KOSCIUSKO 21ST CENTURY FOUNDATION INC: Form 990PF, tax year 2022
View the entire original 990 at ProPublica ↗
- Organization
- KOSCIUSKO 21ST CENTURY FOUNDATION INC (EIN 35-1187105)
- Tax period
- 2022-01-01 to 2022-12-31
- Filed
- 2023-05-09
- IRS object ID
- 202331299349104343
- Schema version
- 2022v5.0
- 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
- Accounting Fees Schedule
- General Explanation Attachment
- Investments Corp Bonds Schedule
- Investments Corp Stock Schedule
- Investments Govt Obligations Sch
- Investments Land Schedule2
- Investments Other Schedule2
- Land Etc Schedule2
- Other Assets Schedule
- Other Expenses Schedule
- Other Income Schedule2
- Other Liabilities Schedule
- Other Professional Fees Schedule
- Taxes Schedule
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2023-05-09T15:15:56-05:00 | ReturnTs |
| Tax Period End | 2022-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 351178661 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BLUE & CO LLC | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 500 N MERIDIAN ST SUITE 200 | AddressLine1Txt |
| City | INDIANAPOLIS | CityNm |
| State Abbreviation | IN | StateAbbreviationCd |
| ZIP | 46204 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990PF | ReturnTypeCd |
| Tax Period Begin | 2022-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 351187105 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | KOSCIUSKO 21ST CENTURY FOUNDATION INC | BusinessNameLine1Txt |
| Business Name Line2 | AKA K21 HEALTH FOUNDATION | BusinessNameLine2Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | KOSC | BusinessNameControlTxt |
| Phone | 5742695188 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1101 PARK AVE | AddressLine1Txt |
| City | WINONA LAKE | CityNm |
| State Abbreviation | IN | StateAbbreviationCd |
| ZIP | 46590 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | RICH HADDAD | PersonNm |
| Person Title | PRESIDENT | PersonTitleTxt |
| Phone | 5742695188 | PhoneNum |
| Signature | 2023-05-09 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | RICH | PersonFirstNm |
| Person Last | HADDAD | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IRS Responsible Prty Info Curr | 0 | IRSResponsiblePrtyInfoCurrInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | EMILIE M KNIERIEM CPA | PreparerPersonNm |
| PTIN | P01330194 | PTIN |
| Phone | 3176334705 | PhoneNum |
| Preparation | 2023-05-09 | PreparationDt |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 2 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2022 | TaxYr |
| Build TS | 2023-04-26 12:10:37Z | BuildTS |
Form 990-PF IRS990PF
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization501c3 Exempt PF | Yes (X) | Organization501c3ExemptPFInd |
| FMV Assets EOY | $75,847,769 | FMVAssetsEOYAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
Analysis Of Revenue And Expenses AnalysisOfRevenueAndExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contri Rcvd Rev And Expnss | $231,637 | ContriRcvdRevAndExpnssAmt |
| Interest On Sav Rev And Expnss | $586,504 | InterestOnSavRevAndExpnssAmt |
| Interest On Sav Net Invst Incm | $586,504 | InterestOnSavNetInvstIncmAmt |
| Dividends Rev And Expnss | $890,389 | DividendsRevAndExpnssAmt |
| Dividends Net Invst Incm | $890,389 | DividendsNetInvstIncmAmt |
| Gross Rents Rev And Expnss | $218,527 | GrossRentsRevAndExpnssAmt |
| Gross Rents Net Invst Incm | $218,527 | GrossRentsNetInvstIncmAmt |
| Net Rental Income Or Loss | $64,090 | NetRentalIncomeOrLossAmt |
| Net Gain Sale Ast Rev And Expnss | $1,477,010 | NetGainSaleAstRevAndExpnssAmt |
| Gross Sales Price | $64,339,020 | GrossSalesPriceAmt |
| Cap Gain Net Incm Net Invst Incm | $1,477,010 | CapGainNetIncmNetInvstIncmAmt |
| Other Income Rev And Expnss | $154,578 | OtherIncomeRevAndExpnssAmt |
| Other Income Net Invst Incm | $154,578 | OtherIncomeNetInvstIncmAmt |
| Other Income Adj Net Incm | $0 | OtherIncomeAdjNetIncmAmt |
| Total Rev And Expnss | $3,558,645 | TotalRevAndExpnssAmt |
| Total Net Invst Incm | $3,327,008 | TotalNetInvstIncmAmt |
| Total Adj Net Incm | $0 | TotalAdjNetIncmAmt |
| Comp Ofcr Dir Trst Rev And Expnss | $226,326 | CompOfcrDirTrstRevAndExpnssAmt |
| Comp Ofcr Dir Trst Net Invst Incm | $0 | CompOfcrDirTrstNetInvstIncmAmt |
| Comp Ofcr Dir Trst Adj Net Incm | $0 | CompOfcrDirTrstAdjNetIncmAmt |
| Comp Ofcr Dir Trst Dsbrs Chrtbl | $226,326 | CompOfcrDirTrstDsbrsChrtblAmt |
| Oth Empl Slrs Wgs Rev And Expnss | $103,533 | OthEmplSlrsWgsRevAndExpnssAmt |
| Oth Empl Slrs Wgs Net Invst Incm | $0 | OthEmplSlrsWgsNetInvstIncmAmt |
| Oth Empl Slrs Wgs Adj Net Incm | $0 | OthEmplSlrsWgsAdjNetIncmAmt |
| Oth Empl Slrs Wgs Dsbrs Chrtbl | $99,948 | OthEmplSlrsWgsDsbrsChrtblAmt |
| Pension Empl Bnft Rev And Expnss | $27,302 | PensionEmplBnftRevAndExpnssAmt |
| Pension Empl Bnft Net Invst Incm | $0 | PensionEmplBnftNetInvstIncmAmt |
| Pension Empl Bnft Adj Net Incm | $0 | PensionEmplBnftAdjNetIncmAmt |
| Pension Empl Bnft Dsbrs Chrtbl | $27,302 | PensionEmplBnftDsbrsChrtblAmt |
| Accounting Fees Rev And Expnss | $19,525 | AccountingFeesRevAndExpnssAmt |
| Accounting Fees Net Invst Incm | $0 | AccountingFeesNetInvstIncmAmt |
| Accounting Fees Adj Net Incm | $0 | AccountingFeesAdjNetIncmAmt |
| Accounting Fees Chrtbl Prps | $19,525 | AccountingFeesChrtblPrpsAmt |
| Other Prof Fees Rev And Expnss | $269,947 | OtherProfFeesRevAndExpnssAmt |
| Other Prof Fees Net Invst Incm | $269,947 | OtherProfFeesNetInvstIncmAmt |
| Other Prof Fees Adj Net Incm | $0 | OtherProfFeesAdjNetIncmAmt |
| Other Prof Fees Dsbrs Chrtbl | $0 | OtherProfFeesDsbrsChrtblAmt |
| Taxes Rev And Expnss | $1,953 | TaxesRevAndExpnssAmt |
| Taxes Net Invst Incm | $1,268 | TaxesNetInvstIncmAmt |
| Taxes Adj Net Incm | $0 | TaxesAdjNetIncmAmt |
| Taxes Dsbrs Chrtbl | $685 | TaxesDsbrsChrtblAmt |
| Deprec And Dpltn Rev And Expnss | $214,061 | DeprecAndDpltnRevAndExpnssAmt |
| Deprec And Dpltn Net Invst Incm | $153,121 | DeprecAndDpltnNetInvstIncmAmt |
| Deprec And Dpltn Adj Net Incm | $0 | DeprecAndDpltnAdjNetIncmAmt |
| Occupancy Rev And Expnss | $32,762 | OccupancyRevAndExpnssAmt |
| Occupancy Net Invst Incm | $0 | OccupancyNetInvstIncmAmt |
| Occupancy Adj Net Incm | $0 | OccupancyAdjNetIncmAmt |
| Occupancy Dsbrs Chrtbl | $32,762 | OccupancyDsbrsChrtblAmt |
| Trav Conf Meeting Rev And Expnss | $7,230 | TravConfMeetingRevAndExpnssAmt |
| Trav Conf Meeting Net Invst Incm | $0 | TravConfMeetingNetInvstIncmAmt |
| Trav Conf Meeting Adj Net Incm | $0 | TravConfMeetingAdjNetIncmAmt |
| Trav Conf Meeting Dsbrs Chrtbl | $7,230 | TravConfMeetingDsbrsChrtblAmt |
| Printing And Pub Rev And Expnss | $3,825 | PrintingAndPubRevAndExpnssAmt |
| Printing And Pub Net Invst Incm | $0 | PrintingAndPubNetInvstIncmAmt |
| Printing And Pub Adj Net Incm | $0 | PrintingAndPubAdjNetIncmAmt |
| Printing And Pub Dsbrs Chrtbl | $3,825 | PrintingAndPubDsbrsChrtblAmt |
| Other Expenses Rev And Expnss | $172,694 | OtherExpensesRevAndExpnssAmt |
| Other Expenses Net Invst Incm | $1,316 | OtherExpensesNetInvstIncmAmt |
| Other Expenses Adj Net Incm | $0 | OtherExpensesAdjNetIncmAmt |
| Other Expenses Dsbrs Chrtbl | $170,890 | OtherExpensesDsbrsChrtblAmt |
| Tot Opr Expenses Rev And Expnss | $1,079,158 | TotOprExpensesRevAndExpnssAmt |
| Tot Opr Expenses Net Invst Incm | $425,652 | TotOprExpensesNetInvstIncmAmt |
| Tot Opr Expenses Adj Net Incm | $0 | TotOprExpensesAdjNetIncmAmt |
| Tot Opr Expenses Dsbrs Chrtbl | $588,493 | TotOprExpensesDsbrsChrtblAmt |
| Contri Paid Rev And Expnss | $3,818,887 | ContriPaidRevAndExpnssAmt |
| Contri Paid Dsbrs Chrtbl | $3,860,667 | ContriPaidDsbrsChrtblAmt |
| Total Expenses Rev And Expnss | $4,898,045 | TotalExpensesRevAndExpnssAmt |
| Total Expenses Net Invst Incm | $425,652 | TotalExpensesNetInvstIncmAmt |
| Total Expenses Adj Net Incm | $0 | TotalExpensesAdjNetIncmAmt |
| Total Expenses Dsbrs Chrtbl | $4,449,160 | TotalExpensesDsbrsChrtblAmt |
| Excess Revenue Over Expenses | -$1,339,400 | ExcessRevenueOverExpensesAmt |
| Net Investment Income | $2,901,356 | NetInvestmentIncomeAmt |
| Adjusted Net Income | $0 | AdjustedNetIncomeAmt |
Form990 PF Balance Sheets Form990PFBalanceSheetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Sav And Temp Cash Invst BOY | $4,938,009 | SavAndTempCashInvstBOYAmt |
| Sav And Temp Cash Invst EOY | $1,368,644 | SavAndTempCashInvstEOYAmt |
| Sav And Temp Cash Invst EOYFMV | $1,368,645 | SavAndTempCashInvstEOYFMVAmt |
| Prepaid Expenses BOY | $10,748 | PrepaidExpensesBOYAmt |
| Prepaid Expenses EOY | $10,260 | PrepaidExpensesEOYAmt |
| Prepaid Expenses EOYFMV | $10,260 | PrepaidExpensesEOYFMVAmt |
| US Government Obligations BOY | $6,319,390 | USGovernmentObligationsBOYAmt |
| US Government Obligations EOY | $6,915,768 | USGovernmentObligationsEOYAmt |
| US Govt Obligations EOYFMV | $6,477,548 | USGovtObligationsEOYFMVAmt |
| Corporate Stock BOY | $27,989,927 | CorporateStockBOYAmt |
| Corporate Stock EOY | $26,171,276 | CorporateStockEOYAmt |
| Corporate Stock EOYFMV | $36,943,666 | CorporateStockEOYFMVAmt |
| Corporate Bonds BOY | $8,914,763 | CorporateBondsBOYAmt |
| Corporate Bonds EOY | $5,829,440 | CorporateBondsEOYAmt |
| Corporate Bonds EOYFMV | $5,428,417 | CorporateBondsEOYFMVAmt |
| Invst Land Cost Or Other Basis | $2,328,270 | InvstLandCostOrOtherBasisAmt |
| Invst Land Accum Depreciation | $1,263,697 | InvstLandAccumDepreciationAmt |
| Land Bldg Investments BOY | $1,217,694 | LandBldgInvestmentsBOYAmt |
| Land Bldg Investments EOY | $1,064,573 | LandBldgInvestmentsEOYAmt |
| Land Bldg Investments EOYFMV | $1,064,573 | LandBldgInvestmentsEOYFMVAmt |
| Other Investments BOY | $14,686,114 | OtherInvestmentsBOYAmt |
| Other Investments EOY | $21,215,986 | OtherInvestmentsEOYAmt |
| Other Investments EOYFMV | $23,451,052 | OtherInvestmentsEOYFMVAmt |
| Land Bldg Equip Cost Or Other Bss | $1,064,979 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $158,457 | LandBldgEquipAccumDeprecAmt |
| Land BOY | $958,062 | LandBOYAmt |
| Land EOY | $906,522 | LandEOYAmt |
| Land EOYFMV | $906,522 | LandEOYFMVAmt |
| Other Assets BOY | $252,193 | OtherAssetsBOYAmt |
| Other Assets EOY | $197,086 | OtherAssetsEOYAmt |
| Other Assets EOYFMV | $197,086 | OtherAssetsEOYFMVAmt |
| Total Assets BOY | $65,286,900 | TotalAssetsBOYAmt |
| Total Assets EOY | $63,679,555 | TotalAssetsEOYAmt |
| Total Assets EOYFMV | $75,847,769 | TotalAssetsEOYFMVAmt |
| Accounts Payable BOY | $38,866 | AccountsPayableBOYAmt |
| Accounts Payable EOY | $3,585 | AccountsPayableEOYAmt |
| Grants Payable BOY | $312,179 | GrantsPayableBOYAmt |
| Grants Payable EOY | $270,399 | GrantsPayableEOYAmt |
| Other Liabilities BOY | $360,022 | OtherLiabilitiesBOYAmt |
| Other Liabilities EOY | $169,138 | OtherLiabilitiesEOYAmt |
| Total Liabilities BOY | $711,067 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $443,122 | TotalLiabilitiesEOYAmt |
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
| No Donor Rstr Net Assests BOY | $63,060,146 | NoDonorRstrNetAssestsBOYAmt |
| No Donor Rstr Net Assests EOY | $61,759,412 | NoDonorRstrNetAssestsEOYAmt |
| Donor Rstr Net Assets BOY | $1,515,687 | DonorRstrNetAssetsBOYAmt |
| Donor Rstr Net Assets EOY | $1,477,021 | DonorRstrNetAssetsEOYAmt |
| Tot Net Ast Or Fund Balances BOY | $64,575,833 | TotNetAstOrFundBalancesBOYAmt |
| Tot Net Ast Or Fund Balances EOY | $63,236,433 | TotNetAstOrFundBalancesEOYAmt |
| Total Liabilities Net Ast BOY | $65,286,900 | TotalLiabilitiesNetAstBOYAmt |
| Total Liabilities Net Ast EOY | $63,679,555 | TotalLiabilitiesNetAstEOYAmt |
Chg In Net Assets Fund Balances ChgInNetAssetsFundBalancesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tot Net Ast Or Fund Balances BOY | $64,575,833 | TotNetAstOrFundBalancesBOYAmt |
| Excess Revenue Over Expenses | -$1,339,400 | ExcessRevenueOverExpensesAmt |
| Other Increases | $0 | OtherIncreasesAmt |
| Subtotal | $63,236,433 | SubtotalAmt |
| Other Decreases | $0 | OtherDecreasesAmt |
| Tot Net Ast Or Fund Balances EOY | $63,236,433 | TotNetAstOrFundBalancesEOYAmt |
Cap Gains Loss Tx Invst Incm Detail CapGainsLossTxInvstIncmDetail
Cap Gains Loss Tx Invst Incm CapGainsLossTxInvstIncmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Property | SALES OF SECURITIES | PropertyDesc |
| Gross Sales Price | $64,339,020 | GrossSalesPriceAmt |
| Cost Or Other Basis | $62,862,010 | CostOrOtherBasisAmt |
| Gain Or Loss | $1,477,010 | GainOrLossAmt |
| Gains Minus Excess Or Losses | $1,477,010 | GainsMinusExcessOrLossesAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Capital Gain Net Income | $1,477,010 | CapitalGainNetIncomeAmt |
Excise Tax Based On Invst Incm ExciseTaxBasedOnInvstIncmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Income Excise Tax | $40,329 | InvestmentIncomeExciseTaxAmt |
| Tax Under Section511 | $0 | TaxUnderSection511Amt |
| Subtotal | $40,329 | SubtotalAmt |
| Subtitle A Tax | $0 | SubtitleATaxAmt |
| Tax Based On Investment Income | $40,329 | TaxBasedOnInvestmentIncomeAmt |
| Estimated Plus Ovpmt Incm Tx | $48,000 | EstimatedPlusOvpmtIncmTxAmt |
| Exempt Frgn Org Tax Wthld At Srce | $0 | ExemptFrgnOrgTaxWthldAtSrceAmt |
| Extsn Request Income Tax Paid | $0 | ExtsnRequestIncomeTaxPaidAmt |
| Backup Withholding Withheld | $0 | BackupWithholdingWithheldAmt |
| Total Payments And Credits | $48,000 | TotalPaymentsAndCreditsAmt |
| Form2220 Attached | Yes (X) | Form2220AttachedInd |
| Es Penalty | $42 | EsPenaltyAmt |
| Overpayment | $7,629 | OverpaymentAmt |
| Applied To ES Tax | $7,629 | AppliedToESTaxAmt |
| Refund | $0 | RefundAmt |
Statements Regarding Acty StatementsRegardingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Legislative Political Acty | 0 | LegislativePoliticalActyInd |
| More Than100 Spent | 0 | MoreThan100SpentInd |
| Form1120 POL Filed | 0 | Form1120POLFiledInd |
| Section4955 Organization Tax | $0 | Section4955OrganizationTaxAmt |
| Section4955 Managers Tax | $0 | Section4955ManagersTaxAmt |
| Tax Reimbursed | $0 | TaxReimbursedAmt |
| Activities Not Previously Rpt | 0 | ActivitiesNotPreviouslyRptInd |
| Changes To Articles Or Bylaws | 0 | ChangesToArticlesOrBylawsInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Organization Dissolved Etc | 0 | OrganizationDissolvedEtcInd |
| Section508e Rqr Satisfied | Yes (1) | Section508eRqrSatisfiedInd |
| At Least5000 In Assets | Yes (1) | AtLeast5000InAssetsInd |
| Org Report Or Register State | IN | OrgReportOrRegisterStateCd |
| Form990 PF Filed With Atty Gen | Yes (1) | Form990PFFiledWithAttyGenInd |
| Private Operating Foundation | 0 | PrivateOperatingFoundationInd |
| New Substantial Contributors | 0 | NewSubstantialContributorsInd |
| Own Controlled Entity | 0 | OwnControlledEntityInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Comply With Public Insp Rqr | Yes (1) | ComplyWithPublicInspRqrInd |
| Website Address | WWW.K21FOUNDATION.ORG | WebsiteAddressTxt |
| Individual With Books | RICH HADDAD | IndividualWithBooksNm |
| Phone | 5742695188 | PhoneNum |
Location Of Books US Address LocationOfBooksUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1101 PARK AVE | AddressLine1Txt |
| City | WINONA LAKE | CityNm |
| State Abbreviation | IN | StateAbbreviationCd |
| ZIP | 46590 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Foreign Accounts Question | 0 | ForeignAccountsQuestionInd |
Statements Regarding Acty4720 StatementsRegardingActy4720Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Sale Or Exch Disqualified Prsn | 0 | SaleOrExchDisqualifiedPrsnInd |
| Brrw Or Lend Disqualified Prsn | 0 | BrrwOrLendDisqualifiedPrsnInd |
| Furn Goods Disqualified Prsn | 0 | FurnGoodsDisqualifiedPrsnInd |
| Pay Comp Disqualified Prsn | Yes (1) | PayCompDisqualifiedPrsnInd |
| Transfer Ast Disqualified Prsn | 0 | TransferAstDisqualifiedPrsnInd |
| Payment To Government Official | 0 | PaymentToGovernmentOfficialInd |
| Acts Fail To Qlfy As Exceptions | 0 | ActsFailToQlfyAsExceptionsInd |
| Uncorrected Prior Acts | 0 | UncorrectedPriorActsInd |
| Undistributed Income PY | 0 | UndistributedIncomePYInd |
| Business Holdings | 0 | BusinessHoldingsInd |
| Jeopardy Investments | 0 | JeopardyInvestmentsInd |
| Uncorrected PY Jeopardy Invst | 0 | UncorrectedPYJeopardyInvstInd |
| Influence Legislation | 0 | InfluenceLegislationInd |
| Influence Election | 0 | InfluenceElectionInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Noncharitable Purpose | 0 | NoncharitablePurposeInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
Officer Dir Trst Key Empl Info OfficerDirTrstKeyEmplInfoGrp
Officer Dir Trst Key Empl OfficerDirTrstKeyEmplGrp (19 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 |
|---|---|---|---|---|---|---|---|---|
| RICHARD HADDAD | ||||||||
| 1101 PARK AVE | WINONA LAKE | IN | 46590 | PRESIDENT | 40.00 | $219,909 | $6,417 | $0 |
| LISA O'NEILL | ||||||||
| 1101 PARK AVE | WINONA LAKE | IN | 46590 | CHAIRMAN | 1.00 | $0 | $0 | $0 |
| BILL SMITH | ||||||||
| 1101 PARK AVE | WINONA LAKE | IN | 46590 | VICE CHAIRMAN | 1.00 | $0 | $0 | $0 |
| MAX MOCK | ||||||||
| 1101 PARK AVE | WINONA LAKE | IN | 46590 | TREASURER | 1.00 | $0 | $0 | $0 |
| JILL GROSS | ||||||||
| 1101 PARK AVE | WINONA LAKE | IN | 46590 | SECRETARY | 1.00 | $0 | $0 | $0 |
| BECKY ALLES | ||||||||
| 1101 PARK AVE | WINONA LAKE | IN | 46590 | DIRECTOR | 1.00 | $0 | $0 | $0 |
| JESSICA BRICKER | ||||||||
| 1101 PARK AVE | WINONA LAKE | IN | 46590 | DIRECTOR | 1.00 | $0 | $0 | $0 |
| TRICIA GALL | ||||||||
| 1101 PARK AVE | WINONA LAKE | IN | 46590 | DIRECTOR-TERM BEGAN | 1.00 | $0 | $0 | $0 |
| JOE GRAHAM | ||||||||
| 1101 PARK AVE | WINONA LAKE | IN | 46590 | DIRECTOR | 1.00 | $0 | $0 | $0 |
| ANDREW GROSSNICKLE | ||||||||
| 1101 PARK AVE | WINONA LAKE | IN | 46590 | DIRECTOR | 1.00 | $0 | $0 | $0 |
| JOELLA HAUSEMANN | ||||||||
| 1101 PARK AVE | WINONA LAKE | IN | 46590 | DIRECTOR | 1.00 | $0 | $0 | $0 |
| KELLY KAASE | ||||||||
| 1101 PARK AVE | WINONA LAKE | IN | 46590 | DIRECTOR | 1.00 | $0 | $0 | $0 |
| RICK KERLIN | ||||||||
| 1101 PARK AVE | WINONA LAKE | IN | 46590 | DIRECTOR | 1.00 | $0 | $0 | $0 |
| ANITA KISHAN | ||||||||
| 1101 PARK AVE | WINONA LAKE | IN | 46590 | DIRECTOR | 1.00 | $0 | $0 | $0 |
| CHAD LARSH | ||||||||
| 1101 PARK AVE | WINONA LAKE | IN | 46590 | DIRECTOR | 1.00 | $0 | $0 | $0 |
| SANDRA PARRA | ||||||||
| 1101 PARK AVE | WINONA LAKE | IN | 46590 | DIRECTOR | 1.00 | $0 | $0 | $0 |
| DR JASMINE SCHLITT | ||||||||
| 1101 PARK AVE | WINONA LAKE | IN | 46590 | DIRECTOR | 1.00 | $0 | $0 | $0 |
| SCOTT TUCKER | ||||||||
| 1101 PARK AVE | WINONA LAKE | IN | 46590 | DIRECTOR | 1.00 | $0 | $0 | $0 |
| STEVE GRILL | ||||||||
| 1101 PARK AVE | WINONA LAKE | IN | 46590 | DIRECTOR-TERM ENDED | 1.00 | $0 | $0 | $0 |
Compensation Highest Paid Empl CompensationHighestPaidEmplGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | JENNIFER STEWART | PersonNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1101 PARK AVE | AddressLine1Txt |
| City | WINONA LAKE | CityNm |
| State Abbreviation | IN | StateAbbreviationCd |
| ZIP | 46590 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Title | MARKETING MANAGER | TitleTxt |
| Average Hrs Per Wk Devoted To Pos | 40.00 | AverageHrsPerWkDevotedToPosRt |
| Compensation | $56,929 | CompensationAmt |
| Employee Benefits | $1,672 | EmployeeBenefitsAmt |
| Expense Account | $0 | ExpenseAccountAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Employee Paid Over50k | 0 | OtherEmployeePaidOver50kCnt |
Compensation Of Hghst Pd Cntrct CompensationOfHghstPdCntrctGrp (4 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | Service TypeServiceTypeTxt | CompensationCompensationAmt |
|---|---|---|---|---|---|
| ROBINSON CONSTRUCTION | |||||
| 445 E 200 NORTH | WARSAW | IN | 46582 | CONSTRUCTION | $285,969 |
| A&Z ENGINGEERING | |||||
| 1220 RUSTON PASS | FORT WAYNE | IN | 46825 | ENGINEERING | $78,623 |
| MARQUETTE ASSOCIATES | |||||
| 180 N LASALLE SUITE 3500 | CHICAGO | IL | 60601 | INVESTMENT CONSULTING | $69,000 |
| PHEND & BROWN | |||||
| PO BOX 150 | MILFORD | IN | 46542 | CONSTRUCTION | $53,000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contractor Paid Over50k | 0 | ContractorPaidOver50kCnt |
Sum Of Program Related Invst SumOfProgramRelatedInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expenses1 | $0 | Expenses1Amt |
| Total | $0 | TotalAmt |
Minimum Investment Return MinimumInvestmentReturnGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Average Monthly FMV Of Sec | $79,340,725 | AverageMonthlyFMVOfSecAmt |
| Average Monthly Cash Balances | $532,447 | AverageMonthlyCashBalancesAmt |
| FMV All Other Noncharitable Ast | $0 | FMVAllOtherNoncharitableAstAmt |
| Total FMV Of Unused Assets | $79,873,172 | TotalFMVOfUnusedAssetsAmt |
| Reduction Claimed | $0 | ReductionClaimedAmt |
| Acquisition Indebtedness | $0 | AcquisitionIndebtednessAmt |
| Adjusted Total FMV Of Unused Ast | $79,873,172 | AdjustedTotalFMVOfUnusedAstAmt |
| Cash Deemed Charitable | $1,198,098 | CashDeemedCharitableAmt |
| Net Vl Noncharitable Assets | $78,675,074 | NetVlNoncharitableAssetsAmt |
| Minimum Investment Return | $3,933,754 | MinimumInvestmentReturnAmt |
Distributable Amount DistributableAmountGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Minimum Investment Return | $3,933,754 | MinimumInvestmentReturnAmt |
| Tax Based On Investment Income | $40,329 | TaxBasedOnInvestmentIncomeAmt |
| Total Tax | $40,329 | TotalTaxAmt |
| Distributable Before Adj | $3,893,425 | DistributableBeforeAdjAmt |
| Recoveries Qualfied Distri | $0 | RecoveriesQualfiedDistriAmt |
| Distributable Before Ded | $3,893,425 | DistributableBeforeDedAmt |
| Deduction From Distributable | $0 | DeductionFromDistributableAmt |
| Distributable As Adjusted | $3,893,425 | DistributableAsAdjustedAmt |
PF Qualifying Distributions PFQualifyingDistributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expenses And Contributions | $4,449,160 | ExpensesAndContributionsAmt |
| Program Related Invst Total | $0 | ProgramRelatedInvstTotalAmt |
| Qualifying Distributions | $4,449,160 | QualifyingDistributionsAmt |
Undistributed Income UndistributedIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Distributable As Adjusted | $3,893,425 | DistributableAsAdjustedAmt |
| Undistributed Income PY | $0 | UndistributedIncomePYAmt |
| Total For Prior Years | $0 | TotalForPriorYearsAmt |
| Excess Distribution Cyov Yr5 | $537,887 | ExcessDistributionCyovYr5Amt |
| Excess Distribution Cyov Yr4 | $624,896 | ExcessDistributionCyovYr4Amt |
| Excess Distribution Cyov Yr3 | $712,716 | ExcessDistributionCyovYr3Amt |
| Total Excess Distribution Cyov | $1,875,499 | TotalExcessDistributionCyovAmt |
| Qualifying Distributions | $4,449,160 | QualifyingDistributionsAmt |
| Applied To Year1 | $0 | AppliedToYear1Amt |
| Applied To Prior Years | $0 | AppliedToPriorYearsAmt |
| Treated As Distri From Corpus | $0 | TreatedAsDistriFromCorpusAmt |
| Applied To Current Year | $3,893,425 | AppliedToCurrentYearAmt |
| Remaining Distri From Corpus | $555,735 | RemainingDistriFromCorpusAmt |
| Excess Distri Cyov App CY Corpus | $0 | ExcessDistriCyovAppCYCorpusAmt |
| Excess Distribution Cyov App CY | $0 | ExcessDistributionCyovAppCYAmt |
| Total Corpus | $2,431,234 | TotalCorpusAmt |
| Prior Year Undistributed Incm | $0 | PriorYearUndistributedIncmAmt |
| Prior Year Deficiency Or Tax | $0 | PriorYearDeficiencyOrTaxAmt |
| Taxable1 | $0 | Taxable1Amt |
| Taxable2 | $0 | Taxable2Amt |
| Undistributed Income CY | $0 | UndistributedIncomeCYAmt |
| Corpus Distri170b1 E Or4942g3 | $0 | CorpusDistri170b1EOr4942g3Amt |
| Excess Distri Cyov From Yr5 | $537,887 | ExcessDistriCyovFromYr5Amt |
| Excess Distri Cyov To Next Yr | $1,893,347 | ExcessDistriCyovToNextYrAmt |
| Excess From Year4 | $624,896 | ExcessFromYear4Amt |
| Excess From Year3 | $712,716 | ExcessFromYear3Amt |
| Excess From Current Year | $555,735 | ExcessFromCurrentYearAmt |
Supplementary Information SupplementaryInformationGrp
Application Submission Info ApplicationSubmissionInfoGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Recipient Person | KOSCIUSKO 21ST CENTURY FOUNDATION I | RecipientPersonNm |
Recipient US Address RecipientUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1101 PARK AVE | AddressLine1Txt |
| City | WINONA LAKE | CityNm |
| State Abbreviation | IN | StateAbbreviationCd |
| ZIP | 46590 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Recipient Phone | 5742695188 | RecipientPhoneNum |
| Form And Info And Materials | SEE STATEMENTS 20 AND 21. | FormAndInfoAndMaterialsTxt |
| Submission Deadlines | SEE STATEMENTS 20 AND 21. | SubmissionDeadlinesTxt |
| Restrictions On Awards | SEE STATEMENTS 20 AND 21. | RestrictionsOnAwardsTxt |
Grant Or Contribution Pd Dur Yr GrantOrContributionPdDurYrGrp (60 entries)
| Address Line1RecipientUSAddress/AddressLine1Txt | CityRecipientUSAddress/CityNm | State AbbreviationRecipientUSAddress/StateAbbreviationCd | ZIPRecipientUSAddress/ZIPCd | Recipient RelationshipRecipientRelationshipTxt | Recipient Foundation StatusRecipientFoundationStatusTxt | Grant Or Contribution PurposeGrantOrContributionPurposeTxt | AmtAmt |
|---|---|---|---|---|---|---|---|
| CANCER CARE GRANTS | |||||||
| 1101 PARK AVE | WINONA LAKE | IN | 46590 | NONE | I | PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS | $140,059 |
| AGAITAS | |||||||
| 1945 PHEASANT RIDGE DRIVE | WARSAW | IN | 46580 | NONE | PC | OPERATIONAL FUNDING | $15,000 |
| AGAITAS | |||||||
| 710 PARK AVE | WINONA LAKE | IN | 46590 | NONE | PC | OPERATING SUPPORT | $2,500 |
| BAKER YOUTH CLUB | |||||||
| 1401 E SMITH ST | WARSAW | IN | 46580 | NONE | PC | OPERATIONAL ASSISTANCE | $50,000 |
| BAKER YOUTH CLUB | |||||||
| 1400 E SMITH ST | WARSAW | IN | 46580 | NONE | PC | OPERATING SUPPORT | $1,500 |
| BIG BROTHERS BIG SISTERS | |||||||
| 1005 WEST RUDISILL BLVD | FORT WAYNE | IN | 46807 | NONE | PC | OPERATIONAL ASSISTANCE | $5,000 |
| BOWEN CENTER | |||||||
| 2621 E JEFFERSON ST | WARSAW | IN | 46581 | NONE | PC | COMMUNITY PARK SUPPORT | $38,460 |
| BRIGHTPOINT | |||||||
| 227 E WASHINGTON BLVD | FORT WAYNE | IN | 46804 | NONE | PC | COVERING KIDS & FAMILIES | $20,000 |
| CANCER SERVICES OF NORTHEAST INDIANA | |||||||
| 6316 MUTUAL DRIVE | FORT WAYNE | IN | 46825 | NONE | PC | DIRECT ASSISTANCE / CLIENT ADVOCACY | $20,000 |
| CARDINAL SERVICES | |||||||
| 504 N BAY ST | WARSAW | IN | 46580 | NONE | PC | FACILITY RENOVATION | $338,514 |
| CITY OF WARSAW | |||||||
| 2191 E FORT WAYNE ST | WARSAW | IN | 46580 | NONE | GOV | AUTOPULSE SUPPORT/PICKLEBALL COURTS/CARES EQUIPMENT | $71,272 |
| COMBINED COMMUNITY SERVICES | |||||||
| 1195 MARINERS DRIVE | WARSAW | IN | 46582 | NONE | PC | PROGRAM SUPPORT/STRATEGIC PLANNING | $79,225 |
| COMBINED COMMUNITY SERVICES | |||||||
| 1195 MARINERS DRIVE | WARSAW | IN | 46582 | NONE | PC | OPERATING SUPPORT | $1,000 |
| FELLOWSHIP MISSIONS | |||||||
| 1520 E WINONA AVE | WARSAW | IN | 46580 | NONE | PC | ADDICTION RECOVERY PROGRAM SUPPORT | $100,000 |
| FELLOWSHIP MISSIONS | |||||||
| 1520 EAST WINONA AVENUE | WARSAW | IN | 46580 | NONE | PC | OPERATING SUPPORT | $1,500 |
| GRACE COLLEGE & SEMINARY | |||||||
| 1 LANCER WAY | WINONA LAKE | IN | 46590 | NONE | PC | LILLY CENTER OPERATIONAL ASSISTANCE | $10,000 |
| GRACE COLLEGE & SEMINARY | |||||||
| 1 LANCER WAY | WINONA LAKE | IN | 46590 | NONE | PC | BIKES PROGRAM/LAKES STUDY | $177,971 |
| HARVEST WITH A HEART | |||||||
| PO BOX 425 | MILFORD | IN | 46542 | NONE | PC | FACILITY SUPPORT | $7,847 |
| HEARTLINE PREGNANCY CENTER | |||||||
| 1515 PROVIDENT DRIVE SUITE 180 | WARSAW | IN | 46580 | NONE | PC | PROGRAM FUNDING/FACILITY RENOVATION | $42,339 |
| JOE'S KIDS | |||||||
| 902 PROVIDENT DRIVE SUITE C | WARSAW | IN | 46580 | NONE | PC | COVID RELIEF SUPPORT | $30,000 |
| JOE'S KIDS | |||||||
| 902 PROVIDENT DRIVE SUITE C | WARSAW | IN | 46580 | NONE | PC | RENT SUBSIDY | $41,220 |
| KCV CYCLING CLUB | |||||||
| PO BOX 325 | WINONA LAKE | IN | 46590 | NONE | PC | TRAINING | $2,000 |
| KOSCIUSKO CARES | |||||||
| 1515 PROVIDENT DRIVE STE 240 | WARSAW | IN | 46580 | NONE | PC | PROGRAM SUPPORT | $17,000 |
| KOSCIUSKO COMMUNITY YMCA | |||||||
| 1305 MARINERS DR | WARSAW | IN | 46582 | NONE | PC | SCREENINGS | $2,300 |
| KOSCIUSKO COMMUNITY YMCA | |||||||
| 1305 MARINERS DRIVE | WARSAW | IN | 46582 | NONE | PC | TECHNOLOGY UPGRADE | $13,187 |
| KOSCIUSKO COUNTY COMMUNITY FOUNDATION | |||||||
| 102 EAST MARKET STREET | WARSAW | IN | 46580 | NONE | PC | GOOD SAMARITAN FUND/FUNDING PROGRAM | $176,000 |
| KOSCIUSKO COUNTY COMMUNITY FOUNDATION | |||||||
| 102 EAST MARKET STREET | WARSAW | IN | 46580 | NONE | PC | RILEY KIDS FUND | $1,000 |
| KOSCIUSKO COUNTY COUNCIL ON AGING | |||||||
| 800 N PARK AVE | WARSAW | IN | 46580 | NONE | PC | OPERATING SUPPORT | $1,000 |
| KOSCIUSKO HEALTH SERVICES PAVILION | |||||||
| 1515 PROVIDENT DRIVE | WARSAW | IN | 46580 | NONE | PC | COVID RELIEF SUPPORT | $12,500 |
| KOSCIUSKO HEALTH SERVICES PAVILION | |||||||
| 1515 PROVIDENT DRIVE | WARSAW | IN | 46582 | NONE | PC | FACILITY RENOVATION | $24,379 |
| KOSCIUSKO HOME CARE & HOSPICE | |||||||
| 1515 PROVIDENT DRIVE STE 250 | WARSAW | IN | 46580 | NONE | PC | OPERATIONAL ASSISTANCE | $168,179 |
| KOSCIUSKO HOME CARE & HOSPICE | |||||||
| 1515 PROVIDENT DRIVE STE 250 | WARSAW | IN | 46580 | NONE | PC | MEDICATION & DENTAL ASSISTANCE | $247,452 |
| LAKE CITY BMX CLUB INC | |||||||
| 750 E ARTHUR STREET | WARSAW | IN | 46580 | NONE | PC | TRACK IMPROVEMENT | $34,895 |
| LITTLE LAMBS MINISTRY | |||||||
| 1413 NORTH LONG DRIVE | SYRACUSE | IN | 46567 | NONE | PC | PLAYGROUND | $15,000 |
| LIVE WELL KOSCIUSKO | |||||||
| 8546 SOUTH 200 WEST | CLAYPOOL | IN | 46510 | NONE | PC | OPERATIONAL FUNDING | $72,479 |
| LOST SPARROWS | |||||||
| PO BOX 751 | WINONA LAKE | IN | 46590 | NONE | PC | CONFERENCE | $20,000 |
| MAD ANTHONY'S CHILDREN'S HOPE HOUSE | |||||||
| 7922 WEST JEFFERSON BLVD | FORT WAYNE | IN | 46804 | NONE | PC | OPERATIONAL ASSISTANCE | $10,000 |
| MCMILLEN CENTER | |||||||
| 600 JIM KELLEY BLVD | FORT WAYNE | IN | 46816 | NONE | PC | HEALTH EDUCATION PROGRAMS | $5,000 |
| MOM OF AN ADDICT INC | |||||||
| 10214 CHESTNUT PLAZA DR | FORT WAYNE | IN | 46814 | NONE | PC | PROGRAM SUPPORT | $1,984 |
| NORTHERN INDIANA HISPANIC HEALTH COALITION | |||||||
| 444 NORTH NAPPANEE STREET | ELKHART | IN | 46514 | NONE | PC | HEALTH SCREENINGS/OPERATIONAL FUNDING | $20,000 |
| OTHER GRANTS LESS THAN 1000 | |||||||
| 1101 PARK AVE | WINONA LAKE | IN | 46590 | NONE | PC | OPERATING SUPPORT | $5,000 |
| OUR LADY OF GUADALUPE CHURCH | |||||||
| PO BOX 1136 | WARSAW | IN | 46580 | NONE | PC | OPERATING SUPPORT | $1,000 |
| PLEASANT VIEW BIBLE CHURCH | |||||||
| 2782 W 200 N | WARSAW | IN | 46580 | NONE | PC | PLAYGROUND | $55,047 |
| RONALD MCDONALD HOUSE CHARITIES | |||||||
| 11109 PARKVIEW PLAZA DR | FORT WAYNE | IN | 46845 | NONE | PC | MOBILE CLINIC AND OPERATING SUPPORT | $5,000 |
| ROSE GARDEN RECOVERY COMMUNITY | |||||||
| 72876 CR 29 | SYRACUSE | IN | 46567 | NONE | PC | OPERATING SUPPORT | $1,000 |
| RYANS CASE FOR SMILES | |||||||
| 295 E SWEDESFORD RD 396 | WAYNE | IN | 19087 | NONE | PC | PROGRAM SUPPLIES | $3,000 |
| SIDNEY JACKSON TOWNSHIP VOLUNTEER FIRE DEPARTMENT | |||||||
| 103 E CENTER STREET | SIDNEY | IN | 46562 | NONE | PC | GENERATOR | $9,307 |
| SUPER SHOT INC | |||||||
| 1515 HOBSON ROAD | FORT WAYNE | IN | 46805 | NONE | PC | OPERATIONAL ASSISTANCE | $5,000 |
| THE OCEAN CLEANUP NORTH PACIFIC FOUNDATION | |||||||
| 100 WALL STREET 10TH FLOOR | NEW YORK | IN | 10005 | NONE | PC | OCEAN CLEANUP | $1,000 |
| THE WATERSHED FOUNDATION | |||||||
| PO BOX 55 | NORTH WEBSTER | IN | 46555 | NONE | PC | OPERATING SUPPORT | $1,500 |
| TOWN OF NORTH WEBSTER | |||||||
| 144 SOUTH MAIN STREET | NORTH WEBSTER | IN | 46555 | NONE | PC | COMMUNITIES GRANT | $1,075 |
| TOWN OF WINONA LAKE | |||||||
| 1310 PARK AVENUE | WINONA LAKE | IN | 46590 | NONE | PC | ICE RINK PAVILION | $1,500,000 |
| TOWN OF WINONA LAKE | |||||||
| 1590 PARK AVENUE | WINONA LAKE | IN | 46590 | NONE | PC | PICKLEBALL COURTS/AED EQUIPMENT & TRAINING | $21,280 |
| TRITON SCHOOL CORPORATION | |||||||
| 100 TRITON DRIVE | BOURBON | IN | 46504 | NONE | PC | FITNESS EQUIPMENT | $35,000 |
| WAGON WHEEL THEATRE INC | |||||||
| 2515 E CENTER ST | WARSAW | IN | 46580 | NONE | PC | OPERATING SUPPORT | $1,000 |
| WARRIORS SWIM INC | |||||||
| PO BOX 128 | NORTH WEBSTER | IN | 46555 | NONE | PC | EQUIPMENT | $19,000 |
| WARSAW AQUATIC CLUB | |||||||
| PO BOX 341 | WINONA LAKE | IN | 46590 | NONE | PC | OPERATING SUPPORT | $1,000 |
| WARSAW COMMUNITY SCHOOLS | |||||||
| 1 ADMINISTRATION DR | WARSAW | IN | 46580 | NONE | PC | NURSES FUND | $10,000 |
| WARSAW COMMUNITY SCHOOLS | |||||||
| 1 ADMINISTRATIION DRIVE | WARSAW | IN | 46580 | NONE | PC | FITNESS TRACKERS/PE EQUIPMENT | $69,073 |
| WARSAW HEALTH EXPENSES | |||||||
| 1101 PARK AVE | WINONA LAKE | IN | 46590 | NONE | PC | PARK DEVELOPMENT ALONG CENTER LAKE | $78,623 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Grant Or Contri Pd Dur Yr | $3,860,667 | TotalGrantOrContriPdDurYrAmt |
| Total Grant Or Contri Apprv Fut | $0 | TotalGrantOrContriApprvFutAmt |
Analysis Income Producing Acty AnalysisIncomeProducingActyGrp
Int On Sav And Temp Cash Invst IntOnSavAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Exclusion | 14 | ExclusionCd |
| Exclusion | $586,504 | ExclusionAmt |
Dividends And Interest From Sec Dtl DividendsAndInterestFromSecDtl
| Field | Value | IRS element (for citing) |
|---|---|---|
| Exclusion | 14 | ExclusionCd |
| Exclusion | $890,389 | ExclusionAmt |
Net Rntl Incm Re Not Debt Fincd Prop NetRntlIncmReNotDebtFincdProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Exclusion | 16 | ExclusionCd |
| Exclusion | $64,090 | ExclusionAmt |
Other Investment Income OtherInvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Exclusion | 01 | ExclusionCd |
| Exclusion | $154,578 | ExclusionAmt |
Gain Sales Ast Oth Than Invntry GainSalesAstOthThanInvntryGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Exclusion | 18 | ExclusionCd |
| Exclusion | $1,477,010 | ExclusionAmt |
Subtotals Incm Producing Acty SubtotalsIncmProducingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Unrelated Business Taxbl Incm | $0 | UnrelatedBusinessTaxblIncmAmt |
| Exclusion | $3,172,571 | ExclusionAmt |
| Related Or Exempt Function Incm | $0 | RelatedOrExemptFunctionIncmAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Income Producing Acty | $3,172,571 | TotalIncomeProducingActyAmt |
Trnsfr Trans Rln Nonchrtbl EO TrnsfrTransRlnNonchrtblEOGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trnsfr Of Cash To Nonchrtbl EO | 0 | TrnsfrOfCashToNonchrtblEOInd |
| Trnsfr Other Asset Nonchrtbl EO | 0 | TrnsfrOtherAssetNonchrtblEOInd |
| Sales Or Exchanges Of Assets | 0 | SalesOrExchangesOfAssetsInd |
| Purchase Of Assets Nonchrtbl EO | 0 | PurchaseOfAssetsNonchrtblEOInd |
| Rental Of Facilities Oth Assets | 0 | RentalOfFacilitiesOthAssetsInd |
| Reimbursement Arrangements | 0 | ReimbursementArrangementsInd |
| Loans Or Loan Guarantees | 0 | LoansOrLoanGuaranteesInd |
| Performance Of Services Etc | 0 | PerformanceOfServicesEtcInd |
| Sharing Of Facilities Etc | 0 | SharingOfFacilitiesEtcInd |
| Relationships Nonchrtbl EO | 0 | RelationshipsNonchrtblEOInd |
Schedule B IRS990ScheduleB
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization501c3 Exempt PF | Yes (X) | Organization501c3ExemptPFInd |
| General Rule | Yes (X) | GeneralRuleInd |
Contributor Information ContributorInformationGrp (7 entries)
| ContributorContributorNum | Address Line1ContributorUSAddress/AddressLine1Txt | CityContributorUSAddress/CityNm | State AbbreviationContributorUSAddress/StateAbbreviationCd | ZIPContributorUSAddress/ZIPCd | Total ContributionsTotalContributionsAmt | Person ContributionPersonContributionInd |
|---|---|---|---|---|---|---|
| THEIME FAMILY FOUNDATION | ||||||
| 1 | 10925 BULLRUSH DR | VENICE | FL | 34293 | $20,000 | Yes (X) |
| MR AND MRS ED BURNWORTH | ||||||
| 2 | 140 SEAVIEW CT UNITE 1001S | MARCO ISLAND | FL | 34145 | $10,000 | Yes (X) |
| MR AND MRS DOUGLAS SCHROCK | ||||||
| 3 | 711 SOUTH STREET | KEY WEST | FL | 33040 | $10,000 | Yes (X) |
| MR AND MRS THOMAS HERALD | ||||||
| 4 | 1300 S HARLESS DR B-7 | SYRACUSE | IN | 46567 | $7,500 | Yes (X) |
| BERTSCH FAMILY CHARITABLE FOUNDATION | ||||||
| 5 | PO BOX 1494 | WARSAW | IN | 46581 | $6,000 | Yes (X) |
| MR AND MRS JEFF WELLS | ||||||
| 6 | 11520 N LAKE VIEW | SYRACUSE | IN | 46567 | $5,400 | Yes (X) |
| LUTHERAN HEALTH NETWORK | ||||||
| 7 | 7916 W JEFFERSON BLVD | FORT WAYNE | IN | 46804 | $5,000 | Yes (X) |
Accounting Fees Schedule AccountingFeesSchedule
Accounting Fees Detail AccountingFeesDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Category | ACCOUNTING FEES | CategoryTxt |
| Amt | $19,525 | Amt |
| Net Investment Income | $0 | NetInvestmentIncomeAmt |
| Adjusted Net Income | $0 | AdjustedNetIncomeAmt |
| Disbursements Charitable Prps | $19,525 | DisbursementsCharitablePrpsAmt |
General Explanation Attachment GeneralExplanationAttachment
General Explanation GeneralExplanationGrp (2 entries)
| IdentifierIdentifierTxt | Form And Line ReferenceFormAndLineReferenceDesc | Medium ExplanationMediumExplanationTxt |
|---|---|---|
| SUPPLEMENTARY INFORMATION | FORM 990-PF, PART XV, LINE 2A THROUGH 2D | LINE 2, NAME OF THE GRANT PROGRAM: K21 HEALTH AND WELLNESS COMMUNITY GRANTSLINE 2A AND 2B, FORM AND CONTENT OF APPLICATION:K21 HEALTH FOUNDATION EXISTS FOR THE BENEFIT OF KOSCIUSKO COUNTY RESIDENTS TO ENSURE HEALTH CARE SERVICES ARE PROVIDED, AND TO ADVANCE PREVENTION AND HEALTHY LIVING. THIS WILL BE ACCOMPLISHED BY IDENTIFYING HEALTH NEEDS IN OUR COMMUNITY AND MAINTAINING AN ENDOWMENT SO FUNDING IS AVAILABLE, THROUGH INVESTMENTS AND GRANTS, FOR THOSE NEEDS. GRANT APPLICATION CAN BE ACCESSED THROUGH AN ONLINE PROCESS AT WWW.K21HEALTHFOUNDATION.ORG UNDER "APPLY" TAB. GRANT APPLICATIONS ARE ACCEPTED 4 TIMES EACH YEAR. APPLICATIONS RECEIVED AFTER THE QUARTERLY DEADLINE DATES WILL BE HELD UNTIL THE NEXT GRANT CYCLE. FOR ASSISTANCE COMPLETING THE APPLICATION CONTACT: GRANT MANAGER JENNIFER STEWART, AT 574.269.5188 OR JENNIFER@K21HEALTHFOUNDATION.ORG.LINE 2C, ANY SUBMISSION DEADLINES: SUBMISSION DEADLINES ARE FEB 1ST, MAY 1ST, AUG 1ST, AND NOV 1ST.LINE 2D, RESTRICTIONS AND QUALIFICATIONS ON AWARDS: GRANTEES MUST MEET THE FOLLOWING REQUIREMENTS: A) NON-PROFIT AGENCY WITH VERIFIED IRS TAX-EXEMPT STATUS, A PUBLIC SCHOOL SYSTEM, OR A GOVERNMENT AGENCY. B) BE IN GOOD STANDING WITH THE INDIANA SECRETARY OF STATE AS INDICATED IN A BUSINESS ENTITY REPORT. C) BYLAWS REQUIRING TERM LIMITS AND A ROTATING BOARD OF DIRECTORS IS STRONGLY ENCOURAGED. TO QUALIFY FOR A GRANT FROM K21, REQUESTS MUST MEET THE FOLLOWING REQUIREMENTS:-THE PROJECT, PROGRAM, OR SERVICE FOR WHICH YOU ARE SEEKING FUNDING MUST BENEFIT THE RESIDENTS OF KOSCIUSKO COUNTY.-THE IMPACT MUST ADDRESS HEALTH AND WELLNESS ISSUES FOR OUR COMMUNITY. THE PRIORITIES FOR FUNDING CONSIDERATION FOCUS ON AREAS IDENTIFIED IN THE MISSION STATEMENT: -DIRECT HEALTH SERVICES -HEALTH PREVENTION SERVICES -HEALTHY LIVING OPPORTUNITIES |
| SUPPLEMENTARY INFORMATION | FORM 990-PF, PART XV, LINE 2A THROUGH 2D | LINE 2, NAME OF THE GRANT PROGRAM: CANCER CARE FUNDLINE 2A AND 2B, FORM AND CONTENT OF APPLICATION:THE KOSCIUSKO COUNTY CANCER CARE FUND, ADMINISTERED BY K21 HEALTH FOUNDATION, WAS ESTABLISHED FOR THE PURPOSE OF PROVIDING FINANCIAL ASSISTANCE TO FINANCIALLY-ELIGIBLE RESIDENTS OF KOSCIUSKO COUNTY WHO ARE SUFFERING FROM CANCER. THE PURPOSE OF THE FUND IS TO RELIEVE SOME OF THE FINANCIAL STRAIN THAT OFTEN ACCOMPANIES THAT DREADED DIAGNOSIS. THE ASSISTANCE PROVIDED INCLUDES BUT IS NOT LIMITED TO ITEMS SUCH AS RENT OR MORTGAGE PAYMENTS, UTILITIES, INSURANCE, FOOD, CAR PAYMENTS, AND PRESCRIPTION MEDICATIONS. IN ALL SITUATIONS, FINANCIAL ASSISTANCE IS PAID DIRECTLY TO A VENDOR ON BEHALF OF THE CLIENTS. IN 2022 THE CANCER CARE FUND PROVIDED FINANCIAL ASSISTANCE TO OVER 100 KOSCIUSKO COUNTY CANCER PATIENTS AND THEIR FAMILIES. THE FUND DISBURSED APPROXIMATELY $140,000 FOR ITEMS SUCH AS RENT OR MORTGAGE PAYMENTS, UTILITIES, INSURANCE, FOOD, AND PRESCRIPTION MEDICATIONS, JUST TO NAME A FEW. THE FUNDS ARE PRIMARILY RAISED BY A GROUP OF DEDICATED INDIVIDUALS IN KOSCIUSKO COUNTY WHO VOLUNTEER HUNDREDS OF HOURS EACH YEAR TO PLAN A NUMBER OF FUNDRAISING EVENTS, SUCH AS THE GOLF OUTING, GALA AND AUCTION.THE CANCER FUND SOCIAL WORKER REVIEWS ALL CASES AND RECEIVES APPROVAL FOR ALL NEW CLIENT ASSISTANCE BY A SEVEN-PERSON CANCER CARE COMMITTEE, AND COLLABORATES WITH A LEAST ONE OF THE COMMITTEE MEMBERS FOR ANY ONGOING ASSISTANCE PROVIDED PREVIOUS APPROVED CLIENTS. FOR APPLICATION ASSISTANCE CONTACT LAURA DEAL-DECKER AT 574.372.3500 OR LAURA@KOSHELPCENTER.ORG.LINE 2C, ANY SUBMISSION DEADLINES: NONELINE 2D, RESTRICTIONS AND LIMITATIONS ON AWARDS: TO QUALIFY FOR ASSISTANCE, A RECIPIENT MUST PROVIDE:1. DOCUMENTED RESIDENT OF KOSCIUSKO COUNTY.2. VERIFIED CANCER DIAGNOSIS WITHIN THE LAST THREE MONTHS. 3. DEMONSTRATE A FINANCIAL NEED.4. COMPLETE REQUIRED APPLICATION. |
Investments Corp Bonds Schedule InvestmentsCorpBondsSchedule
Investments Corporate Bonds InvestmentsCorporateBondsGrp (2 entries)
| BondBondNm | EOY Book ValueEOYBookValueAmt | EOYFMVEOYFMVAmt |
|---|---|---|
| CORPORATE BONDS | $5,161,173 | $4,838,488 |
| FOREIGN BONDS | $668,267 | $589,929 |
Investments Corp Stock Schedule InvestmentsCorpStockSchedule
Investments Corporate Stock InvestmentsCorporateStockGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Stock | EQUITY SECURITIES | StockNm |
| EOY Book Value | $26,171,276 | EOYBookValueAmt |
| EOYFMV | $36,943,666 | EOYFMVAmt |
Investments Govt Obligations Sch InvestmentsGovtObligationsSch
| Field | Value | IRS element (for citing) |
|---|---|---|
| US Govt Obligations Book Vl EOY | $6,915,768 | USGovtObligationsBookVlEOYAmt |
| US Govt Obligations EOYFMV | $6,477,548 | USGovtObligationsEOYFMVAmt |
| State Local Sec Book Vl EOY | $0 | StateLocalSecBookVlEOYAmt |
| State Local Sec EOYFMV | $0 | StateLocalSecEOYFMVAmt |
Investments Land Schedule2 InvestmentsLandSchedule2
Investment Land InvestmentLandGrp (4 entries)
| Category Or ItemCategoryOrItemTxt | Cost Or Other BasisCostOrOtherBasisAmt | Accumulated DepreciationAccumulatedDepreciationAmt | Book ValueBookValueAmt | EOYFMVEOYFMVAmt |
|---|---|---|---|---|
| LAND IMPROVEMENTS | $311,605 | $179,705 | $131,900 | $131,900 |
| LEASEHOLD IMPROVEMENTS | $969,226 | $365,124 | $604,102 | $604,102 |
| BUILDING | $1,023,544 | $718,868 | $304,676 | $304,676 |
| LAND | $23,895 | $0 | $23,895 | $23,895 |
Investments Other Schedule2 InvestmentsOtherSchedule2
Investments Other InvestmentsOtherGrp (7 entries)
| Category Or ItemCategoryOrItemTxt | Listed At Cost Or FMVListedAtCostOrFMVCd | Book ValueBookValueAmt | EOYFMVEOYFMVAmt |
|---|---|---|---|
| REAL ESTATE INVESTMENT FUND | FMV | $1,659,916 | $3,054,245 |
| HEDGE FUND | FMV | $3,886,111 | $3,230,176 |
| GLOBAL MANAGED VOLATILITY | FMV | $2,027,289 | $3,290,350 |
| US EQUITY INDEX PUTWRITE FUND LLC | FMV | $4,477,614 | $3,928,316 |
| PRIVATE EQUITY | FMV | $1,115,833 | $1,452,344 |
| INFRASTRUCTURE INVESTMENTS | FMV | $4,500,000 | $4,654,016 |
| INTERNATIONAL ROLLOVER FUND | FMV | $3,549,223 | $3,841,605 |
Land Etc Schedule2 LandEtcSchedule2
Land Etc LandEtcGrp (3 entries)
| Category Or ItemCategoryOrItemTxt | Cost Or Other BasisCostOrOtherBasisAmt | Accumulated DepreciationAccumulatedDepreciationAmt | Book ValueBookValueAmt | EOYFMVEOYFMVAmt |
|---|---|---|---|---|
| LAND | $34,100 | $0 | $34,100 | $34,100 |
| OFFICE & COMPUTER EQUIPMENT | $150,770 | $69,068 | $81,702 | $81,702 |
| BUILDING | $880,109 | $89,389 | $790,720 | $790,720 |
Other Assets Schedule OtherAssetsSchedule
Other Assets Schedule OtherAssetsScheduleGrp (3 entries)
| DescDesc | BOY Book ValueBOYBookValueAmt | EOY Book ValueEOYBookValueAmt | EOYFMVEOYFMVAmt |
|---|---|---|---|
| NOTES RECEIVABLE HELD FOR GRANT MAKING | $251,002 | $185,240 | $185,240 |
| RECEIVABLE - OTHER | $1,191 | $1,212 | $1,212 |
| RECEIVABLE - TAX REFUND | $0 | $10,634 | $10,634 |
Other Expenses Schedule OtherExpensesSchedule
Other Expenses Schedule OtherExpensesScheduleGrp (4 entries)
| DescDesc | Revenue And Expenses Per BooksRevenueAndExpensesPerBooksAmt | Net Investment IncomeNetInvestmentIncomeAmt | Adjusted Net IncomeAdjustedNetIncomeAmt | Disbursements Charitable PrpsDisbursementsCharitablePrpsAmt |
|---|---|---|---|---|
| FUNDRAISING EXPENSES | $31,622 | $0 | $0 | $31,622 |
| INSURANCE | $10,325 | $0 | $0 | $9,837 |
| MARKETING | $95,210 | $0 | $0 | $95,210 |
| MISCELLANEOUS EXPENSE | $35,537 | $1,316 | $0 | $34,221 |
Other Income Schedule2 OtherIncomeSchedule2
Other Income Detail OtherIncomeDetail (2 entries)
| DescDesc | Revenue And Expenses Per BooksRevenueAndExpensesPerBooksAmt | Net Investment IncomeNetInvestmentIncomeAmt |
|---|---|---|
| OTHER INCOME | $1,060 | $1,060 |
| OTHER INCOME | $153,518 | $153,518 |
Other Liabilities Schedule OtherLiabilitiesSchedule
Other Liabilities Detail OtherLiabilitiesDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | DEFERRED TAX LIABILITY | Desc |
| BOY Book Value | $360,022 | BOYBookValueAmt |
| EOY Book Value | $169,138 | EOYBookValueAmt |
Other Professional Fees Schedule OtherProfessionalFeesSchedule
Other Professional Fees Detail OtherProfessionalFeesDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Category | INVESTMENT MGT FEES | CategoryTxt |
| Amt | $269,947 | Amt |
| Net Investment Income | $269,947 | NetInvestmentIncomeAmt |
| Adjusted Net Income | $0 | AdjustedNetIncomeAmt |
| Disbursements Charitable Prps | $0 | DisbursementsCharitablePrpsAmt |
Taxes Schedule TaxesSchedule
Taxes Detail TaxesDetail (2 entries)
| CategoryCategoryTxt | AmtAmt | Net Investment IncomeNetInvestmentIncomeAmt | Adjusted Net IncomeAdjustedNetIncomeAmt | Disbursements Charitable PrpsDisbursementsCharitablePrpsAmt |
|---|---|---|---|---|
| FOREIGN INCOME TAXES | $1,268 | $1,268 | $0 | $0 |
| OTHER TAXES | $685 | $0 | $0 | $685 |
Comments