KOSCIUSKO 21ST CENTURY FOUNDATION INC: Form 990PF, tax year 2019

View the entire original 990 at ProPublica ↗

Organization
KOSCIUSKO 21ST CENTURY FOUNDATION INC (EIN 35-1187105)
Tax period
2019-01-01 to 2019-12-31
Filed
2020-05-19
IRS object ID
202011409349100801
Schema version
2019v5.1
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 ReturnHeader

FieldValueIRS element (for citing)
Return2020-05-19T08:54:40-05:00ReturnTs
Tax Period End2019-12-31TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN351178661PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1BLUE & CO LLCBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line1500 N MERIDIAN ST SUITE 200AddressLine1Txt
CityINDIANAPOLISCityNm
State AbbreviationINStateAbbreviationCd
ZIP46204ZIPCd
FieldValueIRS element (for citing)
Return Type990PFReturnTypeCd
Tax Period Begin2019-01-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN351187105EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1KOSCIUSKO 21ST CENTURY FOUNDATION INCBusinessNameLine1Txt
Business Name Line2AKA K21 HEALTH FOUNDATIONBusinessNameLine2Txt
FieldValueIRS element (for citing)
Business Name ControlKOSCBusinessNameControlTxt
Phone5742695188PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line12170 N POINTE DRIVEAddressLine1Txt
CityWARSAWCityNm
State AbbreviationINStateAbbreviationCd
ZIP46582ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonRICH HADDADPersonNm
Person TitlePRESIDENTPersonTitleTxt
Phone5742695188PhoneNum
Signature2020-05-19SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonANGELA N CRAWFORD CPAPreparerPersonNm
PTINP00418596PTIN
Phone3176334705PhoneNum
Preparation2020-05-19PreparationDt
FieldValueIRS element (for citing)
Tax2019TaxYr
Build TS2022-09-23 18:48:47ZBuildTS

Form 990-PF IRS990PF

FieldValueIRS element (for citing)
Organization501c3 Exempt PFYes (X)Organization501c3ExemptPFInd
FMV Assets EOY$77,952,977FMVAssetsEOYAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd

Analysis Of Revenue And Expenses AnalysisOfRevenueAndExpenses

FieldValueIRS element (for citing)
Contri Rcvd Rev And Expnss$411,651ContriRcvdRevAndExpnssAmt
Interest On Sav Rev And Expnss$435,781InterestOnSavRevAndExpnssAmt
Interest On Sav Net Invst Incm$435,781InterestOnSavNetInvstIncmAmt
Dividends Rev And Expnss$1,079,442DividendsRevAndExpnssAmt
Dividends Net Invst Incm$1,079,442DividendsNetInvstIncmAmt
Gross Rents Rev And Expnss$264,017GrossRentsRevAndExpnssAmt
Gross Rents Net Invst Incm$264,489GrossRentsNetInvstIncmAmt
Net Rental Income Or Loss$93,770NetRentalIncomeOrLossAmt
Net Gain Sale Ast Rev And Expnss$3,022,645NetGainSaleAstRevAndExpnssAmt
Gross Sales Price$35,768,999GrossSalesPriceAmt
Cap Gain Net Incm Net Invst Incm$3,022,645CapGainNetIncmNetInvstIncmAmt
Other Income Rev And Expnss$1,401OtherIncomeRevAndExpnssAmt
Other Income Net Invst Incm$1,401OtherIncomeNetInvstIncmAmt
Other Income Adj Net Incm$0OtherIncomeAdjNetIncmAmt
Total Rev And Expnss$5,214,937TotalRevAndExpnssAmt
Total Net Invst Incm$4,803,758TotalNetInvstIncmAmt
Total Adj Net Incm$0TotalAdjNetIncmAmt
Comp Ofcr Dir Trst Rev And Expnss$205,947CompOfcrDirTrstRevAndExpnssAmt
Comp Ofcr Dir Trst Net Invst Incm$0CompOfcrDirTrstNetInvstIncmAmt
Comp Ofcr Dir Trst Adj Net Incm$0CompOfcrDirTrstAdjNetIncmAmt
Comp Ofcr Dir Trst Dsbrs Chrtbl$205,947CompOfcrDirTrstDsbrsChrtblAmt
Oth Empl Slrs Wgs Rev And Expnss$84,218OthEmplSlrsWgsRevAndExpnssAmt
Oth Empl Slrs Wgs Net Invst Incm$0OthEmplSlrsWgsNetInvstIncmAmt
Oth Empl Slrs Wgs Adj Net Incm$0OthEmplSlrsWgsAdjNetIncmAmt
Oth Empl Slrs Wgs Dsbrs Chrtbl$88,218OthEmplSlrsWgsDsbrsChrtblAmt
Pension Empl Bnft Rev And Expnss$22,118PensionEmplBnftRevAndExpnssAmt
Pension Empl Bnft Net Invst Incm$0PensionEmplBnftNetInvstIncmAmt
Pension Empl Bnft Adj Net Incm$0PensionEmplBnftAdjNetIncmAmt
Pension Empl Bnft Dsbrs Chrtbl$22,118PensionEmplBnftDsbrsChrtblAmt
Accounting Fees Rev And Expnss$20,150AccountingFeesRevAndExpnssAmt
Accounting Fees Net Invst Incm$0AccountingFeesNetInvstIncmAmt
Accounting Fees Adj Net Incm$0AccountingFeesAdjNetIncmAmt
Accounting Fees Chrtbl Prps$20,150AccountingFeesChrtblPrpsAmt
Other Prof Fees Rev And Expnss$219,485OtherProfFeesRevAndExpnssAmt
Other Prof Fees Net Invst Incm$219,485OtherProfFeesNetInvstIncmAmt
Other Prof Fees Adj Net Incm$0OtherProfFeesAdjNetIncmAmt
Other Prof Fees Dsbrs Chrtbl$0OtherProfFeesDsbrsChrtblAmt
Taxes Rev And Expnss$195,542TaxesRevAndExpnssAmt
Taxes Net Invst Incm$0TaxesNetInvstIncmAmt
Taxes Adj Net Incm$0TaxesAdjNetIncmAmt
Taxes Dsbrs Chrtbl$0TaxesDsbrsChrtblAmt
Deprec And Dpltn Rev And Expnss$164,769DeprecAndDpltnRevAndExpnssAmt
Deprec And Dpltn Net Invst Incm$164,156DeprecAndDpltnNetInvstIncmAmt
Deprec And Dpltn Adj Net Incm$0DeprecAndDpltnAdjNetIncmAmt
Occupancy Rev And Expnss$44,556OccupancyRevAndExpnssAmt
Occupancy Net Invst Incm$0OccupancyNetInvstIncmAmt
Occupancy Adj Net Incm$0OccupancyAdjNetIncmAmt
Occupancy Dsbrs Chrtbl$44,556OccupancyDsbrsChrtblAmt
Trav Conf Meeting Rev And Expnss$8,292TravConfMeetingRevAndExpnssAmt
Trav Conf Meeting Net Invst Incm$0TravConfMeetingNetInvstIncmAmt
Trav Conf Meeting Adj Net Incm$0TravConfMeetingAdjNetIncmAmt
Trav Conf Meeting Dsbrs Chrtbl$8,292TravConfMeetingDsbrsChrtblAmt
Printing And Pub Rev And Expnss$2,115PrintingAndPubRevAndExpnssAmt
Printing And Pub Net Invst Incm$0PrintingAndPubNetInvstIncmAmt
Printing And Pub Adj Net Incm$0PrintingAndPubAdjNetIncmAmt
Printing And Pub Dsbrs Chrtbl$2,115PrintingAndPubDsbrsChrtblAmt
Other Expenses Rev And Expnss$708,496OtherExpensesRevAndExpnssAmt
Other Expenses Net Invst Incm$6,091OtherExpensesNetInvstIncmAmt
Other Expenses Adj Net Incm$0OtherExpensesAdjNetIncmAmt
Other Expenses Dsbrs Chrtbl$146,718OtherExpensesDsbrsChrtblAmt
Tot Opr Expenses Rev And Expnss$1,675,688TotOprExpensesRevAndExpnssAmt
Tot Opr Expenses Net Invst Incm$389,732TotOprExpensesNetInvstIncmAmt
Tot Opr Expenses Adj Net Incm$0TotOprExpensesAdjNetIncmAmt
Tot Opr Expenses Dsbrs Chrtbl$538,114TotOprExpensesDsbrsChrtblAmt
Contri Paid Rev And Expnss$3,145,207ContriPaidRevAndExpnssAmt
Contri Paid Dsbrs Chrtbl$3,190,315ContriPaidDsbrsChrtblAmt
Total Expenses Rev And Expnss$4,820,895TotalExpensesRevAndExpnssAmt
Total Expenses Net Invst Incm$389,732TotalExpensesNetInvstIncmAmt
Total Expenses Adj Net Incm$0TotalExpensesAdjNetIncmAmt
Total Expenses Dsbrs Chrtbl$3,728,429TotalExpensesDsbrsChrtblAmt
Excess Revenue Over Expenses$394,042ExcessRevenueOverExpensesAmt
Net Investment Income$4,414,026NetInvestmentIncomeAmt
Adjusted Net Income$0AdjustedNetIncomeAmt

Form990 PF Balance Sheets Form990PFBalanceSheetsGrp

FieldValueIRS element (for citing)
Sav And Temp Cash Invst BOY$1,420,996SavAndTempCashInvstBOYAmt
Sav And Temp Cash Invst EOY$1,460,596SavAndTempCashInvstEOYAmt
Sav And Temp Cash Invst EOYFMV$1,460,596SavAndTempCashInvstEOYFMVAmt
Prepaid Expenses BOY$9,374PrepaidExpensesBOYAmt
Prepaid Expenses EOY$7,430PrepaidExpensesEOYAmt
Prepaid Expenses EOYFMV$7,430PrepaidExpensesEOYFMVAmt
US Government Obligations BOY$4,137,117USGovernmentObligationsBOYAmt
US Government Obligations EOY$5,028,571USGovernmentObligationsEOYAmt
US Govt Obligations EOYFMV$5,103,581USGovtObligationsEOYFMVAmt
Corporate Stock BOY$30,759,796CorporateStockBOYAmt
Corporate Stock EOY$30,222,616CorporateStockEOYAmt
Corporate Stock EOYFMV$45,352,988CorporateStockEOYFMVAmt
Corporate Bonds BOY$8,008,032CorporateBondsBOYAmt
Corporate Bonds EOY$7,530,216CorporateBondsEOYAmt
Corporate Bonds EOYFMV$7,704,733CorporateBondsEOYFMVAmt
Invst Land Cost Or Other Basis$2,780,506InvstLandCostOrOtherBasisAmt
Invst Land Accum Depreciation$815,366InvstLandAccumDepreciationAmt
Land Bldg Investments BOY$1,677,059LandBldgInvestmentsBOYAmt
Land Bldg Investments EOY$1,965,140LandBldgInvestmentsEOYAmt
Land Bldg Investments EOYFMV$1,965,140LandBldgInvestmentsEOYFMVAmt
Other Investments BOY$12,783,633OtherInvestmentsBOYAmt
Other Investments EOY$13,582,160OtherInvestmentsEOYAmt
Other Investments EOYFMV$15,568,531OtherInvestmentsEOYFMVAmt
Land Bldg Equip Cost Or Other Bss$68,643LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$68,643LandBldgEquipAccumDeprecAmt
Land BOY$613LandBOYAmt
Land EOY$0LandEOYAmt
Land EOYFMV$0LandEOYFMVAmt
Other Assets BOY$1,290,450OtherAssetsBOYAmt
Other Assets EOY$789,978OtherAssetsEOYAmt
Other Assets EOYFMV$789,978OtherAssetsEOYFMVAmt
Total Assets BOY$60,087,070TotalAssetsBOYAmt
Total Assets EOY$60,586,707TotalAssetsEOYAmt
Total Assets EOYFMV$77,952,977TotalAssetsEOYFMVAmt
Accounts Payable BOY$9,945AccountsPayableBOYAmt
Accounts Payable EOY$8,681AccountsPayableEOYAmt
Grants Payable BOY$336,967GrantsPayableBOYAmt
Grants Payable EOY$293,442GrantsPayableEOYAmt
Other Liabilities BOY$90,768OtherLiabilitiesBOYAmt
Other Liabilities EOY$241,391OtherLiabilitiesEOYAmt
Total Liabilities BOY$437,680TotalLiabilitiesBOYAmt
Total Liabilities EOY$543,514TotalLiabilitiesEOYAmt
Organization Follows FASB117Yes (X)OrganizationFollowsFASB117Ind
No Donor Rstr Net Assests BOY$58,730,371NoDonorRstrNetAssestsBOYAmt
No Donor Rstr Net Assests EOY$58,938,930NoDonorRstrNetAssestsEOYAmt
Donor Rstr Net Assets BOY$919,019DonorRstrNetAssetsBOYAmt
Donor Rstr Net Assets EOY$1,104,263DonorRstrNetAssetsEOYAmt
Tot Net Ast Or Fund Balances BOY$59,649,390TotNetAstOrFundBalancesBOYAmt
Tot Net Ast Or Fund Balances EOY$60,043,193TotNetAstOrFundBalancesEOYAmt
Total Liabilities Net Ast BOY$60,087,070TotalLiabilitiesNetAstBOYAmt
Total Liabilities Net Ast EOY$60,586,707TotalLiabilitiesNetAstEOYAmt

Chg In Net Assets Fund Balances ChgInNetAssetsFundBalancesGrp

FieldValueIRS element (for citing)
Tot Net Ast Or Fund Balances BOY$59,649,390TotNetAstOrFundBalancesBOYAmt
Excess Revenue Over Expenses$394,042ExcessRevenueOverExpensesAmt
Other Increases$0OtherIncreasesAmt
Subtotal$60,043,432SubtotalAmt
Other Decreases$239OtherDecreasesAmt
Tot Net Ast Or Fund Balances EOY$60,043,193TotNetAstOrFundBalancesEOYAmt

Cap Gains Loss Tx Invst Incm Detail CapGainsLossTxInvstIncmDetail

Cap Gains Loss Tx Invst Incm CapGainsLossTxInvstIncmGrp

FieldValueIRS element (for citing)
PropertySALE OF SECURITIESPropertyDesc
How AcquiredPHowAcquiredCd
Gross Sales Price$35,768,999GrossSalesPriceAmt
Cost Or Other Basis$32,746,354CostOrOtherBasisAmt
Gain Or Loss$3,022,645GainOrLossAmt
Gains Minus Excess Or Losses$3,022,645GainsMinusExcessOrLossesAmt
FieldValueIRS element (for citing)
Capital Gain Net Income$3,022,645CapitalGainNetIncomeAmt

Qlfy Und Sect4940e Reduced Tax QlfyUndSect4940eReducedTaxGrp

FieldValueIRS element (for citing)
Liable Section4942 Tax0LiableSection4942TaxInd
Adjusted Qlfy Distri Yr1$4,175,726AdjustedQlfyDistriYr1Amt
Net Vl Noncharitable Assets Yr1$72,334,601NetVlNoncharitableAssetsYr1Amt
Distribution Yr10.057728DistributionYr1Rt
Adjusted Qlfy Distri Yr2$3,993,406AdjustedQlfyDistriYr2Amt
Net Vl Noncharitable Assets Yr2$70,162,009NetVlNoncharitableAssetsYr2Amt
Distribution Yr20.056917DistributionYr2Rt
Adjusted Qlfy Distri Yr3$3,694,327AdjustedQlfyDistriYr3Amt
Net Vl Noncharitable Assets Yr3$64,963,804NetVlNoncharitableAssetsYr3Amt
Distribution Yr30.056867DistributionYr3Rt
Adjusted Qlfy Distri Yr4$4,209,526AdjustedQlfyDistriYr4Amt
Net Vl Noncharitable Assets Yr4$66,164,115NetVlNoncharitableAssetsYr4Amt
Distribution Yr40.063622DistributionYr4Rt
Adjusted Qlfy Distri Yr5$3,838,345AdjustedQlfyDistriYr5Amt
Net Vl Noncharitable Assets Yr5$67,153,038NetVlNoncharitableAssetsYr5Amt
Distribution Yr50.057158DistributionYr5Rt
Total Distribution0.292292TotalDistributionRt
Average Distribution0.058458AverageDistributionRt
Net Vl Noncharitable Assets$72,271,913NetVlNoncharitableAssetsAmt
Adj Net Vl Noncharitable Assets$4,224,871AdjNetVlNoncharitableAssetsAmt
Net Investment Income Pct$44,140NetInvestmentIncomePctAmt
Adj Nonchrtbl Net Invst Incm Pct$4,269,011AdjNonchrtblNetInvstIncmPctAmt
Qualifying Distributions$4,282,172QualifyingDistributionsAmt

Excise Tax Based On Invst Incm ExciseTaxBasedOnInvstIncmGrp

FieldValueIRS element (for citing)
Domestic Org Meeting Sect4940eYes (X)DomesticOrgMeetingSect4940eInd
Investment Income Excise Tax$44,140InvestmentIncomeExciseTaxAmt
Tax Under Section511$0TaxUnderSection511Amt
Subtotal$44,140SubtotalAmt
Subtitle A Tax$0SubtitleATaxAmt
Tax Based On Investment Income$44,140TaxBasedOnInvestmentIncomeAmt
Estimated Plus Ovpmt Incm Tx$36,000EstimatedPlusOvpmtIncmTxAmt
Extsn Request Income Tax Paid$0ExtsnRequestIncomeTaxPaidAmt
Backup Withholding Withheld$0BackupWithholdingWithheldAmt
Total Payments And Credits$36,000TotalPaymentsAndCreditsAmt
Form2220 AttachedYes (X)Form2220AttachedInd
Es Penalty$541EsPenaltyAmt
Tax Due$8,681TaxDueAmt

Statements Regarding Acty StatementsRegardingActyGrp

FieldValueIRS element (for citing)
Legislative Political Acty0LegislativePoliticalActyInd
More Than100 Spent0MoreThan100SpentInd
Form1120 POL Filed0Form1120POLFiledInd
Section4955 Organization Tax$0Section4955OrganizationTaxAmt
Section4955 Managers Tax$0Section4955ManagersTaxAmt
Tax Reimbursed$0TaxReimbursedAmt
Activities Not Previously Rpt0ActivitiesNotPreviouslyRptInd
Changes To Articles Or Bylaws0ChangesToArticlesOrBylawsInd
Unrelated Bus Incm Over Limit0UnrelatedBusIncmOverLimitInd
Organization Dissolved Etc0OrganizationDissolvedEtcInd
Section508e Rqr SatisfiedYes (1)Section508eRqrSatisfiedInd
At Least5000 In AssetsYes (1)AtLeast5000InAssetsInd
Org Report Or Register StateINOrgReportOrRegisterStateCd
Form990 PF Filed With Atty GenYes (1)Form990PFFiledWithAttyGenInd
Private Operating Foundation0PrivateOperatingFoundationInd
New Substantial ContributorsYes (1)NewSubstantialContributorsInd
Own Controlled Entity0OwnControlledEntityInd
Donor Advised Fund0DonorAdvisedFundInd
Comply With Public Insp RqrYes (1)ComplyWithPublicInspRqrInd
Website AddressWWW.K21FOUNDATION.ORGWebsiteAddressTxt
Individual With BooksRICH HADDADIndividualWithBooksNm
Phone5742695188PhoneNum

Location Of Books US Address LocationOfBooksUSAddress

FieldValueIRS element (for citing)
Address Line12170 N POINTE DRIVEAddressLine1Txt
CityWARSAWCityNm
State AbbreviationINStateAbbreviationCd
ZIP46582ZIPCd
FieldValueIRS element (for citing)
Foreign Accounts Question0ForeignAccountsQuestionInd

Statements Regarding Acty4720 StatementsRegardingActy4720Grp

FieldValueIRS element (for citing)
Sale Or Exch Disqualified Prsn0SaleOrExchDisqualifiedPrsnInd
Brrw Or Lend Disqualified Prsn0BrrwOrLendDisqualifiedPrsnInd
Furn Goods Disqualified Prsn0FurnGoodsDisqualifiedPrsnInd
Pay Comp Disqualified PrsnYes (1)PayCompDisqualifiedPrsnInd
Transfer Ast Disqualified Prsn0TransferAstDisqualifiedPrsnInd
Payment To Government Official0PaymentToGovernmentOfficialInd
Acts Fail To Qlfy As Exceptions0ActsFailToQlfyAsExceptionsInd
Uncorrected Prior Acts0UncorrectedPriorActsInd
Undistributed Income PY0UndistributedIncomePYInd
Business Holdings0BusinessHoldingsInd
Jeopardy Investments0JeopardyInvestmentsInd
Uncorrected PY Jeopardy Invst0UncorrectedPYJeopardyInvstInd
Influence Legislation0InfluenceLegislationInd
Influence Election0InfluenceElectionInd
Grants To Individuals0GrantsToIndividualsInd
Grants To Organizations0GrantsToOrganizationsInd
Noncharitable Purpose0NoncharitablePurposeInd
Rcv Fnds To Pay Prsnl Bnft Cntrct0RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct0PayPremiumsPrsnlBnftCntrctInd
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTransInd
Subj To Tax Rmnrtn Ex Prcht Pymt0SubjToTaxRmnrtnExPrchtPymtInd

Officer Dir Trst Key Empl Info OfficerDirTrstKeyEmplInfoGrp

Officer Dir Trst Key Empl OfficerDirTrstKeyEmplGrp (18 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdTitleTitleTxtAverage Hrs Per Wk Devoted To PosAverageHrsPerWkDevotedToPosRtCompensationCompensationAmtEmployee Benefit ProgramEmployeeBenefitProgramAmtExpense Account Other AllwncExpenseAccountOtherAllwncAmt
RICHARD HADDAD
2170 NORTH POINTE DRIVEWARSAWIN46582PRESIDENT40.00$200,094$5,853$0
ANDREW GROSSNICKLE
2170 NORTH POINTE DRIVEWARSAWIN46582CHAIRMAN1.00$0$0$0
LISA O'NEILL
2170 NORTH POINTE DRIVEWARSAWIN46582VICE CHAIRMAN1.00$0$0$0
DANA KRULL
2170 NORTH POINTE DRIVEWARSAWIN46582TREASURER1.00$0$0$0
SCOTT TUCKER
2170 NORTH POINTE DRIVEWARSAWIN46582SECRETARY1.00$0$0$0
BECKY ALLES
2170 NORTH POINTE DRIVEWARSAWIN46582DIRECTOR1.00$0$0$0
STEVE GRILL
2170 NORTH POINTE DRIVEWARSAWIN46582DIRECTOR1.00$0$0$0
JILL GROSS
2170 NORTH POINTE DRIVEWARSAWIN46582DIRECTOR1.00$0$0$0
JOELLA HAUSEMANN
2170 NORTH POINTE DRIVEWARSAWIN46582DIRECTOR1.00$0$0$0
RICK KERLIN
2170 NORTH POINTE DRIVEWARSAWIN46582DIRECTOR1.00$0$0$0
ANITA KISHAN
2170 NORTH POINTE DRIVEWARSAWIN46582DIRECTOR1.00$0$0$0
CHAD LARSH
2170 NORTH POINTE DRIVEWARSAWIN46582DIRECTOR1.00$0$0$0
MAX MOCK
2170 NORTH POINTE DRIVEWARSAWIN46582DIRECTOR1.00$0$0$0
SANDRA PARRA
2170 NORTH POINTE DRIVEWARSAWIN46582DIRECTOR1.00$0$0$0
KEVIN ROBERTS
2170 NORTH POINTE DRIVEWARSAWIN46582DIRECTOR1.00$0$0$0
STEVE ROSS
2170 NORTH POINTE DRIVEWARSAWIN46582DIRECTOR1.00$0$0$0
DR JASMINE SCHLITT
2170 NORTH POINTE DRIVEWARSAWIN46582DIRECTOR1.00$0$0$0
BILL SMITH
2170 NORTH POINTE DRIVEWARSAWIN46582DIRECTOR1.00$0$0$0
FieldValueIRS element (for citing)
Comp Of Hghst Pd Empl Or NONENONECompOfHghstPdEmplOrNONETxt
Other Employee Paid Over50k0OtherEmployeePaidOver50kCnt

Compensation Of Hghst Pd Cntrct CompensationOfHghstPdCntrctGrp

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1MARQUETTE ASSOCIATESBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1180 N LASALLE SUITE 3500AddressLine1Txt
CityCHICAGOCityNm
State AbbreviationILStateAbbreviationCd
ZIP60601ZIPCd
FieldValueIRS element (for citing)
Service TypeINVESTMENT CONSULTINGServiceTypeTxt
Compensation$69,000CompensationAmt
FieldValueIRS element (for citing)
Contractor Paid Over50k0ContractorPaidOver50kCnt

Sum Of Program Related Invst SumOfProgramRelatedInvstGrp

FieldValueIRS element (for citing)
Description1FORGIVENESS OF CURRENT LOAN MORTGAGE PRINCIPAL AND INTEREST DUE FROM KOSCIUSKO HEALTH SERVICES PAVILION, INC., A SECTION 501(C(3) ORGANIZATION.Description1Txt
Expenses1$553,743Expenses1Amt
Total$553,743TotalAmt

Minimum Investment Return MinimumInvestmentReturnGrp

FieldValueIRS element (for citing)
Average Monthly FMV Of Sec$73,005,972AverageMonthlyFMVOfSecAmt
Average Monthly Cash Balances$366,529AverageMonthlyCashBalancesAmt
FMV All Other Noncharitable Ast$0FMVAllOtherNoncharitableAstAmt
Total FMV Of Unused Assets$73,372,501TotalFMVOfUnusedAssetsAmt
Reduction Claimed$0ReductionClaimedAmt
Acquisition Indebtedness$0AcquisitionIndebtednessAmt
Adjusted Total FMV Of Unused Ast$73,372,501AdjustedTotalFMVOfUnusedAstAmt
Cash Deemed Charitable$1,100,588CashDeemedCharitableAmt
Net Vl Noncharitable Assets$72,271,913NetVlNoncharitableAssetsAmt
Minimum Investment Return$3,613,596MinimumInvestmentReturnAmt

Distributable Amount DistributableAmountGrp

FieldValueIRS element (for citing)
Minimum Investment Return$3,613,596MinimumInvestmentReturnAmt
Tax Based On Investment Income$44,140TaxBasedOnInvestmentIncomeAmt
Total Tax$44,140TotalTaxAmt
Distributable Before Adj$3,569,456DistributableBeforeAdjAmt
Recoveries Qualfied Distri$0RecoveriesQualfiedDistriAmt
Distributable Before Ded$3,569,456DistributableBeforeDedAmt
Deduction From Distributable$0DeductionFromDistributableAmt
Distributable As Adjusted$3,569,456DistributableAsAdjustedAmt

Qualifying Distri Part XII QualifyingDistriPartXIIGrp

FieldValueIRS element (for citing)
Expenses And Contributions$3,728,429ExpensesAndContributionsAmt
Program Related Invst Total$553,743ProgramRelatedInvstTotalAmt
Qualifying Distributions$4,282,172QualifyingDistributionsAmt
Pct Sect4940e Org Net Invst Incm$44,140PctSect4940eOrgNetInvstIncmAmt
Adjusted Qualifying Distri$4,238,032AdjustedQualifyingDistriAmt

Undistributed Income UndistributedIncomeGrp

FieldValueIRS element (for citing)
Distributable As Adjusted$3,569,456DistributableAsAdjustedAmt
Undistributed Income PY$0UndistributedIncomePYAmt
Total For Prior Years$0TotalForPriorYearsAmt
Excess Distribution Cyov Yr5$87,852ExcessDistributionCyovYr5Amt
Excess Distribution Cyov Yr4$982,854ExcessDistributionCyovYr4Amt
Excess Distribution Cyov Yr3$515,855ExcessDistributionCyovYr3Amt
Excess Distribution Cyov Yr2$539,316ExcessDistributionCyovYr2Amt
Excess Distribution Cyov Yr1$624,896ExcessDistributionCyovYr1Amt
Total Excess Distribution Cyov$2,750,773TotalExcessDistributionCyovAmt
Qualifying Distributions$4,282,172QualifyingDistributionsAmt
Applied To Year1$0AppliedToYear1Amt
Applied To Prior Years$0AppliedToPriorYearsAmt
Treated As Distri From Corpus$0TreatedAsDistriFromCorpusAmt
Applied To Current Year$3,569,456AppliedToCurrentYearAmt
Remaining Distri From Corpus$712,716RemainingDistriFromCorpusAmt
Excess Distri Cyov App CY Corpus$0ExcessDistriCyovAppCYCorpusAmt
Excess Distribution Cyov App CY$0ExcessDistributionCyovAppCYAmt
Total Corpus$3,463,489TotalCorpusAmt
Prior Year Undistributed Incm$0PriorYearUndistributedIncmAmt
Prior Year Deficiency Or Tax$0PriorYearDeficiencyOrTaxAmt
Taxable1$0Taxable1Amt
Taxable2$0Taxable2Amt
Undistributed Income CY$0UndistributedIncomeCYAmt
Corpus Distri170b1 E Or4942g3$0CorpusDistri170b1EOr4942g3Amt
Excess Distri Cyov From Yr5$87,852ExcessDistriCyovFromYr5Amt
Excess Distri Cyov To Next Yr$3,375,637ExcessDistriCyovToNextYrAmt
Excess From Year4$982,854ExcessFromYear4Amt
Excess From Year3$515,855ExcessFromYear3Amt
Excess From Year2$539,316ExcessFromYear2Amt
Excess From Year1$624,896ExcessFromYear1Amt
Excess From Current Year$712,716ExcessFromCurrentYearAmt

Supplementary Information SupplementaryInformationGrp

Application Submission Info ApplicationSubmissionInfoGrp

FieldValueIRS element (for citing)
Recipient PersonKOSCIUSKO 21ST CENTURY FOUNDATION IRecipientPersonNm

Recipient US Address RecipientUSAddress

FieldValueIRS element (for citing)
Address Line12170 NORTH POINTE DRIVEAddressLine1Txt
CityWARSAWCityNm
State AbbreviationINStateAbbreviationCd
ZIP46582ZIPCd
FieldValueIRS element (for citing)
Recipient Phone5742695188RecipientPhoneNum
Form And Info And MaterialsSEE STATEMENTS 20 AND 21.FormAndInfoAndMaterialsTxt
Submission DeadlinesSEE STATEMENTS 20 AND 21.SubmissionDeadlinesTxt
Restrictions On AwardsSEE STATEMENTS 20 AND 21.RestrictionsOnAwardsTxt

Grant Or Contribution Pd Dur Yr GrantOrContributionPdDurYrGrp (128 entries)

Address Line1RecipientUSAddress/AddressLine1TxtCityRecipientUSAddress/CityNmState AbbreviationRecipientUSAddress/StateAbbreviationCdZIPRecipientUSAddress/ZIPCdRecipient RelationshipRecipientRelationshipTxtRecipient Foundation StatusRecipientFoundationStatusTxtGrant Or Contribution PurposeGrantOrContributionPurposeTxtAmtAmt
CANCER CARE GRANT ALICE HENDERSON
PO BOX 1810WARSAWIN465811810NONEIPROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS$2,285
CANCER CARE GRANT ALICIA CENTENO
PO BOX 1810WARSAWIN465811810NONEIPROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS$2,410
CANCER CARE GRANT ANNETTE COENEN
PO BOX 1810WARSAWIN465811810NONEIPROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS$2,500
CANCER CARE GRANT ANTHONY HENSEL
PO BOX 1810WARSAWIN465811810NONEIPROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS$1,503
CANCER CARE GRANT BARBARA SKEANS
PO BOX 1810WARSAWIN465811810NONEIPROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS$4,348
CANCER CARE GRANT BRENDA MILLER
PO BOX 1810WARSAWIN465811810NONEIPROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS$1,465
CANCER CARE GRANT CARL FINKEN
PO BOX 1810WARSAWIN465811810NONEIPROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS$3,504
CANCER CARE GRANT CARL POE
PO BOX 1810WARSAWIN465811810NONEIPROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS$1,473
CANCER CARE GRANT CINDY WADDLE
PO BOX 1810WARSAWIN465811810NONEIPROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS$2,505
CANCER CARE GRANT CLOYD PRUITT
PO BOX 1810WARSAWIN465811810NONEIPROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS$4,479
CANCER CARE GRANT COLE LOVE
PO BOX 1810WARSAWIN465811810NONEIPROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS$1,596
CANCER CARE GRANT CYNTHIA FREDRICK
PO BOX 1811WARSAWIN465811811NONEIPROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS$2,386
CANCER CARE GRANT DAVID COBBS
PO BOX 1810WARSAWIN465811810NONEIPROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS$1,980
CANCER CARE GRANT DAVID EVERLY
PO BOX 1810WARSAWIN465811810NONEIPROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS$1,185
CANCER CARE GRANT DAVID WEAVER
PO BOX 1810WARSAWIN465811810NONEIPROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS$2,107
CANCER CARE GRANT DEBBIE WHYBREW
PO BOX 1810WARSAWIN465811810NONEIPROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS$1,590
CANCER CARE GRANT DELIA NAVARRO
PO BOX 1810WARSAWIN465811810NONEIPROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS$2,000
CANCER CARE GRANT DELLA TRUMP
PO BOX 1810WARSAWIN465811810NONEIPROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS$5,500
CANCER CARE GRANT DONALD MASTERSON
PO BOX 1810WARSAWIN465811810NONEIPROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS$1,895
CANCER CARE GRANT DOROTHY SNYDER
PO BOX 1810WARSAWIN465811810NONEIPROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS$2,099
CANCER CARE GRANT EDWARD DEMPSEY
PO BOX 1810WARSAWIN465811810NONEIPROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS$1,977
CANCER CARE GRANT GAROULD O'BANION
PO BOX 1810WARSAWIN465811810NONEIPROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS$3,500
CANCER CARE GRANT GEORGE HATCHER
PO BOX 1810WARSAWIN465811810NONEIPROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS$2,497
CANCER CARE GRANT JAMES CLEMANS
PO BOX 1810WARSAWIN465811810NONEIPROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS$1,431
CANCER CARE GRANT JAMES NEACE
PO BOX 1810WARSAWIN465811810NONEIPROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS$2,060
CANCER CARE GRANT JEAN ZAJICEK
PO BOX 1810WARSAWIN465811810NONEIPROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS$1,956
CANCER CARE GRANT JIMMY HARTMAN
PO BOX 1810WARSAWIN465811810NONEIPROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS$3,744
CANCER CARE GRANT JULIE LARSON
PO BOX 1810WARSAWIN465811810NONEIPROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS$1,499
CANCER CARE GRANT KAREN DEWITT
PO BOX 1810WARSAWIN465811810NONEIPROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS$2,458
CANCER CARE GRANT KATHY VERMILLION
PO BOX 1810WARSAWIN465811810NONEIPROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS$3,446
CANCER CARE GRANT KATIE WYNKOOP
PO BOX 1810WARSAWIN465811810NONEIPROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS$2,000
CANCER CARE GRANT KRISTIN SUNDIN
PO BOX 1810WARSAWIN465811810NONEIPROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS$2,058
CANCER CARE GRANT KRISTINE TERRELL
PO BOX 1810WARSAWIN465811810NONEIPROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS$1,968
CANCER CARE GRANT LARRY SILVA
PO BOX 1810WARSAWIN465811810NONEIPROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS$1,000
CANCER CARE GRANT LISA CASSEL
PO BOX 1810WARSAWIN465811810NONEIPROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS$3,000
CANCER CARE GRANT MADONNA STEPHENS
PO BOX 1810WARSAWIN465811810NONEIPROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS$2,582
CANCER CARE GRANT MARGARITA MALDONA
PO BOX 1810WARSAWIN465811810NONEIPROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS$1,900
CANCER CARE GRANT MARGARITA PATINO
PO BOX 1810WARSAWIN465811810NONEIPROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS$2,375
CANCER CARE GRANT MARK DEMSKE
PO BOX 1810WARSAWIN465811810NONEIPROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS$1,000
CANCER CARE GRANT MONICA CAPLES
PO BOX 1810WARSAWIN465811810NONEIPROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS$3,500
CANCER CARE GRANT PAT REGAN
PO BOX 1810WARSAWIN465811810NONEIPROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS$1,100
CANCER CARE GRANT PAUL HOPKINS
PO BOX 1810WARSAWIN465811810NONEIPROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS$2,032
CANCER CARE GRANT PENNY KRUECKEBERG
PO BOX 1810WARSAWIN465811810NONEIPROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS$1,000
CANCER CARE GRANT RACHELL CARPENTER
PO BOX 1810WARSAWIN465811810NONEIPROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS$4,460
CANCER CARE GRANT ROBERT SPRAGUE
PO BOX 1810WARSAWIN465811810NONEIPROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS$2,501
CANCER CARE GRANT ROBIN CAMPBELL
PO BOX 1810WARSAWIN465811810NONEIPROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS$3,262
CANCER CARE GRANT RON HELMAN
PO BOX 1810WARSAWIN465811810NONEIPROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS$2,994
CANCER CARE GRANT RONNIE BALDRIDGE
PO BOX 1810WARSAWIN465811810NONEIPROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS$5,500
CANCER CARE GRANT ROXANN ARNOTT
PO BOX 1810WARSAWIN465811810NONEIPROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS$3,401
CANCER CARE GRANT SALLY CHANEY
PO BOX 1810WARSAWIN465811810NONEIPROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS$3,133
CANCER CARE GRANT SANDRA TUNCIL
PO BOX 1810WARSAWIN465811810NONEIPROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS$2,207
CANCER CARE GRANT SANDY PALACIOS
PO BOX 1810WARSAWIN465811810NONEIPROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS$5,000
CANCER CARE GRANT SHERRI SANCHEZ
PO BOX 1810WARSAWIN465811810NONEIPROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS$2,000
CANCER CARE GRANT STANLEY HUTCHINSO
PO BOX 1810WARSAWIN465811810NONEIPROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS$2,000
CANCER CARE GRANT SUE DRAKE
PO BOX 1810WARSAWIN465811810NONEIPROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS$1,500
CANCER CARE GRANT SUSAN DOYLE
PO BOX 1810WARSAWIN465811810NONEIPROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS$1,981
CANCER CARE GRANT TAMERA SMITH
PO BOX 1810WARSAWIN465811810NONEIPROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS$2,370
CANCER CARE GRANT TEALIE GOBLE
PO BOX 1810WARSAWIN465811810NONEIPROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS$2,002
CANCER CARE GRANT TED GILLEM
PO BOX 1810WARSAWIN465811810NONEIPROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS$2,184
CANCER CARE GRANT TINA TRUEX
PO BOX 1810WARSAWIN465811810NONEIPROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS$1,175
CANCER CARE GRANT WILLIAM WOOD
PO BOX 1810WARSAWIN465811810NONEIPROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS$4,385
CANCER CARE GRANT WILLIE FIELDS
PO BOX 1810WARSAWIN465811810NONEIPROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS$4,048
CANCER CARE GRANT OTHER GRANTS LESS
PO BOX 1810WARSAWIN465811810NONEIPROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS$19,898
CONDITIONAL GRANT 2ND MILE ADVENTURES
2562 WALTON BLVD 317WARSAWIN46582NONEPCPROGRAM AND EQUIPMENT$5,917
CONDITIONAL GRANT AGAITAS
1945 PHEASANT RIDGE DRWARSAWIN46580NONEPCEQUIPMENT$18,033
CONDITIONAL GRANT AMERICAN DIABETES ASSOCIATION
6415 CASTLEWAY WEST DR STE 114INDIANAPOLISIN46250NONEPCSCHOLARSHIPS FOR CHILDREN ATTENDING DIABETES CAMP$3,825
CONDITIONAL GRANT BAKER YOUTH CLUB
1401 E SMITH STWARSAWIN46580NONEPCEQUIPMENT$13,043
CONDITIONAL GRANT CASA OF KOSCIUSKO COUNTY
121 NORTH LAKE STREET 2ND FLRWARSAWIN46580NONEPCMARKETING AND MOTIVATIONAL SPEAKER$15,000
CONDITIONAL GRANT CITY OF WARSAW
102 SOUTH BUFFALO STREETWARSAWIN46580NONEPCPICKLEBALL COURTS AND BOULDERING ROCKS$51,933
CONDITIONAL GRANT FELLOWSHIP MISSIONS
1520 EAST WINONA AVENUEWARSAWIN46580NONEPCLAND PURCHASE AND FREEZER$115,730
CONDITIONAL GRANT FOUR WAY AMBULANCE SERVICE INC
PO BOX 225MENTONEIN46539NONEPCEQUIPMENT$117,208
CONDITIONAL GRANT GRACE COLLEGE & SEMINARY
200 SEMINARY DRIVEWINONA LAKEIN46590NONEPCRESEARCH$98,448
CONDITIONAL GRANT HEARTLINE PREGNANCY CENTER
1515 PROVIDENT DR STE 180WARSAWIN46580NONEPCB.A.B.E. BOUTIQUE, CLINICAL SUPPLIES, CAR SEATS, STI TESTING$37,694
CONDITIONAL GRANT HOUSING OPPORTUNITIES OF WARSAW
109 W CATHERINE STMILFORDIN46542NONEPCHOME REPAIRS$12,021
CONDITIONAL GRANT IVY TECH FOUNDATION
2545 SILVEUS CROSSINGWARSAWIN46582NONEPCEQUIPMENT$21,999
CONDITIONAL GRANT JOE'S KIDS
902 PROVIDENT DR SUITE CWARSAWIN46580NONEPCRENT SUBSIDY$41,220
CONDITIONAL GRANT KCV CYCLING CLUB
PO BOX 325WINONA LAKEIN46590NONEPCMAINTENANCE EQUIPMENT$2,874
CONDITIONAL GRANT KOSCIUSKO COUNTY COUNCIL ON AGING
800 PARK AVEWARSAWIN46580NONEPCTRANSPORTATION VAN AND COMPUTERS$14,080
CONDITIONAL GRANT KOSCIUSKO COUNTY SHELTER FOR ABUSE
603 NORTH PARKER STREETWARSAWIN46580NONEPCSECURITY SYSTEM UPDATES$15,839
CONDITIONAL GRANT KOSCIUSKO HEALTH SERVICES PAVILION
1515 PROVIDENT DRIVEWARSAWIN46580NONEPCBUILDING RENOVATIONS$35,467
CONDITIONAL GRANT KOSCIUSKO HOME CARE & HOSPICE
1515 PROVIDENT DRIVE STE 250WARSAWIN46580NONEPCKID'S ORAL HEALTH, MEDICATION AND DENTAL, MEDICAL SUPPLIES, COMPUTERS$334,313
CONDITIONAL GRANT LAKELAND YOUTH CENTER
101 WEST CHICAGO STREETSYRACUSEIN46567NONEPCEQUIPMENT$1,297
CONDITIONAL GRANT LITTLE LAMBS MINISTRY
1413 NORTH LONG DRIVESYRACUSEIN46567NONEPCPLAYGROUND EQUIPMENT$15,000
CONDITIONAL GRANT LIVE WELL KOSCIUSKO
8546 SOUTH 200 WESTCLAYPOOLIN46510NONEPCSMOKING CESSATION PROGRAMS AND OPERATIONAL FUNDING$25,927
CONDITIONAL GRANT NORTHERN INDIANA HISPANIC HEALTH COALITION
444 NORTH NAPPANEE STREETELKHARTIN46514NONEPCOPERATIONAL FUNDING FOR BILINGUAL ADVOCATE/HEALTH FAIRS$42,275
CONDITIONAL GRANT PIERCETON VOLUNTEER FIRE DEPARTMENT
PO BOX 526PIERCETONIN46562NONEPCCARDIAC MONITORS$65,281
CONDITIONAL GRANT QUESTA FOUNDATION
6502 CONSTITUTION DRFORT WAYNEIN46804NONEPCHEALTH SCHOLARS PROGRAM$100,000
CONDITIONAL GRANT REAL SERVICES INC
1151 SOUTH MICHIGAN STREETSOUTH BENDIN46601NONEPCHEALTH EDUCATION PROGRAM$4,000
CONDITIONAL GRANT RIGHT TO LIFE OF NORTH CENTRAL INDIANA
1906 HAMILTON BLVDWINONA LAKEIN46590NONEPCBABY BOX MARKETING CAMPAIGN$1,785
CONDITIONAL GRANT ROSE GARDEN RECOVERY COMMUNITY
PO BOX 571SYRACUSEIN46567NONEPCFACILITY RENOVATION$23,087
CONDITIONAL GRANT SERENITY HOUSE INC
2438 CR 50AUBURNIN46706NONEPCWARSAW FACILITIES RENOVATIONS$49,253
CONDITIONAL GRANT SYRACUSE WAWASEE PARK FOUNDATION
1013 NORTH LONG DRIVESYRACUSEIN46567NONEPCGREENWAY EXPANSION$200,000
CONDITIONAL GRANT THE WATERSHED FOUNDATION
PO BOX 55NORTH WEBSTERIN46567NONEPCSHORELINE RESTORATION PROJECT$2,000
CONDITIONAL GRANT TOWN OF WINONA LAKE
1310 PARK AVENUEWINONA LAKEIN46590NONEPCBICYCLES AND SURVEILLANCE VAN$68,423
CONDITIONAL GRANT TURKEY CREEK FIRE TERRITORY
8138 EAST MCCLINTIC ROADSYRACUSEIN46567NONEPCCARDIAC MONITORS$330,144
CONDITIONAL GRANT TURNING POINT INC
PO BOX 751NORTH WEBSTERIN46555NONEPCCOMPUTERS AND SECURITY SYSTEM UPDATE$8,147
CONDITIONAL GRANT WARSAW COMMUNITY SCHOOLS
1 ADMINISTRATION DRIVEWARSAWIN46580NONEPCTRAC EQUIPMENT, ELEMENTARY PE EQUIPMENT, TOWER GARDENS$408,067
CONDITIONAL GRANT WARSAW LITTLE LEAGUE
PO BOX 153WARSAWIN46580NONEPCPARK RENOVATIONS$53,883
CONDITIONAL GRANT WAWASEE COMMUNITY SCHOOLS
1 WARRIOR PATSYRACUSEIN46567NONEPCHEALTH EDUCATION PROGRAM$14,143
CONDITIONAL GRANT WHITKO COMMUNITY SCHOOLS
434 SOUTH FIRST STREETPIERCETONIN46567NONEPCTOWER GARDEN$3,614
CONDITIONAL GRANTS OTHER GRANTS UNDER 1000
PO BOX 1810WARSAWIN465811810NONEPCEQUIPMENT$2,000
DIRECT GRANT AGAITAS
1945 PHEASANT RIDGE DRWARSAWIN46580NONEPCK21 BOARD OF DIRECTORS DIRECTED DONATION$1,500
DIRECT GRANT BAKER YOUTH CLUB
1401 E SMITH STWARSAWIN46580NONEPCK21 BOARD OF DIRECTORS DIRECTED DONATION, OPERATIONAL$2,500
DIRECT GRANT GRACE COLLEGE & SEMINARY
200 SEMINARY DRIVEWINONA LAKEIN46590NONEPCK21 BOARD OF DIRECTORS DIRECTED DONATION$1,500
DIRECT GRANT KOSCIUSKO COMMUNITY YMCA
1305 MARINERS DRWARSAWIN46582NONEPCOPERATIONAL ASSISTANCE$22,600
DIRECT GRANT NORTH STAR MEDICAL
2045 112TH AVEHOLLANDMI49424NONEPCAED AND MEDICAL EQUIPMENT FOR MULTIPLE ORGANIZATIONS$22,552
DIRECT GRANT NORTH WEBSTER COMMUNITY CENTER
PO BOX 379NORTH WEBSTERIN46555NONEPCK21 BOARD OF DIRECTORS DIRECTED DONATION$1,400
DIRECT GRANT SOCIETY OF ST ANDREW
7840 DITCH ROADINDIANAPOLISIN46260NONEPCFOOD TRANSPORTATION FOR NEED-BASED PROGRAMS$3,500
DIRECT GRANTS OTHER GRANTS UNDER 1000
PO BOX 1810WARSAWIN465811810NONEPCK21 BOARD OF DIRECTORS DIRECTED DONATION$13,627
UNCONDITIONAL GRANT A BRIDGE TO HOPE
499 E 450 SOUTHWARSAWIN46580NONEPCOPERATIONAL ASSISTANCE$75,000
UNCONDITIONAL GRANT BAKER YOUTH CLUB
1401 E SMITH STWARSAWIN46580NONEPCSUMMER FITNESS PROGRAM$20,000
UNCONDITIONAL GRANT BIG BROTHERS BIG SISTERS
499 E 450 SOUTHWARSAWIN46580NONEPCOPERATIONAL ASSISTANCE$5,000
UNCONDITIONAL GRANT BOWEN CENTER
850 N HARRISON STREETWARSAWIN46580NONEPCOPERATIONAL ASSISTANCE$35,000
UNCONDITIONAL GRANT BRIGHTPOINT
227 E WASHINGTON BLVDFORT WAYNEIN46804NONEPCOPERATIONAL ASSISTANCE$17,500
UNCONDITIONAL GRANT CANCER SERVICES OF NORTHEAST INDIANA
6316 MUTUAL DRIVEFORT WAYNEIN46825NONEPCDIRECT ASSISTANCE / CLIENT ADVOCACY$20,000
UNCONDITIONAL GRANT ERIN'S HOUSE FOR GRIEVING CHILDREN
5670 YMCA PARK DRIVE WESTFORT WAYNEIN46835NONEPCOPERATIONAL ASSISTANCE$4,000
UNCONDITIONAL GRANT GRACE COLLEGE & SEMINARY
200 SEMINARY DRIVEWINONA LAKEIN46590NONEPCLILLY CENTER OPERATIONAL ASSISTANCE$20,000
UNCONDITIONAL GRANT GREATER WARSAW CO-OP PRESCHOOL
2032 SOUTH 150 WESTWARSAWIN46580NONEPCINDOOR PLAY EQUIPMENT$1,132
UNCONDITIONAL GRANT HARVEST WITH A HEART
201 SOUTH HIGBEE STREETMILFORDIN46542NONEPCWELLNESS PROGRAM$1,683
UNCONDITIONAL GRANT KOSCIUSKO COMMUNITY YMCA
1305 MARINERS DRWARSAWIN46582NONEPCOPERATIONAL ASSISTANCE$24,905
UNCONDITIONAL GRANT KOSCIUSKO COUNTY COMMUNITY FOUNDATION
102 EAST MARKET STREETWARSAWIN46580NONEPCGOOD SAMARITAN FUND$125,000
UNCONDITIONAL GRANT KOSCIUSKO HOME CARE & HOSPICE
1515 PROVIDENT DRIVE STE 250WARSAWIN46580NONEPCOPERATIONAL ASSISTANCE$166,717
UNCONDITIONAL GRANT MAD ANTHONY'S CHILDREN'S HOPE HOUSE
7922 WEST JEFFERSON BLVDFORT WAYNEIN46804NONEPCOPERATIONAL ASSISTANCE$10,000
UNCONDITIONAL GRANT MCMILLEN CENTER
600 JIM KELLEY BLVDFORT WAYNEIN46816NONEPCHEALTH EDUCATION PROGRAMS$10,000
UNCONDITIONAL GRANT NORTHERN INDIANA HISPANIC HEALTH COALITION
444 NORTH NAPPANEE STREETELKHARTIN46514NONEPCHEALTH FAIR$20,000
UNCONDITIONAL GRANT RONALD MCDONALD HOUSE CHARITIES OF NEIN
11109 PARKVIEW PLAZA DRIVEFORT WAYNEIN46845NONEPCCARE MOBILE OPERATIONAL ASSISTANCE$5,000
UNCONDITIONAL GRANT RYAN'S PLACE INC
PO BOX 73GOSHENIN46527NONEPCOPERATIONAL ASSISTANCE$8,000
UNCONDITIONAL GRANT ROSE GARDEN RECOVERY COMMUNITY
PO BOX 571SYRACUSEIN46567NONEPCMARKETING CAMPAIGN$4,335
FieldValueIRS element (for citing)
Total Grant Or Contri Pd Dur Yr$3,190,315TotalGrantOrContriPdDurYrAmt
Total Grant Or Contri Apprv Fut$0TotalGrantOrContriApprvFutAmt

Analysis Income Producing Acty AnalysisIncomeProducingActyGrp

Int On Sav And Temp Cash Invst IntOnSavAndTempCashInvstGrp

FieldValueIRS element (for citing)
Exclusion14ExclusionCd
Exclusion$435,781ExclusionAmt

Div And Int From Sec Part VII DivAndIntFromSecPartVIIGrp

FieldValueIRS element (for citing)
Exclusion14ExclusionCd
Exclusion$1,079,442ExclusionAmt

Net Rntl Incm Re Not Debt Fincd Prop NetRntlIncmReNotDebtFincdProp

FieldValueIRS element (for citing)
Exclusion16ExclusionCd
Exclusion$93,770ExclusionAmt

Other Investment Incm Part VII OtherInvestmentIncmPartVIIGrp

FieldValueIRS element (for citing)
Exclusion14ExclusionCd
Exclusion$1,401ExclusionAmt

Gain Sales Ast Oth Than Invntry GainSalesAstOthThanInvntryGrp

FieldValueIRS element (for citing)
Exclusion18ExclusionCd
Exclusion$3,022,645ExclusionAmt

Subtotals Incm Producing Acty SubtotalsIncmProducingActyGrp

FieldValueIRS element (for citing)
Unrelated Business Taxbl Incm$0UnrelatedBusinessTaxblIncmAmt
Exclusion$4,633,039ExclusionAmt
Related Or Exempt Function Incm$0RelatedOrExemptFunctionIncmAmt
FieldValueIRS element (for citing)
Total Income Producing Acty$4,633,039TotalIncomeProducingActyAmt

Trnsfr Trans Rln Nonchrtbl EO TrnsfrTransRlnNonchrtblEOGrp

FieldValueIRS element (for citing)
Trnsfr Of Cash To Nonchrtbl EO0TrnsfrOfCashToNonchrtblEOInd
Trnsfr Other Asset Nonchrtbl EO0TrnsfrOtherAssetNonchrtblEOInd
Sales Or Exchanges Of Assets0SalesOrExchangesOfAssetsInd
Purchase Of Assets Nonchrtbl EO0PurchaseOfAssetsNonchrtblEOInd
Rental Of Facilities Oth Assets0RentalOfFacilitiesOthAssetsInd
Reimbursement Arrangements0ReimbursementArrangementsInd
Loans Or Loan Guarantees0LoansOrLoanGuaranteesInd
Performance Of Services Etc0PerformanceOfServicesEtcInd
Sharing Of Facilities Etc0SharingOfFacilitiesEtcInd
Relationships Nonchrtbl EO0RelationshipsNonchrtblEOInd

Schedule B IRS990ScheduleB

FieldValueIRS element (for citing)
Organization501c3 Exempt PFYes (X)Organization501c3ExemptPFInd
General RuleYes (X)GeneralRuleInd

Contributor Information ContributorInformationGrp (6 entries)

ContributorContributorNumAddress Line1ContributorUSAddress/AddressLine1TxtCityContributorUSAddress/CityNmState AbbreviationContributorUSAddress/StateAbbreviationCdZIPContributorUSAddress/ZIPCdTotal ContributionsTotalContributionsAmtNoncash ContributionNoncashContributionIndPerson ContributionPersonContributionInd
DR AND MRS RICK SASSO
110674 WINTERWOODCARMELIN46032$202,034Yes (X)
WOMAN OF TODAY
24687 E CARDINAL DRSYRACUSEIN46567$19,086Yes (X)
BEAVER DAM UM CHURCH
39798 W 1000 SOUTHAKRONIN46910$17,000Yes (X)
DONETTE SMOCK
45867 E ISLAND AVESYRACUSEIN46567$10,000Yes (X)
BERTSCH FAMILY CHARITABLE FOUNDATION
5PO BOX 1494WARSAWIN46581$7,000Yes (X)
LAKELAND CHRISTIAN ACADEMY
61093 S 250 EWINONA LAKEIN46590$6,080Yes (X)

Non Cash Property Contribution NonCashPropertyContributionGrp

FieldValueIRS element (for citing)
Contributor1ContributorNum
Noncash PropertyMARKETABLE SECURITIESNoncashPropertyDesc
Fair Market Value$202,034FairMarketValueAmt
Received2019-12-31ReceivedDt

Accounting Fees Schedule AccountingFeesSchedule

Accounting Fees Detail AccountingFeesDetail

FieldValueIRS element (for citing)
CategoryACCOUNTING FEESCategoryTxt
Amt$20,150Amt
Net Investment Income$0NetInvestmentIncomeAmt
Adjusted Net Income$0AdjustedNetIncomeAmt
Disbursements Charitable Prps$20,150DisbursementsCharitablePrpsAmt

General Explanation Attachment GeneralExplanationAttachment

General Explanation GeneralExplanationGrp (2 entries)

IdentifierIdentifierTxtForm And Line ReferenceFormAndLineReferenceDescMedium ExplanationMediumExplanationTxt
SUPPLEMENTARY INFORMATIONFORM 990-PF, PART XV, LINE 2A THROUGH 2DLINE 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 INFORMATIONFORM 990-PF, PART XV, LINE 2A THROUGH 2DLINE 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)

BondBondNmEOY Book ValueEOYBookValueAmtEOYFMVEOYFMVAmt
CORPORATE BONDS$7,113,254$7,273,892
FOREIGN BONDS$416,962$430,841

Investments Corp Stock Schedule InvestmentsCorpStockSchedule

Investments Corporate Stock InvestmentsCorporateStockGrp

FieldValueIRS element (for citing)
StockEQUITY SECURITIESStockNm
EOY Book Value$30,222,616EOYBookValueAmt
EOYFMV$45,352,988EOYFMVAmt

Investments Govt Obligations Sch InvestmentsGovtObligationsSch

FieldValueIRS element (for citing)
US Govt Obligations Book Vl EOY$5,028,571USGovtObligationsBookVlEOYAmt
US Govt Obligations EOYFMV$5,103,581USGovtObligationsEOYFMVAmt
State Local Sec Book Vl EOY$0StateLocalSecBookVlEOYAmt
State Local Sec EOYFMV$0StateLocalSecEOYFMVAmt

Investments Land Schedule2 InvestmentsLandSchedule2

Investment Land InvestmentLandGrp (4 entries)

Category Or ItemCategoryOrItemTxtCost Or Other BasisCostOrOtherBasisAmtAccumulated DepreciationAccumulatedDepreciationAmtBook ValueBookValueAmtEOYFMVEOYFMVAmt
LAND$57,995$0$57,995$57,995
LAND IMPROVEMENTS$311,605$126,682$184,923$184,923
LEASEHOLD IMPROVEMENTS$969,226$464,412$504,814$504,814
BUILDING$1,441,680$224,272$1,217,408$1,217,408

Investments Other Schedule2 InvestmentsOtherSchedule2

Investments Other InvestmentsOtherGrp (5 entries)

Category Or ItemCategoryOrItemTxtListed At Cost Or FMVListedAtCostOrFMVCdBook ValueBookValueAmtEOYFMVEOYFMVAmt
REAL ESTATE INVESTMENT FUNDFMV$2,429,630$3,283,977
HEDGE FUNDFMV$4,441,390$3,996,343
GLOBAL MANAGED VOLATILITYFMV$2,735,540$4,192,358
US EQUITY INDEX PUTWRITE FUND LLCFMV$3,834,424$3,955,583
PRIVATE EQUITYFMV$141,176$140,270

Land Etc Schedule2 LandEtcSchedule2

Land Etc LandEtcGrp

FieldValueIRS element (for citing)
Category Or ItemOFFICE & COMPUTER EQUIPMENTCategoryOrItemTxt
Cost Or Other Basis$68,643CostOrOtherBasisAmt
Accumulated Depreciation$68,643AccumulatedDepreciationAmt
Book Value$0BookValueAmt

Other Assets Schedule OtherAssetsSchedule

Other Assets Schedule OtherAssetsScheduleGrp (2 entries)

DescDescBOY Book ValueBOYBookValueAmtEOY Book ValueEOYBookValueAmtEOYFMVEOYFMVAmt
NOTES RECEIVABLE HELD FOR GRANT MAKING$1,288,792$788,792$788,792
RECEIVABLE - OTHER$1,658$1,186$1,186

Other Decreases Schedule OtherDecreasesSchedule

Other Decreases Detail OtherDecreasesDetail

FieldValueIRS element (for citing)
DescPRIOR PERIOD ADJUSTMENTDesc
Amt$239Amt

Other Expenses Schedule OtherExpensesSchedule

Other Expenses Schedule OtherExpensesScheduleGrp (5 entries)

DescDescRevenue And Expenses Per BooksRevenueAndExpensesPerBooksAmtNet Investment IncomeNetInvestmentIncomeAmtAdjusted Net IncomeAdjustedNetIncomeAmtDisbursements Charitable PrpsDisbursementsCharitablePrpsAmt
KHSP MORTGAGE INTEREST FORGIVENESS$553,743$0$0$0
FUNDRAISING EXPENSES$29,496$0$0$29,496
INSURANCE$7,720$0$0$5,776
MARKETING$73,627$0$0$73,627
MISCELLANEOUS EXPENSE$43,910$6,091$0$37,819

Other Income Schedule2 OtherIncomeSchedule2

Other Income Detail OtherIncomeDetail

FieldValueIRS element (for citing)
DescOTHER INCOMEDesc
Revenue And Expenses Per Books$1,401RevenueAndExpensesPerBooksAmt
Net Investment Income$1,401NetInvestmentIncomeAmt

Other Liabilities Schedule OtherLiabilitiesSchedule

Other Liabilities Detail OtherLiabilitiesDetail

FieldValueIRS element (for citing)
DescDEFERRED TAX LIABILITYDesc
BOY Book Value$90,768BOYBookValueAmt
EOY Book Value$241,391EOYBookValueAmt

Other Professional Fees Schedule OtherProfessionalFeesSchedule

Other Professional Fees Detail OtherProfessionalFeesDetail

FieldValueIRS element (for citing)
CategoryINVESTMENT MGT FEESCategoryTxt
Amt$219,485Amt
Net Investment Income$219,485NetInvestmentIncomeAmt
Adjusted Net Income$0AdjustedNetIncomeAmt
Disbursements Charitable Prps$0DisbursementsCharitablePrpsAmt

Substantial Contributors Sch SubstantialContributorsSch

Substantial Contributor Detail SubstantialContributorDetail (3 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCd
DR AND MRS RICK SASSO
10674 WINTERWOODCARMELIN46032
LUTHERAN HEALTH FOUNDATION
3024 FAIRFIELD AVENUEFORT WAYNEIN46807
MULTI-TOWNSHIP EMS
34 E ARMSTRONG RDLEESBURGIN46538

Taxes Schedule TaxesSchedule

Taxes Detail TaxesDetail

FieldValueIRS element (for citing)
CategoryEXCISE TAXESCategoryTxt
Amt$195,542Amt
Net Investment Income$0NetInvestmentIncomeAmt
Adjusted Net Income$0AdjustedNetIncomeAmt
Disbursements Charitable Prps$0DisbursementsCharitablePrpsAmt

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