PUBLIC DISCLOSURE COPY - Town of Palm Beach … · PUBLIC DISCLOSURE COPY ... Further, these...

PUBLIC DISCLOSURE COPY

{ Not For I RS Filing )

Form 990 PUBLIC DISCLOSURE COPY - STATE REGISTRATION NO. CH2105

Return of Organization Exempt From Income Tax Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except private foundations)

IJli,. Do not enter social security numbers on this form as it may be made public. 1---~~~"-- Department of the Treasury Internal Revenue Service Information about Form 990 and its instructions is at www.lrs. ov/form990. A For the 2015 calendar year or tax year beginning JUL 1 2 O 15 and ending JUN 3 O 2 O 16 ' . . B Check 1f C Name of organization D Employer identification number

applicable O Address 211 Palm Beach/Treasure Coast, Inc. change O Name Domo business as 23-7153017 change 01nit1al Number and street (or P.O. box 1f mau rs not delivered to street address) I Room/suite E Telephone number return O Final P.O. Box 3588 561-533-1096 return/ termin- City or town, state or province, country, and ZIP or foreign postal code G Gross receipts ê 2.471.449. ated O Amended Lantana. FL 33465-3588 H(a) Is this a group return return DAppl1ca- F Name and address of principal officer Sharon L'Herrou for subordinates? Oves OO No tron pending same as e above H(b) Are all subordinates 1ncluded?DYes D No I Tax-exemot status [xJ 50Hc\(3\ D 50Hc\ ( ) ..... (insert no.) D 4947(a)(1) or D 527 If "No," attach a list (see instructions) J Website:IJli,. www. 211PalmBeach.Ora H(cl Groun axsmotron number IJli,. K Form of ornaruzanort [xJ Corporation D Trust D Assocanon D OtherlJli,. I L Year of formation: 19 711 M State of leaal dormcüe: FL I Part 11 Summary

Cl) 1 Briefly describe the organization's rrusston or most s1gnif1cant acnvmes 211 12rovides em12athetic guidance o and SUQQOrt to individuals and families in distress or in need of e co

D 1f the organization discontinued its operations or disposed of more than 25% of its net assets e 2 Check this box IJli,. ~ 3 Number of voting members of the governing body (Part VI, line 1 a) 3 23 o e 4 Number of independent voting members of the governing body (Part VI, line 1 b) 4 23 oll Ill 5 Total number of mdivrduals employed m calendar year 2015 (Part V, line 2a) 5 63 Cl)

~ 6 Total number of volunteers (estimate 1f necessary) 6 25 +I 7 a Total unrelated business revenue from Part VIII, column (C), line 12 7a -186. ~

b Net unrelated business taxable income from Form 990-T, line 34 7b -9 385. Prior Year Current Year

Cl) 8 Contnbutrons and grants (Part VIII, line 1 h) 2.092.197. 2.330 256. :i

9 Program service revenue (Part VIII, line 2g) o. o. e ~ 10 Investment income (Part VIII, column (A), lines 3, 4, and ?d) 49. -48, 861. Cl) e: Other revenue (Part VIII, column (A), lines 5, 6d, Sc, 9c, 1 Oc, and 11 e) 38-739. 4.235. 11

12 Total revenue - add lines 8 throuah 11 lmust eaual Part VIII, column (A), line 12) 2.130.985. 2,285,630. 13 Grants and smular amounts paid (Part IX, column (A), lines 1 3) 13.220. 33,368. 14 Benefits paid to or for members (Part IX, column (A), line 4) o . o.

Ill 15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 5-10) 1.718.222. 1.904.992. Cl) Ill 16a Professional fundrarsmq fees (Part IX, column (A), line 11 e) o. o. e Cl)

b Total fundra1smg expenses (Part IX, column (D), line 25) .... 87,033 • Q. >< w 17 Other expenses (Part IX, column (A), lines 11 a 11 d, 11f-24e) 378.466. 459 963.

18 Total expenses Add lines 13 17 (must equal Part IX, column (A), line 25) 2 109 908. 2 398 323. 19 Revenue less exoenses Subtract line 18 from line 12 21.077. -112 693.

'-"' Beainnina of Current Year End of Year oa> c., ,g¡c:: Total assets (Part X, line 16) 750 611. 593,694. a,_!S! 20 "'"' "'CD 349 491. 305.267. <:("O 21 Total hatnhties (Part X, line 26)

Öl§ 22 Net assets or fund balances Subtract line 21 from line 20 401-120. 288.427. 2u..

I Part li I Signature Block

Sign Here

~ S1gnàture of officer

ai... Sharon L'Herrou, President/CEO ,.. Type or print name and title

Date

Paid Preparer Use Only

Check D PTIN If self employed PO O O O 2 419

33407 Phone no. 5 61 6 8 9 - 6 O O O May the IRS discuss this return with the preparer shown above? (see 1nstruct1ons) OO Yes D No 532001 12-1e-15 LHA For Paperwork Reduction Act Notice, see the separate instructions.

See Schedule O for Organization Mission Statement Form 990 (2015)

Continuation

Form990 2015 211 Palm Beach Treasure Coast Inc. Part Ill Statement of Program Service Accomplishments

Check 1f Schedule O contains a response or note to any line m this Part Ill

23-7153017 Pa e2

Briefly describe the organization's rrussion 211 Palm Beach/Treasure Coast's mission is to connect people to

financial and community needs and to support the health & human services 24 hours a day by understanding their individual emotional,

service system as a whole. 2 Did the organization undertake any significant program services during the year which were not listed on

the prior Form 990 or 990 EZ? If 'Yes,' describe these new services on Schedule O

3 Did the organization cease conducting, or make siqmñcant changes m how 1t conducts, any program services? If "Yes," describe these changes on Schedule O

4 Describe the organization's program service accomplishments for each of its three largest program services, as measured by expenses Section 501 (c)(3) and 501 (c)(4) organizations are required to report the amount of grants and allocations to others, the total expenses, and revenue, 1f any, for each program service reported

Oves OONo

Oves OONo

4a (Code ) (Expenses$ 9 9 5 , 6 8 7 • including grants of$ ) (Revenue$--------

Re S OUr Ce Center Palm Beach County: This telephone based service

related, requiring intensive support and life-saving assistance.

responded to 59,819 calls from Palm Beach County residents during the fiscal year ending June 30, 2016. Of these calls, 789 were suicide

operates 24 hours a day, 365 days a year. Highly trained specialists

with supportive guidance, were made to 73,095 community needs. This Additionally, 80,097 referrals, requiring assessment of needs along

program has been in operation since 1971 and is nationally accredited. Further, these services are now available via Chat, Text and email in addition to telephone access.

4b (Code ) (Expenses$ 3 4 3 , 4 31 • including grants of$ ) (Revenue$--------

Re S OUrC e Center Treasure Coast: This telephone based service operates 24 hours a day, 365 days a year. Highly trained specialists responded to 18,854 calls from Indian River, Martin, Okeechobee and St. Lucie County residents during the fiscal year ending June 30, 2016. Of these calls, 586 were suicide related, requiring intensive support and life-saving assistance. Additionally, 25,680 referrals, requiring

nationally accredited. Further, these services are now available via

assessment of needs along with supportive guidance, were made to 26,434 community needs. This program has been in operation since 2001 and is

Chat, Text and email in addition to telephone access.

4c (Code ) (Expenses$ 19 9 , 3 2 3 • mcludmq grants of$ 1 , 91 7 • ) (Revenue$--------

Elder Crisis Outreach: This program is devoted to serving vulnerable elders in Palm Beach County who may not have the physical strength, the financial resources or the family or caregiver support to deal with a crisis alone. This program has been operating since 1985, providing skilled staff who will visit the elder should an in-home assessment be needed and provide them with short term assistance in resolving their issues by connecting them with appropriate services to meet their needs. In the fiscal year ending June 30, 2016, a total of 595 elders were served.

4d Other program services (Describe m Schedule O) (Expenses $ 6 5 2 , 2 5 8 • including grants of$ 31 , 4 51 • ) (Revenue $ 4,900.)

4e Total program service expenses ll!i:: 2 , 19 O , 6 9 9 • 532002 12-16 15

Form 990 (2015)

14000320 784176 0146700 2

2015.05050 211 Palm Beach/Treasure Coa 01467001

Form99012015l 211 Palm Beach/Treasure Coast. Inc. 23-7153017 I Part IV I Checklist of Required Schedules

Paae3

Yes No 1 Is the organization described m section 501 (c)(3) or 4947(a)(1) (other than a pnvate foundation)?

If "Yes," complete Schedule A ,__~1-+_X_-t--_ 2 Is the organization required to complete Schedule B, Schedule of Contnbutors> ,__2=--+-'X=---1-- 3 Did the organization engage 1n direct or indirect political campaign acnvmes on behalf of or m opposmon to candidates for

public office? If "Yes," complete Schedule C, Part I 1--3-+--_,__X_ 4 Section 501(c)(3) organizations. Did the organization engage m lobbying acnvrtres, or have a section 501 (h) election m effect

dunng the tax year? If "Yes," complete Schedule C, Part li i--4_,___,__X_ 5 Is the organization a section 501 (c)(4), 501 (c)(5), or 501 (c)(6) organization that receives membership dues, assessments, or

snnüar amounts as defined m Revenue Procedure 98-19? If 'Yes,' complete Schedule C, Part Ill 6 Did the organization maintain any donor advised funds or any similar funds or accounts for which donors have the nght to

provide advice on the drstnbutron or investment of amounts in such funds or accounts? If 'Yes," complete Schedule O, Part I 7 Did the organization receive or hold a conservation easement, mcludmq easements to preserve open space,

the environment, histone land areas, or histone structures? If "Yes," complete Schedule D, Part li 8 Did the organization rnamtam collections of works of art, rustoncal treasures, or other similar assets? If 'Yes," complete

Schedule D, Part Ill 9 Did the organization report an amount m Part X, line 21, for escrow or custodial account liability, serve as a custodian for

amounts not listed m Part X, or provide credit counseling, debt management, credit repair, or debt neçonation services? If "Yes, 'complete Schedule O, Part IV

10 Did the organization, directly or through a related organization, hold assets m temporarily restricted endowments, permanent endowments, or quasi endowments? If "Yes," complete Schedule O, Part V

11 If the organization's answer to any of the following questions rs "Yes," then complete Schedule D, Parts VI, VII, VIII, IX, or X as applicable

a Did the organization report an amount for land, buildmgs, and equipment in Part X, line 1 O? If 'Yes," complete Schedule O, Part VI

b Did the organization report an amount for investments other secunnss m Part X, line 12 that rs 5% or more of its total assets reported m Part X, Ime 16? If 'Yes," complete Schedule D, Part VII

e Did the organization report an amount for investments program related in Part X, line 13 that rs 5% or more of its total assets reported m Part X, Ime 16? If "Yes,' complete Schedule D, Part VIII

d Did the organization report an amount for other assets m Part X, line 15 that rs 5% or more of its total assets reported m Part X, line 16? If "Yes," complete Schedule O, Part IX

e Did the organization report an amount for other hab11it1es tn Part X, line 25? If 'Yes,' complete Schedule O, Part X f Did the organization's separate or consolidated fmancial statements for the tax year include a footnote that addresses

the organization's habtlrty for uncertain tax posmons under FIN 48 (ASC 740)? If "Yes,' complete Schedule O, Part X 12a Did the organization obtain separate, independent audited fmancial statements for the tax year? If "Yes," complete

Schedule D, Parts XI and XII b Was the organization included m consolidated, independent audited tmancial statements for the tax year?

If 'Yes," and 1f the organization answered 'No' to Ime 12a, then completing Schedule D, Parts XI and XII is optional 13 Is the organization a school described m section 170(b)(1)(A)(11)? If "Yes,' complete Schedule E 14a Did the organization rnamtam an office, employees, or agents outside of the United States?

b Did the organization have aggregate revenues or expenses of more than $10,000 from grantmakmg, fundrarsmq, business, investment, and program service acnvmes outside the United States, or aggregate foreign investments valued at $100,000 or more? If 'Yes," complete Schedule F, Parts I and IV

15 Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or other assistance to or for any foreign organization? If 'Yes, 'complete Schedule F, Parts li and IV

16 Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or other assistance to or for foreign mdividuals? If "Yes, complete Schedule F, Parts Ill and IV

17 Did the organization report a total of more than $15,000 of expenses for professional fundrarsmç services on Part IX, column (A), lines 6 and 11 e? If "Yes, 'complete Schedule G, Part I

18 Did the organization report more than $15,000 total of fundraismq event gross income and contnbutions on Part VIII, lines 1 c and Sa? If "Yes, ' complete Schedule G, Part li

19 Did the organization report more than $15,000 of gross income from gaming acnvmes on Part VIII, Ime 9a? If "Yes," como/ete Schedule G Part Ill

5 X

6 X

7 X

8 X

9 X

10 X

11a X

11b X

11c X

11d X 11e X

111 X

12a X

12b X 13 X 14a X

14b X

15 X

16 X

11 X

18 X

19 X

532003 12-16-15

Form 990 (2015)

14000320 784176 0146700 3


Form990(2015\ 211 Palm Beach/Treasure Coast. Inc. 23-7153017 Paae4 I Part IV I Checklist of Required Schedules (continued)

Yes No 2oa X 20b

20a Did the organization operate one or more hospital facihtres? If "Yes," complete Schedule H b If "Yes" to line 20a, did the organization attach a copy of its audited ñnancial statements to this return?

21 Did the organization report more than $5,000 of grants or other assistance to any domestic organization or domestic government on Part IX, column (A), hne 1? If 'Yes," complete Schedule /, Parts I and li

22 Did the organization report more than $5,000 of grants or other assistance to or for domestic mdivrduals on Part IX, column (A), line 2? If 'Yes," complete Schedule I, Parts I and Ill

23 Did the organization answer 'Yes" to Part VII, Section A, line 3, 4, or 5 about compensation of the organization's current and former officers, directors, trustees, key employees, and highest compensated employees? If "Yes, 'complete Schedule J

24a Did the organization have a tax exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that was issued after December 31, 2002? If "Yes," answer tmes 24b through 24d and complete Schedule K If 'No", go to Ime 25a

b Did the organization invest any proceeds of tax exempt bonds beyond a temporary period exception? c Did the organization maintain an escrow account other than a refunding escrow at any time during the year to defease

any tax exempt bonds? d Did the organization act as an "on behalf of" issuer for bonds outstanding at any time during the year?

25a Section 501(c)(3), 501(c)(4), and 501(c)(29) organizations. Did the organization engage in an excess benefit transaction with a disquahfted person during the year? If 'Yes, ' complete Schedule L, Part I

b Is the organization aware that rt engaged in an excess benefit transaction with a disquahüed person m a pnor year, and that the transaction has not been reported on any of the organization's prior Forms 990 or 990 EZ? If 'Yes," complete Schedule L, Part I

26 Did the organization report any amount on Part X, Ime 5, 6, or 22 for receivables from or payables to any current or former officers, directors, trustees, key employees, highest compensated employees, or disquahüed persons? If "Yes, ' complete Schedule L, Part li

27 Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantial contributor or employee thereof, a grant selection committee member, or to a 35% controlled entity or family member of any of these persons? If 'Yes," complete Schedule L, Part Ill

28 Was the organization a party to a business transaction with one of the following parties (see Schedule L, Part IV mstructrons for applicable filing thresholds, conditions. and exceptions)

a A current or former officer, director, trustee, or key employee? If "Yes," complete Schedule L, Part IV b A family member of a current or former officer, director, trustee, or key employee? If "Yes," complete Schedule L, Part IV c An entity of which a current or former officer, director, trustee, or key employee (or a family member thereof) was an officer,

director, trustee, or direct or indirect owner? If 'Yes," complete Schedule L, Part IV 29 Did the organization receive more than $25,000 in non cash contnbutrons? If 'Yes," complete Schedule M 30 Did the organization receive contnbutrons of art, hrstoncal treasures, or other similar assets, or qualified conservation

contnbutrons? If 'Yes, ' complete Schedule M 31 Did the organization liquidate, terminate, or dissolve and cease operations?

If 'Yes, ' complete Schedule N, Part I 32 Did the organization sell, exchange, dispose of, or transfer more than 25% of rts net assets? If 'Yes," complete

Schedule N, Part li 33 Did the organization own 100% of an entity disregarded as separate from the organization under Regulations

sections 301. 7701 2 and 301 7701-3? If 'Yes, ' complete Schedule R, Part I 34 Was the organization related to any tax-exempt or taxable entity? If "Yes," complete Schedule R, Part li, Ill, or IV, and

Part V, Ime 1 35a Did the organization have a controlled entity within the meaning of section 512(b)(13)?

b If "Yes' to line 35a, did the organization receive any payment from or engage in any transaction with a controlled entity wrthm the meaning of section 512(b)(13)? If "Yes," complete Schedule R, Part V, Ime 2

36 Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-chantable related organization? If "Yes, ' complete Schedule R, Part V, Ime 2

37 Did the organization conduct more than 5% of its activrnes through an entity that is not a related organization and that is treated as a partnership tor federal income tax purposes? If 'Yes," complete Schedule R, Part VI

38 Did the organization complete Schedule O and provide explanations m Schedule O for Part Vl, Imes 11 b and 19? Note. All Form 990 fliers are recurred to comolete Schedule O

21 X

22 X

X 23

X 24a 24b

24c 24d

X 25a

X 25b

X 26

X 27

2sa X 28b X

aae X 29 X

30 X

31 X

32 X

33 X

34 X X 35a

35b

X 36

X 37

38 X Form 990 (2015)

532004 12-16 15

4 2015.05050 211 Palm Beach/Treasure Coa 01467001 14000320 784176 0146700

Form990 2015 211 Palm Beach Treasure Coast Inc. 23-7153017 Pa e5 Part V Statements Regarding Other IRS Filings and Tax Compliance

Check 1f Schedule O contains a response or note to any Ime m this Part V D Yes No

1a Enter the number reported m Box 3 of Form 1096 Enter O 1f not applicable I 1a I 17 b Enter the number of Forms W 2G included m hne 1 a Enter -O 1f not applicable I 1b o e Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming

(gambling) winnings to prize winners? 1c X 2a Enter the number of employees reported on Form W-3, Transmittal of Wage and Tax Statements,

I 2a I filed for the calendar year ending with or withm the year covered by this return 63 b If at least one rs reported on hne 2a, did the organization file all required federal employment tax returns? 2b X

Note. If the sum of hnes 1 a and 2a rs greater than 250, you may be required to e-file (see mstructions) 3a Did the organization have unrelated business gross income of $1,000 or more during the year? 3a X b If "Yes," has 1t filed a Form 990 T for this year? If 'No," to Ime 3b, provide an explanation ,n Schedule O 3b X

4a At any time during the calendar year, did the organization have an interest m, or a signature or other authority over, a fmancral account m a foreign country (such as a bank account, securities account, or other financial account)? 4a X

b If "Yes," enter the name of the foreign country lill- See mstructions for filing requirements for F1nCEN Form 114, Report of Foreign Bank and Fmancial Accounts (FBAR)

Sa Was the organization a party to a prolubited tax shelter transaction at any time during the tax year? 5a X b Did any taxable party notify the organization that 1t was or rs a party to a prolubited tax shelter transaction? 5b X e If "Yes," to line 5a or 5b, did the orçaruzanon file Form 8886-T? 5c

6a Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible as charitable contributions? 6a X

b If 'Yes," did the organization include with every solrcrtatton an express statement that such contnbutions or gifts were not tax deductible? 6b

7 Organizations that may receive deductible contributions under section 170(c). a Did the organization receive a payment m excess of $75 made partly as a contnbuuon and partly for goods and services provided to the payer? 7a X b If 'Yes," did the organization notify the donor of the value of the goods or services provided? 7b X e Did the organization sell, exchange, or otherwise dispose of tangible personal property for which 1t was required

to file Form 8282? 7c X d If "Yes," indicate the number of Forms 8282 filed during the year I 1ct I e Did the organization receive any funds, directly or mdirectly, to pay premiums on a personal benefit contract? 7e X f Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract? 7f X g If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required? 7a h If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098 C? 7h

8 Sponsoring organizations maintaining donor advised funds. Did a donor advised fund mamtamed by the sponsoring organization have excess busmess holdings at any time during the year? 8

9 Sponsoring organizations maintaining donor advised funds. a Did the sponsoring organization make any taxable drstnbutrons under section 4966? 9a b Did the sponsoring organization make a distnbution to a donor, donor advisor, or related person? 9b

10 Section 501(c)(7) organizations. Enter I 1oa I a trunation fees and capital contributions included on Part VIII, line 12

b Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facihtres 10b 11 Section 501(c)(12) organizations. Enter

a Gross income from members or shareholders 11a b Gross income from other sources (Do not net amounts due or paid to other sources against

amounts due or received from them ) 11b 12a Section 4947(a)( 1) non-exempt charitable trusts. Is the organization f1hng Form 990 1n heu of Form 1041? 12a

b If 'Yes," enter the amount of tax exempt interest received or accrued during the year I 12b I 13 Section 501(c)(29) qualified nonprofit health insurance issuers.

a Is the organization licensed to issue qualified health plans m more than one state? 13a Note. See the instructions for addtttonal information the organization must report on Schedule O

b Enter the amount of reserves the organization ts required to maintain by the states m which the organization rs licensed to issue qualified health plans I 1ab I

e Enter the amount of reserves on hand 13c 14a Did the organization receive any payments for indoor tanning services during the tax year? 14a X

b If "Yes ' has 1t filed a Form 720 to reoort these oavments? If 'No =orovtde an exolanat1on m Schedule O 14b Form 990 (2015)

532005 12-16 15

14000320 784176 0146700 5


Form990 2015 211 Palm Beach Treasure Coast Inc. 23-7153017 Pa e6 Part VI Governance, Management, and Disclosure For each "Yes ' response to Imes 2 through 7b below, and for a "No" response

to Ime Ba, Bb, or 10b below, descnbe the arcumstences, processes, or changes tn Schedule O See mstructions

Check tf Schedule O contains a response or note to any line in this Part VI [xJ

Yes No 23

23

2 X

3 X 4 X 5 X 6 X

7a X

7b X

Sa X Sb X

9 X

Section A Governing Body and Management

1a Enter the number of voting members of the governing body at the end of the tax year 1-'1'-"ª:....+---------"'-"'i If there are material differences in voting rights among members of the governing body, or tf the governing body delegated broad authority to an executive committee or smuar committee, explain in Schedule O.

b Enter the number of voting members included m line 1 a, above, who are independent c_:1:.=b:........i. ____,,,-"'i 2 Did any officer, director, trustee, or key employee have a family relationstup or a business relationstup with any other

officer, director, trustee, or key employee? 3 Did the organization delegate control over management duties customarily performed by or under the direct supervrsion

of officers, directors, or trustees, or key employees to a management company or other person? 4 Dtd the organization make any siçruncant changes to its governing documents since the pnor Form 990 was filed? 5 Did the organization become aware during the year of a s1gnif1cant diversron of the organization's assets? 6 Did the organization have members or stockholders? 7a Dtd the organization have members, stockholders, or other persons who had the power to elect or appoint one or

more members of the governing body? b Are any governance decrsrons of the organization reserved to (or subject to approval by) members, stockholders, or

persons other than the governing body? 8 Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following: a The governing body? b Each committee with authority to act on behalf of the governing body?

9 Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the oroaruzatron's maihno address? If 'Yes "oroviae the names and addresses tn Schedule O

Section B Policies (This Section B requests information about ooñctes not reawred bv the Internal Revenue Code)

10a Did the organization have local chapters, branches, or affiliates? b If 'Yes," did the organization have written poneres and procedures governing the activitres of such chapters, affiliates,

and branches to ensure their operations are consistent with the organization's exempt purposes? 11 a Has the organization provided a complete copy of this Form 990 to all members of its governing body before f1l1ng the form?

b Describe m Schedule O the process, tf any, used by the organization to review this Form 990 12a Did the organization have a written confhct of interest policy? If 'No,' go to Ime 13 b Were officers, directors, or trustees, and key employees required to disclose annually interests that could give rise to conflicts? c Did the organization regularly and consistently monitor and enforce compliance with the policy? If "Yes, 'descnbe

tn Schedule O how this was done 13 Did the organization have a written whrstleblower policy? 14 Did the organization have a written document retention and destruction policy? 15 Did the process for determining compensation of the following persons include a review and approval by independent

persons, comparability data, and contemporaneous substannanon of the deliberation and decrsion? a The organization's CEO, Executive Director, or top management otñciat b Other officers or key employees of the organization

If "Yes' to line 15a or 15b, describe the process m Schedule O (see mstructrons) 16a Dtd the organization invest in, contribute assets to, or participate m a Joint venture or smular arrangement with a

taxable entity during the year? b If "Yes," did the organization follow a written poltcy or procedure requiring the organization to evaluate rts parttcipanon

m 101nt venture arrangements under applicable federal tax law, and take steps to safeguard the organization's exemot status with resoect to such arranaements?

Yes No 10a X

10b 11a X

12a X 12b X

12c X 13 X 14 X

15a X 15b X

16a X

16b Section C. Disclosure 17 List the states with which a copy of this Form 990 rs required to be filed ~=F-=L=------------------------ 18 Section 6104 requires an orqamzation to make its Forms 1023 (or 1024 1f applicable), 990, and 990 T (Section 501 (c)(3)s only) available

for public mspection Indicate how you made these available Check all that apply [xJ Own website D Another's website D Upon request D Other (exp/am m Schedule O)

19 Describe ,n Schedule O whether (and 1f so, how) the organization made its governing documents, confhct of interest policy, and nnancrat statements available to the public during the tax year

20 State the name, address, and telephone number of the person who possesses the orqaruzation 's books and records ~ _ Mindy Gonzalez - 561 533-1096 P.O. Box 3588, Lantana, FL 33465

Form 990 (2015) 532006 12 16-15

14000320 784176 0146700 6


Form990 2015 211 Palm Beach Treasure Coast Inc. 23-7153017 Pa e 7 Part VII Compensation of Officers, Directors, Trustees, Key Employees, Highest Compensated

Employees, and Independent Contractors Check If Schedule O contains a response or note to any hne in this Part VII D

Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees 1a Complete this table for all persons required to be hsted Report compensation for the calendar year ending with or wrthm the organization's tax year

• List all of the organization's current officers, directors, trustees (whether mdrvrduals or orqamzanons), regardless of amount of compensation Enter ·O· m columns (D), (E), and (F) 1f no compensation was paid.

• List all of the orçaruzatron's current key employees, 1f any See mstructions for defmrtion of "key employee ' • List the organization's five current highest compensated employees (other than an officer, director, trustee, or key employee) who received report

able compensation (Box 5 of Form W-2 and/or Box 7 of Form 1099-MISC) of more than $100,000 from the organization and any related organizations • List all of the organization's former officers, key employees, and highest compensated employees who received more than $100,000 of

reportable compensation from the orqaruzatron and any related organizations • List all of the organization's former directors or trustees that received, m the capacity as a former director or trustee of the orqaruzatron,

more than $10,000 of reportable compensation from the organization and any related organizations List persons in the following order mdrvidual trustees or directors, msntutional trustees, officers, key employees, highest compensated employees, and former such persons De kh b f h h d ff d hec t IS ox I neit ert e oroaruzatron nor anv re ate orqaruzatron compensated anv current o reer, irector. or trustee

(A) (B) (C) (D) (E) (F) Name and Title Average Positron Reportable Reportable Estimated (do not check more than one

hours per box, unless person rs both an compensation compensation amount of week officer and a director/trustee) from from related other

(list any ~ the organizations compensation hours for .¡; ]! organization (;N 2/1099 MISC) from the related

o ~ ~ 0f'./ 2/1099 MISC) ~ organization

organizations -= E and related -= J e-,

~ o ~~ below a organizations :;; s ~~ ê s:

~ Ë line) ~ ~ !?e o :,::- .£

(1) Kimberly Camejo 2.00 Vice President X X o . o. o. (2) Raymond F. Ellis 2.00 Treasurer X X o . o. o. (3) Janie Fogt 2.00 Seeretarv X X o . o. o. (4) Sarah Alsofrom 1.00 Board Member X o . o. o. (5) Bruce Alvigi 1. OO Board Member X o . o. o. (6) Sandra Gove Chamblee 1. OO Board Member X o. o. o . (7) Dr. Yvette Coursey 1.00 Board Member X o . o. o. (8) John Deese 1.00 Board Member X o . o. o. ( 9) Teri Barbera 1.00 Board Member X o . o. o. (10) George Elmore 1. OO Board Member X o. o. o. (11) Christina Lambert 1. OO Board Member X o. o. o. (12) Bill Howden 1.00 Board Member X o. o. o. ( 13) Ty Barnes 1.00 Board Member X o . o. o. (14) Brendan Lynch 1.00 Board Member X o. o. o. ( 15 ) Toni May 1.00 Board Member X o . o. o. (16) Harry Pelton 1. OO Board Member X o . o. o. (17) Therese M. Shehan 1.00 Board Member X o. o . o . 532007 12 16-15 Form 990 (2015)

14000320 784176 0146700 7


Form 990 <2015\ 211 Palm Beach/Treasure Coast. Inc. 23-7153017 Paae8 I Part VII I Section A. Officers Directors Trustees Kev Em alovees and Hiahest Comoensated Emolovees (continued)

(A) (8) (C) (D) (E) (F) Name and title Average Posrtron Reportable Reportable Estimated (do not check more than one hours per box, unless person rs both an compensation compensation amount of

week officer and a director/trustee) from from related other (list any ~ the organizations compensation hours for .¡; !! organization 0N 2/1099 MISC) from the related o ~ :J! (>N-2/1099-MISC) ~ orçaruzanon ~ .s :¡¡

organizations _., ~ ~ e and related

below ~ .9 ~~ "S ~ ~ :a o § organizations

line) i ~ =ë. ~ '='E .£ o :,::~

(18) Nancy Lambrecht 2.00 Board Member X o. o. o. (19) Joanne Davis 1.00 Board Member X o . o. o. (20) Sarah Marcadis l. OO Board Member X o. o. o. (21) Susan K. Buza 40.00 President/CEO X 133.994. o. 1 320. (22) Mindy A. Gonzalez 40.00 Vice President of Finance and Admini X 66.584. o. 674. (23) Diane Huff 26.30 Director of Onerations X 46.478. o. 466. (24) Sharon L'Herrou 40.00 Vice President of Onerations X 70.576. o. 299.

1b Sub-total ..... 317.632. o. 2 759. e Total from continuation sheets to Part VII, Section A ..... o. o. o . d Total ladd lines 1b and 1cl ..... 317.632. o. 2 759.

2 Total number of mdrvtduals (mcludmq but not limited to those listed above) who received more than $100,000 of reportable comoensation from the orcaruzation ..... 1

Yes No 3 Did the organization list any former officer, director, or trustee, key employee, or highest compensated employee on

line ta? If "Yes, ' complete Schedule J for such mdtvtdue: 3 X 4 For any mdivtdual listed on line 1 a, rs the sum of reportable compensation and other compensation from the orqaruzation

and related organizations greater than $150,000? If "Yes," complete Schedule J for such tncùvtdus! 4 X 5 Did any person listed on line ta receive or accrue compensation from any unrelated orqaruzatron or mdividual for services

rendered to the oroamzatron? If "Yes 'como/ete Schedule J for such oerson 5 X Section B. Independent Contractors 1 Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from

the oroaruzanon Reoort comoensation for the calendar vear encima with or wrthm the oroaruzation's tax vear (A) (B) (C)

Name and business address NONE Descnption of services Compensation

2 Total number of independent contractors (mclud1ng but not limited to those listed above) who received more than $1 OO 000 of comoensation from the orcaruzatron ~ o

532008 12-16-15

Form 990 (2015)

14000320 784176 0146700 8


Form990 201s 211 Palm Beach Treasure Coast Inc. 23-7153017 Pa e9 Part VIII Statement of Revenue

D Check 1f Schedule O contains a resoonse or note to anv line m this Part VIII (A) (8) (C) (D)

Total revenue Related or Unrelated Revenue excluded exempt function business from tax under

sections revenue revenue 512 - 514

£l Cl) 1 a Federated campaigns 1a 501.487. Iii 'E ... :::, b Membership dues 1b e, o ~E e Fundrarsmq events 1c 91. 322. 4ª~ e;~ d Related organizations 1d

cñE e Government grants (contnbutions) 1e l. 266. 87f. e·- o<n f All other contributions, gifts, grants, and - ... '5 a, smuíar amounts not included above 1f 470.569. .c:5 EO g Noncash contnbunons included m Imes 1a·11 $ e-e Oc

h Total. Add lines 1a 1f .... 2 330.256. OCll Business Code

Gl 2a o s b Æ~ e E~ d c,J a, ¡;,a:

e o ... c. f All other program service revenue n Total. Add lines 2a-2f ....

3 Investment income (mcludmq divrdends, interest, and other smular amounts) .... 23. 23 .

4 Income from investment of tax exempt bond proceeds .... 5 Royalties ....

(1) Real (11) Personal

6a Gross rents 54,077. b Less rental expenses 54 263. e Rental income or (loss) -186. d Net rental income or (loss) .... -186. -186 .

7 a Gross amount from sales of (1) Securities 111) Other

assets other than inventory b Less cost or other basis

and sales expenses 48.884. e Gain or (loss) -48.884. d Net gain or (loss) .... -48.884. -48.884 •

Q) Sa Gross income from fundra1s1ng events (not :i mcludinq $ 911322. of e ~ contnounons reported on Ime 1 c) See Q) a: Part IV, line 18 79.508. ,_ a Q) 82.672 • .e b Less direct expenses b - o .... -3.164. -3 164. e Net income or (loss) from fundra1sing events

9a Gross income from garning acnvmes See Part IV, line 19 a

b Less direct expenses b e Net income or (loss) from gaming actrvrnes ....

10 a Gross sales of inventory, less returns and allowances a

b Less cost of goods sold b e Net income or (loss) from sales of mventorv ....

Miscellaneous Revenue Business Code

11 a Answering Services 900099 4.900. 4.900. b Training & Other Inc om 900099 4.250. 4.250. e Change in Value Split 900099 -1.565. -1.565. d All other revenue e Total. Add lines 11 a-11 d .... 7 585.

12 Total revenue See instructions. .... 2.285.630. 4 900. -186 . -49 340. 532009 12-16-15

Form 990 (2015)

14000320 784176 0146700 9


Part IX Statement of Functional Expenses Form 990 2015 211 Palm Beach Treasure Coast Inc. 23-7153017 Pa e10

Section 501 (c)(3) and 501 (c)(4) organtzat,ons must complete all columns All other organtzat,ons must complete column (A)

Do not include amounts reported on /Ines 6b, lb, Bb, 9b, and 10b of Part VII/.

Check 1f Schedule O contains a response or note to anv Ime m this Part IX D (A) (B)

Total expenses Program service expenses

(C) Management and aeneral expenses

(D) Fundra1smg expenses

1 Grants and other assistance to domestic organizations and domestic governments. See Part IV, Ime 21

2 Grants and other assistance to domestic mdividuals See Part IV, line 22

3 Grants and other assistance to foreign organizations, foreign governments, and foreign mdivrduals See Part IV, lines 15 and 16

4 Benefits paid to or for members 5 Compensation of current officers, directors,

trustees, and key employees 6 Compensation not included above, to disquahüed

persons (as defined under section 4958(f)(1)) and persons described m section 4958(c)(3)(B)

7 Other salaries and wages s Pension plan accruals and contributions (include

section 401(k) and 403(b) employer contributions) 9 Other employee benefits 10 Payroll taxes 11 Fees for services (non employees)

a Management b Legal e Accounting d Lobbying e Professional fundrarsmq services. See Part IV, Ime 17 1---------+-------1---------1------- f Investment management fees g Other (If Ime 11g amount exceeds 10% of Ime 25,

column (A) amount, list Ime 11g expenses on Sch O.) 1-----=..:=--<..-=-:::..=..-=+------==-=..t....:,:.=.,:o.....:..+------=-=::....:_-=+--------"'=-==:.....:... 12 Advernsmq and promotion 13 Office expenses 14 Information technology 15 Royalties 16 Occupancy 17 Travel 18 Payments of travel or entertainment expenses

for any federal, state, or local public offtcrals 19 Conferences, conventions, and meetings 20 Interest 21 Payments to affiliates 22 Deprecration, depletion, and amornzation 23 Insurance 24 Other expenses. Itemize expenses not covered

above. (List miscellaneous expenses m Ime 24e. If Ime 24e amount exceeds 10% of Ime 25, column (A) amount, list Ime 24e expenses on Schedule O.)

a Equipment Repairs & Mai b Operating Supplies e Other Expenses d --------------- e All other expenses _

25 Total functional expenses Add Imes 1 throuah 24e

33 368. 33.368.

367.087. 338.251. 15.257. 13,579.

1. 211. 011. 1.115.882. 50.332. 44,797.

10.493. 9.783. 331. 379. 179.504. 136.897.

167 128. 127 459.

5.876. 4 481.

6,500. 4 957.

24,525. 23.020. 632. 873.

33.585. 32.829. 327. 429. 38.225. 37 342. 244. 639.

100,231. 86.695. 4 950. 8,586. 65.398. 65 398.

20 716. 71. 20.642. 3. 26.492. 24.769. 629. 1. 094.

3 034. 3.034.

41.862. 31 486. 9 105. 1. 271. 39.369. 36 259. 1.673. 1.437.

33 933. 30.735. 1.884. 1 314. 25.915. 24.622. 364. 929. 6,678. 5.602. 830. 246.

2,398.323. 2.190.699. 120.591. 87,033. 26 Joint costs Complete this Ime only 1f the organization

reported m column (B) Joint costs from a combined educational campaign and fundra1smg sohcitanon, Check here lilJ,, O 1! toüowmn SOP 98 2 fASC 958-720\

532010 12-16-15 Form 990 (2015) 10

2015.05050 211 Palm Beach/Treasure Coa 01467001 14000320 784176 0146700

Form990 2015 211 Palm Beach Treasure Coast Inc. 2 3 - 715 3 O 1 7 Pa e 11 Part X Balance Sheet

C kfSh 10 D hec I c edue contains a resoonse or note to anv line in this Part X (A) (B)

Beginning of year End of year

1 Cash · non-interest bearing 473. 1 29. 2 Savings and temporary cash investments 115,149. 2 2 943. 3 Pledges and grants receivable, net 55.121. 3 109,923. 4 Accounts receivable, net 35,026. 4 10 028. 5 Loans and other receivables from current and former officers, directors,

trustees, key employees, and highest compensated employees Complete Part li of Schedule L 5

6 Loans and other receivables from other dtsquahñed persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501 (c)(9) voluntary

VI employees' benenciary orçaruzatrons (see instr) Complete Part li of Sch L 6 'li, VI 7 Notes and loans receivable, net 7 VI c:i: 8 Inventories for sale or use 8

9 Prepaid expenses and deferred charges 13,633. 9 8,207. 10a Land, buildings, and equipment cost or other

basis Complete Part VI of Schedule D 10a 1 204 396. b Less accumulated depreciatron 10b 790 725. 520 616. 10c 413. 671.

11 Investments publicly traded secunties 11 40,147. 12 Investments · other securities See Part IV, line 11 12

13 Investments · program related See Part IV, line 11 13

14 Intangible assets 14

15 Other assets See Part IV, line 11 10.593. 15 8,746. 16 Total assets. Add lines 1 throuah 15 lmust eaual line 34\ 750 611. 16 593.694. 17 Accounts payable and accrued expenses 178.662. 17 114,308. 18 Grants payable 18

19 Deferred revenue 3 000. 19 2 250. 20 Tax exempt bond lrabumes 20

21 Escrow or custodial account habihty Complete Part IV of Schedule D 21

VI 22 Loans and other payables to current and former officers, directors, trustees, Cl) g key employees, highest compensated employees, and drsquahñed persons ..ô Complete Part li of Schedule L 22 etl :J 23 Secured mortgages and notes payable to unrelated third parties 157.829. 23 178.709.

24 Unsecured notes and loans payable to unrelated third parties 24

25 Other habihttes (including federal income tax, payables to related third parties, and other habihtres not included on lines 17 24) Complete Part X of Schedule D 10.000. 25 10.000.

26 Total liab1hties. Add lines 17 throuoh 25 349. 491. 26 305.267. Organizations that follow SFAS 117 (ASC 958), check here ...... [xJ and

VI complete lines 27 through 29, and lines 33 and 34. Cl) o 27 Unrestricted net assets 292.235. 27 170 093. e: etl 108 885. 118 334. iii 28 Temporarily restricted net assets 28 cc 'O 29 Permanently restricted net assets 29 e:

Organizations that do not follow SFAS 117 (ASC 958), check here ...... D j LL ... and complete lines 30 through 34. o VI 30 Capital stock or trust principal, or current funds 30 - Cl) VI 31 Paid m or capital surplus, or land, building, or equipment fund 31 VI -e - 32 Retained earnings, endowment, accumulated income, or other funds 32 Cl) z 33 Total net assets or fund balances 401.120. 33 288.427.

34 Total habihtres and net assets/fund balances 750. 611. 34 593.694. Form 990 (2015)

532011 12-16-15

14000320 784176 0146700 11


Form990 2015 211 Palm Beach Treasure Coast Inc. 23-7153017 Pa e 12 Part XI Reconciliation of Net Assets

Ch k f S h d I O h D ec I c e ue con ams a response or no e to anv me in t rs Part XI

1 Total revenue (must equal Part VIII, column (A), line 12) 1 2.285.630. 2 Total expenses (must equal Part IX, column (A), Ime 25) 2 2.398,323. 3 Revenue less expenses Subtract line 2 from Ime 1 3 -112.693. 4 Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) 4 401,120. 5 Net unrealized gains (losses) on investments 5 6 Donated services and use of facmtres 6 7 Investment expenses 7 8 Pnor penod ad¡ustments 8 9 Other changes m net assets or fund balances (explain m Schedule O) 9 o. 10 Net assets or fund balances at end of year Combine Imes 3 through 9 (must equal Part X, line 33,

column IB)) 10 288,427. I Part XIII Financial Statements and Reporting

Check 1f Schedule O contains a resoonse or note to any line m this Part XII Yes No

1 Accounting method used to prepare the Form 990 O cash [x] Accrual D Other If the organization changed rts method of accounting from a pnor year or checked "Other,' explain in Schedule O

2a Were the organization's ñnancial statements compiled or reviewed by an independent accountant? 2a X If "Yes,' check a box below to indicate whether the financial statements for the year were compiled or reviewed on a separate basis, consolidated basis, or both D Separate basis D Consolidated basis D Both consolidated and separate basis

b Were the organization's financial statements audited by an independent accountant? 2b X If "Yes,' check a box below to mdicate whether the ñnancral statements for the year were audited on a separate basis, consolidated basis, or both D Separate basis [x] Consolidated basis D Both consolidated and separate basis

e If "Yes" to line 2a or 2b, does the organization have a committee that assumes responsibihty for oversight of the audit, review, or cornpnatron of its ftnancial statements and selection of an independent accountant? 2c X If the organization changed either its oversight process or selection process dunng the tax year, explain in Schedule O

3a As a result of a federal award, was the organization required to undergo an audit or audits as set forth ,n the Single Audit Act and OMB Circular A-133? 3a X

b If 'Yes," did the organization undergo the required audit or audits? If the organization did not undergo the required audit or audits exolam whv m Schedule O and describe anv steos taken to underao such audits 3b

Form 990 (2015)

532012 12-16 15

14000320 784176 0146700 12


SCHEDULE A 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. Department of the Treasury ..... Attach to Form 990 or Form 990-EZ. Open to Public Internal Revenue Service ..... lnformabon about Schedule A (Form 990 or 990-EZ) and its mstrucbons rs at www.lrs.gov/form990. Inspection

OMB No 1545 0047

2015 (Form 990 or 990-EZ)

Name of the organization Employer identification number

211 Palm Beach Treasure Coast Inc. 23-7153017 Part I Reason for Public Charity Status (All organizations must complete this part ) See instructions

The organization rs not a private foundation because rt 1s· (For lines 1 through 11, check only one box.) 1 D A church, convention of churches, or assocratron of churches described in section 170(b)(1)(A)(i). 2 D A school described m section 170(b)(1)(A)(it). (Attach Schedule E (Form 990 or 990-EZ)) 3 D A hospital or a cooperative hospital service organization described m section 170(b)(1)(A)(iii). 4 D A medical research organization operated m coruunctron with a hospital described in section 170(b)(1)(A)(m). Enter the hospital's name,

city, and state-------------------------------------------- 5 D An organization operated for the benefit of a college or university owned or operated by a governmental unit described m

section 170(b)(1)(A)(iv). (Complete Part li) 6 D A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v). 7 [xJ An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in

section 170(b)(1)(A)(v1). (Complete Part li) 8 D A community trust described in section 170(b)(1)(A)(v1). (Complete Part li) 9 D An organization that normally receives (1) more than 33 1/3% of its support from contributions, membership fees, and gross receipts from

acnvrtres related to its exempt functions subject to certain exceptions, and (2) no more than 33 1/3% 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 Ill)

10 D An organization organized and operated exclusively to test for public safety See section 509(a)(4). 11 D An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or

more publicly supported orqaruzations described m section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box in lines 11 a through 11 d that describes the type of supporting organization and complete lines 11 e, 11 f, and 11 g

a D Type l. A supporting organization operated, supervised, or controlled by its supported orçaruzatrorus). typically by g1v1ng the supported orqamzanonts) the power to regularly appoint or elect a majority of the directors or trustees of the supporting organization You must complete Part IV, Sections A and B.

b D Type li. A supporting organization supervised or controlled in connection with its supported orqaruzanonïs), by having control or management of the supporting organization vested m the same persons that control or manage the supported orçarnzanorus) You must complete Part IV, Sections A and C.

c D Type Ill functionally integrated. A supporting organization operated m connection with, and functionally integrated with, its supported orqaruzationts) (see mstrucnons) You must complete Part IV, Sections A, D, and E.

d D Type Ill non-functionally integrated. A supporting organization operated m connection with its supported orqaruzationts) that rs not functionally integrated The organization generally must satisfy a drstnbunon requirement and an attentiveness requirement (see mstrucnons) You must complete Part IV, Sections A and D, and Part V.

D Check this box 1f the organization received a wntten detsrmmauon from the IRS that rt 1s a Type l, Type li, Type Ill e functionally integrated, or Type Ill non functionally integrated supporting organization

Enter the number of supported organizations g Provide the followmo information about the suooorted oraarnzatronts)

(1) Name of supported (u) EIN (111) Type of organization (1v) Is the organization (v) Amount of monetary (v1) Amount of organization (described on Imes 1 9 listed m your support (see other support (see

above (see mstructronsn governing document? mstructions) Yes No mstructions)

Total LHA For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ. 532021 09.23 15

Schedule A (Form 990 or 990-EZ) 2015

14000320 784176 0146700 13


ScheduleA Form990or990· 2015 211 Palm Beach Treasure Coast Inc. 23-7153017 Pa e2 Part li Support Schedule for Organizations Described in Sections 170(b}(1}(A}(iv} and 170(b}(1}(A}(vi}

(Complete only 1f you checked the box on hne 5, 7, or 8 of Part I or 1f the organization failed to qualify under Part Ill If the organization fails to qualify under the tests listed below, please complete Part Ill )

Section A. Public Support Calendar year (or fiscal year beginning in) ..... lal 2011 (bl 2012 Cc\ 2013 (dl 2014 Cel 2015 mTotal

1 Gifts, grants, contnbunons, and membership fees received (Do not include any "unusual grants ") 1731998. 1831572. 1874401. 2092197. 2330256. 9860424.

2 Tax revenues levied for the organ izanon's benefit and either paid to or expended on its behalf

3 The value of services or facthtres furnished by a governmental unit to the organization without charge

4 Total. Add Imes 1 through 3 1731998. 1831572. 1874401. 2092197. 2330256. 9860424. 5 The portion of total contnbutions

by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on Ime 11, column (f) 282. 591.

6 Public suonort, Subtract line 5 from line 4 9577833. Section B. Total Support Calendar year (or fiscal year beginning in) ..... lal 2011 (bl 2012 {cl 2013 {dl 2014 lei 2015 mTotal 7 Amounts from Ime 4 1731998. 1831572. 1874401. 2092197. 2330256. 9860424. 8 Gross income from interest,

civrdenda, payments received on securities loans, rents, royalties and income from smular sources 99,419. 35 545. 39.305. 52.346. 54.100. 280.715.

9 Net income from unrelated busmess actrvmes, whether or not the business rs regularly earned on

10 Other income Do not include gain or loss from the sale of capital assets (Explain m Part VI.) 65.500. 36 100. 57.072. 15.117. 9 150. 182 939.

11 Total support. Add Imes 7 through 10 10324078. 12 Gross receipts from related activmes, etc (see instructions) 12 I 393.661. 13 First five years. If the Form 990 rs 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 14 Public support percentage for 2015 (line 6, column (f) divrded by line 11, column (f)) 15 Public support percentage from 2014 Schedule A, Part li, line 14

14 92.77 % 15 92.82 %

16a 33 1/3% support test- 2015. If the organization did not check the box on line 13, and Ime 14 is 33 1/3% or more, check this box and stop here. The organization qualrñes as a publicly supported organization ..... [xJ

b 33 1/3% support test - 2014. If the organization did not check a box on Ime 13 or 16a, and Ime 15 rs 33 1/3% or more, check this box and stop here. The organization qualifies as a publicly supported organization ..... D

17a 10% -tacts-and-ctrcumstances test - 2015. If the organization did not check a box on line 13, 16a, or 16b, and Ime 14 rs 10% or more, and 1f the organization meets the "facts-and circumstances ' test, check this box and stop here. Explain m Part VI how the orçaruzanon meets the "facts-and circumstances" test The organization qualifies as a publicly supported organization ..... D

b 10% -facts-and-circumstances test - 2014. If the organization did not check a box on line 13, 16a, 16b, or 17a, and line 15 ts 10% or more, and 1f the organization meets the "facts and crrcumstances ' test, check this box and stop here. Explain m Part VI how the organization meets the "facts and circumstances" test The organization qualifies as a publicly supported organization ..... D

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 li!': D Schedule A (Form 990 or 990-EZ) 2015

532022 09-23 15

14000320 784176 0146700 14


Schedule A Form99Dor99D 2015 211 Palm Beach Treasure Coast Inc. 23-7153017 Pa e3 Part Ill Support Schedule for Organizations Described in Section 509(a)(2)

(Complete only 1f you checked the box on line 9 of Part I or 1f the organization failed to qualify under Part li If the organization fails to qualify under the tests listed below, please complete Part li )

Section A. Public Support Calendar year (or fiscal year beginning in),.... Ca) 2011 lb)2012 Ici 2013 ldl 2014 lel 2015 {fl Total

1 Gifts, grants, contnbutions. and membership fees received. (Do not include any "unusual grants ")

2 Gross receipts from admrssions, merchandise sold or services per formed, or tacihnes furnished m any acnvity that ts related to the organization's tax exempt purpose

3 Gross receipts from activrtres that are not an unrelated trade or bus mess under section 513

4 Tax revenues levied for the organ ization's benefit and either paid to or expended on its behalf

5 The value of services or facilrttes 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 drsquaírñed persons b Amounts included on lines 2 and 3 received

from other than drequauñed persons that exceed the greater of $5 000 or 1% of the amount on Ime 13 for the year

e Add Imes 7a and 7b 8 Public suooort, !Subtractlrne 7cfrom Ime 6 l

Section B. Total Support Calendar year (or fiscal year beginning in),.... Cal 2011 lb) 2012 le) 2013 ldl 2014 lel 2015 {fl Total 9 Amounts from Ime 6 10a Gross income from interest,

drvrdends. payments received on securities loans, rents, royalties and income from smular sources

b Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975

e Add Imes 1 Da and 1 Ob 11 Net income from unrelated business

acnvmss not included m line 1 Ob, whether or not the busmess rs regularly earned on

12 Other income Do not include gain or loss from the sale of capital assets (Explain m Part VI )

13 Total support (Add lines g toc 11 and 12)

14 First five years. If the Form 990 rs 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 Percanta e

Section D. Computation of Investment Income Percentage

15 Public support percentage for 2015 (line 8, column (f) divided by line 13, column (f)) 16 Public su ort ercenta e from 2014 Schedule A Part Ill line 15

15 % 16 %

17 Investment income percentage for 2015 (hne 1 Oc, column (f) d1v1ded by hne 13, column (f)) 18 Investment income percentage from 2014 Schedule A, Part Ill, line 17

17 % 18 %

19a 33 1/3% support tests - 2015. If the organization did not check the box on line 14, and line 15 rs more than 33 1/3%, and hne 17 rs not more than 33 1 /3%, check this box and stop here. The organization qualifies as a publicly supported organization

b 33 1/3% support tests - 2014. If the organization did not check a box on line 14 or line 19a, and line 16 rs more than 33 1 /3%, and line 18 ,s not more than 33 1 /3%, check this box and stop here. The organization qualifies as a publicly supported organization ,.... O

20 Private foundation. If the organization did not check a box on line 141 19a, or 19b, check this box and see instructions ~ O 532023 og 23 15 Schedule A (Form 990 or 990-EZ) 2015

14000320 784176 0146700 15


ScheduleA Form990or990· 2015 211 Palm Beach Treasure Coast Part IV Supporting Organizations

(Complete only 1f you checked a box m line 11 on Part I If you checked 11 a of Part I, complete Sections A and B If you checked 11 b of Part I, complete Sections A and C If you checked 11 e of Part I, complete Sections A, D, and E If you checked 11 d of Part I, complete Sections A and D, and complete Part V)

Inc. 2 3 - 715 3 O 1 7 Pa e 4

Section A. All Suooorting Oraanizations Yes No

1 Are all of the organization's supported organizations listed by name m the organization's governing documents? If 'No" descnbe tn Part VI how the supported organizations are designated If designated by class or purpose, descnbe the designation If histone and contmwng releuonsrup, exp/am. 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," exp/am m Part VI how the organization determined that the supported organization was descnbed m section 509(a)(1) or (2) 2

3a Did the organization have a supported organization described m section 501 (c)(4), (5), or (6)? If "Yes, ' answer (b) and (e) below 3a

b Did the organization confirm that each supported organization qualified under section 501 (c)(4), (5), or (6) and satrsfred the public support tests under section 509(a)(2)? If "Yes," descnbe m Part VI when and how the organization made the aetermmeiton 3b

e Did the organization ensure that all support to such organizations was used exclusively for section 170(c)(2)(8) purposes? If 'Yes, 'exp/am tn Part VI what controls the organization put tn place to ensure such use 3c

4a Was any supported organization not organized m the United States ("foreign supported organization")? If "Yes," and if you checked 11 a or 11 b tn Part I, answer (b) and (e) below 4a

b Did the organization have ultimate control and discretton m deciding whether to make grants to the foreign supported organization? If "Yes, ' descnbe tn Part VI how the organization had such control and discretion despite bemg controlled or supervised by orm connection with its supported organizations 4b

e 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, ' exp/am tn Part VI what controls the organization used to ensure that all support to the foreign supported organization was used exclus,vely 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 apphcable) Also, provide detail tn Part VI, mcludmg (1) the names and EIN numbers of the supported organizations added, substituted, or removed, (11) the reasons for each such action, (111) the authonty under the organization's organizing document authonzmg such action, and (iv) how the action was accomphshed (such as by amendment to the organizing document) 5a

b Type I or Type li only. Was any added or substituted supported organization part of a class already designated m the organization's organizing document? 5b

e Substitutions only. Was the substrtution the result of an event beyond the organization's control? 5c 6 Did the organization provide support (whether m the form of grants or the provision of services or facilrtres) to

anyone other than (1) its supported organizations, (11) mdivrduals that are part of the charitable class benefited by one or more of its supported organizations, or (111) other supporting organizations that also support or benefit one or more of the filing organization's supported organizations? If 'Yes," provide detail ,n Part VI. 6

7 Did the organization provide a grant, loan, compensation, or other smular payment to a substantial contributor (defined m section 4958(c)(3)(C)), a family member of a substantial contributor, or a 35% controlled entity with regard to a substantial contributor? If "Yes, ' complete Part I of Schedule L (Form 990 or 990-EZ) 7

8 Did the organization make a loan to a disquahfted person (as defined m section 4958) not described m Ime 7? If "Yes, ' complete Part I of Schedule L (Form 990 or 990-EZ) 8

9a Was the organization controlled directly or indirectly at any time during the tax year by one or more drsquahñed persons as defined m section 4946 (other than foundation managers and organizations described m section 509(a)(1) or (2))? If 'Yes," provide detail tn Part VI. 9a

b Did one or more drsquahfred persons (as defined m line 9a) hold a controlling interest m any entity m which the supporting organization had an interest? If 'Yes," provide detail tn Part VI. 9b

e Did a drsquahfied person (as defined m line 9a) have an ownership interest m, or derive any personal benefit from, assets m which the supporting organization also had an interest? If 'Yes," provide detail m Part VI. 9c

10a Was the organization subject to the excess business holdings rules of section 4943 because of section 4943(f) (regarding certain Type li supporting organizations, and all Type Ill non-functionally integrated supporting organizations)? If 'Yes," answer 10b below 10a

b Did the organization have any excess business holdings m the tax year? (Use Schedule C, Form 4720, to determine whether the orastuzstton had excess busmess holdmas I 10b

532024 09 23 15

14000320 784176 0146700 16



2ms 211 Palm Beach Treasure Coast Inc. 23-7153017 Pa e5 anizations continued

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 m (b) and (e)

below, the governing body of a supported organization? b A family member of a person described m (a) above?

rovuie detail tn Part VI.

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 ma¡onty of the organization's directors or trustees at all times dunng the tax year? If 'No, ' descnbe tn Part VI how the supported organizat,on(s) effectively operated, supervtsed, or controlled the organization's ecuvmee If the organization had more than one supported orgamzatton, descnbe how the powers to appoint and/or remove directors or trustees were allocated among the supported organizations and what concùttons or restnettons, if any, applted to such powers during the tax year

2 Did the orqaruzation operate for the benefit of any supported organization other than the supported orçaruzatrorus) that operated, supervised, or controlled the supporting organization? If 'Yes," exp/am in Part VI how providing such benefit earned out the purposes of the supported orgamzat,on(s) that operated,

Yes No

11a 11b 11c

2

Yes No 1 Were a rnaionty of the organization's directors or trustees dunng the tax year also a ma¡onty of the directors

or trustees of each of the orqaruzauon's supported orgarnzat1on(s)? If "No," descnbe in Part VI how control

Yes No 1 Did the orqaruzatron 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, (11) a copy of the Form 990 that was most recently filed as of the date of notmcanon, and (111) copies of the organization's governing documents m effect on the date of notmcanon, to the extent not previously provided?

2 Were any of the organization's officers, directors, or trustees either (1) appointed or elected by the supported orçaruzattonts) or (11) serving on the governing body of a supported organization? If "No," explain in Part VI how the organization maintained a close and continuous working reteuonsmp with the supported orgamzat,on(s)

3 By reason of the relatronslup described m (2), did the organization's supported organizations have a siqruñcant voice m the organization's investment policies and m directing the use of the organization's income or assets at all times dunng the tax year? If "Yes,' descnbe tn Part VI the role the organization's su orted or. emzeuons la ed in this re ard

2

3 Section E. Type Ill Functionally-Integrated Supporting Organizations

1 Check the box next to the method that the organization used to satisfy the Integral Part Test during the yea(see Instructions): a D The organization sansñsd the Actrvities Test Complete /Ine 2 below b D The organization rs the parent of each of its supported organizations Complete Ime 3 below e D The orqamzation supported a governmental entity Descnbe in Part VI how you supported a government entity (see instructions)

2 Activrtres Test Answer (a) and (b) below. Yes No a Did substantially all of the organization's activrties during the tax year directly further the exempt purposes of

the supported orqaruzatrorus) to which the organization was responsive? If 'Yes, ' then m Part VI Identify those supported organizations and explain how these acnvmes dtrectly furthered thetr exempt purposes, how the organization was responsive to those supported orçemzetions, and how the organization determined that these ecuvmes constituted substantially all of its ectivme« 2a

b Did the activmes described m (a) constitute activitres that, but for the organization's involvement, one or more of the organization's supported orqaruzanonís) would have been engaged m? If 'Yes, ' exp/am in Part VI the reasons for the organization's posmon that tts supported orgamzat,on(s) would have engaged m these ecuvtues but for the orqenaetion '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 majonty of the officers, directors, or

trustees of each of the supported organizations? Provide details m Part VI. 3a b Did the organization exercise a substantial degree of direction over the poucies, programs, and act1v1t1es of each

of its sunnorted oroaruzatrons? If 'Yes " describe m Part VI the role olaved bv the oraentæuon m this reaard 3b 532025 09 23-15 Schedule A (Form 990 or 990-EZ) 2015

14000320 784176 0146700 17


23-7153017 Pa e6

Check here 1f the organization satrsñed the Integral Part Test as a qualifying trust on Nov 20, 1970 See instructions. All other Tvoe Ill non-functionallv integrated supportmq orcaruzanons must comolete Sections A throuqh E

Section A - Adjusted Net Income (A) Pnor Year (B) Current Year

(optional)

1 Net short-term caortal nam 1 2 Recovenes of pnor year drstnbutions 2 3 Other aross income (see mstructionsï 3 4 Add Imes 1 throuah 3 4 5 Depreciatron 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 orooertv held for production of income (see mstructrons) 6

7 Other expenses (see instructions) 7 8 Adiusted Net Income (subtract Imes 5, 6 and 7 from hne 4) 8

Section B - Minimum Asset Amount (A) Pnor Y ear (B) Current Year

(optional)

1 Aggregate fatr market value of all non-exempt use assets (see mstructions for short tax year or assets held for part of year)

a Averace monthly value of securrttes 1a b Averaae monthly cash balances 1b c Fair market value of other non exempt use assets 1c d Total (add hnes 1 a, 1 b, and 1 cl 1d e Discount claimed for blockage or other

factors (explain m detail m Part Vil 2 Acqursrtion indebtedness applicable to non exempt use assets 2 3 Subtract Ime 2 from hne 1 d 3 4 Cash deemed held for exempt use Enter 1 1/2% of Ime 3 (for greater amount,

see mstructrons) 4 5 Net value of non exemot use assets (subtract hne 4 from line 3) 5 6 Multiply hne 5 by 035 6 7 Recovenes of onor year distnbutrons 7 8 Minimum Asset Amount (add Ime 7 to Ime 6) 8

Section C - Distributable Amount Current Year

1 Adjusted net income for onor year (from Section A, hne 8, Column A) 1 2 Enter 85% of Ime 1 2 3 Minimum asset amount for onor year (from Section B, hne 8, Column Al 3 4 Enter ç¡reater of hne 2 or hne 3 4 5 Income tax unoosed m onor vear 5 6 Distributable Amount. Subtract Ime 5 from hne 4, unless sub¡ect to

emergency temporary reduction (see instructions) 6 7 LJ Check here 1f the current year rs the organization's first as a non functionally integrated Type Ill supporting organization (see

mstructrons Schedule A (Form 990 or 990-EZ) 2015

532026 09-23·15

14000320 784176 0146700 18


Schedule A (Form 990 or 990-EZ) 2015 211 Palm Beach/Treasure Coast. Inc. 23-7153017 Paae7 I Part V I Type Ill Non-Functionally Integrated 509 a)(3) Suooortina Organizations (continued) Section D - Distributions Current Year

1 Amounts paid to suonorted omaruzauons to accomplish exempt Purposes 2 Amounts paid to perform actïvity that directly furthers exempt purposes of supported

oraaruzanons, in excess of income from activitv 3 Adrmrustranve expenses paid to accomplish exempt purposes of supported oroaruzatrons 4 Amounts paid to acquire exempt use assets 5 Qualified set-aside amounts (onor IRS aonroval recuuec) 6 Other drstnbutions (describe m Part VI) See mstructrons ' 7 Total annual distributions. Add lines 1 throuah 6 8 Distnbutrons to attentive supported organizations to which the organization ts responsive

(provide details m Part VI) See instructions 9 Drstnbutable amount for 2015 from Section C, line 6 10 Line 8 amount divided by Line 9 amount

(i) (ii) (iii) Excess Distributions Underd1str1butions Distributable

Section E - Dlstnbutron Allocations (see instructions) Pre-2015 Amount for 2015

1 D1stnbutable amount for 2015 from Section C, line 6 2 Underdrstnbunons, 1f any, for years pnor to 2015

(reasonable cause required see instructions) 3 Excess dtstnbutrons carrvover, 1f any, to 2015 a b c d From 2013 e From 2014 f Total of lines 3a through e a Aonhed to underdrstnbutrons of onor years h Aoohed to 2015 distnbutabie amount i Carrvover from 201 O not aoohed (see mstrucnons) I Remainder Subtract lines 3g, 3h, and 31 from 3f

4 Drstnbutions for 2015 from Section D, line 7 $

a Aoolied to underdtstnbutrons of pnor vears b Annhed to 2015 distnbutable amount c Remainder Subtract hnes 4a and 4b from 4

5 Remaining underdistnbuucns for years pnor to 2015, 1f any Subtract lines 3g and 4a from hne 2 (1f amount greater than zero, see mstructions)

6 Remaining underdrstnbunona for 2015 Subtract lines 3h and 4b from Ime 1 (1f amount greater than zero, see instruction sl

7 Excess distributions carryover to 2016. Add lines 3J and 4c

8 Breakdown of line 7 a b e Excess from 2013 d Excess from 2014 e Excess from 2015


532027 09-23 15

14000320 784176 0146700 19


ScheduleA Form990or990· 2015 211 Palm Beach Treasure Coast Inc. 23-7153017 Pa es Part VI Supplemental Information. Provide the explanations required by Part li, Ime 10, Part li, Ime 17a or 17b, Part Ill, Ime 12,

Part IV, Sectron A, lrnes 1, 2, 3b, 3c, 4b, 4c, 5a, 6, 9a, 9b, 9c, 11 a, 11 b, and 11 c, Part IV, Sectron B, lrnes 1 and 2, Part IV, Sectron C, lrne 1, Part IV, Section D, Ir nes 2 and 3, Part IV, Sectron E, Imes 1 o, 2a, 2b, 3a and 3b. Part V, lrne 1, Part V, Section B, lrne 1 e, Part V, Section D, lrnes 5, 6, and 8, and Part V, Sectron E, lrnes 2, 5, and 6. Also complete thrs part for any addrtronal rnformatron (See rnstructrons )

532028 09 23 15 Schedule A (Form 990 or 990-EZ) 2015

14000320 784176 0146700 20


** PUBLIC DISCLOSURE COPY**

Schedule B (Form 990, 990-EZ, or 990-PF) Department of the Treasury Internal Revenue Service

Schedule of Contributors ~ Attach to Form 990, Form 990-EZ, or Form 990-PF.

~ Information about Schedule B (Form 990, 990-EZ, or 990-PF) and its instructions is at www.irs.gov/form990 . 2015

OMB No 1545 0047

211 Palm Beach/Treasure Coast. Inc.

Employer ldentrñcatron number Name of the organization

23-7153017 Organization type(check one)

Filers of: Section:

Form 990 or 990-EZ [xJ 501 (c)( 3 ) (enter number) organization

D 494 7(a)(1) nonexempt charitable trust not treated as a private foundation

D 527 political organization

Form 990 PF D 501 (c)(3) exempt private foundation

D 4947(a)(1) nonexempt charitable trust treated as a private foundation

D 501 (c)(3) taxable private foundation

Check 1f your organization rs covered by the General Rule or a Special Rule. Note. Only a section 501 (c)(7), (8), or (1 O) organization can check boxes for both the General Rule and a Special Rule See mstructions

General Rule

D For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, contributions totaling $5,000 or more (1n money or property) from any one contributor Complete Parts I and li See mstructions for determining a contributor's total contributions

Special Rules

[xJ For an organization described in section 501 (c)(3) filing Form 990 or 990 EZ that met the 33 1 /3% support test of the regulations under sections 509(a)(1) and 170(b)(1)(A)(v1), that checked Schedule A (Form 990 or 990-EZ), Part li, line 13, 16a, or 16b, and that received from any one contributor, during the year, total contributions of the greater of (1) $5,000 or (2) 2% of the amount on (1) Form 990, Part VIII, line 1 h, or (11) Form 990 EZ, line 1 Complete Parts I and li

D For an organization described m section 501 (c)(7), (8), or (1 O) filing Form 990 or 990 EZ that received from any one contributor, during the year, total contributions of more than $1,000 exclus,vely for religious, charitable, screntrñc, literary, or educational purposes, or for the prevention of cruelty to children or animals Complete Parts I, li, and Ill

D For an organization described in section 501 (c)(7), (8), or (1 O) filing Form 990 or 990 EZ that received from any one contributor, during the year, contributions exc/ustve/y for rel1g1ous, charitable, etc , purposes, but no such contributions totaled more than $1,000 If this box rs checked, enter here the total contributions that were received during the year for an exc/ustvely religious, charitable, etc , purpose Do not complete any of the parts unless the General Rule applies to this orqamzanon because 1t received nonexclus,vely religious, charitable, etc , contributions totaling $5,000 or more during the year ~ $ _

Caution. An organization that rs not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990, 990 EZ, or 990 PF), but rt must answer "No" on Part IV, line 2, of its Form 990, or check the box on line Hof its Form 990 EZ or on its Form 990 PF, Part I, line 2, to certify that rt does not meet the filing requirements of Schedule B (Form 990, 990-EZ, or 990-PF)

LHA 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) (2015)

523451 10-26-15

211 Palm Beach Treasure Coast Inc.

Page2 Schedule B (Form 990, 990 EZ, or 990-PF) (2015) Name of organization Employer identification number

23-7153017 Part I Contributors (see mstructtons) Use duplicate copies of Part I 1f addrttonal space is needed

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

__ 1 Person [xJ Payroll D

$ 2061850. Noncash D (Complete Part li for noncash contributions ) ,



$ 215 1 771. Noncash D (Complete Part li for noncash contributions )

(a) (b} (c) (d) No. Name, address, and ZIP + 4 Total contributions Type of contribution


$ 1711000. Noncash D (Complete Part li for noncash contributions )



$ 280 1 631. Non cash D (Complete Part li for noncash contnbutions )

(a) (b) (c) (d} No. Name, address, and ZIP + 4 Total contributions Type of contribution


$ 1111772. Noncash D (Complete Part li for noncash contnbutrons )



$ 951434. Noncash D (Complete Part li for noncash contnounons )

523452 10-26-15 Schedule B (Form 990, 990-EZ, or 990-PF) (2015)

16070320 784176 0146700 22



Page2 Schedule B (Form 990, 990 EZ, or 990 PF) (2015) Name of organization Employer identification number

23-7153017

Part I Contributors (see mstructions) Use duplicate copies of Part I 1f addrtional space rs needed



$ 160(400. Noncash D (Complete Part li for noncash contnbutions )


8 Person [xJ Payroll D

$ 329(999. Noncash D (Complete Part li for noncash contnbunons )



$ 55[000. Noncash D (Complete Part li for noncash contnbutions )


10 Person [xJ Payroll D

$ 70[000. Noncash D (Complete Part li for noncash contnbunons )


--- Person D Payroll D

$ Noncash D (Complete Part 11 for noncash contnbutions )

(a) (b} (c) (d) No. Name, address, and ZIP + 4 Total contributions Type of contribution

--- Person D Payroll D

$ Noncash D (Complete Part li for noncash contnbutions.)


16070320 784176 0146700 23



Page3 Schedule B (Form 990, 990 EZ, or 990 PF) (2015) Name of organization Employer identification number

23-7153017 Part li Noncash Property (see mstrucnons) Use duplicate copies of Part li 1f addrtional space rs needed

(a) (c) No. (b)

FMV (or estimate) (d) from Description of noncash property given (see instructions) Date received Part I

---

$

(a) (c) No. (b)

FMV (or estimate) (d) from Description of noncash property given (see instructions) Date received Part I

---

$

(a) (c) No. (b) FMV (or estimate) (d)

from Description of noncash property given (see instructions) Date received Part I

---

$



---

$



---

$


from Description of noncash property given (see mstrucnons) Date received Part I

---

$ 523453 10-26-15 Schedule B (Form 990, 990-EZ, or 990-PF) (2015)

16070320 784176 0146700 24


Schedule B (Form 990, 990-EZ, or 990-PF) (2015) Page4

211 Palm Beach Treasure Coast Inc. 23-7153017

Name of organization Employer identification number

Part Ill 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 Ime entry. For organizations completing Part Ill enter the total of exclusively religious, charitable etc contributions of $1,000 or less for the year (Enler this mio once) ~ $. _ Use duohcate cornes of Part Ill if additional soace is needed

(a) No. from (b) Purpose of gift (e) Use of gift (d) Description of how gift is held Part I

---

(e) Transfer of gift

Transferee's name address and ZIP + 4 Relat1onshio of transferor to transferee


---


Transferee's name address, and ZIP + 4 Relat1onsh10 of transferor to transferee


---


Transferee's name address and ZIP + 4 Belatronshto of transferor to transferee

(a) No. from (b) Purpose of gift (e) Use of gift (d) Description of how gift rs held Part I

---


Transferee's name address and ZIP + 4 Helanonshm of transferor to transferee


16070320 784176 0146700 25


SCHEDULED (Form 990)

Supplemental Financial Statements .... Complete if the organization answered "Yes" on Form 990,

Part IV, Ime 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b. .... Attach to Form 990.

Information about Schedule D Form 990 and its instructions is at www.lrs. ov/form990.

2015 OMB No 1545-0047

Department of the Treasury Internal Revenue Service

Open to Public Inspection

Name of the organization Employer identification number 211 Palm Beach Treasure Coast Inc. 23-7153017

Part I Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts.complete 1fthe organization answered "Yes" on Form 990, Part IV, Ime 6

(a) Donor advised funds (b) Funds and other accounts 1 Total number at end of year 2 Aggregate value of contnbutrons to (dunng year) 3 Aggregate value of grants from (dunng year) 4 Aggregate value at end of year 5 Ord the organization inform all donors and donor advisors m wntmg that the assets held m donor advised funds

are the organization's property, subject to the organization's exclusive legal control? 6 Ord the organization mform all grantees, donors, and donor advisors m wnt,ng that grant funds can be used only

for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring rm errmssible nvate benefit?

Oves 0No

Oves 0No Part li Conservation Easements. Complete rfthe organization answered "Yes" on Form 990, Part IV, line 7 1 Purpose(s) of conservation easements held by the organization (check all that apply)

O Preservation of land for public use (e g , recreation or education) D Preservation of a hrstoncally important land area O Protection of natural habitat D Preservation of a certrñed histone structure O Preservation of open space

2 Complete lines 2a through 2d rf the orqaruzatron held a qualified conservation contnbution m the form of a conservation easement on the last day of the tax year Held at the End of the Tax Year

2a 2b 2c

2d

a Total number of conservation easements b Total acreage restricted by conservation easements e Number of conservation easements on a certrñed histone structure included m (a) d Number of conservation easements included m (e) acquired after 8/17 /06, and not on a histone structure

listed m the National Register 3 Number of conservation easements modrñed, transferred, released, extmquished, or terminated by the organization dunng the tax

year .... _ 4 Number of states where property subject to conservation easement rs located .... _ 5 Does the organization have a written policy regarding the penodrc monitoring, mspectron, handling of

violanone, and enforcement of the conservation easements rt holds? Oves 0No 6 Staff and volunteer hours devoted to monitoring, mspectmq, handling of violanons, and enforcing conservation easements dunng the year

.... 7 Amount of expenses incurred m monitoring, mspectrng, handling of violations, and enforcing conservation easements dunng the year

.... $ 8 Does each conservation easement reported on Ime 2(d) above satisfy the requirements of section 170(h)(4)(8)(1)

and section 170(h)(4)(8)(11)? Oves 0No 9 ln Part XIII, describe how the organization reports conservation easements m its revenue and expense statement, and balance sheet, and

include, rf applicable, the text of the footnote to the organization's ftnancial statements that describes the organization's accounting for conservation easements I Part Ill I Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.

Complete rf the organization answered 'Yes' on Form 990, Part IV, line 8

1a If the organization elected, as permitted under SFAS 116 (ASC 958), not to report m its revenue statement and balance sheet works of art, hrstortcal treasures, or other similar assets held for public exlubmon, education, or research m furtherance of public service, provide, m Part XIII, the text of the footnote to its tmancial statements that describes these items

b If the organization elected, as permitted under SFAS 116 (ASC 958), to report m rts revenue statement and balance sheet works of art, hrstoncal treasures, or other smular assets held for public exhibmon, education, or research m furtherance of public service, provide the following amounts relatmg to these items (i) Revenue included on Form 990, Part VIII, line 1 (ti) Assets included m Form 990, Part X

.... $ _

.... $ _ 2 If the organization received or held works of art, hrstoncal treasures, or other smular assets for fmancral garn, provide

the following amounts required to be reported under SFAS 116 (ASC 958) relating to these items a Revenue included on Form 990, Part VIII, line 1 b Assets mcluded m Form 990, Part X

.... $ _

~ $ LHA For Paperwork Reduction Act Notice, see the Instructions for Form 990. 532051 11 02-15

Schedule D (Form 990) 2015

14000320 784176 0146700 26


ScheduleD Form990 2015 211 Palm Beach Treasure Coast Inc. 23-7153017 Pa e2 Part III Or anizations Maintainin Collections of Art, Historical Treasures, or Other Similar Asset contmued 3 Using the organization's acquismon, accession, and other records, check any of the following that are a s1gnif1cant use of its collection items

(check all that apply) a D Public exlubrtron d D Loan or exchange programs b D Scholarly research e D Other _ e D Preservation for future generations

4 Provide a descnption of the organization's collections and explain how they further the organization's exempt purpose m Part XIII. 5 Dunng the year, did the organization solicit or receive donations of art, histoncal treasures, or other sirmlar assets

to be sold to raise funds rather than to be mamtamed as art of the or arnzatron's collection? O Yes O No Part IV Escrow and Custodial Arrangements. Complete 1f the organization answered "Yes• on Form 990, Part IV, Ime 9, or

reported an amount on Form 990, Part X, line 21 .

1a Is the organization an agent, trustee, custodian or other intermediary for contnbuttons or other assets not included on Form 990, Part X? Oves 0No

b If "Yes," explain the arrangement m Part XIII and complete the following table

Amount 1c 1d 1e 1f

Oves O No O

e Beginning balance d Addmons dunng the year e Drstnbutrons dunng the year f Ending balance

2a Did the organization include an amount on Form 990, Part X, Ime 21, for escrow or custodial account liability? b If 'Yes " exnlam the arranaement m Part XIII Check here 1f the exolanation has been provided on Part XIII

I Part V I Endowment Funds. Complete 1f the organization answered "Yes" on Form 990, Part IV, line 1 O lal Current vear (bl Pnor vear fel Two vears back ldl Three vears back fel Four vears back

1a Beginning of year balance b Oontnbuncns e Net investment earnings, gains, and losses d Grants or scholarships e Other expenditures for facthties

and programs f Adrmrustratrve expenses g End of year balance

2 Provide the estimated percentage of the current year end balance (Ime 1 g, column (a)) held as a Board designated or quasi-endowment ~ % b Permanent endowment ~ e Temporarily restricted endowment ~ %

The percentages on lines 2a, 2b, and 2c should equal 100% 3a Are there endowment funds not m the possession of the organization that are held and administered for the organization

by (i) unrelated organizations (1i) related organizations

b If "Yes' on line 3a(11), are the related organizations listed as required on Schedule R? 4 Describe m Part XIII the intended uses of the or aruzation's endowment funds

Yes No 3afil 3afhl 3b

Part VI Land, Buildings, and Equipment. Complete 1f the organization answered "Yes" on Form 990, Part IV line 11 a See Form 990 Part X Ime 10 . . .

Descnptton of property (a) Cost or other (b) Cost or other (e) Accumulated (d) Book value basis (investment) basis (other) deprecranon

1a Land 160.000. 160.000. b Btnldmqs 326.099. 103 896. 291 684. 138.311. e Leasehold improvements 217.922. 188.690. 29.232. d Equipment 347.595. 310. 351. 37.244. e Other 48 884. 48 884.

Total. Add Imes 1a throuah 1e (Column fdl must eaual Form 990 Part X column rai Ime 10c J ..... 413.671. Schedule D (Form 990) 2015

532052 09 21-15

14000320 784176 0146700 27


Schedule O Form990 2015 211 Palm Beach Treasure Coast Inc. Part VII Investments - Other Securities.

Complete 1f the orqaruzatron answered 'Yes" on Form 990, Part IV, hne 11 b See Form 990, Part X, line 12

23-7153017 Pa e3

(a) Description of security or category (including name or security) (b) Book value (e) Method of valuation Cost or end of year market value

(1) Financial derivatives

(2) Closely held equity interests

(3) Other IA)

181 IC) (Dl IR

{F)

(Gl IH)

Total <Col. lb) must eaual Form 990 Part X col. (B) Ime 12.l • I Part VIII I Investments - Program Related.

Comolete 1fthe oruaruzatron answered "Yes" on Form 990, Part IV, hne 11c See Form 990, Part X, line 13 (a) Descnptron of investment (b) Book value (e) Method of valuation Cost or end of-year market value

111 12)

131 14)

151

161

17\ (81

(9)

Total (Col, lbl must eaual Form 990 Part X col. (B) Ime 13.l • I Part IX I Other Assets.

' (a) Dsscnptron (b) Book value

(1)

121

131 141

151

16)

171

181 191

Total. fColumn (b) must eaual Form 990 Part X col (B) Ime 15 J .... I Part X I Other Liabilities.

Complete 1f the organization answered "Yes" on Form 990, Part IV, hne 11 d See Form 990 Part X, line 15

Complete 1f the organization answered "Yes" on Form 990, Part IV, hne 11 e or 11f See Form 990, Part X, fine 25

1. (a) Description of habihty (b) Book value 111 Federal income taxes 12) Securitv Deoosit-PBC Food Bank 10.000. 131

14)

15)

161 17)

{8)

19l

Total. (Column lb! must equal Form 990, Part X, col IB) Ime 25 J ~ 10.000. 2. uabiüty for uncertain tax positrons ln Part XIII, provide the text of the footnote to the organization's ñnancial statements that reports the

organization's hab1hty for uncertain tax pos1t1ons under FIN 48 (ASC 740) Check here 1f the text of the footnote has been provided 1n Part XIII [xJ Schedule D (Form 990) 2015

532053 09-21 15

14000320 784176 0146700 28


Schedule D Form 990 2015 211 Palm Beach Treasure Coast Inc. 2 3-7153 017 Pa e4 Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return.

Complete 1f the organization answered "Yes" on Form 990 Part IV line 12a . . 1 Total revenue, gains, and other support per audited financial statements 1 2 518 839. 2 Amounts included on line 1 but not on Form 990, Part VIII, line 12 a Net unrealized gains (losses) on investments 2a b Donated services and use of facihtres 2b 47 390. e Recoveries of prior year grants 2c d Other (Describe m Part XIII ) 2d 185 819. e Add lines 2a through 2d 2e 233.209.

3 Subtract line 2e from line 1 3 2.285 630. 4 Amounts included on Form 990, Part VIII, line 12, but not on line 1

I 4a I a Investment expenses not included on Form 990, Part VIII, line 7b b Other (Describe m Part XIII ) 4b c Add lines 4a and 4b 4c o.

5 Total revenue Add lines 3 and 4c. ïttns must anual Form 990 Part I Ime 12 l 5 2-285 630. I Part XII [ Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. . .

1 Total expenses and losses per audited ñnancral statements 1 2.631 532. 2 Amounts included on line 1 but not on Form 990, Part IX, line 25 a Donated services and use of facihtres 2a 47.390. b Prior year adjustments 2b c Other losses 2c d Other (Describe m Part XIII ) 2d 185.819. e Add lines 2a through 2d 2e 233 209.

3 Subtract line 2e from line 1 3 2.398.323. 4 Amounts included on Form 990, Part IX, line 25, but not on line 1

I 4a I a Investment expenses not included on Form 990, Part VIII, line 7b b Other (Describe m Part XIII ) 4b e Add lines 4a and 4b 4c o.

5 Total exoenses Add lines 3 and 4c. ïïtus must anual Form 990 Part I Ime 18 l 5 2-398.323. I Part Xllll Supplemental Information.

Complete 1f the organization answered 'Yes" on Form 990 Part IV line 12a

Provide the descriptions required for Part li, lines 3, 5, and 9, Part Ill, lines 1 a and 4, Part IV, lines 1 band 2b, Part V, line 4, Part X, line 2, Part XI, Imes 2d and 4b, and Part XII, lines 2d and 4b Also complete this part to provide any addmonal mtormanon

Part X Line 2:

The organization is exempt from federal income tax under Section 501(c)(3)

of the Internal Revenue Code. However, income from certain activities not

directly related to 21l's tax-exempt purpose is subject to taxation as

unrelated business income. In addition, 211 qualifies for the charitable

contribution deduction under Section 170(b)(l)(A) and has been classified

as an organization other than a private foundation under Section

509(a)(2). Based upon an analysis of its net unrelated business income

for the current year and the net operating loss carryovers available from

earlier years, The Organization does not believe there is any income tax

owed for the period and there is no tax liability recognized in these

financial statements. 532054 09-21 15

14000320 784176 0146700 29



Schedule D Form 990 2015 211 Palm Beach Treasure Coast Inc. Part XIII Su lemental Information continued

23-7153017 Pa e5

The Organization has adopted FASB ASC 740-10, Accounting for Uncertainty

in Income Taxes. This pronouncement seeks to reduce the diversity in

practice associated with certain aspects of measurement and recognition in

accounting for income taxes. It prescribes a recognition threshold and

measurement attribute for financial statement recognition and measurement

of a tax position that an entity takes or expects to take in a tax return.

An entity may only recognize or continue to recognize tax positions that

meet a "more likely than not" threshold. The Organization assesses its

income tax positions based on management's evaluation of the facts,

circumstances and information available at the reporting date. The

Organization uses the prescribed "more likely than not" threshold when

making its assessment. At adoption, the Organization did not record any

cumulative effect adjustment, and the Organization did not accrue any

interest expense or penalties related to tax positions. There are

currently no open Federal or State tax years under audit.

Part XI, Line 2d - Other Adjustments:

Special Fundraising Event Expenses 82,672.

Rental Expenses 54,263.

Loss on disposition of assets 48,884.

Total to Schedule D, Part XI, Line 2d 185,819.

Part XII, Line 2d - Other Adjustments:

Special Fundraising Event Expenses 82,672.

Rental Expenses 54,263.

Loss on disposition of assets 48,884.

Total to Schedule D, Part XII, Line 2d 185,819. 532055 09-21-15


14000320 784176 0146700 30


SCHEDULEG (Form 990 or 990-EZ)

Supplemental Information Regarding Fundraising or Gaming Activities Complete if the organization answered "Yes" on Form 990, Part IV, lines 17, 18, or 19, or if the

organization entered more than $15,000 on Form 990-EZ, line 6a. .... Attach to Form 990 or Form 990-EZ.

OMB No 1545-0047


Information about Schedule G Form 990 or 990-EZ and its instructions rs at www.lrs. oviform 990. Open to Public Inspection

2015 Name of the organization

211 Palm Beach Treasure Coast Inc. Employer identification number

23-7153017 I Part I I Fundraising Activities. Complete 1f the organization answered "Yes' on Form 990, Part IV, line 17 Form 990·EZ filers are not

required to complete this part

1 Indicate whether the organization raised funds through any of the following actrvmes Check all that apply a D Mail sohcitanons e D Sohcitation of non-government grants b D Internet and email soltcttatrons f D soucitanon of government grants c D Phone sohcitatrons g D Special fundrarsmq events d D ln-person soücrtanons

2 a Did the organization have a wntten or oral agreement with any mdivrdual (including officers, directors, trustees or key employees listed in Form 990, Part VII) or entity m connection with professional fund raising services? Oves 0No

b If "Yes," list the ten highest paid mdivrduals or sntmes (fund raisers) pursuant to agreements under which the fund raiser rs to be compensated at least $5,000 by the organization

(1) Name and address of mdrvidual (11~ Did (1v) Gross receipts (v) Amount paid (vi) Amount paid fun raiser to (or retained by)

or entity (fundraiser) (ii) Actrvrty have custody from activity fund raiser to (or retained by) or control of organization contributions? listed in col (i)

Yes No

Total .... 3 List all states m which the organization rs registered or licensed to solicit contnbutions or has been notmed 1t rs exempt from reçrstration

or licensing

LHA For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ. Schedule G (Form 990 or 990-EZ) 2015

532081 09-14 15

14000320 784176 0146700 31


ScheduleG Form990or990 2015 211 Palm Beach Treasure Coast Inc. 23-7153017 Pa e2 Part li Fundraising Events. Complete 1fthe organization answered "Yes" on Form 990, Part IV, line 18, or reported more than $15,000

of fundraismq event contnbutions 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

Le Ci raue Gatsbv 1 (add col (a) through

(event type) (event type) (total number) col (c))

<l> :J e: œ

170.830. > 1 Gross receipts 147.292. 15.720. 7.818. <l> e:

2 Less Contnbuttons 71.992. 14.830. 4.500. 91.322.

3 Gross income lime 1 minus line 2) 75.300. 890. 3.318. 79.508.

4 Cash pnzes

5 Noncash pnzes rJJ œ rJJ e: 6 Rent/facility costs 30 138. 10.040. 4.975. 45.153. <l> c. X ui

o 7 Food and beverages (!? o 8 Entertainment 12 992. 1.700. 247. 14.939. 9 Other direct expenses 11 887. 2.863. 7,830. 22 580. 10 Direct expense summary Add Imes 4 through 9 m column {d) .... 82 672 . 11 Net income summarv Subtract line 1 O from line 3 column Id\ ..... -3 164.

I Part Ill I Gaming. Complete 1f the organization answered "Yes" on Form 990, Part IV, Ime 19, or reported more than

<l> (a) Bingo (b) Pull tabs/instant (o) Other gaming (d) Total gaming {add :J bingo/progressive bingo col (a) through col (c)) e: œ > <l> e:

1 Gross revenue

rJJ 2 Cash pnzes <l> rJJ e: œ

Noncash pnzes c. 3 X w o (!? 4 Rent/fac1l1ty costs o

5 Other direct expenses Oves % Oves % Oves %

6 Volunteer labor 0No DNo DNo

7 Direct expense summary Add lines 2 through 5 m column (d) .... 8 Net aamma income summarv Subtract line 7 from line 1 column Id\ ~

$15,000 on Form 990 EZ, Ime 6a

9 Enter the state(s) m which the organization conducts gaming activrties -------------------,==-----==---- ª Is the organization licensed to conduct gaming actrvitres m each of these states? D Yes D No b If "No," explain

10a Were any of the organization's gaming licenses revoked, suspended or terminated dunng the tax year? D Yes D No b If "Yes," explain ------------------------------------------

532oa2 09 14.15 Schedule G (Form 990 or 990-EZ) 2015

14000320 784176 0146700 32


ScheduleG(Form990or990EZ)2015 211 Palm Beach/Treasure Coast, Inc. 23-7153017 Page3 11 Does the organization conduct gaming acnvmes with nonmembers? 12 Is the organization a granter, benenciary or trustee of a trust or a member of a partnership or other entity formed

to administer charitable gaming? 13 Indicate the percentage of gaming activity conducted m

a The organization's facthty b An outside facility

14 Enter the name and address of the person who prepares the orqamzation's gam1ng/spec1al events books and records

Oves 0No

Oves 0No

% %

Name ....

15a Does the organization have a contract with a third party from whom the organization receives gaming revenue? Oves ONo

b If "Yes, enter the amount of gaming revenue received by the organization .... $ of gaming revenue retained by the third party .... $ _

e If "Yes," enter name and address of the third party

_______ and the amount

Name ....

Address .... ---------------------------------------------

16 Gaming manager mforrnatron

Name ....

Gaming manager compensation .... $ _

Description of services provided .... --------------------------------------

O Director/officer O Employee O Independent contractor

17 Mandatory drstnbutions a Is the organization required under state law to make charitable distnbuttons from the gaming proceeds to retain the state gaming license? Oves O No

b Enter the amount of dtstnbutrons required under state law to be distributed to other exempt organizations or spent m the or amzation's own exem t acnvrtres durm the tax ear $

Part IV Supplemental Information. Provide the explanations required by Part I, line 2b, columns (111) and (v), and Part Ill, lines 9, 9b, 10b, 15b, 15c, 16, and 17b, as applicable Also provide any addmonal information (see 1nstruct1ons)

14000320 784176 0146700 33


Schedule G (Form 990 or 990-EZ) 2015 532083 09 14 15

ScheduleG Form990or990 211 Palm Beach Treasure Coast Inc. 23-7153017 Pa e4 Part IV Supplemental Information (continued)

532084 04-01 15

Schedule G (Form 990 or 990-EZ)

14000320 784176 0146700 34


SCHEDULE I (Form 990)

Grants and Other Assistance to Organizations, Governments, and Individuals in the United States

Complete 1f the organization answered "Yes" on Form 990, Part IV, line 21 or 22 . .... Attach to Form 990.

lnformªj:ion about Schedule I (FOIJJL990) and its insjr3,tcJ1ons is at www.lrs.gov/form990. Open to Public

Inspection

OMB No 1545-004 7

2015 Department of the Treasury Internal Revenue Service

Name of the organization 211 Palm Beach/Treaaure.Coast Inc.

Employer identification number 23-7153017

Part I General Information on Grants and Assistance

1 Does the organization rnamtam records to substantiate the amount of the grants or assistance, the grantees' elig1b11ity for the grants or assistance, and the selection entena used to award the grants or assistance?

2~~çnbe m Part IV the oruaruzation's procedures for rnorutonno the use of orant funds m the United States [xJ Yes 0No

Part li Grants and Other Assistance to Domestic Organizations and Domestic Governments. Complete rt the organization answered "Yes" on Form 990, Part IV, line 21, for any .. ------- ------ ---·--· -,---- -- -------

1 (a) Name and address of organization (b) EIN (c) IRC section (d) Amount of (e) Amount of (f) Method of (g) Descnpnon of (h) Purpose of grant valuation (book, or government 1f applicable cash grant non cash FMV, appraisal, non-cash assistance or assistance assistance other)

2 Enter total number of section 501 (c)(3) and government organizations listed m the line 1 table .... 3 Enter total number of other organizations listed 1n the line 1 table .....

LHA For Paperwork Reduction Act Notice, see the Instructions for Form 990. Schedule I (Form 990) (2015)

532101 10 as 15 35

Schedule I (Form 990) (2015) 211 Palm Beach/Treasure Coast, Inc. 23-7153017 Paqe2 Part III i Grants and Other Assistance to Domestic Indrvrduals. Complete 1f the organization answered "Yes" on Form 990, Part IV, hne 22

Part Ill can be duplicated 1f addrttonal space ts needed

(a) Type of grant or assistance (b) Number of (c) Amount of (d) Amount of non- (e~ Method of valuation (f) Descnption of non cash assistance recipients cash grant cash assistance (boo , FMV, appraisal, other)

Gift Cards, utilities and transportation ~etail value of goods assistance 54 1 917 o .,.nd services nrovided

Snecial Needs Pro~ram 2 31 451 o

I Part IV I Sunolernental Information. Provide the information recurred m Part I, line 2, Part Ill, column (b\, and any other addmonal mformanon

Part IL Line 2:

Elder Crisis Outreach Program: Minor living expenses for the elderly that

are in a financial crisis may have some of their most immediate needs paid

for by the organization.

These funds are donated to the agency from individuals and FP&L to help

this population. When we receive the funds, we put them into "Temporary

Restricted Assets" until a request is made.

532102 10 28 15 36 Schedule I (Form 990) (2015)

Schedule I Form990 211 Palm Beach Treasure Coast Inc. Part IV Supplemental Information

23-7153017 Pa e2

Special Needs Program:

Schedule I, Page 2, Part IV

Funds were awarded for this program in Fiscal Year's 2014/15 and

2015/16. They were to assist Special Needs families chosen by the

annual Season to Share campaign sponsored by The Palm Beach Post. 211

Palm Beach/Treasure Coast was very fortunate to have had clients

selected two years in a row. A portion of the amount spent on

assistance to individuals was to close out the proiect from the prior

fiscal year; and the remainder was for the family selected in 2015/16.

532291 04-01 15

Schedule I (Form 990)

14000320 784176 0146700 37


SCHEDULE L (Form 990 or 990-EZ)

Transactions With Interested Persons .... Complete if the organization answered "Yes" on Form 990, Part IV, line 25a, 25b, 26, 27, 28a,

28b, or 28c, or Form 990-EZ, Part V, line 38a or 40b • .... Attach to Form 990 or Form 990-EZ.

.... Information about Schedule L (Form 990 or 990-EZ) and its instructions is at www.lrs.gov/form990. Open To Public Inspection

OMB No 1545 0047

2015 Oepartment of the Treasury Internal Revenue Service

Name of the organization Employer identification number

Part I Excess Benefit Transactions (section 501 (c)(3), section 501 (c)(4), and 501 (c)(29) organizations only) 211 Palm Beach Treasure Coast Inc. 23-7153017

Complete 1f the orqamzanon answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990·EZ, Part V, line 40b 1 (b) Helationshrp between drsqualrñed

(c) Descnption of transaction Id\ Corrected? (a) Name of dtsquahfied person person and organization Yes No

2 Enter the amount of tax incurred by the organization managers or disquahñed persons during the year under section 4958 $ _

3 Enter the amount of tax, 1f any, on line 2, above, reimbursed by the organization $ _

I Part li I Loans to and/or From Interested Persons. Complete 1f the orqaruzanon answered "Yes" on Form 990 EZ, Part V, line 38a or Form 990, Part IV, line 26, or 1f the organization reoorted an amount on Form 990, Part X, line 5, 6, or 22

(a) Name of (b) Relat1onsh1p (c) Purpose ( d) Loan to or (e) Original (f) Balance due (g) ln (h)Approvec (1) Written interested person with organization of loan from the pnncipal amount default? by board or agreement? organization? committee?

To From Yes No Yes No Yes No

Total ~ $ I Part III I Grants or Assistance Benefiting Interested Persons.

Como lete 1f the oruaruzatron answere es on orm . a , ine (a) Name of interested person (b) Relationstup between (c) Amount of (d) Type of (e) Purpose of

interested person and assistance assistance assistance the organization

d "Y F 990 P rt IV I 27

LHA For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ. Schedule L (Form 990 or 990-EZ) 2015

532131 10-02 15

14000320 784176 0146700 38


ScheduleL Form990or990 2015 211 Palm Beach Treasure Coast Inc. Part IV Business Transactions Involving Interested Persons.

2 3 - 715 3 O 1 7 Pa e 2

Comolete 1f the oroamzanon answered "Yes" on Form 990, Part IV, line 28a, 28b, or 28c (a) Name of interested person (b) Relat1onsh1p between interested (c) Amount of (d) Dascnption of (e) Shanng of

organization's person and the organization transaction transaction revenues? Yes No

Rav Buza Soouse of President 116 700. Rav Buza. a X

I Part V I Supplemental Information Provide addmonal information for responses to questions on Schedule L (see 1nstruct1ons)

Sch L, Part IV, Business Transactions Involving Interested Persons:

(a) Name of Person: Ray Buza

(b) Relationship Between Interested Person and Organization:

Spouse of President/CEO

(c) Amount of Transaction$ 116,700.

{d) Description of Transaction: Ray Buza, an independent contractor,

spouse of Executive Director, Susan Buza. Mr. Buza owns 100% of the

insurance agency that represents the insurance company providing health

coverage to the Organization. The payments are made directly to Blue

Cross/Blue Shield of Florida and Florida Combined Life. There are no

direct payments to Ray Buza or his company from this Organization. This

transaction incorporates the usual and customary terms offered by other

venders and are periodically evaluated for reasonableness, and is

undertaken with the approval of "211's" Board of Directors.

(e) Sharing of Organization Revenues?= No

532132 10-02 15

Schedule L (Form 990 or 990-EZ) 2015

14000320 784176 0146700 39


SCHEDULE O (Form 990 or 990-EZ)

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 . .... Attach to Form 990 or 990-EZ. Open to Public

lnformabon about Schedule O Form 990 or 990-EZ and its mstrucbons is at www.lrs. oviform 990. Ins ection

2015 OMS No 1545 0047


Name of the organization 211 Palm Beach Treasure Coast Inc.


Form 990, Part I, Line l, Description of Organization Mission:

information about health and human services programs. This free and

confidential telephone-based assistance is available 24 hours a day,

365 days a year to anyone who dials 2-1-1. The agency also provides

daily telephone reassurance calls to homebound elders; navigation

assistance directed to individuals in need of health services; to

elders in distress; to families with special needs children from birth

to age 22; and to families of children 0-8 who are at-risk for

behavioral or developmental disabilities. This year 211 responded to

89,581 callers, of which 48,165 of them were in either a financial or

emotional crisis.

Form 990, Part III, Line 4d, Other Program Services:

Sunshine Telephone Reassurance: This, primarily volunteer program

established in 1973, provides daily telephone reassurance calls to

elders and homebound individuals in Palm Beach, St. Lucie, Okeechobee,

Indian River and Martin counties. In the fiscal year ending June 30,

2016, 713 isolated elders or disabled individuals received daily

telephone reassurance calls through the contribution of our 25

volunteers, equating to approximately 4,532 hours of volunteer service.

Further during the year, 295 incidents of potential risk were

identified through the Sunshine program that required some follow-up to

ensure a client's safety.

Expenses$ 76,750. including grants of$ O. Revenue$ O.

Healthcare Advocacy: This program, staffed by trained professionals, LHA For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ. 532211 09-02 15

Schedule O (Form 990 or 990-EZ) (2015)

14000320 784176 0146700 40


Schedule O Form 990 or 990 E 2015 Pa e2

211 Palm Beach Treasure Coast Inc. Employer ldentlñcatron number

23-7153017 Name of the organization

helps vulnerable individuals and families within Palm Beach County to

easily find and appropriately access community healthcare resources

(physical and mental). This program was established in November 2010.

In the fiscal year ending June 30, 2016, approximately 413 cases were

served.

Expenses$ 64,870. including grants of$ O. Revenue$ O.

Special Needs: The Special Needs HelpLine was initiated in 2013 to

assist and support parents and caregivers of children (birth to 22

years) who have special needs to effectively navigate the complex maze

of available services such as healthcare, financial assistance, support

groups, education, respite, and other services. l,779 families reached

out to the 211 Special Needs HelpLine in the fiscal year with 364

families with children who have special needs receiving individualized

short term case management and assistance with navigating the maze of

available services.

Expenses$ 100,654. including grants of$ 31,451. Revenue$ O.

Other programs and services.

Expenses$ 409,984. including grants of$ O. Revenue$ 4,900.

Form 990, Part VI, Section B, line 11:

The organization along with the independent auditor presents its form 990

and 990-T to the governing body at a scheduled board meeting and otherwise

provides these forms upon request via email.

Form 990, Part VI, Section B, Line 12c:

The organization requires its officers, directors, trustees and employees 532212 09.02 15 Schedule O (Form 990 or 990-EZ) (2015)

14000320 784176 0146700 41


Schedule O Form 990 or 990· 2015 Pa e z Name of the organization

211 Palm Beach Treasure Coast Inc. Employer ldentrñcation number

23-7153017

to disclose potential conflicts of interest in a "conflict of interest

form" which is reviewed annually.

Form 990, Part VI, Section B, Line 15:

The executive committee of the board of directors meets annually and

reviews the performance of the executive director. A compensation analysis

is prepared of base salary compensation levels of nonprofit executive

directors for the committee to base their compensation decision on.

All employees receive an annual performance evaluation and the annual wage

adjustment is based on performance.

Form 990, Part VI, Section C, Line 19:

The organization makes its governing documents, conflict of interest

policy, and financial statements available to the public upon request.

PART XII LINE 2B

The audit report as presented by the independent auditor, is reviewed

by the audit committee at its yearly meeting. The process has not

changed from prior year.

14000320 784176 0146700 42


Schedule O (Form 990 or 990-EZ) (2015) 532212 09 02-15

SCHEDULER (Form 990)

Related Organizations and Unrelated Partnerships ..... Complete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37 .

..... Attach to Form 990. Information about Schedule R (Form 990) and its mstructionsJ~Lat 11rww.irs.gov/form990.

2015 OMS No 1545-0047

Department of the Treasury Internal R_e_v_~n_ue_$_er_v1cJ!

Open to Public Inspection

Name of the orqaruzatton 211 Palm Beach/Treasure Coast Inc.


Part I ldentrñcation of Disregarded Entities Complete 1f the orqaruzanon answered "Yes" on Form 990, Part IV, hne 33

(a) (b) (c) (d} (e) (f) Name, address, and EIN (rf applicable) Pnmary actrvrty Legal domicile (state or Total income End of year assets Direct controlling

of disregarded entity foreign country) entity

Part li Identification of Related Tax-Exempt Organizations Complete 1f the organization answered "Yes" on Form 990, Part IV, line 34 because rt had one or more related tax-exempt orqaruzations dunng the tax year

(a) (b) (c) (d) (e) (f) (g) Name, address, and EIN Pnmary actrvrty Legal dormcile (state or Exempt Code Pubhc chanty Direct controlling

Section 512(bX13) controlled

of related orçaruzanon foreign country) section status (1f section entity entity? 501 (c)(3)) Yes No

415 Gator Drive Inc 65-0951123 211 Palm p o Box 3588 Beach/Treasure Lantana FL 33465 Real Estate Rental Pl or ida 50l(C)(2} :::cast Inc. X

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Schedule R (Form 990) 2015

532161 og os 15 LHA 43

ScheduleR{Form990)2015 211 Palm Beach/Treasure Coast, Inc. 23-7153017 Page2

Part Ill Identification of Related Organizations Taxable as a Partnership Complete 1f the organization answered "Yes" on Form 990, Part IV, line 34 because 1t had one or more related organizations treated as a partnership dunng the tax year

(a) (b) (c) (d) (e) (f) (g) (h) (i) (J) (k) Name, address, and EIN Pnmary acnvrty Legal Direct controlling Predominant income Share of total Share of D1spropor1Jonate Code V-UBI General or Percentage dormcue of related organization (state or entity (related, unrelated, income end-of-year allocabons? amount m box managing ownership

foreign excluded from tax under assets 20 of Schedule partner?

country) sections 512-514) Yes No K 1 (Form 1065) Ves No

Part IV Identification of Related Organizations Taxable as a Corporation or Trust Complete 1f the organization answered "Yes" on Form 990, Part IV, line 34 because 1t had one or more related organizations treated as a corporation or trust dunng the tax year

(a) (b) (c) (d) (e) (f) (g) (h) (i)

Name, address, and EIN Pnmary actrvrty Direct controlling Type of entity Share of total Share of Percentage Section

Legal dornrene 512(bX13) of related organization (state or entity (C corp, S corp, income end of year ownership controlled

foreign or trust) assets ent,tv? country) Yes No

532162 09-08-15 44 Schedule R (Form 990) 2015

ScheduleR(Form990)2015 211 Palm Beach/Treasure Coast, Inc. 23-7153017 Page3

Part V Transactions With Related Organizations Complete 1f the organization answered "Yes" on Form 990, Part IV, line 34, 35b, or 36

Note. Complete line 1 1f any entity rs listed in Parts li, Ill, or IV of this schedule Yes No 1 Dunng the tax year, did the organization engage m any of the following transactions with one or more related organizations listed in Parts li IV? a Receipt of (1) interest, (n) armurnes, (iii) royalties, or (rv) rent from a controlled entity 1a X b Gift, grant, or capital contnbution to related orçarnzationts) 1b X e Gift, grant, or capital contnbution from related orqaruzationís) 1c X d Loans or loan guarantees to or for related orqaruzationts) 1d X e Loans or loan guarantees by related orçaruzanonts) 1e X

f Dividends from related orçaruzanonts) 1f X g Sale of assets to related orqaruzationís) 1a X h Purchase of assets from related orqaruzationís) 1h X I Exchange of assets with related orqaruzationís) 11 X J Lease of facilmes, equipment, or other assets to related orçanzationts) 1i X

k Lease of tacnmes, equipment, or other assets from related orqaruzanonís) 1k X I Performance of services or membership or fund raising solicitations for related orçaruzationts) 11 X m Performance of services or membership or fund raising sohcrtations by related orçaruzationts) 1m X n Sharing of facilrnes, equipment, mailing lists, or other assets with related orqamzatiorus) 1n X o Shanng of paid employees with related orqamzatronts) 10 X

p Reimbursement paid to related orqaruzattonís) for expenses 1p X q Reimbursement paid by related orqamzanonís) for expenses 1a X

r Other transfer of cash or property to related orçamzationts) 1r X s Other transfer of cash or property from related oroarnzationïs) 1s X - 11 "' •- -••-ww_, .,..., -•, ...,, "' , .... --- • - •- • --, --- -· • ••• •• --·-· -- • .......

(a) (b) (e) (d) Name of related organization Transaction Amount involved Method of determining amount involved

type (as)

(1) 415 Gator Drive Inc. D 22.633. :ons. Audit

(2) 415 Gator Drive. Inc. K 37.470. :::'.ons. Audit

(3)

(4)

(5}

(6}

532163 09-08-15 45 Schedule R (Form 990) 2015

ScheduleR(Form990)2015 211 Palm Beach/Treasure Coast, Inc. 23-7153017 Page4

Part VI Unrelated Organizations Taxable as a Partnership Complete 1f the organization answered "Yes" on Form 990, Part IV, hne 37

Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its acnvmss (measured by total assets or gross revenue) that was not a related organization See mstrucnons regarding exclusion for certain investment partnerships

(a) (b) (c) (d) (e) (f) (g) (h) (i) (j) (k) Legal domicile Predominant income

Are au Share of Share of D1spropor Code V-UBI Name, address, and EIN Primary actrvrty partners sec General o r Percentage

of entity (state or foreign (related, unrelated, 501 (c)~3) total end of year bo nate amount in box 20 managing ownership excluded from tax under Ol! S allocations? of Schedule K-1 partner? country) >-----~

sections 512-514) Yes No income assets Yes No (Form 1065) Yes No

Schedule R (Form 990) 2015

532164 09-08-15 46

Schedule A Form990 2015 211 Palm Beach Treasure Coast Inc. 23-7153017 Pa e s Part VII Supplemental Information

Provide addrtional mtormation for responses to questions on Schedule R (see instructions)

532165 09 08 15 Schedule R (Form 990) 2015

14000320 784176 0146700 47


Form 8868 (Rev. January 2014)

Application for Extension of Time To File an Exempt Organization Return OMS No 1545 1709


..,_ Fiie a separate application for each return. ..,_ Information about Form 8868 and its instructions is at www.lrs.gov/form8868

• If you are fihng for an Automatic 3-Month Extension, complete only Part I and check this box • If you are fihng for an Additional (Not Automatic) 3-Month Extension, complete only Part li (on page 2 of this form). Do not complete Part li unless you have already been granted an automatic 3 month extension on a previously filed Form 8868 Electronic filing (e-file). You can electronically file Form 8868 1f you need a 3 month automatic extension of time to file (6 months for a corporation required to file Form 990·1), or an addrnonal (not automatic) 3 month extension of time. You can electronically file Form 8868 to request an extension of time to file any of the forms hsted in Part I or Part li wrth the exception of Form 8870, Information Return for Transfers Associated With Certain Personal Benefit Contracts, which must be sent to the IRS in paper format (see instructions) For more details on the electronic fihng of this form, visit www ,rs ovlef1le and click on e-fife for Chenties & Non toùts

A corporation required to file Form 990·T and requesting an automatic 6 month extension - check this box and complete Part I only All other corporations (mcludmg 1120-C ft/ers), partnerships, REM/Cs, and trusts must use Form 7004 to request an extension of time to file income tax returns

Type or print

Enter filer's rdentrtvinc number

211 Palm Beach/Treasure Coast. Inc. 23-7153017

Name of exempt organization or other filer, see mstructíons Employer rdentrñcatron number (EIN) or

~~: ~~t:~or Number, street, and room or suite no If a P.O box, see instructions

~~~~:~;e P.O. Box 3 588 msíruchons City, town or post office, state, and ZIP code For a foreign address. see instructions

Lantana FL 33465-3588

Social security number (SSN)

Enter the Return code for the return that this application rs for (file a separate apphcatron for each return)

Application Return Application Return Is For Code Is For Code Form 990 or Form 990 EZ 01 Form 990 T (corporation) 07 Form 990 BL 02 Form 1041-A 08 Form 4720 (mdivrduaf 03 Form 4 720 (other than 1nd1v1dual] 09 Form 990PF 04 Form 5227 10 Form 990 T (sec 401 lal or 408lal trust) 05 Form 6069 11 Form 990 T (trust other than abovel 06 Form 8870 12

Mindy Gonzalez • The books are m the care of ..,_ =p_;;•o...;O=-..:c... --=B'--'o""'x=-""'"3~5~8~8~_-_L_a~n~t~a=n~ª~'--"F'--'L=-~3~3_4~6~5~--------------

Telephone No..,_ 561 5 3 3-1096 Fax No ..,_ • If the organization does not have an office or place of business m the United States, check this box • If this rs for a Group Return, enter the organization's four d1g1t Group Exemption Number (GEN) If this is for the whole group, check this box ..,._ D If 1t 1s for part of the group, check this box ..,._ D and attach a hst with the names and El Ns of all members the extension is for 1 I request an automatic 3 month (6 months for a corporation required to file Form 9901) extension of time until

February 15, 2 O 1 7 , to file the exempt organization return for the organization named above The extension

rs for the organization's return for ..,_ D calendar year or ..,_ [xJ tax year begin~ JUL l , 2 O 15 , and ending JUN 3 O , 2 O 16

2 If the tax year entered m line 1 rs for less than 12 months, check reason

D D Initial return D Final return

Chanae m accountmo period

3a If this applrcatron 1s for Forms 990-BL, 990 PF, 990 T, 4720, or 6069, enter the tentative tax, less any

nonrefundable credits See instructions. 3a $ o. b If this application rs for Forms 990 PF, 990-T, 4720, or 6069, enter any refundable credits and

estimated tax payments made Include anv Prior vear overpayment allowed as a credit 3b $ o. e Balance due. Subtract hne 3b from line 3a Include your payment with this form, If required,

bv usina EFTPS !Electronic Federal Tax Pavment Svsteml See mstructrons 3c s o. Caution. If you are going to make an electronic funds withdrawal (direct debit) with this Form 8868, see Form 8453 EO and Form 8879 EO for payment instructions

LHA For Privacy Act and Paperwork Reduction Act Notice, see Instructions. 523841 04-01-15

Form 8868 (Rev 1 2014)

09501031 784176 0146700 2015.04030 211 Palm Beach/Treasure Coa 01467001

Form 8868 (Rev. 1·2014)

• If you are fihng for an Additional (Not Automatic) 3-Month Extension, complete only Part li and check this box Note. Only complete Part li If you have already been granted an automatic 3·month extension on a previously filed Form 8868 • If you are fihng for an Automatic 3-Month Extension, complete only Part I (on page 1) I Part li ! Additional (Not Automatic) 3-Month Extension of Time. Only file the original (no copies needed).

Enter filer's identifvina number see instructions

23-7153017

Type or print Fllebythe 211 Palm Beach/Treasure Coast, Inc. due dale for Number, street, and room or suite no If a P.O. box, see instructions. filing your return See O • O • Box 3 5 8 8 instructions City, town or post office, state, and ZIP code For a foreign address, see instructions

Lantana, FL 33465-3588

Name of exempt organization or other filer, see instructions Employer ldentrñcation number (EIN) or

Social secunty number (SSN)

Enter the Return code for the return that this apphcatron ,s for (file a separate application for each return)

Application Return Application Return ls For Code ls For Code Form 990 or Form 990·EZ 01 Form990·BL 02 Form 1041·A 08 Form 4720 Ilndtviduañ 03 Form 4720 !other than mdivrduaf) 09 Form 990 PF 04 Form 5227 10 Form 990 TI sec. 401 íal or 408(a) trustl 05 Form 6069 11 Form 990-T <trust other than above\ 06 Form 8870 12 STOP! Do not complete Part li if you were not already granted an automatic 3-month extension on a previously filed Form 8868.

Mindy Gonzalez • Thebooksare,nthecareof .... P.O. Box 3588 - Lantana, FL 33465

Telephone No..... 5 61 5 3 3-1O96 Fax No i,.. _ • If the organization does not have an office or place of business in the Unrted States, check this box i,.. D • If this rs for a Group Return, enter the orçaruzatron's four d1g1t Group Exemption Number (GEN) If this rs for the whole group, check this box i,.. D If rt rs for part of the group check this box IJll,, D and attach a hst with the names and El Ns of all members the extension rs for 4 I request an additional 3 month extension of time until May 15 , 2 O 1 7 5 For calendar year , or other tax year beginning JUL l , 2 O 15 , and ending JUN 3 O , 2 O 16 6 If the tax year entered m line 5 rs for less than 12 months, check reason D lrutial return D Final return

D Change m accounting penad 7 State m detail why you need the extension

Additional time is needed to gather information

Sa If this applrcanon rs for Forms 990-BL, 990 PF, 990 T, 4720, or 6069, enter the tentative tax, less any nonrefundable credits See instructions Sa s o.

b If this apphcatron 1s for Forms 990 PF, 990-T, 4720, or 6069, enter any refundable credits and estimated tax payments made Include any prior year overpayment allowed as a credit and any amount paid - nrevrouslv wrth Form 8S68 Sb $ o.

e Balance due. Subtract line 8b from hne Sa. Include your payment with this form, 1f required, by using EFTPS <Electronic Federal Tax Pavment Svsteml See mstructions Sc s o.

Signature and Verification must be completed for Part li only. that I have exam med this form, mcludmg accompanying schedules and statements, and to the best of my knowledge and belief, that I am authorized to prepare this form.

Date~ Form 8868 (Rev. 1·2014)

523842 04-01-15

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