TY 2011 Form 990

- TIN:

Form990

Department of the Treasury
Internal Revenue Service

Return of Organization Exempt From Income Tax

Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except black lung benefit trust or private foundation)

The organization may have to use a copy of this return to satisfy state reporting requirements.

OMB No. 1545-0047

2011

Open to Public Inspection

A For the calendar year, or tax year beginning 07-01-2011 and ending 06-30-2012

BCheck if applicable: Address change Name change Initial return Terminated Amended return Application pending

CName of organization
KOSCIUSKO COUNTY COMMUNITY FOUNDATION INC

Doing Business As

Number and street (or P.O. box if mail is not delivered to street address)
102 E Market Street

Room/suite

City or town, state or country, and ZIP + 4
Warsaw, IN465802806

D Employer identification number

35-6086777

E Telephone number

G Gross receipts $ 15,420,339

F Name and address of principal officer:
Suzanne M Light
102 E Market Street
Warsaw,IN46580

Tax-exempt status: 501(c)(3) 501(c) ( ) LeftBullet

(insert no.) 4947(a)(1) or 527

Website:

www.kcfoundation.org

H(a)

Is this a group return for
affiliates? Yes No

H(b)

Are all affiliates included?

Yes No

If "No," attach a list. (see instructions)

H(c)

Group exemption number MediumBullet

K Form of organization: Corporation Trust Association Other MediumBullet

L Year of formation: 1968

M State of legal domicile: IN

Part I

Summary

1	Briefly describe the organization’s mission or most significant activities: The Community Foundation's mission is to bring caring people and charitable endeavors together for the good of our community. In addition to awarding over $1.8 million in grants in the areas of arts/culture, civic projects, human services, recreation, health, education and the environment, the Community Foundation hosted educational workshops for nonprofits and professional advisors, provided meeting space for community groups and served as a catalyst and convener for community enhancement initiatives, such as community development and educational programs aimed at at-risk students.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a).....	3	22
4	Number of independent voting members of the governing body (Part VI, line 1b) ....	4	22
5	Total number of individuals employed in calendar year 2011 (Part V, line 2a) ...	5	10
6	Total number of volunteers (estimate if necessary) ....	6	230
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ..	7a	0
b	Net unrelated business taxable income from Form 990-T, line 34 ..	7b	0

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	3,277,057	2,545,206
9	Program service revenue (Part VIII, line 2g) .........	575,099	583,464
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	1,269,208	948,362
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	638,515	14,084
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)...................	5,759,879	4,091,116
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	7,058,306	1,808,255
14	Benefits paid to or for members (Part IX, column (A), line 4).....	0	0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	411,868	455,495
16a	Professional fundraising fees (Part IX, column (A), line 11e).....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 238,875
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24f)....	1,875,167	907,893
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	9,345,341	3,171,643
19	Revenue less expenses. Subtract line 18 from line 12.......	-3,585,462	919,473
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	39,479,182	39,775,892
21	Total liabilities (Part X, line 26).............	2,333,022	2,257,201
22	Net assets or fund balances. Subtract line 21 from line 20.....	37,146,160	37,518,691

Part II

Signature Block

Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.

Sign Here

	Signature of officer	Date

	Type or print name and title.

Paid preparer use only

Print/type preparer's name

Preparer's signature

Date

Check if
self-employed

PTIN

Firm's name Right pointing arrowhead image

Firm's EIN Right pointing arrowhead image

Firm's address Right pointing arrowhead image

Phone no.

May the IRS discuss this return with the preparer shown above? See instructions ......... bullet

YesNo

For Paperwork Reduction Act Notice, see the separate instructions.

Cat. No. 11282Y

Form 990 (2011)

Page 2

Part III

Statement of Program Service Accomplishments

Check if Schedule O contains a response to any question in this Part III .........

Briefly describe the organization’s mission: The mission of the Community Foundation: By bringing caring people and charitable endeavors together, we make donor dreams shine for the good of our community. We do this by: 1) Serving as the vehicle for donors' charitable dreams, 2) Awarding grants to charitable projects and organizations, 3) Addressing community needs as a catalyst and convener.

Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 990-EZ? .................... Yes No

If “Yes,” describe these new services on Schedule O.

Did the organization cease conducting, or make significant changes in how it conducts, any program services? .......................... Yes No

If “Yes,” describe these changes on Schedule O.

Describe the organization’s program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations and section 4947(a)(1) trusts are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.


4a	(Code: ) (Expenses $ 1,273,280 including grants of $ 1,189,096 ) (Revenue $ 422,306 )
	Grantmaking - Awarded over 600 grants totaling nearly $1.2 million to nonprofits and charitable projects in the areas of human services (31%), education (27%), health (14%), recreation (9%), arts and culture (8%), civic projects (8%) and the environment (3%).

4b	(Code: ) (Expenses $ 415,635 including grants of $ 379,557 ) (Revenue $ 147,038 )
	Scholarships - Awarded educational scholarships to students pursuing college, university or trade school education ($379,557 to 195 area students).

4c	(Code: ) (Expenses $ 247,614 including grants of $ 239,602 ) (Revenue $ 14,120 )
	Good Samaritan - Benevolent assistance to over 600 area residents experiencing financial crisis due to a medical condition ($239,602 in 1,436 awards).

4d	Other program services (Describe in Schedule O.)
	(Expenses $ 0 including grants of $ 0 ) (Revenue $ 0 )
4e	Total program service expenses$ 1,936,529

Form 990 (2011)

Page 3

Part IV

Checklist of Required Schedules

Yes

Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If “Yes,” complete Schedule A Click to see attachment

.....................

Yes

Is the organization required to complete Schedule B, Schedule of Contributors? Click to see attachment

........

Yes

Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? If “Yes,” complete Schedule C, Part I..........

Section 501(c)(3) organizations. Did the organization engage in lobbying activities? If “Yes,” complete Schedule C,
Part II.........................

Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Revenue Procedure 98-19? If “Yes,” complete Schedule C, Part III........................

Did the organization maintain any donor advised funds or any similar funds or accounts for which donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If “Yes,” complete Schedule D, Part I Click to see attachment

....................

Yes

Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas or historic structures? If “Yes,” complete Schedule D, Part II...

Did the organization maintain collections of works of art, historical treasures, or other similar assets? If “Yes,” complete Schedule D, Part III ....................

Did the organization report an amount in Part X, line 21; serve as a custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services? If “Yes,”
complete Schedule D, Part IV...................

Did the organization, directly or through a related organization, hold assets in temporarily restricted endowments, permanent endowments, or quasi-endowments? If “Yes,” complete Schedule D, Part V Click to see attachment

Yes

If the organization’s answer to any of the following questions is ‘Yes,’ then complete Schedule D, Parts VI, VII, VIII, IX, or X as applicable:

Did the organization report an amount for land, buildings, and equipment in Part X, line10? If “Yes,” complete Schedule D, Part VI. Click to see attachment

11a

Yes

Did the organization report an amount for investments—other securities in Part X, line 12 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VII.

11b

Did the organization report an amount for investments—program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VIII.

11c

Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part IX. Click to see attachment

11d

Yes

Did the organization report an amount for other liabilities in Part X, line 25? If “Yes,” complete Schedule D, Part X. Click to see attachment

11e

Yes

Did the organization’s separate or consolidated financial statements for the tax year include a footnote that addresses the organization’s liability for uncertain tax positions under FIN 48 (ASC 740)? If “Yes,” complete Schedule D, Part X. Click to see attachment

11f

Yes

12a

Did the organization obtain separate, independent audited financial statements for the tax year?
If “Yes,” complete Schedule D, Parts XI, XII, and XIII Click to see attachment

12a

Was the organization included in consolidated, independent audited financial statements for the tax year? If “Yes,” and if the organization answered ‘No’ to line 12a, then completing Schedule D, Parts XI, XII, and XIII is optional Click to see attachment

12b

Yes

Is the organization a school described in section 170(b)(1)(A)(ii)? If “Yes,” complete Schedule E

14a

Did the organization maintain an office, employees, or agents outside of the United States?....

14a

Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, investment, and program service activities outside the United States or aggregate foreign investments valued at $100,000 or more? If “Yes,” complete Schedule F, Part I.........

14b

Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or assistance to any organization or entity located outside the U.S.? If “Yes,” complete Schedule F, Part II..

Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or assistance to individuals located outside the U.S.? If “Yes,” complete Schedule F, Part III..

Did the organization report a total of more than $15,000, of expenses for professional fundraising services on Part IX, column (A), lines 6 and 11e? If “Yes,” complete Schedule G, Part I

Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines 1c and 8a? If “Yes,” complete Schedule G, Part II..........

Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? If “Yes,” complete Schedule G, Part III...................

20a

Did the organization operate one or more hospitals? If “Yes,” complete Schedule H.....

20a

If “Yes” to line 20a, did the organization attach a copy of its audited financial statement to this return? Note. All Form 990 filers that operated one or more hospitals must attach audited financial statements.

20b

Form 990 (2011)

Page 4

Part IV

Checklist of Required Schedules (continued)

Did the organization report more than $5,000 of grants and other assistance to any government or organization in the United States on Part IX, column (A), line 1? If “Yes,” complete Schedule I, Parts I and II.. Click to see attachment

Yes

Did the organization report more than $5,000 of grants and other assistance to individuals in the United States on Part IX, column (A), line 2? If “Yes,” complete Schedule I, Parts I and III..... Click to see attachment

Yes

Did the organization answer “Yes” to Part VII, Section A, questions 3, 4, or 5, about compensation of the organization’s current and former officers, directors, trustees, key employees, and highest compensated employees? If “Yes,” complete Schedule J................

24a

Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that was issued after December 31, 2002? If “Yes,” answer questions 24b–24d and complete Schedule K. If “No,” go to line 25................

24a

Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...

24b

Did the organization maintain an escrow account other than a refunding escrow at any time during the year
to defease any tax-exempt bonds?......................

24c

Did the organization act as an “on behalf of” issuer for bonds outstanding at any time during the year?...

24d

25a

Section 501(c)(3) and 501(c)(4) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If “Yes,” complete Schedule L, Part I......

25a

Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization’s prior Forms 990 or 990-EZ? If “Yes,” complete Schedule L, Part I................

25b

Was a loan to or by a current or former officer, director, trustee, key employee, highly compensated employee, or disqualified person outstanding as of the end of the organization’s tax year? If “Yes,” complete Schedule L,
Part II.........................

Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantial contributor or employee thereof, a grant selection committee member, or to a 35% controlled entity or family member of any of these persons? If “Yes,” complete Schedule L, Part III.........

Was the organization a party to a business transaction with one of the following parties? (see Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions):

A current or former officer, director, trustee, or key employee? If “Yes,” complete Schedule L, Part IV .........................

28a

A family member of a current or former officer, director, trustee, or key employee? If “Yes,”
complete Schedule L, Part IV...................

28b

An entity of which a current or former officer, director, trustee, or key employee (or a family member thereof) was an officer, director, trustee, or owner? If “Yes,” complete Schedule L, Part IV..

28c

Did the organization receive more than $25,000 in non-cash contributions? If “Yes,” complete Schedule M Click to see attachment

Yes

Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If “Yes,” complete Schedule M............

Did the organization liquidate, terminate, or dissolve and cease operations? If “Yes,” complete Schedule N,
Part I...........................

Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If “Yes,” complete Schedule N, Part II.......................

Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? If “Yes,” complete Schedule R, Part I........

Was the organization related to any tax-exempt or taxable entity? If “Yes,” complete Schedule R, Parts II, III, IV, and V, line 1..................... Click to see attachment

Yes

35a

Did the organization have a controlled entity within the meaning of section 512(b)(13)?

35a

Yes

If ‘Yes’ to line 35a, did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If “Yes,” complete Schedule R, Part V, line 2...

35b

Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable related organization? If “Yes,” complete Schedule R, Part V, line 2...........

Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes? If “Yes,” complete Schedule R, Part VI

Did the organization complete Schedule O and provide explanations in Schedule O for Part VI, lines 11 and 19? Note. All Form 990 filers are required to complete Schedule O. ............

Yes

Form 990 (2011)

Page 5

Part V

Statements Regarding Other IRS Filings and Tax Compliance

Check if Schedule O contains a response to any question in this Part V .........

Yes

Enter the number reported in Box 3 of Form 1096. Enter -0- if not applicable. .......

Enter the number of Forms W-2G included in line 1a. Enter -0- if not applicable.

Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? ..................

Enter the number of employees reported on Form W-3, Transmittal of Wage and Tax Statements filed for the calendar year ending with or within the year covered by this return .....................

If at least one is reported on line 2a, did the organization file all required federal employment tax returns?

Note. If the sum of lines 1a and 2a is greater than 250, you may be required to e-file. (see instructions)

Yes

Did the organization have unrelated business gross income of $1,000 or more during the year?.............................

If “Yes,” has it filed a Form 990-T for this year? If “No,” provide an explanation in Schedule O.....

At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account or securities account)?.......................

If "Yes," enter the name of the foreign country: MediumBullet

See instructions for filing requirements for Form TD F 90-22.1, Report of Foreign Bank and Financial Accounts.

Was the organization a party to a prohibited tax shelter transaction at any time during the tax year?..

Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?

If “Yes” to line 5a or 5b, did the organization file Form 8886-T? ........

Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible?..........

If “Yes,” did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible?........................

Organizations that may receive deductible contributions under section 170(c).

Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor?....................

If “Yes,” did the organization notify the donor of the value of the goods or services provided?.....

Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282?...........................

If “Yes,” indicate the number of Forms 8282 filed during the year ....

Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?..........................

Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract?..

If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required?...................

If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C?...............

Sponsoring organizations maintaining donor advised funds and section 509(a)(3) supporting organizations. Did the supporting organization, or a donor advised fund maintained by a sponsoring organization, have excess business holdings at any time during the year?................

Sponsoring organizations maintaining donor advised funds.

Did the organization make any taxable distributions under section 4966?.........

Did the organization make a distribution to a donor, donor advisor, or related person?......

Section 501(c)(7) organizations. Enter:

Initiation fees and capital contributions included on Part VIII, line 12 ...

10a

Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities

10b

Section 501(c)(12) organizations. Enter:

Gross income from members or shareholders .........

11a

Gross income from other sources (Do not net amounts due or paid to other sources against amounts due or received from them) ........

11b

12a

Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041?

12a

If “Yes,” enter the amount of tax-exempt interest received or accrued during the year.

12b

Section 501(c)(29) qualified nonprofit health insurance issuers.

Is the organization licensed to issue qualified health plans in more than one state?
Note. All 501(c)(29) organizations must list in Schedule O each state in which they are licensed to issue qualified health plans, the amount of reserves required by each state, and the amount of reserves the organization allocated to each state.

13a

Enter the aggregate amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans.

13b

Enter the aggregate amount of reserves on hand.

13c

14a

Did the organization receive any payments for indoor tanning services during the tax year?.....

14a

If "Yes," has it filed a Form 720 to report these payments? If “No,” provide an explanation in Schedule O..

14b

Form 990 (2011)

Page 6

Part VI

Governance, Management, and Disclosure For each “Yes” response to lines 2 through 7b below, and for a “No” response to lines 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instructions.

Check if Schedule O contains a response to any question in this Part VI .........

Section A. Governing Body and Management

Yes

Enter the number of voting members of the governing body at the end of the tax year
If the governing body delegated broad authority to an executive committee or similar committee, explain in Schedule O.

Enter the number of voting members included in line 1a, above, who are independent .................

Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee? .................

Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors or trustees, or key employees to a management company or other person? .

Did the organization make any significant changes to its governing documents since the prior Form 990 was filed?

Did the organization become aware during the year of a significant diversion of the organization’s assets? .

Did the organization have members or stockholders? ................

Did the organization have members, stockholders, or other persons who had the power to elect or appoint one or more members of the governing body? .................

Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or persons other than the governing body? ............

Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:

The governing body? .........................

Yes

Each committee with authority to act on behalf of the governing body? ..........

Yes

Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization’s mailing address? If “Yes,” provide the names and addresses in Schedule O .....

Section B. Policies (This Section B requests information about policies not required by the Internal
Revenue Code.)

Yes

10a

Did the organization have local chapters, branches, or affiliates? ............

10a

If “Yes,” did the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with the organization's exempt purposes? ....

10b

11a

Has the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form?

11a

Yes

Describe in Schedule O the process, if any, used by the organization to review the Form 990. .....

12a

Did the organization have a written conflict of interest policy? If “No,” go to line 13.......

12a

Yes

Were officers, directors or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ........................

12b

Yes

Did the organization regularly and consistently monitor and enforce compliance with the policy? If “Yes,” describe in Schedule O how this was done ....................

12c

Yes

Did the organization have a written whistleblower policy? ...............

Yes

Did the organization have a written document retention and destruction policy? .........

Yes

Did the process for determining compensation of the following persons include a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision?

The organization’s CEO, Executive Director, or top management official ...........

15a

Yes

Other officers or key employees of the organization ................

15b

If "Yes," to line 15a or 15b, describe the process in Schedule O (see instructions).

16a

Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity during the year? ......................

16a

If “Yes,” did the organization follow a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and take steps to safeguard the organization’s exempt status with respect to such arrangements? ............

16b

Section C. Disclosure

List the States with which a copy of this Form 990 is required to be filed MediumBullet

Section 6104 requires an organization to make its Form 1023 (or 1024 if applicable), 990, and 990-T (501(c)(3)s only) available for public inspection. Indicate how you made these available. Check all that apply.

Own website Another's website Upon request

Describe in Schedule O whether (and if so, how), the organization made its governing documents, conflict of interest policy, and financial statements available to the public during the tax year.

State the name, physical address, and telephone number of the person who possesses the books and records of the organization: MediumBullet

Suzanne M Light
102 E Market Street
Warsaw,IN465802806
(574) 267-1901

Form 990 (2011)

Page 7

Part VII

Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors

Check if Schedule O contains a response to any question in this Part VII .........

Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees

1a Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization’s tax year.
RoundBullet

List all of the organization’s current officers, directors, trustees (whether individuals or organizations), regardless of amount
of compensation, and current key employees. Enter -0- in columns (D), (E), and (F) if no compensation was paid.

List all of the organization’s current key employees, if any. See instructions for definition of "key employee."

List the organization’s five current highest compensated employees (other than an officer, director, trustee or key employee)
who received reportable compensation (Box 5 of Form W-2 and/or Box 7 of Form 1099-MISC) of more than $100,000 from the
organization and any related organizations.

List all of the organization’s former officers, key employees, or highest compensated employees who received more than $100,000
of reportable compensation from the organization and any related organizations.

List all of the organization’s former directors or trustees that received, in the capacity as a former director or trustee of the
organization, more than $10,000 of reportable compensation from the organization and any related organizations.

List persons in the following order: individual trustees or directors; institutional trustees; officers; key employees; highest
compensated employees; and former such persons.

Check this box if neither the organization nor any related organizations compensated any current or former officer, director, or trustee.

(A) Name and Title	(B) Average hours per week (describe hours for related organizations in Schedule O)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(D) Reportable compensation from the organization (W- 2/1099-MISC)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(A) Name and Title
(1) Ceaneh Alexis Board Member	.13	X	0	0	0
(2) Jack Birch Board Member	.23	X	0	0	0
(3) Bob Bishop Board Member	.45	X	0	0	0
(4) Jerry Clevenger Finance Chair	.32	X	0	0	0
(5) Marsha Cook Board Member	.45	X	0	0	0
(6) Marlene Mulero-Betances Board Member	.55	X	0	0	0
(7) Zoe Howard Board Member	.91	X	0	0	0
(8) Tracy Jackson Board Member	.22	X	0	0	0
(9) Mike Kinsey Board Member	.20	X	0	0	0
(10) Barbara Kissane Board Member	.38	X	0	0	0
(11) Vern Landis Board Member	.35	X	0	0	0
(12) Ron Manahan Board Member	.19	X	0	0	0
(13) James McFadden Board Member	.59	X	0	0	0
(14) Allison McSherry Board Member	.61	X	0	0	0
(15) Rob Parker Board Member	.40	X	0	0	0
(16) Rita Price Simpson Board Member	.14	X	0	0	0
(17) Jeannie Ross Board Member	.17	X	0	0	0

Form 990 (2011)

Page 8

Part VII

Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued)

(A) Name and Title	(B) Average hours per week (describe hours for related organizations in Schedule O)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)		(D) Reportable compensation from the organization (W- 2/1099-MISC)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(A) Name and Title
(18) Rita Schobert Snyder Board Member	.18	X		0	0	0
(19) Sharon Sommers Board Member	.74	X		0	0	0
(20) Cynthia Zehr Board Member	.49	X		0	0	0
(21) Jerry Yeager President	.72	X	X	0	0	0
(22) Craig Tidball Vice President	.14	X	X	0	0	0
(23) Mindy Truex Secretary	.43	X	X	0	0	0
(24) Alan Alderfer Treasurer	.66	X	X	0	0	0
(25) Suzanne M Light Executive Director/CEO	45		X	89,685	0	7,441

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)............	89,685	0	7,441

Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organization MediumBullet

Yes

Did the organization list any former officer, director or trustee, key employee, or highest compensated employee on line 1a? If “Yes,” complete Schedule J for such individual .............

For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000? If “Yes,” complete Schedule J for such individual...........................

Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? If “Yes,” complete Schedule J for such person .....

Section B. Independent Contractors

Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from the organization. Report compensation for the calendar year ending with or within the organization’s tax year.

(A) Name and business address	(B) Description of services	(C) Compensation
Cambridge Education LLC 400 Blue Hill Dr Ste 100 Westwood,MA02090	Study of local schools	170,000




2 Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization 1

Form 990 (2011)

Page 9

Part VIII

Statement of Revenue

				(A) Total revenue	(B) Related or exempt function revenue	(C) Unrelated business revenue	(D) Revenue excluded from tax under sections 512, 513, or 514
1a	Federated campaigns..1a		0
b	Membership dues....1b		0
c	Fundraising events....1c		0
d	Related organizations...1d		0
e	Government grants (contributions)1e		0

f	All other contributions, gifts, grants, and similar amounts not included above1f		2,545,206
g	Noncash contributions included in lines 1a-1f:$ 1,119,481
h	Total. Add lines 1a-1f.......			2,545,206
			Business Code
2a	Administrative Fees		561,000	583,464	583,464	0	0
b
c
d
e
f	All other program service revenue .			0	0	0	0
g	Total. Add lines 2a–2f........			583,464
3	Investment income (including dividends, interest
	and other similar amounts).....			1,050,246	0	0	1,050,246
4	Income from investment of tax-exempt bond proceeds..			0	0	0	0
5	Royalties............			0	0	0	0
		(i) Real	(ii) Personal
6a	Gross rents	0	0
b	Less: rental expenses	0	0
c	Rental income or (loss)	0	0
d	Net rental income or (loss).......			0	0	0	0
		(i) Securities	(ii) Other
7a	Gross amount from sales of assets other than inventory	11,227,339	0
b	Less: cost or other basis and sales expenses	11,329,223	0
c	Gain or (loss)	-101,884	0
d	Net gain or (loss)..........			-101,884	0	0	-101,884
8a	Gross income from fundraising events (not including $ 0 of contributions reported on line 1c). See Part IV, line 18 ...
	a		0
b	Less: direct expenses ...b		0
c	Net income or (loss) from fundraising events..			0		0	0
9a	Gross income from gaming activities. See Part IV, line 19 ...
	a		0
b	Less: direct expenses ...b		0
c	Net income or (loss) from gaming activities...			0	0	0	0
10a	Gross sales of inventory, less returns and allowances .
	a		0
b	Less: cost of goods sold ..b		0
c	Net income or (loss) from sales of inventory..			0	0	0	0
Miscellaneous Revenue			Business Code
11a	Miscellaneous Income		900,099	2,771	2,771	0	0
b	Split Interest agreements value adjustments		900,099	17,377	17,377	0	0
c	Future annuity payments value adjustment		900,099	-6,064	-6,064	0	0
d	All other revenue ....			0	0	0	0
e	Total. Add lines 11a–11d ......			14,084
12	Total revenue. See Instructions....			4,091,116	597,548	0	948,362

Form 990 (2011)

Page 10

Part IX

Statement of Functional Expenses

Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A) but are not required to complete columns (B), (C), and (D).
Check if Schedule O contains a response to any question in this Part IX. .........

Do not include amounts reported on lines 6b, 7b, 8b, 9b, and 10b of Part VIII.		(A) Total expenses	(B) Program service expenses	(C) Management and general expenses	(D) Fundraising expenses
1	Grants and other assistance to governments and organizations in the United States. See Part IV, line 21	1,189,096	1,189,096
2	Grants and other assistance to individuals in the United States. See Part IV, line 22	619,159	619,159
3	Grants and other assistance to governments, organizations, and individuals outside the United States. See Part IV, lines 15 and 16	0	0
4	Benefits paid to or for members	0	0
5	Compensation of current officers, directors, trustees, and key employees ....	100,971	15,811	49,931	35,229
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....	0	0	0	0
7	Other salaries and wages	286,310	64,654	106,698	114,958
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	0	0	0	0
9	Other employee benefits .......	39,152	8,264	19,387	11,501
10	Payroll taxes ...........	29,062	6,046	11,762	11,254
11	Fees for services (non-employees):
a	Management ......	583,464	0	583,464	0
b	Legal .........	9,813	0	9,813	0
c	Accounting ...........	7,600	0	7,600	0
d	Lobbying ...........	0	0	0	0
e	Professional fundraising. See Part IV, line 17..	0			0
f	Investment management fees ......	104,059	0	104,059	0
g	Other ..........	7,420	7,040	380	0
12	Advertising and promotion ....	31,010	4,642	2,321	24,047
13	Office expenses .......	23,879	7,541	8,450	7,888
14	Information technology ......	20,767	2,814	13,604	4,349
15	Royalties ..	0	0	0	0
16	Occupancy ...........	37,890	0	37,890	0
17	Travel ............	5,983	1,424	2,358	2,201
18	Payments of travel or entertainment expenses for any federal, state, or local public officials ......	0	0	0	0
19	Conferences, conventions, and meetings ....	6,301	1,360	2,253	2,688
20	Interest ...........	0	0	0	0
21	Payments to affiliates .......	0	0	0	0
22	Depreciation, depletion, and amortization .....	36,460	8,678	14,369	13,413
23	Insurance ..............	1,645	0	1,645	0
24	Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24f. If line 24f amount exceeds 10% of line 25, column (A) amount, list line 24f expenses on Schedule O.)
a	Memberships & Subscriptions Expense	19,702	0	19,702	0
b	Development Expenses	11,347	0	0	11,347
c	Loss on Disposal of Asset	553	0	553	0
d
e
f	All other expenses	0	0	0	0
25	Total functional expenses. Add lines 1 through 24f	3,171,643	1,936,529	996,239	238,875
26	Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here if following SOP 98-2 (ASC 958-720).

Form 990 (2011)

Page 11


				(A) Beginning of year		(B) End of year
1	Cashnon-interest-bearing ..........			400	1	1,286
2	Savings and temporary cash investments .......			1,460,477	2	1,141,714
3	Pledges and grants receivable, net .........			584,127	3	309,740
4	Accounts receivable, net .........			0	4	275
5	Receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
	Schedule L ..........			0	5	0
6	Receivables from other disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B). Complete Part II of
	Schedule L ..........			0	6	0
7	Notes and loans receivable, net .............			0	7	148,910
8	Inventories for sale or use ..............			0	8	0
9	Prepaid expenses and deferred charges ............			13,789	9	35,268
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	969,204
b	Less: accumulated depreciation. .....	10b	537,470	459,384	10c	431,734
11	Investments—publicly traded securities ..........			33,770,330	11	34,458,389
12	Investments—other securities. See Part IV, line 11 ......			0	12	0
13	Investments—program-related. See Part IV, line 11 ..			0	13	0
14	Intangible assets .........			0	14	0
15	Other assets. See Part IV, line 11 ...........			3,190,675	15	3,248,576
16	Total assets. Add lines 1 through 15 (must equal line 34)...			39,479,182	16	39,775,892
17	Accounts payable and accrued expenses .			46,954	17	76,967
18	Grants payable ..........			596,436	18	534,760
19	Deferred revenue ..........			0	19	0
20	Tax-exempt bond liabilities ..........			0	20	0
21	Escrow or custodial account liability. Complete Part IV of Schedule D..			0	21	0
22	Payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
	persons. Complete Part II of Schedule L..........			0	22	0
23	Secured mortgages and notes payable to unrelated third parties ..			0	23	0
24	Unsecured notes and loans payable to unrelated third parties ....			0	24	0
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D.....			1,689,632	25	1,645,474
26	Total liabilities. Add lines 17 through 25.....			2,333,022	26	2,257,201
	Organizations that follow SFAS 117, check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets .....			33,407,824	27	34,049,829
28	Temporarily restricted net assets .....			3,738,336	28	3,468,862
29	Permanently restricted net assets .....			0	29	0
	Organizations that do not follow SFAS 117, check here and complete lines 30 through 34.
30	Capital stock or trust principal, or current funds .....				30
31	Paid-in or capital surplus, or land, building or equipment fund .....				31
32	Retained earnings, endowment, accumulated income, or other funds				32
33	Total net assets or fund balances .....			37,146,160	33	37,518,691
34	Total liabilities and net assets/fund balances .....			39,479,182	34	39,775,892

Form 990 (2011)

Page 12

Part XI

Reconcilliation of Net Assets

Check if Schedule O contains a response to any question in this Part XI .........

Total revenue (must equal Part VIII, column (A), line 12) ...

4,091,116

Total expenses (must equal Part IX, column (A), line 25) ....

3,171,643

Revenue less expenses. Subtract line 2 from line 1 ...

919,473

Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) ..

37,146,160

Other changes in net assets or fund balances (explain in Schedule O) ...

-546,942

Net assets or fund balances at end of year. Combine lines 3, 4, and 5 (must equal Part X, line 33, column (B)) ....

37,518,691

Part XII

Financial Statements and Reporting

Check if Schedule O contains a response to any question in this Part XII .........

Yes

Accounting method used to prepare the Form 990: Cash Accrual Other
If the organization changed its method of accounting from a prior year or checked "Other," explain in
Schedule O.

Were the organization’s financial statements compiled or reviewed by an independent accountant?....

Were the organization’s financial statements audited by an independent accountant?........

Yes

If “Yes,” to 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit, review, or compilation of its financial statements and selection of an independent accountant? If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O. ...........................

Yes

If “Yes” to line 2a or 2b, check a box below to indicate whether the financial statements for the year were issued on a separate basis, consolidated basis, or both:

Separate basis Consolidated basis Both consolidated and separated basis

As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit Act and OMB Circular A-133? ................

If “Yes,” did the organization undergo the required audit or audits? If the organization did not undergo the required audit or audits, explain why in Schedule O and describe any steps taken to undergo such audits. ..

Form 990 (2011)

Additional Data

Software ID:	11000129
Software Version:	v1.00

Form 990, Special Condition Description:

Special Condition Description

- TIN:

SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service

Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.

Attach to Form 990 or Form 990-EZ. right arrow

See separate instructions.

OMB No. 1545-0047

2011

Open to Public
Inspection

Name of the organization

KOSCIUSKO COUNTY COMMUNITY FOUNDATION INC

Employer identification number

35-6086777

Part I

Reason for Public Charity Status (All organizations must complete this part.) See instructions

The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)

A church, convention of churches, or association of churches. section 170(b)(1)(A)(i).

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E.)

A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii).

A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii). Enter the hospital's name, city, and state:

An organization operated for the benefit of a college or university owned or operated by a governmental unit described in

section 170(b)(1)(A)(iv). (Complete Part II.)

A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v).

An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in

section 170(b)(1)(A)(vi). (Complete Part II.)

A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.)

An organization that normally receives: (1) more than 331/3% of its support from contributions, membership fees, and gross

receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of

its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses

acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)

An organization organized and operated exclusively to test for public safety. Seesection 509(a)(4).

An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box that describes the type of supporting organization and complete lines 11e through 11h.

Type I

Type II

Type III - Functionally integrated

Type III - Other

By checking this box, I certify that the organization is not controlled directly or indirectly by one or more disqualified persons other than foundation managers and other than one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2).

If the organization received a written determination from the IRS that it is a Type I, Type II or Type III supporting organization, check this box ..................................................

Since August 17, 2006, has the organization accepted any gift or contribution from any of the
following persons?

(i) a person who directly or indirectly controls, either alone or together with persons described in (ii)

Yes

and (iii) below, the governing body of the the supported organization? ................

11g(i)

(ii) a family member of a person described in (i) above? ......................

11g(ii)

(iii) a 35% controlled entity of a person described in (i) or (ii) above? ................

11g(iii)

Provide the following information about the supported organization(s).

(i) Name of supported organization	(ii) EIN	(iv) Is the organization in col. (i) listed in your governing document?		(v) Did you notify the organization in col. (i) of your support?		(vi) Is the organization in col. (i) organized in the U.S.?		(vii) Amount of support?
(i) Name of supported organization	(ii) EIN	Yes	No	Yes	No	Yes	No	(vii) Amount of support?


Total

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 11285F

Schedule A (Form 990 or 990-EZ) 2011

Page 2

Part II

Support Schedule for Organizations Described in IRC 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization fails to qualify under the tests listed below, please complete Part III.)

Section A. Public Support

Calendar year(or fiscal year beginning in)		(a) 2007	(b) 2008	(c) 2009	(d) 2010	(e) 2011	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....	2,622,845	1,617,054	8,268,583	3,277,057	2,544,117	18,329,656
2	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......	0	0	0	0	0	0
3	The value of services or facilities furnished by a governmental unit to the organization without charge..	0	0	0	0	0	0
4	Total. Add lines 1 through 3..	2,622,845	1,617,054	8,268,583	3,277,057	2,544,117	18,329,656
5	The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..						8,482,566
6	Public Support. Subtract line 5 from line 4.						9,847,090

Section B. Total Support

Calendar year(or fiscal year beginning in)		(a) 2007	(b) 2008	(c) 2009	(d) 2010	(e) 2011	(f) Total
7	Amounts from line 4..	2,622,845	1,617,054	8,268,583	3,277,057	2,544,117	18,329,656
8	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..	1,073,757	862,950	1,031,474	1,065,498	1,050,246	5,083,925
9	Net income from unrelated business activities, whether or not the business is regularly carried on..	0	0	0	0	0	0
10	Other income. (Explain in Part IV.) Do not include gain or loss from the sale of capital assets..	0	0	0	0	0	0
11	Total support (Add lines 7 through 10).						23,413,581

Gross receipts from related activities, etc. (See instructions.) ..................

First Five Years If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here.......................................... right arrow

Section C. Computation of Public Support Percentage

Public Support Percentage for 2010 (line 6 column (f) divided by line 11 column (f)) .........

42.057 %

Public Support Percentage for 2009 Schedule A, Part II, line 14 ...............

45.656 %

16a

33 1/3% support test—2011. If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization ...................... right arrow

33 1/3% support test—2010. If the organization did not check the box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization ..................... right arrow

17a

10%-facts-and-circumstances test—2011. If the organization did not check a box on line 13, 16a, or 16b and line 14
is 10% or more, and if the organization meets the "facts and circumstances" test, check this box and stop here. Explain
in Part IV how the organization meets the "facts and circumstances" test. The organization qualifies as a publicly supported
organization .................................................. right arrow

10%-facts-and-circumstances test—2010. If the organization did not check a box on line 13, 16a, 16b, or 17a and line
15 is 10% or more, and if the organization meets the "facts and circumstances" test, check this box and stop here.
Explain in Part IV how the organization meets the "facts and circumstances" test. The organization qualifies as a publicly
supported organization .............................................. right arrow

Private Foundation If the organization did not check a box on line 13, 16a, 16b, 17a or 17b, check this box and see
instructions ................................................... right arrow

Schedule A (Form 990 or 990-EZ) 2011

Page 3

Part III

Support Schedule for Organizations Described in IRC 509(a)(2)
(Complete only if you checked the box on line 9 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)

Section A. Public Support

Calendar year(or fiscal year beginning in)		(a) 2007	(b) 2008	(c) 2009	(d) 2010	(e) 2011	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2	Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......
3	Gross receipts from activities that are not an unrelated trade or business under section 513..
4	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5	The value of services or facilities furnished by a governmental unit to the organization without charge..
6	Total. Add lines 1 through 5.
7a	Amounts included on lines 1, 2, and 3 received from disqualified persons...
b	Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c	Add lines 7a and 7b..
8	Public Support (Subtract line 7c from line 6.)

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2007	(b) 2008	(c) 2009	(d) 2010	(e) 2011	(f) Total
9	Amounts from line 6...
10a	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b	Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c	Add lines 10a and 10b.
11	Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
12	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)
13	Total support (Add lines 9, 10c, 11 and 12.).

Section C. Computation of Public Support Percentage

Public Support Percentage for 2011 (line 8 column (f) divided by line 13 column (f)) .........

Public support percentage from 2010 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2011 (line 10c column (f) divided by line 13 column (f)) ......

Investment income percentage from 2010 Schedule A, Part III, line 17 .............

19a

33 1/3% support tests—2011. If the organization did not check the box on line 14, and line 15 is more than 33 1/3% and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization .......... right arrow

33 1/3% support tests—2010. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization .... right arrow

Private Foundation If the organization did not check a box on line 14, 19a or 19b, check this box and see instructions ..... right arrow

Schedule A (Form 990 or 990-EZ) 2011

Page 4

Part IV

Supplemental Information. Supplemental Information. Complete this part to provide the explanation required by Part II, line 10; Part II, line 17a or 17b; or Part III, line 12. Also complete this part for any additional information. (See instructions).

Facts And Circumstances Test

Explanation

Schedule A (Form 990 or 990-EZ) 2011

Additional Data

Software ID:	11000129
Software Version:	v1.00

- TIN:

Schedule B
(Form 990, 990-EZ,
or 990-PF)

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

Attach to Form 990, 990-EZ, or 990-PF.

OMB No. 1545-0047

2011

Name of organization

KOSCIUSKO COUNTY COMMUNITY FOUNDATION INC

Employer identification number

35-6086777

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

4947(a)(1) nonexempt charitable trust not treated as a private foundation

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

4947(a)(1) nonexempt charitable trust treated as a private foundation

501(c)(3) taxable private foundation

Check if your organization is covered by the General Rule or a Special Rule.
Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.

General Rule

For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, $5,000 or more (in money or
property) from any one contributor. Complete Parts I and II.

Special Rules

For a section 501(c)(3) organization filing Form 990 or 990-EZ that met the 33¹/3% support test of the regulations
under sections 509(a)(1) and 170(b)(1)(A)(vi), and received from any one contributor, during the year, a contribution of the
greater of (1) $5,000 or (2) 2% of the amount on (i) Form 990, Part VIII, line 1h, or (ii) Form 990-EZ, line 1. Complete Parts I and II.

For a section 501(c)(7), (8), or (10) organization filing Form 990, or 990-EZ that received from any one contributor,
during the year, total contributions of more than $1,000 for use exclusively for religious, charitable,
scientific, literary, or educational purposes, or the prevention of cruelty to children or animals. Complete Parts I, II, and
III.

For a section 501(c)(7), (8), or (10) organization filing Form 990, or 990-EZ that received from any one contributor,
during the year, contributions for use exclusively for religious, charitable, etc., purposes, but these contributions did
not total to more than $1,000. If this box is checked, enter here the total contributions that were received during
the year for an exclusively religious, charitable, etc., purpose. Do not complete any of the parts unless the General Rule
applies to this organization because it received nonexclusively religious, charitable, etc., contributions of $5,000 or more
during the year. ......................... Arrow Bullet

Caution. An Organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its
Form 990-EZ or on Part I, line 2, of its Form 990-PF, to certify that it does not meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).

For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.

Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2011)

Page 2

Name of organization KOSCIUSKO COUNTY COMMUNITY FOUNDATION INC
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)
Part I	Contributors (see Instructions). Use duplicate copies of Part I if additional space is needed.
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
RESTRICTED	RESTRICTED RESTRICTED RESTRICTED RESTRICTED, RESTRICTED RESTRICTED	$RESTRICTED	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)

Page 3

Name of organization KOSCIUSKO COUNTY COMMUNITY FOUNDATION INC
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)
Part II	Noncash Property (see Instructions). Use duplicate copies of Part II if additional space is needed.
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions).	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions).	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions).	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions).	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions).	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions).	(d) Date received
		$
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)

Page 4

Schedule B (Form 990, 990-EZ, or 990-PF) (2011)

Name of organization
KOSCIUSKO COUNTY COMMUNITY FOUNDATION INC

Employer identification number

35-6086777

Part III

Exclusively religious, charitable, etc., individual contributions to section 501(c)(7), (8), or (10) organizations
that total more than $1,000 for the year. Complete columns (a) through (e) and the following line entry.
For organizations completing Part III, enter the total of exclusively religious, charitable, etc.,
contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet

$
Use duplicate copies of Part III if additional space is needed

(a) No.
from
Part I

(b)
Purpose of gift

(d)
Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a) No.
from
Part I

(b)
Purpose of gift

(d)
Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a) No.
from
Part I

(b)
Purpose of gift

(d)
Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a) No.
from
Part I

(b)
Purpose of gift

(d)
Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

Schedule B (Form 990, 990-EZ, or 990-PF) (2011)

Additional Data

Software ID:	11000129
Software Version:	v1.00

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

Complete if the organization answered "Yes," to Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b
SchDMd Bullet

Attach to Form 990. SchDMd Bullet

See separate instructions.

OMB No. 1545-0047

2011

Open to Public Inspection

Name of the organization

KOSCIUSKO COUNTY COMMUNITY FOUNDATION INC

Employer identification number

35-6086777

Part I

Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" to Form 990, Part IV, line 6.

		(a) Donor advised funds	(b) Funds and other accounts
1	Total number at end of year .......	39	1
2	Aggregate contributions to (during year) ...	1,087,682	29
3	Aggregate grants from (during year) ...	379,342	456
4	Aggregate value at end of year .......	5,587,807	10,766

Did the organization inform all donors and donor advisors in writing that the assets held in donor advised
funds are the organization's property, subject to the organization's exclusive legal control? ............

Yes No

Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be
used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................

Yes No

Part II

Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7.

Purpose(s) of conservation easements held by the organization (check all that apply).

Preservation of land for public use (e.g., recreation or education) Preservation of an historically important land area

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.


a	Total number of conservation easements .......................	2a
b	Total acreage restricted by conservation easements ..................	2b
c	Number of conservation easements on a certified historic structure included in (a) .....	2c
d	Number of conservation easements included in (c) acquired after 8/17/06, and not on a historic structure listed in the National Register ....................	2d

Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the tax year SchDMd Bullet

Number of states where property subject to conservation easement is located SchDMd Bullet

Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and
enforcement of the conservation easements it holds? .............................

Yes No

Staff and volunteer hours devoted to monitoring, inspecting and enforcing conservation easements during the year SchDMd Bullet

Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet

Does each conservation easement reported on line 2(d) above satisfy the requirements of section
170(h)(4)(B)(i) and 170(h)(4)(B)(ii)? ....................................

Yes No

In Part XIV, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" to Form 990, Part IV, line 8.

If the organization elected, as permitted under SFAS 116 (ASC 958), not to report in its revenue statement and balance sheet works of
art, historical treasures, or other similar assets held for public exhibition, education or research in furtherance of public service,
provide, in Part XIV, the text of the footnote to its financial statements that describes these items.

If the organization elected, as permitted under SFAS 116 (ASC 958), to report in its revenue statement and balance sheet works of art,
historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service,
provide the following amounts relating to these items:

(i)

Revenues included in Form 990, Part VIII, line 1 ........................ SchDMd Bullet

(ii)

Assets included in Form 990, Part X .............................. SchDMd Bullet

If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 (ASC 958), relating to these items:

Revenues included in Form 990, Part VIII, line 1 .......................... SchDMd Bullet

Assets included in Form 990, Part X ............................... SchDMd Bullet

For Privacy Act and Paperwork Reduction Act Notice, see the Intructions for Form 990

Cat. No. 52283D

Schedule D (Form 990) 2011

Page 2

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)

Using the organization’s accession and other records, check any of the following that are a significant use of its collection
items (check all that apply):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIV.

During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?........

Yes No

Part IV

Escrow and Custodial Arrangements. Complete if the organization answered "Yes" to Form 990,
Part IV, line 9, or reported an amount on Form 990, Part X, line 21.

Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................

Yes No

If "Yes," explain the arrangement in Part XIV and complete the following table:


c	Beginning balance .................................	1c
d	Additions during the year ..............................	1d
e	Distributions during the year .............................	1e
f	Ending balance ...................................	1f

Did the organization include an amount on Form 990, Part X, line 21? .....................

Yes No

If “Yes,” explain the arrangement in Part XIV.

Part V

Endowment Funds. Complete if the organization answered "Yes" to Form 990, Part IV, line 10.

		(a)Current Year	(b)Prior Year	(c)Two Years Back	(d)Three Years Back
1a	Beginning of year balance ....	31,351,186	24,884,700	22,616,400	26,989,418
b	Contributions ........	1,543,711	2,739,291	451,768	751,274
c	Net investment earnings, gains, and losses ...	188,365	5,324,552	3,354,577	-3,544,616
d	Grants or scholarships .....	1,234,409	1,059,474	1,059,216	1,163,876
e	Other expenditures for facilities and programs ........	6,500	223	0	0
f	Administrative expenses ....	544,381	537,660	478,829	415,800
g	End of year balance ......	31,297,972	31,351,186	24,884,700	22,616,400

Provide the estimated percentage of the year end balance (line 1g) held as:

Board designated or quasi-endowment SchDMd Bullet

100 %

Permanent endowment SchDMd Bullet

0 %

Temporarily restricted endowment SchDMd Bullet

0 %

The percentages in lines 2a, 2b, and 2c should equal 100%.

Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes

(i) unrelated organizations ........................

3a(i)

(ii) related organizations ........................

3a(ii)

If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........

Describe in Part XIV the intended uses of the organization's endowment funds.

Part VI

Land, Buildings, and Equipment. See Form 990, Part X, line 10.

Description of property		(a) Cost or other basis (investment)	(b)Cost or other basis (other)	(c) Accumulated depreciation	(d) Book value
1a	Land .................	0	15,000		15,000
b	Buildings ................	0	756,543	385,324	371,219
c	Leasehold improvements ............	0	0	0	0
d	Equipment ................	0	197,661	152,146	45,515
e	Other .................	0	0	0	0
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......					431,734

Schedule D (Form 990) 2011

Page 3

Part VII

InvestmentsOther Securities. See Form 990, Part X, line 12.

(a) Description of security or category (including name of security)		(b)Book value	(c) Method of valuation: Cost or end-of-year market value
(1)Financial derivatives
(2)Closely-held equity interests
Other








Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)

Part VIII

InvestmentsProgram Related. See Form 990, Part X, line 13.

(a) Description of investment type		(b) Book value	(c) Method of valuation: Cost or end-of-year market value









Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)

Part IX

Other Assets. See Form 990, Part X, line 15.

(a) Description				(b) Book value
(1) Charitable Remainder Trusts				3,159,118
(2) Cash Surrender Value of Life Insurance Policy				58,150
(3) Interest and Dividends Receivable				31,308






Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........				3,248,576

Part X

Other Liabilities. See Form 990, Part X, line 25.

1.(a) Description of Liability		(b) Book value
Federal Income Taxes		0
Agency endowments in accordance w/SFAS 136		1,622,127
Present Value of Future Annuity Payments		23,347







Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)		1,645,474
2. Fin 48 (ASC 740) Footnote. In Part XIV, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC740).

Schedule D (Form 990) 2011

Page 4

Part XI Reconciliation of Change in Net Assets from Form 990 to Financial Statements
1	Total revenue (Form 990, Part VIII, column (A), line 12) ....................	1	4,091,116
2	Total expenses (Form 990, Part IX, column (A), line 25) .....................	2	3,171,643
3	Excess or (deficit) for the year. Subtract line 2 from line 1 .............	3	919,473
4	Net unrealized gains (losses) on investments ..........................	4	-559,947
5	Donated services and use of facilities .............................	5	0
6	Investment expenses ...................................	6	0
7	Prior period adjustments ..................................	7	0
8	Other (Describe in Part XIV.) .................................	8	13,005
9	Total adjustments (net). Add lines 4 through 8 .........................	9	-546,942
10	Excess or (deficit) for the year per financial statements. Combine lines 3 and 9 .........	10	372,531

Part XII Reconciliation of Revenue per Audited Financial Statements With Revenue per Return
1	Total revenue, gains, and other support per audited financial statements .......			1	3,477,404
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains on investments ..........	2a	-559,947
b	Donated services and use of facilities .........	2b	0
c	Recoveries of prior year grants ...........	2c	0
d	Other (Describe in Part XIV.) ............	2d	-1,088
e	Add lines 2a through 2d .....................			2e	-561,035
3	Subtract line 2e from line 1.....................			3	4,038,439
4	Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b .	4a	0
b	Other (Describe in Part XIV.) ...........	4b	52,677
c	Add lines 4a and 4b.......................			4c	52,677
5	Total Revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......			5	4,091,116

Part XIII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return
1	Total expenses and losses per audited financial statements .............			1	3,104,873
2	Amounts included on line 1 but not on Form 990, Part IX, line 25:
a	Donated services and use of facilities ..........	2a	0
b	Prior year adjustments ..............	2b	0
c	Other losses ................	2c	0
d	Other (Describe in Part XIV.) ............	2d	0
e	Add lines 2a through 2d......................			2e	0
3	Subtract line 2e from line 1.....................			3	3,104,873
4	Amounts included on Form 990, Part IX, line 25, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b ..	4a	0
b	Other (Describe in Part XIV.) ............	4b	66,770
c	Add lines 4a and 4b.......................			4c	66,770
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......			5	3,171,643

Part XIV

Supplemental Information

Complete this part to provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b;
Part V, line 4; Part X; Part XI, line 8; Part XII, lines 2d and 4b; and Part XIII, lines 2d and 4b. Also complete this part to provide any additional information.

Identifier	Return Reference	Explanation
SchD_P05_S00_L01g	Schedule D, Part V, Line 1g	The Community Foundation has variance authority on all of its funds. Following SFAS117 classifications, the Community Foundation has recorded the majority of our assets as unrestricted. Only pledges receivable and Charitable Remainder Trusts are not unrestricted and therefore are classified as temporarily restricted net assets instead. Even though most of the Community Foundation's assets are classified as unrestricted, the majority of Community Foundation funds are held in permanent endowment funds and are maintained to provide a permanent source of grant revenue for our community.
SchD_P05_S00_L04	Schedule D, Part V, Line 4	The Community Foundation's endowment funds are intended to award grants for charitable, educational or scientific projects and purposes. Permanent endowment funds are intended to award charitable grants in perpetuity.
SchD_P10_S00_L02	Schedule D, Part X, Line 2	The Foundation follows the Income Tax topic of the FASB ASC. The Foundation now recognizes a tax benefit only if it is more likely than not the tax position would be sustained in a tax examination, with a tax examination being presumed to occur. The amount recognized will be the largest amount of tax benefit that is greater than 50% likely of being realized on examination. For tax positions not meeting the more-likely-than-not test, no tax benefit will be recorded. The Foundation has examined this issue and has determined there are no material contingent tax liabilities.
SchD_P11_S00_L08	Schedule D, Part XI, Line 8	Net of Agency Gifts, Grants, Earnings and Expenses and an uncollectible pledge of $1,088.
SchD_P12_S00_L02d	Schedule D, Part XII, Line 2d	Wrote off uncollectible pledge.
SchD_P12_S00_L04b	Schedule D, Part XII, Line 4b	Agency Gifts and Earnings.
SchD_P13_S00_L04b	Schedule D, Part XIII, Line 4b	Agency Grants and Expenses.

Schedule D (Form 990) 2011

Additional Data

Software ID:	11000129
Software Version:	v1.00

- TIN:

Schedule I
(Form 990)

Department of the Treasury
Internal Revenue Service

Grants and Other Assistance to Organizations,
Governments and Individuals in the United States

Complete if the organization answered "Yes," to Form 990, Part IV, line 21 or 22.
lBullet

Attach to Form 990

OMB No. 1545-0047

2011

Open to Public
Inspection

Name of the organization
KOSCIUSKO COUNTY COMMUNITY FOUNDATION INC

Employer identification number
35-6086777

Part I

General Information on Grants and Assistance

Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ....................................

Yes No

Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.

Part II

Grants and Other Assistance to Governments and Organizations in the United States. Complete if the organization answered "Yes" to
Form 990, Part IV, line 21 for any recipient that received more than $5,000. Check this box if no one recipient received more than $5,000. Use
Part IV and Schedule I-1 (Form 990) if additional space is needed ......................... lBullet

(a) Name and address of organization or government	(b) EIN	(c) IRC Code section if applicable	(d) Amount of cash grant	(f) Method of valuation (book, FMV, appraisal, other)	(g) Description of non-cash assistance	(h) Purpose of grant or assistance
(1) 2nd Mile Adventures Inc1740 Park Ave PO Box 733 Winona Lake,IN46590	26-0293304	501(c)(3)	9,477	N/A	N/A	Educational and nutritional programs for children
(2) American Cancer SocietyNorthwest Indiana Office 130 Red Coach Drive Mishawaka,IN46545	38-1387120	501(c)(3)	8,026	N/A	N/A	Research and general support
(3) Animal Welfare League3489 E 100 S-Pierceton PO Box 1906 Warsaw,IN465811906	35-1782336	501(c)(3)	21,914	N/A	N/A	Equipment purchases, building campaign and general support
(4) Anthony Wayne Area Council Inc Boy Scouts8315 West Jefferson Boulevard Fort Wayne,IN468048320	35-0876343	501(c)(3)	8,608	N/A	N/A	General support
(5) Arts United of Greater Fort Wayne300 E Main Street Fort Wayne,IN46802	35-0992067	501(c)(3)	17,798	N/A	N/A	Support of life enrichment programs through Chautauqua Wawasee
(6) Atwood Aldersgate United Methodist Church7364 W Lutes Drive Warsaw,IN46582	35-1559017	501(c)(3)	7,056	N/A	N/A	General support
(7) Baker Youth Clubs765 W Market Street Warsaw,IN46580	35-0888006	501(c)(3)	36,270	N/A	N/A	General, program and equipment support
(8) Boomerang Backpacks Inc4616 E Dupont Rd Ste C Fort Wayne,IN46825	80-0570852	501(C)3	6,000	N/A	N/A	Nutrition program for low income students
(9) The Otis R Bowen Center for Human Services Inc850 N Harrison Street Warsaw,IN46580	35-1057889	501(c)(3)	12,160	N/A	N/A	Program support
(10) Camp Alexander Mack IncPO Box 158 Milford,IN46542	35-1076829	501(c)(3)	10,637	N/A	N/A	General support and capital improvements
(11) Cancer Services of Northeast Indiana6316 Mutual Drive Fort Wayne,IN46825	35-0965609	501(c)(3)	7,500	N/A	N/A	Services to cancer patients in Kosciusko County
(12) Cardinal Services Inc of Indiana504 N Bay Drive Warsaw,IN46580	35-6005615	501(c)(3)	15,733	N/A	N/A	General support, capital improvements, equipment
(13) CASA of Kosciusko County Inc121 N Lake Street Warsaw,IN465802783	35-1944123	501(c)(3)	8,273	N/A	N/A	General and program support
(14) Childrens Hope House7922 W Jefferson Blvd Fort Wayne,IN46804	35-2032408	501(c)(3)	10,000	N/A	N/A	Provide overnight stays for families with a sick child
(15) The Christian Performing Artists Fellowship1001 College St PO Box 700 Winona Lake,IN465900700	54-1296085	501(c)(3)	17,894	N/A	N/A	General support of arts and cultural programs, equipment
(16) City County Athletic Complex3215 W Old Road 30 Warsaw,IN465806846	31-1254631	501(c)(3)	8,545	N/A	N/A	General support and equipment
(17) Combined Community Services1195 Mariners Drive Warsaw,IN46582	35-1615506	501(c)(3)	11,818	N/A	N/A	General, program and equipment support
(18) Community Action of NE IndianaPO Box 10570 Fort Wayne,IN468530570	35-1111819	501(C)3	6,000	N/A	N/A	Support of programs helping low income individuals in Kosciusko County
(19) Diocese of Fort Wayne-South Bend Inc1103 S Calhoun PO Box 390 Fort Wayne,IN468010390	35-0876373	501(c)(3)	10,000	N/A	N/A	General and program support
(20) Encompass World Partners999 College Avenue PO Box 588 Winona Lake,IN46590	35-0992713	501(c)(3)	8,468	N/A	N/A	General support and capital improvements
(21) Etna Green United Methodist Church131 W Broadway PO Box 161 Etna Green,IN46524	35-1582803	501(c)(3)	7,056	N/A	N/A	General support
(22) First Christian Church115 Park Ridge Drive Warsaw,IN46580	35-1538049	501(c)(3)	11,676	N/A	N/A	General support and capital improvements
(23) First United Methodist Church of Warsaw179 S Indiana St Warsaw,IN465802805	35-0876369	501(c)(3)	12,972	N/A	N/A	General and program support
(24) Goodwill Industries of Michiana IncPO Box 3846 South Bend,IN46619	35-1093073	501(c)(3)	6,000	N/A	N/A	General support
(25) Grace College & Seminary200 Seminary Drive Winona Lake,IN46590	35-0868095	501(c)(3)	21,143	N/A	N/A	General and program support for educational purposes
(26) Grace College Westminster Project200 Seminary Drive Winona Lake,IN46590	35-0868095	501(c)(3)	9,626	N/A	N/A	General support for the maintenance of this historic building
(27) Grace Village Retirement Community337 Grace Village Drive Winona Lake,IN46590	35-1282401	501(c)(3)	6,994	N/A	N/A	General, program and equipment support
(28) Greenville College315 E College Ave Greenville,IL62246	37-0681530	501(c)(3)	21,250	N/A	N/A	General and program support for educational purposes
(29) Habitat for Humanity of Kosciusko CountyPO Box 1913 Warsaw,IN465811913	35-1830351	501(c)(3)	14,159	N/A	N/A	General and program support
(30) Health Connect Inc5515 Provident Drive Warsaw,IN46580	31-0896412	501(c)(3)	6,177	N/A	N/A	General support
(31) Heartline Pregnancy Center Inc1515 Provident Dr Ste 180 Warsaw,IN465803294	35-1620996	501(c)(3)	11,284	N/A	N/A	General and program support
(32) Housing Opportunities of Warsaw Inc109 E Catherine St PO Box 387 Milford,IN46542	35-2024026	501(c)(3)	17,700	N/A	N/A	General and program support
(33) Ivy Tech Foundation50 W Fall Creek Pky North Dr Indianapolis,IN46208	23-7073977	501(c)(3)	25,000	N/A	N/A	Capital campaign for new facility
(34) Junior Achievement serving Warsaw and Tippecanoe Valley914 Country Club Drive Warsaw,IN46580	84-1267604	501(c)(3)	6,324	N/A	N/A	General and program support
(35) KCV Cycling Club Inc116 W Market Street Warsaw,IN46580	26-1198633	501(c)(3)	9,200	N/A	N/A	General support, signage
(36) Kosciusko Community YMCA1401 E Smith Street Warsaw,IN46580	35-1068182	501(c)(3)	60,346	N/A	N/A	General and program support, capital campaign
(37) Kosciusko County Educational Development (KC-Ed)PO Box 174 Warsaw,IN465810174	27-4939514	501(c)(3)	32,167	N/A	N/A	Educational program support
(38) Kosciusko Home Care and Hospice Inc1515 Provident Drive Ste 250 PO Box 1196 Warsaw,IN465811196	35-2074505	501(c)(3)	6,456	N/A	N/A	General support
(39) Kosciusko Literacy Services Inc201 N Union Street Warsaw,IN465802724	35-1900716	501(c)(3)	8,722	N/A	N/A	General and program support
(40) Lakeland Christian Academy1093 S 250 E Winona Lake,IN465905763	35-1327583	501(c)(3)	22,136	N/A	N/A	General support for educational purposes
(41) Leesburg United Methodist ChurchPO Box 175 Leesburg,IN46538	35-1356575	501(c)(3)	5,163	N/A	N/A	General support
(42) Leesburg Volunteer Fire Dept6396 N Old State Road 15 Leesburg,IN465389044	90-0104314	Government	8,605	N/A	N/A	General support
(43) Lifeline Youth and Family Services IncPO Box 80487 Fort Wayne,IN468980487	35-1167389	501(c)(3)	10,000	N/A	N/A	General support, equipment
(44) CO Mollenhour Conservation Camp Council IncPO Box 1366 Warsaw,IN465811366	35-6043416	501(c)(3)	5,895	N/A	N/A	General and program support
(45) New Beginnings Preschool and Child Care Inc706 West Syracuse Street Milford,IN46542	35-1988335	501(c)(3)	12,274	N/A	N/A	General and program support, furniture
(46) North Webster Youth LeaguePO Box 33 North Webster,IN46555	35-1962827	501(c)(3)	10,000	N/A	N/A	Youth league field improvements
(47) Our Father's House401 Argonne Road Warsaw,IN46580	35-2029493	501(c)(3)	8,800	N/A	N/A	General and program support
(48) Poor Handmaids of Jesus Christ FoundationPO Box 1 Donaldson,IN46513	27-1688707	501(C)3	25,000	N/A	N/A	Capital/Building campaign
(49) Presby Preschool210 S High Street Warsaw,IN465804409	68-0585575	501(c)(3)	10,000	N/A	N/A	Purchase of mini-bus for use by preschool
(50) Questa Foundation for Education Inc3468 Stellhorn Road Fort Wayne,IN46815	35-6025795	501(C)3	37,450	N/A	N/A	Educational scholarship support
(51) Remnant Trust Inc1101 Park Avenue Winona Lake,IN46590	35-2072847	501(c)(3)	12,028	N/A	N/A	Program support
(52) Riley Children's Foundation30 S Meridian Ste 200 Indianapolis,IN462043509	35-0868147	501(c)(3)	78,376	N/A	N/A	General support
(53) The Rose Home North72876 CR 29 PO Box 571 Syracuse,IN46567	26-0833406	501(c)(3)	6,600	N/A	N/A	Capital improvements
(54) Saint Anne's Church424 West Market Warsaw,IN46580	35-1323902	501(c)(3)	10,519	N/A	N/A	General support
(55) St Jude Children's Research Hospital501 St Jude Place Memphis,TN38105	62-0646012	501(c)(3)	5,588	N/A	N/A	General support
(56) Syracuse-Turkey Creek Twp Public Library115 East Main Street Syracuse,IN46567	35-6003014	Government	6,446	N/A	N/A	General support and support of preservation activities
(57) Syracuse-Wawasee Park Foundation310 N Huntington Street Syracuse,IN46567	35-1910250	501(c)(3)	20,700	N/A	N/A	Youth Sports Complex capital project, bike/walking trail support
(58) Tippecanoe Environmental Lake & Watershed FoundationPO Box 55 North Webster,IN465550055	35-2020845	501(c)(3)	6,207	N/A	N/A	Program and equipment support
(59) Town of LeesburgPO Box 372 Leesburg,IN465380372	35-6001087	Government	8,605	N/A	N/A	Maintenance of town park
(60) United Way of Kosciusko County Inc3755 Lake City Highway Suite A PO Box 923 Warsaw,IN465810923	35-1044331	501(c)(3)	13,970	N/A	N/A	General support, support of program to help homeless
(61) Warsaw Christian School909 S Buffalo St Warsaw,IN465804713	35-1043361	501(c)(3)	23,672	N/A	N/A	General and program support, supplies and equipment
(62) Warsaw Community Church103 Enterprise Drive Warsaw,IN46580	35-1909524	501(c)(3)	10,000	N/A	N/A	Support of program serving the needy in Honduras
(63) Warsaw Community SchoolsPO Box 288 Warsaw,IN46581	35-6002915	Government	5,500	N/A	N/A	Mental health services for students, nutritional program for low-income students
(64) Warsaw Little League IncPO Box 153 Warsaw,IN465810153	35-1859050	501(c)(3)	5,245	N/A	N/A	Facility improvements
(65) Winona Lake Free Methodist Church902 College Avenue Winona Lake,IN46590	35-1180941	501(c)(3)	8,413	N/A	N/A	General and facility support
(66) Winona Lake Grace Brethren Church1200 Kings Hwy Winona Lake,IN46590	35-1319207	501(c)(3)	25,000	N/A	N/A	General support, and Youth Center Building Project

Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image

Enter total number of other organizations listed in the line 1 table ......................... . Bullet Image

For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50055P

Schedule I (Form 990) 2011

Page 2

Part III

Grants and Other Assistance to Individuals in the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 22.
Use Schedule I-1 (Form 990) if additional space is needed.

(a)Type of grant or assistance	(b)Number of recipients	(c)Amount of cash grant	(e)Method of valuation (book, FMV, appraisal, other)	(f)Description of non-cash assistance
(1) Educational scholarships for tuition, books and fees.	195	379,557	N/A	N/A
(2) Medical expenses for financially distressed individuals with serious medical conditions.	488	82,697	N/A	N/A
(3) Housing/Shelter assistance for financially distressed individuals with serious medical conditions.	238	61,383	N/A	N/A
(4) Utility/Phone expenses for financially distressed individuals with serious medical conditions.	345	61,109	N/A	N/A
(5) Transportation expenses for financially distressed individuals with serious medical conditions.	279	17,146	N/A	N/A
(6) Dental expenses for financially distressed individuals with serious medical conditions.	49	9,181	N/A	N/A
(7) Other expenses for financially distressed individuals with serious medical conditions.	37	8,086	N/A	N/A

Part IV

Supplemental Information. Complete this part to provide the information required in Part I, line 2, and any other additional information.

Identifier	Return Reference	Explanation
SchI_P01_S00_L02	Schedule I, Part I, Line 2	Depending on the type of fund from which a grant is made, the Community Foundation implements one of the following grant monitoring processes: 1) The grantee acknowledges by depositing the grant check that they agree to use the funds for the purpose for which they were granted. The Community Foundation reserves the right to ask for a refund of funds if the grantee misuses the funds. 2) The grantee does not receive approved funds until they can show proof of expenditure, receipts must be submitted within 30 days. Additionally, the grantee is required to submit a final report to the Community Foundation (usually within one year of the grant approval date) outlining how the funds were used.

Schedule I (Form 990) 2011

Additional Data

Software ID:	11000129
Software Version:	v1.00

- TIN:

SCHEDULE M
(Form 990)

Department of the Treasury

Internal Revenue Service

NonCash Contributions

Complete if the organization answered "Yes" on Form 990, Part IV, lines 29 or 30.
Right pointing arrow large image

Attach to Form 990.

OMB No. 1545-0047

2011

Open to Public Inspection

Name of the organization

KOSCIUSKO COUNTY COMMUNITY FOUNDATION INC

Employer identification number

35-6086777

Part I

Types of Property

	(a) Check if applicable	(b) Number of Contributions or items contributed	(c) Noncash contribution amounts reported on Form 990, Part VIII, line 1g	(d) Method of determining noncash contribution amounts
1 Art—Works of art ....
2 Art—Historical treasures .
3 Art—Fractional interests ..
4 Books and publications ..
5 Clothing and household goods .......
6 Cars and other vehicles ..
7 Boats and planes ....
8 Intellectual property ...
9 Securities—Publicly traded .	X	8	969,107	Average of high/low values
10 Securities—Closely held stock .
11 Securities—Partnership, LLC, or trust interests ....
12 Securities—Miscellaneous ..
13 Qualified conservation contribution—Historic structures .....
14 Qualified conservation contribution—Other ...
15 Real estate—Residential .
16 Real estate—Commercial ..
17 Real estate—Other ...
18 Collectibles .....
19 Food inventory ...
20 Drugs and medical supplies .
21 Taxidermy ......
22 Historical artifacts ....
23 Scientific specimens ..
24 Archeological artifacts ...
25 Other ( Promissory Note )	X	1	150,374	Amortization Schedule
26 Other ( )
27 Other ( )
28 Other ( )

Number of Forms 8283 received by the organization during the tax year for contributions
for which the organization completed Form 8283, Part IV, Donee Acknowledgement ...

Yes

30a

During the year, did the organization receive by contribution any property reported in Part I, lines 1-28 that it

must hold for at least three years from the date of the initial contribution, and which is not required to be used

for exempt purposes for the entire holding period? ..................

30a

If "Yes," describe the arrangement in Part II.

Does the organization have a gift acceptance policy that requires the review of any non-standard contributions?

Yes

32a

Does the organization hire or use third parties or related organizations to solicit, process, or sell noncash

contributions? ............................

32a

If "Yes," describe in Part II.

If the organization did not report revenues in column (c) for a type of property for which column (a) is checked,

describe in Part II.

For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 51227J

Schedule M (Form 990) 2011

Page 2

Part II

Supplemental Information. Complete this part to provide the information required by Part I, lines 30b,
32b, and 33 and whether the organization is reporting in Part I, column (b) the number of contributions, the number of items received, or a combination of both. Also complete this part for any additional information.

Identifier	Return Reference	Explanation

Schedule M (Form 990) 2011

Additional Data

Software ID:	11000129
Software Version:	v1.00

- TIN:

SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
MediumBullet

Attach to Form 990 or 990-EZ.

OMB No. 1545-0047

2011

Open to Public
Inspection

Name of the organization

KOSCIUSKO COUNTY COMMUNITY FOUNDATION INC

Employer identification number

35-6086777

Identifier	Return Reference	Explanation
F990_P06_S0A_L01a	Form 990, Part VI, Section A, Line 1a	Description of delegation of authority to Executive Committee: Bylaws of the Community Foundation as amended July 31, 2003 state the following: Section 4.01. The Executive Committee of the Board of Directors shall consist of the President, Vice President, Secretary and Treasurer of the Board of Directors, the Executive Director of the Foundation, and the Chairs of the publicity, finance, long range planning, scholarship, grant and development committees (all members of the Board of Directors). Section 4.02. Powers of the Executive Committee. During the intervals between meetings of the Board of Directors, the Executive Committee shall have and may exercise all of the authority of the Board of Directors, except that the Executive Committee shall not have the authority to amend the By-Laws.
F990_P06_S0B_L11b	Form 990, Part VI, Section B, Line 11b	Upon completion of the Form 990, an electronic version of the return is distributed to all Board Members at least three days before the second Monday of November. At the November Board Meeting, which takes place on the second Monday, the Board Treasurer presents the Form 990 for acceptance. The Board votes to accept or not accept the Form 990 as presented. If accepted, the Form 990 is then submitted to the IRS. If not accepted, the Form 990 will be revised until accepted by the Board of Directors.
F990_P06_S0B_L12c	Form 990, Part VI, Section B, Line 12c	The Community Foundation requires a signed conflict of interest disclosure form from all board members and from any committee member who is in a position to recommend grant distributions. Disclosure forms are renewed and re-signed annually or each time they (board members) serve on a grant or scholarship committee. The Executive Director collects and reviews the disclosure forms as they are returned and makes sure that all who are required to complete a disclosure form have done so. When an individual reports an actual, potential, or perceived conflict of interest, the Community Foundation follows the procedures outlined in its policy for disclosure of conflicts to the applicable body of decision-makers and recusal of individual(s) with conflicts from the decision-making process.
F990_P06_S0B_L15	Form 990, Part VI, Section B, Line 15	15a) The following process was undertaken in fiscal year 2010/2011, with respect to compensation paid to the Executive Director in fiscal year 2011/2012. The Board President and the Executive Director complete a formal review instrument independently and then review results. The Board President meets with the Executive Committee; the Executive Director does not attend. The Executive Committee reviews the Executive Director's performance in the areas of Board Relations; Staff Planning and Supervision; Grants and Program Management; and Public Relations and Resource Development. The Executive Committee then determines continued employment, the strengths and possible areas of improvement and compensation. This information is then shared with the Executive Director. In preparation for the Executive Director evaluation, the Community Foundation President (as chair of the Executive Committee) is provided a compilation of the Council on Foundations' nationwide salary information. The President is also provided with community foundation salary information for the state of Indiana and also for the Northeast Region of Indiana. Minutes of the Executive Committee's compensation deliberations and decisions are prepared no later than the next meeting of the Executive Committee, or sixty days after the date of the meeting at which the compensation is approved, whichever is later. Line 15b) N/A-the Community Foundation has no "other officers or key employees" to report on.
F990_P06_S0C_L19	Form 990, Part VI, Section C, Line 19	The Community Foundation makes its governing documents available for public review in our Public Review File. This file is kept in a binder in a public area of the Community Foundation offices, and is available for inspection upon request. The file contains Form 1023, Articles of Incorporation, By-laws, IRS determination letter, State Sales Tax Exemption Certificate, Resolutions, a list of board and staff members, IRS Form 990's from the most recent 5 years, policies (such as our policy on donations, investment policy, conflict of interest policy, whistleblower policy, etc.), copies of our grant and scholarship applications, our most recent audited financial statements and sample fund agreements.
F990_P07_S0A_L01a	Form 990, Part VII, Section A, Line 1a	Column (B) - Estimate of the average hours per week for a related organization: Ron Manahan and Suzanne Light both served approximately .25 per week volunteer hours on the board of directors for Orthopedics Capital Foundation, Inc., a related organization and supporting organization of the Kosciusko County Community Foundation.
F990_P11_S00_L05	Form 990, Part XI, Line 5	Other changes in net assets include ($559,945) in unrealized losses on investments carried at market value; an uncollectible pledge of ($1,088); ($9,590) in gifts to agency funds; $45,275 in grants from agency funds; ($43,087) from net earnings for agency funds and $21,493 in fees for agency funds.

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2011

Additional Data

Software ID:	11000129
Software Version:	v1.00

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

Complete if the organization answered "Yes" to Form 990, Part IV, line 33, 34, 35, 36, or 37.
MediumBullet

Attach to Form 990. MediumBullet

See separate instructions.

OMB No. 1545-0047

2011

Open to Public Inspection

Name of the organization

KOSCIUSKO COUNTY COMMUNITY FOUNDATION INC

Employer identification number

35-6086777

Part I

Identification of Disregarded Entities (Complete if the organization answered "Yes" on Form 990, Part IV, line 33.)

(a) Name, address, and EIN of disregarded entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Total income	(e) End-of-year assets	(f) Direct controlling entity

Part II

Identification of Related Tax-Exempt Organizations (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.)

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	(g) Section 512(b)(13) controlled organization
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	Yes	No
(1) Orthopedics Capital Foundation Inc 102 E Market Street Warsaw,IN46580 27-1038452	Charitable/Education activities	IN	501(c)(3)	11a-509(a)(3) Type I	Kosciusko County Community Foundation Inc	Yes

For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50135Y

Schedule R (Form 990) 2011

Page 2

Part III

Identification of Related Organizations Taxable as a Partnership (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.)

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

Part IV

Identification of Related Organizations Taxable as a Corporation or Trust (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.)

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(h) Percentage ownership

Schedule R (Form 990) 2011

Page 3

Part V

Transactions With Related Organizations (Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35, 35A, or 36.)

Note. Complete line 1 if any entity is listed in Parts II, III or IV.

Yes

1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?

a Receipt of (i) interest (ii) annuities (iii) royalties (iv) rent from a controlled entity . . . . . . . . . . . . . . . . . . . . . . .

b Gift, grant, or capital contribution to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

c Gift, grant, or capital contribution from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

d Loans or loan guarantees to or for related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

e Loans or loan guarantees by related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

f Sale of assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

g Purchase of assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

h Exchange of assets with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

i Lease of facilities, equipment, or other assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .

j Lease of facilities, equipment, or other assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .

k Performance of services or membership or fundraising solicitations for related organization(s) . . . . . . . . . . . . . . . . . . . .

l Performance of services or membership or fundraising solicitations by related organization(s) . . . . . . . . . . . . . . . . . . . .

m Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) . . . . . . . . . . . . . . . . . . . . .

n Sharing of paid employees with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

o Reimbursement paid to related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

p Reimbursement paid by related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

q Other transfer of cash or property to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

r Other transfer of cash or property from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.

(a) Name of other organization	(b) Transaction type(a-r)	(c) Amount involved	(d) Method of determining amount involved
(1)
(2)
(3)
(4)
(5)
(6)

Schedule R (Form 990) 2011

Page 4

Part VI

Unrelated Organizations Taxable as a Partnership (Complete if the organization answered "Yes" on Form 990, Part IV, line 37.)

Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.

(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(e) Are all partners section 501(c)(3) organizations?		(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	Yes	No	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

Schedule R (Form 990) 2011

Page 5

Part VII

Supplemental Information

Complete this part to provide additional information for responses to questions on Schedule R (see instructions).

Identifier	Return Reference	Explanation

Additional Data

Software ID:	11000129
Software Version:	v1.00