2019-05-09T16:37:55-05:00 2018-12-31 351178661 BLUE & CO LLC 500 N MERIDIAN ST SUITE 200 INDIANAPOLIS IN 46204 990PF 2018-01-01 351187105 KOSCIUSKO 21ST CENTURY FOUNDATION INC AKA K21 HEALTH FOUNDATION KOSC 5742695188 2170 N POINTE DRIVE WARSAW IN 46582 RICH HADDAD PRESIDENT 5742695188 2019-05-09 1 ANGELA N CRAWFORD CPA P00418596 3176334705 2019-05-08 165.225.0.203 2019-05-09 16:37:50 ED P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 38D9E49CC0CA71BE8938C550DFC6219FF2DB8390 2018 2019-02-21 02:37:17Z X 69163858 X 536025 450331 450331 1035283 1035283 230898 230169 77012 1960397 33039096 1960397 86 86 0 4213020 3676266 0 198234 0 0 198234 76248 0 0 72248 26536 0 0 26536 18025 0 0 18025 227334 227334 0 0 32950 0 0 0 154702 152382 0 45947 0 0 45947 11460 0 0 11460 2264 0 0 2264 1054344 1504 0 128910 1848044 381220 0 503624 2817167 2765855 4665211 381220 0 3269479 -452191 3295046 0 1142163 1420996 1420996 6420 9374 9374 4442800 4137117 4132037 30811741 30759796 38826650 7579592 8008032 7861734 2328270 651211 1823101 1677059 1677059 12528870 12783633 13944945 68643 68030 3388 613 613 2147815 1290450 1290450 60485890 60087070 69163858 9945 293541 336967 159729 90768 453270 437680 X 59288022 58730371 744598 919019 60032620 59649390 60485890 60087070 60032620 -452191 6965103 66545532 6896142 59649390 SALE OF SECURITIES P 33039096 31078699 1960397 1960397 1960397 0 3993406 70162009 0.056917 3694327 64963804 0.056867 4209526 66164115 0.063622 3838345 67153038 0.057158 3352218 62610514 0.053541 0.288105 0.057621 72334601 4167992 32950 4200942 4208676 X 32950 0 32950 0 32950 27005 0 0 27005 X 238 6183 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 192646 5438 150 SCOTT TUCKER 2170 NORTH POINTE DRIVE WARSAW IN 46582 CHAIRMAN 1.00 0 0 0 ANDREW GROSSNICKLE 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 SHARI BOYLE 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 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 JENNIFER LUCHT 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 LISA O'NEILL 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 68917 0 FORGIVENESS OF CURRENT LOAN MORTGAGE PRINCIPAL AND INTEREST DUE FROM KOSCIUSKO HEALTH SERVICES PAVILION, INC., A SECTION 501(C(3) ORGANIZATION. 850643 FORGIVENESS OF CURRENT LOAN PRINCIPAL AND INTEREST DUE FROM HARVEST WITH A HEART, INC. A SECTION 501(C)(3) ORGANIZATION. 88554 939197 72891593 544550 0 73436143 0 0 73436143 1101542 72334601 3616730 3616730 32950 32950 3583780 0 3583780 0 3583780 3269479 939197 4208676 32950 4175726 3583780 0 0 87852 982854 515855 539316 2125877 4208676 0 0 0 3583780 624896 0 0 2750773 0 0 0 0 0 0 0 2750773 87852 982854 515855 539316 624896 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 ABBY MEEKS PO BOX 1810 WARSAW IN 465811810 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 2000 CANCER CARE GRANT ALICE HENDERSON PO BOX 1810 WARSAW IN 465811810 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 2335 CANCER CARE GRANT ANITA SORIANO PO BOX 1810 WARSAW IN 465811810 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 4000 CANCER CARE GRANT ANNETTE COENEN PO BOX 1810 WARSAW IN 465811810 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 2000 CANCER CARE GRANT ANTHONY WILSON PO BOX 1810 WARSAW IN 465811810 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 1000 CANCER CARE GRANT CATHRYN TAYLOR PO BOX 1810 WARSAW IN 465811810 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 1500 CANCER CARE GRANT CAYLE WOODWARD PO BOX 1810 WARSAW IN 465811810 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 1880 CANCER CARE GRANT CHARLES SWIHART PO BOX 1810 WARSAW IN 465811810 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 2500 CANCER CARE GRANT CHRISTINE BROWN PO BOX 1810 WARSAW IN 465811810 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 1335 CANCER CARE GRANT CLINT CARDEN PO BOX 1810 WARSAW IN 465811810 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 2700 CANCER CARE GRANT CLOYD PRUITT PO BOX 1810 WARSAW IN 465811810 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 3936 CANCER CARE GRANT DANIEL FATTORUSSO PO BOX 1810 WARSAW IN 465811810 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 1500 CANCER CARE GRANT DAVID COBBS PO BOX 1810 WARSAW IN 465811810 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 2480 CANCER CARE GRANT DAVID COLLINS PO BOX 1810 WARSAW IN 465811810 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 1932 CANCER CARE GRANT DEBRA WALLACE PO BOX 1810 WARSAW IN 465811810 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 6000 CANCER CARE GRANT DONALD MASTERSON PO BOX 1810 WARSAW IN 465811810 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 1571 CANCER CARE GRANT DOROTHY SNYDER PO BOX 1810 WARSAW IN 465811810 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 1650 CANCER CARE GRANT EDWARD DEMPSEY PO BOX 1810 WARSAW IN 465811810 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 1305 CANCER CARE GRANT ERICA WEISSER PO BOX 1810 WARSAW IN 465811810 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 1935 CANCER CARE GRANT ERIN ALLISON PO BOX 1810 WARSAW IN 465811810 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 3766 CANCER CARE GRANT GEORGE HATCHER PO BOX 1810 WARSAW IN 465811810 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 2500 CANCER CARE GRANT GEORGINA MITCHELL PO BOX 1810 WARSAW IN 465811810 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 1163 CANCER CARE GRANT GERALD KONKLE PO BOX 1810 WARSAW IN 465811810 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 1314 CANCER CARE GRANT HEIDI PAUL PO BOX 1810 WARSAW IN 465811810 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 3070 CANCER CARE GRANT JAMES CLEMANS PO BOX 1810 WARSAW IN 465811810 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 3341 CANCER CARE GRANT JENNIFER MILLER PO BOX 1810 WARSAW IN 465811810 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 4504 CANCER CARE GRANT JIMMY HARTMAN PO BOX 1810 WARSAW IN 465811810 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 4335 CANCER CARE GRANT KATIE WYNKOOP PO BOX 1810 WARSAW IN 465811810 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 4574 CANCER CARE GRANT KEVIN HAINES PO BOX 1810 WARSAW IN 465811810 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 1000 CANCER CARE GRANT KRISTIN SUNDIN PO BOX 1810 WARSAW IN 465811810 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 3428 CANCER CARE GRANT LARRY SILVA PO BOX 1810 WARSAW IN 465811810 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 2000 CANCER CARE GRANT LIN JONES PO BOX 1810 WARSAW IN 465811810 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 2628 CANCER CARE GRANT LISA CASSEL PO BOX 1810 WARSAW IN 465811810 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 3500 CANCER CARE GRANT LISA OSBORN PO BOX 1810 WARSAW IN 465811810 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 2536 CANCER CARE GRANT LORENE MARVEL PO BOX 1810 WARSAW IN 465811810 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 2917 CANCER CARE GRANT MARK CLINGENPEEL PO BOX 1810 WARSAW IN 465811810 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 1262 CANCER CARE GRANT MARSHA MCGLENNEN PO BOX 1810 WARSAW IN 465811810 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 3802 CANCER CARE GRANT MERLIN SCHWARTZ PO BOX 1810 WARSAW IN 465811810 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 1167 CANCER CARE GRANT MICHELLE BAKER PO BOX 1810 WARSAW IN 465811810 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 1000 CANCER CARE GRANT NELIA DAVIS PO BOX 1810 WARSAW IN 465811810 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 1600 CANCER CARE GRANT NIKOLAI MARTINEZ PO BOX 1810 WARSAW IN 465811810 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 4343 CANCER CARE GRANT PATRICIA BOWSER PO BOX 1810 WARSAW IN 465811810 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 1993 CANCER CARE GRANT PENNY KRUECKEBERG PO BOX 1810 WARSAW IN 465811810 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 4000 CANCER CARE GRANT REBECCA MARSH PO BOX 1810 WARSAW IN 465811810 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 1249 CANCER CARE GRANT RICHARD MONROE PO BOX 1810 WARSAW IN 465811810 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 1106 CANCER CARE GRANT RICHARD SILVEUS PO BOX 1810 WARSAW IN 465811810 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 1943 CANCER CARE GRANT RON BRANDENBURG PO BOX 1810 WARSAW IN 465811810 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 2200 CANCER CARE GRANT RON HELMAN PO BOX 1810 WARSAW IN 465811810 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 4021 CANCER CARE GRANT RONNIE BALDRIDGE PO BOX 1810 WARSAW IN 465811810 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 2500 CANCER CARE GRANT ROSARIO NUNEZ PO BOX 1810 WARSAW IN 465811810 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 6000 CANCER CARE GRANT SANDY PALACIOS PO BOX 1810 WARSAW IN 465811810 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 3887 CANCER CARE GRANT SHANE SEWARD PO BOX 1810 WARSAW IN 465811810 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 1815 CANCER CARE GRANT SHELBA DEWELLS PO BOX 1810 WARSAW IN 465811810 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 2000 CANCER CARE GRANT STANLEY HUTCHISON PO BOX 1810 WARSAW IN 465811810 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 4000 CANCER CARE GRANT TERESA MOSS PO BOX 1810 WARSAW IN 465811810 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 4700 CANCER CARE GRANT TERRY KREFT PO BOX 1810 WARSAW IN 465811810 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 2828 CANCER CARE GRANT TINA TRUEX PO BOX 1810 WARSAW IN 465811810 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 2059 CANCER CARE GRANT VINCENT FLETCHER PO BOX 1810 WARSAW IN 465811810 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 1000 CANCER CARE GRANT WILLIAM WOOD PO BOX 1810 WARSAW IN 465811810 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 1954 CANCER CARE GRANT WILLIE FIELDS PO BOX 1810 WARSAW IN 465811810 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 3109 CANCER CARE GRANT OTHER GRANTS LESS PO BOX 1810 WARSAW IN 465811810 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 24080 CONDITIONAL GRANT 2ND MILE ADVENTURES 2562 WALTON BLVD 317 WARSAW IN 46582 NONE PC PROGRAM AND EQUIPMENT 8766 CONDITIONAL GRANT A BRIDGE TO HOPE 499 E 450 SOUTH WARSAW IN 46580 NONE PC OPERATIONAL ASSISTANCE 64960 CONDITIONAL GRANT AGAITAS 1945 PHEASANT RIDGE DR WARSAW IN 46580 NONE PC EQUIPMENT 7582 CONDITIONAL GRANT AMERICAN DIABETES ASSOCIATION 6415 CASTLEWAY WEST DR STE 114 INDIANAPOLIS IN 46250 NONE PC SCHOLARSHIPS FOR CHILDREN ATTENDING DIABETES CAMP 5100 CONDITIONAL GRANT BAKER YOUTH CLUB 1401 E SMITH ST WARSAW IN 46580 NONE PC EQUIPMENT 48551 CONDITIONAL GRANT BOWEN CENTER 2621 E JEFFERSON ST WARSAW IN 46580 NONE PC ASSESSMENT, EQUIPMENT, OPERATIONAL 69105 CONDITIONAL GRANT GRACE COLLEGE & SEMINARY 200 SEMINARY DRIVE WINONA LAKE IN 46590 NONE PC RESEARCH AND FACILITY EXPANSION 717087 CONDITIONAL GRANT HEALTHY COMMUNITY COALITION 8546 S 200 WEST CLAYPOOL IN 46510 NONE PC TOBACCO USE REDUCTION AND PREVENTION PROGRAMS 33592 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 31208 CONDITIONAL GRANT HOUSING OPPORTUNITIES OF WARSAW 109 W CATHERINE ST MILFORD IN 46542 NONE PC HOME REPAIRS 10614 CONDITIONAL GRANT JOE'S KIDS 902 PROVIDENT DR SUITE C WARSAW IN 46580 NONE PC OPERATIONAL ASSISTANCE 41221 CONDITIONAL GRANT KCV CYCLING CLUB PO BOX 325 WINONA LAKE IN 46590 NONE PC MAINTENANCE EQUIPMENT 13891 CONDITIONAL GRANT KOSCIUSKO COUNTY COUNCIL ON AGING 800 PARK AVE WARSAW IN 46580 NONE PC TRANSPORTATION VAN 10400 CONDITIONAL GRANT KOSCIUSKO HOME CARE & HOSPICE 1515 PROVIDENT DRIVE STE 250 WARSAW IN 46580 NONE PC CHILDREN'S ORAL HEALTH, MEDICATION AND DENTAL, MEDICAL SUPPLIES 315076 CONDITIONAL GRANT LAKELAND CHRISTIAN ACADEMY 1095 S 250 E WINONA LAKE IN 46590 NONE PC NURSE FACILITY AND EQUIPMENT 5000 CONDITIONAL GRANT MENTONE YOUTH LEAGUE PO BOX 233 MENTONE IN 46539 NONE PC FACILITY IMPROVEMENT 24815 CONDITIONAL GRANT NORTHERN INDIANA HISPANIC HEALTH COALITION 323 STOCKER COURT ELKHART IN 46516 NONE PC OPERATIONAL FUNDING FOR BILINGUAL ADVOCATE/HEALTH FAIRS 59775 CONDITIONAL GRANT QUESTA FOUNDATION 6502 CONSTITUTION DR FORT WAYNE IN 46804 NONE PC HEALTH SCHOLARS PROGRAM 100000 CONDITIONAL GRANT THE ROSE HOME PO BOX 571 SYRACUSE IN 46567 NONE PC HOME REPAIRS AND OPERATIONAL ASSISTANCE 11954 CONDITIONAL GRANT THE WATERSHED FOUNDATION PO BOX 55 NORTH WEBSTER IN 46555 NONE PC COMMUNITY OUTREACH AND EDUCATION 31817 CONDITIONAL GRANT TIPPECANOE VALLEY SCHOOL CORP 8643 S STATE ROAD 19 AKRON IN 46910 NONE PC EQUIPMENT 133907 CONDITIONAL GRANT WARSAW LITTLE LEAGUE PO BOX 153 WARSAW IN 46581 NONE PC FACILITY IMPROVEMENT 4215 CONDITIONAL GRANT WAWASEE COMMUNITY SCHOOLS 502 W BROOKLYN ST SYRACUSE IN 46567 NONE PC EQUIPMENT 63787 CONDITIONAL GRANT YOUNG TIGER FOOTBALL PO BOX 1362 WARSAW IN 46581 NONE PC EQUIPMENT 6939 DIRECT GRANT 212 MEDIA STUDIOS 929 E CENTER ST WARSAW IN 46580 NONE PC NONPROFIT COMMUNICATIONS WORKSHOP 2500 DIRECT GRANT A BRIDGE TO HOPE 301 N LAKE ST WARSAW IN 46580 NONE PC K21 BOARD OF DIRECTORS DIRECTED DONATION 1000 DIRECT GRANT AGAITAS 1945 PHEASANT RIDGE DR WARSAW IN 46580 NONE PC K21 BOARD OF DIRECTORS DIRECTED DONATION 2000 DIRECT GRANT AMERICAN DIABETES ASSOCIATION 6415 CASTLEWAY WEST DR STE 114 INDIANAPOLIS IN 46250 NONE PC K21 BOARD OF DIRECTORS DIRECTED DONATION 1000 DIRECT GRANT AMERICAN LUNG ASSOCIATION 115 W WASHINGTON ST STE 1180 INDIANAPOLIS IN 46204 NONE PC SMOKING CESSATION TRAINING 1050 DIRECT GRANT BAKER YOUTH CLUB 1401 E SMITH ST WARSAW IN 46580 NONE PC K21 BOARD OF DIRECTORS DIRECTED DONATION, OPERATIONAL 21000 DIRECT GRANT BOWEN CENTER 2621 E JEFFERSON ST WARSAW IN 46580 NONE PC K21 BOARD OF DIRECTORS DIRECTED DONATION, OPERATIONAL 20300 DIRECT GRANT CARDINAL SERVICES 504 N BAY DR WARSAW IN 46580 NONE PC K21 BOARD OF DIRECTORS DIRECTED DONATION, OPERATIONAL 21500 DIRECT GRANT CITY COUNTY ATHLETIC COMPLEX 3215 W OLD RD 30 WARSAW IN 46580 NONE PC OPERATIONAL ASSISTANCE 20000 DIRECT GRANT CITY OF WARSAW 102 S BUFFALO ST WARSAW IN 46580 NONE PC PARK REDEVELOPMENT PLAN 14000 DIRECT GRANT COMBINED COMMUNITY SERVICES 3215 W OLD RD 30 WARSAW IN 46580 NONE PC OPERATIONAL ASSISTANCE 20000 DIRECT GRANT GRACE COLLEGE & SEMINARY 200 SEMINARY DRIVE WINONA LAKE IN 46590 NONE PC K21 BOARD OF DIRECTORS DIRECTED DONATION 2000 DIRECT GRANT HARVEST WITH A HEART 201 S HIGBEE ST MILFORD IN 36542 NONE PC OPERATIONAL ASSISTANCE 1000 DIRECT GRANT HEARTLINE PREGANCY CENTER 1515 PROVIDENT DR SUITE 180 WARSAW IN 46580 NONE PC OPERATIONAL ASSISTANCE 20000 DIRECT GRANT JOE'S KIDS 902 PROVIDENT DR SUITE C WARSAW IN 46580 NONE PC K21 BOARD OF DIRECTORS DIRECTED DONATION 1000 DIRECT GRANT KOSCIUSKO COMMUNITY YMCA 1305 MARINERS DR WARSAW IN 46582 NONE PC OPERATIONAL ASSISTANCE 42500 DIRECT GRANT KOSCIUSKO COUNTY COUNCIL ON AGING 800 PARK AVE WARSAW IN 46580 NONE PC K21 BOARD OF DIRECTORS DIRECTED DONATION, OPERATIONAL 21000 DIRECT GRANT KOSCIUSKO COUNTY SHELTER FOR ABUSE PO BOX 12 WARSAW IN 46581 NONE PC OPERATIONAL ASSISTANCE 20000 DIRECT GRANT KOSCIUSKO HOME CARE & HOSPICE 1515 PROVIDENT DRIVE STE 250 WARSAW IN 46580 NONE PC OPERATIONAL ASSISTANCE 20000 DIRECT GRANT MILESTONES EARLY EDUCATION CENTER PO BOX 316 N WEBSTER IN 46555 NONE PC K21 BOARD OF DIRECTORS DIRECTED DONATION 1000 DIRECT GRANT NORTHERN INDIANA HISPANIC HEALTH COALITION 323 STOCKER COURT ELKHART IN 46516 NONE PC K21 BOARD OF DIRECTORS DIRECTED DONATION 1000 DIRECT GRANT RILEY CHILDREN'S FOUNDATION 30 SOUTH MERIDIAN ST INDIANAPOLIS IN 46204 NONE PC K21 BOARD OF DIRECTORS DIRECTED DONATION 1000 DIRECT GRANT SOCIETY OF ST ANDREW 7840 DITCH ROAD INDIANAPOLIS IN 46260 NONE PC FOOD TRANSPORTATION FOR NEED-BASED PROGRAMS 3500 DIRECT GRANT WAGON WHEEL THEATRE INC 2515 E CENTER ST WARSAW IN 46580 NONE PC K21 BOARD OF DIRECTORS DIRECTED DONATION 1500 DIRECT GRANT WARSAW COMMUNITY SCHOOLS 1 ADMINISTRATION DR WARSAW IN 46580 NONE PC MENTAL HEALTH CONVOCATIONS 2000 DIRECT GRANTS OTHER GRANTS UNDER 1000 PO BOX 1810 WARSAW IN 465811810 NONE PC K21 BOARD OF DIRECTORS DIRECTED DONATION 4812 UNCONDITIONAL GRANT A BRIDGE TO HOPE 499 E 450 SOUTH WARSAW IN 46580 NONE PC OPERATIONAL ASSISTANCE 25000 UNCONDITIONAL GRANT ALL THINGS NEW PO BOX 367 WINONA LAKE IN 46590 NONE PC OPERATIONAL ASSISTANCE 4786 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 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 15000 UNCONDITIONAL GRANT CARDINAL SERVICES 504 N BAY DR WARSAW IN 46580 NONE PC COMMUNICATIONS IMPROVEMENT 10200 UNCONDITIONAL GRANT HEARTLINE PREGNANCY CENTER 1515 PROVIDENT DRIVE WARSAW IN 46580 NONE PC MOBILE UNIT OPERATIONS 10000 UNCONDITIONAL GRANT KOSCIUSKO COMMUNITY YMCA 1305 MARINERS DR WARSAW IN 46582 NONE PC OPERATIONAL ASSISTANCE 45100 UNCONDITIONAL GRANT KOSCIUSKO COUNTY COMMUNITY FOUNDATION 102 EAST MARKET STREET WARSAW IN 46580 NONE PC GOOD SAMARITAN FUND 156250 UNCONDITIONAL GRANT KOSCIUSKO HOME CARE & HOSPICE 1515 PROVIDENT DRIVE STE 250 WARSAW IN 46580 NONE PC OPERATIONAL ASSISTANCE 163742 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 E 525 NORTH WARSAW IN 46582 NONE PC COMMUNICATIONS IMPROVEMENT 10000 UNCONDITIONAL GRANT YOUNG TIGER FOOTBALL PO BOX 1362 WARSAW IN 46581 NONE PC COMMUNICATIONS IMPROVEMENT 7500 2765855 0 14 450331 14 1035283 16 77012 14 86 18 1960397 0 3523109 0 3523109 0 0 0 0 0 0 0 0 0 0 X X 1 DR AND MRS RICK SASSO 10674 WINTERWOOD CARMEL IN 46032 200123 X 2 LUTHERAN HEALTH FOUNDATION 3024 FAIRFIELD AVE FORT WAYNE IN 46807 5500 X 3 LEIGHTON WELLS 7991 E CHEROKEE RD SYRACUSE IN 46567 5500 X 4 DOUGLAS SCHROCK 631 E NORTHSHORE DR SYRACUSE IN 46567 10000 X 5 DONETTE SMOCK 5867 E ISLAND AVE SYRACUSE IN 46567 15295 X 6 BRIAN HULL 7796 E VAWTER PARK RD SYRACUSE IN 46567 5250 X 7 DONALD GUNDEN 64874 ORCHARD DRIVE GOSHEN IN 46526 5000 X 8 BERTSCH FAMILY CHARITABLE FOUNDATION PO BOX 1494 WARSAW IN 46581 7500 X 9 W MERWIN FORBES 1433 CAMELOT DR WINONA LAKE IN 46590 5000 X 10 MULTI-TOWNSHIP EMS 34 E ARMSTRONG RD LEESBURG IN 46538 123732 X 1 MARKETABLE SECURITIES 200123 2018-12-31 ACCOUNTING FEES 18025 0 0 18025 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 7491563 7354372 FOREIGN BONDS 516469 507362 EQUITY SECURITIES 30759796 38826650 4137117 4132037 0 0 LAND 23895 0 23895 23895 LAND IMPROVEMENTS 311605 104601 207004 207004 LEASEHOLD IMPROVEMENTS 969226 367489 601737 601737 BUILDING 1023544 179121 844423 844423 REAL ESTATE INVESTMENT FUND FMV 2328475 3191856 HEDGE FUND FMV 4037964 3465756 GLOBAL MANAGED VOLATILITY FMV 3071287 3883913 US EQUITY INDEX PUTWRITE FUND LLC FMV 3345907 3403420 OFFICE & COMPUTER EQUIPMENT 68643 68030 613 613 NOTES RECEIVABLE HELD FOR GRANT MAKING 2139032 1288792 1288792 RECEIVABLE - OTHER 929 1658 1658 EXCISE TAX ASSET - OVERPAYMENT 7854 0 0 UNREALIZED GAIN ON INVESTMENTS 6896142 KHSP MORTGAGE INTEREST FORGIVENESS 850643 0 0 0 HARVEST LOAN FORGIVENESS 88554 0 0 0 FUNDRAISING EXPENSES 40044 0 0 40044 INSURANCE 7272 0 0 10701 MARKETING 40688 0 0 40688 MISCELLANEOUS EXPENSE 39456 1504 0 37477 EXPIRED GRANTS -12313 0 0 0 OTHER INCOME 86 86 2018 BOOK VALUE AND MARKET VALUE CHANGE BETWEEN YEARS 6896142 CHANGE IN DEFERRED TAX ASSETS 68961 DEFERRED TAX LIABILITY 159729 90768 INVESTMENT MGT FEES 227334 227334 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 32950 0 0 0