Form990-EZ
Click to see list of attachments
Department of the Treasury
Internal Revenue Service
Short Form
Return of Organization Exempt From Income Tax
Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except private
foundations)
bullet Do not enter social security numbers on this form as it may be made public.
bullet Information about Form 990-EZ and its instructions is at www.irs.gov/form990.
OMB No. 1545-1150
2014
Open to Public
Inspection
A
For the 2014 calendar year, or tax year beginning 10-01-2014, and ending 09-30-2015
B
Check if applicable:
C Name of organization
HEARTREACH MICHIANA INC
 
Number and street (or P. O. box, if mail is not delivered to street address)500 ARCADE AVE SUITE 230
  Room/suite
City or town, state or province, country, and ZIP or foreign postal code ELKHART, IN46514
D Employer identification number

20-2527524
E Telephone number

(574) 296-6500
F Group Exemption
Numberbullet  
G Accounting Method: Other (specify) bullet   H Check bulletI Website:bulletWWW.HEARTREACHMICHIANA.ORGJ Tax-exempt status(check only one) - Click to see attachment(   ) bullet(insert no.) or
K Form of organization:  
L Add lines 5b, 6c, and 7b to line 9 to determine gross receipts. If gross receipts are $200,000 or more, or if total assets (Part II, column (B) below) are $500,000 or more, file Form 990 instead of Form 990-EZ . . . . . . . . . bullet $ 78,736
Part I
Revenue, Expenses, and Changes in Net Assets or Fund Balances (see the instructions for Part I)Check if the organization used Schedule O to respond to any question in this Part I..................
VerticalRevenue 1 Contributions, gifts, grants, and similar amounts received............... 1 78,736
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 $   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  
c Less: direct expenses from gaming and fundraising events....... 6c 13,486
d Net income or (loss) from gaming and fundraising events (add lines 6a and 6b and subtract line 6c) 6d -13,486
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.............. Bullet 9 65,250
VerticalExpenses 10 Grants and similar amounts paid (list in Schedule O) ................. 10 58,186
11 Benefits paid to or for members........................ 11  
12 Salaries, other compensation, and employee benefits................ 12 4,950
13 Professional fees and other payments to independent contractors............ 13  
14 Occupancy, rent, utilities, and maintenance................... 14 753
15 Printing, publications, postage, and shipping................... 15 193
16 Other expenses (describe in Schedule O) .................... 16 1,781
17 Total expenses. Add lines 10 through 16 ................. Bullet 17 65,863
VerticalNetAssets 18 Excess or (deficit) for the year (Subtract line 17 from line 9)............ 18 -613
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 57,820
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.........Bullet 21 57,207
For Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 10642I Form 990-EZ (2014)
Form 990-EZ (2014)
Page 2
Part IIBalance Sheets (see the instructions for Part II)Check if the organization used Schedule O to respond to any question in this Part II.................

(A) Beginning of year(B) End of year
22Cash, savings, and investments................
57,820
22
57,207
23Land and buildings....................
 
23
 
24Other assets (describe in Schedule O) ..........
 
24
 
25Total assets......................
57,820
25
57,207
26
Total liabilities (describe in Schedule O) .............
0
26
0
27Net assets or fund balances (line 27 of column (B) must agree with line 21)..
57,820
27
57,207
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; 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 75 AUTOMATIC ELECTRONIC DEFIBRILLATORS (AED'S) AND PLACE THEM INTO THE COMMUNITY. THESE ARE A LIFE-SAVING PIECE OF EQUIPMENT.
(Grants $ 58,186) If this amount includes foreign grants, check here ...MediumBullet		 28a 58,186
29
(Grants $   ) If this amount includes foreign grants, check here ...MediumBullet 		29a
30
(Grants $   ) If this amount includes foreign grants, check here ...MediumBullet 		30a
31 Other program services (describe in Schedule O)
(Grants $   ) If this amount includes foreign grants, check here...MediumBullet		 31a
32 Total program service expenses (add lines 28a through 31a).......... bullet 32 58,186
Part IV
List of Officers, Directors, Trustees, and Key Employees (list each one even if not compensated — see the instructions for Part IV)Check if the organization used Schedule O to respond to any question in this Part IV............
(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-) 		(d) Health benefits, contributions to employee benefit plans,
and deferred compensation		 (e) Estimated amount
of other compensation
WALTER HALLORAN MD  
PRESIDENT 		0.50 0 0 0
KAREN WELDY  
MANAGER 		10.00 4,950 0 0
CAREY DRURY  
BOARD MEMBER 		0.50 0 0 0
TERRI RICKEL  
BOARD MEMBER 		0.50 0 0 0
Form 990-EZ (2014)
Form 990-EZ (2014)
Page 3
Part V
Other Information
(Note the Schedule A and personal benefit contract statement requirements in the
instructions for Part V.) Check if the organization used Schedule O to respond to any question in this Part V.......
Yes
No
33
Did the organization engage in any significant activity not previously reported to the IRS? If "Yes," provide a detailed description of each activity in Schedule O ...................
33
 
No
34
Were any significant changes made to the organizing or governing documents? If "Yes," attach a conformed copy of the amended documents if they reflect a change to the organization’s name. Otherwise, explain the changeon Schedule O (see instructions) ..........................
34
 
No
35a
Did the organization have unrelated business gross income of $1,000 or more during the year from business activities (such as those reported on lines 2, 6a, and 7a, among others)? ............
35a
 
No
b
If "Yes," to line 35a, has the organization filed a Form 990-T for the year? If "No," provide an explanation in Schedule O
35b
 
 
c
Was the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization subject to section 6033(e) notice, reporting, and proxy tax requirements during the year? If "Yes," complete Schedule C, Part III
35c
 
No
36
Did the organization undergo a liquidation, dissolution, termination, or significant disposition of net assets during the year? If “Yes," complete applicable parts of Schedule N ................
36
 
No
37a
Enter amount of political expenditures, direct or indirect, as described in the instructions. bullet
37a
0
b
Did the organization file Form 1120-POL for this year?...................
37b
 
 
38a
Did the organization borrow from, or make any loans to, any officer, director, trustee, or key employee or were
any such loans made in a prior year and still outstanding at the end of the tax year covered by this return?..
38a
 
No
b
If “Yes," complete Schedule L, Part II and enter the total amount involved .
38b
 
39
Section 501(c)(7) organizations. Enter:
a
Initiation fees and capital contributions included on line 9.......
39a
 
b
Gross receipts, included on line 9, for public use of club facilities.....
39b
 
40a
Section 501(c)(3) organizations. Enter amount of tax imposed on the organization during the year under:
section 4911 bullet0 ; section 4912 bullet0 ; section 4955 bullet0
b
Section 501(c)(3), 501(c)(4), and 501(c)(29) organizations. Did the organization engage in any section 4958 excess benefit transaction during the year, or did it engage in an excess benefit transaction in a prior year that has not been reported on any of its prior Forms 990 or 990-EZ? If “Yes," complete Schedule L, Part I
40b
 
No
c
Section 501(c)(3), 501(c)(4), and 501(c)(29) organizations. Enter amount of tax imposed on organization managers or disqualified persons during the year under sections 4912, 4955, and 4958bullet0
d
Section 501(c)(3), 501(c)(4), and 501(c)(29) organizations. Enter amount of tax on line 40c reimbursed by the organization...........bullet0
e
All organizations. At any time during the tax year, was the organization a party to a prohibited tax shelter transaction? If "Yes," complete Form 8886-T ......................
40e
 
No
41List the states with which a copy of this return is filed. bulletIN
42aThe organization's books are in care of bulletKAREN WELDY Telephone no. bullet (574) 296-6500
Located at bullet500 ARCADE AVENUE SUITE 230ELKHART,IN ZIP + 4bullet46514
b
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, securities account, or other financial account)?
Yes
No
42b
 
No
If “Yes," enter the name of the foreign country: bullet
See the instructions for exceptions and filing requirements for FinCEN Form 114, Report of Foreign Bank and Financial Accounts (FBAR)
c
At any time during the calendar year, did the organization maintain an office outside the U.S.? . . .
42c
 
No
If “Yes," enter the name of the foreign country: bullet
43......bullet
and enter the amount of tax-exempt interest received or accrued during the tax year....bullet43
 
Yes
No
44a
Did the organization maintain any donor advised funds during the year? If "Yes," Form 990 must be completed instead of
Form 990-EZ................................
44a
 
No
b
Did the organization operate one or more hospital facilities during the year? If "Yes," Form 990 must be completedinstead of Form 990-EZ.............................
44b
 
No
c
Did the organization receive any payments for indoor tanning services during the year?.........
44c
 
No
d
If "Yes," to line 44c, has the organization filed a Form 720 to report these payments? If "No," provide an
explanation in Schedule O ............................
44d
 
 
45a
Did the organization have a controlled entity within the meaning of section 512(b)(13)?.........
45a
 
No
45b
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," Form 990 and Schedule R may need to be completed instead of Form 990-EZ (see instructions)......................
45b
 
 
Form 990-EZ (2014)
Form 990-EZ (2014)
Page 4
Yes
No
46
Did the organization engage, directly or indirectly, in political campaign activities on behalf of or in opposition tocandidates for public office? If “Yes," complete Schedule C, Part I. ..............
46
 
No
Part VI
Section 501(c)(3) organizations only All section 501(c)(3) organizations must answer questions 47-49b and 52, and complete the tables for lines 50 and 51 Check if the organization used Schedule O to respond to any question in this Part VI ................
Yes
No
47
Did the organization engage in lobbying activities or have a section 501(h) election in effect during the tax year? If "Yes," complete Schedule C, Part II .......................
47
 
No
48
Is the organization a school as described in section 170(b)(1)(A)(ii)? If "Yes," complete Schedule E ..
48
 
No
49a
Did the organization make any transfers to an exempt non-charitable related organization?......
49a
 
No
b
If "Yes," was the related organization a section 527 organization?................
49b
 
 
50
Complete this table for the organization's five highest compensated employees (other than officers, directors, trustees and key employees) who each received more than $100,000 of compensation from the organization. If there is none, enter "None."
(a) Name and title of each employee (b) Average
hours per week
devoted to position		 (c) Reportable compensation
(Forms W-2/1099-MISC) 		(d) Health benefits, contributions to employee benefit plans, and deferred compensation (e) Estimated amount of other compensation
NONE
f
Total number of other employees paid over $100,000 .................bullet  

51
Complete this table for the organization's five highest compensated independent contractors who each received more than $100,000 of compensation from the organization. If there is none, enter "None."
(a) Name and business address of each independent contractor (b) Type of service (c) Compensation
NONE
d
Total number of other independent contractors each receiving over $100,000..........bullet  
52
Did the organization complete Schedule A? NOTE. All Section 501(c)(3) organizations must attach a completed Schedule A ...............bullet
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
JumboBullet
Signature of officer Date
JumboBullet
Type or print name and title
Paid Preparer Use Only
Print/Type preparer's name
Preparer's signature
Date
PTIN
Firm's name bullet

Firm's EIN bullet
Firm's address bullet



Phone no.
May the IRS discuss this return with the preparer shown above? See instructions .........bullet
Form 990-EZ (2014)


Form 990-EZ, Special Condition Description:
Special Condition Description

Additional Data


Software ID:  
Software Version:  
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.
right arrow Attach to Form 990 or Form 990-EZ.
right arrow Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2014
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.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
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.)
10
11
a
b
c
d
e
f
Enter the number of supported organizations .............................  
g
Provide the following information about the supported organization(s).
(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
Total    

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990EZ.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2014
Schedule A (Form 990 or 990-EZ) 2014
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) right arrow (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.") .... 89,661 77,368 79,418 92,172 78,736 417,355
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 89,661 77,368 79,418 92,172 78,736 417,355
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).. 60,012
6 Public support. Subtract line 5 from line 4. 357,343
Section B. Total Support
Calendar year (or fiscal year beginning in) right arrow (a) 2010 (b) 2011 (c) 2012 (d) 2013 (e) 2014 (f) Total
7 Amounts from line 4.. 89,661 77,368 79,418 92,172 78,736 417,355
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. 417,355
12
12
-76,052
13
First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization, check this box and stop here........................................right arrow
Section C. Computation of Public Support Percentage
14
14
85.620 %
15
15
82.370 %
16a
b
17a
b
18
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) 2014
Schedule A (Form 990 or 990-EZ) 2014
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) right arrow (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.)  
Section B. Total Support
Calendar year (or fiscal year beginning in) right arrow (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.)..            
14
Section C. Computation of Public Support Percentage
15
15
 
16
16
 
Section D. Computation of Investment Income Percentage
17
17
 
18
18
 
19a
b
20
Schedule A (Form 990 or 990-EZ) 2014
Schedule A (Form 990 or 990-EZ) 2014
Page 4
Part IV
Supporting Organizations
(Complete only if you checked a box on line 11 of Part I. If you checked 11a of Part I, complete Sections A and B. If you checked 11b of Part I, complete Sections A and C. If you checked 11c of Part I, complete Sections A, D, and E. If you checked 11d of Part I, complete Sections A and D, and complete Part V.)
Section A. All Supporting Organizations
Yes
No
1
Are all of the organization’s supported organizations listed by name in the organization’s governing documents?
If "No," describe in Part VI how the supported organizations are designated. If designated by class or purpose,
describe the designation. If historic and continuing relationship, explain.
1
 
 
2
Did the organization have any supported organization that does not have an IRS determination of status under section 509(a)(1) or (2)? If "Yes," explain in Part VI how the organization determined that the supported organization was described in section 509(a)(1) or (2).
2
 
 
3a
Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer (b) and (c) below.
3a
 
 
b
Did the organization confirm that each supported organization qualified under section 501(c)(4), (5), or (6) and satisfied the public support tests under section 509(a)(2)? If "Yes," describe in Part VI when and how the organization made the determination.
3b
 
 
c
Did the organization ensure that all support to such organizations was used exclusively for section 170(c)(2)(B) purposes? If "Yes," explain in Part VI what controls the organization put in place to ensure such use.
3c
 
 
4a
Was any supported organization not organized in the United States ("foreign supported organization")? If “Yes” and if you checked 11a or 11b in Part I, answer (b) and (c) below.
4a
 
 
b
Did the organization have ultimate control and discretion in deciding whether to make grants to the foreign supported organization? If “Yes,” describe in Part VI how the organization had such control and discretion despite being controlled or supervised by or in connection with its supported organizations....
4b
 
 
c
Did the organization support any foreign supported organization that does not have an IRS determination under sections 501(c)(3) and 509(a)(1) or (2)? If “Yes,” explain in Part VI what controls the organization used to ensure that all support to the foreign supported organization was used exclusively for section 170(c)(2)(B) purposes.
4c
 
 
5a
Did the organization add, substitute, or remove any supported organizations during the tax year? If “Yes,” answer (b) and (c) below (if applicable). Also, provide detail in Part VI, including (i) the names and EIN numbers of the supported organizations added, substituted, or removed, (ii) the reasons for each such action, (iii) the authority under the organization's organizing document authorizing such action, and (iv) how the action was accomplished (such as by amendment to the organizing document).
5a
 
 
b
Type I or Type II only. Was any added or substituted supported organization part of a class already designated in the organization's organizing document?
5b
 
 
c
Substitutions only. Was the substitution the result of an event beyond the organization's control?
5c
 
 
6
Did the organization provide support (whether in the form of grants or the provision of services or facilities) to anyone other than (a) its supported organizations; (b) individuals that are part of the charitable class benefited by one or more of its supported organizations; or (c) other supporting organizations that also support or benefit one or more of the filing organization’s supported organizations? If “Yes,” provide detail in Part VI.
6
 
 
7
Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor (defined in IRC 4958(c)(3)(C)), a family member of a substantial contributor, or a 35-percent controlled entity with regard to a substantial contributor? If “Yes,” complete Part I of Schedule L (Form 990) .
7
 
 
8
Did the organization make a loan to a disqualified person (as defined in section 4958) not described in line 7? If “Yes,” complete Part II of Schedule L (Form 990).
8
 
 
9a
Was the organization controlled directly or indirectly at any time during the tax year by one or more disqualified persons as defined in section 4946 (other than foundation managers and organizations described in section 509(a)(1) or (2))? If “Yes,” provide detail in Part VI.
9a
 
 
b
Did one or more disqualified persons (as defined in line 9(a)) hold a controlling interest in any entity in which the supporting organization had an interest? If “Yes,” provide detail in Part VI.
9b
 
 
c
Did a disqualified person (as defined in line 9(a)) have an ownership interest in, or derive any personal benefit from, assets in which the supporting organization also had an interest? If “Yes,” provide detail in Part VI.
9c
 
 
10a
Was the organization subject to the excess business holdings rules of IRC 4943 because of IRC 4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated supporting organizations)? If “Yes,” answer b below.
10a
 
 
b
Did the organization have any excess business holdings in the tax year? (Use Schedule C, Form 4720, to determine whether the organization had excess business holdings).
10b
 
 
11
Has the organization accepted a gift or contribution from any of the following persons?
a
A person who directly or indirectly controls, either alone or together with persons described in (b) and (c) below, the governing body of a supported organization?
11a
 
 
b
A family member of a person described in (a) above?
11b
 
 
c
A 35% controlled entity of a person described in (a) or (b) above? If “Yes” to a, b, or c, provide detail in Part VI.
11c
 
 
Schedule A (Form 990 or 990-EZ) 2014
Schedule A (Form 990 or 990-EZ) 2014
Page 5
Part IV
Supporting Organizations (continued)

Section B. Type I Supporting Organizations
Yes
No
1
Did the directors, trustees, or membership of one or more supported organizations have the power to regularly appoint or elect at least a majority of the organization’s directors or trustees at all times during the tax year? If “No,” describe in Part VI how the supported organization(s) effectively operated, supervised, or controlled the organization’s activities. If the organization had more than one supported organization, describe how the powers to appoint and/or remove directors or trustees were allocated among the supported organizations and what conditions or restrictions, if any, applied to such powers during the tax year.
1
 
 
2
Did the organization operate for the benefit of any supported organization other than the supported organization(s) that operated, supervised, or controlled the supporting organization? If “Yes,” explain in Part VI how providing such benefit carried out the purposes of the supported organization(s) that operated, supervised or controlled the supporting organization.
2
 
 
Section C. Type II Supporting Organizations
Yes
No
1
Were a majority of the organization’s directors or trustees during the tax year also a majority of the directors or trustees of each of the organization’s supported organization(s)? If “No,” describe in Part VI how control or management of the supporting organization was vested in the same persons that controlled or managed the supported organization(s).
1
 
 
Section D. All Type III Supporting Organizations
Yes
No
1
Did the organization provide to each of its supported organizations, by the last day of the fifth month of the organization’s tax year, (1) a written notice describing the type and amount of support provided during the prior tax year, (2) a copy of the Form 990 that was most recently filed as of the date of notification, and (3) copies of the organization’s governing documents in effect on the date of notification, to the extent not previously provided?
1
 
 
2
Were any of the organization’s officers, directors, or trustees either (i) appointed or elected by the supported organization(s) or (ii) serving on the governing body of a supported organization? If "No," explain in Part VI how the organization maintained a close and continuous working relationship with the supported organization(s).
2
 
 
3
By reason of the relationship described in (2), did the organization’s supported organizations have a significant voice in the organization’s investment policies and in directing the use of the organization’s income or assets at all times during the tax year? If "Yes," describe in Part VI the role the organization’s supported organizations played in this regard.
3
 
 
Section E. Type III Functionally-Integrated Supporting Organizations
1
Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):
a
b
c
2
Activities Test. Answer (a) and (b) below.
Yes
No
a
Did substantially all of the organization’s activities during the tax year directly further the exempt purposes of the supported organization(s) to which the organization was responsive? If "Yes," then in Part VI identify those supported organizations and explain how these activities directly furthered their exempt purposes, how the organization was responsive to those supported organizations, and how the organization determined that these activities constituted substantially all of its activities.
2a
 
 
b
Did the activities described in (a) constitute activities that, but for the organization’s involvement, one or more of the organization’s supported organization(s) would have been engaged in? If "Yes," explain in Part VI the reasons for the organization’s position that its supported organization(s) would have engaged in these activities but for the organization’s involvement.
2b
 
 
3
Parent of Supported Organizations. Answer (a) and (b) below.
a
Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or trustees of each of the supported organizations? Provide details in Part VI.
3a
 
 
b
Did the organization exercise a substantial degree of direction over the policies, programs and activities of each of its supported organizations? If "Yes," describe in Part VI the role played by the organization in this regard.
3b
 
 
Schedule A (Form 990 or 990-EZ) 2014
Schedule A (Form 990 or 990-EZ) 2014
Page 6
Part V – Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations

1.   Check here if the organization satisfied the Integral Part Test as a qualifying trust on Nov. 20, 1970. See instructions. All other Type III non-functionally integrated supporting organizations must complete Sections A through E.
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)
Schedule A (Form 990 or 990-EZ) 2014
Schedule A (Form 990 or 990-EZ) 2014
Page 7
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 		 
2 Underdistributions, if any, for years prior to 2014
(reasonable cause required--see instructions)		  
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)		  
6 Remaining underdistributions for 2014. Subtract
lines 3h and 4b from line 1 (if amount greater than
zero, see instructions)		  
7 Excess distributions carryover to 2015. Add lines
3j and 4c.		  
8 Breakdown of line 7:
a From 2010.......X
b From 2011.......X
c From 2012.......X
d From 2013.......  
e From 2014.......  
Schedule A (Form 990 or 990-EZ) (2014)
Schedule A (Form 990 or 990-EZ) 2014
Page 8
Part VI
Supplemental Information. Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; Part III, line 12; Part IV, Section A, lines 1, 2, 3b, 3c, 4b, 4c, 5a, 6, 9a, 9b, 9c, 11a, 11b, and 11c; Part IV, Section B, lines 1 and 2; Part IV, Section C, line 1; Part IV, Section D, lines 2 and 3; Part IV, Section E, lines 1c, 2a, 2b, 3a and 3b; Part V, line 1; Part V, Section B, line 1e; Part V Section D, lines 5, 6, and 8; and Part V, Section E, lines 2, 5, and 6. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
 
Return Reference Explanation
Schedule A (Form 990 or 990-EZ) 2014

Additional Data


Software ID:  
Software Version:  
Schedule B
(Form 990, 990-EZ,
or 990-PF)
Department of the Treasury
Internal Revenue Service
Schedule of Contributors
Arrow Bullet Attach to Form 990, 990-EZ, or 990-PF.
Arrow Bullet Information about Schedule B (Form 990, 990-EZ, or 990-PF) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2014
Name of the organization
HEARTREACH MICHIANA INC
 
Employer identification number

20-2527524
Organization type (check one):
Filers of:
Section:
Form 990 or 990-EZ





Form 990-PF




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
Special Rules
......... 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) (2014)

Schedule B (Form 990, 990-EZ, or 990-PF) (2014)
Page 2
Name of organization
HEARTREACH MICHIANA INC
  		Employer identification number

20-2527524
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


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

   
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

   
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

   
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

   
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

   
 
 

$  


(Complete Part II for noncash contributions.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2014)

Schedule B (Form 990, 990-EZ, or 990-PF) (2014)
Page 3
Name of organization
HEARTREACH MICHIANA INC
  		Employer identification number

20-2527524
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) (2014)

Schedule B (Form 990, 990-EZ, or 990-PF) (2014)
Page 4
Name of organization
HEARTREACH MICHIANA INC
  		Employer identification number

20-2527524
Part III
Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10)
that total more than $1,000 for the year from any one contributor. 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 (c) Use 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 (c) Use 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 (c) Use 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 (c) Use 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) (2014)

Additional Data


Software ID:  
Software Version:  
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 990-EZ 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
2014
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: BASHOR CHILDREN'S HOME. GRANTEE ADDRESS: 1011 N. MAIN ST. GOSHEN, IN 46526. 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: 1,908. AMOUNT GIVEN: 1,908.
FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID ACTIVITY CLASSIFICATION: DONATION. GRANTEE NAME: CALVERT ROD & GUN CLUB. GRANTEE ADDRESS: 1010 E. MISHAWAKA RD LAKEVILLE, IN 46536. 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: 954. AMOUNT GIVEN: 954.
FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID ACTIVITY CLASSIFICATION: DONATION. GRANTEE NAME: CANAAN BAPTIST CHURCH. GRANTEE ADDRESS: 933 FIELDHOUSE AVE. ELKHART, IN 46514. 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: 954. AMOUNT GIVEN: 954.
FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID ACTIVITY CLASSIFICATION: DONATION. GRANTEE NAME: CITY OF ELKHART. GRANTEE ADDRESS: 201 S. SECOND ST. ELKHART, IN 46514. 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: 1,908. AMOUNT GIVEN: 1,908.
FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID ACTIVITY CLASSIFICATION: DONATION. GRANTEE NAME: CITY OF MISHAWAKA. GRANTEE ADDRESS: 600 E. THIRD ST. MISHAWAKA, IN 46544. 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: 1,908. AMOUNT GIVEN: 1,908.
FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID ACTIVITY CLASSIFICATION: DONATION. GRANTEE NAME: COALBUSH UNITED METHODIST. GRANTEE ADDRESS: 10221 JACKSON RD. MISHAWAKA, IN 46544. 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: 954. AMOUNT GIVEN: 954.
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. 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: 1,908. AMOUNT GIVEN: 1,908.
FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID ACTIVITY CLASSIFICATION: DONATION. GRANTEE NAME: ELKHART CO. HUMANE SOCIETY. GRANTEE ADDRESS: 54687 CO. RD. 19 BRISTOL, IN 46507. 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: 954. AMOUNT GIVEN: 954.
FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID ACTIVITY CLASSIFICATION: DONATION. GRANTEE NAME: ELKHART CO. SPECIAL EDUC.COOP. GRANTEE ADDRESS: 704 W. LINCOLN AVE. GOSHEN, IN 46526. 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: 954. AMOUNT GIVEN: 954.
FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID ACTIVITY CLASSIFICATION: DONATION. GRANTEE NAME: ELKHART CENTRAL HIGH SCHOOL. GRANTEE ADDRESS: 1 BLAZER BLVD. ELKHART, IN 46514. 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: 1,908. AMOUNT GIVEN: 1,908.
FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID ACTIVITY CLASSIFICATION: DONATION. GRANTEE NAME: FAIRFIELD HIGH SCHOOL. GRANTEE ADDRESS: 67530 U.S. 33 GOSHEN, IN 46526. 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: 1,908. AMOUNT GIVEN: 1,908.
FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID ACTIVITY CLASSIFICATION: DONATION. GRANTEE NAME: GRACE CHURCH. GRANTEE ADDRESS: 111 E. JEFFERSON ST. GRANGER, IN 46530. 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: 954. AMOUNT GIVEN: 954.
FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID ACTIVITY CLASSIFICATION: DONATION. GRANTEE NAME: HANNAH'S HOUSE. GRANTEE ADDRESS: 518 W. FOURTH ST. MISHAWAKA, IN 46544. 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: 954. AMOUNT GIVEN: 954.
FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID ACTIVITY CLASSIFICATION: DONATION. GRANTEE NAME: HARVEST BIBLE CHAPEL. GRANTEE ADDRESS: 52277 HICKORY RD. GRANGER, IN 46530. 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: 1,908. AMOUNT GIVEN: 1,908.
FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID ACTIVITY CLASSIFICATION: DONATION. GRANTEE NAME: HEART CITY HEALTH. GRANTEE ADDRESS: 236 SIMPSON ST. ELKHART, IN 46516. 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: 954. AMOUNT GIVEN: 954.
FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID ACTIVITY CLASSIFICATION: DONATION. GRANTEE NAME: INDIANA POLICE FIREARMS TRAIN. . GRANTEE ADDRESS: ONE SYLVESTER AVE. MISHAWAKA, IN 46544. 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: 1,908. AMOUNT GIVEN: 1,908.
FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID ACTIVITY CLASSIFICATION: DONATION. GRANTEE NAME: JACKSON TWP. EMS. GRANTEE ADDRESS: 181 CO. RD. 46 NEW PARIS, IN 46553. 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: 1,908. AMOUNT GIVEN: 1,908.
FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID ACTIVITY CLASSIFICATION: DONATION. GRANTEE NAME: LAKEVILLE POLICE DEPT.. GRANTEE ADDRESS: 105 S. MICHIGAN ST. LAKEVILLE, IN 46536. 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: 1,908. AMOUNT GIVEN: 1,908.
FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID ACTIVITY CLASSIFICATION: DONATION. GRANTEE NAME: LIFE ACTION. GRANTEE ADDRESS: P.O. BOX 31 BUCHANAN, MI 49107. 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: 1,908. AMOUNT GIVEN: 1,908.
FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID ACTIVITY CLASSIFICATION: DONATION. GRANTEE NAME: MARIAN HIGH SCHOOL. GRANTEE ADDRESS: 1311 S. LOGAN ST. MISHAWAKA, IN 46544. 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: 954. AMOUNT GIVEN: 954.
FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID ACTIVITY CLASSIFICATION: DONATION. GRANTEE NAME: MISHAWAKA CITY SCHOOLS. GRANTEE ADDRESS: 1401 S. MAIN ST. MISHAWAKA, IN 46544. 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: 954. AMOUNT GIVEN: 954.
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 46544. 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: 954. AMOUNT GIVEN: 954.
FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID ACTIVITY CLASSIFICATION: DONATION. GRANTEE NAME: NAPPANEE FIRE DEPT.. GRANTEE ADDRESS: 301 E. LINCOLN ST. NAPPANEE, IN 46550. 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: 954. AMOUNT GIVEN: 954.
FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID ACTIVITY CLASSIFICATION: DONATION. GRANTEE NAME: NORTHRIDGE HIGH SCHOOL. GRANTEE ADDRESS: 56805 NORTHRIDGE DR. MIDDLEBURY, IN 46540. 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: 1,908. AMOUNT GIVEN: 1,908.
FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID ACTIVITY CLASSIFICATION: DONATION. GRANTEE NAME: NORTHSIDE CH.OF THE NAZARENE. GRANTEE ADDRESS: 53569 CR 17 ELKHART, IN 46514. 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: 954. AMOUNT GIVEN: 954.
FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID ACTIVITY CLASSIFICATION: DONATION. GRANTEE NAME: OSCEOLA FIRE DEPT.. GRANTEE ADDRESS: 850 LINCOLNWAY WEST OSCEOLA, IN 46561. 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: 2,862. AMOUNT GIVEN: 2,862.
FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID ACTIVITY CLASSIFICATION: DONATION. GRANTEE NAME: PLYMOUTH POLICE DEPT.. GRANTEE ADDRESS: 60556 CROOKED CREEK RD. PLYMOUTH, IN 46563. 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: 5,723. AMOUNT GIVEN: 5,723.
FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID ACTIVITY CLASSIFICATION: DONATION. GRANTEE NAME: SO. BEND COMM. SCHOOLS. GRANTEE ADDRESS: 215 S. ST. JOE ST. SOUTH BEND, IN 46601. PROPERTY DESCRIPTION: DEFIBRILLATOR (AED'S) 4. METHOD USED TO DETERMINE BOOK VALUE: PURCHASE PRICE. METHOD USED TO DETERMINE FMV: PURCHASE PRICE. BOOK VALUE OF PROPERTY: 3,815. AMOUNT GIVEN: 3,815.
FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID ACTIVITY CLASSIFICATION: DONATION. GRANTEE NAME: ST. JOE CO. POLICE DEPT.. GRANTEE ADDRESS: 401 W. SAMPLE ST. SOUTH BEND, IN 46601. 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: 5,723. AMOUNT GIVEN: 5,723.
FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID ACTIVITY CLASSIFICATION: DONATION. GRANTEE NAME: ST. VINCENT DEPAUL. GRANTEE ADDRESS: 520 CRESCENT AVE. SOUTH BEND, IN 46617. 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: 954. AMOUNT GIVEN: 954.
FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID ACTIVITY CLASSIFICATION: DONATION. GRANTEE NAME: TRINITY SCHOOL AT GREENLAWN. GRANTEE ADDRESS: 202 S. GREENE RD. SOUTH BEND, IN 46617. 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: 954. AMOUNT GIVEN: 954.
FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID ACTIVITY CLASSIFICATION: DONATION. GRANTEE NAME: VERITAS ACADEMY. GRANTEE ADDRESS: 530 E. IRELAND RD. BLDG.B SOUTH BEND, IN 46614. 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: 954. AMOUNT GIVEN: 954.
FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID ACTIVITY CLASSIFICATION: DONATION. GRANTEE NAME: YMCA OF MICHIANA. GRANTEE ADDRESS: 510 ROOSEVELT RD. SOUTH BEND, IN 46615. 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: 1,903. AMOUNT GIVEN: 1,903. TOTAL INCLUDED ON FORM 990-EZ, LINE 10: 58,186.
FORM 990-EZ, PART I, LINE 16 - OTHER EXPENSES DESCRIPTION: SUPPLIES. AMOUNT: 697. DESCRIPTION: FEES. AMOUNT: 228. DESCRIPTION: MEETINGS. AMOUNT: 856. TOTAL TO FORM 990-EZ, LINE 16: 1,781.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2014

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TY 2014 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.