SURPLUS LINE ASSOCIATION OF ARIZONA FOUNDATION TR: Form 990PF, tax year 2015
View the entire original 990 at ProPublica ↗
- Organization
- SURPLUS LINE ASSOCIATION OF ARIZONA FOUNDATION TR (EIN 86-6320000)
- Tax period
- 2015-01-01 to 2015-12-31
- Filed
- 2016-10-14
- IRS object ID
- 201602889349100710
- Schema version
- 2015v2.1
- 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 | 2016-10-14T12:36:27-05:00 | ReturnTs |
| Tax Period End | 2015-12-31 | 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 | 2015-01-01 | 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 M DOWNEY | PersonNm |
| Person Title | President | PersonTitleTxt |
| Phone | 8008391754 | PhoneNum |
| Signature | 2016-09-29 | 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 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2015 | TaxYr |
| Build TS | 2017-02-10 21:41:12Z | BuildTS |
Form 990-PF IRS990PF
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization501c3 Exempt PF | Yes (X) | Organization501c3ExemptPFInd |
| FMV Assets EOY | $6,523,071 | 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 | $729,500 | ContriRcvdRevAndExpnssAmt |
| Interest On Sav Rev And Expnss | $15 | InterestOnSavRevAndExpnssAmt |
| Interest On Sav Net Invst Incm | $15 | InterestOnSavNetInvstIncmAmt |
| Dividends Rev And Expnss | $39,682 | DividendsRevAndExpnssAmt |
| Dividends Net Invst Incm | $39,682 | DividendsNetInvstIncmAmt |
| Net Gain Sale Ast Rev And Expnss | -$442 | NetGainSaleAstRevAndExpnssAmt |
| Gross Sales Price | $97,253 | GrossSalesPriceAmt |
| Cap Gain Net Incm Net Invst Incm | $0 | CapGainNetIncmNetInvstIncmAmt |
| Other Income Rev And Expnss | $240,685 | OtherIncomeRevAndExpnssAmt |
| Other Income Net Invst Incm | $240,685 | OtherIncomeNetInvstIncmAmt |
| Total Rev And Expnss | $1,009,440 | TotalRevAndExpnssAmt |
| Total Net Invst Incm | $280,382 | TotalNetInvstIncmAmt |
| Comp Ofcr Dir Trst Rev And Expnss | $0 | CompOfcrDirTrstRevAndExpnssAmt |
| Taxes Rev And Expnss | $4,956 | TaxesRevAndExpnssAmt |
| Other Expenses Rev And Expnss | $29,904 | OtherExpensesRevAndExpnssAmt |
| Other Expenses Dsbrs Chrtbl | $29,904 | OtherExpensesDsbrsChrtblAmt |
| Tot Opr Expenses Rev And Expnss | $34,860 | TotOprExpensesRevAndExpnssAmt |
| Tot Opr Expenses Net Invst Incm | $0 | TotOprExpensesNetInvstIncmAmt |
| Tot Opr Expenses Dsbrs Chrtbl | $29,904 | TotOprExpensesDsbrsChrtblAmt |
| Contri Paid Rev And Expnss | $531,500 | ContriPaidRevAndExpnssAmt |
| Contri Paid Dsbrs Chrtbl | $531,500 | ContriPaidDsbrsChrtblAmt |
| Total Expenses Rev And Expnss | $566,360 | TotalExpensesRevAndExpnssAmt |
| Total Expenses Net Invst Incm | $0 | TotalExpensesNetInvstIncmAmt |
| Total Expenses Dsbrs Chrtbl | $561,404 | TotalExpensesDsbrsChrtblAmt |
| Excess Revenue Over Expenses | $443,080 | ExcessRevenueOverExpensesAmt |
| Net Investment Income | $280,382 | NetInvestmentIncomeAmt |
Form990 PF Balance Sheets Form990PFBalanceSheetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Sav And Temp Cash Invst BOY | $44,381 | SavAndTempCashInvstBOYAmt |
| Sav And Temp Cash Invst EOY | $236,302 | SavAndTempCashInvstEOYAmt |
| Sav And Temp Cash Invst EOYFMV | $236,302 | SavAndTempCashInvstEOYFMVAmt |
| US Government Obligations BOY | $316,817 | USGovernmentObligationsBOYAmt |
| US Government Obligations EOY | $316,817 | USGovernmentObligationsEOYAmt |
| US Govt Obligations EOYFMV | $312,721 | USGovtObligationsEOYFMVAmt |
| Corporate Bonds BOY | $737,402 | CorporateBondsBOYAmt |
| Corporate Bonds EOY | $747,876 | CorporateBondsEOYAmt |
| Corporate Bonds EOYFMV | $744,257 | CorporateBondsEOYFMVAmt |
| Other Investments BOY | $4,743,664 | OtherInvestmentsBOYAmt |
| Other Investments EOY | $4,984,349 | OtherInvestmentsEOYAmt |
| Other Investments EOYFMV | $5,229,791 | OtherInvestmentsEOYFMVAmt |
| Total Assets BOY | $5,842,264 | TotalAssetsBOYAmt |
| Total Assets EOY | $6,285,344 | TotalAssetsEOYAmt |
| Total Assets EOYFMV | $6,523,071 | TotalAssetsEOYFMVAmt |
| Total Liabilities EOY | $0 | TotalLiabilitiesEOYAmt |
| Org Does Not Follow SFAS117 | Yes (X) | OrgDoesNotFollowSFAS117Ind |
| Retained Earning BOY | $5,842,264 | RetainedEarningBOYAmt |
| Retained Earning EOY | $6,285,344 | RetainedEarningEOYAmt |
| Tot Net Ast Or Fund Balances BOY | $5,842,264 | TotNetAstOrFundBalancesBOYAmt |
| Tot Net Ast Or Fund Balances EOY | $6,285,344 | TotNetAstOrFundBalancesEOYAmt |
| Total Liabilities Net Ast BOY | $5,842,264 | TotalLiabilitiesNetAstBOYAmt |
| Total Liabilities Net Ast EOY | $6,285,344 | TotalLiabilitiesNetAstEOYAmt |
Chg In Net Assets Fund Balances ChgInNetAssetsFundBalancesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tot Net Ast Or Fund Balances BOY | $5,842,264 | TotNetAstOrFundBalancesBOYAmt |
| Excess Revenue Over Expenses | $443,080 | ExcessRevenueOverExpensesAmt |
| Subtotal | $6,285,344 | SubtotalAmt |
| Tot Net Ast Or Fund Balances EOY | $6,285,344 | 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 | $97,253 | GrossSalesPriceAmt |
| Cost Or Other Basis | $97,695 | CostOrOtherBasisAmt |
| Gain Or Loss | -$442 | GainOrLossAmt |
| Gains Minus Excess Or Losses | -$442 | GainsMinusExcessOrLossesAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Capital Gain Net Income | -$442 | CapitalGainNetIncomeAmt |
Qlfy Und Sect4940e Reduced Tax QlfyUndSect4940eReducedTaxGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Liable Section4942 Tax | false | LiableSection4942TaxInd |
| Adjusted Qlfy Distri Yr1 | $507,625 | AdjustedQlfyDistriYr1Amt |
| Net Vl Noncharitable Assets Yr1 | $6,189,942 | NetVlNoncharitableAssetsYr1Amt |
| Distribution Yr1 | 0.082008 | DistributionYr1Rt |
| Adjusted Qlfy Distri Yr2 | $508,447 | AdjustedQlfyDistriYr2Amt |
| Net Vl Noncharitable Assets Yr2 | $6,095,464 | NetVlNoncharitableAssetsYr2Amt |
| Distribution Yr2 | 0.083414 | DistributionYr2Rt |
| Adjusted Qlfy Distri Yr3 | $454,887 | AdjustedQlfyDistriYr3Amt |
| Net Vl Noncharitable Assets Yr3 | $5,993,418 | NetVlNoncharitableAssetsYr3Amt |
| Distribution Yr3 | 0.075898 | DistributionYr3Rt |
| Adjusted Qlfy Distri Yr4 | $326,225 | AdjustedQlfyDistriYr4Amt |
| Net Vl Noncharitable Assets Yr4 | $5,858,765 | NetVlNoncharitableAssetsYr4Amt |
| Distribution Yr4 | 0.055682 | DistributionYr4Rt |
| Adjusted Qlfy Distri Yr5 | $103,652 | AdjustedQlfyDistriYr5Amt |
| Net Vl Noncharitable Assets Yr5 | $5,294,120 | NetVlNoncharitableAssetsYr5Amt |
| Distribution Yr5 | 0.019579 | DistributionYr5Rt |
| Total Distribution | 0.316581 | TotalDistributionRt |
| Average Distribution | 0.063316 | AverageDistributionRt |
| Net Vl Noncharitable Assets | $6,358,013 | NetVlNoncharitableAssetsAmt |
| Adj Net Vl Noncharitable Assets | $402,564 | AdjNetVlNoncharitableAssetsAmt |
| Net Investment Income Pct | $2,804 | NetInvestmentIncomePctAmt |
| Adj Nonchrtbl Net Invst Incm Pct | $405,368 | AdjNonchrtblNetInvstIncmPctAmt |
| Qualifying Distributions | $561,404 | 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 | $2,804 | InvestmentIncomeExciseTaxAmt |
| Subtotal | $2,804 | SubtotalAmt |
| Tax Based On Investment Income | $2,804 | TaxBasedOnInvestmentIncomeAmt |
| Estimated Plus Ovpmt Incm Tx | $3,000 | EstimatedPlusOvpmtIncmTxAmt |
| Total Payments And Credits | $3,000 | TotalPaymentsAndCreditsAmt |
| Form2220 Attached | Yes (X) | Form2220AttachedInd |
| Overpayment | $196 | OverpaymentAmt |
| Applied To ES Tax | $196 | AppliedToESTaxAmt |
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 (12 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 |
| Larry Beach | ||||||||
| Foundation Source 501 Silverside Rd | Wilmington | DE | 198091377 | Sec / Treas | 1.0 | $0 | $0 | $0 |
| Karla Burt | ||||||||
| Foundation Source 501 Silverside Rd | Wilmington | DE | 198091377 | Dir | 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 | 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 |
| 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 |
| 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 | $1,055,696 | AverageMonthlyFMVOfSecAmt |
| Average Monthly Cash Balances | $95,908 | AverageMonthlyCashBalancesAmt |
| FMV All Other Noncharitable Ast | $5,303,232 | FMVAllOtherNoncharitableAstAmt |
| Total FMV Of Unused Assets | $6,454,836 | TotalFMVOfUnusedAssetsAmt |
| Acquisition Indebtedness | $0 | AcquisitionIndebtednessAmt |
| Adjusted Total FMV Of Unused Ast | $6,454,836 | AdjustedTotalFMVOfUnusedAstAmt |
| Cash Deemed Charitable | $96,823 | CashDeemedCharitableAmt |
| Net Vl Noncharitable Assets | $6,358,013 | NetVlNoncharitableAssetsAmt |
| Minimum Investment Return | $317,901 | MinimumInvestmentReturnAmt |
Distributable Amount DistributableAmountGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Minimum Investment Return | $317,901 | MinimumInvestmentReturnAmt |
| Tax Based On Investment Income | $2,804 | TaxBasedOnInvestmentIncomeAmt |
| Total Tax | $2,804 | TotalTaxAmt |
| Distributable Before Adj | $315,097 | DistributableBeforeAdjAmt |
| Distributable Before Ded | $315,097 | DistributableBeforeDedAmt |
| Distributable As Adjusted | $315,097 | DistributableAsAdjustedAmt |
Qualifying Distri Part XII QualifyingDistriPartXIIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expenses And Contributions | $561,404 | 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 | $561,404 | QualifyingDistributionsAmt |
| Pct Sect4940e Org Net Invst Incm | $2,804 | PctSect4940eOrgNetInvstIncmAmt |
| Adjusted Qualifying Distri | $558,600 | AdjustedQualifyingDistriAmt |
Undistributed Income UndistributedIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Distributable As Adjusted | $315,097 | DistributableAsAdjustedAmt |
| Prior Year1 | 2013 | PriorYear1Yr |
| Prior Year2 | 2012 | PriorYear2Yr |
| Prior Year3 | 2011 | PriorYear3Yr |
| Excess Distribution Cyov Yr2 | $193,552 | ExcessDistributionCyovYr2Amt |
| Excess Distribution Cyov Yr1 | $204,024 | ExcessDistributionCyovYr1Amt |
| Total Excess Distribution Cyov | $397,576 | TotalExcessDistributionCyovAmt |
| Qualifying Distributions | $561,404 | QualifyingDistributionsAmt |
| Applied To Current Year | $315,097 | AppliedToCurrentYearAmt |
| Remaining Distri From Corpus | $246,307 | RemainingDistriFromCorpusAmt |
| Total Corpus | $643,883 | TotalCorpusAmt |
| Undistributed Income CY | $0 | UndistributedIncomeCYAmt |
| Excess Distri Cyov To Next Yr | $643,883 | ExcessDistriCyovToNextYrAmt |
| Excess From Year2 | $193,552 | ExcessFromYear2Amt |
| Excess From Year1 | $204,024 | ExcessFromYear1Amt |
| Excess From Current Year | $246,307 | 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 (36 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 | $15,000 |
| 88-CRIME INC | |||||||
| 32 N STONE AVE STE 1400 | TUCSON | AZ | 85701 | N/A | PC | General & Unrestricted | $3,000 |
| AAMGA EDUCATION FOUNDATION | |||||||
| 150 S WARNER RD STE 156 | KING OF PRUSSIA | PA | 19406 | N/A | PC | General & Unrestricted | $100,000 |
| 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 | |||||||
| 1636 N SWAN RD | TUCSON | AZ | 85712 | N/A | PC | General & Unrestricted | $2,500 |
| AMYOTROPHIC LATERAL SCLEROSIS ASSOCIATION | |||||||
| 4643 E THOMAS RD STE 1 | PHOENIX | AZ | 85018 | N/A | PC | General & Unrestricted | $5,000 |
| ARIZONA COMMUNITY FOUNDATION | |||||||
| 2201 E CAMELBACK RD STE 405B | PHOENIX | AZ | 85016 | N/A | PC | General & Unrestricted | $2,500 |
| ARIZONA DIABETES FOUNDATION INC | |||||||
| GREENWAY PROFESSIONAL BLDG | PHOENIX | AZ | 85032 | N/A | PC | General & Unrestricted | $5,000 |
| ARTHRITIS FOUNDATION INC - PHOENIX CHAPTER | |||||||
| 1221 E OSBORN RD STE 201 | PHOENIX | AZ | 85014 | N/A | PC | General & Unrestricted | $5,000 |
| ASSISTANCE LEAGUE OF TUCSON INC | |||||||
| 1307 N ALVERNON WAY | TUCSON | AZ | 85712 | 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 | |||||||
| 2025 N 3RD ST STE 250 | PHOENIX | AZ | 85004 | N/A | PC | General & Unrestricted | $10,000 |
| BOY SCOUTS OF AMERICA | |||||||
| 2969 N GREENFIELD RD | PHOENIX | AZ | 85016 | N/A | PC | General & Unrestricted | $5,000 |
| BOYS HOPE GIRLS HOPE | |||||||
| 4225 MALSBARY RD STE 208 | BLUE ASH | OH | 45242 | N/A | PC | General & Unrestricted | $3,000 |
| CAMELBACK KIWANIS SERVICE FUND | |||||||
| 7220 N 16TH ST STE I | PHOENIX | AZ | 85020 | N/A | PC | General & Unrestricted | $5,000 |
| COMMUNITY FOOD BANK INC | |||||||
| 3003 S COUNTRY CLUB RD | TUCSON | AZ | 85713 | N/A | PC | General & Unrestricted | $30,000 |
| DEREK HUGHES NAPSLO EDUCATIONAL FOUNDATION INC | |||||||
| 4131 N MULBERRY DR STE 200 | KANSAS CITY | MO | 64116 | N/A | PC | General & Unrestricted | $100,000 |
| DESERT SURVIVORS INC | |||||||
| 1020 W STARR PASS BLVD | TUCSON | AZ | 85713 | N/A | PC | General & Unrestricted | $5,000 |
| DODADS INC | |||||||
| 12237 N MAKAYLA CANYON LN | ORO VALLEY | AZ | 85755 | 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 |
| INSURANCE TRAINING AND EDUCATION CENTER INC | |||||||
| 2828 N 36TH ST | PHOENIX | AZ | 85008 | N/A | PC | General & Unrestricted | $50,000 |
| 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 | |||||||
| 8711 E PINNACLE PEAK RD STE F101 | SCOTTSDALE | AZ | 85255 | N/A | PC | General & Unrestricted | $5,000 |
| MAKE A WISH FOUNDATION OF ARIZONA INC | |||||||
| 2901 N 78TH ST | SCOTTSDALE | AZ | 85251 | N/A | PC | General & Unrestricted | $10,000 |
| ORAL EDUCATIONAL OPPORTUNITIES FOR THE HEARING IMP | |||||||
| 3426 E SHEA BLVD | PHOENIX | AZ | 85028 | N/A | PC | General & Unrestricted | $12,500 |
| PAZ DE CRISTO COMMUNITY CENTER | |||||||
| 424 W BROADWAY RD | MESA | AZ | 85210 | N/A | PC | General & Unrestricted | $12,000 |
| PLUS FOUNDATION | |||||||
| 5353 WAYZATA BLVD STE 600 | MINNEAPOLIS | MN | 55416 | N/A | SO I | General & Unrestricted | $15,000 |
| RYAN HOUSE | |||||||
| 110 W MERRELL ST FL 1 | PHOENIX | AZ | 85013 | N/A | PC | General & Unrestricted | $2,500 |
| 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 | $5,000 |
| SOUTHWEST DISTRICT KIWANIS FOUNDATION | |||||||
| PO BOX 1603 | MESA | AZ | 85211 | N/A | PC | General & Unrestricted | $15,000 |
| ST MARYS FOOD BANK ALLIANCE | |||||||
| 2831 N 31ST AVE | PHOENIX | AZ | 85009 | N/A | PC | General & Unrestricted | $15,000 |
| TUMBLEWEED CENTER FOR YOUTH DEVELOPMENT | |||||||
| 3707 N 7TH ST STE 30 | PHOENIX | AZ | 85014 | N/A | PC | General & Unrestricted | $6,000 |
| UNITED SERVICE ORGANIZATIONS INC | |||||||
| PO BOX 96860 | WASHINGTON | DC | 20077 | N/A | PC | General & Unrestricted | $2,500 |
| WASTE NOT INC | |||||||
| 1700 N GRANITE REEF RD | SCOTTSDALE | AZ | 85257 | N/A | PC | General & Unrestricted | $15,000 |
| YES SOLUTIONS INC | |||||||
| 549 W 123RD ST | NEW YORK | NY | 10027 | N/A | PC | General & Unrestricted | $10,000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Grant Or Contri Pd Dur Yr | $531,500 | 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 | $15 | ExclusionAmt |
Div And Int From Sec Part VII DivAndIntFromSecPartVIIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Exclusion | 14 | ExclusionCd |
| Exclusion | $39,682 | 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Exclusion | 18 | ExclusionCd |
| Exclusion | -$442 | 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 | $240,685 | ExclusionAmt |
Subtotals Incm Producing Acty SubtotalsIncmProducingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Exclusion | $279,940 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Income Producing Acty | $279,940 | 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 | KIERLAND BUS CTR 15849 N 71ST ST | AddressLine1Txt |
| City | Scottsdale | CityNm |
| State Abbreviation | AZ | StateAbbreviationCd |
| ZIP | 85254 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | $729,500 | TotalContributionsAmt |
| Person Contribution | Yes (X) | PersonContributionInd |
Compensation Explanation CompensationExplanation
Compensation Explanation CompensationExplanationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Karla Burt | PersonNm |
| Short Explanation | *Removed from foundation in 2015. | ShortExplanationTxt |
Depreciation Schedule DepreciationSchedule
Investments Corp Bonds Schedule InvestmentsCorpBondsSchedule
Investments Corporate Bonds InvestmentsCorporateBondsGrp (25 entries)
| BondBondNm | EOY Book ValueEOYBookValueAmt | EOYFMVEOYFMVAmt |
|---|---|---|
| ANHEUSER-BUSCH INBEVFIN NT - 2 | $40,047 | $38,485 |
| BANK AMER - 5.150% - 11/15/201 | $25,673 | $26,647 |
| BANK OF AMERICA - 3.550% - 11/ | $20,000 | $20,269 |
| BURLINGTON NORTHERN SANTA FE - | $54,372 | $54,073 |
| CATERPILLAR FINANCIAL SE MTN - | $27,118 | $27,301 |
| CATERPILLAR FINL CORP PWRNTSBE | $30,000 | $30,135 |
| CITIGROUP INC - 5.500% - 09/13 | $28,857 | $27,275 |
| CITIGROUP INC SUB NT - 3.500% | $24,065 | $24,489 |
| DEUTSCHE BANK - 3.250% - 01/11 | $51,027 | $50,027 |
| GE - 5.000% - 03/15/2029 | $55,230 | $54,980 |
| GE CAPITAL - 4.800% - 03/15/20 | $11,967 | $12,911 |
| GE CAPITAL CORP - 4.500% - 11/ | $27,075 | $26,920 |
| GE CAPITAL INTERNOTES - 5.100% | $26,765 | $27,075 |
| GENERAL ELECTRIC CAPITAL CORP | $25,722 | $25,989 |
| GOLDMAN SACHS GP INC - 5.950% | $32,165 | $33,371 |
| GOLDMAN SACHS GROUP INC - 3.50 | $11,770 | $11,449 |
| GOLDMAN SACHS GRP INC MTN BE - | $25,249 | $25,244 |
| HANCOCK JOHN LIFE INS CO - 5.0 | $17,689 | $17,443 |
| JPMORGAN CHASE & CO - 4.125% - | $25,267 | $24,967 |
| MERRILL LYNCH MTN BE - 6.400% | $27,829 | $26,839 |
| SHELL INTERNATIONAL FIN - 4.30 | $53,402 | $53,289 |
| STATOIL ASA - 3.125% - 08/17/2 | $25,573 | $25,611 |
| STATOIL ASA NT - 3.700% - 03/0 | $26,045 | $25,316 |
| WAL MART STORES INC NT - 5.800 | $28,280 | $27,356 |
| ZIMMER HLDGS INC NOTE - 4.625% | $26,689 | $26,796 |
Investments Govt Obligations Sch InvestmentsGovtObligationsSch
| Field | Value | IRS element (for citing) |
|---|---|---|
| US Govt Obligations Book Vl EOY | $27,974 | USGovtObligationsBookVlEOYAmt |
| US Govt Obligations EOYFMV | $28,592 | USGovtObligationsEOYFMVAmt |
| State Local Sec Book Vl EOY | $288,843 | StateLocalSecBookVlEOYAmt |
| State Local Sec EOYFMV | $284,129 | StateLocalSecEOYFMVAmt |
Investments Other Schedule2 InvestmentsOtherSchedule2
Investments Other InvestmentsOtherGrp (14 entries)
| Category Or ItemCategoryOrItemTxt | Book ValueBookValueAmt | EOYFMVEOYFMVAmt |
|---|---|---|
| JACKSON NATIONAL LIFE ANNUITY | $581,055 | $581,055 |
| COLUMBUS LIFE # CM5040241A | $479,084 | $502,260 |
| COLUMBUS LIFE - POLICY # CM504 | $286,447 | $346,296 |
| COLUMBUS LIFE CM5037899A | $276,728 | $297,228 |
| COLUMBUS LIFE CM5037917A | $278,620 | $313,671 |
| COLUMBUS LIFE CM5037965A | $282,135 | $352,295 |
| COLUMBUS LIFE CM5064902A | $146,238 | $144,701 |
| JACKSON NATION LIFE ANNUITY # | $273,114 | $341,608 |
| JACKSON NATIONAL ANNUITY 10062 | $262,579 | $271,452 |
| JACKSON NATIONAL LIFE #1003556 | $276,650 | $282,203 |
| JACKSON NATIONAL LIFE 10047137 | $354,657 | $354,657 |
| INTEGRITY LIFE INSURANCE ANNUI | $950,110 | $873,388 |
| NY LIFE INSURANCE ANNUITY #521 | $244,921 | $244,921 |
| UNITED OF OMAHA LIFE INSURANCE | $292,011 | $324,056 |
Other Expenses Schedule OtherExpensesSchedule
Other Expenses Schedule OtherExpensesScheduleGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | Administrative Fees | Desc |
| Revenue And Expenses Per Books | $29,904 | RevenueAndExpensesPerBooksAmt |
| Disbursements Charitable Prps | $29,904 | DisbursementsCharitablePrpsAmt |
Other Income Schedule2 OtherIncomeSchedule2
Other Income Detail OtherIncomeDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | INCOME FROM ANNUITIES | Desc |
| Revenue And Expenses Per Books | $240,685 | RevenueAndExpensesPerBooksAmt |
| Net Investment Income | $240,685 | NetInvestmentIncomeAmt |
Taxes Schedule TaxesSchedule
Taxes Detail TaxesDetail (3 entries)
| CategoryCategoryTxt | AmtAmt |
|---|---|
| 990-PF Estimated Tax for 2015 | $3,000 |
| 990-PF Excise Tax for 2014 | $8 |
| 990-PF Extension for 2014 | $1,948 |
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