2024-09-24T16:32:07-05:00 2023-12-31 352123203 KSM BUSINESS SERVICES INC PO BOX 40857 INDIANAPOLIS IN 46240 990PF 2023-01-01 844845473 MJ INSURANCE CHARITABLE FOUNDATION MJIN 3178057500 3900 E CAMELBACK ROAD 225 PHOENIX AZ 85018 BRIAN FRIEND CFO 3178057508 2024-09-18 1 1 CASSE TATE P01271193 3175802000 2024-09-18 2023 2024-08-08 14:25:15Z X 212797 X 186612 0 14151 0 200763 0 0 0 0 0 0 0 115060 115060 115060 0 115060 85703 0 127094 212797 212797 127094 212797 212797 0 0 X 0 0 0 0 127094 212797 127094 212797 127094 212797 127094 85703 0 212797 0 212797 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 AZ 1 0 0 0 0 1 N/A BRIAN FRIEND 3178057508 3900 EAST CAMELBACK ROAD SUITE 225 PHOENIX AZ 85018 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 BRITNI SHROUT C/O MJ INSURANCE 571 MONON BLVD STE 400 CARMEL IN 46032 EXECUTIVE DIRECTOR 1.00 0 0 0 BRIAN FRIEND C/O MJ INSURANCE 571 MONON BLVD STE 400 CARMEL IN 46032 CHIEF FINANCIAL OFFICER 1.00 0 0 0 MICHAEL H BILL 3900 E CAMELBACK RD SUITE 225 PHOENIX AZ 85018 DIRECTOR/ PRESIDENT 1.00 0 0 0 LAURA M BILL 3900 E CAMELBACK RD SUITE 225 PHOENIX AZ 85018 DIRECTOR/ VICE PRESIDENT/ SEC'Y 1.00 0 0 0 NONE 0 NONE 0 0 0 164278 0 164278 0 0 164278 2464 161814 8091 8091 0 8091 0 8091 0 8091 115060 0 115060 8091 0 0 90590 90590 115060 0 0 0 8091 106969 0 0 197559 0 0 0 0 0 0 0 197559 90590 106969 MICHAEL H BILL LAURA M BILL X BUTLER FOUNDATION 4600 SUNSET AVE JORDAN HALL INDIANAPOLIS IN 46208 N/A PC GENERAL CONTRIBUTION 75000 DAYSPRING CENTER PO BOX 44105 INDIANAPOLIS IN 462440105 N/A PC GENERAL CONTRIBUTION 6500 THE CENTER FOR HABILITATION 215 WEST LODGE DRIVE 3652 TEMPE AZ 85283 N/A PC GENERAL CONTRIBUTION 6980 WOMENS BEAN PROJECT 1300 W ALAMEDA AVE DENVER CO 80223 N/A PC GENERAL CONTRIBUTION 6580 INDY BOOK PROJECT 1537 W OAK ST ZIONSVILLE IN 46077 N/A PC GENERAL CONTRIBUTION 10000 KITCHEN ON THE STREET 2650 E MOHAWK LN STE 168 PHOENIX AZ 85050 N/A PC GENERAL CONTRIBUTION 10000 115060 0 MJI GOLF EVENT REVENUE 01 14151 0 14151 0 14151 0 0 0 0 0 0 0 0 0 0 X X 1 ANDY VETOR 2994 STILLWATER LANE ZIONSVILLE IN 46077 5000 X 2 ANTHEM 3075 VANDERCAR WAY CINCINNATI OH 45209 10000 X 3 CNA 550 POLARIS PARKWAY STE 100 WESTERVILLE OH 43082 5000 X 4 WESTFIELD - LEGACY OF CARING ONE PARK CIRCLE WESTFIELD CENTER OH 44251 6500 X 5 JON LOFTIN 10098 BROOKS EDGE CIRCLE FISHERS IN 46040 5000 X 6 WESTFIELD PROPEL ONE PARK CIRCLE WESTERVILLE OH 44251 5000 X 7 MICHAEL M BILL 12663 TIMBER CREST DRIVE CARMEL IN 46033 42500 X 8 MICHAEL H BILL 5940 E PAISANO CIRCLE PHOENIX AZ 85018 15186 X 9 MJ INSURANCE 571 MONON BLVD STE 400 CARMEL IN 46032 57604 X 10 JUSTIN SCOTT 5200 E ARCADIA LN PHOENIX AZ 85018 5000 X PURSUANT TO IRS SEC. 4942(H)(2) AND REG. 53.49(A)-3(D)(2), THE ABOVE REFERENCED FOUNDATION HEREBY ELECTS TO TREAT CURRENT YEAR QUALIFYING DISTRIBUTIONS IN EXCESS OF THE IMMEDIATELY PRECEDING TAX YEAR'S UNDISTRIBUTED INCOME AS BEING MADE OUT OF UNDISTRIBUTED INCOME FROM THE 2020 TAX YEAR IN THE AMOUNT OF $346. FORM 990-PF, PART VI-B, LINES 1A(3) AND 1B PART VI-B, LINE 1A(3) HAS BEEN ANSWERED "YES" BECAUSE MICHAEL BILL AND LAURA BILL ARE SUBSTANTIAL CONTRIBUTORS TO MJ INSURANCE CHARITABLE FOUNDATION AND THEREFORE ARE DISQUALIFIED PERSONS. THEY PROVIDE "SERVICE" TO THE ORGANIZATION BY SERVICING ON ITS BOARD. LINE 1B IS ANSWERED "NO" BECAUSE THEY ARE NOT COMPENSATED AND THIS SERVICE QUALIFIES UNDER THE EXCEPTIONS DESCRIBED IN REGULATIONS 53.4941 (D)-3. MJI GOLF EVENT REVENUE 14151 14151