KOSCIUSKO 21ST CENTURY FOUNDATION INC: Form 990PF, tax year 2021
View the entire original 990 at ProPublica ↗
- Organization
- KOSCIUSKO 21ST CENTURY FOUNDATION INC (EIN 35-1187105)
- Tax period
- 2021-01-01 to 2021-12-31
- Filed
- 2022-05-10
- IRS object ID
- 202231309349102438
- Schema version
- 2021v4.2
- 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 Increases Schedule
- Other Liabilities Schedule
- Other Professional Fees Schedule
- Taxes Schedule
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2022-05-10T12:03:11-05:00 | ReturnTs |
| Tax Period End | 2021-12-31 | 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 | 2021-01-01 | 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 | 2022-04-29 | 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 |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 3176334705 | PhoneNum |
| Preparation | 2022-04-29 | PreparationDt |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 3 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2021 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990-PF IRS990PF
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization501c3 Exempt PF | Yes (X) | Organization501c3ExemptPFInd |
| FMV Assets EOY | $91,187,789 | 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 | $405,378 | ContriRcvdRevAndExpnssAmt |
| Interest On Sav Rev And Expnss | $380,945 | InterestOnSavRevAndExpnssAmt |
| Interest On Sav Net Invst Incm | $380,945 | InterestOnSavNetInvstIncmAmt |
| Dividends Rev And Expnss | $1,192,913 | DividendsRevAndExpnssAmt |
| Dividends Net Invst Incm | $1,192,913 | DividendsNetInvstIncmAmt |
| Gross Rents Rev And Expnss | $218,527 | GrossRentsRevAndExpnssAmt |
| Gross Rents Net Invst Incm | $218,527 | GrossRentsNetInvstIncmAmt |
| Net Rental Income Or Loss | $64,340 | NetRentalIncomeOrLossAmt |
| Net Gain Sale Ast Rev And Expnss | $5,532,322 | NetGainSaleAstRevAndExpnssAmt |
| Gross Sales Price | $64,223,214 | GrossSalesPriceAmt |
| Cap Gain Net Incm Net Invst Incm | $5,532,322 | CapGainNetIncmNetInvstIncmAmt |
| Other Income Rev And Expnss | $530 | OtherIncomeRevAndExpnssAmt |
| Other Income Net Invst Incm | $530 | OtherIncomeNetInvstIncmAmt |
| Other Income Adj Net Incm | $0 | OtherIncomeAdjNetIncmAmt |
| Total Rev And Expnss | $7,730,615 | TotalRevAndExpnssAmt |
| Total Net Invst Incm | $7,325,237 | TotalNetInvstIncmAmt |
| Total Adj Net Incm | $0 | TotalAdjNetIncmAmt |
| Comp Ofcr Dir Trst Rev And Expnss | $219,709 | 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 | $219,709 | CompOfcrDirTrstDsbrsChrtblAmt |
| Oth Empl Slrs Wgs Rev And Expnss | $102,173 | 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 | $104,419 | OthEmplSlrsWgsDsbrsChrtblAmt |
| Pension Empl Bnft Rev And Expnss | $28,424 | PensionEmplBnftRevAndExpnssAmt |
| Pension Empl Bnft Net Invst Incm | $0 | PensionEmplBnftNetInvstIncmAmt |
| Pension Empl Bnft Adj Net Incm | $0 | PensionEmplBnftAdjNetIncmAmt |
| Pension Empl Bnft Dsbrs Chrtbl | $28,424 | PensionEmplBnftDsbrsChrtblAmt |
| Accounting Fees Rev And Expnss | $18,975 | AccountingFeesRevAndExpnssAmt |
| Accounting Fees Net Invst Incm | $0 | AccountingFeesNetInvstIncmAmt |
| Accounting Fees Adj Net Incm | $0 | AccountingFeesAdjNetIncmAmt |
| Accounting Fees Chrtbl Prps | $18,975 | AccountingFeesChrtblPrpsAmt |
| Other Prof Fees Rev And Expnss | $265,190 | OtherProfFeesRevAndExpnssAmt |
| Other Prof Fees Net Invst Incm | $265,190 | OtherProfFeesNetInvstIncmAmt |
| Other Prof Fees Adj Net Incm | $0 | OtherProfFeesAdjNetIncmAmt |
| Other Prof Fees Dsbrs Chrtbl | $0 | OtherProfFeesDsbrsChrtblAmt |
| Taxes Rev And Expnss | $166,997 | TaxesRevAndExpnssAmt |
| Taxes Net Invst Incm | $51 | TaxesNetInvstIncmAmt |
| Taxes Adj Net Incm | $0 | TaxesAdjNetIncmAmt |
| Taxes Dsbrs Chrtbl | $6,081 | TaxesDsbrsChrtblAmt |
| Deprec And Dpltn Rev And Expnss | $212,036 | DeprecAndDpltnRevAndExpnssAmt |
| Deprec And Dpltn Net Invst Incm | $153,122 | DeprecAndDpltnNetInvstIncmAmt |
| Deprec And Dpltn Adj Net Incm | $0 | DeprecAndDpltnAdjNetIncmAmt |
| Occupancy Rev And Expnss | $26,157 | OccupancyRevAndExpnssAmt |
| Occupancy Net Invst Incm | $0 | OccupancyNetInvstIncmAmt |
| Occupancy Adj Net Incm | $0 | OccupancyAdjNetIncmAmt |
| Occupancy Dsbrs Chrtbl | $26,157 | OccupancyDsbrsChrtblAmt |
| Trav Conf Meeting Rev And Expnss | $4,768 | TravConfMeetingRevAndExpnssAmt |
| Trav Conf Meeting Net Invst Incm | $0 | TravConfMeetingNetInvstIncmAmt |
| Trav Conf Meeting Adj Net Incm | $0 | TravConfMeetingAdjNetIncmAmt |
| Trav Conf Meeting Dsbrs Chrtbl | $4,768 | TravConfMeetingDsbrsChrtblAmt |
| Printing And Pub Rev And Expnss | $3,307 | PrintingAndPubRevAndExpnssAmt |
| Printing And Pub Net Invst Incm | $0 | PrintingAndPubNetInvstIncmAmt |
| Printing And Pub Adj Net Incm | $0 | PrintingAndPubAdjNetIncmAmt |
| Printing And Pub Dsbrs Chrtbl | $3,307 | PrintingAndPubDsbrsChrtblAmt |
| Other Expenses Rev And Expnss | $909,854 | OtherExpensesRevAndExpnssAmt |
| Other Expenses Net Invst Incm | $1,065 | OtherExpensesNetInvstIncmAmt |
| Other Expenses Adj Net Incm | $0 | OtherExpensesAdjNetIncmAmt |
| Other Expenses Dsbrs Chrtbl | $87,743 | OtherExpensesDsbrsChrtblAmt |
| Tot Opr Expenses Rev And Expnss | $1,957,590 | TotOprExpensesRevAndExpnssAmt |
| Tot Opr Expenses Net Invst Incm | $419,428 | TotOprExpensesNetInvstIncmAmt |
| Tot Opr Expenses Adj Net Incm | $0 | TotOprExpensesAdjNetIncmAmt |
| Tot Opr Expenses Dsbrs Chrtbl | $499,583 | TotOprExpensesDsbrsChrtblAmt |
| Contri Paid Rev And Expnss | $3,162,915 | ContriPaidRevAndExpnssAmt |
| Contri Paid Dsbrs Chrtbl | $2,309,247 | ContriPaidDsbrsChrtblAmt |
| Total Expenses Rev And Expnss | $5,120,505 | TotalExpensesRevAndExpnssAmt |
| Total Expenses Net Invst Incm | $419,428 | TotalExpensesNetInvstIncmAmt |
| Total Expenses Adj Net Incm | $0 | TotalExpensesAdjNetIncmAmt |
| Total Expenses Dsbrs Chrtbl | $2,808,830 | TotalExpensesDsbrsChrtblAmt |
| Excess Revenue Over Expenses | $2,610,110 | ExcessRevenueOverExpensesAmt |
| Net Investment Income | $6,905,809 | NetInvestmentIncomeAmt |
| Adjusted Net Income | $0 | AdjustedNetIncomeAmt |
Form990 PF Balance Sheets Form990PFBalanceSheetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Sav And Temp Cash Invst BOY | $657,305 | SavAndTempCashInvstBOYAmt |
| Sav And Temp Cash Invst EOY | $4,938,009 | SavAndTempCashInvstEOYAmt |
| Sav And Temp Cash Invst EOYFMV | $4,938,009 | SavAndTempCashInvstEOYFMVAmt |
| Prepaid Expenses BOY | $10,109 | PrepaidExpensesBOYAmt |
| Prepaid Expenses EOY | $10,748 | PrepaidExpensesEOYAmt |
| Prepaid Expenses EOYFMV | $10,748 | PrepaidExpensesEOYFMVAmt |
| US Government Obligations BOY | $6,051,741 | USGovernmentObligationsBOYAmt |
| US Government Obligations EOY | $6,319,390 | USGovernmentObligationsEOYAmt |
| US Govt Obligations EOYFMV | $6,252,302 | USGovtObligationsEOYFMVAmt |
| Corporate Stock BOY | $31,076,371 | CorporateStockBOYAmt |
| Corporate Stock EOY | $27,989,927 | CorporateStockEOYAmt |
| Corporate Stock EOYFMV | $50,811,931 | CorporateStockEOYFMVAmt |
| Corporate Bonds BOY | $6,800,646 | CorporateBondsBOYAmt |
| Corporate Bonds EOY | $8,914,763 | CorporateBondsEOYAmt |
| Corporate Bonds EOYFMV | $8,871,556 | CorporateBondsEOYFMVAmt |
| Invst Land Cost Or Other Basis | $2,328,270 | InvstLandCostOrOtherBasisAmt |
| Invst Land Accum Depreciation | $1,110,576 | InvstLandAccumDepreciationAmt |
| Land Bldg Investments BOY | $2,239,024 | LandBldgInvestmentsBOYAmt |
| Land Bldg Investments EOY | $1,217,694 | LandBldgInvestmentsEOYAmt |
| Land Bldg Investments EOYFMV | $1,217,694 | LandBldgInvestmentsEOYFMVAmt |
| Other Investments BOY | $13,996,621 | OtherInvestmentsBOYAmt |
| Other Investments EOY | $14,686,114 | OtherInvestmentsEOYAmt |
| Other Investments EOYFMV | $17,875,294 | OtherInvestmentsEOYFMVAmt |
| Land Bldg Equip Cost Or Other Bss | $1,055,579 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $97,517 | LandBldgEquipAccumDeprecAmt |
| Land BOY | $114,319 | LandBOYAmt |
| Land EOY | $958,062 | LandEOYAmt |
| Land EOYFMV | $958,062 | LandEOYFMVAmt |
| Other Assets BOY | $789,262 | OtherAssetsBOYAmt |
| Other Assets EOY | $252,193 | OtherAssetsEOYAmt |
| Other Assets EOYFMV | $252,193 | OtherAssetsEOYFMVAmt |
| Total Assets BOY | $61,735,398 | TotalAssetsBOYAmt |
| Total Assets EOY | $65,286,900 | TotalAssetsEOYAmt |
| Total Assets EOYFMV | $91,187,789 | TotalAssetsEOYFMVAmt |
| Accounts Payable BOY | $15,141 | AccountsPayableBOYAmt |
| Accounts Payable EOY | $38,866 | AccountsPayableEOYAmt |
| Grants Payable BOY | $280,196 | GrantsPayableBOYAmt |
| Grants Payable EOY | $312,179 | GrantsPayableEOYAmt |
| Other Liabilities BOY | $296,023 | OtherLiabilitiesBOYAmt |
| Other Liabilities EOY | $360,022 | OtherLiabilitiesEOYAmt |
| Total Liabilities BOY | $591,360 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $711,067 | TotalLiabilitiesEOYAmt |
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
| No Donor Rstr Net Assests BOY | $59,898,316 | NoDonorRstrNetAssestsBOYAmt |
| No Donor Rstr Net Assests EOY | $63,060,146 | NoDonorRstrNetAssestsEOYAmt |
| Donor Rstr Net Assets BOY | $1,245,722 | DonorRstrNetAssetsBOYAmt |
| Donor Rstr Net Assets EOY | $1,515,687 | DonorRstrNetAssetsEOYAmt |
| Tot Net Ast Or Fund Balances BOY | $61,144,038 | TotNetAstOrFundBalancesBOYAmt |
| Tot Net Ast Or Fund Balances EOY | $64,575,833 | TotNetAstOrFundBalancesEOYAmt |
| Total Liabilities Net Ast BOY | $61,735,398 | TotalLiabilitiesNetAstBOYAmt |
| Total Liabilities Net Ast EOY | $65,286,900 | TotalLiabilitiesNetAstEOYAmt |
Chg In Net Assets Fund Balances ChgInNetAssetsFundBalancesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tot Net Ast Or Fund Balances BOY | $61,144,038 | TotNetAstOrFundBalancesBOYAmt |
| Excess Revenue Over Expenses | $2,610,110 | ExcessRevenueOverExpensesAmt |
| Other Increases | $821,685 | OtherIncreasesAmt |
| Subtotal | $64,575,833 | SubtotalAmt |
| Other Decreases | $0 | OtherDecreasesAmt |
| Tot Net Ast Or Fund Balances EOY | $64,575,833 | 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 | $64,223,214 | GrossSalesPriceAmt |
| Cost Or Other Basis | $58,690,892 | CostOrOtherBasisAmt |
| Gain Or Loss | $5,532,322 | GainOrLossAmt |
| Gains Minus Excess Or Losses | $5,532,322 | GainsMinusExcessOrLossesAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Capital Gain Net Income | $5,532,322 | CapitalGainNetIncomeAmt |
Excise Tax Based On Invst Incm ExciseTaxBasedOnInvstIncmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Income Excise Tax | $95,991 | InvestmentIncomeExciseTaxAmt |
| Tax Under Section511 | $0 | TaxUnderSection511Amt |
| Subtotal | $95,991 | SubtotalAmt |
| Subtitle A Tax | $0 | SubtitleATaxAmt |
| Tax Based On Investment Income | $95,991 | TaxBasedOnInvestmentIncomeAmt |
| Estimated Plus Ovpmt Incm Tx | $58,000 | 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 | $58,000 | TotalPaymentsAndCreditsAmt |
| Form2220 Attached | Yes (X) | Form2220AttachedInd |
| Es Penalty | $875 | EsPenaltyAmt |
| Tax Due | $38,866 | TaxDueAmt |
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 (18 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 | $213,479 | $6,230 | $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 |
| JOE GRAHAM | ||||||||
| 1101 PARK AVE | WINONA LAKE | IN | 46590 | DIRECTOR | 1.00 | $0 | $0 | $0 |
| STEVE GRILL | ||||||||
| 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 |
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 | $55,206 | CompensationAmt |
| Employee Benefits | $1,623 | EmployeeBenefitsAmt |
| Expense Account | $0 | ExpenseAccountAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Employee Paid Over50k | 0 | OtherEmployeePaidOver50kCnt |
Compensation Of Hghst Pd Cntrct CompensationOfHghstPdCntrctGrp (5 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | Service TypeServiceTypeTxt | CompensationCompensationAmt |
|---|---|---|---|---|---|
| DAVE'S ELECTRIC HEATING & COOLING INC | |||||
| PO BOX 273 | NORTH WEBSTER | IN | 46555 | BUILDING RENOVATIONS | $80,000 |
| USI CONSULTANTS | |||||
| 8415 E 56TH ST | INDIANAPOLIS | IN | 46216 | CONSULTING | $80,000 |
| MARQUETTE ASSOCIATES | |||||
| 180 N LASALLE SUITE 3500 | CHICAGO | IL | 60601 | INVESTMENT CONSULTING | $69,000 |
| 212 MEDIA STUDIOS | |||||
| 1042 E WINONA AVE | WARSAW | IN | 46580 | MARKETING | $66,910 |
| COTTAGE WATCHMAN | |||||
| 883 S 900 E | PIERCETON | IN | 46562 | SECURITY | $50,009 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contractor Paid Over50k | 0 | ContractorPaidOver50kCnt |
Sum Of Program Related Invst SumOfProgramRelatedInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description1 | FORGIVENESS OF CURRENT LOAN MORTGAGE PRINCIPAL AND INTEREST DUE FROM KOSCIUSKO HEALTH SERVICES PAVILION, INC., A SECTION 501(C(3) ORGANIZATION. | Description1Txt |
| Expenses1 | $821,685 | Expenses1Amt |
| Total | $821,685 | TotalAmt |
Minimum Investment Return MinimumInvestmentReturnGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Average Monthly FMV Of Sec | $85,649,888 | AverageMonthlyFMVOfSecAmt |
| Average Monthly Cash Balances | $518,445 | AverageMonthlyCashBalancesAmt |
| FMV All Other Noncharitable Ast | $0 | FMVAllOtherNoncharitableAstAmt |
| Total FMV Of Unused Assets | $86,168,333 | TotalFMVOfUnusedAssetsAmt |
| Reduction Claimed | $0 | ReductionClaimedAmt |
| Acquisition Indebtedness | $0 | AcquisitionIndebtednessAmt |
| Adjusted Total FMV Of Unused Ast | $86,168,333 | AdjustedTotalFMVOfUnusedAstAmt |
| Cash Deemed Charitable | $1,292,525 | CashDeemedCharitableAmt |
| Net Vl Noncharitable Assets | $84,875,808 | NetVlNoncharitableAssetsAmt |
| Minimum Investment Return | $4,243,790 | MinimumInvestmentReturnAmt |
Distributable Amount DistributableAmountGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Minimum Investment Return | $4,243,790 | MinimumInvestmentReturnAmt |
| Tax Based On Investment Income | $95,991 | TaxBasedOnInvestmentIncomeAmt |
| Total Tax | $95,991 | TotalTaxAmt |
| Distributable Before Adj | $4,147,799 | DistributableBeforeAdjAmt |
| Recoveries Qualfied Distri | $0 | RecoveriesQualfiedDistriAmt |
| Distributable Before Ded | $4,147,799 | DistributableBeforeDedAmt |
| Deduction From Distributable | $0 | DeductionFromDistributableAmt |
| Distributable As Adjusted | $4,147,799 | DistributableAsAdjustedAmt |
PF Qualifying Distributions PFQualifyingDistributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expenses And Contributions | $2,808,830 | ExpensesAndContributionsAmt |
| Program Related Invst Total | $821,685 | ProgramRelatedInvstTotalAmt |
| Qualifying Distributions | $3,630,515 | QualifyingDistributionsAmt |
Undistributed Income UndistributedIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Distributable As Adjusted | $4,147,799 | DistributableAsAdjustedAmt |
| Undistributed Income PY | $0 | UndistributedIncomePYAmt |
| Total For Prior Years | $0 | TotalForPriorYearsAmt |
| Excess Distribution Cyov Yr5 | $515,855 | ExcessDistributionCyovYr5Amt |
| Excess Distribution Cyov Yr4 | $539,316 | ExcessDistributionCyovYr4Amt |
| Excess Distribution Cyov Yr3 | $624,896 | ExcessDistributionCyovYr3Amt |
| Excess Distribution Cyov Yr2 | $712,716 | ExcessDistributionCyovYr2Amt |
| Total Excess Distribution Cyov | $2,392,783 | TotalExcessDistributionCyovAmt |
| Qualifying Distributions | $3,630,515 | QualifyingDistributionsAmt |
| Applied To Year1 | $0 | AppliedToYear1Amt |
| Applied To Prior Years | $0 | AppliedToPriorYearsAmt |
| Treated As Distri From Corpus | $0 | TreatedAsDistriFromCorpusAmt |
| Applied To Current Year | $3,630,515 | AppliedToCurrentYearAmt |
| Remaining Distri From Corpus | $0 | RemainingDistriFromCorpusAmt |
| Excess Distri Cyov App CY Corpus | $517,284 | ExcessDistriCyovAppCYCorpusAmt |
| Excess Distribution Cyov App CY | $517,284 | ExcessDistributionCyovAppCYAmt |
| Total Corpus | $1,875,499 | 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 | $0 | ExcessDistriCyovFromYr5Amt |
| Excess Distri Cyov To Next Yr | $1,875,499 | ExcessDistriCyovToNextYrAmt |
| Excess From Year4 | $537,887 | ExcessFromYear4Amt |
| Excess From Year3 | $624,896 | ExcessFromYear3Amt |
| Excess From Year2 | $712,716 | ExcessFromYear2Amt |
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 (67 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 | $107,983 |
| BAKER YOUTH CLUB | |||||||
| 1401 E SMITH ST | WARSAW | IN | 46580 | NONE | PC | OPERATIONAL ASSISTANCE | $37,500 |
| BOWEN CENTER | |||||||
| 2621 EAST JEFFERSON STREET | WARSAW | IN | 46580 | NONE | PC | SYSTEMS OF CARE COORDINATOR | $2,500 |
| 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 |
| FELLOWSHIP MISSIONS | |||||||
| 1520 EAST WINONA AVENUE | WARSAW | IN | 46580 | NONE | PC | CAMP CROSLEY RENTAL | $10,000 |
| GRACE COLLEGE & SEMINARY | |||||||
| 1 LANCER WAY | WINONA LAKE | IN | 46590 | NONE | PC | LILLY CENTER OPERATIONAL ASSISTANCE/COVID FUNDING | $20,000 |
| GRACE VILLAGE HEALTH CARE | |||||||
| 337 GRACE VILLAGE DR | WINONA LAKE | IN | 46590 | NONE | PC | COVID RELIEF SUPPORT | $17,400 |
| IVY TECH - WARSAW | |||||||
| 337 GRACE VILLAGE DR | WINONA LAKE | IN | 46590 | NONE | PC | COVID RELIEF SUPPORT | $2,761 |
| KOSCIUSKO COMMUNITY YMCA | |||||||
| 1305 MARINERS DR | WARSAW | IN | 46582 | NONE | PC | OEPRATIONAL ASSISTANCE/YOUTH SPORTS PROGRAMS | $22,500 |
| KOSCIUSKO COUNTY COMMUNITY FOUNDATION | |||||||
| 102 EAST MARKET STREET | WARSAW | IN | 46580 | NONE | PC | GOOD SAMARITAN FUND | $125,000 |
| KOSCIUSKO HOME CARE & HOSPICE | |||||||
| 1515 PROVIDENT DRIVE STE 250 | WARSAW | IN | 46580 | NONE | PC | OPERATIONAL ASSISTANCE | $172,400 |
| LAKELAND CHRISTIAN ACADEMY | |||||||
| 1093 S 250 E | WINONA LAKE | IN | 46590 | NONE | PC | COVID RELIEF SUPPORT | $9,000 |
| 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 |
| RONALD MCDONALD HOUSE CHARITIES | |||||||
| 11109 PARKVIEW PLAZA DR | FORT WAYNE | IN | 46845 | NONE | PC | MOBILE CLINIC AND OPERATING SUPPORT | $5,000 |
| RYAN'S PLACE INC | |||||||
| PO BOX 73 | GOSHEN | IN | 46527 | NONE | PC | OPERATIONAL ASSISTANCE | $8,000 |
| SAFE HARBOR CHILD ADVOCACY CENTER | |||||||
| 1515 PROVIDENT DRIVE | WARSAW | IN | 46580 | NONE | PC | OPERATIONAL ASSISTANCE | $10,000 |
| TIPPECANOE VALLEY SCHOOL CORP | |||||||
| 8343 S SR 19 | AKRON | IN | 46910 | NONE | PC | SEL CURRICULUM PROGRAM | $10,000 |
| TOWN OF SILVER LAKE | |||||||
| 604 N JEFFERSON ST | SILVER LAKE | IN | 46982 | NONE | PC | COVID RELIEF SUPPORT | $1,933 |
| WAGON WHEEL THEATRE INC | |||||||
| 2515 E CENTER ST | WARSAW | IN | 46580 | NONE | PC | COVID RELIEF SUPPORT | $3,279 |
| WARSAW COMMUNITY SCHOOLS | |||||||
| 1 ADMINISTRATION DR | WARSAW | IN | 46580 | NONE | PC | WATER DISPENSERS | $19,163 |
| 2ND MILE ADVENTURES | |||||||
| 2562 WALTON BLVD | WARSAW | IN | 46582 | NONE | PC | PROGRAM EQUPMENT | $2,241 |
| ALL THINGS NEW | |||||||
| PO BOX 376 | WINONA LAKE | IN | 46590 | NONE | PC | PROGRAM SUPPLIES | $2,458 |
| BAKER YOUTH CLUB | |||||||
| 1401 EAST SMITH STREET | WARSAW | IN | 46580 | NONE | PC | FACILITY RENOVATION | $25,000 |
| COMBINED COMMUNITY SERVICES | |||||||
| 1195 MARINERS DRIVE | WARSAW | IN | 46582 | NONE | PC | FACILITY RENOVATION AND PROGRAM SUPPORT | $90,009 |
| FELLOWSHIP MISSIONS | |||||||
| 1520 E WINONA AVE | WARSAW | IN | 46580 | NONE | PC | ADDICTION RECOVERY PROGRAM SUPPORT | $100,000 |
| GRACE COLLEGE & SEMINARY | |||||||
| 1 LANCER WAY | WINONA LAKE | IN | 46590 | NONE | PC | LAKE RESEARCH | $22,371 |
| HARVEST WITH A HEART | |||||||
| PO BOX 425 | MILFORD | IN | 46542 | NONE | PC | FACILITY PURCHASE AND RENOVATION | $71,459 |
| HEARTLINE PREGNANCY CENTER | |||||||
| 1515 PROVIDENT DRIVE SUITE 180 | WARSAW | IN | 46580 | NONE | PC | PROGRAM FUNDING | $37,990 |
| JOE'S KIDS | |||||||
| 902 PROVIDENT DRIVE SUITE C | WARSAW | IN | 46580 | NONE | PC | RENT SUBSIDY | $41,220 |
| KOSCIUSKO COMMUNITY YMCA | |||||||
| 1305 MARINERS DR | WARSAW | IN | 46582 | NONE | PC | TECHNOLOGY UPGRADE | $12,959 |
| KOSCIUSKO HEALTH SERVICES PAVILION | |||||||
| 1515 PROVIDENT DR | WARSAW | IN | 46582 | NONE | PC | FACILITY RENOVATION | $13,683 |
| KOSCIUSKO HOME CARE & HOSPICE | |||||||
| 1515 PROVIDENT DRIVE STE 250 | WARSAW | IN | 46581 | NONE | PC | MEDICATION & DENTAL ASSISTANCE/COMPUTERS | $258,445 |
| LAKE CITY SKIERS | |||||||
| 2455 HIDDEN LAKE DRIVE | WARSAW | IN | 46580 | NONE | PC | LEARN TO SKI PROGRAM EQUIPMENT | $14,653 |
| LIVE WELL KOSCIUSKO | |||||||
| 8546 SOUTH 200 WEST | CLAYPOOL | IN | 46510 | NONE | PC | OPERATIONAL FUNDING | $95,286 |
| MOM OF AN ADDICT INC | |||||||
| 10214 CHESTNUT PLAZA DR | FORT WAYNE | IN | 46814 | NONE | PC | PROGRAM SUPPORT | $9,260 |
| NORTHERN INDIANA HISPANIC HEALTH COALITION | |||||||
| 444 NORTH NAPPANEE STREET | ELKHART | IN | 46514 | NONE | PC | HEALTH SCREENINGS/CLIENT ADVOCAC;Y | $42,545 |
| PARKVIEW HOSPITAL INC | |||||||
| 10622 PARKVIEW PLAZA DR | FORT WAYNE | IN | 46845 | NONE | PC | PROGRAM SUPPORT | $11,073 |
| ROSE GARDEN RECOVERY COMMUNITY | |||||||
| 72876 CR 29 | SYRACUSE | IN | 46567 | NONE | PC | FACILITY RENOVATION | $4,000 |
| SAFE HARBOR CHILD ADVOCACY CENTER | |||||||
| 1515 PROVIDENT DRIVE | WARSAW | IN | 46580 | NONE | PC | PROGRAM EQUPMENT | $8,460 |
| SYRACUSE WAWASEE PARK FOUNDATION | |||||||
| 1013 N LONG DR | SYRACUSE | IN | 46567 | NONE | PC | GREENWAY FEASIBILITY STUDY | $50,000 |
| TIPPECANOE VALLEY SCHOOL CORP | |||||||
| 8343 S SR 19 | AKRON | IN | 46910 | NONE | PC | PROJECT LEAD THE WAY PROGRAM | $29,982 |
| TOWN OF AKRON | |||||||
| 206 W ROCHESTER ST | AKRON | IN | 46910 | NONE | PC | WALKING TRAIL | $15,000 |
| TOWN OF NORTH WEBSTER | |||||||
| 144 SOUTH MAIN STREET | NORTH WEBSTER | IN | 46555 | NONE | PC | COMMUNITIES GRANT | $154,046 |
| TOWN OF SYRACUSE | |||||||
| 310 N HUNTINGTON ST | SYRACUSE | IN | 46567 | NONE | PC | COMMUNITIES GRANT | $200,000 |
| TOWN OF WINONA LAKE | |||||||
| 1310 PARK AVENUE | WINONA LAKE | IN | 46590 | NONE | PC | GREENWAY AND EQUIPMENT | $154,768 |
| WARSAW COMMUNITY SCHOOLS | |||||||
| 1 ADMINISTRATIION DRIVE | WARSAW | IN | 46580 | NONE | PC | PROGRAM EQUIPMENT | $50,000 |
| WHITKO COMMUNITY SCHOOLS | |||||||
| 710 NORTH SR 5 | LARWILL | IN | 46764 | NONE | PC | EMERGENCY PREPAREDNESS EQUPIMENT | $16,313 |
| YOUNG TIGER FOOTBALL | |||||||
| PO COX 1362 | WARSAW | IN | 46580 | NONE | PC | EQUIPMENT | $11,291 |
| OTHER GRANTS LESS THAN 1000 | |||||||
| 1101 PARK AVE | WINONA LAKE | IN | 46590 | NONE | PC | OPERATING SUPPORT | $5,518 |
| AGAITAS | |||||||
| 710 PARK AVE | WINONA LAKE | IN | 46590 | NONE | PC | OPERATING SUPPORT | $2,500 |
| BPO ELKS LODGE #802 | |||||||
| 310 E CENTER ST | WARSAW | IN | 46580 | NONE | PC | HOLIDAY PROGRAM SUPPORT | $2,000 |
| BAKER YOUTH CLUB | |||||||
| 1400 E SMITH ST | WARSAW | IN | 46580 | NONE | PC | OPERATING SUPPORT | $2,000 |
| BRANCHES VINEYARD CHURCH | |||||||
| 765 W MARKET ST | WARSAW | IN | 46580 | NONE | PC | OPERATING SUPPORT | $1,000 |
| FELLOWSHIP MISSIONS | |||||||
| 1520 EAST WINONA AVENUE | WARSAW | IN | 46580 | NONE | PC | OPERATING SUPPORT | $2,000 |
| GRACE COLLEGE & SEMINARY | |||||||
| 1 LANCER WAY | WINONA LAKE | IN | 46590 | NONE | PC | OPERATING SUPPORT | $2,000 |
| FRONT-LINE WORKER RESOURCES | |||||||
| 1101 PARK AVE | WINONA LAKE | IN | 46590 | NONE | PC | DIRECTORY RESOURCES | $1,153 |
| KOSCIUSKO COUNTY COUNCIL ON AGING | |||||||
| 800 N PARK AVE | WARSAW | IN | 46580 | NONE | PC | OPERATING SUPPORT | $1,000 |
| LAKELAND YOUTH CENTER | |||||||
| 101 W CHICAGO ST | SYRACUSE | IN | 46567 | NONE | PC | OPERATING SUPPORT | $1,000 |
| NORTHERN INDIANA HISPANIC HEALTH COALITION | |||||||
| 444 NORTH NAPPANEE STREET | ELKHART | IN | 46514 | NONE | PC | OPERATING SUPPORT | $1,000 |
| OUR LADY OF GUADALUPE CHURCH | |||||||
| PO BOX 1136 | WARSAW | IN | 46580 | NONE | PC | OPERATING SUPPORT | $1,000 |
| NORTH STAR MEDICAL | |||||||
| 124 JAMES STREET | HOLLAND | MI | 49424 | NONE | PC | AED AND MEDICAL EQUIPMENT FOR MULTIPLE ORGANIZATIONS | $35,635 |
| RILEY CHILDREN'S FOUNDATION | |||||||
| 30 S MERIDIAN ST | INDIANAPOLIS | IN | 46204 | NONE | PC | OPERATING SUPPORT | $1,000 |
| ROSE GARDEN RECOVERY COMMUNITY | |||||||
| 72876 CR 29 | SYRACUSE | IN | 46567 | NONE | PC | OPERATING SUPPORT | $1,000 |
| VACCINE EDUCATION CAMPAIGN | |||||||
| 1101 PARK AVE | WINONA LAKE | IN | 46590 | NONE | PC | PUBLIC HEALTH EDUCATION CAMPAIGN | $64,510 |
| WAGON WHEEL THEATRE INC | |||||||
| 2515 E CENTER ST | WARSAW | IN | 46580 | NONE | PC | OPERATING SUPPORT | $1,000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Grant Or Contri Pd Dur Yr | $2,309,247 | 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 | $380,945 | ExclusionAmt |
Dividends And Interest From Sec Dtl DividendsAndInterestFromSecDtl
| Field | Value | IRS element (for citing) |
|---|---|---|
| Exclusion | 14 | ExclusionCd |
| Exclusion | $1,192,913 | ExclusionAmt |
Net Rntl Incm Re Not Debt Fincd Prop NetRntlIncmReNotDebtFincdProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Exclusion | 16 | ExclusionCd |
| Exclusion | $64,340 | ExclusionAmt |
Other Investment Income OtherInvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Exclusion | 14 | ExclusionCd |
| Exclusion | $530 | ExclusionAmt |
Gain Sales Ast Oth Than Invntry GainSalesAstOthThanInvntryGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Exclusion | 18 | ExclusionCd |
| Exclusion | $5,532,322 | ExclusionAmt |
Subtotals Incm Producing Acty SubtotalsIncmProducingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Unrelated Business Taxbl Incm | $0 | UnrelatedBusinessTaxblIncmAmt |
| Exclusion | $7,171,050 | ExclusionAmt |
| Related Or Exempt Function Incm | $0 | RelatedOrExemptFunctionIncmAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Income Producing Acty | $7,171,050 | 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 (6 entries)
| ContributorContributorNum | Address Line1ContributorUSAddress/AddressLine1Txt | CityContributorUSAddress/CityNm | State AbbreviationContributorUSAddress/StateAbbreviationCd | ZIPContributorUSAddress/ZIPCd | Total ContributionsTotalContributionsAmt | Noncash ContributionNoncashContributionInd | Person ContributionPersonContributionInd |
|---|---|---|---|---|---|---|---|
| DR AND MRS RICK SASSO | |||||||
| 1 | 10674 WINTERWOOD | CARMEL | IN | 46032 | $200,359 | Yes (X) | |
| LUTHERAN HEALTH NETWORK | |||||||
| 2 | 7916 W JEFFERSON BLVD | FORT WAYNE | IN | 46804 | $5,000 | Yes (X) | |
| BERTSCH FAMILY CHARITABLE FOUNDATION | |||||||
| 3 | PO BOX 1494 | WARSAW | IN | 46581 | $6,000 | Yes (X) | |
| MR AND MRS DOUGLAS SCHROCK | |||||||
| 4 | 711 SOUTH STREET | KEY WEST | FL | 33040 | $10,000 | Yes (X) | |
| MR AND MRS DONALD GUNDEN | |||||||
| 5 | 64874 ORCHARD DR | GOSHEN | IN | 46526 | $5,000 | Yes (X) | |
| MR W MERWIN FORBES | |||||||
| 6 | 1433 CAMELOT DR | WINONA LAKE | IN | 46590 | $5,000 | Yes (X) | |
Non Cash Property Contribution NonCashPropertyContributionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | 1 | ContributorNum |
| Noncash Property | MARKETABLE SECURITIES | NoncashPropertyDesc |
| Fair Market Value | $200,359 | FairMarketValueAmt |
Accounting Fees Schedule AccountingFeesSchedule
Accounting Fees Detail AccountingFeesDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Category | ACCOUNTING FEES | CategoryTxt |
| Amt | $18,975 | Amt |
| Net Investment Income | $0 | NetInvestmentIncomeAmt |
| Adjusted Net Income | $0 | AdjustedNetIncomeAmt |
| Disbursements Charitable Prps | $18,975 | 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 CITIZENS 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 APPLICATIONS CAN BE ACCESSED THROUGH AN ONLINE PROCESS AT WWW.K21FOUNDATION.ORG UNDER "APPLY FOR GRANTS". GRANT APPLICATIONS ARE ACCEPTED FOUR TIMES EACH YEAR. APPLICATIONS RECEIVED AFTER THESE DEADLINES WILL BE HELD UNTIL THE NEXT CYCLE. FOR ASSISTANCE COMPLETING THE APPLICATION CONTACT: GRANT COORDINATOR, HOLLY SWOVERLAND, AT (574) 269-5188 OR HSWOVERLAND@K21FOUNDATION.ORG.LINE 2C, ANY SUBMISSION DEADLINES: SUBMISSION DEADLINES ARE FEB 1ST, MAY 1ST, AUG 1ST, AND NOV 1ST.LINE 2D, RESTRICTIONS AND LIMITATIONS ON AWARDS: GRANTEES MUST MEET THE FOLLOWING REQUIREMENTS:A)NON-PROFIT AGENCY WITH VERIFIED IRS TAX-EXEMPT STATUS, OR A GOVERNMENT AGENCY. B)BE IN GOOD STANDING WITH THE INDIANA SECRETARY OF STATE AS INDICATED IN A BUSINESS ENTITY REPORT. C)BYLAWS MUST REQUIRE TERM LIMITS FOR DIRECTORS AND A ROTATING BOARD IS STRONGLY ENCOURAGED.GRANT REQUESTS MUST MEET THE FOLLOWING REQUIREMENTS:A) PROJECT, PROGRAM, OR SERVICES MUST BENEFIT RESIDENTS OF KOSCIUSKO COUNTY.B) K21 GRANT PRIORITIES ARE FOR HEALTH NEEDS OR HEALTH IMPROVEMENT. ALTHOUGH THE FOUNDATION CONSIDERS ANY GRANT OPPORTUNITIES THAT CLEARLY ADDRESSES HEALTH AND WELLNESS ISSUES FOR OUR COMMUNITY, OUR PRIORITIES FOR FUNDING CONSIDERATION FOCUS ON THE FOLLOWING:1) NON-PROFIT ORGANIZATIONS PROVIDING DIRECT HEALTH SERVICES TO PEOPLE IN NEED.2) FUNDING ORGANIZATIONS THAT ARE MAKING ADVANCES OR PROVIDING SERVICES IN PREVENTION IMPROVEMENTS TO MINIMIZE THE NEED FOR HEALTH SERVICES.3) SUPPORTING THOSE WHO ARE DEVELOPING AND IMPLEMENTING SOLUTIONS TOWARD PROVIDING OPPORTUNITIES TO PURSUE HEALTHY LIFESTYLES AND DECISIONS. 4)A COMMITMENT TO REGULAR, CONSISTENT ASSESSMENT AND PARTICIPATION IN THE DISCOVERY OF EXISTING HEALTH NEEDS OF OUR COMMUNITY. |
| 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 2017 THE CANCER CARE FUND PROVIDED FINANCIAL ASSISTANCE TO OVER 100 KOSCIUSKO COUNTY CANCER PATIENTS AND THEIR FAMILIES. THE FUND DISBURSED APPROXIMATELY $185,000 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 COLLABORATES WITH ONE OR MORE MEMBERS OF THE NINE-PERSON CANCER CARE COMMITTEE TO AUTHORIZE PAYMENTS FROM THE FUND. FOR APPLICATION ASSISTANCE, PLEASE CONTACT LAURA DEAL-DECKER AT (574) 372-3500 OR LAURA@KOSHELPCENTER.ORGLINE 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 | $7,982,763 | $7,938,852 |
| FOREIGN BONDS | $932,000 | $932,704 |
Investments Corp Stock Schedule InvestmentsCorpStockSchedule
Investments Corporate Stock InvestmentsCorporateStockGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Stock | EQUITY SECURITIES | StockNm |
| EOY Book Value | $27,989,927 | EOYBookValueAmt |
| EOYFMV | $50,811,931 | EOYFMVAmt |
Investments Govt Obligations Sch InvestmentsGovtObligationsSch
| Field | Value | IRS element (for citing) |
|---|---|---|
| US Govt Obligations Book Vl EOY | $6,319,390 | USGovtObligationsBookVlEOYAmt |
| US Govt Obligations EOYFMV | $6,252,302 | 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 | $160,277 | $151,328 | $151,328 |
| LEASEHOLD IMPROVEMENTS | $969,226 | $310,370 | $658,856 | $658,856 |
| BUILDING | $1,023,544 | $639,929 | $383,615 | $383,615 |
| LAND | $23,895 | $0 | $23,895 | $23,895 |
Investments Other Schedule2 InvestmentsOtherSchedule2
Investments Other InvestmentsOtherGrp (5 entries)
| Category Or ItemCategoryOrItemTxt | Listed At Cost Or FMVListedAtCostOrFMVCd | Book ValueBookValueAmt | EOYFMVEOYFMVAmt |
|---|---|---|---|
| REAL ESTATE INVESTMENT FUND | FMV | $1,593,619 | $2,787,331 |
| HEDGE FUND | FMV | $4,483,324 | $4,102,349 |
| GLOBAL MANAGED VOLATILITY | FMV | $2,718,389 | $4,861,190 |
| US EQUITY INDEX PUTWRITE FUND LLC | FMV | $4,920,238 | $4,943,641 |
| PRIVATE EQUITY | FMV | $970,544 | $1,180,783 |
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 | $38,167 | $112,603 | $112,603 |
| BUILDING | $870,709 | $59,350 | $811,359 | $811,359 |
Other Assets Schedule OtherAssetsSchedule
Other Assets Schedule OtherAssetsScheduleGrp (2 entries)
| DescDesc | BOY Book ValueBOYBookValueAmt | EOY Book ValueEOYBookValueAmt | EOYFMVEOYFMVAmt |
|---|---|---|---|
| NOTES RECEIVABLE HELD FOR GRANT MAKING | $788,792 | $251,002 | $251,002 |
| RECEIVABLE - OTHER | $470 | $1,191 | $1,191 |
Other Expenses Schedule OtherExpensesSchedule
Other Expenses Schedule OtherExpensesScheduleGrp (5 entries)
| DescDesc | Revenue And Expenses Per BooksRevenueAndExpensesPerBooksAmt | Net Investment IncomeNetInvestmentIncomeAmt | Adjusted Net IncomeAdjustedNetIncomeAmt | Disbursements Charitable PrpsDisbursementsCharitablePrpsAmt |
|---|---|---|---|---|
| KHSP MORTGAGE INTEREST FORGIVENESS | $821,685 | $0 | $0 | $0 |
| FUNDRAISING EXPENSES | $26,430 | $0 | $0 | $26,430 |
| INSURANCE | $9,884 | $0 | $0 | $10,523 |
| MARKETING | $10,654 | $0 | $0 | $10,654 |
| MISCELLANEOUS EXPENSE | $41,201 | $1,065 | $0 | $40,136 |
Other Income Schedule2 OtherIncomeSchedule2
Other Income Detail OtherIncomeDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | OTHER INCOME | Desc |
| Revenue And Expenses Per Books | $530 | RevenueAndExpensesPerBooksAmt |
| Net Investment Income | $530 | NetInvestmentIncomeAmt |
Other Increases Schedule OtherIncreasesSchedule
Other Increases Detail OtherIncreasesDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | LOAN FORGIVENESS RECOGNIZED AS GRANTS ON FINANCIALS | Desc |
| Amt | $821,685 | Amt |
Other Liabilities Schedule OtherLiabilitiesSchedule
Other Liabilities Detail OtherLiabilitiesDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | DEFERRED TAX LIABILITY | Desc |
| BOY Book Value | $296,023 | BOYBookValueAmt |
| EOY Book Value | $360,022 | EOYBookValueAmt |
Other Professional Fees Schedule OtherProfessionalFeesSchedule
Other Professional Fees Detail OtherProfessionalFeesDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Category | INVESTMENT MGT FEES | CategoryTxt |
| Amt | $265,190 | Amt |
| Net Investment Income | $265,190 | NetInvestmentIncomeAmt |
| Adjusted Net Income | $0 | AdjustedNetIncomeAmt |
| Disbursements Charitable Prps | $0 | DisbursementsCharitablePrpsAmt |
Taxes Schedule TaxesSchedule
Taxes Detail TaxesDetail (3 entries)
| CategoryCategoryTxt | AmtAmt | Net Investment IncomeNetInvestmentIncomeAmt | Adjusted Net IncomeAdjustedNetIncomeAmt | Disbursements Charitable PrpsDisbursementsCharitablePrpsAmt |
|---|---|---|---|---|
| EXCISE TAXES | $160,865 | $0 | $0 | $0 |
| FOREIGN INCOME TAXES | $51 | $51 | $0 | $0 |
| PROPERTY TAXES | $6,081 | $0 | $0 | $6,081 |
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