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Home My WebLink About2010id i :3L6AS�iiII 'nie Sebastiarn Clanlb keuFow- -A*16AL%k. on 2011 F1r V T`UV Organizers of the World Famous SEBASTIAN CLAMBAKE LAGOON FESTIVAL TO: Sebastian City Council Members FROM: Dorri Bosworth, Secret Sebastian Clambake Foundation DATE: February 3, 2010 SUBJECT: 2010 Sebastian Clambake Foundation Financials Attached please find a preliminary unaudited financial statement for the November 2010 Clambake Festival. The Clambake Foundation's agreement with the City of Sebastian states that the Clambake Foundation will provide to the City an annual financial report, prepared and certified by a Certified Public Accountant, showing all Foundation revenue and expenses within 120 days of the last day of the Clambake. Unfortunately the Clambake Foundation's fiscal year runs from June 1 through May 30. Therefore, our Annual Report for 2010 will not be filed until after May 30, 2011. Since our books will not be closed until May 30, 2011, we respectfully ask for an extension until June 30, 2011 to furnish a copy of our 2010 Annual Report and Financial Statements. If you have any questions, please contact me. Our books are always open for your inspection by contacting Dot Judah (772) 589 -4873. Thank you for your consideration in this matter. PO Box 780436 a Sebastian, Florida, 32978 a webmaster @sebastianciambake.org SEBASTIAN CLAMBAKE FOUNDATION PRELIMINARY FINANCIAL STATEMENT (UNAUDITED) February 2, 2011 Beginning Balance 6/1/10 $ 17,707.68 REVENUES Donations / Sponsor Fees $ 2,093.25 Exhibitor/Vendor Income $ 15,720.00 Boat Show $ 1,050.00 City of Sebastian - Advertising $ 5,000.00 Ticket Sales $ 117,027.55 Kids Zone - Wristbands $ 6,990.00 T -Shirt Sales $ 76.00 Interest $ 88.57 Total Revenues $ 148,045.37 FESTIVAL EXPENSES Administrative Charges $ 3,224.87 Food /Beverage $ 60,118.01 Advertising $ 8,882.00 Sales Tax $ 8,703.55 Liability Insurance $ 8,116.03 Entertainment $ 5,600.00 T- Shirts $ 1,995.45 Misc Supplies $ 6,071.04 Contest Awards $ 400.00 Kids Zone $ 5,537.57 Total Festival Expenses $ 108,648.52 Other Expenditures Membership Grants $ 9,000.00 TOTAL EXPENDITURES $ 117,648.52 BALANCE 2/2/2011 $ 48,104.53 To Be Distributed: SR Little League $ 10,000.00 By the River $ 7,920.00 Rowing Team $ 12,230.00 American Legion $ 8,153.00 Adjusted Balance $ 9,801.53 Form 8879 -EO IRS a -fife Signature Authorization for an Exempt Organization DMB No Ro, eaiaddar x.arzo,o.o, �Uai xeardeomnmv_5 /01_ -, 2010, add edada_ 4/30 2011, oedanmem of me neasdw nle,na1 Rerenw semce ' Do not send to the IRS. Keep for your records. ' See instructions _ 2010 ANJANI CIRILLO PRESIDENT Type of Return and Return Information (Whole Dollars Only) Check the box for the return for which you are using this Form 8879 -EO and enter the applicable amount, if any, from the return. If you check the box on line la, 2a, 3a, 4a, or 5a, below, and the amount on that line for the return being Lied with this form was blank, then leave line lb, 2b, 31, 4b, or 5b, whichever is applicable, blank (do not enter -0 -). But, if you entered 0- on the return, then enter -0 on the applicable line below. Do not complete more than 1 line in Part I. 1 a Form 99D check here.... ❑ b Total revenue, if any (Form 990, Part VIII, column (A), line 12)......... 1 b 2. Form 990 -EZ check here ... [X] b Total revenue, if any (Form 990 EZ, line 9), .... ............ 26 41,451. 3a Form 1120 -POL check here...... ii L] b Total tax (Form 1120 POL, line 22) ............................ 3b 4a Form 990,PF check here ... ❑ b Tax based on Investment income (Form 990 PF, Part VI, line 5).... 4b 5a Form 8865 check here... b Balance Due (Form 8868, Part I, line 3c or Part 11, line 8c). _ . . .. . . , 1 56 penalties of perjury, I declare that I am an officer of the above organization and that I have examined a copy of the organization's 2010 onic return . and accompanying schedules and statements antl to the best of my knowledge and belief, they are true, correct, and late. further declare that the amount in Part I above is the amount shown on the copy of the organization's electronic return. I consent t my intermediate service provider, transmitter, or electronic return originator (ERO) to send the organization's return to the IRS and to ,e from the IRS (a) an acknowledgement of receipt or reason for resection of Me fra—,n,«ind rbx lo. ate, .,,., ales.,.. ;_ ------- Ue Ulu envy ,o me unanciai insulation account indicated in the tax preparation software for payment of the on this return and the financial institution to debit the entry to this account To revoke a payment, I must dl Agent at 1-888 3534537 no later than 2 business days prior to the payment (settlement) date. I also involved in the processing of the electronic payment of taxes to receive confidential information necessary to is related to the payment. I have selected a personal identification number (PIN) as my signature for the d, if applicable, the organization's consent to electronic funds withdrawal. Officers PIN: check one box only X� 1 authorize ANTHONY M. DONINI, CPA, PA to enter my PIN 32132 as my signature ERO III name Einar bax numae,x, but do am am. an :em: on the organization's tax year 2010 electronically filed return. If I have indicated within this return that a copy of the return is being filed with a state agency(ies) regulating charities as part of the IRS Fed /State program, I also authorize the aforementioned ERO to enter with PIN on the return's disclosure consent screen. As an officer of the organization, I will enter my PIN as my siggnature on the organization's tax year 2010 electronically filed return. If I have indicated within this return that a copy of the return is being filetl with a state agency(ies) regulating charities as part of the IRS Fed /State program,I will enter my PIN on the return's disclosure consent screen. onia;: aignawre Dale' Certification and Authentication ERO'. EFIN /PIN. Enter your six-digit electronic filing identification number (EFIN) followed by your five-digit self - selected PIN ...................... ............................... 65330812255 do dot enter all ao,o. 1 certify that the above numeric entry is my PIN, which is my signature on the 2010 electronically filed return for the organization indicated above. I confirm that I am submitting this return in accordance with the requirements of Pub 4163, Modernized a -File g eF) Information for Authorized IRS a file Providers for Business Returns. ERO 's sipaefe ' Date' ERO Must Retain This Form - See Instructions Do Not Submit This Form To the IRS Unless Requested To Do So BAA For Paperwork Reduction Act Notice, see instructions. Form 8879 -EO (2010) l EA74011. la lo MV Revenue Service n I rM1P a on rural assets real than y,mi at mw o rtre year may un, fhb form, gamnew mar naaa an thsa u soar or ma ®mm to:aoar, arum monarch, "Quarmenm. A For the 2010 calendar year, or tax year beginning 5/01 ,2010, and end! n2 4/30 2011 B check it applicable: [1EBASTIAN D Emvmysaaenencation number Adi ebanga CLAMBAKE FOUNDATION, INC Copy Name mange BOX 780436 E Telephone number lnaml,arm BASTIAN, FL 32978 Terminated 772- 386 -4733 Amenead mikch F Grid Exemption Application ranking N he G Accounting Method: U Cash U Accrual Other (specify) r N Check - XN it the organization is not I Websiti � WWW. SEBASTIANCLAMBAKE.ORG raq ired to attach Schedule B (Form J Tax - exempt status (ck only one) - X 501diD) 501(o ( ) - (inset no.) 4947(aXl) or 527 990, 990 EZ, or 990 PF). K Check � II if the organization is not a section 509(a)(3) supporting organization and its gross receipts are normally not more than $50,000. A Form 990 -EZ or Form 990 return is not required though Form 990 -N (e postcard) may be required (see instructions). But if the organization chooses to file a return, be sure to file a complete return, receipts. r rocs receipts are dr uu,uuu or more, or it total assets (Part It, line 25, column (B) below) are $ 00,000 or more, ile Form 990 instead of Form 990- EZ........ $ 148.171. Revenue, expenses, and Changes In Net Assets or Fund Balances (See the instructions for Part I.) Check if the organization used Schedule O to respond to any question in this Part ............ ............................... X Grants and similar amounts paid (list in Schedule O) ..................... SEE . SCHEDULE ..0..... _. 1 Contributions, gifts, grants, and similar amounts receivetl .............. ............................... 1 8,087. 2 Program service revenue including government fees and contracts, ............................. 2 11 3 Membership dues and assessments .... __.............. ........... ......................_........ 1 3 12 Salaries, other compensation, and employee benefits. ......... .. ............................... 4 Investment income. _....... - ... .... ... ._.... ....._ ......................... ........ 4 214. 5a Gross amount from sale of assets other than inventory .................... 5a 13 Professional fees and other payments to independent contrac tors ...... ............................... b Less: cost or other basis and sales expenses. 56 550. e Gain or (loss) from sale of assets other than imentor, (Subtract line Su from line 5a) .. .. 5c Occupancy, rent, utilities, and maintenance........ ........ _..._...... _...... _.... _..... 6 Gaming and fundraising events E s E a Gross income from gaming (attach Schedule G if greater than $15,000) .... 6a b Gross income from fundraising events (not including $ 8, 087. of contributions from fundraising events reported on line 1) (attach Schedule G if the sum of such gross income and contributions exceeds $15,000) ................. 66 139, 870. 15 Printing, publications, postage, and shipping_ ...... _............ _..__............. c Less: direct expenses from gaming and fundraising events .........I ..... 6c 106, 720. of Net income or (loss) from gaming and fundraising events (add lines 6a and 6b and subtract line 6c)..._. ...._ ... ... _..... _. _......... _._ ..............._. fit 33,150. 7a Gross sales of inventory, less returns and allowances., ............. 7a 16 Other expenses (describe in Schedule 0).... ............................ SEE . SCHEDULE..O....... to Less: cost of goods sold ................. ............................... 7b Total expenses, Add lines 10 through 16 ..... ................. ............................... 17 to Gross profit or (loss) from sales of inventory (Subtract line 71, from line 7d), .... .... . 7c 8 Other revenue (describe in Schedule 0) ... ___......._....._. ... _..... _......._......_...... 8 18 121,715 9 Total revenue. Add lines 1, 2, 3, 4, Sc, 6d, 7c, and 8 ................ ............................... 9 41 451 TEEpplil oatont 10 Grants and similar amounts paid (list in Schedule O) ..................... SEE . SCHEDULE ..0..... _. 10 25, 234. 11 Benefits Paid to or for members....... ...... ....... .... .... .......... ... ......... ................... 11 E x.... 12 Salaries, other compensation, and employee benefits. ......... .. ............................... 12 E 13 Professional fees and other payments to independent contrac tors ...... ............................... 13 550. N14 s_..... Occupancy, rent, utilities, and maintenance........ ........ _..._...... _...... _.... _..... 14 E s............. 15 Printing, publications, postage, and shipping_ ...... _............ _..__............. 15 16 2,952. 16 Other expenses (describe in Schedule 0).... ............................ SEE . SCHEDULE..O....... 17 Total expenses, Add lines 10 through 16 ..... ................. ............................... 17 28,736. 78 Excess or (deficit) for the year (Subtract line 17 from line 9), .......... ............................... 18 121,715 A N 5 19 Net assets or fund balances at beginning of year from line 27, column A 9 9 Y ( ()) (must agree with end ofyear Es figure reported on prior year's return). _._..... _.. ..... ....... ...... 19 24,753. T T 20 Other changes in net assets or fund balances (explain in Schedule 0), .......... 20 s 21 ............ Net assets or fund balances at end of year. Combine lines 18 through 20. .... 21 37,468. BAA For Paperwork Reduction Act Notice, see the separate instructions. Form 990-EZ (2010) TEEpplil oatont Part 11.) vear 22 Cash, savings, and investments ...................... ............................... 23 Land and buildings......... _.... ... _ .............. ......._ ......... .. .. ... .. 24 Other assets (describe in Schedule O) SEE SCHEDULE 0 1... 26 Total assets...... _ ............ .... .._.... ... .... _....... _._...._.......... 26 Total liabilities (describe in Schedule 0) ) ..... 27 Net assets or fund balances line 27 of column must agree with line 21 .... .... ... 17, 707. 22 31,849. (e) Expense account and other allowances 23 PRESIDENT 7 096. 24 5 619. 29 753. 25 37 468. 0. 26 0. 24 753. 27 37,468. Statement of Program Service Accomplishments (see the instrs for Part III.) Check if the organization used Schedule O to respond to an uestion in this Part 111............ X expenses ((RRequired for section 501(c)(3) and501(c)(4) What is the organization's primary exempt purpose? SEF. SCHEDU I Describe what was achieved in carrying out the organization's exempt purposes. n a c ear and concise manner, describe the services provided, the number of persons benefited, and other relevant information for each ro ram title. organizations and section 4947(8,)() trusts; optional for othhers.) 28 SEE. SCHEDULE_ Q__ _______________________________ ____________________ _______________________________ _________________ Grants $ 25 234. If this amount includes foreign rants, check here...... _.. ..... 268, 25 234. 29 ____________________ _______________________________ ____________________ _______________________________ Grants $ If this amount includes forei n rants, check here..... . 298, 30 ----------------------- _-------------- _------------ ____________________ _______________________________ Grants $ If this amount includes forei n rants, check _39________ 31 Other program services (describe in Schedule O) ..... .... ... .. Grants $ If this amount includes foreign rants, check here ..... ... .. ... *32 32 Total ro ram service ex nses (add lines 28a throw h 31a .9 ................. ........ 9... .. ...... ... TREASURE 25, 234 . ff�Li5ioi0iiicers, Directors, trustees, and Key Employees. List each we rued if not compensated. (see the instructions for Part IV.1 Check if the oroanization used Schedule n to remnnd to aov mm�,- m 11n� awn n, IL, (a) Name and address (b) Title and average hours per week devoted to osibon (c) Compensation of not paid, enter k.) ((d) Conat ibidals to emplwn benefit plans and deferred compensation (e) Expense account and other allowances ANJANI CIRILLO _ _ _ _ _ _ _ ___________ PRESIDENT 0. 0. 0. 11155 ROSELAND RD 3.00 SEBASTIAN, FL 32958 RICHARD STRINGER_ _ VICE PRESIDENT 0. 0. 0. 356 CONCHA DR. _S_EBAS__A _F_L 3.00 _39________ DOT ,IUDAH_ TREASURE 0. 0. p, 13685 77TH TERRACE ___ _________ 3.00 _ _ _ _ _ SEBASTIAN, FL 32958 DOROTHY BOSWORTH _____________________ SECRETAR 0. 0. 0. 8366 99TH_ CT ___ 3.00 VERO BEACH FL 32967 TEDDI_ HULSE __ DIRECTO 0. 0. 0. 402 PLY TERR CO 1.00 _ _ _ _ SEBASTIAN, FL 32958 PAT RIVIZEO _ DIRE1.0 0. 0. 0. 7880 92ND AVE 1.00 _ ___ _____ _ VERO BEACH FL 32967 _____________________ SAA ttenosla 02,18,11 Form 990-FS (2010) Form 990 -EZ 2070) SEBASTIAN CLAMBAKE FOUNDATION, INC page 3 Other Information (Note the statement requirements in the instructions for Part V.) SEE SCHEDULE 0 Check if the organization used Schedule O to respond to any Question in this Part V.— ...................... n 33 Did the organization engagge in any activity not previously reported to the IRS? If 'Yes,' provide a detailed description of each activity in Schedule 0..... ..1111 ......................... .. _ .............. 1111.... ,....... ... ....... 34 Were any significant changes made to the colonizing or governing documents? If 'Yes,' attach a conformed copy of the amended document if they reflect a change to the organization's name. Otherwise, explain the change on Schedule 0 (see instructions) ........ ............................... 35 If the organizalon had income from business activities, such as those reported on lines 2, 6a, and 73 (among others), bud not reported on Form 990-T, explain in Schedule 0 wly the organization tlitl not report the income on Form 990 T. a Did the organization have unrelated business gross income of $1,000 or more or was it a section 501 (c)(4), 501 (c)(5), or 507(,)(6) organization subject to section 6033(e) notice, reporting, and proxy tax requirements? 1111, 111............1.. b If 'Yes,' has it filed a tax return on Form 990 -T for this year (see instructions) ? ........ ............. _................ 36 Did the organization undergo a liquidation, dissolution, termination, or significant disposition of net assets during the year? If' es,' complete applicable parts of Schedule N..... _ .................. _ ............. _ 1 ........... 1 . 11.. 37. Enter amount of political expenditures, direct or indirect, as described in the instructions. -1 37a 0. to Did the organization file Form 1120 -POL for this year? 1 .1. 1 .. 1 ........ _ 1111.. _ 1111 . ............................... 38a Did the organization borrow from, or make any loans to, any officer, director, trustee, or key employee or were any such loans made in a prior year and still outstanding at the end of the tax year covered by this return ?_ ........ ... b If 'Yes,' complete Schedule L, Part II and enter the total 386 N/A amount involved 39 Section 501(,)(7) organizations. Enter a Initiation fees and capital contributions included on line 9 ..... ... ... 39a N/A b Gross receipts, included on line 9 for public use of club facilities .. ...... 39b N/A 40a Section 501(,)(3) organizations. Enter amount of tax imposed on the organization during the year under: section 4911 0. ; section 4912 � 0. ; section 4955 ' 0. b Section 501(,)(3) and 501(,)(4) organizations. Did the organization engage in any section 4958 excess benefit transaction during the year or tlitl it engage in an excess benefit transaction in a prior year that has not been reported on any of its prior Forms 990 or 990 E9? If 'Yes,' complete Schedule L. Part I., ............ as Section 501(,)(3) and 51 organizations. Enter amount of tax imposed on organization managers or disqualified persons during the year under sections 4912, 4955, and 4958........ 0. all Section 501(,)(3) and 501(,)(4) organizations. Enter amount of tax on line 40c reimbursed by the organization .,..._.... 1111.._. 1111..._...._........ 11 0. e All organizations. At any time during the tax year, was the organization a party to a prohibited tax shelter transaction? If 'Yes,' complete Form 8886- T ... ............................... ............................... 41 List the states with which a copy of this return is filed � NONE 42a The organization's brooks are in care of- TREASURER _______ ______ _ Telephoneno.� 772 -581 -3199 ____ Located ate PO BOX 780936 SEBASTIAN FL ------- - - - - -- ____________________ 21P +4- 32958 b At any time during the calendar year, did the organization have an interest in or a signature or other authority over a Yes No financial account in a foreign country (such as a bank account, securities account, or other financial account)?..., _.. 426 X If 'Yes; enter the name of the foreign country:.. ii� See the instructions for exceptions and filing requirements for Form TD F 90 -22.7, Report of a Foreign Bank and Financial Accounts. c At any time during the calendar year, did the organization maintain an office outside of the U.S.?, . WX If 'Yes,' enter the name of the foreign country:.. 43 Section 4947(a)(1) nonexempt charitable trusts filing Form 990 -EZ in lieu of Form 1041 — Check here ...................... N/A and enter the amount of tax - exempt interest received or accrued during the lax year. . . ...... ....... el 43 N/A 44a Did the organization maintain any donor advised funds during the year? If 'Yes,' Form 990 must be completed instead ofForm 990- EZ ........ ............................__._... ........................_...... ............... Ix Did the organization operate one or more hospital facilities during the year? If 'Yes,' Form 990 must be completed insteadof Form 990 - p .................... ............................... _ 1111... ............................... c Did the organization receive any payments for indoor tanning services during the year? 1111. _ ........................ d If 'Yes' to line 44c. has the organization filed a Form 720 to report these payments? If 'Nq' provide an explanation in Schedule O ..................... 111__1... 111__1. 1111.. _... ._........... reeaoeizr oaian 4 45 Is any related organization a controlled entity of the organization within the meaning of section 512(6)(13)7 ............ 45 X a Did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 12(b)(13)? 9'Yes,' Form 990 and Schedule R may need to be completed instead of Form 990 -F1 (see inst.} I 45a X 46 Did the organization enggage, directly or intlirectly, in political campaign activities on behalf of or in opposition to candidates for public office? if 'Yes,' complete Schedule C, Pad I .................. ............................... _. 46 X Section 501(cx3) organizations and section 4947(axl) nonexempt charitable trusts only. All section 501(c)(3) organizations and section 4947(a)(1) nonexempt charitable trusts must answer questions 47 -49b and 52, and complete the tables for lines 50 and 51. Check if the organization used Schedule O to respond to any question in this Pad VI To ........ Yes No 47 Did the organization engage in lobbying activities? If'Yes; complete Schedule C, Pad X 48 Is the organization a school as described in section 170(b)(1)(A)(ii)? If'Yes; complete Schedule EX 41 Did the organization make any transfers to an exempt nom charitable related organization ?a X b If 'Yes,'was the related organization a section 527 organization? ..................... ......................6 50 Com nl this table for the organization's five highest compensated employees (other than officers, directors, trustees and key >c) whom ash r i .n o than ¢inn nn ,✓ � ., w,. .. p) Wme a c address of earn emp� %ee pale mwe man Into ON ro) red and average Mu,z pe, r,crk III to pasoM (c)comceessan (U)canoWtons to empbyee vanel,l�alJns aM deran d [enaa4m (elEE.pense um and olfK, allowances NONE Paid ANTHONY M. DONINI CPA /�//r!!l ea20 d Preparer IFIcaravani ANTHONY M. DON NI, CPA, PA Use Only PirmYaddredi 1623 US HWY 1 SUITE B -4 r,m.elN f Total number of other employees paid over $100,000....... 51 Complete this table for the organization's five highest compensated independent contractors who each received more than $100,000 of com ensatio. from the or anaation. If there is none, enter 'None.' (a) came and address of each indecenhod ecnbanor paid m«e aun $Iaxi @) Type of service (c) eompenaaron n ------------------------------------- - - - - -1 c Tolal number of other independent contractors each receiving over $100,000....... 52 Did the organization complete Schedule A? Note: All section 501(c)(3) organizations and 4947(a)(1) nonexempt r� charitable trusts most attach a completed Schedule A ............................ ............................... ei Inl Yes Pike under cenanles of wian_ detlara mau nave exeminea mia,ew,n, IgtlWing amwnoanyly zcMtlmes and stalemenls, and Islas Msr of no krowledge and belie( Iris Sign Here See TEEAD In oVWI Pram pa reapers, s name P par qn Oahe LMG u if she Paid ANTHONY M. DONINI CPA /�//r!!l ea20 d Preparer IFIcaravani ANTHONY M. DON NI, CPA, PA Use Only PirmYaddredi 1623 US HWY 1 SUITE B -4 r,m.elN See TEEAD In oVWI 'SCHEDULE A Public Chart Status and Public Support (Form 990 or 990 -EZ) PP Complete if the organization is a section 501(cX3) organization or a section 49470 ) nonexempt charitablla trust. bepanover or me Treasury eternal nevnnne ser.oe ' Attach to Form 990 or Form 990 -EZ.' See separate instructions. Name of me orif -Inuon I Empl 2010 Fhe organization is not a private foundation because it is: (For lines I through 11, check only one box.) 1 A church, convention of churches or association of churches described in section 170(b)(1)(AXi). 2 A school described in section 170(bX1XAXii). (Attach Schedule E ) 3 A hospital or a cooperative hospital service organization described in section 170(bX1XAXiii). 4 A medical research organization operated in conjunction with a hospital described in section 170(bX1XAXili). Enter the hospital's name, city, and state: 5 An organization operated for the benefit of a college or university owned or operated by a governmental unit described in section 170(bX1XAXiv). (Complete Part 11.) 6 H A federal, state, or local government or governmental unit described in section 170(bX1XAXv), 7 An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in section 170(bX7XAXvi). (Complete Part It.) 8 ❑ A community trust described in section 170(bX1XAXvi). (Complete Part Il.) 9 [X An organization that normally receives: (1) more than 33 -113% of its support from contributions, membership fees, and gross receipts from activities 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 HQ 10 a An organization organized and operated exclusively to test for public safety. See section 509(a)(4} 11 An organization organized and operated exclusively for the benefit of, to perform the functions of, or car ryry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(aX3). Check the box that describes the type of supporting organization and complete lines I le through I Ih. Fla Type I b []Type II c [] Type III — Functionally integrated d Type III — Other e By checking this box, I certify that the organization is not controlled directly or indirectly by one or more disqualified persons other than foundation managers and other than one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). I If the or received a written determination from the IRS that is a Type Type II or Type III supporting organization, check this box ............ ....... ....... 9 Since August 17, 2006, has the organization accepted any gift or contribution from any of the following persons? Yes No (i) A person who directly or indirectly controls, either alone or together with persons described In (II) and (iii) below, the governing hotly of the supported either alone organization? _ . .. and ( it i (it) A family member of a person described in (i) above ?... ... ...... 71 (it (iii) A 35% controlled entity of a person described in (i) or (if) above ... ... ... .. 11 lit If Provide the following information about the sunnnrted nrnannannn(�1 (I) Name of auppa ganizalr op EIN 01pTrp o(wgamaaro (de hN on Lnes 1 9 Cove w IflC SecOOn (zn lnsWNOns)) ov) IS me rgamxalion o column (a hsled Io Ypn 9wernin9 eocumenl? (v) old you non, the onianlzalion in column (b of Your suitWrt? (vp is the organization In okre, (p or9au5 io the hdo nmoum of suppal Yes No Yes I No Yes No A) B) C D E Total BAA For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990 -EZ. TsEech R l2st3rg Schedule A (Form 990 or 990 EZ) 2010 Schedule A (Form 990 or 990 -EZ) 2010 SEBASTIAN CLAMBAKE FOUNDATION INC Page 2 Support Schedule for Organizations Described In Sections 170(bX1XAXiv) and 170(bX1XAXvi) (Complete only if you checked the box on line 5, 7 or 8 of Part I or if the organization failed to qualify under Part Ill. If the organization fails to qualify under the tests listed below, please complete Part III ) Calendar year (or fiscal year (a)2006 beginning in) t Gifts, grants, contributions, and membership fees received. (Do not include 'unusual grants').. 2 Tax revenues levied for the organization's benefit and either paid to it or expended on its behalf. . , , . ........ 3 The value of services or facilities furnished by a governmental unit to the organization without charge.... 4 Total. Add lines 1 through 3... 5 The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)... 6 Public support. Subtract line 5 from line 4 Calendar year (o beginning in) w 7 Amounts fr 8 Gross inco dividends, on securitie royalties an similar sour 9 Net income business ac not the bust carried on.. 10 Other incom gain or loss capital asset Part IV.).... 11 Total suppo through 10.. (b) 2007 (c) 2008 I (d) 2009 I (.)2010 (f) Total r fiscal year ( (a) 2006 ( (b) 2007 ( (c) 2008 ( (d) 2009 (e)2010 ( (1) Total 12 Gross receipts from related activities, etc (see instructions), ........................ ..... .......... .... ..... .. 12 13 First lye years. If the Form 990 is for Me organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization, check this box and stop here ................._.................. _..._..............- ........._. 14 Public support percentage for 2010 (line 6, column (f) divided by line 11, column (f)) ... ... .... _.......... _ ... 14 15 Public support percentage from 2009 Schedule A, Part Ii, line 14 . _ .................. . _.......... 15 - % 16a 33-1/3% support test — 2010. If the organization did not check the box on line 13, and the line 14 is 331/3% or more, check this box and stop here. The organization qualifies as a publicly supported Organization_ ......... _......... _ .............. ❑ b 33-113% support test — 2009. If the organization did not check a box on line 13 or 16a, and line 15 is 33 -1/3% or more, check this box and stop here. The organization qualifies as a publicly supported organization.. . ... , _ .. .., . . , ........ ._ .... _., ....... Lj 17a 10 %- facts- and - circumstances test — 2010. If the organization did not check a box on line 13, 16a, or 16b, and line 14 is 10% or more, and if the organization meets the facts- and - circumstances' test, check this box and stop here. Explain in Part IV how the organization meets the'facts- and - circumstances' test. The organization qualifies as a publicly supported organization......... to l0 %- facts- and - circumstances test— 2009. If the organization did not check a box on line 13, 16a, 16b, or 17a, and line 15 is 10% of more, and if the organization meets the 'facts- and - circumstances' lest, check this box and stop here. Explain in Part IV how the organization meets the 'facts- and - circumstances' test. The organization qualifies as a publicly supported organization .. n 18 Private foundation. If the organization did not check a box on line 13 16a 16b 17 176 check this box d t t' n 'AA Schedule A (Form 990 or 990 -EZ) 2010 *EEn ?L loDIlo Schedule A Form 990 or 990 -E 2010 SEBASTIAN CLAMBAKE FOUNDATION, INC Page 3 Support Schedule for Organizations Described in Section 509(ax2) (Complete only if you checked the box on line 9 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part 11.) Section A. Public Support Calendar year (or fiscal yr beginning in) (a ) 2006 6 2007 c 2008 2009 (.)2010 Total 1 Gifts, grants, contributions and membership fees racerveit (Do not include any 'unusual grants.')......... 2,000. 9,000. 9,600. 8,087. 28,687. dividends, pa ments received on securities loans, rents, royalties and income from similar sources ............... 2 Gross receipts from admis- sions, merchandise sold or to Unrelated business taxable services performed, or facilities income (less section 511 furnished in any activity that is taxes) from businesses related to the organization's tax - exempt purpose.......... 177 533. 7,183. 163, 879. 171, 002. 139, 870. 659, 467. 0. c Add lines 1 do and 101a _ ...... 0. 0. 0. 0. 3 Gross receipts from activities that are not an unrelated trade 11 Net income from unrelated business or business under section 513. activities not included in line 10b, 0. 4 Tax revenues levied for the whether or Pat the business is organization's benefit and either paid to or expended on its behalf ...... ............ regularly Earned on ............... 0. 5 The value of services or 0. facilities furnished by a r 179 533. 7,183. 172,879.1 180 602. 148,171. 688,368. governmental unit to the organization without charge... is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) 0. 179,533. 7,183. 172,879. 180,602. 147,957. 688,154. 6 Total. Add lines l through 5... 7a Amounts included on lines 1, 2, and 3 received from disqualified persons........... 0. 0. 0. 0. 0. 0. b Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or ) % of the amount on line 13 for the year. . .. . ., . ., , _ 0. 0. D. 0. 0. 0. 0. 0. 0. 0. 0. 0. c Add lines 7a and 7b........... 8 Public support (Subtract line 7c from line 6.) M 688. 1 S4 _ Calendar year (or fiscal in beginning in) w a 2006 b 2007 c 2008 2009 a 2010 Total 179 533. 7 183. 172 879. 180 602. 147 957. 688 154. 9 Amounts from line 6....... 10a Gross income from interest, dividends, pa ments received on securities loans, rents, royalties and income from similar sources ............... 214. 214. to Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975... 0. c Add lines 1 do and 101a _ ...... 0. 0. 0. 0. 214. 214. 11 Net income from unrelated business activities not included in line 10b, whether or Pat the business is regularly Earned on ............... 0. 0. 12 Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.) ...................... r 179 533. 7,183. 172,879.1 180 602. 148,171. 688,368. 13 Total support. (Am " 91 1 m. 11. ma 12) is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) _ I 14 First fiveyears. If the Form 990, 15 Public support percentage for 2010 (line 8, column (0 divided by line 13, column (I)) ..................... 17 Investment income percentage for 2010 (line 10c, column (0 divided by line 13, column (0) .................... 17 18 Investment income percentage from 2009 Schedule A, Part ill, line 17.. ........ ............................... 18 19a 331/3% support tests - 2010. If the organization did not check the box on line 14, and line 15 is more than 33 -1/3 %, and line 17 is not more than 33 -1/3 %, check this box and stop here. The organization qualifies as a publicly supported organization.......... X� 633 -1/3 %support tests -2009. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 -1/3 %, and line 18 is not more than 331/3 %, check this box and stop here. The organization qualifies as a publicly supported organization.... 20 private foundation. If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions............ SAA TEe Wcn_ 1029110 Schedule A (Form 990 or 990 EZ) 2010 Also complete this part for any BAA Schedule A (Form 990 or 990 -EZ) 2010 � 09W10 Form 990 F tilers are not required to complete this part 1 Indicate whether the organization raised funds through any of the following activities. Check all that apply. a Mail solicitations a Solicitation of non government grants le Internet and email solicitations f Solicitation of government grants c Phone solicitations g Special fundraising events I In person solicitations 2a Did the organization have a written or oral agreement with any individual (including officers, directors, trustees or key employees listed in Form 990, Part VII) or entity in connection with professional fundraising services2 .... -.. ....... []Yes ❑ No In If 'Yes,' list the ten highest paid individuals or entities (fundraisers) pursuant to agreements under which the fundraiser is to be compensated at least %9 00n by the or --firm (1) Name and address of individual or entity (fundraiser) (ii) Activity (iii) Did fundraiser have custody or control of contributions? (iv) Gross receipts from activity (v) Amount paid to (or retained by) funtlraiser listed in column (i) (vi) Amount paid to (or retained by) organization 1 Yes No 2 3 4 5 6 7 8 9 10 Tolal. ............................... .......... .. ... „ur �� u, nao uuun notion if Is exempt from registration or licensing. __________________________________ _______________________________ __________________________________ _______________________________ __________________________________ _______________________________ __________________________________ _______________________________ __________________________________ _______________________________ __________________________________ _______________________________ __________________________________ _______________________________ __________________________________ _______________________________ __________________________________ _______________________________ __________________________________ _______________________________ __________________________________ _______________________________ __________________________________ _______________________________ aAA For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990 -EZ. Schedule G (Form 990 or 990 -EZ) 2070 TEEA17011- 03125111 or UfiBM Fundraising Events. Complete if the organization answered 'Yes' to Form 990, Part IV, line 78, or reported more than $15,000 of fundraising event contributions and gross income on Form 990 -EZ, lines 1 and 6a. List events with gross receipts greater than $5 000. 9 Enter the states) in which the organization operates gaming activities: a Is the organization licensed to operate gaming activities in each of these states ?........... _ ..................... Yes No b If'No,' explain: __________________________________ _______________________________ ________________________ _______________________________ _ _ Ira Were any of the organization's gaming licenses revoked, suspended or terminated during the tax year ?............ Yes No b If 'Yes,' explain: __________________________________ _______________________________ SAA TEM702- 0)113111 Schedule G (form 990 or 990 -EZ) 2010 (a) Event #1 (b) Event #2 (c) Other events (d) Total events CLAMBA FESTI add column (a) E through column (c)) 0-1 Nce) (o�am Nce) (total numbep v 147,957. 147,957. E N 1 Gross receipts, E 2 Less: Charitable contributions. ..... 8,087. 8,087. 139 870. 139 870. 3 Gross income line I minus line 2 .. 4 Cash prizes– , .. – . _ . ......... 400. 400. 5 Noncash prizes .......__. ... ..... ... 0 R 6 Rent /facility costs ................. 20,319. 20,319. E c T 7 Food and beverages ................... 60,568. 60,568. E x e Entertainment. ................. _.... 5, 672. 5, 672. E 19,761. Hs 9 Other direct expenses ......... _.._.. 19 761. E s 10 Direct expense summary. Add lines 4- through 9 in column (d).......... _ ...... ......... ....:......... 106 720. 11 Net income summary.Combine line 3, column n, and line 10_ r _... ................ 33,150. Gaming. Complete if the organization answered 'Yes' to Form 990, Part IV, line 19, or reported more than $15,000 on Form 990 -EZ, line 6a. R (a) Bingo (b) Pull tabs /Instant (c) Other gaming (d) Total gamingg E bingo /progressive (adtl column (a) c lingo through column (c)) R U E 1 Gross revenue ........................ 2 Cash prizes, . E o x e e m 3 No cash prizes...... . ............. EN c 5 E s 4 Rent /facility costs ..................... 5 Other direct expenses ................. Yes $ Yes $ Yes % 6 Volunteer labor ........._ ............ No No No 7 Direct expense summary. Add lines 2 through 5 in column (d). 9 Net gaming income summary. Combine lines 1, column d and line 7. 9 Enter the states) in which the organization operates gaming activities: a Is the organization licensed to operate gaming activities in each of these states ?........... _ ..................... Yes No b If'No,' explain: __________________________________ _______________________________ ________________________ _______________________________ _ _ Ira Were any of the organization's gaming licenses revoked, suspended or terminated during the tax year ?............ Yes No b If 'Yes,' explain: __________________________________ _______________________________ SAA TEM702- 0)113111 Schedule G (form 990 or 990 -EZ) 2010 Schedule G (Form 990 or 990 -E 2010 SEBASTIAN CLAMBAKE FOUNDATION, INC Pa e 3 11 Does the organization operate gaming activities with nonmembers?.. _...................... L Yes Lj No 12 Is the organization a grantor, beneficiary or trustee of a trust or a member of a partnership or other entity formed to administer charitable gaming?. ........... ............................ .... ❑ Yes ❑ No .............................. 13 Indicate the percentage of gaming activity operated in a The organizations facility .... .... .... ._ . 13a if b An outside facility, ..... ... ...... ..... ..... ...... I 13b % 14 Enter the name and address of the person who prepares the organizat[on's gaming /special events books and records: Name Address 15a Does the organization have a contact with a third party from whom the organization receives gaming revenue? ....... F]Yes [] No b If 'Yes,' enter the amount of gaming revenue received by the organization $ and the amount of gaming revenue retained by the third party ' $ c If 'Yes,' enter name and address of the third party: Name Address 16 Gaming manager information: Name ______________________________ _______________________________ Gaming manager compensation � $ Description of services provided w ❑ Director /officer Employee Independent contractor 17 Mandatory distributions a Is the organization required under state law to make charitable distributions from the gaming proceeds to retain the state gaming license ?..._..... ..__._. __......... ... _..... _....___.... _.._.......:. F]Yes rNo b Enter the amount of distributions required under state law to be distributed to other exempt organizations or spent in the oatinnk nwn exemnf activitie -s durinn the tax vear � S Supplemental Information. Complete this part to provide the explanations required by Part I, line 2b, columns (iii) and (v), and Part III, lines 9, 96, 10b, 15b, 15c, 16, and 17b, as applicable. Also complete this part to provide any additional information (see instructions). TEEA3703L 01119111 Schedule G (Form 990 or 990 -En 2010 SCHEDULEO (Fora 990 or 990.EZ) IBnte,mtnal R—m— Servlce'Y Name of ate o,ganixatm Supplemental Information to Form 990 or 990 -EZ Complete to rode information for responses to specific questions on Fora 990 or 990 -U or to provide any additional information. Attach to Form 990 or 990 -EZ. OMB NO, I Wi O017 2010 _ _ _FORM 990 -EZ, PART III_ ORGANIZATION'S PRIMARY EXEMPT PURPOSE_ ___SUPPORT-LOCAL CHARITIES --- FOR"O-EZ 1 PART III LINE 28 _STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTS ___THE AN_NUAL _ _ _ CLAMBAKE _ _ _ _ _ __FESTIVAL, _ _ _ _ _ ___THROUGH _ _ _ _ __ THE _ __ EFFORTS _ _ _ _ _ OF VOLUNTEERS, DONATED OVER ___$83,000—FOR-THE-BOYS AND GIRLS-CLUB'S-NEW FACILITY _ ON MAIN—STREET,—HELPED FUND A _______ __ NEW _AFFORDABLE _ SENIOR HOUSING FACILITY, _CONTRIBUTED FUNDS FOR NEW SOCCER FIELDS _IN _____ ___SEBASTIAN AND FOR IMPROVED LIGHTING IN SEBASTIAN'S RIVERVIEW PARK.—WE—ALSO—FUNDED __ MAJOR IMPROVEMENTS FOR LOCAL YOUTH _ FOOTBALL _FACILITIES, _THE _SEBASTIAN VFW MEETING ___________________ _____________________________ __ HALL AND THE H.A.L.O. _ ANIMAL RESCUE _MISSION IN SEBASTIAN. ___ _______________________________ _FORM 990 -EZ, PART —V - REGARDING TRANSFERS ASSOCIATED WITH PERSONAL BENEFIT _ CONTRACTS (A _ _ _ _ DID THE ORGANIZATION, DURING THE YEAR, RECEIVE ANY _FUNDS_ __, DIRECTLY _OR ____________ INDIRECTLY, _TO _ PAY _ PREMIUMS _ON _ A PERSONAL BENEFIT CONTRACT ?......._ .._............ .... NO (B) _ DID THE ORGANIZATION, DURING THE YEAR,-PAY-PREMIUMS,-DIRECTLY-OR _______________ ____________________________ INDIRECTLY, ON A PERSONAL BENEFIT CONTRACT ? ....... .........._...... _... _._.............. NO BAA For Paperwork Reduction Act Notice, see the Instructions for Form 990 at 990 -EZ. TEEna90a twzano Schedule 0 (Form 990 or 990 -EZ) 2010 2010 SCHEDULE O - SUPPLEMENTAL INFORMATION PAGE 21 SEBASTIAN CLAMBAKE FOUNDATION, INC FORM 990 -EZ, PART I, LINE 10 GRANTS AND SIMILAR AMOUNTS PAID IN EXCESS OF $5,000 DONEE'S NAME: BY THE RIVER AFFORDABLE SENIOR HOUSING DONEE'S ADDRESS: 11155 ROSELAND RD SEBASTIAN, FL 32958 CASH AMOUNT GIVEN: DONEE'S NAME: AMERICAN LEGION DONEE'S ADDRESS: 807 LOUISIANA AVE. SEBASTIAN, FL 32958 CASH AMOUNT GIVEN: FORM 990 -EZ, PART I, LINE 16 OTHER EXPENSES DEPRECIATION ............. OFFICE EXPENSES.... _ ... ....... FORM 990 -EZ, PART 11, LINE 24 OTHER ASSETS $ 7. 920. $ 8,153. I ........ $ 2,375. ........ 577. TOTAL $ 2,952. BEGINNING ENDING MACHINERY AND EQUIPMENT ... .........._.................... _.........._. $ 7,096. S 5,619. TOTAL $ 7,046. $ 5,619. 2010 SUPPORTING DETAIL SEBASTIAN CLAMBAKE FOUNDATION, INC PAGE 1,. FUNDRAISING AND GAMING .. . ........ 9,586. RENT/FACILITY COSTS ..... .._........... _ ._. 44,308. CLAMBAKE FESTIVAL .. . . . ... . ... ........_......., _..... 334. INSURANCE_. ._.. ....__..... _....._......... _... _ ... .................... $ 7,816. EQUIPRENTAL _..... .._ ........... ..............._........._..... _............... 1,319. STORAGE...... ....... ..._..... _ ................. ...... . 2,142. ADVERTISING...... ... ... ... ... ........ ...... .... _.... ............... _ ................ 9 042. TOTAL ST 20,319. FUNDRAISING AND GAMING OTHER DIRECT EXPENSES CLAMBAKE FESTIVAL FUEL .,... ....... ..._... ... ......... .. . _ SUPPLIES. $ 1,422. .... ... ..__...._. .. . . ...... .._... .. .. ... T- SHIRTS..... ........... ....................................._...._..._.......... .._.................. ... ... ... ....... ... 7,439. 2,196. ........... SALES TAX.... ._...... -.. _._. _ ..... ............... 8 704. TOTAL T 19,76 FUNDRAISING AND GAMING FOOD AND BEVERAGES CLAMBAKE FESTIVAL BEER.................. ...... ... ....... ... $ 6,340. ._.. CLAMS ... ....... . . . . . ... .. . ._... .. . ........ 9,586. ... . FOOD ._.._..... . .. ..... _.. . . _.. ..... .._........... _ ._. 44,308. SODA,..._.._........ ........ ...._..... ...... .. . . . ... . ... ........_......., _..... 334. TOTAL S 60,568.