2018-05-04T15:32:24-05:00 2017-12-31 351178661 BLUE & CO LLC 500 N MERIDIAN ST SUITE 200 INDIANAPOLIS IN 46204 990PF 2017-01-01 351187105 KOSCIUSKO 21ST CENTURY FOUNDATION INC AKA K21 HEALTH FOUNDATION KOSC 5742695188 2170 N POINTE DRIVE WARSAW IN 46582 RICH HADDAD PRESIDENT 5742695188 2018-05-04 1 AMBER KOCHER CPA P00418596 3176334705 2018-05-04 2017 2022-09-23 18:48:47Z X 76458820 X 530592 590450 590450 1036491 1036491 230898 230898 78036 1226892 46660314 1226892 1612 1612 0 3616935 3086343 0 185622 0 0 185622 78908 0 0 78908 26064 0 0 26064 17515 0 0 17515 233013 233013 0 0 96618 0 0 0 154155 151161 0 40982 0 0 40982 7644 0 0 7644 2645 0 0 2645 928298 1701 0 120586 1771464 385875 0 479966 2731240 2732649 4502704 385875 0 3212615 -885769 2700468 0 989203 1142163 1142163 8668 6420 6420 5871192 4442800 4399699 31647424 30811741 44960813 9453825 7579592 7488611 2321930 498829 1545947 1823101 1823101 8657118 12528870 14486810 69098 65710 298729 3388 3388 2835381 2147815 2147815 61307487 60485890 76458820 298983 293541 90116 159729 389099 453270 X 60369514 59288022 548874 744598 60918388 60032620 61307487 60485890 60918388 -885769 6961330 66993949 6961329 60032620 SALE OF SECURITIES P 46660314 45433422 1226892 1226892 1226892 0 3694327 64963804 0.056867 4209526 66164115 0.063622 3838345 67153038 0.057158 3352218 62610514 0.053541 3002834 57062361 0.052624 0.283812 0.056762 70162009 3982536 27005 4009541 4020411 X 27005 0 27005 0 27005 34859 0 0 34859 X 0 7854 7854 0 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 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 185622 5464 0 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 DR DAVID DICK 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 JOE HAWN 2170 NORTH POINTE DRIVE WARSAW IN 46582 DIRECTOR 1.00 0 0 0 ROSY JANSMA 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 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 BILL SMITH 2170 NORTH POINTE DRIVE WARSAW IN 46582 DIRECTOR 1.00 0 0 0 NONE 0 WJ CAREY CONSTRUCTION PO BOX 534 SOUTH WHITLEY IN 46787 GENERAL CONTRACTOR 120396 MARQUETTE ASSOCIATES 180 N LASALLE SUITE 3500 CHICAGO IL 60601 INVESTMENT CONSULTING 68000 0 FORGIVENESS OF CURRENT LOAN MORTGAGE PRINCIPAL AND INTEREST DUE FROM KOSCIUSKO HEALTH SERVICES PAVILION, INC., A SECTION 501(C(3) ORGANIZATION. 799208 FORGIVENESS OF CURRENT LOAN PRINCIPAL AND INTEREST DUE FROM HARVEST WITH A HEART, INC. A SECTION 501(C)(3) ORGANIZATION. 8588 807796 70812625 417841 0 71230466 0 0 71230466 1068457 70162009 3508100 3508100 27005 27005 3481095 0 3481095 0 3481095 3212615 807796 4020411 27005 3993406 3481095 0 0 87852 982854 515855 1586561 4020411 0 0 0 3481095 539316 0 0 2125877 0 0 0 0 0 0 0 2125877 87852 982854 515855 539316 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 AMOS ENGLAND PO BOX 1810 WARSAW IN 465811810 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 2069 CANCER CARE GRANT AMY VOTH-REED PO BOX 1810 WARSAW IN 465811810 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 2050 CANCER CARE GRANT ANITA SORIANO PO BOX 1810 WARSAW IN 465811810 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 4851 CANCER CARE GRANT ANTHONY GEE PO BOX 1810 WARSAW IN 465811810 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 4700 CANCER CARE GRANT CARLOTTA TACKETT PO BOX 1810 WARSAW IN 465811810 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 1420 CANCER CARE GRANT CATHRYN TAYLOR PO BOX 1810 WARSAW IN 465811810 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 1000 CANCER CARE GRANT CAYLE WOODWARD PO BOX 1810 WARSAW IN 465811810 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 2000 CANCER CARE GRANT CHARLES SWIHART PO BOX 1810 WARSAW IN 465811810 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 2417 CANCER CARE GRANT CLINT CARDEN PO BOX 1810 WARSAW IN 465811810 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 2900 CANCER CARE GRANT DANIEL FATTORUSSO PO BOX 1810 WARSAW IN 465811810 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 4918 CANCER CARE GRANT DAVID COLLINS PO BOX 1810 WARSAW IN 465811810 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 1920 CANCER CARE GRANT DAVID MCDONALD PO BOX 1810 WARSAW IN 465811810 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 3575 CANCER CARE GRANT DELIA NAVARRO PO BOX 1810 WARSAW IN 465811810 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 2900 CANCER CARE GRANT DIANA SALDIVAR PO BOX 1810 WARSAW IN 465811810 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 2288 CANCER CARE GRANT DONALD CAVERLEY PO BOX 1810 WARSAW IN 465811810 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 2324 CANCER CARE GRANT ERICA WEISSER PO BOX 1810 WARSAW IN 465811810 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 3000 CANCER CARE GRANT ERIN ALLISON PO BOX 1810 WARSAW IN 465811810 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 1500 CANCER CARE GRANT EVERETT GILLMAN PO BOX 1810 WARSAW IN 465811810 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 1100 CANCER CARE GRANT GARIN VOORHEIS PO BOX 1810 WARSAW IN 465811810 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 2500 CANCER CARE GRANT HEIDI PAUL PO BOX 1810 WARSAW IN 465811810 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 2860 CANCER CARE GRANT ISAAC CROW PO BOX 1810 WARSAW IN 465811810 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 1000 CANCER CARE GRANT JAMES SHELDON PO BOX 1810 WARSAW IN 465811810 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 5168 CANCER CARE GRANT JAY RICE PO BOX 1810 WARSAW IN 465811810 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 1630 CANCER CARE GRANT JEFFREY 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NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 2825 CANCER CARE GRANT SONIA HUNZIKER PO BOX 1810 WARSAW IN 465811810 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 3500 CANCER CARE GRANT STACEY YOTTER PO BOX 1810 WARSAW IN 465811810 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 1500 CANCER CARE GRANT STEVE CONAWAY PO BOX 1810 WARSAW IN 465811810 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 1055 CANCER CARE GRANT TAMARA DRAKE PO BOX 1810 WARSAW IN 465811810 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 2500 CANCER CARE GRANT TERESA MOSS PO BOX 1810 WARSAW IN 465811810 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 2000 CANCER CARE GRANT TONYA OUIMET PO BOX 1810 WARSAW IN 465811810 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 1000 CANCER CARE GRANT VICKI RANDALL PO BOX 1810 WARSAW IN 465811810 NONE I PROVIDE FINANCIAL ASSISTANCE DUE TO CANCER DIAGNOSIS 1492 CANCER CARE GRANT VONDARENE PERKINS 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BOUTIQUE, CLINICAL SUPPLIES, CAR SEATS, STI TESTING 52950 CONDITIONAL GRANT HOUSING OPPORTUNITIES OF WARSAW 109 W CATHERINE ST MILFORD IN 46542 NONE PC HOME REPAIRS 26676 CONDITIONAL GRANT KOSCIUSKO COUNTY YMCA 1305 MARINERS DR WARSAW IN 46582 NONE PC LIVESTRONG PROGRAM 23100 CONDITIONAL GRANT KOSCIUSKO COUNTY COUNCIL ON AGING 800 PARK AVE WARSAW IN 46580 NONE PC TRANSPORTATION VAN 14761 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 318188 CONDITIONAL GRANT LAKE CITY BMX CLUB 5105 N DOVEWOOD TRAIL WARSAW IN 46582 NONE PC TRACK RENOVATIONS 35919 CONDITIONAL GRANT LAKELAND CHRISTIAN ACADEMY 1095 S 250 E WINONA LAKE IN 46590 NONE PC NURSE FACILITY AND EQUIPMENT 8000 CONDITIONAL GRANT MAGICAL MEADOWS 3386 E 525 NORTH WARSAW IN 46582 NONE PC LAND PURCHASE 80000 CONDITIONAL GRANT NORTHERN INDIANA HISPANIC HEALTH COALITION 323 STOCKER COURT ELKHART IN 46516 NONE PC OPERATIONAL FUNDING FOR BILINGUAL ADVOCATE/HEALTH FAIRS 76250 CONDITIONAL GRANT P4C PADDLE CLUB PO BOX 634 WARSAW IN 46581 NONE PC EQUIPMENT 4990 CONDITIONAL GRANT POSITIVE RESOURCE CONNECTION 525 OXFORD STREET FORT WAYNE IN 46806 NONE PC HEALTH TESTING SUPPLIES 3791 CONDITIONAL GRANT QUESTA FOUNDATION 6502 CONSTITUTION DR FORT WAYNE IN 46804 NONE PC HEALTH SCHOLARS PROGRAM 100000 CONDITIONAL GRANT SYRACUSE WAWASEE PARK FOUNDATION 1013 NORTH LONG DR SYRACUSE IN 46567 NONE PC TRAILS, ICE RINK, AND EQUIPMENT 39870 CONDITIONAL GRANT THE ROSE HOME PO BOX 571 SYRACUSE IN 46567 NONE PC HOME REPAIRS AND OPERATIONAL ASSISTANCE 21336 CONDITIONAL GRANT THE WATERSHED FOUNDATION PO BOX 55 NORTH WEBSTER IN 46555 NONE PC COMMUNITY OUTREACH AND EDUCATION 17636 CONDITIONAL GRANT TIPPECANOE VALLEY SCHOOL CORP 8643 S STATE ROAD 19 AKRON IN 46910 NONE PC EQUIPMENT 6413 CONDITIONAL GRANT TOWN OF WINONA LAKE 1310 PARK AVE WINONA LAKE IN 46590 NONE PC PATHWAY DEVELOPMENT 51875 CONDITIONAL GRANT WARSAW COMMUNITY SCHOOLS 1 ADMINISTRATION DR WARSAW IN 46580 NONE PC EQUIPMENT 22800 CONDITIONAL GRANT WAWASEE COMMUNITY SCHOOLS 502 W BROOKLYN ST SYRACUSE IN 46567 NONE PC EQUIPMENT 5828 CONDITIONAL GRANT OTHER GRANTS LESS THAN 1000 502 W BROOKLYN ST SYRACUSE IN 46567 NONE PC EQUIPMENT 17437 DIRECT GRANT 2ND MILE MISSIONS PO BOX 733 WINONA LAKE IN 46590 NONE PC K21 BOARD OF DIRECTORS DIRECTED DONATION 1000 DIRECT GRANT 212 MEDIA STUDIOS 929 E CENTER ST WARSAW IN 46580 NONE PC COMMUNICATIONS WORKSHOP FOR NONPROFITS 2500 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 BPO ELKS LODGE 310 E CENTER ST WARSAW IN 46580 NONE PC HOLIDAY ASSISTANCE FOR POOR 1100 DIRECT GRANT BAKER YOUTH CLUB 1401 E SMITH ST WARSAW IN 46580 NONE PC K21 BOARD OF DIRECTORS DIRECTED DONATION 2000 DIRECT GRANT CITY OF WARSAW 102 S BUFFALO ST WARSAW IN 46580 NONE PC ALLEY DEVELOPMENT 2200 DIRECT GRANT GRACE COLLEGE & SEMINARY 200 SEMINARY DRIVE WINONA LAKE IN 46590 NONE PC K21 BOARD OF DIRECTORS DIRECTED DONATION 2000 DIRECT GRANT HEARTLINE PREGANCY CENTER 1515 PROVIDENT DR SUITE 180 WARSAW MI 46580 NONE PC K21 BOARD OF DIRECTORS DIRECTED DONATION 1000 DIRECT GRANT HOUSING OPPORTUNITIES OF WARSAW 1090W CATHERINE ST MILFORD IN 46542 NONE PC HEALTHY HOMES TRAINING 1000 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 COUNTY COMMUNITY FOUNDATION 102 E MARKET ST WARSAW IN 46580 NONE PC K21 BOARD OF DIRECTORS DIRECTED DONATION 1000 DIRECT GRANT MILESTONES EARLY EDUCATION CENTER PO BOX 316 NORTH WEBSTER IN 46555 NONE PC K21 BOARD OF DIRECTORS DIRECTED DONATION 1000 DIRECT GRANT NORTHSTAR MEDICAL 6540 FULTON E SUITE A ADA IN 49301 NONE PC AED PURCHASES 4180 DIRECT GRANT RILEY CHILDREN'S FOUNDATION 30 SOUTH MERIDIAN ST INDIANAPOLIS IN 46204 NONE PC K21 BOARD OF DIRECTORS DIRECTED DONATION 1000 DIRECT GRANT TIPPECANOE VALLEY COMMUNITY SCHOOLS 8343 SOUTH STATE ROAD 19 AKRON IN 16910 NONE PC K21 BOARD OF DIRECTORS DIRECTED DONATION 1000 DIRECT GRANT WARSAW COMMUNITY SCHOOLS 1 ADMINISTRATION DR WARSAW IN 46580 NONE PC MENTAL HEALTH CONVOCATIONS 4500 DIRECT GRANTS OTHER GRANTS UNDER 1000 PO BOX 1810 WARSAW IN 465811810 NONE PC K21 BOARD OF DIRECTORS DIRECTED DONATION 7748 UNCONDITIONAL GRANT A BRIDGE TO HOPE 499 E 450 SOUTH WARSAW IN 46580 NONE PC OPERATIONAL ASSISTANCE 11580 UNCONDITIONAL GRANT AGAITAS 1945 PHEASANT RIDGE DR WARSAW IN 46580 NONE PC OPERATIONAL ASSISTANCE 9500 UNCONDITIONAL GRANT ALL THINGS NEW PO BOX 367 WINONA LAKE IN 46590 NONE PC OPERATIONAL ASSISTANCE 6600 UNCONDITIONAL GRANT BAKER YOUTH CLUB 1401 E SMITH ST WARSAW IN 46580 NONE PC SUMMER FITNESS PROGRAM 26700 UNCONDITIONAL GRANT BIG BROTHERS BIG SISTERS 499 E 450 SOUTH WARSAW IN 46580 NONE PC OPERATIONAL ASSISTANCE 15000 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 CENTER FOR LAKES AND STREAMS 200 SEMINARY DRIVE WINONA LAKE IN 46590 NONE PC OPERATIONAL ASSISTANCE 40000 UNCONDITIONAL GRANT CITY-COUNTY ATHLETIC COMPLEX 3215 W OLD RD 30 WARSAW IN 46580 NONE PC OPERATIONAL ASSISTANCE 4800 UNCONDITIONAL GRANT COMBINED COMMUNITY SERVICES 1195 MARINERS DR WARSAW IN 46582 NONE PC OPERATIONAL ASSISTANCE 17000 UNCONDITIONAL GRANT ERIN'S HOUSE FOR GRIEVING CHILDREN 5670 YMCA PARK DRVIE WEST FORT WAYNE IN 46835 NONE PC OPERATIONAL ASSISTANCE 6000 UNCONDITIONAL GRANT FELLOWSHIP MISSIONS PO BOX 382 WINONA LAKE IN 46590 NONE PC FACILITY REPAIR 15000 UNCONDITIONAL GRANT GRACE COLLEGE 200 SEMINARY DRIVE WINONA LAKE IN 46590 NONE PC CLAS OPERATING ASSISTANCE; TOBACCO CESSATION PROGRAM 52950 UNCONDITIONAL GRANT HARVEST WITH A HEART 201 S HIGBEE ST MILFORD IN 36542 NONE PC OPERATIONAL ASSISTANCE 6735 UNCONDITIONAL GRANT HEARTLINE PREGNANCY CENTER 1515 PROVIDENT DRIVE WARSAW IN 46580 NONE PC MOBILE UNIT OPERATIONS 44300 UNCONDITIONAL GRANT HOUSING OPPORTUNITIES OF WARSAW 109 W CATHERINE ST MILFORD IN 46542 NONE PC OPERATIONAL ASSISTANCE 15670 UNCONDITIONAL GRANT JOE'S KIDS 902 PROVIDENT DR SUITE C WARSAW IN 46580 NONE PC OPERATIONAL ASSISTANCE 8100 UNCONDITIONAL GRANT KCV CYCLING CLUB PO BOX 325 WINONA LAKE IN 46590 NONE PC OPERATIONAL ASSISTANCE 9000 UNCONDITIONAL GRANT KOSCIUSKO COMMUNITY YMCA 1305 MARINERS DR WARSAW IN 46582 NONE PC OPERATIONAL ASSISTANCE 8000 UNCONDITIONAL GRANT KOSCIUSKO COUNTY COMMUNITY FOUNDATION 102 EAST MARKET STREET WARSAW IN 46580 NONE PC GOOD SAMARITAN FUND 62500 UNCONDITIONAL GRANT KOSCIUSKO COUNTY SHELTER FOR ABUSE PO BOX 12 WARSAW IN 46581 NONE PC OPERATING TRANSITION ASSISTANCE 15000 UNCONDITIONAL GRANT KOSCIUSKO HOME CARE & HOSPICE 1515 PROVIDENT DRIVE STE 250 WARSAW IN 46580 NONE PC OPERATIONAL ASSISTANCE 182200 UNCONDITIONAL GRANT LAKE CITY BMX INC 5105 N DOVEWOOD TRAIL WARSAW IN 46582 NONE PC OPERATIONAL ASSISTANCE 10800 UNCONDITIONAL GRANT LAKELAND YOUTH CENTER 101 W CHICAGO ST SYRACUSE IN 46567 NONE PC OPERATIONAL ASSISTANCE 9600 UNCONDITIONAL GRANT MAD ANTHONY'S CHILDREN'S HOPE HOUSE 7922 WEST JEFFERSON BLVD FORT WAYNE IN 46804 NONE PC OPERATIONAL ASSISTANCE 10000 UNCONDITIONAL GRANT POSITIVE RESOURCE CONNECTION 7922 WEST JEFFERSON BLVD FORT WAYNE IN 46804 NONE PC OPERATIONAL ASSISTANCE 12000 UNCONDITIONAL GRANT RYAN'S PLACE PO BOX 73 GOSHEN IN 46527 NONE PC OPERATIONAL ASSISTANCE 6000 UNCONDITIONAL GRANT THE WATERSHED FOUNDATION PO BOX 73 GOSHEN IN 46527 NONE PC OPERATIONAL ASSISTANCE 3400 2732649 0 14 590450 14 1036491 16 78036 14 1612 18 1226892 0 2933481 0 2933481 0 0 0 0 0 0 0 0 0 0 X X 1 DR AND MRS RICK SASSO 10674 WINTERWOOD CARMEL IN 46032 201271 X 2 LUTHERAN HEALTH FOUNDATION 3024 FAIRFIELD AVE FORT WAYNE IN 46807 100000 X 3 JOHN THOMAS HALL TRUST 5867 E ISLAND AVE SYRACUSE IN 46567 10000 X 4 DOUGLAS SCHROCK 631 E NORTHSHORE DR SYRACUSE IN 46567 10000 X 5 DONETTE SMOCK 5867 E ISLAND AVE SYRACUSE IN 46567 8000 X 6 KCV CYCLING CLUB PO BOX 325 WINONA LAKE IN 46590 5000 X 7 DONALD GUNDEN 64874 ORCHARD DRIVE GOSHEN IN 46526 5000 X 8 BERTSCH FAMILY CHARITABLE FOUNDATION PO BOX 1494 WARSAW IN 46581 5000 X 1 MARKETABLE SECURITIES 201271 2017-12-31 ACCOUNTING FEES 17515 0 0 17515 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 7096039 7005483 FOREIGN BONDS 483553 483128 EQUITY SECURITIES 30811741 44960813 4442800 4399699 0 0 LAND 23895 0 23895 23895 LAND IMPROVEMENTS 305265 83260 222005 222005 LEASEHOLD IMPROVEMENTS 969226 270567 698659 698659 BUILDING 1023544 145002 878542 878542 REAL ESTATE INVESTMENT FUND FMV 2251048 3003571 HEDGE FUND FMV 3562012 3702866 GLOBAL MANAGED VOLATILITY FMV 3081921 4173669 US EQUITY INDEX PUTWRITE FUND LLC FMV 3633889 3606704 OFFICE & COMPUTER EQUIPMENT 69098 65710 3388 3388 NOTES RECEIVABLE HELD FOR GRANT MAKING 2829100 2139032 2139032 RECEIVABLE - OTHER 340 929 929 EXCISE TAX ASSET - OVERPAYMENT 5941 7854 7854 2017 BOOK VALUE AND MARKET VALUE CHANGE BETWEEN YEARS 6961329 KHSP MORTGAGE INTEREST FORGIVENESS 799208 0 0 0 HARVEST LOAN FORGIVENESS 8588 0 0 0 FUNDRAISING EXPENSES 49268 0 0 49268 INSURANCE 7186 0 0 7113 MARKETING 34149 0 0 34149 MISCELLANEOUS EXPENSE 33932 1701 0 30056 EXPIRED GRANTS -4033 0 0 0 OTHER INCOME 1612 1612 UNREALIZED GAIN ON INVESTMENTS 6961330 DEFERRED TAX LIABILITY 90116 159729 INVESTMENT MGT FEES 233013 233013 0 0 DR AND MRS RICK SASSO 10674 WINTERWOOD CARMEL IN 46032 LUTHERAN HEALTH FOUNDATION 3024 FAIRFIELD AVENUE FORT WAYNE IN 46807 EXCISE TAXES 96618 0 0 0