2021-05-11T08:52:25-05:00 2020-12-31 351178661 BLUE & CO LLC 500 N MERIDIAN ST SUITE 200 INDIANAPOLIS IN 46204 990PF 2020-01-01 351187105 KOSCIUSKO 21ST CENTURY FOUNDATION INC AKA K21 HEALTH FOUNDATION KOSC 5742695188 1101 PARK AVE WINONA LAKE IN 46590 RICH HADDAD PRESIDENT 5742695188 2021-05-11 1 RICH HADDAD 999009999 ANGELA N CRAWFORD CPA P00418596 3176334705 2021-05-11 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z X X 83032013 X 333267 390905 390905 977125 977125 252710 252710 64537 2877980 50118310 2877980 3081 3081 0 4835068 4501801 0 221057 0 0 221057 102177 0 0 99931 25956 0 0 25956 19150 0 0 19150 229069 229069 0 0 111454 47 0 0 180691 180691 0 31980 0 0 31980 2961 0 0 2961 4732 0 0 4732 136904 7482 0 99118 1066131 417289 0 504885 2667830 2681075 3733961 417289 0 3185960 1101107 4084512 0 1460596 657305 657305 7430 10109 10109 5028571 6051741 6053922 30222616 31076371 49951449 7530216 6800646 7101934 3226514 987490 1965140 2239024 2239024 13582160 13996621 16114687 122885 8566 0 114319 114319 789978 789264 789264 60586707 61735400 83032013 8681 14881 293442 280196 241391 296023 543514 591100 X 58938930 59898578 1104263 1245722 60043193 61144300 60586707 61735400 60043193 1101107 0 61144300 0 61144300 SALES OF SECURITIES 50118310 47240330 2877980 2877980 2877980 56775 0 56775 0 56775 44140 0 0 0 44140 X 260 12895 0 0 0 0 0 0 0 0 0 0 1 1 IN 1 0 0 0 0 1 WWW.K21FOUNDATION.ORG RICH HADDAD 5742695188 1101 PARK AVE WINONA LAKE IN 46590 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 RICHARD HADDAD 1101 PARK AVE WINONA LAKE IN 46590 PRESIDENT 40.00 214782 6275 0 ANDREW GROSSNICKLE 1101 PARK AVE WINONA LAKE IN 46590 CHAIRMAN 1.00 0 0 0 LISA O'NEILL 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 SCOTT TUCKER 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 JILL GROSS 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 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 STEVE ROSS 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 BILL SMITH 1101 PARK AVE WINONA LAKE IN 46590 DIRECTOR 1.00 0 0 0 JENNIFER STEWART 1101 PARK AVE WINONA LAKE IN 46590 MARKETING MANAGER 40.00 52984 1589 0 0 WINONA LAKE RESTORATION 28520 CR 50 NAPPANEE IN 46550 BUILDING RENOVATIONS 388345 MARQUETTE ASSOCIATES 180 N LASALLE SUITE 3500 CHICAGO IL 60601 INVESTMENT CONSULTING 69000 CUSTER 217 GRANDSVILL AVE GRAND RAPIDS MI 49503 FURNITURE 60815 0 FORGIVENESS OF CURRENT LOAN MORTGAGE PRINCIPAL AND INTEREST DUE FROM KOSCIUSKO HEALTH SERVICES PAVILION, INC., A SECTION 501(C(3) ORGANIZATION. 32983 32983 73015578 406048 0 73421626 0 0 73421626 1101324 72320302 3616015 3616015 56775 56775 3559240 0 3559240 0 3559240 3185960 32983 3218943 0 3218943 3559240 0 0 982854 515855 539316 624896 712716 3375637 3218943 0 0 0 3218943 0 340297 340297 3035340 0 0 0 0 0 0 642557 2392783 515855 539316 624896 712716 KOSCIUSKO 21ST CENTURY FOUNDATION I 1101 PARK AVE WINONA LAKE IN 46590 5742695188 SEE STATEMENTS 20 AND 21. SEE STATEMENTS 20 AND 21. SEE STATEMENTS 20 AND 21. CANCER CARE GRANT ALICIA CENTENO 1101 PARK AVE WINONA LAKE IN 46590 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 1784 CANCER CARE GRANT ANA MORALES 1101 PARK AVE WINONA LAKE IN 46590 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 1063 CANCER CARE GRANT ANDY KERR 1101 PARK AVE WINONA LAKE IN 46590 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 1605 CANCER CARE GRANT ANTHONY HENSEL 1101 PARK AVE WINONA LAKE IN 46590 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 4134 CANCER CARE GRANT BARBARA SKEANS 1101 PARK AVE WINONA LAKE IN 46590 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 3000 CANCER CARE GRANT BRAXTON ELLIOT 1101 PARK AVE WINONA LAKE IN 46590 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 7050 CANCER CARE GRANT CARL FINKEN 1101 PARK AVE WINONA LAKE IN 46590 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 4524 CANCER CARE GRANT CARL POE 1101 PARK AVE WINONA LAKE IN 46590 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 2967 CANCER CARE GRANT DAVID WEAVER 1101 PARK AVE WINONA LAKE IN 46590 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 1742 CANCER CARE GRANT DEBBIE WHYBREW 1101 PARK AVE WINONA LAKE IN 46590 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 3459 CANCER CARE GRANT DELIA NAVARRO 1101 PARK AVE WINONA LAKE IN 46590 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 4100 CANCER CARE GRANT DONALD BIAS 1101 PARK AVE WINONA LAKE IN 46590 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 4669 CANCER CARE GRANT DOROTHY SNYDER 1101 PARK AVE WINONA LAKE IN 46590 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 2627 CANCER CARE GRANT GEORGE HATCHER 1101 PARK AVE WINONA LAKE IN 46590 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 1000 CANCER CARE GRANT GEORGE YOUNG 1101 PARK AVE WINONA LAKE IN 46590 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 4717 CANCER CARE GRANT JAMES KECK 1101 PARK AVE WINONA LAKE IN 46590 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 1997 CANCER CARE GRANT JAMES NEACE 1101 PARK AVE WINONA LAKE IN 46590 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 1100 CANCER CARE GRANT JAMES OVERBEY 1101 PARK AVE WINONA LAKE IN 46590 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 3325 CANCER CARE GRANT JEAN ZAJICEK 1101 PARK AVE WINONA LAKE IN 46590 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 6000 CANCER CARE GRANT JIMMY HARTMAN 1101 PARK AVE WINONA LAKE IN 46590 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 1305 CANCER CARE GRANT JON MAUK 1101 PARK AVE WINONA LAKE IN 46590 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 3217 CANCER CARE GRANT JONATHAN GOON 1101 PARK AVE WINONA LAKE IN 46590 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 1251 CANCER CARE GRANT LEI WANG 1101 PARK AVE WINONA LAKE IN 46590 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 1000 CANCER CARE GRANT MARK DEMSKE 1101 PARK AVE WINONA LAKE IN 46590 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 1000 CANCER CARE GRANT MAX THOMPSON 1101 PARK AVE WINONA LAKE IN 46590 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 2650 CANCER CARE GRANT MELISSA FUGATE 1101 PARK AVE WINONA LAKE IN 46590 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 2300 CANCER CARE GRANT MONICA CAPLES 1101 PARK AVE WINONA LAKE IN 46590 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 3494 CANCER CARE GRANT NEELEY SCHWINNEN 1101 PARK AVE WINONA LAKE IN 46590 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 2179 CANCER CARE GRANT PAUL BARTELS 1101 PARK AVE WINONA LAKE IN 46590 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 4500 CANCER CARE GRANT PAUL HOPKINS 1101 PARK AVE WINONA LAKE IN 46590 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 5112 CANCER CARE GRANT PAULA HAWN 1101 PARK AVE WINONA LAKE IN 46590 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 3200 CANCER CARE GRANT REAGAN DICE 1101 PARK AVE WINONA LAKE IN 46590 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 5602 CANCER CARE GRANT REBECCA PHEND 1101 PARK AVE WINONA LAKE IN 46590 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 4549 CANCER CARE GRANT REBECCA VANCE 1101 PARK AVE WINONA LAKE IN 46590 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 1217 CANCER CARE GRANT RICHARD HARRELL 1101 PARK AVE WINONA LAKE IN 46590 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 1352 CANCER CARE GRANT RICKY GIBSON 1101 PARK AVE WINONA LAKE IN 46590 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 3706 CANCER CARE GRANT ROBERT CRAWFORD 1101 PARK AVE WINONA LAKE IN 46590 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 2500 CANCER CARE GRANT ROBERT SPRAGUE 1101 PARK AVE WINONA LAKE IN 46590 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 4500 CANCER CARE GRANT RONNIE BALDRIDGE 1101 PARK AVE WINONA LAKE IN 46590 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 1000 CANCER CARE GRANT RYAN VANCUREN 1101 PARK AVE WINONA LAKE IN 46590 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 5500 CANCER CARE GRANT SUSAN GARDNER 1101 PARK AVE WINONA LAKE IN 46590 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 4761 CANCER CARE GRANT TAMARA NEISWONGER 1101 PARK AVE WINONA LAKE IN 46590 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 1500 CANCER CARE GRANT TED GILLEM 1101 PARK AVE WINONA LAKE IN 46590 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 1349 CANCER CARE GRANT TERESA BOYER 1101 PARK AVE WINONA LAKE IN 46590 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 1368 CANCER CARE GRANT TERRY WALTERS 1101 PARK AVE WINONA LAKE IN 46590 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 2589 CANCER CARE GRANT TIM HAND 1101 PARK AVE WINONA LAKE IN 46590 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 1765 CANCER CARE GRANT OTHER GRANTS LESS 1101 PARK AVE WINONA LAKE IN 46590 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 19149 CONDITIONAL GRANT HEARTLINE PREGNANCY CENTER 1515 PROVIDENT DRIVE SUITE 180 WARSAW IN 46580 NONE PC PROGRAM FUNDING 54767 CONDITIONAL GRANT LIVE WELL KOSCIUSKO 8546 SOUTH 200 WEST CLAYPOOL IN 46510 NONE PC OPERATIONAL FUNDING 65437 CONDITIONAL GRANT KOSCIUSKO HOME CARE & HOSPICE 1515 PROVIDENT DRIVE STE 250 WARSAW IN 46581 NONE PC MEDICATION & DENTAL ASSISTANCE/COMPUTERS 286474 CONDITIONAL GRANT GRACE COLLEGE & SEMINARY 200 SEMINARY DRIVE WINONA LAKE IN 46590 NONE PC LILLY CENTER FOR LAKES & STREAMS RESEARCH 100639 CONDITIONAL GRANT ROSE GARDEN RECOVERY COMMUNITY 72876 CR 29 SYRACUSE IN 46567 NONE PC FACILITY RENOVATION 148288 CONDITIONAL GRANT BAKER YOUTH CLUB 1401 EAST SMITH STREET WARSAW IN 46580 NONE PC EXERGAME EQUIPMENT/FITBITS/AED 1945 CONDITIONAL GRANT NORTHERN INDIANA HISPANIC HEALTH COALITION 444 NORTH NAPPANEE STREET ELKHART IN 46514 NONE PC HEALTH SCREENINGS/CLIENT ADVOCAC;Y 40000 CONDITIONAL GRANT RIGHT TO LIFE OF NORTH CENTRAL INDIANA 1906 HAMILTON BLVD WINONA LAKE IN 46590 NONE PC BABYBOX MARKETING CAMPAIGN 7215 CONDITIONAL GRANT SERENITY HOUSE INC 622 EAST FORT WAYNE STREET WARSAW IN 46580 NONE PC FACILITIES RENOVATIONS 55747 CONDITIONAL GRANT WARSAW COMMUNITY SCHOOLS 1 ADMINISTRATIION DRIVE WARSAW IN 46580 NONE PC SUICIDE PREVENTION SPEAKER/QPR TRAINING 14000 CONDITIONAL GRANT KOSCIUSKO COUNTY FREE CLINIC 7822 EAST EPWORTH FOREST ROAD NORTH WEBSTER IN 46555 NONE PC COMPUTER HARDWARE/SOFTWARE 16047 CONDITIONAL GRANT KOSCIUSKO HEALTH SERVICES PAVILION 1515 PROVIDENT DRIVE WARSAW IN 46580 NONE PC BUILDING RENOVATIONS 175395 CONDITIONAL GRANT CAMP ALEXANDER MACK PO BOX 158 MILFORD IN 46542 NONE PC HIGH/LOW ROPES COURSE 65600 CONDITIONAL GRANT COMBINED COMMUNITY SERVICES 1195 MARINERS DRIVE WINONA LAKE IN 46582 NONE PC REFRIGERATION-FREEZER ROOM/EQUIPMENT/COMPUTERS 78480 CONDITIONAL GRANT ENDS OF THE EARTH OUTREACH PO BOX 2021 WARSAW IN 46581 NONE PC COUNT ON ME PROGRAM 2000 CONDITIONAL GRANT KOSCIUSKO COUNTY SHELTER FOR ABUSE 603 NORTH PARKER STREET WARSAW IN 46580 NONE PC GENERATOR 24966 CONDITIONAL GRANT QUESTA FOUNDATION 6502 CONSTITUTION DR FORT WAYNE IN 46804 NONE PC QUESTA SCHOLARS PROGRAM 60000 CONDITIONAL GRANT TOWN OF WINONA LAKE 1310 PARK AVENUE WINONA LAKE IN 46590 NONE PC GREENWAY ENGINEERING 82780 CONDITIONAL GRANT TRITON SCHOOL CORPORATION 100 TRITON DRIVE BOURBON IN 46504 NONE PC TENNIS COURT RESURFACING 75000 CONDITIONAL GRANT CARDINAL SERVICES 504 NORTH BAY DRIVE WARSAW IN 46580 NONE PC GROWING GREAT KIDS CURRICULUM 19400 CONDITIONAL GRANT CITY OF WARSAW 102 SOUTH BUFFALO STREET WARSAW IN 46580 NONE PC MECHANICAL CPR DEVICES/GREENWAY TRAIL STUDY 246130 CONDITIONAL GRANT HOUSING OPPORTUNITIES OF WARSAW 109 WEST CATHERINE STREET MILFORD IN 46542 NONE PC HEALTHY HOMES PROGRAM 2580 CONDITIONAL GRANT KOSCIUSKO COUNTY 121 WEST MAIN STREET WARSAW IN 46580 NONE PC JCAP PROGRAM FUNDING 9058 CONDITIONAL GRANT KOSCIUSKO COUNTY COMMUNITY FOUNDATION 102 EAST MARKET STREET WARSAW IN 46580 NONE PC COUNTYWIDE COMPREHENSIVE PLAN 50000 CONDITIONAL GRANT KOSCIUSKO COMMUNITY YMCA 1305 MARINERS DRIVE WARSAW IN 46582 NONE PC DIABETES PREVENTION PROGRAM 6796 CONDITIONAL GRANT LAKE CITY SKI TEAM 2455 HIDDEN LAKE DRIVE WARSAW IN 46580 NONE PC LEARN TO SKI PROGRAM EQUIPMENT 26550 CONDITIONAL GRANT TOWN OF NORTH WEBSTER 144 SOUTH MAIN STREET NORTH WEBSTER IN 46555 NONE PC COMMUNITIES GRANT 44878 CONDITIONAL GRANT JOE'S KIDS 902 PROVIDENT DRIVE SUITE C WARSAW IN 46580 NONE PC RENT SUBSIDY 41220 CONDITIONAL GRANT LAKELAND CHRISTIAN ACADEMY 1093 SOUTH 250 EAST WINONA LAKE IN 46590 NONE PC NURSE'S OFFICE EQUIPMENT 8996 CONDITIONAL GRANTS OTHER GRANTS UNDER 1000 1101 PARK AVE WINONA LAKE IN 46590 NONE PC EQUIPMENT 1580 DIRECT GRANT BAKER YOUTH CLUB 1401 E SMITH ST WARSAW IN 46580 NONE PC K21 BOARD OF DIRECTORS DIRECTED DONATION, OPERATIONAL 2500 DIRECT GRANT FELLOWSHIP MISSIONS 1520 EAST WINONA AVENUE WARSAW IN 46580 NONE PC K21 BOARD OF DIRECTORS DIRECTED DONATION 1500 DIRECT GRANT KOSCIUSKO COUNTY COMMUNITY FOUNDATION 102 EAST MARKET STREET WARSAW IN 46580 NONE PC COVID-19 RAPID RESPONSE FUND 10000 DIRECT GRANT KOSCIUSKO COMMUNITY YMCA 1305 MARINERS DR WARSAW IN 46582 NONE PC OPERATIONAL ASSISTANCE 21405 DIRECT GRANT LIVE WELL KOSCIUSKO 8546 SOUTH 200 WEST CLAYPOOL IN 46510 NONE PC GALLUP POLL STUDY 44250 DIRECT GRANT NORTH STAR MEDICAL 2045 112TH AVE HOLLAND MI 49424 NONE PC AED AND MEDICAL EQUIPMENT FOR MULTIPLE ORGANIZATIONS 5907 DIRECT GRANT WARSAW ELKS LODGE 310 EAST CENTER STREET WARSAW IN 46580 NONE PC NEEDY CHILDREN'S CHRISTMAS PARTY 2000 DIRECT GRANTS OTHER GRANTS UNDER 1000 1101 PARK AVE WINONA LAKE IN 46590 NONE PC K21 BOARD OF DIRECTORS DIRECTED DONATION 16800 UNCONDITIONAL GRANT BAKER YOUTH CLUB 1401 E SMITH ST WARSAW IN 46580 NONE PC OPERATIONAL ASSISTANCE 40000 UNCONDITIONAL GRANT BIG BROTHERS BIG SISTERS 1005 WEST RUDISILL BLVD 101 FORT WAYNE IN 46804 NONE PC OPERATIONAL ASSISTANCE 5000 UNCONDITIONAL GRANT BOWEN CENTER 2621 EAST JEFFERSON STREET WARSAW IN 46580 NONE PC SYSTEMS OF CARE COORDINATOR 20000 UNCONDITIONAL GRANT BRIGHTPOINT 227 E WASHINGTON BLVD FORT WAYNE IN 46804 NONE PC COVERING KIDS & FAMILIES 20000 UNCONDITIONAL GRANT CANCER SERVICES OF NORTHEAST INDIANA 6316 MUTUAL DRIVE FORT WAYNE IN 46825 NONE PC DIRECT ASSISTANCE / CLIENT ADVOCACY 20000 UNCONDITIONAL GRANT COMBINED COMMUNITY SERVICES 1195 MARINERS DRIVE WARSAW IN 46582 NONE PC WORKSHOPS/PROGRAM INCENTIVES 5000 UNCONDITIONAL GRANT EARLY CHILDHOOD ALLIANCE 3800 NORTH ANTHONY BLVD FORT WAYNE IN 46805 NONE PC OPERATIONAL ASSISTANCE FOR CHILD CARE FOR ESSENTIAL WORKERS 7805 UNCONDITIONAL GRANT FELLOWSHIP MISSIONS 1520 EAST WINONA AVENUE WARSAW IN 46580 NONE PC CAMP CROSLEY RENTAL 30000 UNCONDITIONAL GRANT GRACE COLLEGE & SEMINARY 200 SEMINARY DRIVE WINONA LAKE IN 46590 NONE PC LILLY CENTER OPERATIONAL ASSISTANCE/COVID FUNDING 65000 UNCONDITIONAL GRANT KOSCIUSKO COMMUNITY YMCA 1305 MARINERS DR WARSAW IN 46582 NONE PC OEPRATIONAL ASSISTANCE/YOUTH SPORTS PROGRAMS 56500 UNCONDITIONAL GRANT KOSCIUSKO COUNTY COMMUNITY FOUNDATION 102 EAST MARKET STREET WARSAW IN 46580 NONE PC GOOD SAMARITAN FUND 93750 UNCONDITIONAL GRANT KOSCIUSKO COUNTY SHELTER FOR ABUSE 603 NORTH PARKER STREET WARSAW IN 46580 NONE PC OPERATIONAL ASSISTANCE 20000 UNCONDITIONAL GRANT KOSCIUSKO HOME CARE & HOSPICE 1515 PROVIDENT DRIVE STE 250 WARSAW IN 46580 NONE PC OPERATIONAL ASSISTANCE 167220 UNCONDITIONAL GRANT MAD ANTHONY'S CHILDREN'S HOPE HOUSE 7922 WEST JEFFERSON BLVD FORT WAYNE IN 46804 NONE PC OPERATIONAL ASSISTANCE 10000 UNCONDITIONAL GRANT MAGICAL MEADOWS 3386 EAST 525 NORTH WARSAW IN 46582 NONE PC OPERATIONAL ASSISTANCE 4000 UNCONDITIONAL GRANT MCMILLEN CENTER 600 JIM KELLEY BLVD FORT WAYNE IN 46816 NONE PC HEALTH EDUCATION PROGRAMS 5000 UNCONDITIONAL GRANT TOWN OF WINONA LAKE 1310 PARK AVENUE WINONA LAKE IN 46590 NONE PC PROTECTIVE FACE MASKS 5625 UNCONDITIONAL GRANT TOWN OF SYRACUSE 310 NORTH HUNTINGTON STREET SYRACUSE IN 46567 NONE PC PROTECTIVE FACE MASKS 8297 UNCONDITIONAL GRANT TOWN OF PIERCETON 207 NORTH 1ST STREET PIERCETON IN 46562 NONE PC PROTECTIVE FACE MASKS 2909 UNCONDITIONAL GRANT TOWN OF NORTH WEBSTER 144 SOUTH MAIN STREET NORTH WEBSTER IN 46555 NONE PC PROTECTIVE FACE MASKS 3771 UNCONDITIONAL GRANT REAL SERVICES INC 1151 SOUTH MICHIGAN STREET SOUTH BEND IN 46601 NONE PC MINI RESOURCE LIBRARIES 1500 UNCONDITIONAL GRANT ROSE GARDEN RECOVERY COMMUNITY PO BOX 571 SYRACUSE IN 46567 NONE PC OPERATIONAL ASSISTANCE 3600 UNCONDITIONAL GRANT RYAN'S PLACE INC PO BOX 73 GOSHEN IN 46527 NONE PC OPERATIONAL ASSISTANCE 8000 UNCONDITIONAL GRANT TURNING POINT 225 NORTH MAIN STREET NORTH WEBSTER IN 46555 NONE PC TECHNOLOGY UPGRADE 5900 UNCONDITIONAL GRANT OTHER GRANTS UNDER 1000 1101 PARK AVE WINONA LAKE IN 46590 NONE PC UNCONDITIONAL GRANTS TO ORGANIZATIONS 1390 2681075 0 14 390905 14 977125 16 64537 14 3081 18 2877980 0 4313628 0 4313628 0 0 0 0 0 0 0 0 0 0 X X 1 DR AND MRS RICK SASSO 10674 WINTERWOOD CARMEL IN 46032 201248 X 2 BEAVER DAM UM CHURCH 9798 W 1000 SOUTH AKRON IN 46910 14000 X 3 BERTSCH FAMILY CHARITABLE FOUNDATION PO BOX 1494 WARSAW IN 46581 6000 X 4 DOUG SCHROCK 711 SOUTH STREET KEY WEST FL 33040 5000 X 1 MARKETABLE SECURITIES 201248 2020-12-31 ACCOUNTING FEES 19150 0 0 19150 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. CORPORATE BONDS 6128634 6395237 FOREIGN BONDS 672012 706697 EQUITY SECURITIES 31076371 49951449 6051741 6053922 0 0 LAND 57995 0 57995 57995 LAND IMPROVEMENTS 311605 148762 162843 162843 LEASEHOLD IMPROVEMENTS 969226 561335 407891 407891 BUILDING 1887688 277393 1610295 1610295 REAL ESTATE INVESTMENT FUND FMV 2450568 3232633 HEDGE FUND FMV 4304941 3993789 GLOBAL MANAGED VOLATILITY FMV 2726823 4126027 US EQUITY INDEX PUTWRITE FUND LLC FMV 4134877 4349903 PRIVATE EQUITY FMV 379412 412335 OFFICE & COMPUTER EQUIPMENT 122885 8566 114319 114319 NOTES RECEIVABLE HELD FOR GRANT MAKING 788792 788792 788792 RECEIVABLE - OTHER 1186 472 472 KHSP MORTGAGE INTEREST FORGIVENESS 32983 0 0 0 FUNDRAISING EXPENSES 15824 0 0 15824 INSURANCE 8817 0 0 11496 MARKETING 28940 0 0 28940 MISCELLANEOUS EXPENSE 50340 7482 0 42858 OTHER INCOME 3081 3081 DEFERRED TAX LIABILITY 241391 296023 INVESTMENT MGT FEES 229069 229069 0 0 EXCISE TAXES 111407 0 0 0 FOREIGN INCOME TAXES 47 47 0 0