2020-05-19T08:54:40-05:00 2019-12-31 351178661 BLUE & CO LLC 500 N MERIDIAN ST SUITE 200 INDIANAPOLIS IN 46204 990PF 2019-01-01 351187105 KOSCIUSKO 21ST CENTURY FOUNDATION INC AKA K21 HEALTH FOUNDATION KOSC 5742695188 2170 N POINTE DRIVE WARSAW IN 46582 RICH HADDAD PRESIDENT 5742695188 2020-05-19 1 ANGELA N CRAWFORD CPA P00418596 3176334705 2020-05-19 2019 2022-09-23 18:48:47Z X 77952977 X 411651 435781 435781 1079442 1079442 264017 264489 93770 3022645 35768999 3022645 1401 1401 0 5214937 4803758 0 205947 0 0 205947 84218 0 0 88218 22118 0 0 22118 20150 0 0 20150 219485 219485 0 0 195542 0 0 0 164769 164156 0 44556 0 0 44556 8292 0 0 8292 2115 0 0 2115 708496 6091 0 146718 1675688 389732 0 538114 3145207 3190315 4820895 389732 0 3728429 394042 4414026 0 1420996 1460596 1460596 9374 7430 7430 4137117 5028571 5103581 30759796 30222616 45352988 8008032 7530216 7704733 2780506 815366 1677059 1965140 1965140 12783633 13582160 15568531 68643 68643 613 0 0 1290450 789978 789978 60087070 60586707 77952977 9945 8681 336967 293442 90768 241391 437680 543514 X 58730371 58938930 919019 1104263 59649390 60043193 60087070 60586707 59649390 394042 0 60043432 239 60043193 SALE OF SECURITIES P 35768999 32746354 3022645 3022645 3022645 0 4175726 72334601 0.057728 3993406 70162009 0.056917 3694327 64963804 0.056867 4209526 66164115 0.063622 3838345 67153038 0.057158 0.292292 0.058458 72271913 4224871 44140 4269011 4282172 X 44140 0 44140 0 44140 36000 0 0 36000 X 541 8681 0 0 0 0 0 0 0 0 0 0 1 1 IN 1 0 1 0 0 1 WWW.K21FOUNDATION.ORG RICH HADDAD 5742695188 2170 N POINTE DRIVE WARSAW IN 46582 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 RICHARD HADDAD 2170 NORTH POINTE DRIVE WARSAW IN 46582 PRESIDENT 40.00 200094 5853 0 ANDREW GROSSNICKLE 2170 NORTH POINTE DRIVE WARSAW IN 46582 CHAIRMAN 1.00 0 0 0 LISA O'NEILL 2170 NORTH POINTE DRIVE WARSAW IN 46582 VICE CHAIRMAN 1.00 0 0 0 DANA KRULL 2170 NORTH POINTE DRIVE WARSAW IN 46582 TREASURER 1.00 0 0 0 SCOTT TUCKER 2170 NORTH POINTE DRIVE WARSAW IN 46582 SECRETARY 1.00 0 0 0 BECKY ALLES 2170 NORTH POINTE DRIVE WARSAW IN 46582 DIRECTOR 1.00 0 0 0 STEVE GRILL 2170 NORTH POINTE DRIVE WARSAW IN 46582 DIRECTOR 1.00 0 0 0 JILL GROSS 2170 NORTH POINTE DRIVE WARSAW IN 46582 DIRECTOR 1.00 0 0 0 JOELLA HAUSEMANN 2170 NORTH POINTE DRIVE WARSAW IN 46582 DIRECTOR 1.00 0 0 0 RICK KERLIN 2170 NORTH POINTE DRIVE WARSAW IN 46582 DIRECTOR 1.00 0 0 0 ANITA KISHAN 2170 NORTH POINTE DRIVE WARSAW IN 46582 DIRECTOR 1.00 0 0 0 CHAD LARSH 2170 NORTH POINTE DRIVE WARSAW IN 46582 DIRECTOR 1.00 0 0 0 MAX MOCK 2170 NORTH POINTE DRIVE WARSAW IN 46582 DIRECTOR 1.00 0 0 0 SANDRA PARRA 2170 NORTH POINTE DRIVE WARSAW IN 46582 DIRECTOR 1.00 0 0 0 KEVIN ROBERTS 2170 NORTH POINTE DRIVE WARSAW IN 46582 DIRECTOR 1.00 0 0 0 STEVE ROSS 2170 NORTH POINTE DRIVE WARSAW IN 46582 DIRECTOR 1.00 0 0 0 DR JASMINE SCHLITT 2170 NORTH POINTE DRIVE WARSAW IN 46582 DIRECTOR 1.00 0 0 0 BILL SMITH 2170 NORTH POINTE DRIVE WARSAW IN 46582 DIRECTOR 1.00 0 0 0 NONE 0 MARQUETTE ASSOCIATES 180 N LASALLE SUITE 3500 CHICAGO IL 60601 INVESTMENT CONSULTING 69000 0 FORGIVENESS OF CURRENT LOAN MORTGAGE PRINCIPAL AND INTEREST DUE FROM KOSCIUSKO HEALTH SERVICES PAVILION, INC., A SECTION 501(C(3) ORGANIZATION. 553743 553743 73005972 366529 0 73372501 0 0 73372501 1100588 72271913 3613596 3613596 44140 44140 3569456 0 3569456 0 3569456 3728429 553743 4282172 44140 4238032 3569456 0 0 87852 982854 515855 539316 624896 2750773 4282172 0 0 0 3569456 712716 0 0 3463489 0 0 0 0 0 0 87852 3375637 982854 515855 539316 624896 712716 KOSCIUSKO 21ST CENTURY FOUNDATION I 2170 NORTH POINTE DRIVE WARSAW IN 46582 5742695188 SEE STATEMENTS 20 AND 21. SEE STATEMENTS 20 AND 21. SEE STATEMENTS 20 AND 21. CANCER CARE GRANT ALICE HENDERSON PO BOX 1810 WARSAW IN 465811810 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 2285 CANCER CARE GRANT ALICIA CENTENO PO BOX 1810 WARSAW IN 465811810 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 2410 CANCER CARE GRANT ANNETTE COENEN PO BOX 1810 WARSAW IN 465811810 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 2500 CANCER CARE GRANT ANTHONY HENSEL PO BOX 1810 WARSAW IN 465811810 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 1503 CANCER CARE GRANT BARBARA SKEANS PO BOX 1810 WARSAW IN 465811810 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 4348 CANCER CARE GRANT BRENDA MILLER PO BOX 1810 WARSAW IN 465811810 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 1465 CANCER CARE GRANT CARL FINKEN PO BOX 1810 WARSAW IN 465811810 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 3504 CANCER CARE GRANT CARL POE PO BOX 1810 WARSAW IN 465811810 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 1473 CANCER CARE GRANT CINDY WADDLE PO BOX 1810 WARSAW IN 465811810 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 2505 CANCER CARE GRANT CLOYD PRUITT PO BOX 1810 WARSAW IN 465811810 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 4479 CANCER CARE GRANT COLE LOVE PO BOX 1810 WARSAW IN 465811810 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 1596 CANCER CARE GRANT CYNTHIA FREDRICK PO BOX 1811 WARSAW IN 465811811 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 2386 CANCER CARE GRANT DAVID COBBS PO BOX 1810 WARSAW IN 465811810 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 1980 CANCER CARE GRANT DAVID EVERLY PO BOX 1810 WARSAW IN 465811810 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 1185 CANCER CARE GRANT DAVID WEAVER PO BOX 1810 WARSAW IN 465811810 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 2107 CANCER CARE GRANT DEBBIE WHYBREW PO BOX 1810 WARSAW IN 465811810 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 1590 CANCER CARE GRANT DELIA NAVARRO PO BOX 1810 WARSAW IN 465811810 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 2000 CANCER CARE GRANT DELLA TRUMP PO BOX 1810 WARSAW IN 465811810 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 5500 CANCER CARE GRANT DONALD MASTERSON PO BOX 1810 WARSAW IN 465811810 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 1895 CANCER CARE GRANT DOROTHY SNYDER PO BOX 1810 WARSAW IN 465811810 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 2099 CANCER CARE GRANT EDWARD DEMPSEY PO BOX 1810 WARSAW IN 465811810 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 1977 CANCER CARE GRANT GAROULD O'BANION PO BOX 1810 WARSAW IN 465811810 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 3500 CANCER CARE GRANT GEORGE HATCHER PO BOX 1810 WARSAW IN 465811810 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 2497 CANCER CARE GRANT JAMES CLEMANS PO BOX 1810 WARSAW IN 465811810 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 1431 CANCER CARE GRANT JAMES NEACE PO BOX 1810 WARSAW IN 465811810 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 2060 CANCER CARE GRANT JEAN ZAJICEK PO BOX 1810 WARSAW IN 465811810 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 1956 CANCER CARE GRANT JIMMY HARTMAN PO BOX 1810 WARSAW IN 465811810 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 3744 CANCER CARE GRANT JULIE LARSON PO BOX 1810 WARSAW IN 465811810 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 1499 CANCER CARE GRANT KAREN DEWITT PO BOX 1810 WARSAW IN 465811810 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 2458 CANCER CARE GRANT KATHY VERMILLION PO BOX 1810 WARSAW IN 465811810 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 3446 CANCER CARE GRANT KATIE WYNKOOP PO BOX 1810 WARSAW IN 465811810 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 2000 CANCER CARE GRANT KRISTIN SUNDIN PO BOX 1810 WARSAW IN 465811810 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 2058 CANCER CARE GRANT KRISTINE TERRELL PO BOX 1810 WARSAW IN 465811810 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 1968 CANCER CARE GRANT LARRY SILVA PO BOX 1810 WARSAW IN 465811810 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 1000 CANCER CARE GRANT LISA CASSEL PO BOX 1810 WARSAW IN 465811810 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 3000 CANCER CARE GRANT MADONNA STEPHENS PO BOX 1810 WARSAW IN 465811810 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 2582 CANCER CARE GRANT MARGARITA MALDONA PO BOX 1810 WARSAW IN 465811810 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 1900 CANCER CARE GRANT MARGARITA PATINO PO BOX 1810 WARSAW IN 465811810 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 2375 CANCER CARE GRANT MARK DEMSKE PO BOX 1810 WARSAW IN 465811810 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 1000 CANCER CARE GRANT MONICA CAPLES PO BOX 1810 WARSAW IN 465811810 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 3500 CANCER CARE GRANT PAT REGAN PO BOX 1810 WARSAW IN 465811810 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 1100 CANCER CARE GRANT PAUL HOPKINS PO BOX 1810 WARSAW IN 465811810 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 2032 CANCER CARE GRANT PENNY KRUECKEBERG PO BOX 1810 WARSAW IN 465811810 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 1000 CANCER CARE GRANT RACHELL CARPENTER PO BOX 1810 WARSAW IN 465811810 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 4460 CANCER CARE GRANT ROBERT SPRAGUE PO BOX 1810 WARSAW IN 465811810 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 2501 CANCER CARE GRANT ROBIN CAMPBELL PO BOX 1810 WARSAW IN 465811810 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 3262 CANCER CARE GRANT RON HELMAN PO BOX 1810 WARSAW IN 465811810 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 2994 CANCER CARE GRANT RONNIE BALDRIDGE PO BOX 1810 WARSAW IN 465811810 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 5500 CANCER CARE GRANT ROXANN ARNOTT PO BOX 1810 WARSAW IN 465811810 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 3401 CANCER CARE GRANT SALLY CHANEY PO BOX 1810 WARSAW IN 465811810 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 3133 CANCER CARE GRANT SANDRA TUNCIL PO BOX 1810 WARSAW IN 465811810 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 2207 CANCER CARE GRANT SANDY PALACIOS PO BOX 1810 WARSAW IN 465811810 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 5000 CANCER CARE GRANT SHERRI SANCHEZ PO BOX 1810 WARSAW IN 465811810 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 2000 CANCER CARE GRANT STANLEY HUTCHINSO PO BOX 1810 WARSAW IN 465811810 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 2000 CANCER CARE GRANT SUE DRAKE PO BOX 1810 WARSAW IN 465811810 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 1500 CANCER CARE GRANT SUSAN DOYLE PO BOX 1810 WARSAW IN 465811810 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 1981 CANCER CARE GRANT TAMERA SMITH PO BOX 1810 WARSAW IN 465811810 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 2370 CANCER CARE GRANT TEALIE GOBLE PO BOX 1810 WARSAW IN 465811810 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 2002 CANCER CARE GRANT TED GILLEM PO BOX 1810 WARSAW IN 465811810 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 2184 CANCER CARE GRANT TINA TRUEX PO BOX 1810 WARSAW IN 465811810 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 1175 CANCER CARE GRANT WILLIAM WOOD PO BOX 1810 WARSAW IN 465811810 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 4385 CANCER CARE GRANT WILLIE FIELDS PO BOX 1810 WARSAW IN 465811810 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 4048 CANCER CARE GRANT OTHER GRANTS LESS PO BOX 1810 WARSAW IN 465811810 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 19898 CONDITIONAL GRANT 2ND MILE ADVENTURES 2562 WALTON BLVD 317 WARSAW IN 46582 NONE PC PROGRAM AND EQUIPMENT 5917 CONDITIONAL GRANT AGAITAS 1945 PHEASANT RIDGE DR WARSAW IN 46580 NONE PC EQUIPMENT 18033 CONDITIONAL GRANT AMERICAN DIABETES ASSOCIATION 6415 CASTLEWAY WEST DR STE 114 INDIANAPOLIS IN 46250 NONE PC SCHOLARSHIPS FOR CHILDREN ATTENDING DIABETES CAMP 3825 CONDITIONAL GRANT BAKER YOUTH CLUB 1401 E SMITH ST WARSAW IN 46580 NONE PC EQUIPMENT 13043 CONDITIONAL GRANT CASA OF KOSCIUSKO COUNTY 121 NORTH LAKE STREET 2ND FLR WARSAW IN 46580 NONE PC MARKETING AND MOTIVATIONAL SPEAKER 15000 CONDITIONAL GRANT CITY OF WARSAW 102 SOUTH BUFFALO STREET WARSAW IN 46580 NONE PC PICKLEBALL COURTS AND BOULDERING ROCKS 51933 CONDITIONAL GRANT FELLOWSHIP MISSIONS 1520 EAST WINONA AVENUE WARSAW IN 46580 NONE PC LAND PURCHASE AND FREEZER 115730 CONDITIONAL GRANT FOUR WAY AMBULANCE SERVICE INC PO BOX 225 MENTONE IN 46539 NONE PC EQUIPMENT 117208 CONDITIONAL GRANT GRACE COLLEGE & SEMINARY 200 SEMINARY DRIVE WINONA LAKE IN 46590 NONE PC RESEARCH 98448 CONDITIONAL GRANT HEARTLINE PREGNANCY CENTER 1515 PROVIDENT DR STE 180 WARSAW IN 46580 NONE PC B.A.B.E. BOUTIQUE, CLINICAL SUPPLIES, CAR SEATS, STI TESTING 37694 CONDITIONAL GRANT HOUSING OPPORTUNITIES OF WARSAW 109 W CATHERINE ST MILFORD IN 46542 NONE PC HOME REPAIRS 12021 CONDITIONAL GRANT IVY TECH FOUNDATION 2545 SILVEUS CROSSING WARSAW IN 46582 NONE PC EQUIPMENT 21999 CONDITIONAL GRANT JOE'S KIDS 902 PROVIDENT DR SUITE C WARSAW IN 46580 NONE PC RENT SUBSIDY 41220 CONDITIONAL GRANT KCV CYCLING CLUB PO BOX 325 WINONA LAKE IN 46590 NONE PC MAINTENANCE EQUIPMENT 2874 CONDITIONAL GRANT KOSCIUSKO COUNTY COUNCIL ON AGING 800 PARK AVE WARSAW IN 46580 NONE PC TRANSPORTATION VAN AND COMPUTERS 14080 CONDITIONAL GRANT KOSCIUSKO COUNTY SHELTER FOR ABUSE 603 NORTH PARKER STREET WARSAW IN 46580 NONE PC SECURITY SYSTEM UPDATES 15839 CONDITIONAL GRANT KOSCIUSKO HEALTH SERVICES PAVILION 1515 PROVIDENT DRIVE WARSAW IN 46580 NONE PC BUILDING RENOVATIONS 35467 CONDITIONAL GRANT KOSCIUSKO HOME CARE & HOSPICE 1515 PROVIDENT DRIVE STE 250 WARSAW IN 46580 NONE PC KID'S ORAL HEALTH, MEDICATION AND DENTAL, MEDICAL SUPPLIES, COMPUTERS 334313 CONDITIONAL GRANT LAKELAND YOUTH CENTER 101 WEST CHICAGO STREET SYRACUSE IN 46567 NONE PC EQUIPMENT 1297 CONDITIONAL GRANT LITTLE LAMBS MINISTRY 1413 NORTH LONG DRIVE SYRACUSE IN 46567 NONE PC PLAYGROUND EQUIPMENT 15000 CONDITIONAL GRANT LIVE WELL KOSCIUSKO 8546 SOUTH 200 WEST CLAYPOOL IN 46510 NONE PC SMOKING CESSATION PROGRAMS AND OPERATIONAL FUNDING 25927 CONDITIONAL GRANT NORTHERN INDIANA HISPANIC HEALTH COALITION 444 NORTH NAPPANEE STREET ELKHART IN 46514 NONE PC OPERATIONAL FUNDING FOR BILINGUAL ADVOCATE/HEALTH FAIRS 42275 CONDITIONAL GRANT PIERCETON VOLUNTEER FIRE DEPARTMENT PO BOX 526 PIERCETON IN 46562 NONE PC CARDIAC MONITORS 65281 CONDITIONAL GRANT QUESTA FOUNDATION 6502 CONSTITUTION DR FORT WAYNE IN 46804 NONE PC HEALTH SCHOLARS PROGRAM 100000 CONDITIONAL GRANT REAL SERVICES INC 1151 SOUTH MICHIGAN STREET SOUTH BEND IN 46601 NONE PC HEALTH EDUCATION PROGRAM 4000 CONDITIONAL GRANT RIGHT TO LIFE OF NORTH CENTRAL INDIANA 1906 HAMILTON BLVD WINONA LAKE IN 46590 NONE PC BABY BOX MARKETING CAMPAIGN 1785 CONDITIONAL GRANT ROSE GARDEN RECOVERY COMMUNITY PO BOX 571 SYRACUSE IN 46567 NONE PC FACILITY RENOVATION 23087 CONDITIONAL GRANT SERENITY HOUSE INC 2438 CR 50 AUBURN IN 46706 NONE PC WARSAW FACILITIES RENOVATIONS 49253 CONDITIONAL GRANT SYRACUSE WAWASEE PARK FOUNDATION 1013 NORTH LONG DRIVE SYRACUSE IN 46567 NONE PC GREENWAY EXPANSION 200000 CONDITIONAL GRANT THE WATERSHED FOUNDATION PO BOX 55 NORTH WEBSTER IN 46567 NONE PC SHORELINE RESTORATION PROJECT 2000 CONDITIONAL GRANT TOWN OF WINONA LAKE 1310 PARK AVENUE WINONA LAKE IN 46590 NONE PC BICYCLES AND SURVEILLANCE VAN 68423 CONDITIONAL GRANT TURKEY CREEK FIRE TERRITORY 8138 EAST MCCLINTIC ROAD SYRACUSE IN 46567 NONE PC CARDIAC MONITORS 330144 CONDITIONAL GRANT TURNING POINT INC PO BOX 751 NORTH WEBSTER IN 46555 NONE PC COMPUTERS AND SECURITY SYSTEM UPDATE 8147 CONDITIONAL GRANT WARSAW COMMUNITY SCHOOLS 1 ADMINISTRATION DRIVE WARSAW IN 46580 NONE PC TRAC EQUIPMENT, ELEMENTARY PE EQUIPMENT, TOWER GARDENS 408067 CONDITIONAL GRANT WARSAW LITTLE LEAGUE PO BOX 153 WARSAW IN 46580 NONE PC PARK RENOVATIONS 53883 CONDITIONAL GRANT WAWASEE COMMUNITY SCHOOLS 1 WARRIOR PAT SYRACUSE IN 46567 NONE PC HEALTH EDUCATION PROGRAM 14143 CONDITIONAL GRANT WHITKO COMMUNITY SCHOOLS 434 SOUTH FIRST STREET PIERCETON IN 46567 NONE PC TOWER GARDEN 3614 CONDITIONAL GRANTS OTHER GRANTS UNDER 1000 PO BOX 1810 WARSAW IN 465811810 NONE PC EQUIPMENT 2000 DIRECT GRANT AGAITAS 1945 PHEASANT RIDGE DR WARSAW IN 46580 NONE PC K21 BOARD OF DIRECTORS DIRECTED DONATION 1500 DIRECT GRANT BAKER YOUTH CLUB 1401 E SMITH ST WARSAW IN 46580 NONE PC K21 BOARD OF DIRECTORS DIRECTED DONATION, OPERATIONAL 2500 DIRECT GRANT GRACE COLLEGE & SEMINARY 200 SEMINARY DRIVE WINONA LAKE IN 46590 NONE PC K21 BOARD OF DIRECTORS DIRECTED DONATION 1500 DIRECT GRANT KOSCIUSKO COMMUNITY YMCA 1305 MARINERS DR WARSAW IN 46582 NONE PC OPERATIONAL ASSISTANCE 22600 DIRECT GRANT NORTH STAR MEDICAL 2045 112TH AVE HOLLAND MI 49424 NONE PC AED AND MEDICAL EQUIPMENT FOR MULTIPLE ORGANIZATIONS 22552 DIRECT GRANT NORTH WEBSTER COMMUNITY CENTER PO BOX 379 NORTH WEBSTER IN 46555 NONE PC K21 BOARD OF DIRECTORS DIRECTED DONATION 1400 DIRECT GRANT SOCIETY OF ST ANDREW 7840 DITCH ROAD INDIANAPOLIS IN 46260 NONE PC FOOD TRANSPORTATION FOR NEED-BASED PROGRAMS 3500 DIRECT GRANTS OTHER GRANTS UNDER 1000 PO BOX 1810 WARSAW IN 465811810 NONE PC K21 BOARD OF DIRECTORS DIRECTED DONATION 13627 UNCONDITIONAL GRANT A BRIDGE TO HOPE 499 E 450 SOUTH WARSAW IN 46580 NONE PC OPERATIONAL ASSISTANCE 75000 UNCONDITIONAL GRANT BAKER YOUTH CLUB 1401 E SMITH ST WARSAW IN 46580 NONE PC SUMMER FITNESS PROGRAM 20000 UNCONDITIONAL GRANT BIG BROTHERS BIG SISTERS 499 E 450 SOUTH WARSAW IN 46580 NONE PC OPERATIONAL ASSISTANCE 5000 UNCONDITIONAL GRANT BOWEN CENTER 850 N HARRISON STREET WARSAW IN 46580 NONE PC OPERATIONAL ASSISTANCE 35000 UNCONDITIONAL GRANT BRIGHTPOINT 227 E WASHINGTON BLVD FORT WAYNE IN 46804 NONE PC OPERATIONAL ASSISTANCE 17500 UNCONDITIONAL GRANT CANCER SERVICES OF NORTHEAST INDIANA 6316 MUTUAL DRIVE FORT WAYNE IN 46825 NONE PC DIRECT ASSISTANCE / CLIENT ADVOCACY 20000 UNCONDITIONAL GRANT ERIN'S HOUSE FOR GRIEVING CHILDREN 5670 YMCA PARK DRIVE WEST FORT WAYNE IN 46835 NONE PC OPERATIONAL ASSISTANCE 4000 UNCONDITIONAL GRANT GRACE COLLEGE & SEMINARY 200 SEMINARY DRIVE WINONA LAKE IN 46590 NONE PC LILLY CENTER OPERATIONAL ASSISTANCE 20000 UNCONDITIONAL GRANT GREATER WARSAW CO-OP PRESCHOOL 2032 SOUTH 150 WEST WARSAW IN 46580 NONE PC INDOOR PLAY EQUIPMENT 1132 UNCONDITIONAL GRANT HARVEST WITH A HEART 201 SOUTH HIGBEE STREET MILFORD IN 46542 NONE PC WELLNESS PROGRAM 1683 UNCONDITIONAL GRANT KOSCIUSKO COMMUNITY YMCA 1305 MARINERS DR WARSAW IN 46582 NONE PC OPERATIONAL ASSISTANCE 24905 UNCONDITIONAL GRANT KOSCIUSKO COUNTY COMMUNITY FOUNDATION 102 EAST MARKET STREET WARSAW IN 46580 NONE PC GOOD SAMARITAN FUND 125000 UNCONDITIONAL GRANT KOSCIUSKO HOME CARE & HOSPICE 1515 PROVIDENT DRIVE STE 250 WARSAW IN 46580 NONE PC OPERATIONAL ASSISTANCE 166717 UNCONDITIONAL GRANT MAD ANTHONY'S CHILDREN'S HOPE HOUSE 7922 WEST JEFFERSON BLVD FORT WAYNE IN 46804 NONE PC OPERATIONAL ASSISTANCE 10000 UNCONDITIONAL GRANT MCMILLEN CENTER 600 JIM KELLEY BLVD FORT WAYNE IN 46816 NONE PC HEALTH EDUCATION PROGRAMS 10000 UNCONDITIONAL GRANT NORTHERN INDIANA HISPANIC HEALTH COALITION 444 NORTH NAPPANEE STREET ELKHART IN 46514 NONE PC HEALTH FAIR 20000 UNCONDITIONAL GRANT RONALD MCDONALD HOUSE CHARITIES OF NEIN 11109 PARKVIEW PLAZA DRIVE FORT WAYNE IN 46845 NONE PC CARE MOBILE OPERATIONAL ASSISTANCE 5000 UNCONDITIONAL GRANT RYAN'S PLACE INC PO BOX 73 GOSHEN IN 46527 NONE PC OPERATIONAL ASSISTANCE 8000 UNCONDITIONAL GRANT ROSE GARDEN RECOVERY COMMUNITY PO BOX 571 SYRACUSE IN 46567 NONE PC MARKETING CAMPAIGN 4335 3190315 0 14 435781 14 1079442 16 93770 14 1401 18 3022645 0 4633039 0 4633039 0 0 0 0 0 0 0 0 0 0 X X 1 DR AND MRS RICK SASSO 10674 WINTERWOOD CARMEL IN 46032 202034 X 2 WOMAN OF TODAY 4687 E CARDINAL DR SYRACUSE IN 46567 19086 X 3 BEAVER DAM UM CHURCH 9798 W 1000 SOUTH AKRON IN 46910 17000 X 4 DONETTE SMOCK 5867 E ISLAND AVE SYRACUSE IN 46567 10000 X 5 BERTSCH FAMILY CHARITABLE FOUNDATION PO BOX 1494 WARSAW IN 46581 7000 X 6 LAKELAND CHRISTIAN ACADEMY 1093 S 250 E WINONA LAKE IN 46590 6080 X 1 MARKETABLE SECURITIES 202034 2019-12-31 ACCOUNTING FEES 20150 0 0 20150 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 7113254 7273892 FOREIGN BONDS 416962 430841 EQUITY SECURITIES 30222616 45352988 5028571 5103581 0 0 LAND 57995 0 57995 57995 LAND IMPROVEMENTS 311605 126682 184923 184923 LEASEHOLD IMPROVEMENTS 969226 464412 504814 504814 BUILDING 1441680 224272 1217408 1217408 REAL ESTATE INVESTMENT FUND FMV 2429630 3283977 HEDGE FUND FMV 4441390 3996343 GLOBAL MANAGED VOLATILITY FMV 2735540 4192358 US EQUITY INDEX PUTWRITE FUND LLC FMV 3834424 3955583 PRIVATE EQUITY FMV 141176 140270 OFFICE & COMPUTER EQUIPMENT 68643 68643 0 NOTES RECEIVABLE HELD FOR GRANT MAKING 1288792 788792 788792 RECEIVABLE - OTHER 1658 1186 1186 PRIOR PERIOD ADJUSTMENT 239 KHSP MORTGAGE INTEREST FORGIVENESS 553743 0 0 0 FUNDRAISING EXPENSES 29496 0 0 29496 INSURANCE 7720 0 0 5776 MARKETING 73627 0 0 73627 MISCELLANEOUS EXPENSE 43910 6091 0 37819 OTHER INCOME 1401 1401 DEFERRED TAX LIABILITY 90768 241391 INVESTMENT MGT FEES 219485 219485 0 0 DR AND MRS RICK SASSO 10674 WINTERWOOD CARMEL IN 46032 LUTHERAN HEALTH FOUNDATION 3024 FAIRFIELD AVENUE FORT WAYNE IN 46807 MULTI-TOWNSHIP EMS 34 E ARMSTRONG RD LEESBURG IN 46538 EXCISE TAXES 195542 0 0 0