ORGANIZATION;
SUBMITTAL DATE:
CHECK LIST FOR CULTURAL ARTS APPLICATION
Completed application must be submitted with the following documentation:
1. Cover letter on organization's letterhead (preferred)
2. Completed Request for Cultural Arts Financial Assistance Application with signature of Executive Director in blue ink
3. IRS Determination Letter (highlight effective date)
4. Completed Budget Form
5. Most recent IRS 990 Form or organization audit report
6. Complete roster of Board of Directors, as referenced in Section lll-D-Eligibility
7. Support materials such as resumes, marketing plan, brochures. Community feedback, surveys, etc. Pa m Coast V fDUKDATIO PO Box 351766
Palm Coast FL 32135-1766
office: 386-263-299 i Luanne Santangelo, Director www.thepcaf.org Parks and Recreation Department 305 Palm Coast Parkway NE Palm Coast, FL 32137
Dear Ms. Santangelo:
Enclosed you will find the required documentation regarding the Palm Coast Arts Foundation's request for a Cultural Arts Grant which will assist us in our efforts to bring the Jacksonville Symphony Orchestra to Palm Coast.
1 believe all of the forms are in order per the requirements of the application process and criteria.
If you need any fiirther information or have questions please feel freet o contact me.
Sincerely,
Lindsey Florence 2016 Picnic and Pops Chairman PCAF Trustee
386-586-4023 [email protected]
August 15,2015 CITY OF PALM COAST REQUEST FOR CULTURAL ARTS FINANCIAL ASSISTANCE Application
ORGANIZATION NAME: PALM COAST ARTS FOUNDATION.
Has the Organization received $3,000 or more funding from the City of Palm Coast for current fiscal year? • Yes • No If Yes, organization is not eligible for additional funds through this grant application. If No, continue with application process below.
PROGRAM TO BE CONSIDERED FOR FUNDING: Picnic and Pops 2016
HOW MANY TIMES HAS THIS PROGRAM BEEN PRESENTED TO THE PUBLIC? 8
Total Program Cost: $46.000
Grant Request (Maximum Request $3,000): $3.000 Name & Title of the Person completing application: Lindsey Florence
Organization address: P. O. Box 351766 Palm Coast. Fl. 32135
Phone: 386-263-2991 Fax: (same) E -Mail: [email protected]
Was the above listed organization a recipient of Cultural Arts Financial Assistance in 2014-2015? Yes
If yes, what was the grant amount received and the final cost of the program funded: $3.000 / $46.000
On a separate page, (organization letterhead) respond to each question. All submissions must be typed 1. Describe the purpose of the organization. 2. Describe the program being considered for funding and its purpose. Include event date(s), description, location and anticipated attendance at each presentation. Explain why the program being offered is important to Palm Coast residents and visitors. 3. If awarded, describe how the City of Palm Coast's financialassistanc e will be used and why funding from the City is essential for development of the program.
Sam Perkovich Signature Print,Name President Title Date
1 I P a » e 2 0 16 Cultural Arts Grant Application Pa w Coast V fOMNDATIOH PO Box 351766
Palm Coast, FL 32135-
office: 386-263-2991
1. Describe the purpose of the organization. www.thepcaf.org
The purpose of our non-profit organization is to raise fimdst o construct a state of the art Cultural Center for Palm Coast and Flagler County. This will broaden access to the arts for residents and visitors, thereby improving our quality of life and enhancing economic development in this area.
2. Describe the program being considered for funding and its purpose. Include event date(s), descriptions and location and anticipated attendance. Explain why the program being considered is important to Palm Coast residents and visitors
Picnic and Pops is our signature event. This "pops" concert presented by the Jacksonville Symphony Orchestra in Central Park on Sunday, May 1, 2016 brings a great program to students of music and music lovers of all ages and ethnic groups. This definitely increases our quality of life. This is our eighth Picnic and Pops. It is extremely popular, having been sold out the last two years (900+ in attendance). Actually this event is a concert the community has come to expect.
3. If awarded, describe how the City of Palm Coast's financial assistance will be used.
Financial assistance from the City of Palm Coast will be used to help with expenses of the Jacksonville Symphony. Also the City will be identified on all collateral materials and advertising as a sponsor. A minimum often percent (10%) will be used for marketing.
The overall costs of this event are substantial, and a grant from the City is essential to help keep the admission costs reasonable and protect PCAF from any financial loss. DR-14 Consumer's Certificate of Exemption R. 04/05 11/24/10 Issued Pursuant to Chapter 212, Fiorida Statutes o: Srt PAK'fMENREVE-^UEI 85-8013465359C-3 12/31/2010 12/31/2015 501(C)(3) ORGANIZATION Certificate Nutmber Effective Date Expiration Date Exemption Category
This certifies that
PALM COAST ARTS FOUNDATION INC '020 BRODKHAVEN CT N PALM COAST FL 32164-2441
IS exempt from the payment of Florida sales and use tax on real property rented, transient rental property rented, tangible personal property purchased or rented, or services purchased.
DR-14 Important Information for Exempt Organizations R. 04/05
SIlCARTMENT OF REVENUE
You must provide all vendors and suppliers with an exemption certificate before making tax-exempt purchases. See Rule 12A-1.038, Florida Administrative Code (FAC).
Your Consumer's Certificate of Exemption is to be used solely by your organization for your organization's customary nonprofit activities.
Purchases made by an individual on behalf of the organization are taxable, even if the individual will be reimbursed by the organization.
This exemption applies only to purchases your organization makes. The sale or lease to others by your organization of tangible personal property, sleeping accommodations or other real property is taxable. Your organization must register, and collect and remit sales and use tax on such taxable transactions. Note; Churches are exempt from this requirement except when they are the lessor of real property (Rule 12A-1.070, FAC).
it is a criminal offense to fraudulently present this certificate to evade the payment of sales tax. Under no circumstances should this certificate be used for the personal benefit of any individual. Violators will be liable for pay.ment of the sales tax plus a penalty of 200% of the tax, and may be subject to conviction of a third degree felony Any violation will necessitate the revocation of this certificate.
If you have questions regarding your exemption certificate, please contact the Exemption Unit of Central Registration at 850-487-4130. The mailing address is PO BOX 6480. Tallahassee, FL 32314-6480. City of Palm Coast Cultural Arts Financial Assistance Grant ! i Budget Worksheet
Organization Name Palm Coast Arts Foundation
I Federal ID Number (FEIN) 80-0101548
Organization - Fiscal Year End Jun-15
Name of Program Being Considered
\for Funding: Picnic and Pops 2016
Budget Eligible Items of Program Organization to be Being Fiscal Year Considered for Considered for Budget Funding Funding
Income
Government Grants 30001 3000: 3000
Foundation and Corporate Grants 1500; 25000
Admission Fees 22015 4150O
Contributions from Individuals 28000 13000
Membership Income 15000 I Fundraising
i Earned Income
^Interest Income
Other Income
Total Income S4S15 3000 97500
Personnel Expenses
Salaries and Wages 21000
: Professional Development/Training
Employee Benefits and Taxes 3000
Total Personnel Costs 24000
; Operating Expenses
Utility Expenses (water, Phone, Internet etc.) \ 1605
Office Equipment Rental & Maintenance 2500!
Aw/ards, Scholarships
: Fundraising/Development Expenses
Insurance Expense 6081 1253
i Marketing/Advertising 4500 5226
i Professional Fees/Honorariums 725[ 3150
Supplies for Program 1240 2300
I Postage and Delivery 100 670 Travel Expense
; Caterer and Wine 50001
•JSOfee 25000 Other Expenses Specify Printing 900; 3387
Security 448
Total Operational Costs 41521 0! 28091
Total Expenses 415211 52091 TRUSTREES DIRECTORY 2015
George Allison, Development Lor! Genk, Secretary Joan Mangano 30 Erickson Place 14 Ocean St. 16 Curry Ct. Palm Coast, FL 32164 Palm Coast, FL 32137 Palm Coast, FL 32137 Home: Bus: 386-585-4372 Home: 446-1339 Cell: Home: 447-0093 ioanmangano38(5)gmail.com gallison70(5)Rmaii.com Cell: 585-0924 [email protected] Leon McLaurIn Tom Corum PO Box 351217 Member at Large Julie Guimond Palm Coast, FL 32135 9 Live Oak Lane 19 Poplar Dr. Home: 446-5994 Palm Coast, FL 32137 Palm Coast, FL 32164 Cell: 562-4556 Home: 446-9687 Business: 386-263-7109 [email protected] Cell: 931-5234 Cell: 386-848-5772 ticcdc(S)aol.com sensiblewatersoiutions@gmail Sam Perkovich, President com 8 Erickson Place Attorney Michael Davis Palm Coast, FL 32164 35 Fairways Circle Awilda Hamilton Home: 437-3346 Palm Coast, FL 32137 Special Events Cell: 931-3145 Cell: 407-619-3086 13 River Park Dr. N. [email protected] MRDavis(g) LawverMikeD.com Palm Coast, FL 32137 Home: 597-6950 Bettie Eubanks Cell: 216-272-2677 24 Osprey Circle [email protected] NANCY CROUCH Palm Coast, FL 32137 EXECUTIVE DIRECTOR Home: 986-3534 Dr. Leila Hardison 6 St. Andrews Court Cell: 904-372-4642 40 Mt. Vernon Lane Palm Coast, FL 32137 [email protected] Palm Coast, FL 32164 Office: 263-2991 Home: 447-5708 Home: 986-3112 Lindsey Florence Cell: 302-602-0783 Cell: 847-309-6233 Member at Large [email protected] [email protected] 180 Eric Drive [email protected] Palm Coast, FL 32164 Linda Hellings, Special Events Home: 586-4023 21 River Park Dr. N [email protected] Palm Coast, FL 32137 Home: 446-6688 Joseph Ganci Cell: 610-368-7268 President Ex-officio [email protected] 51 Woodhollow Lane Palm Coast, FL 32164 Pat Leipfert Home: 446-2288 26 Westlee Lane Cell: 793-9002 Palm Coast, FL 32164 [email protected] Home: 445-9418 [email protected] ADVISORS
Betty Chapman 9 Wentworth Lane Palm Coast, FL 32164 Home: 447-1444 Cell: 569-9105 bichapman(a) cfl.rr.com
James Harter 19 Tanglewood Ct. Palm Coast, FL 32137 Home: 447-9246 Cell: 503-6987 [email protected]
IVIiilssa Holland 510 N. Julia St. (work address) Jacksonville, FL 32202 Cell 237-4526 [email protected]
Howard Holley 22 Hammock Beach Pkwy. Palm Coast, FL 32137 Work: 283-5907 Cell: 571-527-6437 [email protected]
Jules Kwiatkowski 7 Bassett Lane Palm Coast, FL 32137 Home: 446-3166 [email protected]
Sue Thomson 6 Chilham Ct. Palm Coast, FL 32137 Home: 597-7500 Cell: 847-977-8999 [email protected] 2016 PICNIC AND POPS MARKETING PLAN
Radio: Easy Oldies 100.9 Beach 92.7
Newsprint: Palm Coast/Ormond Beach Observer News Tribune/News Journal
Magazines: Sun and Surf Pelican Post
Newsletters: Grand Haven Oal Electronic: Next Door Grand Haven FlaglerLive Palm Coast Arts Foundation (PCAF) e-blasts (1000+) Flagler County Art League (FCAL) e-blasts PCAF website Other: Jacksonville Symphony Orchestra (JSO) posts our ads in their communications Flyers/Posters are distributed throughout the community (100+) City of Palm Coast Community Calendar Flagler County Chamber of Commerce Community Calendar Bright House Networks community calendar (TV) WNZF/Beach 92.7/Easy Oldies/KIX 98.7 2405 East Moody Blvd. OrderlD: 1128-005 Suite 402 Bunnell, FL 32110 Sponsor: Palm Coast Flagler Arts and 386-437-1992 Product: Palm Coast Flagler Arts and Estimate/PO: AccountRep: Ann Weaver BillingCycle: Calendar Month InvoiceType: Detail Run Dates: 4/8/2015-4/15/2015 PALM COAST FLAGLER ARTS AND Items Ordered: 116 PO BOX 351766 Gross Amount: 800.00 PALM COAST FL 32135 Discounts: 0.00 Agency Commission: 0.00 Net Amount: 800.00 Scheduled Station(s): Beach 92.7 FM (WBHQ) / Easy Oldies 100.9 Palm Coast Flagler Arts and Entertainment Printed 1/27/2015 2:04:05 PIW Pagel Run Dates Run Weel 01 4/8/2015-4/11/2015 All Weeks 07:00 AM - 07:00 PM 7 7 7 7 28 :30 Spot 0386 28 [Package] [Package] 02 4/12/2015-4/15/2015 All Weeks 07:00 AM - 07:00 PM 7 8 8 7 30 :30 Spot 0386 30 [Package] [Package] Calendar Month Projected Billing: Apr-15 800.0C1 May-15 0.00 Jun-15 0.00 Q2-2015 800.00 Confirmed Correct; Payment Guaranteed Accepted for Flagler Broadcasting TheFlagler^PalmCoas^^ APRIL 23,2015 aassiiiisJi^Heal .Estate 29 I THURSDAY,* CERVICAL SPII Noon at Palm O Therapy Center. Drive, Building/i limited. Call 447 GAME DAY SO( 12:30 p.m. at th« Community Can Coast Parkway t 2323. SEA QUILLS Wi 1-3 p.m. at the Fl Library. Refreshi •A DAY LATE AN A DOLLAR SHO 2 p.m. at the AA< ter,4422 U.S.U McMillan's best- 1. ,i • •>•.;-r\ ^ • Photos by Brittany Dunn FITNESS POLE Maria DeCarlo, Paula Benham. Jean Soberanls. Buddy and Ann Rogers, Debbie DeCarlo, Richard DeCarlo, Frank Benham and Frank and Jelena 4p.m.atWaterfr keaveney attended Picnic and Pops for the eighth year In a row. Demo Keen Fit W vided. Pre-registi Call 904-794-155 SUNSET CONCI 6p.matthe Day, lege Amphithean man Brothers Tri FRIDAY, APRIL SCENIC AlA ME 9 a.m. at the Han nity Center, 79 M in the Hammock, local projects, co parks and trails if ccmmittse repor http-. VvAvw.news-joumalonline.com'article 2U12! i i / r TneDsv-torB Beach ink land-lease mmd Considering annuities? Ifvou have a S500 300 per*-* and are corsKie-TO arnuif es you s'^oyia review By -Annuity Insights: Your Guide to Better STAFF V^TJTBR Pu^-'h^hed-.Sfirifrsay. Soverxber 2012 at 5:.>c.' '^i-m- Understanding Annuities' Tf ss •;...;c= i^cT, fo-ties CCSJ-I-:T S: Ka:- P.sne- s f.fm P.-\LM CO.-*ST - Champagne was fiov-mg 'svesis the r nden 'acts behind thess cortrac-s Tc.i vou need to "We re .starting a Ss-mdiio•r,-„^n ,,r,;--,capuail /-amn^i^Cdmpaun n'^hli i^m noY.:" said foundation president Sam Perko'.ich, The group is planning to start ^sith an events center on the site and add the larger arts center compk-X later. "We've done the feasibility stud}'." Ganci said. Perkovich said in addition to sho-Aing a need for the arts complex, the study also identifies "knovm contributors to the arts" and details potentiai oonors -.nthm a 50-mile radius of Paim Coast. ••We also planned for the gro^rth of the conimunit>-," Ganci said. Perkoxich said the .roup beliex-es there is a need for the kind of arts complex diey envision, which xvill include a main auditorium area as -Ml as other space tor art,s.s. The events center v.ill include three rooms. Uvo of ^vhich '.sill be adaptable tor banquets, along <-nth a full kitchen facility. "This is the missing link to all of Flagler Count,-." she said. 'We have eventhing else." Asked about die Flagler Auditorium on State Road 100. Perkovich had praise for the taciiitv- but said "thej-'il never support a Broadv'.'ay sho-,v." GanH added that while the Flagler Auditorium that ven- night v^as presenting the Broadway touring sho.v of -Titanic: The Musical." that the arts tounaation s plans are different. •There are Broadv.av- shows and there are Bn^advvay shows," he said. "Our theater 1013 <; Paee 1 of 1 1st 6*fION* l£ACH iNEl'S-JOURNAL Arts foimdation holds 'Symphony Under the Stars' Pubiishi.d: l^'edni'sdau. Aphi 2S, 2012 a: s:3oa.rn. PAL^! CO.-VST - The south side of die iake at Centra! Park at Town Center could have passed for a Nevv York Cit\- concert hall Sunday night as die Palm Coast Arts Foundation celebrated its 6th annua! Picnic and Pops event. This xear's event had a "Svinphonj- under the Stars" theme with things getting started a bit later into the evening AXD guests enjoving dinner and wine at around 6:30 and die Jacksomille S\-mphony Orchestra taking die stage lakeside at around 8. The s\-mphom- was joined by Michael Kraemer, conductor of the Buffalo Philharmonic Orchestra, who was the maestro for the evening. Kraemer led die orchestra through nearh- tsvo hours of music, including classical pieces. New Orleans standards and a piece from the .lohn Williams score of the movie "E.T. The E.xtra Terrestrial." which all receiv-ed thunderous applause from the hundreds who attended the event. "You guys sure know how to "ihrow a partv- here in Palm Coast." Kraemer said bebs'eenselections. The foundation was also accepting new members on the night of the event, and others that are interested in joining can visit Diijacoa^^iarliliismiklJlffl Copv-right g 2013 Xews-JournalOniine.com - .All rights reset^-ed. Restricted use onlv http://\NW.news^ouma!online.com/article/20120425/ARTICLES^304259979/0/SEARCH... 8'20/2013 Short Form OMB No. 1545-1150 Form 990-EZ Return of Organization Exempt From Income Tax 2014 Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except private foundations) Open to Public >• Do not enter social security numbers on this form as it may be made public. Department of the Treasury Inspection Internal Revenue Service • Information about Form 990-EZ and its instructions is at www.lrs.9Ov/form990. A For the 2014 calendar year, or tax year beginning 07-01 , 2014, and ending 06-30 ,2015 B Check if applicable; C Name of organization D Employer identification number n Address change PALM COAST ARTS FOUNDATION INC 80-0101548 j 1 Name change Number and street (or P.O. box, if mail Is not delivered to street address) Room/suite E Telephone number j 1 Initial return n Final return/terminated PO BOX 351766 (386)263-2991 City or town, state or province, country, and ZIP or foreign postal code 1 i Amended return F Group Exemption [Zi Application pending PALM COAST, FL 32135-1766 Number • G Accounting Metiiod: S Casli U Accrual Other (specify) • H Check • U if the organization is not 1 Website: • required to attach Schedule B J Tax-exempt status (check only one) - E 501(c)(3) n50i(c)( )•< (insert no.) Q 4947(a)(1) or 0527 (Form 990, 990-EZ, or 990-PF). K Form of organization: Q] Corporation D Trust D Association D Other .lililiiiijiijlll; L Add lines 5b, 6c, and 7b to line 9 to determine gross receipts. If gross receipts are $200,000 or mor|,.or if f6tSt?8s^|ts (Part II, column (B) below) are $500,000 or more, file Form 990 instead of Form 990-EZ > . 197,639 Revenue, Expenses, and Changes in Net Assets or Fund ^||ricesl(||^ the instructions for Part I) Check if the organization used Schedule O to respond to any question tf^tbts Part I 1 Contributions, gifts, grants, and similar amounts received > - . ' 91,164 2 Program service revenue including government fees and contracts 3 Membership dues and assessments 14,568 4 Investment income , < u + < . . 61 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 (Subtrac^jteKsSb frqfnsiine 5a) 5c 6 Gaming and fundraising events a Gross income from gaming (attach Schedule G if greater than a> 3 $15,000) 6a C o > b Gross income from fundraising events (not includia|;ij|||».,^ 39,850 of contributions from fundraising events reported on line 1) (att.g5^;.5chediii^si§;f t sum of such gross income and contributions :pSs|||;|.15,000) 6b 91,846 Less: direct expenses from gaming and fi iiiiilillil statement of Program Service Accomplishments (see the instructions for Part iii) Expenses Check if the organization used Schedule O to respond to any question in this Part III • (Required for section What is the organization's primary exempt purpose? RAISE FUNDS BUILD A CULTURAL ART CENTER 501(c)(3) and 501(c)(4) Describe the organization's program service accomplishments for each of its three largest program services, organizations; optional for as measured by expenses. In a clear and concise manner, describe the services provided, the number of for others.) persons benefited, and other relevant information for each program title. 28 SPONSORED LOCAL MUSIC AND ART EVENTS AND PROGRAMS IN THE COMMUNITY TO RAISE FUNDS AND BUILD AWARENESS OF THE FOUNDATIONS GOAL TO BUILD A CULTURAL ART CENTER IN FLAGLER (Grants $ 17,744 ) If this amount includes foreign grants, check &6f^ < • • 28a 91,846 29 (Grants $ If this amount includes foreign gra')te, cheta< tore • • 29a 30 (Grants $ ) If this amount inclu^::|preign gra|ii check here • D 30a 31 Other program services (describe in Schedule O) .... (Grants $ ) If this amount includes fdt8i§i|iitnts, check here • • 31a 32 Total program service expenses (add lines 28a through 31a) 32 91,846 Part iV I List of Officers, Directors, Trustees, and Key;||i|!i|lbyees (list each one even if not compensated (see the instructions for Part IV) • (c) Reportable (d) Health benefits, *;::|S''(i)) Average (e) Estimated amount of compensation contributions to employee (a) Name and title hours per week (Forms W-2/1099-MISC) benefit plans, and other compensation devoted to position See 990 OFOV (if not paid, enter -0-) deferred compensation SHIRLYN PERKOVICH PRESIDENT 10.00 0 0 0 MARGO YORK EMPLOYEE 17.00 22,860 0 0 JOAN MANGANO TRUSTEE 2.00 0 0 0 JOSEPH GANCI TRUSTEE 2.00 0 0 0 TOM CORUM TRUSTEE 2.00 0 0 0 GORDON L FLORENCE TRUSTEE 2.00 0 0 0 LORI GENK SECRETARY TREASURER 2.00 0 0 0 NANCY CROUCH EXECUTIVE DIRECTOR 2.00 6,230 0 0 BETTIE EUBANKS TRUSTEE 2.00 0 0 0 LINDA HELLINGS TRUSTEE 2.00 0 0 0 GEORGE ALLISON TRUSTEE 2.00 0 0 0 MICHAEL DAVIS ATTORNEY 0.00 0 0 0 JULIE GUIMOND TRUSTEE 0.00 0 0 0 Form 990-EZ (2014) PALM COAST ARTS FOUNDATION INC 80-0101548 Pages Part VI 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 tlie 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 X 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. Othenwise, explain the change on Schedule O (see instructions) 34 X 35 a 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 X 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 111 35c 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 X_ 37 a Enter amount of political expenditures, direct or indirect, as described in the instructions . . . • ''|||[ b Did the organization file Form 1120-POL for this year? 37b x_ 38 a Did the organization borrow from, or make any loans to, any officer, director, trustee, or key employee briiS^li 38a X 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 Gross receipts, included on line 9, for public use of club facilities .... S* • • • •5S 5* 39b ction ' organizations. Enter amount of tax imposed on the org||5Eatiori;|||f|ng th|;;|^ar under: n4i,i • ; section 4912 • jpli|f '''•Ij^lon 4955 • _ Section 501(c)(3), 501(c)(4), and 501(c)(29) organizations. Did the^anization e|^ge in any section 4958 excess benefit transaction during the year, or did it engage in an e)^p|s benefit tri||action in a prior year that has not been reported on any of its prior Forms 990 or 990-EZ? ff *Ye*<" cgmpfete Schedule L, Part I 40b X Section 501(c)(3), 501(c)(4), and 501(c)(29) organizations. Enter amouritlliipiiffiposed on organization managers or disqualified persons during the year under sections 4912, 4955, and 4958 • < • Section 501(c)(3), 501(c)(4), and 501(c)(29) organizations Enfefr amqunt of tax on line 40c reimbursed by the organization • All organizations. At any time during the tax year, vi«^-th^;iE«Eganization a party to a prohibited tax shelter transaction? If "Yes," complete Form 8886-T , + 40e X 41 List the states with which a copy of this return is fiiii|||i;:, • FL 42 a The organization's books are in care of %::ipfi|||ifiYiif'^:;||feRKOVICH Telephone no. • 386-263-2991 Located at • 8 ERICKSON PL, PALM COAgT, FL Z1P-H4 • 32164 At any time during the calendarijfiear. did tjfe^ffgarMigation have an interest in or a signature or other authority over Yes No a financial account In a for^^j^urt^^^i^bank account, securities account, or other financial account)? 42b X If "Yes," enter the name of thef(ii5«ngn cTOfttry;. • See the instructions fQCi:Ki!f<5^tioriS;;i|||i:finng:tequirements for FinCEN Form 114, Report of Foreign Bank and Financial AccountsspSAR). At any time during;|ii^ calendar did the organization maintain an office outside the U.S.? 42c X If "Yes," enter the r^^:gf the fqf|j|in country: • 43 Section 4947(a)(1) ndirili||ip|;i0iiiritable trusts filing Form 990-EZ in lieu of Form 1041-Check here and enter the amount of tax-exempt interest received or accrued during the tax year • 43 Yes No 44 a Did the organization maintain any donor advised funds during the year? If "Yes," Form 990 must be completed instead of Form 990-EZ 44a X b Did the organization operate one or more hospital facilities during the year? If "Yes," Form 990 must be completed instead of Form 990-EZ 44b X c Did the organization receive any payments for indoor tanning services during the year? 44c X 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 45 a Did the organization have a controlled entity within the meaning of section 512(b)(13)? 45a X b 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 X Form 990-EZ (2014) Form 990-EZ (2014) PALM COAST ARTS FOUNDATION INC 80-0101548 Page 4 Yes No 46 Did tiie organization engage, directiy or indirectly, in political campaign activities on behalf of or in opposition 46 X mmm 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 X 48 Is the organization a school as described in section 170(b)(1 )(A)(ii)? If "Yes," complete Schedule E 48 X 49a Did the organization make any transfers to an exempt non-charitable related organization? 49a X 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 n^e, enter "None." *|i|}Health benefits, (b) Average (c) Reportable :..:.,cont(|i^ions to employee (e) Estimated amount of (a) Name and title of each employee hours per week compensation i::|3«n NONE f Total number of other employees paid over $100,000 • 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 ther|:||::Pne, enter "None." (a) Name and business address of each independent contractor ' ' (b) Type of service (c) Compensation d Total number of ot|||.independd|||pntractors each receiving over $100,000 ... • 52 Did the organizatiorKSQroplete ScbSdule A? Note. All section 501(c)(3) organizations must attach a completed Schedule A . . Yes • No 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 infonnation of which preparer has any knowledge. L SHIRLYN PERKOVICH Sign W Signature of officer Date Here ^ SHIRLYN PERKOVICH, PRESIDENT ^ Type or print name and title .^^"^) Print/Type preparer's name Date Check S if PTIN Paid tiary H Langhauser ^lary M Langhauser 08-19-2015 self-employed P00021314 Preparer Firm's name • Mary M Langhauser, CPA Firm's EIN • Use Only Firm's address • 35 Barkwood Lane Palm Coast FL 32137 Phoneno. 386-446-3570 IVlay the IRS discuss this return with the preparer shown above? See instructions Yes • No Form 990-EZ (2014) Form 990_OfOv (2014) PALM COAST ARTS FOUNDATION INC 80-0101548 Page 01 List of Officers, Directors, Trustees, and Key Employees 1 List all officers, directors, trustees, and key employees for the year even if they were not compensated (c) Reportable (d) Health benefits, (b) Average compensation contributions to employee (e) Estimated amount of (a) Name and title hours per week (Fomi W-2/1099-MISC) benefit plans, and other compensation devoted to position (if not paid, enter -0-) defen-ed compensation DR LEILA HARDISON TRUSTEE 2.00 0 0 0 PAT LEIPFERT TRUSTEE 2.00 0 0 0 EEA Form 990_OfOv (2014) Form 4562 Depreciation and Amortization OMB No. 1545-0172 (Including Information on Listed Property) 2014 • Attach to your tax return. Department of the Treasury Attachment Internal Revenue Service (99) > Information about Form 4562 and its separate Instructions Is at www.irs.gov/form4562. Sequence No. 179 Name(s) shown on return Business or activity to whicti this form relates Identifying number PALM COAST ARTS FOUNDATION INC FORM 990 - 1 80-0101548 i?aifiii Election To Expense Certain Property Unde r Section 179 Note: If you have any listed property, complete Part V before you complete Part 1 Maximum amount (see instructions) 1 2 Total cost of section 179 property placed in service (see instructiorIS ) 2 3 Threshold cost of section 179 property before reduction in limitatior1 (see instructions] 3 4 Reduction in limitation. Subtract line 3 from line 2. If zero or less, e iter-0- . . . 4 5 Dollar limitation for tax year. Subtract line 4 from line 1. If zero or less , enter -0-. If married fi ing 5 6 (a) Description of property (b) Cost {business use on(y) (c) Elected cost 7 Listed property. Enter the amount from line 29 7 8 Total elected cost of section 179 property. Add amounts in column (c), lines 6 and 7 8 9 Tentative deduction. Enter the smaller of line 5 or line 8 + 9 10 Carryover of disallowed deduction from line 13 of your 2013 Form 4562 , 10 11 Business income limitation. Enter the smaller of business income (not less than zero) or Sa6 5 {-sse mstaictions) 11 12 Section 179 expense deduction. Add lines 9 and 10, but do not enter more thanstfiiii 12 13 Carryover of disallowed deduction to 2015. Add lines 9 and 10, less line 12 M Note: Do not use Part II or Part III below for listed property. Instead, use RaJj-V. Part II Special Depreciation Allowance and Ottv^E^reciM^^i^o not include listed property.) (See instructions.) 14 Special depreciation allowance for qualified property (other thailiipted properjjljiplaced in service during the tax year (see instructions) < < 14 15 Property subject to section 168(f)(1) election ^ 15 16 Other depreciation (including ACRS) 16 Part III MACRS Depreciation (Do not include listed property.) (See instructions.) Section A 17 MACRS deductions for assets placed in service in talilii^l^^ijegijining before 2014 17 382 18 If you are electing to group any assets placed in jftjiiice diili||:||f tax year into one or more general asset accounts, check here ^ ^ Section B - Assets PlacedfjiijiBrvice gi|iiiihg 2014 Tax Year Using the General Depreciation System (b) Month afili^f:;. (c) Basis for (jepreciation (d) Recovery, (a) Classification of property .aim t! jli^^usiness/investment use (e) Convention (f) Method (g) Depreciation deduction period ' ..iliJSiiii^. only-see instructions) ;':X;:-- ->>:<;• 19a 3-year property b 5-year property 740 5 HY 200 DB 148 c 7-year property .(iilSij. '^^ill d 10-year property '•'lllls;.. ^iiiiiiil e 15-year property f 20-year propet^ijF g 25-year prctpe^j. 25 yrs. S/L h Residential reri|||:,.,.. Ji- 27.5 yrs. MM S/L property '''^^iliiljs^^^^^^^ 27.5 yrs. MM S/L i Nonresidential real 39 yrs. MM S/L property MM S/L Section C - Assets Placed In Service During 2014 Tax Year Using the Alternative Depreciation System 20 a Class life S/L b 12-year 12 yrs. S/L c 40-year 40 yrs. MM S/L jiiilPl Summary (See instructions.) 21 Listed property. Enter amount from line 28 21 22 Total. Add amounts from line 12, lines 14 through 17, lines 19 and 20 in column (g), and line 21. Enter here and on the appropriate lines of your return. Partnerships and S corporations - see instructions 22 530 23 For assets shown above and placed in service during the current year, enter the portion of the basis attributable to section 263A costs 23 For Paperwork Reduction Act Notice, see separate instructions. Form 4562 (2014) EEA IRS e-file Signature Authorization 8879-EO for an Exempt Organization OMB No. 1545-1878 For calendar year 2014, or fiscal year beginning 07-01-2014 , and ending 06-30-2015 ^ Do not send to the IRS. Keep for your records. Department of ttie Treasury 2014 Internal Revenue Service • Information about Form 8879-EO and Its instructions is at www.lrs.gov/form8879eo. Name of exempt organization Employer identification number PALM COAST ARTS FOUNDATION INC 80-0101548 Name and title of officer SHIRLYN PERKOVICH, PRESIDENT iiiiil Type of Retum and Retum Information (Whole Dollars Only) ! Cfieck tite box for the return for which you are using this Form 8879-EO and enter the applicable amount, if any, from the return. If you check the box on line 1a, 2a, 3a, 4a, or 5a, below, and the amount on that line for the return being filed with this form was blank, then leave line 1 b, 2b, 3b, 4b, or 5b, whichever is applicable, blank (do not enter -0-). But, if you entered -0- on the return, then enter -0- on the applicable line below. Do not complete more than 1 line in Part I. la Form 990 check here b Total revenue, if any (Form 990, Part VIII, column (A), line 12) ...... lb 2a Form 990-EZ check here • ^ b Total revenue, if any (Form 990-EZ, line 9) - * . . . 2b 129,071 3a Form 1120-POL check here b Total tax (Form 1120-POL, line 22) 11;:. . . 3b 4a Form 990-PF check here b Tax based on investment income (Form 990-PF, Part VI, lifte 5-1 4b 5a Form 8868 check here •Q b Balance Due (Form 8868, Part I, line 3c or Part II, line 8c) 5b iiit ill Declaration and Signature Authorization of Officer Under penalties of perjury, I declare that I am an officer of the above organization and that I hav&feXiSMTiined a copy of the organization's 2014 electronic return and accompanying schedules and statements and toS)"© besf tjf «1V knowledge and belief, they are true, correct, and complete. I further declare that the amount in Part I above is the ^OuntiiSJsawn dfiiifeft-copy of the organization's electronic return. I consent to allow my intermediate service provider, tr||^mitter,'i|electrofi1c return originator (ERG) to send the organization's return to the IRS and to receive from the IRS (a) an acknowfedgement Of receipt or reason for rejection of the transmission, (b) the reason for any delay in processing the return or Sfeftrnd, and (c) Uiedafe of any refund. If applicable, I authorize the U.S. Treasury and its designated Financial Agent to initiat|:p electroniq.:|i.nds withdrawal (direct debit) entry to the financial institution account indicated in the tax preparation software for:;||j);ment of the-Qfganization's federal taxes owed on this return, and the financial institution to debit the entry to this account. To i^S||!s.g a paym.^11 must contact the U.S. Treasury Financial Agent at 1-888-353-4537 no later than 2 business days prior to the paymeBil;:|gettea*e»*{) date. I also authorize the financial institutions involved in the processing of the electronic payment of taxes to receive confiaiiSl^mfbrmation necessary to answer inquiries and resolve issues related to the payment. I have selected a personal identification number (PIN) as my signature for the organization's electronic return and, if applicable, the organization's conservljQ^i^ctronlc funds withdrawal. Officer's PIN: check one box only i I authorize Mary M Langhauser, CPA to enter my PIN 01548 as my signature ERO firm name Enter five numbers, but do not enter all zeros on the organization's tax year 2014 electrorilj!ii§i|::|led retiJfh. If I have indicated within this return that a copy of the return is being filed with a state agency(ies) regulating cteifies as part of the IRS Fed/State program, I also authorize the aforementioned ERO to enter my PIN on the return's difedosafe consent screen. As an officer of the organiiSphj.J. wiil;i^||f. m^^^ as my signature on the organization's tax year 2014 electronically filed return. If I have indicated withig;|)[i.s re«|||;;^af'i:|i|^%f the return is being filed with a state agency(ies) regulating charities as part of the IRS Fed/State progi^l||^|::wii(l|||^^ PIN on the return's disclosure consent screen. Officer's signature Date ^ 08-20-2015 Wmrni Certifi#t!ol^ and A Wntication ERO's EFIN/PIN. Ent#;i|pur six-digii|pctronic filing identification number (EFIN) followeai:||:^gur five-flft self-selected PIN. 598799 52729 do not enter all zeros I certify that the above numeric entry is my PIN, which is my signature on the 2014 electronically filed return for the organization indicated above. I confirm that I am submitting this return in accordance with the requirements of Pub. 4163, Modernized e-File (MeF) Information for Authorized IRS e-file Providers for Business Returns. ERO's signature ^ Mary M Langhauser Date ^ 08-19-2015 ERO Must Retain This Form - See Instructions Do Not Submit This Form To the IRS Unless Requested To Do So For Paperwork Reduction Act Notice, see Instructions. Form 8879-EO (2014) EEA SCHEDULE A Public Charity Status and Public Support OMB No. 1545-0047 (Form 990 or 990-EZ) Complete if the organization is a section 501(c)(3) organization or a section 4947(a)(1) nonexempt charitable trust. 2014 Open to Public Department of ttie Treasury • Attach to Form 990 or Form 990-EZ. Internal Revenue Service • information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990. Inspection Name of the organization Employer identification number PALM COAST ARTS FOUNDATION INC 80-0101548 iiijij Reason for Public Charity Status (All organizations must complete this part.) See instructions. Tiie organization is not a private foundation because it is; (For lines 1 ttirough 11, check only one box.) 1 Da church, convention of churches, or association of churches described in section 170(b)(1)(A)(l). 2 Da 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 urtt-Of ftiomttfe 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 33 1/3% of its support from cont|i|{ions, tlii|^^bership fees, and gross receipts from activities related to its exempt functions - subject to certain exceptions, al|i||||jQ,?||iife than 33 1/3% of its support from gross investment income and unrelated business taxable income [ims 9 (i) Name of supportec^-^^nization "^W^ •• (il) EIN (iii) Type of organization (iv) Is the organization (v) Amount of monetary (vi) Amount of (described on lines 1-9 listed in your governing support (see other support (see above or IRC section document? instructions) instructions) (see instructions)) Yes No (A) (B) (C) (D) (E) Total For Paperwork Reduction Act Notice, see the Instructions for Schedule A (Form 990 or 990-EZ) 2014 Form 990 or 990-EZ. EEA Schedul_ e A (Form 990 or 990-EZ) 2014 PALM COAST ARTS FOUMDATION INC 80-0101548 Page 2 WMM 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) 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.") 70,558 86,810 112,350 71,456 105,732 446,906 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 70,558 86,810 112,350 71,456 105,732 446,906 5 The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on iiiiillllllB line 1 that exceeds 2% of the amount shown on line 11, column (f) — 96,209 6 Public support. Subtract line 5 from line 4 . . 350,697 Section B. Total Support Calendar year (or fiscal year beginning in) (a) 2010 (b) 201 Is...;,,.. ^ilf5i2oi ip (d) 2013 (e) 2014 (f) Total 7 Amounts from line 4 70,558 6*,810 m,350 71,456 105,732 446,906 8 Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources 76 118 382 31 11 618 9 Net income from unrelated business activities, whether or not the business is regularly carried on 2, Iii 2,061 3,009 50 7,719 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 10 455,243 12 Gross receipts from related activities, etc. (see instriii|i^,) | 12 13 First five years. If the Form 990 is for the ofganizstbn's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization, check this box and Sjtpp here Section C. Computation of Pliljjg Sliji^rtifercentage 14 Public support percentage fof^|4 (l{S|;||;|;^li3iPSl*:i(f) divided by line 11, column (f)) 14 77,04 % 15 Public support percentage from'2g?{a.Sche^te;A, Part II, line 14 15 88.00 % 16a 33 1/3% support test jj^||i|tf theli^|||atiSh did not check the box on line 13, and line 14 is 33 1/3% or more, check this box and stop here. |j||'6rganizatiog.qu"i§ls as a publicly supported organization 33 1/3% support test" 2013. If the Calendar year (or fiscal year beginning In) ^ (a) 2010 (b) 2011 (c) 2012 (d) 2013 (e) 2014 (f) Total 1 Gifts, grants, contributions, and membersiiip 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 bus. under sec 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 w/ithout 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.) 55 ;S it^^m Section B. Total Support Calendar year (or fiscal year beginning in) >• (a) 2010 III* r (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 busim •<;& activities not included in line 10b, whem|||:5;.. or not the business is regul^f^ (jaffled on . , , 12 Other income. Do notli|pude gain Qfil;;. loss from the sale of c|||tal assets '1*1: (Explain in Part VI.) •<,...,,.. 13 Total support. (Add lines 9,1<30,11, and 12.) 'TT 14 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 , • • Section C. Computation of Public Support Percentage 15 Public support percentage for 2014 (line 8, column (f) divided by line 13, column (f)) 15 16 Public support percentage from 2013 Schedule A, Part III, line 15 ...... 16 % Section D. Computation of Investment Income Percentage 17 investment income percentage for 2014 (line 10c, column (f) divided by line 13, column (f)) 17 % 18 Investment income percentage from 2013 Schedule A, Part 111, line 17 18 19a 33 1/3% support tests - 2014. 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 • D b 33 1/3% support tests - 2013. 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 • • 20 Private foundation. If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions . • • EEA Schedule A (Form 990 or 990-EZ) 2014 Schedule B Schedule of Contributors OMB No. 1545-0047 (Form 990, 990-EZ, or 990-PF) • Attach to Form 990, Form 990-EZ, or Form 990-PF. Department of ttie Treasury 2014 Internal Revenue Service ^ Information about Schedule B (Form 990, 990-EZ, or 990-PF) and its instructions is at www.irs.govyform990. Name of the organization Employer Identification number PALM COAST ARTS FOUNDATION INC 80-0101548 Organization type (check one): Filers of: Section: Form 990 or 990-EZ ^ 501(c)( 3 ) (enter number) organization n 4947(a)(1) nonexempt charitable trust not treated as a pr-ivate foundation n 527 political organization '^iH:, Form 990-PF n 501(c)(3) exempt private foundation D 4947(a)(1) nonexempt charitable trust treated as a priyaJgsfoundafJc^ • 501(c)(3) taxable private foundation .iililils:.. '"Ilk, Check if your organization is covered by the General Rule or a Special Ruld. Note. Only a section 501(c)(7), (8), or (10) organization can check box^for both thQ:;||^neral Rule and a Special Rule. See instructions. 'S^l... General Rule ^ For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, contributions totaling $5,000 or more (in money or property) from any one contributes' Complete Parts I and II. See instructions for determining a contributor's total contributions. .sliWife-. Special Rules n For an organization described in section 50.J||ii|g) filing'-i|pl 990 or 990-EZ that met the 33 1/3% support test of the regulations under sections 509(a)(1) and 17d|i|i|iA)(vi), that checked Schedule A (Form 990 or 990-EZ), Part II, line 13,16a, or 16b, and that received fro^::||||^e cd?^||iiutor, during the year, total contributions of the greater of (1) $5,000 or (2) 2% of the ampjynt on (ij-forrB|l9Qi Part VIII, line 1h, or (11) Form 990-EZ, line 1. Complete Parts I and II. n For an organization de,||||.ed iMi|||gori''iil|iii;f(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor, during the yeasgtota) confeSstUions of more than $1,000 exclusively for religious, charitable, scientific, literary, or educajtipaial purpose?, t?r for the prevention of cruelty to children or animals. Complete Parts I, II, and III. n For an organizaifipn described 10 section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor, du^|:|j.g year, .^iributions exclusively for religious, charitable, etc., purposes, but no such contributions totaled )?K|HT^#Bn $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 totaling $5,000 or more during the year • $ 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 990-PF, 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. Schedule B (Form 990, 990-EZ, or 990-PF) (2014) EEA Schedule B (Form 990, 990-EZ, or 990-PF) (2014) Page 2 Name of organization Employer Identification number PALM COAST ARTS FOUNDATION INC 80-0101548 iijililill Contributors (see instructions). Use duplicate copies of Part I if additional space is needed. (a) (b) (c) (d) No. Name, address, and ZIP + 4 Total contributions Type of contribution 1 SAGE FOUNDATION Person B Payroll • 210 OLD KINGS RD S STE 900 $ 35,000 Noncash • (Complete Part 11 for FLAGLER BEACH, FL 32136 noncash: contributions.) (a) (b) (d) No. Name, address, and ZIP + 4 Total contriiSillpns Type of contribution 2 TOM CORUM Person ^ Payroll • 9 LIVE OAK LN $ JII. 1^6'51 0 Noncash • (Complete Part II for PALM COAST, FL 32137 noncasfi contributions.) (a) (b) (c) (d) No. Name, address, and ZIP + 4 ''^ii^^taA contributions Type of contribution 3 SAM PERKOVICH Person M Payroll • 8 ERICKSON PL $ 9,285 Noncash • (Complete Part II for PALM COAST, FL 32164 noncasfi contributions.) (a) (b) ,m^.^. '^'^^^ (c) (d) No. Name, address, ai0W^^A Total contributions Type of contribution 4 FLORIDA DEPARTMENT OF ST^||i|^|lANT Person ^ Payroll • 200 EAST GAINES ST $ 12,744 Noncash • (Complete Part II for TALLAHASSE^^||-L 9 noncash contributions.) (a) (c) (d) No. Name^ adiilress! and ZIP + 4 Total contributions Type of contribution Person • Payroll • $ Noncash • (Complete Part II for noncash contributions.) (a) (b) (c) (d) No. Name, address, and ZIP + 4 Total contributions Type of contribution Person • Payroll • $ Noncash • (Complete Part II for noncash contributions.) EEA Schedule B (Form 990, 990-EZ, or 990-PF) (2014) SCHEDULE G Supplemental Information Regarding Fundraising or Gaming Activitie s OMB No. 1545-0047 (Form 990 or 990-EZ Complete if the organization answered "Yes" to Form 990, Part iV, lines 17,18, or 19, or if the organization entered more than $15,000 on Form 990-EZ, line 6a. 2014 Department of ttie Treasury • Attach to Form 990 or Form 990-EZ. Open to Publii Internal Revenue Service • Information about Schedule G (Form 990 or 990-EZ) and its instructions is at www.irs.goi /tform990. Inspection Name of ttie organization Employer identification number PALM COAST ARTS FOUNDATION INC 80-0101548 Form 990-EZ filers are not required to complete this part. I 1 Indicate whether the organization raised funds through any of the following activities. Check all that apply, a D Mail solicitations e D Solicitation of non-government grants b • Internet and email solicitations f • Solicitation of government grants c • Phone solicitations g • Special fundraising events d D In-person solicitations 2a Did the organization have a written or oral agreement with any individual (including officers, directors, trustees or key employees listed in Form 990, Part VII) or entity in connection with professional fundraising sen/ices? D Yes • No b If "Yes," list the ten highest paid individuals or entities (fundraisers) pursuant to agreements under whi^j:|ie fundraiser is to be compensated at least $5,000 by the organization. (vJ-Atnount paid to (iii) Did fundraiser have (vi) Amount paid to (i) Name and address of individual (iv) Grossm*^ (oft||jl^ined by) custody or control of (or retained by) or entity (fundraiser) (ii) Activity from 3(!tiViiy fundraiser listed in contributions? organization col. (i) Yes No 1 2 3 4 1 5 6 7 8 9 Total < • 3 List all states in wf«<;h the organjjsation is registered or licensed to solicit contributions or has been notified it is exempt from registration or licetl^iij,.. J|p' For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ. Scliedule G (Form 990 or 990-EZ) 2014 EEA Schedule G (Form 990 or 990-EZ) 2014 PALM COAST ARTS FOUNDATION INC 80-0101548 Page 2 Part It i Fundraising Events. Complete if the organization answered "Yes" to Form 990, Part IV, line 18, or reported more than $15,000 of fundraising event contributions and gross income on Form 990-EZ, lines 1 and 6b. List events with gross receipts greater than $5,000. (a) Event #1 (b) Event #2 (c) Other events (d) Total events DINNER PLAY ORCH CONCERT 5 (add col. (a) through col. (c)) (event type) (event type) (total number) 1 Gross receipts 23,461 90,964 17,271 131,696 Revenu e 2 Less: Contributions 3 Gross income (line 1 minus line 2) 23,461 90,964 17,271 131,696 4 Cash prizes 5 Noncash prizes 6 Rent/facility costs 2,497 4,385 10,725 7 Food and beverages 5,645 5,9|||i| 4U75 16,066 Expense s 8 Entertainment 1,200 Ipl, 650 33,220 Direc t 9 Other direct expenses 1,355 1,471 8,557 10 Direct expense summary. Add lines 4 through 9 in column (d||f , • 68,568 11 Net income summary. Subtract line 10 from line 3, column (d) • 63,128 Part til Gaming. Complete if the organization answered *Ye$" to Fofm 990, Part IV, line 19, or reported more than $15,000 on Form 993-EZ , line 6a. '"'•illP^^^^ (b) Pull tabs/instant (d) Total gaming (add (c) Other gaming (a) Bifigo bingo/progressive bingo col. (a) through col. (c)) Revenu e 1 Gross revenue 2 Cash prizes 3 Noncash prizes Expense s 4 Rent/facility costs ...... ' Direc t 5 Other direct expenses , , , . . "a Yes % • Yes % • Yes % 6 Volunteer lat^lp' . '. . . ^'U No • No ! • No 7 Direct expense^gommary. lines 2 through 5 in column (d) • 8 Net gaming income summary. Subtract line 7 from line 1, column (d) • 9 Enter the state(s) in which the organization conducts gaming activities: a Is the organization licensed to conduct gaming activities in each of these states? • Yes • No b If "No," explain: 10a Were any of the organization's gaming licenses revoked, suspended or terminated during the tax year? D Yes Q No b If "Yes," explain: EEA Schedule G (Form 990 or 990-EZ) 2014 OMB No. 1545-0047 SCHEDULE O Supplemental Information to Form 990 or 990-EZ (Form 990 or 990-EZ) Complete to provide Information for responses to specific questions on 2014 Form 990 or 990-EZ or to provide any additional information. Open to Public Department of the Treasury • Attach to Form 990 or 990-EZ. Internal Revenue Service Inspection Name of the organization Employer identification number PALM COAST ARTS FOUNDATION INC 80-0101548 01. Description of other expenses (Part I, line 16) DESCRIPTION AMOUNT INSURANCE 1,699 OFFICE EXPENSES 3, 047 DEPRECIATION 530 ADVERTISING MISCELLANEOUS 778 SCHOLARSHIPS 2,000 SOFTWARE AND COMPUTER 2,386 BANK AND INTEREST CHARGES , 5 If 02. Description of other assets (PaJcti 11^ line 24) CATEGORY BEGINNING OF YEAR END OF YEAR DEPOSITS 1,162 1,162 03. Description of total Utilities (Part II, line 26) CATEGORY || j BEGINNING OF YEAR END OF YEAR PAYROLL TAXES .|||,_^ ''^'iilfit, ''^ 1,202 1,971 j ACCRUED EXPENSES 147 0 LINE OF CREDItIII 0 67,745 For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ. Schedule O (Form 990 or 990-EZ) (2014) EEA