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            <StateAbbreviationCd>CO</StateAbbreviationCd>
            <ZIPCd>80138</ZIPCd>
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          <FormAndInfoAndMaterialsTxt>ALL APPLICATIONS SHOULD BE ACCOMPANIED BY A BRIEF SYLLABUS OF LESS THAN FIVE PAGES WHICH CONTAINS THE NAME, ADDRESS, AND TELEPHONE NUMBER OF THE ORGANIZATION MAKING THE REQUEST; A STATEMENT REGARDING THE ORGANIZATION'S EXEMPT STATUS; DATE OF ESTABLISHMENT AND BRIEF HISTORY OF THE ORGANIZATION; STATEMENT OF THE PURPOSES AND GOALS OF THE ORGANIZATION; STATEMENT OF THE PURPOSES AND GOALS FOR WHICH THE GRANT IS REQUESTED; AND THE PROJECTED TIMETABLE FOR THE EXPENDITURE OF THE GRANT.</FormAndInfoAndMaterialsTxt>
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            <CityNm>CASTLE ROCK</CityNm>
            <StateAbbreviationCd>CO</StateAbbreviationCd>
            <ZIPCd>80109</ZIPCd>
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          <GrantOrContributionPurposeTxt>GENERAL SUPPORT</GrantOrContributionPurposeTxt>
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        <GrantOrContributionPdDurYrGrp>
          <RecipientBusinessName>
            <BusinessNameLine1Txt>INTERNATIONAL STUDENTS INC</BusinessNameLine1Txt>
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            <AddressLine1Txt>PO BOX C</AddressLine1Txt>
            <CityNm>COLORADO SPRINGS</CityNm>
            <StateAbbreviationCd>CO</StateAbbreviationCd>
            <ZIPCd>80901</ZIPCd>
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          <RecipientRelationshipTxt>NONE</RecipientRelationshipTxt>
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          <GrantOrContributionPurposeTxt>GENERAL SUPPORT</GrantOrContributionPurposeTxt>
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        <GrantOrContributionPdDurYrGrp>
          <RecipientBusinessName>
            <BusinessNameLine1Txt>SECOR CARES</BusinessNameLine1Txt>
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            <AddressLine1Txt>17151 PINE LANE</AddressLine1Txt>
            <CityNm>PARKER</CityNm>
            <StateAbbreviationCd>CO</StateAbbreviationCd>
            <ZIPCd>80134</ZIPCd>
          </RecipientUSAddress>
          <RecipientRelationshipTxt>NONE</RecipientRelationshipTxt>
          <RecipientFoundationStatusCd>NC</RecipientFoundationStatusCd>
          <GrantOrContributionPurposeTxt>GENERAL SUPPORT</GrantOrContributionPurposeTxt>
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        <GrantOrContributionPdDurYrGrp>
          <RecipientBusinessName>
            <BusinessNameLine1Txt>WELLSPRING COMMUNITY</BusinessNameLine1Txt>
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        <RentalOfFacilitiesOthAssetsInd>0</RentalOfFacilitiesOthAssetsInd>
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      <GeneralRuleInd>X</GeneralRuleInd>
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        <NetInvestmentIncomeAmt>2239</NetInvestmentIncomeAmt>
        <DisbursementsCharitablePrpsAmt>0</DisbursementsCharitablePrpsAmt>
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        <CategoryOrItemTxt>CHARLES SCHWAB</CategoryOrItemTxt>
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        <RevenueAndExpensesPerBooksAmt>15726</RevenueAndExpensesPerBooksAmt>
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      <OtherExpensesScheduleGrp>
        <Desc>LIFE INSURANCE PREMIUM</Desc>
        <RevenueAndExpensesPerBooksAmt>102000</RevenueAndExpensesPerBooksAmt>
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