TY 2013 Form 990EZ


	1	Contributions, gifts, grants, and similar amounts received...............	1	92,172
2	Program service revenue including government fees and contracts ............	2
3	Membership dues and assessments......................	3
4	Investment income...........................	4
5a	Gross amount from sale of assets other than inventory........	5a
b	Less: cost or other basis and sales expenses...........	5b
c	Gain or (loss) from sale of assets other than inventory (Subtract line 5b from line 5a) ......	5c
6	Gaming and fundraising events
a	Gross income from gaming (attach Schedule G if greater than $15,000) .	6a
b	Gross income from fundraising events (not including $ 87,337 of contributions from fundraising events reported on line 1) (attach Schedule G if the
	sum of such gross income and contributions exceeds $15,000)	6b	1,085
c	Less: direct expenses from gaming and fundraising events.......	6c	16,260
d	Net income or (loss) from gaming and fundraising events (add lines 6a and 6b and subtract line 6c)	6d	-15,175
7a	Gross sales of inventory, less returns and allowances........	7a
b	Less: cost of goods sold.................	7b
c	Gross profit or (loss) from sales of inventory (Subtract line 7b from line 7a) .........	7c
8	Other revenue (describe in Schedule O) .....................	8
9	Total revenue. Add lines 1, 2, 3, 4, 5c, 6d, 7c, and 8..............	9	76,997
	10	Grants and similar amounts paid (list in Schedule O) .................	10	66,964
11	Benefits paid to or for members........................	11
12	Salaries, other compensation, and employee benefits................	12	4,962
13	Professional fees and other payments to independent contractors............	13
14	Occupancy, rent, utilities, and maintenance...................	14	720
15	Printing, publications, postage, and shipping...................	15	693
16	Other expenses (describe in Schedule O) ....................	16	855
17	Total expenses. Add lines 10 through 16 .................	17	74,194
	18	Excess or (deficit) for the year (Subtract line 17 from line 9)............	18	2,803
19	Net assets or fund balances at beginning of year (from line 27, column (A)) (must agree with
	end-of-year figure reported on prior year’s return)................	19	55,017
20	Other changes in net assets or fund balances (explain in Schedule O) ..........	20	0
21	Net assets or fund balances at end of year. Combine lines 18 through 20.........	21	57,820

Part IIIStatement of Program Service Accomplishments (see the instructions for Part III) Check if the organization used Schedule O to respond to any question in this Part III .	Expenses (Required for section 501(c)(3) and 501(c)(4) organizations and section 4947(a)(1) trusts; optional for others.)
What is the organization's primary exempt purpose? TO SERVE THOSE AFFECTED BY HEART DISEASE IN THE MICHIANA AREA BY PROVIDING DIRECT ASSISTANCE TO LOCAL SCHOOLS, CHURCHES, AND NON-PROFIT ORGANIZATIONS AND PUBLIC VENUES.
Describe the organization’s program service accomplishments for each of its three largest program services, as measured by expenses. In a clear and concise manner, describe the services provided, the number of persons benefited, and other relevant information for each program title.
28 THIS YEAR WE WERE ABLE TO PURCHASE 69 AUTOMATIC ELECTRONIC DEFIBRILLATORS (AED'S) AND PLACE THEM INTO THE COMMUNITY. THESE ARE A LIFE-SAVING PIECE OF EQUIPMENT. (Grants $ 66,964) If this amount includes foreign grants, check here ...	28a	66,964
29 (Grants $ ) If this amount includes foreign grants, check here ...	29a
30 (Grants $ ) If this amount includes foreign grants, check here ...	30a
31 Other program services (describe in Schedule O) (Grants $ ) If this amount includes foreign grants, check here...	31a
32 Total program service expenses (add lines 28a through 31a)..........	32	66,964

(a) Name and title	(b) Average hours per week devoted to position	(c)Reportable compensation (Forms W-2/1099-MISC) (if not paid, enter -0-)
WALTER HALLORAN MDPRESIDENT	0.50	0
KAREN WELDYMANAGER	10.00	4,962
CAREY DRURYBOARD MEMBER	0.50	0
TERRI RICKELBOARD MEMBER	0.50	0

- 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.
right arrow

Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2013

Open to Public
Inspection

Name of the organization

HEARTREACH MICHIANA INC

Employer identification number

20-2527524

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 described in 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. See section 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 - Non-functionally integrated

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 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 monetary support
(i) Name of supported organization	(ii) EIN	Yes	No	Yes	No	Yes	No	(vii) Amount of monetary support


Total

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

Cat. No. 11285F

Schedule A (Form 990 or 990-EZ) 2013

Page 2

Part II

Support Schedule for Organizations Described in Sections 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) 2009	(b) 2010	(c) 2011	(d) 2012	(e) 2013	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....	57,256	89,661	77,368	79,418	92,172	395,875
2	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......
3	The value of services or facilities furnished by a governmental unit to the organization without charge..
4	Total. Add lines 1 through 3	57,256	89,661	77,368	79,418	92,172	395,875
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)..						69,794
6	Public support. Subtract line 5 from line 4.						326,081

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2009	(b) 2010	(c) 2011	(d) 2012	(e) 2013	(f) Total
7	Amounts from line 4..	57,256	89,661	77,368	79,418	92,172	395,875
8	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...
9	Net income from unrelated business activities, whether or not the business is regularly carried on..
10	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)..
11	Total support (Add lines 7 through 10).						395,875

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

-79,382

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 2013 (line 6, column (f) divided by line 11, column (f)) .........

82.370 %

Public support percentage for 2012 Schedule A, Part II, line 14 ...............

81.630 %

16a

33 1/3% support test—2013. 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—2012. If the organization did not check a 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—2013. 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—2012. 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) 2013

Page 3

Part III

Support Schedule for Organizations Described in Section 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) 2009	(b) 2010	(c) 2011	(d) 2012	(e) 2013	(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) 2009	(b) 2010	(c) 2011	(d) 2012	(e) 2013	(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.)..

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 2013 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2012 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2013 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2012 Schedule A, Part III, line 17 .............

19a

33 1/3% support tests—2013. 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—2012. 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) 2013

Page 4

Part IV

Supplemental Information. Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; and 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) 2013

Additional Data

Software ID:
Software Version:

- 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.

Information about Schedule B (Form 990, 990-EZ, or 990-PF) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2013

Name of the organization

HEARTREACH MICHIANA INC

Employer identification number

20-2527524

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 for 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 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 its Form 990PF, Part I, line 2, 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) (2013)

Schedule B (Form 990, 990-EZ, or 990-PF) (2013)

Page 2

Name of organization HEARTREACH MICHIANA INC

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, RESTRICTEDRESTRICTED	$RESTRICTED	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2013)

Schedule B (Form 990, 990-EZ, or 990-PF) (2013)

Page 3

Name of organization HEARTREACH MICHIANA INC

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) (2013)

Schedule B (Form 990, 990-EZ, or 990-PF) (2013)

Page 4

Name of organization
HEARTREACH MICHIANA INC

Employer identification number

20-2527524

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) (2013)

Additional Data

Software ID:
Software Version:

- 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.
MediumBullet

Information about Schedule O (Form 990 or 990-EZ) and its instructions is at
www.irs.gov/form990.

OMB No. 1545-0047

2013

Open to Public
Inspection

Name of the organization

HEARTREACH MICHIANA INC

Employer identification number

20-2527524

Return Reference	Explanation
FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID	ACTIVITY CLASSIFICATION: DONATION. GRANTEE NAME: BARODA FIRE DEPT. GRANTEE ADDRESS: 9081 FIRST ST BARODA, MI 49101. GRANTEE RELATIONSHIP: COMMUNITY ORGANIZATION. PROPERTY DESCRIPTION: DEFIBRILLATOR (AED'S) 1. METHOD USED TO DETERMINE BOOK VALUE: PURCHASE PRICE. METHOD USED TO DETERMINE FMV: PURCHASE PRICE. BOOK VALUE OF PROPERTY: 970. AMOUNT GIVEN: 970.
FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID	ACTIVITY CLASSIFICATION: DONATION. GRANTEE NAME: BERRIEN COUNTY SHERIFFS. GRANTEE ADDRESS: 919 PORT ST ST. JOSEPH, MI 49085. GRANTEE RELATIONSHIP: COMMUNITY ORGANIZATION. PROPERTY DESCRIPTION: DEFIBRILLATOR (AED'S) 2. METHOD USED TO DETERMINE BOOK VALUE: PURCHASE PRICE. METHOD USED TO DETERMINE FMV: PURCHASE PRICE. BOOK VALUE OF PROPERTY: 1,942. AMOUNT GIVEN: 1,942.
FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID	ACTIVITY CLASSIFICATION: DONATION. GRANTEE NAME: B.K. CLUB. GRANTEE ADDRESS: 721 W. WEST ST MISHAWAKA, IN 46544. GRANTEE RELATIONSHIP: COMMUNITY ORGANIZATION. PROPERTY DESCRIPTION: DEFIBRILLATOR (AED'S) 1. METHOD USED TO DETERMINE BOOK VALUE: PURCHASE PRICE. METHOD USED TO DETERMINE FMV: PURCHASE PRICE. BOOK VALUE OF PROPERTY: 970. AMOUNT GIVEN: 970.
FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID	ACTIVITY CLASSIFICATION: DONATION. GRANTEE NAME: BREMEN UNITED METHODIST CHURCH. GRANTEE ADDRESS: 302 W PLYMOUTH ST BREMEN, IN 46506. GRANTEE RELATIONSHIP: COMMUNITY ORGANIZATION. PROPERTY DESCRIPTION: DEFIBRILLATOR (AED'S) 1. METHOD USED TO DETERMINE BOOK VALUE: PURCHASE PRICE. METHOD USED TO DETERMINE FMV: PURCHASE PRICE. BOOK VALUE OF PROPERTY: 970. AMOUNT GIVEN: 970.
FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID	ACTIVITY CLASSIFICATION: DONATION. GRANTEE NAME: BEULAH MISSIONARY CHURCH. GRANTEE ADDRESS: 57595 OLD CO. RD 17 GOSHEN, IN 46528. GRANTEE RELATIONSHIP: COMMUNITY ORGANIZATION. PROPERTY DESCRIPTION: DEFIBRILLATOR (AED'S) 1. METHOD USED TO DETERMINE BOOK VALUE: PURCHASE PRICE. METHOD USED TO DETERMINE FMV: PURCHASE PRICE. BOOK VALUE OF PROPERTY: 970. AMOUNT GIVEN: 970.
FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID	ACTIVITY CLASSIFICATION: DONATION. GRANTEE NAME: BOURBON POLICE DEPT. GRANTEE ADDRESS: 100 TRITON DRIVE BOURBON, IN 46504. GRANTEE RELATIONSHIP: COMMUNITY ORGANIZATION. PROPERTY DESCRIPTION: DEFIBRILLATOR (AED'S) 1. METHOD USED TO DETERMINE BOOK VALUE: PURCHASE PRICE. METHOD USED TO DETERMINE FMV: PURCHASE PRICE. BOOK VALUE OF PROPERTY: 970. AMOUNT GIVEN: 970.
FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID	ACTIVITY CLASSIFICATION: DONATION. GRANTEE NAME: BRENNENMAN MEMORIAL MISSIONARY. GRANTEE ADDRESS: 61115 ST. RD 15 GOSHEN, IN 46528. GRANTEE RELATIONSHIP: COMMUNITY ORGANIZATION. PROPERTY DESCRIPTION: DEFIBRILLATOR (AED'S) 1. METHOD USED TO DETERMINE BOOK VALUE: PURCHASE PRICE. METHOD USED TO DETERMINE FMV: PURCHASE PRICE. BOOK VALUE OF PROPERTY: 970. AMOUNT GIVEN: 970.
FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID	ACTIVITY CLASSIFICATION: DONATION. GRANTEE NAME: CALVARY ASSEMBLY OF GOD. GRANTEE ADDRESS: 1010 E. MISHAWAKA ELKHART, IN 46517. GRANTEE RELATIONSHIP: COMMUNITY ORGANIZATION. PROPERTY DESCRIPTION: DEFIBRILLATOR (AED'S) 1. METHOD USED TO DETERMINE BOOK VALUE: PURCHASE PRICE. METHOD USED TO DETERMINE FMV: PURCHASE PRICE. BOOK VALUE OF PROPERTY: 970. AMOUNT GIVEN: 970.
FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID	ACTIVITY CLASSIFICATION: DONATION. GRANTEE NAME: CENTER FOR HEALING AND HOPE. GRANTEE ADDRESS: PO BOX 195 GOSHEN, IN 46527. GRANTEE RELATIONSHIP: COMMUNITY ORGANIZATION. PROPERTY DESCRIPTION: DEFIBRILLATOR (AED'S) 1. METHOD USED TO DETERMINE BOOK VALUE: PURCHASE PRICE. METHOD USED TO DETERMINE FMV: PURCHASE PRICE. BOOK VALUE OF PROPERTY: 970. AMOUNT GIVEN: 970.
FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID	ACTIVITY CLASSIFICATION: DONATION. GRANTEE NAME: CHRIST THE KING LUTHERAN CHURCH. GRANTEE ADDRESS: 17195 CLEVELAND RD SOUTH BEND, IN 46601. GRANTEE RELATIONSHIP: COMMUNITY ORGANIZATION. PROPERTY DESCRIPTION: DEFIBRILLATOR (AED'S) 1. METHOD USED TO DETERMINE BOOK VALUE: PURCHASE PRICE. METHOD USED TO DETERMINE FMV: PURCHASE PRICE. BOOK VALUE OF PROPERTY: 970. AMOUNT GIVEN: 970.
FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID	ACTIVITY CLASSIFICATION: DONATION. GRANTEE NAME: ELKHART CO. CORRECTIONAL CENTER. GRANTEE ADDRESS: 26861 CO RD 26 ELKHART, IN 46517. GRANTEE RELATIONSHIP: COMMUNITY ORGANIZATION. PROPERTY DESCRIPTION: DEFIBRILLATOR (AED'S) 1. METHOD USED TO DETERMINE BOOK VALUE: PURCHASE PRICE. METHOD USED TO DETERMINE FMV: PURCHASE PRICE. BOOK VALUE OF PROPERTY: 970. AMOUNT GIVEN: 970.
FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID	ACTIVITY CLASSIFICATION: DONATION. GRANTEE NAME: ELKHART CO SHERRIFF'S DEPT. GRANTEE ADDRESS: 26861 CO RD 26 ELKHART, IN 46517. GRANTEE RELATIONSHIP: COMMUNITY ORGANIZATION. PROPERTY DESCRIPTION: DEFIBRILLATOR (AED'S) 3. METHOD USED TO DETERMINE BOOK VALUE: PURCHASE PRICE. METHOD USED TO DETERMINE FMV: PURCHASE PRICE. BOOK VALUE OF PROPERTY: 2,912. AMOUNT GIVEN: 2,912.
FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID	ACTIVITY CLASSIFICATION: DONATION. GRANTEE NAME: ELKHART GENERAL HOSPITAL. GRANTEE ADDRESS: 600 EAST BLVD ELKHART, IN 46514. GRANTEE RELATIONSHIP: COMMUNITY ORGANIZATION. PROPERTY DESCRIPTION: DEFIBRILLATOR (AED'S) 6. METHOD USED TO DETERMINE BOOK VALUE: PURCHASE PRICE. METHOD USED TO DETERMINE FMV: PURCHASE PRICE. BOOK VALUE OF PROPERTY: 5,823. AMOUNT GIVEN: 5,823.
FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID	ACTIVITY CLASSIFICATION: DONATION. GRANTEE NAME: GOSHEN POLICE DEPT. GRANTEE ADDRESS: 111 E JEFFERSON GOSHEN, IN 46528. GRANTEE RELATIONSHIP: COMMUNITY ORGANIZATION. PROPERTY DESCRIPTION: DEFIBRILLATOR (AED'S) 6. METHOD USED TO DETERMINE BOOK VALUE: PURCHASE PRICE. METHOD USED TO DETERMINE FMV: PURCHASE PRICE. BOOK VALUE OF PROPERTY: 5,823. AMOUNT GIVEN: 5,823.
FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID	ACTIVITY CLASSIFICATION: DONATION. GRANTEE NAME: GRACE CHURCH. GRANTEE ADDRESS: 52025 GUMWOOD RD GRANGER, IN 46530. GRANTEE RELATIONSHIP: COMMUNITY ORGANIZATION. PROPERTY DESCRIPTION: DEFIBRILLATOR (AED'S) 1. METHOD USED TO DETERMINE BOOK VALUE: PURCHASE PRICE. METHOD USED TO DETERMINE FMV: PURCHASE PRICE. BOOK VALUE OF PROPERTY: 970. AMOUNT GIVEN: 970.
FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID	ACTIVITY CLASSIFICATION: DONATION. GRANTEE NAME: GRANGER COMMUNITY CHURCH. GRANTEE ADDRESS: 2701 E BRISTOL ELKHART, IN 46514. GRANTEE RELATIONSHIP: COMMUNITY ORGANIZATION. PROPERTY DESCRIPTION: DEFIBRILLATOR (AED'S) 1. METHOD USED TO DETERMINE BOOK VALUE: PURCHASE PRICE. METHOD USED TO DETERMINE FMV: PURCHASE PRICE. BOOK VALUE OF PROPERTY: 970. AMOUNT GIVEN: 970.
FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID	ACTIVITY CLASSIFICATION: DONATION. GRANTEE NAME: GREATER BERRIEN SPRINGS PUBLIC SCHOOL. GRANTEE ADDRESS: ONE SYLVESTER AVE BERRIEN SPRINGS, MI 49103. GRANTEE RELATIONSHIP: COMMUNITY ORGANIZATION. PROPERTY DESCRIPTION: DEFIBRILLATOR (AED'S) 1. METHOD USED TO DETERMINE BOOK VALUE: PURCHASE PRICE. METHOD USED TO DETERMINE FMV: PURCHASE PRICE. BOOK VALUE OF PROPERTY: 970. AMOUNT GIVEN: 970.
FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID	ACTIVITY CLASSIFICATION: DONATION. GRANTEE NAME: INDIANA POLICE FIREARMS TRAINING ASSOC.. GRANTEE ADDRESS: 3910 ROCKMOUNT LANE MISHAWAKA, IN 46544. GRANTEE RELATIONSHIP: COMMUNITY ORGANIZATION. PROPERTY DESCRIPTION: DEFIBRILLATOR (AED'S) 3. METHOD USED TO DETERMINE BOOK VALUE: PURCHASE PRICE. METHOD USED TO DETERMINE FMV: PURCHASE PRICE. BOOK VALUE OF PROPERTY: 2,912. AMOUNT GIVEN: 2,912.
FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID	ACTIVITY CLASSIFICATION: DONATION. GRANTEE NAME: KERN RD MENNONITE CHURCH. GRANTEE ADDRESS: 18211 KERN RD SOUTH BEND, IN 46614. GRANTEE RELATIONSHIP: COMMUNITY ORGANIZATION. PROPERTY DESCRIPTION: DEFIBRILLATOR (AED'S) 1. METHOD USED TO DETERMINE BOOK VALUE: PURCHASE PRICE. METHOD USED TO DETERMINE FMV: PURCHASE PRICE. BOOK VALUE OF PROPERTY: 970. AMOUNT GIVEN: 970.
FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID	ACTIVITY CLASSIFICATION: DONATION. GRANTEE NAME: LAKEVILLE POLICE DEPT. GRANTEE ADDRESS: PO BOX 252 LAKEVILLE, IN 46536. GRANTEE RELATIONSHIP: COMMUNITY ORGANIZATION. PROPERTY DESCRIPTION: DEFIBRILLATOR (AED'S) 1. METHOD USED TO DETERMINE BOOK VALUE: PURCHASE PRICE. METHOD USED TO DETERMINE FMV: PURCHASE PRICE. BOOK VALUE OF PROPERTY: 970. AMOUNT GIVEN: 970.
FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID	ACTIVITY CLASSIFICATION: DONATION. GRANTEE NAME: LAKEVILLE VOLUNTEER FIRE DEPT. GRANTEE ADDRESS: 117 S MAIN ST LAKEVILLE, IN 46536. GRANTEE RELATIONSHIP: COMMUNITY ORGANIZATION. PROPERTY DESCRIPTION: DEFIBRILLATOR (AED'S) 3. METHOD USED TO DETERMINE BOOK VALUE: PURCHASE PRICE. METHOD USED TO DETERMINE FMV: PURCHASE PRICE. BOOK VALUE OF PROPERTY: 2,912. AMOUNT GIVEN: 2,912.
FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID	ACTIVITY CLASSIFICATION: DONATION. GRANTEE NAME: LERNER THEATRE. GRANTEE ADDRESS: 410 S MAIN ST ELKHART, IN 46516. GRANTEE RELATIONSHIP: COMMUNITY ORGANIZATION. PROPERTY DESCRIPTION: DEFIBRILLATOR (AED'S) 2. METHOD USED TO DETERMINE BOOK VALUE: PURCHASE PRICE. METHOD USED TO DETERMINE FMV: PURCHASE PRICE. BOOK VALUE OF PROPERTY: 1,942. AMOUNT GIVEN: 1,942.
FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID	ACTIVITY CLASSIFICATION: DONATION. GRANTEE NAME: MATTERHORN RESTAURANT. GRANTEE ADDRESS: 2041 CASSOPOLIS ST ELKHART, IN 46514. GRANTEE RELATIONSHIP: COMMUNITY ORGANIZATION. PROPERTY DESCRIPTION: DEFIBRILLATOR (AED'S) 1. METHOD USED TO DETERMINE BOOK VALUE: PURCHASE PRICE. METHOD USED TO DETERMINE FMV: PURCHASE PRICE. BOOK VALUE OF PROPERTY: 970. AMOUNT GIVEN: 970.
FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID	ACTIVITY CLASSIFICATION: DONATION. GRANTEE NAME: MCCOY MEMORIAL BAPTIST CHURCH. GRANTEE ADDRESS: 134 ST. CLAIR AVE ELKHART, IN 46516. GRANTEE RELATIONSHIP: COMMUNITY ORGANIZATION. PROPERTY DESCRIPTION: DEFIBRILLATOR (AED'S) 1. METHOD USED TO DETERMINE BOOK VALUE: PURCHASE PRICE. METHOD USED TO DETERMINE FMV: PURCHASE PRICE. BOOK VALUE OF PROPERTY: 970. AMOUNT GIVEN: 970.
FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID	ACTIVITY CLASSIFICATION: DONATION. GRANTEE NAME: MISHAWAKA FIRE DEPT. GRANTEE ADDRESS: 333 E DOUGLAS RD MISHAWAKA, IN 46545. GRANTEE RELATIONSHIP: COMMUNITY ORGANIZATION. PROPERTY DESCRIPTION: DEFIBRILLATOR (AED'S) 2. METHOD USED TO DETERMINE BOOK VALUE: PURCHASE PRICE. METHOD USED TO DETERMINE FMV: PURCHASE PRICE. BOOK VALUE OF PROPERTY: 1,942. AMOUNT GIVEN: 1,942.
FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID	ACTIVITY CLASSIFICATION: DONATION. GRANTEE NAME: NAPPANEE POLICE DEPT. GRANTEE ADDRESS: 301 W LINCOLN AVE NAPPANEE, IN 46550. GRANTEE RELATIONSHIP: COMMUNITY ORGANIZATION. PROPERTY DESCRIPTION: DEFIBRILLATOR (AED'S) 3. METHOD USED TO DETERMINE BOOK VALUE: PURCHASE PRICE. METHOD USED TO DETERMINE FMV: PURCHASE PRICE. BOOK VALUE OF PROPERTY: 2,912. AMOUNT GIVEN: 2,912.
FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID	ACTIVITY CLASSIFICATION: DONATION. GRANTEE NAME: OSCEOLA POLICE DEPT. GRANTEE ADDRESS: 850 LINCOLNWAY WEST OSCEOLA, IN 46561. GRANTEE RELATIONSHIP: COMMUNITY ORGANIZATION. PROPERTY DESCRIPTION: DEFIBRILLATOR (AED'S) 1. METHOD USED TO DETERMINE BOOK VALUE: PURCHASE PRICE. METHOD USED TO DETERMINE FMV: PURCHASE PRICE. BOOK VALUE OF PROPERTY: 970. AMOUNT GIVEN: 970.
FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID	ACTIVITY CLASSIFICATION: DONATION. GRANTEE NAME: RV HALL OF FAME. GRANTEE ADDRESS: 21565 EXECUTIVE PKWY BRISTOL, IN 46507. GRANTEE RELATIONSHIP: COMMUNITY ORGANIZATION. PROPERTY DESCRIPTION: DEFIBRILLATOR (AED'S) 1. METHOD USED TO DETERMINE BOOK VALUE: PURCHASE PRICE. METHOD USED TO DETERMINE FMV: PURCHASE PRICE. BOOK VALUE OF PROPERTY: 970. AMOUNT GIVEN: 970.
FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID	ACTIVITY CLASSIFICATION: DONATION. GRANTEE NAME: SALEM MENNONITE CHURCH. GRANTEE ADDRESS: 69456 CR 19 NEW PARIS, IN 46553. GRANTEE RELATIONSHIP: COMMUNITY ORGANIZATION. PROPERTY DESCRIPTION: DEFIBRILLATOR (AED'S) 1. METHOD USED TO DETERMINE BOOK VALUE: PURCHASE PRICE. METHOD USED TO DETERMINE FMV: PURCHASE PRICE. BOOK VALUE OF PROPERTY: 970. AMOUNT GIVEN: 970.
FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID	ACTIVITY CLASSIFICATION: DONATION. GRANTEE NAME: SBC SCHOOLS. GRANTEE ADDRESS: 215 S ST. JOSEPH ST SOUTH BEND, IN 46601. GRANTEE RELATIONSHIP: COMMUNITY ORGANIZATION. PROPERTY DESCRIPTION: DEFIBRILLATOR (AED'S) 2. METHOD USED TO DETERMINE BOOK VALUE: PURCHASE PRICE. METHOD USED TO DETERMINE FMV: PURCHASE PRICE. BOOK VALUE OF PROPERTY: 1,942. AMOUNT GIVEN: 1,942.
FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID	ACTIVITY CLASSIFICATION: DONATION. GRANTEE NAME: SOUTH BEND FIRE DEPT. GRANTEE ADDRESS: 1222 S MICHIGAN ST SOUTH BEND, IN 46601. GRANTEE RELATIONSHIP: COMMUNITY ORGANIZATION. PROPERTY DESCRIPTION: DEFIBRILLATOR (AED'S) 2. METHOD USED TO DETERMINE BOOK VALUE: PURCHASE PRICE. METHOD USED TO DETERMINE FMV: PURCHASE PRICE. BOOK VALUE OF PROPERTY: 1,942. AMOUNT GIVEN: 1,942.
FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID	ACTIVITY CLASSIFICATION: DONATION. GRANTEE NAME: ST. JOE COUNTY PARKS DEPT. GRANTEE ADDRESS: 50651 LAUREL ST SOUTH BEND, IN 46637. GRANTEE RELATIONSHIP: COMMUNITY ORGANIZATION. PROPERTY DESCRIPTION: DEFIBRILLATOR (AED'S) 2. METHOD USED TO DETERMINE BOOK VALUE: PURCHASE PRICE. METHOD USED TO DETERMINE FMV: PURCHASE PRICE. BOOK VALUE OF PROPERTY: 1,942. AMOUNT GIVEN: 1,942.
FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID	ACTIVITY CLASSIFICATION: DONATION. GRANTEE NAME: ST. JOSEPH HIGH SCHOOL. GRANTEE ADDRESS: 1441 N MICHIGAN ST SOUTH BEND, IN 46617. GRANTEE RELATIONSHIP: COMMUNITY ORGANIZATION. PROPERTY DESCRIPTION: DEFIBRILLATOR (AED'S) 1. METHOD USED TO DETERMINE BOOK VALUE: PURCHASE PRICE. METHOD USED TO DETERMINE FMV: PURCHASE PRICE. BOOK VALUE OF PROPERTY: 970. AMOUNT GIVEN: 970.
FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID	ACTIVITY CLASSIFICATION: DONATION. GRANTEE NAME: ST. JOE COUNTY SHERRIFF DEPT. GRANTEE ADDRESS: 125 S LAFAYETTE SOUTH BEND, IN 46601. GRANTEE RELATIONSHIP: COMMUNITY ORGANIZATION. PROPERTY DESCRIPTION: DEFIBRILLATOR (AED'S) 8. METHOD USED TO DETERMINE BOOK VALUE: PURCHASE PRICE. METHOD USED TO DETERMINE FMV: PURCHASE PRICE. BOOK VALUE OF PROPERTY: 7,765. AMOUNT GIVEN: 7,765.
FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID	ACTIVITY CLASSIFICATION: DONATION. GRANTEE NAME: ST. MATTHEW CATHEDRAL SCHOOL. GRANTEE ADDRESS: 1015 E DAYTON SOUTH BEND, IN 46614. GRANTEE RELATIONSHIP: COMMUNITY ORGANIZATION. PROPERTY DESCRIPTION: DEFIBRILLATOR (AED'S) 1. METHOD USED TO DETERMINE BOOK VALUE: PURCHASE PRICE. METHOD USED TO DETERMINE FMV: PURCHASE PRICE. BOOK VALUE OF PROPERTY: 971. AMOUNT GIVEN: 971.
FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID	ACTIVITY CLASSIFICATION: DONATION. GRANTEE NAME: TRINITY LUTHERAN CHURCH AND SCHOOL. GRANTEE ADDRESS: 30888 CR 6 ELKHART, IN 46514. GRANTEE RELATIONSHIP: COMMUNITY ORGANIZATION. PROPERTY DESCRIPTION: DEFIBRILLATOR (AED'S) 1. METHOD USED TO DETERMINE BOOK VALUE: PURCHASE PRICE. METHOD USED TO DETERMINE FMV: PURCHASE PRICE. BOOK VALUE OF PROPERTY: 970. AMOUNT GIVEN: 970.
FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID	ACTIVITY CLASSIFICATION: DONATION. GRANTEE NAME: TRITON SCHOOLS. GRANTEE ADDRESS: MAIN ST BOURBON, IN 46504. GRANTEE RELATIONSHIP: COMMUNITY ORGANIZATION. PROPERTY DESCRIPTION: DEFIBRILLATOR (AED'S) 2. METHOD USED TO DETERMINE BOOK VALUE: PURCHASE PRICE. METHOD USED TO DETERMINE FMV: PURCHASE PRICE. BOOK VALUE OF PROPERTY: 1,942. AMOUNT GIVEN: 1,942. TOTAL INCLUDED ON FORM 990-EZ, LINE 10: 66,964.
FORM 990-EZ, PART I, LINE 16 - OTHER EXPENSES	DESCRIPTION: SUPPLIES. AMOUNT: 286. DESCRIPTION: FEES. AMOUNT: 166. DESCRIPTION: MEETINGS. AMOUNT: 74. DESCRIPTION: AED BANQUET. AMOUNT: 329. TOTAL TO FORM 990-EZ, LINE 16: 855.

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

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2013

Additional Data

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Software Version:

- TIN:

TY 2013 TransferPrsnlBnftContractsDecl

Name:

HEARTREACH MICHIANA INC

EIN: 20-2527524

Declaration:

THE ORGANIZATION DID NOT, DURING THE YEAR, RECEIVE ANY FUNDS, DIRECTLY,OR INDIRECTLY, TO PAY PREMIUMS ON A PERSONAL BENEFIT CONTRACT.THE ORGANIZATION, DID NOT, DURING THE YEAR, PAY ANY PREMIUMS, DIRECTLY,OR INDIRECTLY, ON A PERSONAL BENEFIT CONTRACT.

(a) Name and business address of each independent contractor	(b) Type of service	(c) Compensation
NONE

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