vl Noncharitable Assets Yr1 | $6,456,875 | NetVlNoncharitableAssetsYr1Amt |
| Distribution Yr1 | 0.11562 | DistributionYr1Rt |
| Adjusted Qlfy Distri Yr2 | $558,600 | AdjustedQlfyDistriYr2Amt |
| Net Vl Noncharitable Assets Yr2 | $6,358,013 | NetVlNoncharitableAssetsYr2Amt |
| Distribution Yr2 | 0.087858 | DistributionYr2Rt |
| Adjusted Qlfy Distri Yr3 | $507,625 | AdjustedQlfyDistriYr3Amt |
| Net Vl Noncharitable Assets Yr3 | $6,189,942 | NetVlNoncharitableAssetsYr3Amt |
| Distribution Yr3 | 0.082008 | DistributionYr3Rt |
| Adjusted Qlfy Distri Yr4 | $508,447 | AdjustedQlfyDistriYr4Amt |
| Net Vl Noncharitable Assets Yr4 | $6,095,464 | NetVlNoncharitableAssetsYr4Amt |
| Distribution Yr4 | 0.083414 | DistributionYr4Rt |
| Adjusted Qlfy Distri Yr5 | $454,887 | AdjustedQlfyDistriYr5Amt |
| Net Vl Noncharitable Assets Yr5 | $5,993,418 | NetVlNoncharitableAssetsYr5Amt |
| Distribution Yr5 | 0.075898 | DistributionYr5Rt |
| Total Distribution | 0.444798 | TotalDistributionRt |
| Average Distribution | 0.08896 | AverageDistributionRt |
| Net Vl Noncharitable Assets | $6,397,515 | NetVlNoncharitableAssetsAmt |
| Adj Net Vl Noncharitable Assets | $569,123 | AdjNetVlNoncharitableAssetsAmt |
| Net Investment Income Pct | $1,311 | NetInvestmentIncomePctAmt |
| Adj Nonchrtbl Net Invst Incm Pct | $570,434 | AdjNonchrtblNetInvstIncmPctAmt |
| Qualifying Distributions | $783,982 | QualifyingDistributionsAmt |
Excise Tax Based On Invst Incm ExciseTaxBasedOnInvstIncmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Domestic Org Meeting Sect4940e | Yes (X) | DomesticOrgMeetingSect4940eInd |
| Investment Income Excise Tax | $1,311 | InvestmentIncomeExciseTaxAmt |
| Subtotal | $1,311 | SubtotalAmt |
| Tax Based On Investment Income | $1,311 | TaxBasedOnInvestmentIncomeAmt |
| Estimated Plus Ovpmt Incm Tx | $1,000 | EstimatedPlusOvpmtIncmTxAmt |
| Total Payments And Credits | $1,000 | TotalPaymentsAndCreditsAmt |
| Form2220 Attached | Yes (X) | Form2220AttachedInd |
| Tax Due | $311 | 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 |
Officer Dir Trst Key Empl Info OfficerDirTrstKeyEmplInfoGrp
Officer Dir Trst Key Empl OfficerDirTrstKeyEmplGrp (10 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 | Dir | 1.0 | $0 | $0 | $0 |
| T Curtis Anderson | ||||||||
| Foundation Source 501 Silverside Rd | Wilmington | DE | 198091377 | VP | 1.0 | $0 | $0 | $0 |
| Timothy Downey | ||||||||
| Foundation Source 501 Silverside Rd | Wilmington | DE | 198091377 | Pres | 1.0 | $0 | $0 | $0 |
| Lanny Hair | ||||||||
| Foundation Source 501 Silverside Rd | Wilmington | DE | 198091377 | Dir | 1.0 | $0 | $0 | $0 |
| Erick L Johnson CPCU | ||||||||
| Foundation Source 501 Silverside Rd | Wilmington | DE | 198091377 | Dir | 1.0 | $0 | $0 | $0 |
| Konnie Keaschall-Kiser | ||||||||
| Foundation Source 501 Silverside Rd | Wilmington | DE | 198091377 | Dir / Sec / Treas | 1.0 | $0 | $0 | $0 |
| Ronda Lofton | ||||||||
| Foundation Source 501 Silverside Rd | Wilmington | DE | 198091377 | Dir | 1.0 | $0 | $0 | $0 |
| James Mann | ||||||||
| Foundation Source 501 Silverside Rd | Wilmington | DE | 198091377 | Dir | 1.0 | $0 | $0 | $0 |
| Gerald L Silver | ||||||||
| Foundation Source 501 Silverside Rd | Wilmington | DE | 198091377 | Dir | 1.0 | $0 | $0 | $0 |
| J Scott Wede | ||||||||
| Foundation Source 501 Silverside Rd | Wilmington | DE | 198091377 | 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 | $928,287 | AverageMonthlyFMVOfSecAmt |
| Average Monthly Cash Balances | $101,759 | AverageMonthlyCashBalancesAmt |
| FMV All Other Noncharitable Ast | $5,464,893 | FMVAllOtherNoncharitableAstAmt |
| Total FMV Of Unused Assets | $6,494,939 | TotalFMVOfUnusedAssetsAmt |
| Acquisition Indebtedness | $0 | AcquisitionIndebtednessAmt |
| Adjusted Total FMV Of Unused Ast | $6,494,939 | AdjustedTotalFMVOfUnusedAstAmt |
| Cash Deemed Charitable | $97,424 | CashDeemedCharitableAmt |
| Net Vl Noncharitable Assets | $6,397,515 | NetVlNoncharitableAssetsAmt |
| Minimum Investment Return | $319,876 | MinimumInvestmentReturnAmt |
Distributable Amount DistributableAmountGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Minimum Investment Return | $319,876 | MinimumInvestmentReturnAmt |
| Tax Based On Investment Income | $1,311 | TaxBasedOnInvestmentIncomeAmt |
| Total Tax | $1,311 | TotalTaxAmt |
| Distributable Before Adj | $318,565 | DistributableBeforeAdjAmt |
| Distributable Before Ded | $318,565 | DistributableBeforeDedAmt |
| Distributable As Adjusted | $318,565 | DistributableAsAdjustedAmt |
Qualifying Distri Part XII QualifyingDistriPartXIIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expenses And Contributions | $783,982 | 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 | $783,982 | QualifyingDistributionsAmt |
| Pct Sect4940e Org Net Invst Incm | $1,311 | PctSect4940eOrgNetInvstIncmAmt |
| Adjusted Qualifying Distri | $782,671 | AdjustedQualifyingDistriAmt |
Undistributed Income UndistributedIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Distributable As Adjusted | $318,565 | DistributableAsAdjustedAmt |
| Prior Year1 | 2015 | PriorYear1Yr |
| Prior Year2 | 2014 | PriorYear2Yr |
| Prior Year3 | 2013 | PriorYear3Yr |
| Excess Distribution Cyov Yr4 | $193,552 | ExcessDistributionCyovYr4Amt |
| Excess Distribution Cyov Yr3 | $204,024 | ExcessDistributionCyovYr3Amt |
| Excess Distribution Cyov Yr2 | $246,307 | ExcessDistributionCyovYr2Amt |
| Excess Distribution Cyov Yr1 | $435,618 | ExcessDistributionCyovYr1Amt |
| Total Excess Distribution Cyov | $1,079,501 | TotalExcessDistributionCyovAmt |
| Qualifying Distributions | $783,982 | QualifyingDistributionsAmt |
| Applied To Current Year | $318,565 | AppliedToCurrentYearAmt |
| Remaining Distri From Corpus | $465,417 | RemainingDistriFromCorpusAmt |
| Total Corpus | $1,544,918 | TotalCorpusAmt |
| Undistributed Income CY | $0 | UndistributedIncomeCYAmt |
| Excess Distri Cyov To Next Yr | $1,544,918 | ExcessDistriCyovToNextYrAmt |
| Excess From Year4 | $193,552 | ExcessFromYear4Amt |
| Excess From Year3 | $204,024 | ExcessFromYear3Amt |
| Excess From Year2 | $246,307 | ExcessFromYear2Amt |
| Excess From Year1 | $435,618 | ExcessFromYear1Amt |
| Excess From Current Year | $465,417 | 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 (34 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 |
| AAMGA EDUCATION FOUNDATION | |||||||
| 150 S WARNER RD STE 156 | KING OF PRUSSIA | PA | 19406 | N/A | PC | General & Unrestricted | $200,000 |
| ABILITY360 INC | |||||||
| 5025 E WASHINGTON ST STE 200 | PHOENIX | AZ | 85034 | N/A | PC | General & Unrestricted | $5,000 |
| ABT PERFORMING ARTS ASSOCIATION INC | |||||||
| 7701 W PARADISE LN | PEORIA | AZ | 85382 | N/A | PC | General & Unrestricted | $5,000 |
| AMERICAN CANCER SOCIETY - GREAT WEST DIVISION | |||||||
| 2015 W RIVER RD STE 245 | TUCSON | AZ | 85704 | N/A | PC | General & Unrestricted | $7,500 |
| AMYOTROPHIC LATERAL SCLEROSIS ASSOCIATION | |||||||
| 360 E CORONADO RD STE 140 | PHOENIX | AZ | 85004 | N/A | PC | General & Unrestricted | $3,000 |
| ARIZONA COMMUNITY FOUNDATION | |||||||
| 2201 E CAMELBACK RD STE 405B | PHOENIX | AZ | 85016 | N/A | PC | General & Unrestricted | $3,000 |
| ARIZONA DIABETES FOUNDATION INC | |||||||
| 15255 N 40th St 127 | 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 |
| BANNER ALZHEIMERS FOUNDATION | |||||||
| 2901 N CENTRAL AVE STE 160 | PHOENIX | AZ | 85012 | N/A | PC | General & Unrestricted | $10,000 |
| BOY SCOUTS OF AMERICA | |||||||
| 2969 N GREENFIELD RD | PHOENIX | AZ | 85016 | N/A | PC | General & Unrestricted | $7,500 |
| CAMELBACK KIWANIS SERVICE FUND | |||||||
| 7220 N 16TH ST STE I | PHOENIX | AZ | 85020 | N/A | PC | General & Unrestricted | $8,000 |
| COMMUNITY FOOD BANK INC | |||||||
| 3003 S COUNTRY CLUB RD | TUCSON | AZ | 85713 | N/A | PC | General & Unrestricted | $20,000 |
| CYSTIC FIBROSIS FOUNDATION | |||||||
| 2777 E CAMELBACK RD STE 330 | PHOENIX | AZ | 85016 | N/A | PC | General & Unrestricted | $5,000 |
| DESERT SURVIVORS INC | |||||||
| 1020 W STARR PASS BLVD | TUCSON | AZ | 85713 | N/A | PC | General & Unrestricted | $15,000 |
| HACIENDA SNF INC | |||||||
| 1402 E S MOUNTAIN AVE | PHOENIX | AZ | 85042 | N/A | PC | General & Unrestricted | $15,000 |
| INSURANCE TRAINING AND EDUCATION CENTER INC | |||||||
| 333 E FLOWER ST | PHOENIX | AZ | 85012 | N/A | PC | General & Unrestricted | $80,000 |
| JUVENILE DIABETES RESEARCH FOUNDATION INTERNATIONA | |||||||
| 4343 E CAMELBACK RD STE 230 | PHOENIX | AZ | 85018 | N/A | PC | General & Unrestricted | $5,000 |
| KITCHEN ON THE STREET INC | |||||||
| 2650 E MOHAWK BLDG 3 STE 168 | PHOENIX | AZ | 85050 | N/A | PC | General & Unrestricted | $15,000 |
| LEADERSHIP WORKSHOPS FOUNDATION FOR YOUTH AND FAMI | |||||||
| 8040 E CAMINO DEL MONTE | SCOTTSDALE | AZ | 85255 | N/A | PC | General & Unrestricted | $7,000 |
| MAKE A WISH FOUNDATION OF ARIZONA INC | |||||||
| 2901 N 78TH ST | SCOTTSDALE | AZ | 85251 | N/A | PC | General & Unrestricted | $5,000 |
| MARICOPA COUNTY COMMUNITY COLLEGE DISTRICT FOUNDAT | |||||||
| 2419 W 14TH ST | TEMPE | AZ | 85281 | N/A | PC | General & Unrestricted | $15,000 |
| OPERATION WELCOME HOME AZ INC | |||||||
| 1760 E PECOS RD STE 310 | GILBERT | AZ | 85295 | N/A | PC | General & Unrestricted | $5,000 |
| PAZ DE CRISTO COMMUNITY CENTER | |||||||
| 424 W BROADWAY RD | MESA | AZ | 85210 | N/A | PC | General & Unrestricted | $15,000 |
| 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 RD 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 | $10,000 |
| SOUTHWEST DISTRICT KIWANIS FOUNDATION | |||||||
| 5318 KINGS ROW NE | ALBUQUERQUE | AZ | 87109 | N/A | PC | General & Unrestricted | $15,000 |
| ST MARYS FOOD BANK ALLIANCE | |||||||
| 2831 N 31ST AVE | PHOENIX | AZ | 85009 | N/A | PC | General & Unrestricted | $30,000 |
| THE WSIA EDUCATION FOUNDATION | |||||||
| 4131 N MULBERRY DR STE 200 | KANSAS CITY | MO | 64116 | N/A | PC | General & Unrestricted | $150,000 |
| TUMBLEWEED CENTER FOR YOUTH DEVELOPMENT | |||||||
| 3707 N 7TH ST STE 305 | PHOENIX | AZ | 85014 | N/A | PC | General & Unrestricted | $10,000 |
| UNITED SERVICE ORGANIZATIONS INC | |||||||
| PO BOX 96860 | WASHINGTON | DC | 20077 | N/A | PC | General & Unrestricted | $7,500 |
| WASTE NOT INC | |||||||
| 1700 N GRANITE REEF RD | SCOTTSDALE | AZ | 85257 | N/A | PC | General & Unrestricted | $20,000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Grant Or Contri Pd Dur Yr | $753,500 | 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 | $37 | ExclusionAmt |
Div And Int From Sec Part VII DivAndIntFromSecPartVIIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Exclusion | 14 | ExclusionCd |
| Exclusion | $38,172 | 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 Incm Part VII | OtherInvestmentIncmPartVIIGrp | |
| Gain Sales Ast Oth Than Invntry | GainSalesAstOthThanInvntryGrp | |
| 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 | $93,334 | ExclusionAmt |
Subtotals Incm Producing Acty SubtotalsIncmProducingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Exclusion | $131,543 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Income Producing Acty | $131,543 | 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 St Ste 100 | AddressLine1Txt |
| City | Scottsdale | CityNm |
| State Abbreviation | AZ | StateAbbreviationCd |
| ZIP | 85254 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | $450,000 | TotalContributionsAmt |
| Person Contribution | Yes (X) | PersonContributionInd |
Depreciation Schedule DepreciationSchedule
Investments Corp Bonds Schedule InvestmentsCorpBondsSchedule
Investments Corporate Bonds InvestmentsCorporateBondsGrp (20 entries)
| BondBondNm | EOY Book ValueEOYBookValueAmt | EOYFMVEOYFMVAmt |
|---|---|---|
| ANHEUSER-BUSCH INBEVFIN NT - 2 | $40,047 | $39,857 |
| BANK AMER - 5.150% - 11/15/201 | $25,673 | $25,567 |
| BURLINGTON NORTHERN SANTA FE - | $54,372 | $52,118 |
| CATERPILLAR FINANCIAL SE MTN - | $27,118 | $27,147 |
| CITIGROUP INC - 5.500% - 09/13 | $28,857 | $28,157 |
| CITIGROUP INC SUB NT - 3.500% | $24,065 | $25,443 |
| GE CAPITAL - 4.800% - 03/15/20 | $11,967 | $12,294 |
| GE CAPITAL CORP - 4.500% - 11/ | $27,075 | $26,216 |
| GE CAPITAL INTERNOTES - 5.100% | $26,765 | $25,642 |
| GENERAL ELECTRIC CAPITAL CORP | $25,722 | $25,806 |
| GENERAL ELECTRIC CO - 5.000% - | $55,230 | $54,103 |
| GOLDMAN SACHS GP INC - 5.950% | $32,165 | $35,045 |
| GOLDMAN SACHS GROUP INC - 3.50 | $11,770 | $11,469 |
| GOLDMAN SACHS GRP INC MTN BE - | $25,249 | $25,522 |
| HANCOCK JOHN LIFE INS CO - 5.0 | $17,689 | $17,612 |
| JPMORGAN CHASE & CO - 4.125% - | $25,267 | $26,373 |
| SHELL INTERNATIONAL FIN - 4.30 | $53,402 | $51,795 |
| STATOIL ASA NT - 3.700% - 03/0 | $26,045 | $26,260 |
| WAL MART STORES INC NT - 5.800 | $28,280 | $25,111 |
| ZIMMER HLDGS INC NOTE - 4.625% | $26,689 | $25,955 |
Investments Govt Obligations Sch InvestmentsGovtObligationsSch
| Field | Value | IRS element (for citing) |
|---|---|---|
| US Govt Obligations Book Vl EOY | $29,039 | USGovtObligationsBookVlEOYAmt |
| US Govt Obligations EOYFMV | $29,270 | USGovtObligationsEOYFMVAmt |
| State Local Sec Book Vl EOY | $288,843 | StateLocalSecBookVlEOYAmt |
| State Local Sec EOYFMV | $271,710 | StateLocalSecEOYFMVAmt |
Investments Other Schedule2 InvestmentsOtherSchedule2
Investments Other InvestmentsOtherGrp (11 entries)
| Category Or ItemCategoryOrItemTxt | Book ValueBookValueAmt | EOYFMVEOYFMVAmt |
|---|---|---|
| COLUMBUS LIFE # CM5046890A | $385,071 | $374,674 |
| COLUMBUS LIFE # CM5064902A | $158,619 | $151,481 |
| COLUMBUS LIFE # CM5108868A | $1,574,083 | $1,569,820 |
| INTEGRITY LIFE INSURANCE | $950,368 | $877,665 |
| JACKSON NATIONAL LIFE # 10035 | $299,389 | $299,389 |
| JACKSON NATIONAL LIFE # 10047 | $376,256 | $376,256 |
| JACKSON NATIONAL LIFE # 10049 | $362,412 | $362,412 |
| JACKSON NATIONAL LIFE # 10062 | $282,419 | $282,419 |
| JACKSON NATIONAL LIFE # 10158 | $635,140 | $616,086 |
| NEW YORK LIFE # 52132702 | $259,845 | $259,845 |
| UNITED OF OMAHA # U01139674 | $348,081 | $333,320 |
Other Expenses Schedule OtherExpensesSchedule
Other Expenses Schedule OtherExpensesScheduleGrp (2 entries)
| DescDesc | Revenue And Expenses Per BooksRevenueAndExpensesPerBooksAmt | Disbursements Charitable PrpsDisbursementsCharitablePrpsAmt | Net Investment IncomeNetInvestmentIncomeAmt |
|---|---|---|---|
| Administrative Fees | $30,482 | $30,482 | |
| Bank Charges | $480 | $480 |
Other Income Schedule2 OtherIncomeSchedule2
Other Income Detail OtherIncomeDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | INCOME FROM ANNUITIES | Desc |
| Revenue And Expenses Per Books | $93,334 | RevenueAndExpensesPerBooksAmt |
| Net Investment Income | $93,334 | NetInvestmentIncomeAmt |
Taxes Schedule TaxesSchedule
Taxes Detail TaxesDetail (3 entries)
| CategoryCategoryTxt | AmtAmt |
|---|---|
| 990-PF Estimated Tax for 2017 | $1,000 |
| 990-PF Excise Tax for 2016 | $3,062 |
| IRS Miscellaneous Fee | $103 |
Comments