2021-03-30T15:33:18-05:00 2020-05-31 410746749 CLIFTONLARSONALLEN LLP 420 SOUTH ORANGE AVENUE SUITE 500 ORLANDO FL 32801 990PF 2019-06-01 593010451 HANS AND CAY JACOBSEN CHARITABLE FOUNDATION INC HANS 4078106672 PO BOX 2149 WINTER PARK FL 32790 TERESA W BORCHECK PRESIDENT 4078106672 2021-01-19 1 AMY CHAPMAN P00843460 4078021200 2021-01-19 2019 2022-09-23 18:48:47Z X 5133768 X 1000 X 3559 3559 102662 102662 62185 2023872 62185 383 383 169789 168789 44000 12000 32000 570 285 285 17484 13987 3497 36467 18234 18233 101 101 0 767 767 0 3521 3521 0 102910 48895 54015 443750 443750 546660 48895 497765 -376871 119894 400835 388664 388664 451253 450599 459034 2132831 1656462 3242367 325163 100135 100103 584417 921768 943600 3894499 3517628 5133768 0 0 X 3894499 3517628 3894499 3517628 3894499 3517628 3894499 -376871 0 3517628 0 3517628 PUBLICLY TRADED SECURITIES 2018933 1961687 57246 57246 CAPITAL GAINS DIVIDENDS P 4939 4939 4939 62185 0 236805 5242553 0.045170 350285 5305021 0.066029 558221 5235118 0.106630 300751 5471777 0.054964 359359 5994087 0.059952 0.332745 0.066549 5119061 340668 1199 341867 497765 X 1199 0 1199 0 1199 1755 0 0 1755 0 556 556 0 0 0 0 0 0 0 0 0 0 0 1 1 FL 1 0 0 0 0 1 N/A CAPITAL CITY TRUST COMPANY 8668209671 PO BOX 1549 TALLAHASSEE FL 32302 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 TERESA W BORCHECK PO BOX 2149 WINTER PARK FL 32790 PRESIDENT 10.00 20000 0 0 W THOMAS BROOKS PO BOX 2149 WINTER PARK FL 32790 VICE PRESIDENT 6.00 8000 0 0 BRIAN BROOKS PO BOX 2149 WINTER PARK FL 32790 TREASURER 3.00 8000 0 0 SHANNON MCLIN CARLYLE PO BOX 2149 WINTER PARK FL 32790 SECRETARY 3.00 8000 0 0 NONE 0 NONE 0 0 4950840 246176 0 5197016 0 0 5197016 77955 5119061 255953 255953 1199 1199 254754 0 254754 0 254754 497765 0 497765 1199 496566 254754 0 0 70219 29200 302287 88914 490620 497765 0 0 0 254754 243011 0 0 733631 0 0 0 0 0 0 70219 663412 29200 302287 88914 243011 TERESA W BORCHECK PO BOX 2149 WINTER PARK FL 32790 4078106672 INFO@HCJF.ORG CONTACT THE FOUNDATION DIRECTLY OR VISIT THE FOUNDATION'S WEBSITE AT WWW.HJCF.ORG FOR INFORMATION REGARDING FORM AND CONTENT OF APPLICATIONS. REQUESTS ARE TO BE RECEIVED BY APRIL 15 AND NOVEMBER 1 FOR CONSIDERATION AT THE SEMIANNUAL MEETINGS GRANTS ARE GENERALLY RESTRICTED TO PROGRAMS WHICH ASSIST CHILDREN AND YOUNG ADULTS IN THE AREAS OF HEALTH, EDUCATION, CULTURE, RECREATION, AND ANY OTHER PROGRAMS THAT WILL ADD TO THE BETTERMENT OF THEIR LIFE AND THEIR PARTICIPATION AS GOOD CITIZENS. GRANTS ARE GENERALLY RESTRICTED TO PROGRAMS CONDUCTED IN LAKE AND/OR SUMTER COUNTY FLORIDA. BOYS & GIRLS CLUB OF CENTRAL FLORIDA 101 E COLONIAL DRIVE ORLANDO FL 32801 N/A PC CORONAVIRUS RELIEF FOOD PROGRAMS 20000 CAMP BOGGY CREEK 30500 BRANTLEY BRANCH RD EUSTIS FL 32736 N/A PC CAMPERSHIPS FOR LAKE & SUMTER STUDENTS 20000 CENTRAL FLORIDA BIBLE CAMP INC 23813 COUNTY 44A EUSTIS FL 32736 N/A PC RENOVATIONS TO CABIN FOR STAFF 15000 CHRISTIAN CARE CENTER 115 N 13TH ST LEESBURG FL 34748 N/A PC CORONAVIRUS RELIEF FOOD PROGRAMS 20000 CHRISTIAN HOME AND BIBLE SCHOOL (MOUNT DORA CHRISTIAN ACADEMY 301 W 13TH AVENUE MOUNT DORA FL 32757 N/A PC FUNDING SINGLE PARENT MINISTRY 20000 CHRISTIAN HOME AND BIBLE SCHOOL (MOUNT DORA CHRISTIAN ACADEMY 301 W 13TH AVENUE MOUNT DORA FL 32757 N/A PC 2/2 OF COMMITMENT FOR SINGLE PARENT MINISTRY REHAB OF LIVING QUARTERS 25000 EARLY LEARNING COALITION OF LAKE COUNTY 1300 CITIZENS BLVD STE 206 LEESBURG FL 34748 N/A PC PROGRAM SUPPORT 10000 EASTER SEALS CAMP CHALLENGE 2010 CROSBY WAY WINTER PARK FL 32792 N/A PC TO FUND SCHOLARSHIPS FOR CHILDREN WITH DISABILITIES TO ATTEND SESSIONS AT CAMP CHALLENGE 15000 EDUCATIONAL FOUNDATION OF LAKE COUNTY INC 2045 PRUITT STREET LEESBURG FL 34748 N/A PC ACT READING PREPERATION COURSE 10000 EDUCATIONAL FOUNDATION OF LAKE COUNTY TO THE SCOTT STRONG MEMORIAL SCHOLARS 2045 PRUITT STREET LEESBURG FL 34748 N/A PC SCOTT STRONG MEMORIAL SCHOLARSHIP FUND 10000 EDUCATIONAL FOUNDATION OF LAKE COUNTY 2045 PRUITT STREET LEESBURG FL 34748 N/A PC MOBILE HOT SPOT SUPPORT FUNDS FOR MOBILE LEARNING 15000 HAVEN OF LAKE AND SUMTER COUNTY 2600 SOUTH STREET LEESBURG FL 34748 N/A PC OPERATIONAL SUPPORT DURING COVID SHUTDOWN 30000 LAKE CARE INC 2001 WEST OLD HIGHWAY 441 SUITE 1 MOUNT DORA FL 32757 N/A PC LAKE COUNTY FOOD BANK SERVICES 7500 LAKE CARES INC 2001 WEST OLD HIGHWAY 441 SUITE 1 MOUNT DORA FL 32757 N/A PC CORONAVIRUS RELIEF FOOD PROGRAMS 20000 LAKE COMMUNITY ACTION AGENCY 501 N BAY ST EUSTIS FL 32726 N/A PC LAKE COUNTY CHILDREN'S PROGRAM 20000 LAKE COMMUNITY ACTION AGENCY 501 N BAY ST EUSTIS FL 32726 N/A PC PROGRAM SUPPORT 15000 LAKE COMMUNITY ACTION AGENCY INC 501 N BAY STREET EUSTIS FL 32726 N/A PC LAKE COUNTY CHILDREN'S PROGRAM 20000 LAKE SUMTER CHILDREN'S ADVOCACY CENTER 300 S CANAL STREET LEESBURG FL 34748 N/A PC CASE MANAGER/FAMILY ADVOCATE 25000 LAKE SUMTER STATE COLLEGE 9501 US HWY 441 LEESBURG FL 34788 N/A GOV CORONAVIRUS RELIEF FOOD PROGRAMS 20000 LAKE SUMTER STATE COLLEGE 9501 US HWY 441 LEESBURG FL 34788 N/A GOV NURSING PROGRAM FUNDING 20000 LIFE TO THE MAX INC 705 LAKE ELLA RD FRUITLAND PARK FL 34731 N/A PC STEM PROGRAM 15000 LIFESTREAM BEHAVIORAL CENTER INC PO BOX 491000 LEESBURG FL 34749 N/A PC PROGRAM SUPPORT 10000 QUEST INC PO BOX 531125 ORLANDO FL 32853 N/A PC CAMPERSHIPS FOR LAKE & SUMTER STUDENTS TO CAMP THUNDERBIRD 12000 RODEHEAVER FOUNDATION PO BOX 5 PALATKA FL 32178 N/A PC TUTORING PROGRAM FOR RESIDENTS 12000 SOUTHERN SCHOLARSHIP FOUNDATION INC 322 STADIUM DR TALLAHASSEE FL 32304 N/A PC SPONSOR LAKE & SUMTER STUDENTS IN SSF HOUSING ON FLORIDA COLLEGE CAMPUS 6000 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