Attach to Form 990 or Form 990-EZ.
Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
| (i)Name of supported organization | (ii) EIN | (iii) Type of organization (described on lines 1- 9 above or IRC section (see instructions)) | (iv) Is the organization listed in your governing document? | (v) Amount of monetary support (see instructions) | (vi) Amount of other support (see instructions) | |
|---|---|---|---|---|---|---|
| Yes | No | |||||
| (A)
KOSCIUSKO COUNTY COMMUNITY FOUNDATION INC |
356086777 | 7 | Yes | 0 | 0 | |
Total 1
|
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Calendar year (or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .... | ||||||
| 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 | ||||||
| 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).. | ||||||
| 6 | Public support. Subtract line 5 from line 4. | ||||||
Calendar year
(or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | ||||||
| 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 VI.).. | ||||||
| 11 | Total support Add lines 7 through 10. | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (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.) | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (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 VI.) .. | ||||||
| 13 | Total support. (Add lines 9, 10c, 11, and 12.).. | ||||||
| Section A - Adjusted Net Income | (A) Prior Year |
(B) Current Year (optional) |
||||
| 1 | Net short-term capital gain | 1 | ||||
| 2 | Recoveries of prior-year distributions | 2 | ||||
| 3 | Other gross income (see instructions) | 3 | ||||
| 4 | Add lines 1 through 3 | 4 | ||||
| 5 | Depreciation and depletion | 5 | ||||
| 6 | Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions) | 6 | ||||
| 7 | Other expenses (see instructions) | 7 | ||||
| 8 | Adjusted Net Income (subtract lines 5, 6 and 7 from line 4) | 8 | ||||
| Section B - Minimum Asset Amount | (A) Prior Year |
(B) Current Year (optional) |
||||
| 1 | Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year): | 1 | ||||
| a | Average monthly value of securities | 1a | ||||
| b | Average monthly cash balances | 1b | ||||
| c | Fair market value of other non-exempt-use assets | 1c | ||||
| d | Total (add lines 1a, 1b, and 1c) | 1d | ||||
| e | Discount claimed for blockage or other factors (explain in detail in Part VI): | |||||
| 2 | Acquisition indebtedness applicable to non-exempt use assets | 2 | ||||
| 3 | Subtract line 2 from line 1d | 3 | ||||
| 4 | Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions). | 4 | ||||
| 5 | Net value of non-exempt-use assets (subtract line 4 from line 3) | 5 | ||||
| 6 | Multiply line 5 by .035 | 6 | ||||
| 7 | Recoveries of prior-year distributions | 7 | ||||
| 8 | Minimum Asset Amount (add line 7 to line 6) | 8 | ||||
| Section C - Distributable Amount | Current Year | |||||
| 1 | Adjusted net income for prior year (from Section A, line 8, Column A) | 1 | ||||
| 2 | Enter 85% of line 1 | 2 | ||||
| 3 | Minimum asset amount for prior year (from Section B, line 8, Column A) | 3 | ||||
| 4 | Enter greater of line 2 or line 3 | 4 | ||||
| 5 | Income tax imposed in prior year | 5 | ||||
| 6 | Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions) | 6 | ||||
| 7 | Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions) | |||||
| Section D - Distributions | Current Year | |
|---|---|---|
| 1 Amounts paid to supported organizations to accomplish exempt purposes | ||
|
2
Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity |
||
| 3 Administrative expenses paid to accomplish exempt purposes of supported organizations | ||
| 4 Amounts paid to acquire exempt-use assets | ||
| 5 Qualified set-aside amounts (prior IRS approval required) | ||
| 6 Other distributions (describe in Part VI). See instructions | ||
| 7Total annual distributions. Add lines 1 through 6. | ||
|
8
Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions |
||
| 9 Distributable amount for 2014 from Section C, line 6 | ||
| 10 Line 8 amount divided by Line 9 amount | ||
| Section E - Distribution Allocations (see instructions) |
(i) Excess Distributions |
(ii) Underdistributions Pre-2014 |
(iii) Distributable Amount for 2014 |
|
|---|---|---|---|---|
|
1
Distributable amount for 2014 from Section C, line 6 |
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|
2
Underdistributions, if any, for years prior to 2014 (reasonable cause required--see instructions) |
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| 3 Excess distributions carryover, if any, to 2014: | ||||
| a From 2009.......X | ||||
| b From 2010.......X | ||||
| c From 2011.......X | ||||
| d From 2012.......X | ||||
| e From 2013....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2014 distributable amount | ||||
|
i
Carryover from 2009 not applied (see instructions) |
||||
| j Remainder. Subtract lines 3g, 3h, and 3i from 3f. | ||||
| 4Distributions for 2014 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2014 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from 4. | ||||
|
5
Remaining underdistributions for years prior to 2014, if any. Subtract lines 3g and 4a from line 2 (if amount greater than zero, see instructions) |
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|
6
Remaining underdistributions for 2014. Subtract lines 3h and 4b from line 1 (if amount greater than zero, see instructions) |
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|
7 Excess distributions carryover to 2015. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a From 2010.......X | ||||
| b From 2011.......X | ||||
| c From 2012.......X | ||||
| d From 2013....... | ||||
| e From 2014....... | ||||
| Facts And Circumstances Test |
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| Return Reference | Explanation |
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Attach to Form 990 or 990-EZ.
Information about Schedule O (Form 990 or 990-EZ) and its instructions is at| Return Reference | Explanation |
|---|---|
| FORM 990 - ORGANIZATION'S MISSION | PART I, LINE 1 AND PART III, LINE 1 (CONTINUED)- FOR THE BENEFIT OF THE KOSCIUSKO COUNTY REGION, WE SEEK TO SUPPORT THE LONG-TERM SUSTAINABILITY AND GROWTH OF WARSAW'S ORTHOPEDIC COMMUNITY THROUGH CHARITABLE, EDUCATIONAL AND SCIENTIFIC ACTIVITIES FOCUSED ON: EDUCATION, TALENT AND WORKFORCE DEVELOPMENT, COMMUNITY ENHANCEMENT, INNOVATION AND ENTREPRENEURSHIP, TRANSPORTATION AND LOGISTICS, AND BRANDING AND AWARENESS. |
| FORM 990, PAGE 2, PART III, LINE 4A | MAY 2015 TO CREATE A VALUE CHAIN MODEL THAT WILL BE USED TO EDUCATE ACADEMICS REGARDING SKILL NEEDS IN THE ORTHOPEDIC INDUSTRY AND WHICH WILL BE USED AS THE ORGANIZING PRINCIPLE FOR AN INDUSTRY-EDUCATION CONFERENCE IN NOVEMBER 2015. IN THE FALL OF 2014, OCF SUPPORTED A PROGRAM TO CREATE AWARENESS OF CAREER OPPORTUNITIES IN ADVANCED MANUFACTURING. THE PROGRAM INVOLVES A BUS TOUR FOR K-12 ADMINISTRATORS, GUIDANCE COUNSELORS AND TEACHERS TO EXPOSE THEM TO BOTH MANUFACTURING ENVIRONMENTS AT THE REGION'S ORTHOPEDIC COMPANIES AND TO THE TRAINING FACILITIES AT IVY TECH AND THE WARSAW AREA CAREER CENTER. OCF CONDUCTED ANOTHER SUCH TOUR IN SPRING OF 2015 AND WILL CONTINUE AGAIN THIS FALL. |
| FORM 990, PAGE 2, PART III, LINE 4B | THAT FOR SEVERAL REASONS, INCLUDING THE COMPETITION AMONG HEALTH CARE PROVIDERS, THE RESEARCH NETWORK IS NOT FEASIBLE AT THIS TIME. |
| FORM 990, PAGE 2, PART III, LINE 4D | OCF'S TRANSPORTATION AND LOGISTICS INITIATIVE LEADS A COALITION THAT IS WORKING WITH COMMUNITIES ALONG THE US 30 CORRIDOR TO RAISE AWARENESS, ECONOMIC AND SAFETY BENEFITS OF IMPROVING US 30 IN NORTHERN INDIANA TO INTERSTATE-LEVEL STANDARDS. OCF HAS ALSO CONTINUED ITS INVOLVEMENT WITH A COALITION SUPPORTING RESTORATION OF PASSENGER RAIL SERVICE IN THE REGION. |
| FORM 990, PAGE 6, PART VI, LINE 8B | ORTHOPEDICS CAPITAL FOUNDATION DOES NOT HAVE ANY COMMITTEES WITH THE AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY. |
| FORM 990, PAGE 6, PART VI, LINE 11B | UPON COMPLETION OF THE FORM 990, AN ELECTRONIC VERSION OF THE RETURN IS DISTRIBUTED TO ALL BOARD MEMBERS. BOARD MEMBERS ARE ASKED TO REVIEW THE RETURN AND INDICATE WHETHER THEY ACCEPT OR DO NOT ACCEPT THE FORM 990 AS PRESENTED. IF ACCEPTED BY A MAJORITY OF THE BOARD, 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. |
| FORM 990, PAGE 6, PART VI, LINE 12C | EACH DIRECTOR AND OFFICER ANNUALLY RECEIVES A CONFLICT OF INTEREST QUESTIONNAIRE THROUGH WHICH THEY ARE ASKED TO CONFIRM OR REPORT THE FOLLOWING: (I) THAT HE OR SHE HAS READ AND UNDERSTANDS OCF'S CONFLICT OF INTEREST POLICY (WHICH IMPOSES UPON EACH DIRECTOR AND OFFICER A CONTINUING, AFFIRMATIVE DUTY TO REPORT ANY PERSONAL OWNERSHIP, INTEREST, OR RELATIONSHIP THAT MIGHT AFFECT HIS OR HER ABILITY TO EXERCISE IMPARTIAL, ETHICAL, AND BUSINESS-BASED JUDGEMENTS IN FULFILLING RESPONSIBILITIES TO OCF); (II) THAT HE OR SHE IS IN COMPLIANCE WITH THE POLICY; (III) THAT HE OR SHE IS REPORTING (WITH HIS OR HER COMPLETED QUESTIONNAIRE) ALL ACTUAL OR POTENTIAL CONFLICTS OF INTEREST THAT ARISE AS A RESULT OF HIS OR HER ROLE WITH OCF, AND EACH POSITION THAT HE OR SHE HOLDS AS A DIRECTOR, TRUSTEE, OFFICER, OR EMPLOYEE OF ANY OTHER NONPROFIT ORGANIZATION; AND (IV) THAT HE OR SHE WILL REPORT PROMPTLY ANY CHANGES IN INFORMATION REPORTED IN HIS OR HER QUESTIONNAIRE OR IN ANY OTHER MATTERS THAT MIGHT AFFECT COMPLIANCE WITH THE POLICY. THE BOARD CHAIR COLLECTS AND REVIEWS THE QUESTIONNAIRES AS THEY ARE RETURNED AND MAKES SURE THAT ALL WHO ARE REQUIRED TO COMPLETE A CONFLICT QUESTIONNAIRE HAVE DONE SO. WHEN AN INDIVIDUAL REPORTS AN ACTUAL, POTENTIAL, OR PERCEIVED CONFLICT OF INTEREST, OCF 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. PURSUANT TO THE POLICY, OCF'S BOARD OF DIRECTORS IS RESPONSIBLE FOR THE OVERSIGHT OF, AND ACTION REGARDING, ALL DISCLOSURES AND/OR FAILURES TO DISCLOSE. |
| FORM 990, PAGE 6, PART VI, LINE 15A | OCF DOES NOT HAVE ANY EMPLOYEES. THE CEO IS LEASED FROM ORTHOWORX, INC. (AN ORGANIZATION UNRELATED TO OCF) AND PROVIDES SERVICES TO OCF PURSUANT TO AN EMPLOYEE LEASE AGREEMENT WITH ORTHOWORX. |
| FORM 990, PAGE 6, PART VI, LINE 15B | OCF DOES NOT HAVE ANY EMPLOYEES. THE SECRETARY/TREASURER IS LEASED FROM ORTHOWORX, INC. (AN ORGANIZATION UNRELATED TO OCF) AND PROVIDES SERVICES TO OCF PURSUANT TO AN EMPLOYEE LEASE AGREEMENT WITH ORTHOWORX. |
| FORM 990, PAGE 6, PART VI, LINE 19 | UPON REQUEST, ORTHOPEDICS CAPITAL FOUNDATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, FORM 1023, FORM 990S AND AUDITED FINANCIAL STATEMENTS AVAILABLE TO THE GENERAL PUBLIC. |
| FORM 990, PART IX, LINE 11G | EMPLOYEE LEASE EXPENSES 1,053,157 0 22,369 MEMBERSHIP DUES 9,033 0 0 O/S FUNDRAISING REGISTRATION 12,629 0 0 MISCELLANEOUS 902 16 0 |
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