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Home My WebLink About2003-253I V Indian River County Grant Contract This Grant Contract ("Contract" ) entered into effective this 1st day of October 2003 by and between Indian River County , a political subdivision of the State of Florida , 1840 25th Street , Vero Beach FL , 32960 ("County" ) and St . Peters Human Services (" Recipient") ; of: (Address ) St . Peters Human Services 425038 th Avenue Gifford , Florida 32967 Village of Excellence Training Institute for Girls Background Recitals A. The County has determined that it is in the public interest to promote healthy children in a healthy community . B . The County adopted Ordinance 99- 1 on January 19 , 1999 ("Ordinance" ) and established the Children 's Services Advisory Committee to promote healthy children in a healthy community and to provide a unified system of planning and delivery within which children 's needs can be identified , targeted , evaluated and addressed . C . The Children 's Services Advisory Committee has issued a request for proposals from individuals and entities that will assist the Children 's Services Advisory Committee in fulfilling its purpose . D . The proposals submitted to the Children 's Services Advisory Committee and the recommendation of the Children 's Services Advisory Committee have been reviewed by the County . E . The Recipient, by submitting a proposal to the Children 's Services Advisory Committee , has applied for a grant of money ("Grant" ) for the Grant Period (as such term is hereinafter defined ) on the terms and conditions set forth herein . F . The County has agreed to provide such Grant funds to the Recipient for the Grant Period (as such term is hereinafter defined ) on the terms and conditions set forth herein . NOW THEREFORE , in consideration of the mutual covenants and promises herein contained , and other good and valuable consideration , the receipt and adequacy of which are hereby acknowledged , the parties agree as follows : 1 . Background Recitals The background recitals are true and correct and form a material part of this Contract . 2 . Purpose of Grant The Grant shall be used only for the purposes set forth in the complete proposal submitted by the Recipient attached hereto as Exhibit "A" and incorporated herein by this reference (such purposes hereinafter referenced as "Grant Purposes" ) . 3 . Term The Recipient acknowledges and agrees that the Grant is limited to the fiscal year 2003/2004 ("Grant Period") . The Grant Period commences on October 1 , 2003 and ends on September 30 , 2004 . — 1 — 4 . Grant Funds and Payment The approved Grant for the Grant Period is Twenty Thousand Dollars ( $20 , 000 ) . The County agrees to reimburse the Recipient from such Grant funds for actual documented costs incurred for Grant Purposes provided in accordance with this Contract. Reimbursement requests may be made no more frequently than monthly. Each reimbursement request shall contain the information , at a minimum , that is set forth in Exhibit "B" attached hereto and incorporated herein by this reference . All reimbursement requests are subject to audit by the County . In addition , the County may require additional documentation of expenditures , as it deems appropriate . 5 . Additional Obligations of Recipient . 5 . 1 Records . The Recipient shall maintain adequate internal controls in order to safeguard the Grant. In addition , the Recipient shall maintain adequate records fully to document the use of the Grant funds for at least three (3 ) years after the expiration of the Grant Period . The County shall have access to all books , records , and documents as required in this Section for the purpose of inspection or audit during normal business hours at the County' s expense , upon five ( 5 ) days prior written notice . 5 . 2 Compliance with Laws . The Recipient shall comply at all times with all applicable federal , state, and local laws , rules , and regulations . 5 . 3 Quarterly Performance Reports . The Recipient shall submit Quarterly Performance Reports to the Human Services Department of the County within fifteen ( 15 ) business days following : December 31 , March 31 , June 30 , and September 30 . 5 .4 Audit Requirements . If Recipient receives $25 , 000 or more in the aggregate from all Indian River County government funding sources , the Recipient is required to have an audit completed by an independent certified public accountant at the end of the Recipient's fiscal year. Within 120 days of the end of the Recipient 's fiscal year, the Recipient shall submit the audit to the Indian River County Office of Management and Budget . The fiscal year will be as reported on the application for funding , and the Recipient agrees to notify the County prior to any change in the fiscal period of Recipient . The Recipient acknowledges that the County may deny funding to any Recipient if an audit required by this Contract for a prior fiscal year is past due and has not been submitted by May 1 . 5 .4 . 1 The Recipient further acknowledges that, promptly upon receipt of a qualified opinion from its independent auditor, such qualified opinion shall immediately be provided to the Indian River County Office of Management and Budget. The qualified opinion shall thereupon be reported to the Board of Commissioners and funding under this Contract will cease immediately. The foregoing termination right is in addition to any other right of the County to terminate this Contract . 5 .4 . 2 The Indian River County Office of Management and Budget reserves the right at any time to send a letter to the Recipient requesting clarification if there are any questions regarding a part of the financial statements , audit comments , or notes . 5 . 5 Insurance Requirements . Recipient shall , no later than September 23 , 2003 , provide to the Indian River County Risk Management Division a certificate or certificates issued by an insurer or insurers authorized to conduct business in Florida 2 - that is rated not less than category A- : VII by A. M . Best, subject to approval by Indian River County's risk manager, of the following types and amounts of insurance : ( i ) Commercial General Liability Insurance in an amount not less than $ 1 , 000 , 000 combined single limit for bodily injury and property damage , including coverage for premises/operations , products/completed operations , contractual liability, and independent contractors ; ( ii ) Business Auto Liability Insurance in an amount not less than $ 1 , 000 , 000 per occurrence combined single limit for bodily injury and property damage , including coverage for owned autos and other vehicles , hired autos and other vehicles , non -owned autos and other vehicles ; and ( iii ) Workers ' Compensation and Employer's Liability (current Florida statutory limit) 5 . 6 Insurance Administration . The insurance certificates , evidencing all required insurance coverages shall be fully acceptable to County in both form and content , and shall provide and specify that the related insurance coverage shall not be cancelled without at least thirty ( 30 ) calendar days prior written notice having been given to the County. In addition , the County may request such other proofs and assurances as it may reasonably require that the insurance is and at all times remains in full force and effect . Recipient agrees that it is the Recipient's sole responsibility to coordinate activities among itself, the County, and the Recipient's insurer(s ) so that the insurance certificates are acceptable to and accepted by County within the time limits set forth in this Contract . The County shall be listed as an additional insured on all insurance coverage required by this Contract, except Workers ' Compensation insurance . The Recipient shall , upon ten ( 10 ) days' prior written request from the County, deliver copies to the County, or make copies available for the County's inspection at Recipient's place of business , of any and all insurance policies that are required in this Contract . If the Recipient fails to deliver or make copies of the policies available to the County; fails to obtain replacement insurance or have previous insurance policies reinstated or renewed upon termination or cancellation of existing required coverages ; or fails in any other regard to obtain coverages sufficient to meet the terms and conditions of this Contract , then the County may, at its sole option , terminate this Contract . 5 . 7 Indemnification . The Recipient shall indemnify and save harmless the County, its agents , officials , and employees from and against any and all claims , liabilities , losses , damage , or causes of action which may arise from any misconduct, negligent act, or omissions of the Recipient, its agents , officers , or employees in connection with the performance of this Contract . 5 . 8 Public Records . The Recipient agrees to comply with the provisions of Chapter 119 , Florida Statutes ( Public Records Law) in connection with this Contract . 6 . Termination . This Contract may be terminated by either party, without cause , upon thirty (30 ) days prior written notice to the other party. In addition , the County may terminate this Contract for convenience upon ten ( 10 ) days prior written notice to the Recipient if the County determines that such termination is in the public interest . 7 . Availability of Funds . The obligations of the County under this Contract are subject to the availability of funds lawfully appropriated for its purpose by the Board of County Commissioners of Indian River County. 3 - 8 . Standard Terms . This Contract is subject to the standard terms attached hereto as Exhibit C and incorporated herein in its entirety by this reference . IN WITNESS WHEREOF , County and Recipient have entered into this Contract on the date first above written . INDIAN RIVER COUNTY BOARD OF COUNTY COMMISSIO ERS By: �44 IVA ennet R . %facht , Chairman Attest : J . K. Barton , Clerk i By : Deputy Clerk Approved : woo S' James Chandler, 6ounty Administrator Appr ved as to form and legal sufficierwy: 10,16 elf, farssista5t County w6ey RECIPIENT : St . Peters Human Services 4250 38th Avenue Gifford , Florida 32967 By ame Andrea Jefferson Title - President - 4 - EXHIBIT A [Copy of complete proposal/application] - 1 - EXHIBIT B [From policy adopted by Indian River County Board Of County Commissioners on February 19 , 2002] " D . Nonprofit Agency Responsibilities After Award of Funding Indian River County provides funding to all nonprofit agencies on a reimbursement basis only . All reimbursable expenses must be documented by an invoice and/or a copy of the canceled check . Any expense not documented properly to the satisfaction of the Office of Management & Budget and/or the County Administrator may not be reimbursed . If an agency repeatedly fails to provide adequate documentation , this may be reported to the Board of Commissioners . In the event an agency provides inadequate documentation on a consistent basis , funding may be discontinued immediately . Additionally, this may adversely affect future funding requests . Expenditures may only be reimbursed from the fiscal year for which funding was awarded . For example , no expenditures prior to October 1St may be reimbursed with funds from the following year. Additionally, if any funds are unexpended at the end of a fiscal year, these funds are not carried over to the next year unless expressly authorized by the Board of Commissioners . All requests for reimbursement at fiscal year end ( September 30th) must be submitted on a timely basis . Each year, the Office of Management & Budget will send a letter to all nonprofit agencies advising of the deadline for reimbursement requests for the fiscal year . This deadline is typically early to mid October, since the Finance Department does not process checks for the prior fiscal year beyond that point . Each reimbursement request must include a summary of expenses by type . These summaries should be broken down into salaries , benefits , supplies , contractual services , etc . If Indian River County is reimbursing an agency for only a portion of an expense (e . g . salary of an employee ) , then the method for this portion should be disclosed on the summary. The Office of Management & Budget has summary forms available . Indian River County will not reimburse certain types of expenditures . These expenditure types are listed below . a . Travel expenses for travel outside the County including but not limited to ; mileage reimbursement , hotel rooms , meals , meal allowances , per Diem , and tolls . Mileage reimbursement for local travel (within Indian River County) is allowable . b . Sick or Vacation payments for employees . Since agencies may have various sick and vacation pay policies , these must be provided from other sources . c . Any expenses not associated with the provision of the program for which the County has awarded funding . d . Any expense not outlined in the agency's funding application . The County reserves the right to decline reimbursement for any expense as deemed necessary." - 1 - EXHIBIT C STANDARD TERMS FOR GRANT CONTRACT 1 . Notices : Any notice , request , demand , consent , approval or other communication required or permitted by this Contract shall be given or made in writing , by any of the following methods : facsimile transmission ; hand delivery to the other party; delivery by commercial overnight courier service ; or mailed by registered or certified mail ( postage prepaid ) , return receipt requested at the addresses of the parties shown below: County: Joyce Johnston -Carlson , Director Indian River County Human Services 184025 1h Street Vero Beach , Florida 32960-3365 Recipient : Pastor Andrew Jefferson St . Peters Human Services 425038 1h Avenue Gifford , Florida 32967 2 , Venue ; Choice of Law: The validity, interpretation , construction , and effect of this Contract shall be in accordance with and governed by the laws of the State of Florida , only . The location for settlement of any and all claims , controversies , or disputes , arising out of or relating to any part of this Contract , or any breach hereof, as well as any litigation between the parties , shall be Indian River County , Florida for claims brought in state court , and the Southern District of Florida for those claims justifiable in federal court. 3 . Entirety of Agreement : This Contract incorporates and includes all prior and contemporaneous negotiations , correspondence , conversations , agreements , and understandings applicable to the matters contained herein and the parties agree that there are no commitments , agreements , or understandings concerning the subject matter of this Contract that are not contained herein . Accordingly , it is agreed that no deviation from the terms hereof shall be predicated upon any prior representations or agreements , whether oral or written . It is further agreed that no modification , amendment or alteration in the terms and conditions contained herein shall be effective unless contained in a written document signed by both parties . 4 . Severability: In the event any provision of this Contract is determined to be unenforceable or invalid , such unenforceability or invalidity shall not affect the remaining provisions of this Contract , and every other term and provision of this Contract shall be deemed valid and enforceable to the extent permitted by law . To that extent , this Contract is deemed severable . 5 . Captions and Interpretations : Captions in this Contract are included for convenience only and are not to be considered in any construction or interpretation of this Contract or any of its provisions . Unless the context indicates otherwise , words importing the singular number include the plural - 1 - number, and vice versa . Words of any gender include the correlative words of the other genders , unless the sense indicates otherwise . 6 . Independent Contractor, The Recipient is and shall be an independent contractor for all purposes under this Contract . The Recipient is not an agent or employee of the County, and any and all persons engaged in any of the services or activities funded in whole or in part performed pursuant to this Contract shall at all times and in all places be subject to the Recipient's sole direction , supervision , and control . 7 . Assignment , This Contract may not be assigned by the Recipient without the prior written consent of the County. - 2 - = c� c4i T Lv . 1' I Flilficr� _ i,J_:I I�'FiJI_c i14 411 1-G , � '��I� F' . h1 . _ _ 'l� 1 AC,ORD CERTIFICATE OF LIABILITY INSURANCE GP 10 DATE (MMIDOIYYYY) ST:PK! 09 / 23 / 03 �RODucsR THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Hatcher Insurance , Inc . HOLDER, THIS CERTIFICATE DOES NOT AMEND , EXTEND OR P . O . Box 540659 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW Orlando FL "32894 -0689 Phone : 407 - 841 -2686 Fax 407 - 841 -2688 i INSURERS AFFORDING COVERAGE NAIC # -I.IICU�R-ED - - � &.lsur.C, A ph Riladelphia Indemnity Ins . to PiSURER15: American Ir_ternational Group St . Peters Academy Charter 3c'i - -- - - St . Peters Human Services , Inc NS!IkERt: -� 4250 38th Avenue rlNSURER0 I Vero Beach FL 32967 - 1711 r-- ---- IN6JRER E: COVERAGES THE POLICIES OF oNSURANCE LiSTED BELOW HAVE SEEN ISSUED TO THE INSURED vAMED ABOVE FOR THE PO_ICY PERIOD INDICATED . NOTWI THSTAK)ING ANY REQUIF.E)JEN T TERM OR CON DITICN OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHI0i THIS CERTIF.CAT ! MAY BE ISSUED OR MAY PERTAIN , THE INSURANCE AFFOROED BY THE PCLICIES CESCRIBED HEREIN IS SUBJECT TO ALL THE TERNS , EXCLU91ONS AND CONDITIONS OF SUCH POLICISS , AGGREGATE LIN41I7S SHOVIN NI AY HAVE BEEN REDUCED OY PAID CLAING , - - — - - -- T PGLIC�FFFE TfJE POLZR E3li�1RxTI0N _ _. . LTR INSRO TYPE OF INSURANCE POLICY NUM6ER DATE IMMIO9IYYI I OATS ( MM!CDIYY) UMTS DENERALLLSIL'TY I FACHCLGVRF. EN(;F S 1000000 A i rx 1CCIAWRGIA. GENEriA`_ UAPI!rTY PHPK060275 I 09 / 17 / 03 ; 09 / 17 / 04 ?Rctut:SEs ;E3 u;:c :o_nc�1 _ E 100000 CLAIMSt/AD'c $ j OCCUR i MADEX= :Ar.VCneperson, is 5000 .. . -...... . . I �� •_ — I PEK $CNAL 6 ADV ;NJURY Is 100 ,0000 ---- - -- I CENPAA: AGC-mECA -S $ 2000000 i ACGREC) A`S LIMIT APFutm$ FSR 2000000 S' CGMPr'J�= A :�G _ $ 2000000 — f I ROUPUf 4 JECT OC AUTOfAOBIIE LIABIU?V —� I GCM9:N�,'G SiNGLE LWIT (E3 ANY RUTG I 9001^.e e; I j CtH�CJLEC ? UTQa (Per erum1., ;7v f__ A_L GWNEC AJTO., I F09, LY Ir4,I I --- NREDA=T S i RCCILI INJURY S NOiwOWNEC AJTOS (PP acddart I � II PR ^PE4':Y DAMAGE �I - j (Rc: acclewt) 15 i _ 1 GARAGE MASILITYAUTO ON v • EA ACCICENT 5 ANY AJ'O I OTHER THAN pA ACC 5 .__ i ! I I AUTO ONLv. EXCE£SME!BRELLAAU E'I_ITY EACH OCCURRENCE f S 1000000 A X OCCUR I Ci, AIMSMADE � RENEWAL OF PHUB012211909117 / 03 k 09 / 17 / 04 1' AGGREGATE � 5 1000000 _ -- i 7C R=_-retirGN s 10 Roo I � � • � s I WORKERS COMPENSATION AND I �+CRY LI11 ' 1' d _ ftp EMPLOYERS' LIABILITY WG` 782937 7 ` 09 / 17 /003 j 09 / 17 / 04 x. L. % CH A!=9KT - £ 100000 B I AM' PRC,PP,IRORlPARTNERF..JCEMTN•E I I ! .. i I '= L clseasE - FA =r.IP_c Is s 100000 �,F I FICeRRAEM6 r'. EXGLUGED? ..._ —_ . . 19 yah, daw-ke urrer 1 F. . L. CISEASE POLr_`r 0.1i 1, $ 50 O 110 C GZEC' AL PRON3SONS belay, I _ I OIFHFR I 1 I I DESCRIPTION OF OPERATIONS I LOoAT10Ns 1 VEHICLES I EXCLUSIONS, ADDED 13 EN0 RSEMENT I SPEOIAr PROVISIONS Certificate holder is included as add:. tional insured applicable General Liability Coverage . *Except as required by Florida Statute . I CERTIFICATE HOLDER CANCELLATION SCHODI3 SHOULD AOF THr ABOVE OBSCRtBEO /501-101155 515 CANC = LED BEFORE THE EXPIRATION NY School District Of Indian LATE , rEREOP TME ISSUINO INSURER WILL ENDEAVOR TO MAIL 30 * OAYS WRITTEN River Co / Judy Bartlett NOTICE TO THE CERTIFICATE HOLDER NAIAEO TO THE LEFT, BUT FAI _URE TO DO SO SHALL y, 772 - 569 - 4139 IMPOSE NC OBLIGATIO R LIABILITY OF ANY K1NC IIPON THE INSURER, ITS AGENTS OR 1990 25th Street REPRESENTATIVES _ Vero Beach FL 32960 AUTHORIZED REP A RD 25 (2001 /08 ) ORD CORPORATION 1 TOTAL PtOl To : 561562842C Frei: State Farm Fax : State Farm LTOPCALL at : OCT-02-2003-08: 11 0oc : 767 Fage: 002 CERTIFICATE OF INSURANCE SUCH INSURANCE AS RESPECTS THE INTEREST OF THE CERTIFICATE HOLDER WILL NOT BE CANCELED OR OTHERWIS TERMINATED WITHOUT GIVING 10 DAYS PRIOR WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED BELOW, BUT IN Nr EVENT SHALL THIS CERTIFICATE BE VALID MORE THAN 30 DAYS FROM THE DATE WRITTEN . THIS CERTIFICATE OF INSURANCi DOES NOT CHANGE THE CCVERAGE PROVIDED BY ANY POLICY DESCRIBED BELOW. This cetif! es that: El STATE FARM MUT JA A.U70MOBILE INSURANCE COMPANY of Bloomington , Illinois , or ❑ STATE FARM FIRE AND CASUALTY COMPANY of Bloomington. Illinois has coverage in force for the foilowing Named insured as shown belowr : Named Insured St Peter's MissionaR, Baptist Ch ,. rch Inc Address cf Aained Insured 42;,0 ^084 ', Awe Vero Beach . FL 32967 I POLICY NUMBER 8402332DO959F –_—`— POLICY ! 1994 DODGE B350 VAN DESCRIPTION OF VEHICLE j LIABI _ITY COVERAGE_--� _ ❑YES ❑ NO ❑YES ❑ NO ❑YES ❑ NO ❑ YES [] NC LIMITS CF LIABILITY - -- -- -- � - - - a . Bocily Injury Each Person --- ---- - - -- - - ! --� a . Bodily Irjury -- -Each Accident b. Property Damage { - - - -- - -- -- -- -- -------- -- c . Bodily Injury & — -� -- ---- - --- - --- - --- - --- ------ ---- PropertyDamage $ 19000,C00 .00 Single Limit Each Accident _ PHYSICAL DAMAGE -t - --- - --- _— - ❑ YES � NO � ❑ YES � NC ❑ YES � NO � ❑YES � N� G COVERAGES 5250 OC DedLctible Deductible DeductibieDeductible a . Comprehensve -- — —❑ YES 21\10 - - YES - - - --� - b collision $ 0 -0p Deductible Deductible ❑ NO YES No Deducuble Deductible EMPLOYER'S NON-0WNERSHiP ❑YES [:INC) DYES 0` NO ❑YES Dc ❑ YES ❑ NO COVERAGE HIRED CAR COVEW E _ AYES ❑ MO OYES ONO LYES UJNC ❑ Y'ES LINO Agent 2733 10/02/03 Signature cf Authorized Representative Title Agent' s Code Number Date Name and Address of Certificate Holder Name and Address of Agent Indian River County David E Hedges, State Farm Insurance Agency 1990 25" Street 2601 2C' Street Suite B Vero Beach , FL 32960 Vero Beach FL 32960 i Check if a permanent Certificate of Insurance for Liability coverage ; s needed ❑ heck if the Certif Cate Holder should be added as an Additional Insured : ❑ Remarks. 158.4430.2 Rw. 9-54 Fr:n:ed in J . SA. MAL REVENUE SERVICE OEPARThENT OF THE tREASURY IT-gICT DIRECTOR BOX 2108 I ) " TI , Ott 45ZOtO'er Employer Identification Number : 31 - 148063 DLNO 17053042275008 ST PETERS HUMAN SERVICES Contact Person : INCORPORATED D _ A . DONNING C/ O REV ANDREU JEFFERSON Contact Telephone Number : 4250 38TH AVE " ( 513 ) 241 - 5199 GIFFORD , FL 32967 Accounting Period Endinq : Auqust 31, Fare 990 Required _ Yes Addendum Applies : Yes Dear Applicant : Based on information supplied , and assuminq your operations will be as stated in your application for recognition of exemption , we have determined you are ex " pt from federal income tax under section 501 ( a ) of the Internal Revenue Code as an organization described in section 501 ( c ) ( 3 ) _ We have further determined that you are not a private foundation within the eeaninq of section 509 ( a ) of the Cade , because you are an organization described in sections 509 ( a ) ( 1 ) and 170 ( b ) ( 1 ) ( A ) ( ii ) . If your sources of support , or your purposes , character , or method of operation change , please let us know so we can consider the effect of the change on your exempt status and foundation status . Ia the case of an amend - ment to your organizational document or bylaws , please send us a• copy at the amended document or bylaws . Also , you should inform us of all changes in your name or address . An ai 71..-. nary 1 , 1984 , ;cc: are liable for taxes carder the Federal insurance Ccntrihutions Act ( social security taxes ) on . remuneeation off` 3100 or more you pay to each of your employees during a calendar year_ You are not liable for the tax imposed under the Federal Unemployment Tax Act ( FUTA ) . Since you are not a private foundation , you are not subject to the excise taxes under Chapter 42 of the Cade . However , it you are involved in an excess benefit transaction , that transaction might be subject to the excise taxes of section 4958 . Additionally , you are not automatically exempt from other federal excise taxes . If you have any questions about excise , employment , or other federal taxes , please contact your key district office . Grantors and contributors may rely on this deterain .ition unle4s the Internal Revenue Service publishes notice to the contrary . However , if you lose your section 509 ( a ) ( 1 ) status , a grantor or contributor may not rely on this determination if he or she was in part responsible for , or was aware of , the act or failure to act , or the substantial or material change, on the part of the organization that resulted in your loss of such status , or it he or she acquired knowledge that the Internal Revenue Service had given notice that Letter 947 ( DO/ CS ) _ _ It % eqST PETERS HUMAN SERVICEES you would no longer be classified as a section 509 ( a ) ( 1 ) organization . ; l Donors may deduct contributions to you as provided in section 170 of the Code _ Bequests , legacies , devises , transfers , or gifts to you or for your use are deductible for federal estate and gift tax purposes if they meet the applicable provisions of Code sections 2055 , 2106 , and 2522 . Contribution deductions are allowable to donors only to the extent that their contributions are gifts , with no consideration received . Ticket pur -_ chases and similar payments in conjunction with fundraisinq events may not necessarily qualify as deductible contributions , depending on the circum - stances - See Revenue Ruling 67 - 246 , published in Cumulative Bulletin 1967 - 2 , on page 104 , which sets forth guidelines regarding the deductibility , as Chari - ' table contributions , of payments made by taxpayers for admission to or other participation in fundraising activities for charity . i In the heading of this letter me have indicated whether you must file Form 990 , Return of Organization Exempt From Income Tax . If Yes is indicated , you j ire required to file Form 990 only if your gross receipts each year are normally more than $25 , 000 _ However , if you receive a Form 990 package in the mail , please file the return even • if you do not exceed the gross receipts test _ If you are rot required to file , simply attach the label provided , check the box in the heading to indicate that your annual gross receipts are normally f 5251000 or less , and sign the return . If a return is required , it - must be filed by the 15th day of the fifth month after the end of your annual . accoun tinq period . A penalty of $20 a day is charged when a return is filed late , unless there is reasonable cause for the delay . However , the maximum penalty charged cannot exceed 610 , 000 or 5 percent of your gross receipts for the year , whichever is less . For organizations with gross receipts exceeding $ 1 , 000 , 000 in any year , the penalty is $ 100 per day per return , unless there is reasonable cause fer the delay . The maximum penalty for an organization with gross receipts exceeding $ 1 , 000 , 000 shall not exceed $ 50 , 000 . This penalty may also be charged if a • return is not complete , so be sure your return is complete before you file it . You are required to make your annual return available for public inspection for three years after the return is due . You are also required to make available a copy of your exemption application , any supporting documents , and this exemption letter . Failure to make these documents available for public inspection may subject you to a penalty of 320 per day for each day there is a failure to comply ( up to a maximum of $ 10 , 000 in the case of an annual return ) . You are not required to file federal income tax returns unless you are subject to the tax on unrelated business income under section 511 of the Code . If you are subject to this tax , you must file an income tax return on Form 990 - T , Exempt Organization Business Income Tax Return _ In this letter we are not deteraininq whether any of your present or proposed activities are unre- lated trade or business as defined in section 513 of the Code . Letter 947 ( DO / CG ) ST PETERS HUMAN SERVICES You need an employer identification number even if you have no employees . If an employer identification number was not entered on your application , a number will be assigned to you and you will be advised of it . Please use that number on all returns you file and in all correspondence with the Internal Revenue Service . This determination is based on evidence that your funds are dedicated to the purposes listed in section 5OL ( c ) ( 3 ) of the Code . To assure your Continued exemption , you should keep records to show tha-t funds are expended only for those purposes . If you distribute funds to other organizations , your records should show whether they are exempt under section 501 ( c ) ( 3 ) . In cases where the recipient organization is not exe ■ pt under section 501 ( c ) ( 3 ) , there should be evidence that the funds will remain dedicated to the required purposes and that they will be used for those purposes by the recipient . . If distributions are made to individuals , case histories regarding the recipients should be kept showing names , addresses , purposes of awards , manner of selection , relationship ( if any ) to members , officers , trustees or donors of funds to you , so that any and all distributions made to individuals can be substantiated upon request by the Internal Revenue Service . ( Revenue Ruling 56 -304 , C . B . 1456 - 2 , page 306 . ) If we have indicated in the heading of this letter that an addendum applies , the enclosed addendum is an integral part of this lettetr . Because this letter could help resolve any questions about your exempt sti tus and foundation status , you should keep .it in your - permanent records . If you have any questions , please contact the person whose name and telephone number are shown in the heading of this letter . Sincerely yours , Oe District Director v Enclosure ( s ) : Addendum Letter 947 ( DO /Chi ) 00025 Consumer ' s Certificate of Exemption R oR/ o2 DE DEPARTMENT Issued Pursuant to Chapter 212 , Florida Statutes OF REVENUE 85 -8012583781 C-6 10/07/2003 10/31 /2008 501 (C) (3) ORGANIZATION Certificate Number Effective Date Expiration Date Exemption Category This certifies that ST PETERS HUMAN SERVICES INCORPORATED 4250 38TH AVE VERO BEACH FL 32967 is exempt from the payment of Florida sales and use tax on real property rented , transient rental property rented , tangible personal property purchased or rented , or services purchased . Important Information for Exempt Organizations DR R . 01 /02/02 DEPARTMENT OF REVENUE 1 . You must provide all vendors and suppliers with an exemption certificate before making tax -exempt purchases . See Rule 12A- 1 . 039 , Florida Administrative Code ( FAC ) . 2 . Your Consumer 's Certificate of Exemption is to be used solely by your organization for your organization 's customary nonprofit activities . x 3 . Purchases made by an individual on behalf of the organization are taxable , even if the individual will be reimbursed by the organization . 4 . This exemption applies only to purchases your organization makes . The sale or lease to others by your organization of tangible personal property, sleeping accommodations or other real property is taxable . Your organization must register, and collect and remit sales and use tax on such taxable transactions . Note : Churches are exempt from this requirement except when they are the lessor of real property ( Rule 12A- 1 . 070 , FAC ) . 5 . It is a criminal offense to fraudulently present this certificate to evade the payment of sales tax . Under no circumstances should this certificate be used for the personal benefit of any individual . Violators will be liable for payment of the sales tax plus a penalty of 200% of the tax , and may be subject to conviction of a third degree felony. Any violation will necessitate the revocation of this certificate . 6 . If you have questions regarding your exemption certificate , please contact the Exemption Unit of Central Registration at 850-487-4130 . The mailing address is 5050 West Tennessee Street , Tallahassee , FL 32399 -0100 . =4ct - - ACORD CERTIFICATE OF LIABILITY INSURANCEGP I<a DATE (MMIDOIYYYV) ST�ETEA 09 / 23 / 03 �Toouc6R THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMAn ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Hatcher Insurance , Lnc . HOLDER, THIS CERTIFICATE DOES NOT AMEND , EXTEND OR P . O . Box 540659 ALTER THE COVERAGE AFFORDED 6Y THE POLICIES BELOW Orlando FL 32854 - 0689 Phone : 407 - 841 -2Eg6 Fax : 407 - 841 -2688 I INSURERS AFFORDING COVERAGE NAIC # _ _— — 14FURED — - I .".USURER A' Qhi ladelphla Indemn.:.ty In ' C o miSURERe: American International Group St . Peters Academy Charter Sch _ — - -- –_. - Ste Peters Human Services , Inc :15UptRC: - • • ___ . . ._ 4250 38th Avenue rMSURERO _ Vera Beach FL 32967 - 1711 isees - - - ---- - "JRER E: COVERAGES THE POLICIES OF MURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE PO_ICY PERIOD INDICATED. NOTWITHSTAIVUING ANY REOUIREMEr, T TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHILI-i THIS CERTIF.CAT = NIAY BE ISSUED OR MAY PERTAIN , THE JNSUPANCE AFFORDED BY THE POLICIES CESCRIBEC HEREIN IS SUBJECT TO ALL THE TERNS , EXCLU9=NS AND CONDITIONS OF SUCH POLICIES , AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED CY PAID CLAIW , LIC�EFFE'7T17E ' POL�YFXr�TRATION LtM .TS - --- - -- - STU y ! PUMOV NUMBER DATE Rr�MIODIYYI I DATE ( MM!OO/YY Lrq INSR❑ T PE OF INSURANCE 3ENERALL4BIL;TY r I FACHCCCURkEN.E ` 51000000 p I X ; COMrALR•JIALGENERA`_ L1A81Lm' PEPK060275 , 09 / 17 / 03 ; 09 / 17 / 04 rRErns=s (E3 u:dance) s 100000 _— I r l I I MED EX= :Any cne per:Dn`, — is 5000 . .� CLAIMS JAC'c I $ OCCUR I i ! I '-- - - .. .. .- �- PERSCNAL & AM INJURY 131000000 i I - GENSRAe. AGGREGA -E 5 2000000 Ij ?GULP . :ROCIOIS CGNPr,c A. y 5 �.000OOO* F%P- AGGREGA' LNIT APPLI ;. � _ . PRO- ' WC -_ IECI ! AUTOh!OBILELIABIUTY I CCM15!NECJ SINGLE U .Mil c I r ANYF.'JTO ` I (E9 occl^.err,: ,--. . I -- ALL OWNED AJTOS 60IXLY IN.CJ ! S I (Pcr pers )n) j I CrCIaFCU�ED AUTCG hIftEQ AUTOS I i� i ECCILY Ik,iURV I S NON-CWNEC AJTO$ 1 (Ppr accitl2ntf .. .._ ---• i ? R ^P E.R7Y DAMAGE S GARAGE UABILITV i I kJTG 7NLY • EP ACGIGENT -rS --- . .. _.N ANY A.1"O 1 I 1 I OTHER THAN GA AC'C S P I AUTO ONLY. i`C; _ $ _....... . .__ I EXCE8S ,1641SRELLA UAEI_ITY I EACs: CCCURRENCE I t 1000000 p, FX OCCUR I J C: A.AMSrtAUE RENEWAL Oe 2HUB0122!1909117 / 03 ! 09 / 17 / 04 I AGsAEGATE S1000000 I r—Iwo ; F- DEDUCTILILE I 1 0 00.2 S I WORKERS COMPENSATIOM AND I X i -CRYukrik IsRE ' — _ _ ,• — B I!( EMPLOYERS' LIABILITY I ` k=. L . �ACH ACr�DEL:T . . . _ IS3. 00000 WC7829377 09 / 1703 09 / 17 / 04 AM' PRGPPIEOZrPARTi=RF�iECTNE L CISEA5E • cA E .IP�C_E7 f SOOOOO �^FPCCR .?AIME=r EXCLUGE07 _.- . If yd6. lfAscrA:e urCBr SzECIAL PROVISONS he!cr. ( j t+. L. GSEASE . ?OLY_'y LIMIT S 500000 ! OTHER I I i DESCRIPTION OF OPERATIONS ( LOCATIONS I V15HIC .ES I EXCLUSIONS ADDED BY ENDORSE111 NT I SPEOIAr PROVISIONS Certificate holder is included as additional insured applicable General Liability Coverage . *Except as required by Florida Statute . t CERTIFICATE HOLDER CANCELLATION SCHODI3 SHOVLO ANY OF THC ABOVE DESCRIBED POLICIES be CANCE• .LED SEFCRE TILE EXPIRATION School District of Indian DATETHEREOf The ISSUING INSURER WILL ENDEAVOR TO MAIL 30 * DAYSWRTTTEN River Co / Judy Bartlett NOTICE TO THE CERTIFICATE HOLDER NMAED TO THE LEFT, BUT FAI _URF TODD 50 5HALL } INPO� NC OBLIGATIO "ILITY OF ANY KIND VPON THE INSURER, ITS fi4ENTS OR 1990 25th Street REPRESENTATIVES _ Ve :o Beach FL 32960 AUTHORIZED REPRE s oe A RD 25 (2001103 } A=ORDCORPORATION 1 TOTAL P , C11 To : 5615628920 From : State Fare Fax : State Farm LTOFCALL at . CCT-02-2003-08: 11 Bac : 767 Fage : 002 CERTIFICATE OF INSURANCE SUCH INSURANCE AS RESPECTS THE INTEREST OF THE CERTIFICATE HOLDER WILL NOT BE CANCELED OR OTHERWIS TERMINATED WITHOUT GIVING 10 DAYS PRIOR WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED BELOW, BUT IN Nt EVENT SHALL THIS CERTIFICATE BE VALID MORE THAN 30 DAYS FROM THE DATE WRITTEN . THIS CERTIFICATE OF INSURANCi DOES NOT CHANGE THE CCVERAGE PROVIDED BY ANY POLICY DESCRIBED BELOW. This cetif!es that: El STATE FARM MUTUALAUTOMOBILE INSURANCE COMPANYof Bloomington , Ilinois, or ❑ S7ATE FARM FIREANDCASU.ALTYCOMPANYof Bloomington. Illinois has coverage in force for the fo ioMng Named !nsured as shown belovr : Named Insured St Peter's Missionarti;Ba ist Ch :, rch Inc Address of Named Insured 4zn0 3t3" Ave. Voro Beach , FL 32967 POLICY NUMBER 6402632D0959F EFFECTIVE UP.-E OF 04109103• 10109103 POLICY ! 1994 DODGE 8350 VAN DESCRiPTIONOF VEHICLE j LIABILITY COVERAGE ❑ ES ❑ NO �- ❑YES ❑ NO []YES [] NO ❑ YES El NO LIMITS OF UAB ! LITY -- -- � - - - - a. Bocily Injury _ Each Person - -- --� I -- - - - a. Bodily Irjury - -- --- --- — Each Accident — � b. Property Damage �— - - ------ - t- --- — ---- - - -t -- -- ---- - - — c . Bodily injury & -- -� - - --- - --- -t ---- — - -- ---- + Property Damage $ 1 ,000 ,c00 .00 Single Limit Each Accident — PHYSiCAL DAMAGENO - -- yES � NO ❑ YES ❑ - - -- - INO YES COVERAGESI 5253 OC Deductible i DeductibleCNJ a . Comprehensive Deductible Deductible � ' - -- S - - - ❑ NO YES ❑ NO ❑YES NO b . collision 550000 Deductue I Deductible Deductible Deductible EMPLOYERS NON-0NNERSHiP j ❑ VES ❑ NO ❑YES ❑' NO :]YES ❑ NC DYES ❑ %IC OVERAGE _ _ HIREQCARCOVERAGE ❑'VES ❑ NO ❑Yc5 ❑ NO ❑YES ❑ NC - - ❑SES [] NO i Agent 2733 10/02/03 Signature cf Authcnzed Representative Title Agent' s Code Number Date Nagle and Add -ess cf Certificate Holder Name and Address of Agent Indian River County David E Hedges, State Farm Insurance Agency 1990 215` Street 2601 2UStreet Suite B Vero Beach , FL 32960 Vero Beach FL 32960 i Check if a permanent Certificate of Insurance for iiability coverage s needed ❑ CDeck if the Certificate Holder should be added as an Additional Insured : ❑ Remarks. 156-4430.2 Rev. 9-94 Princcd in J .SA. r11f4AL REVENUE SERVICc 0EP•ARTMENT OF THE TREASURY 1RICT DIRECTOR �` P• . BOX Me U" TI , off 41201 _ • : ' Employer Identification Numoer : �'• Date : 31 - 148063 DLN : 17053042275008 ST PETERS HUMAN SERVICES Contact Person : I14CORPIORATED D _ A . DONNING C/ 0 REV 0MREW JEFFERSON Contact Telephone Number : 4250 38TH AVE ( 513 ) 241 - 5199 GIFFORD , FL 32967 Accounting Period Ending : August 3t Fare 990 Required : Yes Addendum Applies : Yes Dear Applicant : Based on information supplied , and assuming your operations will be as stated in your application for recognition of exemption , we have determined you are exempt from federal income tax under section 501 ( a ) of the Internal Revenue Code as an organization described in section 501 ( c ) ( 3 ) . We have further determined that you are not a private foundation within the weaninq of section 509 ( a ) of the Cade , became you are an organization described in sections 509 ( a ) ( 1 ) and 170 ( b ) ( I ) ( A ) ( ii ) . If your sources of support , or your purposes , character , or method of operation change , please let us know so we can consider the effect of the change on your exempt status and foundation status . In the case of an amend - ment to your organizational document or bylaws , please send us. a- copy of the amended document or bylaws . Also , you should inform us of all changes in your name or address . zr�vz: :lary 1 , M!34 . ;cc: are liable far taxes sander the Federal insurance Contributions Act ( social security taxes ) on - remscner'ation of 3100 or more you pay to each of your employees durinq a calendar year. You are not liable for the tax imposed under the Federal Unemployment Tax Act ( FUTA ) . Since you are not a private foundation , you are not subject to the excise taxes under Chapter 42 of the Code . However , if you are involved in an excess benefit transaction , that transaction might be subject to the excise taxes of section 4938 . Additionally , you are not automatically exempt from other federal excise taxes . If you have any questions about excise , employment , or other federal taxes , please contact your key district office . Grantors and carp tributory may rely on this determination unless the Internal Revenue Service publishes notice to the contrary . However , if you lose your section 509 ( a ) ( 1 ) status , a grantor or contributor may not rely on this determination if he or she was in part responsible for , or was awarr of , the act or failure to act , or the substantial or material change- on tho part of the organization that resulted in your loss of such status , or it he or she acquired knowledge that the Internal Revenue Service had given notice that Letter 947 ( WIM ) ter, '•i • jtjtfj r. 5'i PETERS HUMAN SERVICES you would no longer be classified as a section 509 ( a ) ( 1 ) organization . Donors may deduct contributions to you as provided in section 170 of the Code . Bequests , legacies , devises , transfers , or gifts to you or for your use are deductible for federal estate and gift tax purposes if they meet the applicable provisions of Code sections 2055 , 2106 , and 2522 . Contribution deductions are allowable to donors only to the extent that their contributions are gifts , with no consideration received . Ticket pur -_ chases and similar payments in conjunction with fundraisinq events may not necessarily qualify as deductible contributions , depending on the circum - s stances . See Revenue Ruling 67 - 246 , published in Cumulative Bulletin 1967 - 2 , on page 104 , which sets forth guidelines regarding the deductibility , as Chari - table contributions , of payments made by taxpayers for admission to or other participation in fundraising activities for charity . In the heading of this letter me have indicated whether you must file Form 990 , Return of Organization Exempt From Income Tax . If Yes is indicated , you are required to file Form 990 only if your gross receipts each year are normally more than $ 25 , 000. However , if you receive a Form 990 package in the mail , please file the return even if you do not exceed the gross receipts test . If you .are rot required to file , simply attach the label provided , check the box in the heading to indicate that your annual gross receipts are normally 5251000 or less , and sign the return . If a return is required , it - must be filed by the 15th day of the fifth month after the end of your annual . accounting period . A penalty of $20 a day is charged when a return is filed late , unless there is reasonable cause for the delay . However , the maximum penalty charged cannot exceed 610 , 000 or 5 percent of your gross receipts for the year , whichever is less . For organizations with gross receipts exceeding $ 1 , 000 , 000 in any year , the penalty is 5100 per day per return , unless there is reasonable cause far the delay . The maximum penalty for an organization with gross receipts exceeding 61 , 000 , 000 shall not exceed $ 50 , 000 . This penalty may also be charged if a • return is not complete , so be sure your return is complete before you file it . You are required to make your annual return available for public inspection for three years after the return is due . You are also required to make available a copy of your exemption application , any supporting documents , and this exemption letter . Failure to make these documents available for public inspection may subject you to a penalty of 320 per day for each day there is a failure to comply ( up to a maximum of $ 10 , 000 in the use of an annual return ) . You are not required to file federal income tax returns unless you are subject to the tax on unrelated business income under section 511 of the Code . If you are subject to this tax , you must file an income tax return on Form 990 - T , Exempt Organization Business Income Tax Return . In this letter we are not determining whether any of your present or proposed activities are unre- lated trade or business as defined in section 513 of the Code . Letter 947 ( DO / CG ) i • - 3 - ST PETERS HUMAN SERVICES You need an employer identification number even if you have no employees . If an employer identification number was not entered on your application , a number will be assigned to you and you will be advised of it . Please use that number on all returns you file and in all correspondence with the Internal Revenue Service . This determination is based on evidence that your funds are dedicated to the purposes listed in section 501 ( c ) ( 3 ) of the Code . To assure your continued exemption , you should keep records to show that funds are expended only for those purposes . If you distribute funds to other organizations , your records should show whether they are exempt under section 501 ( c ) ( 3 ) . In cases where the recipient organization is not exempt under section 501 ( c ) ( 3 ) , there should be evidence that the funds will remain dedicated to the required purposes and that they will be used for those purposes by the recipient . . If distributions are made to individuals , case histories regarding the recipients should be kept showing names , addresses , purposes of awards , manner of selection , relationship ( if any ) to members , officers , trustees or donors of funds to you , so that any and all distributions made to individuals can be substantiated upon request by the Internal Revenue Service . ( Revenue Ruling 56 -304 , C . B . 1956 - 2 , page 346 . ) If me have indicated in the heading of this letter that an addendum applies , the enclosed addendum is an integral part of this letter . Because this letter could help resolve any questions about your exempt status and foundation status , you should keep .it in your . permanent records . If you have any questions , please contact the person whosr- name and telephone number are shown in the heading of this letter . Sincerely yours , District Director Enclosure ( s ) : Addendum Letter 947 ( DO / CG ) 00025 Consumer ' s Certificate of Exem tion DR- 14 p R . 01 /02 \ DEPARTMENT Issued Pursuant to Chapter 212 , Florida Statutes OF REVENUE 85 -8012583781 C-6 10/07/2003 10/31 /2008 501 ( C) (3) ORGANIZATION Certificate Number Effective Date Expiration Date Exemption Category This certifies that ST PETERS HUMAN SERVICES INCORPORATED 4250 38TH AVE VERO BEACH FL 32967 is exempt from the payment of Florida sales and use tax on real property rented , transient rental property rented , tangible personal property purchased or rented , or services purchased . DR -14 LE R . 01 /02 DEPARTMENT OF REVENUE 1 . You must provide all vendors and suppliers with an exemption certificate before making tax -exempt purchases . See Rule 12A - 1 . 039 , Florida Administrative Code ( FAC ) . 2 . Your Consumer 's Certificate of Exemption is to be used solely by your organization for your organization 's customary nonprofit activities . 3 . Purchases made by an individual on behalf of the organization are taxable , even if the individual will be reimbursed by the organization . 4 . This exemption applies only to purchases your organization makes . The sale or lease to others by your organization of tangible personal property, sleeping accommodations or other real property is taxable . Your organization must register, and collect and remit sales and use tax on such taxable transactions . Note : Churches are exempt from this requirement except when they are the lessor of real property ( Rule 12A- 1 . 070 , FAC) . 5 . It is a criminal offense to fraudulently present this certificate to evade the payment of sales tax . Under no circumstances should this certificate be used for the personal benefit of any individual . Violators will be liable for payment of the sales tax plus a penalty of 200% of the tax , and may be subject to conviction of a third degree felony. Any violation will necessitate the revocation of this certificate . 6 . If you have questions regarding your exemption certificate , please contact the Exemption Unit of Central Registration at 850 -487 -4130 . The mailing address is 5050 West Tennessee Street , Tallahassee , FL 32399-0100 . Indian River County Grant Contract This Grant Contract ("Contract" ) entered into effective this 1st day of October 2003 by and between Indian River County, a political subdivision of the State of Florida , 1840 25th Street , Vero Beach FL , 32960 ("County") and St . Peters Human Services (" Recipient") ; of: (Address ) St . Peters Human Services 425038 th Avenue Gifford , Florida 32967 Boys Development and Training Institute Program Background Recitals A. The County has determined that it is in the public interest to promote healthy children in a healthy community . B . The County adopted Ordinance 99- 1 on January 19 , 1999 ("Ordinance") and established the Children 's Services Advisory Committee to promote healthy children in a healthy community and to provide a unified system of planning and delivery within which children 's needs can be identified , targeted , evaluated and addressed . C . The Children 's Services Advisory Committee has issued a request for proposals from individuals and entities that will assist the Children 's Services Advisory Committee in fulfilling its purpose . D . The proposals submitted to the Children 's Services Advisory Committee and the recommendation of the Children 's Services Advisory Committee have been reviewed by the County . E . The Recipient, by submitting a proposal to the Children 's Services Advisory Committee , has applied for a grant of money ("Grant") for the Grant Period (as such term is hereinafter defined ) on the terms and conditions set forth herein . F . The County has agreed to provide such Grant funds to the Recipient for the Grant Period (as such term is hereinafter defined ) on the terms and conditions set forth herein . NOW THEREFORE , in consideration of the mutual covenants and promises herein contained , and other good and valuable consideration , the receipt and adequacy of which are hereby acknowledged , the parties agree as follows : 1 . Background Recitals The background recitals are true and correct and form a material part of this Contract . 2 . Purpose of Grant The Grant shall be used only for the purposes set forth in the complete proposal submitted by the Recipient attached hereto as Exhibit "A" and incorporated herein by this reference (such purposes hereinafter referenced as "Grant Purposes" ) . 3 . Term The Recipient acknowledges and agrees that the Grant is limited to the fiscal year 2003/2004 ("Grant Period") . The Grant Period commences on October 1 , 2003 and ends on September 30 , 2004 . — 1 — 4 . Grant Funds and Payment The approved Grant for the Grant Period is Thirty Thousand Dollars ($30 , 000 ) . The County agrees to reimburse the Recipient from such Grant funds for actual documented costs incurred for Grant Purposes provided in accordance with this Contract . Reimbursement requests may be made no more frequently than monthly . Each reimbursement request shall contain the information , at a minimum , that is set forth in Exhibit " B" attached hereto and incorporated herein by this reference . All reimbursement requests are subject to audit by the County . In addition , the County may require additional documentation of expenditures , as it deems appropriate . 5 . Additional Obligations of Recipient 5 . 1 Records . The Recipient shall maintain adequate internal controls in order to safeguard the Grant . In addition , the Recipient shall maintain adequate records fully to document the use of the Grant funds for at least three (3 ) years after the expiration of the Grant Period . The County shall have access to all books , records , and documents as required in this Section for the purpose of inspection or audit during normal business hours at the County's expense , upon five (5 ) days prior written notice . 5 . 2 Compliance with Laws . The Recipient shall comply at all times with all applicable federal , state , and local laws , rules , and regulations . 5 . 3 Quarterly Performance Reports , The Recipient shall submit Quarterly Performance Reports to the Human Services Department of the County within fifteen ( 15 ) business days following : December 31 , March 31 , June 30 , and September 30 . 5 . 4 Audit Requirements . If Recipient receives $25 , 000 or more in the aggregate from all Indian River County government funding sources , the Recipient is required to have an audit completed by an independent certified public accountant at the end of the Recipient's fiscal year. Within 120 days of the end of the Recipient' s fiscal year, the Recipient shall submit the audit to the Indian River County Office of Management and Budget. The fiscal year will be as reported on the application for funding , and the Recipient agrees to notify the County prior to any change in the fiscal period of Recipient . The Recipient acknowledges that the County may deny funding to any Recipient if an audit required by this Contract for a prior fiscal year is past due and has not been submitted by May 1 . 5 . 4 . 1 The Recipient further acknowledges that , promptly upon receipt of a qualified opinion from its independent auditor, such qualified opinion shall immediately be provided to the Indian River County Office of Management and Budget . The qualified opinion shall thereupon be reported to the Board of Commissioners and funding under this Contract will cease immediately. The foregoing termination right is in addition to any other right of the County to terminate this Contract . 5 .4 .2 The Indian River County Office of Management and Budget reserves the right at any time to send a letter to the Recipient requesting clarification if there are any questions regarding a part of the financial statements , audit comments , or notes . 5 . 5 Insurance Requirements . Recipient shall , no later than September 23 , 2003 , provide to the Indian River County Risk Management Division a certificate or certificates issued by an insurer or insurers authorized to conduct business in Florida - 2 - that is rated not less than category A- : VII by A. M . Best, subject to approval by Indian River County's risk manager, of the following types and amounts of insurance : (i ) Commercial General Liability Insurance in an amount not less than $ 1 , 000 , 000 combined single limit for bodily injury and property damage , including coverage for premises/operations , products/completed operations , contractual liability, and independent contractors ; ( ii ) Business Auto Liability Insurance in an amount not less than $ 1 , 000 , 000 per occurrence combined single limit for bodily injury and property damage , including coverage for owned autos and other vehicles , hired autos and other vehicles , non -owned autos and other vehicles ; and (iii ) Workers' Compensation and Employer's Liability (current Florida statutory limit) 5 . 6 Insurance Administration . The insurance certificates , evidencing all required insurance coverages shall be fully acceptable to County in both form and content, and shall provide and specify that the related insurance coverage shall not be cancelled without at least thirty (30 ) calendar days prior written notice having been given to the County. In addition , the County may request such other proofs and assurances as it may reasonably require that the insurance is and at all times remains in full force and effect . Recipient agrees that it is the Recipient's sole responsibility to coordinate activities among itself, the County, and the Recipient's insurer(s ) so that the insurance certificates are acceptable to and accepted by County within the time limits set forth in this Contract . The County shall be listed as an additional insured on all insurance coverage required by this Contract, except Workers ' Compensation insurance . The Recipient shall , upon ten ( 10 ) days ' prior written request from the County, deliver copies to the County, or make copies available for the County's inspection at Recipient's place of business , of any and all insurance policies that are required in this Contract . If the Recipient fails to deliver or make copies of the policies available to the County; fails to obtain replacement insurance or have previous insurance policies reinstated or renewed upon termination or cancellation of existing required coverages ; or fails in any other regard to obtain coverages sufficient to meet the terms and conditions of this Contract, then the County may, at its sole option , terminate this Contract . 5 . 7 Indemnification . The Recipient shall indemnify and save harmless the County, its agents , officials , and employees from and against any and all claims , liabilities , losses , damage , or causes of action which may arise from any misconduct, negligent act, or omissions of the Recipient, its agents , officers , or employees in connection with the performance of this Contract. 5 . 8 Public Records . The Recipient agrees to comply with the provisions of Chapter 119 , Florida Statutes ( Public Records Law) in connection with this Contract . 6 . Termination , This Contract may be terminated by either party, without cause , upon thirty (30) days prior written notice to the other party. In addition , the County may terminate this Contract for convenience upon ten ( 10 ) days prior written notice to the Recipient if the County determines that such termination is in the public interest . 7 . Availability of Funds . The obligations of the County under this Contract are subject to the availability of funds lawfully appropriated for its purpose by the Board of County Commissioners of Indian River County . 3 - 8 . Standard Terms . This Contract is subject to the standard terms attached hereto as Exhibit C and incorporated herein in its entirety by this reference . IN WITNESS WHEREOF , County and Recipient have entered into this Contract on the date first above written . INDIAN RIVER COUNTY BOARD OF COUNTY COMMISSIO RS By: enneth . acht, Chairm n Attest: J . K. Barton , Clerk Z,ei� e�� (. 2" By: Deputy Clerk Approved : /11mes Chandle , ounty Administrator pro as to form and legal sufficiency : a I , stant CbuP4 n RECIPIENT: St , Peters Human Services 425038 th Avenue Gifford , Florida 32967 B N aX Andrew Jefferson President Title - 4 - EXHIBIT A [Copy of complete proposal/application] - 1 - EXHIBIT B [From policy adopted by Indian River County Board Of County Commissioners on February 19 , 2002] " D . Nonprofit Agency Responsibilities After Award of Funding Indian River County provides funding to all nonprofit agencies on a reimbursement basis only. All reimbursable expenses must be documented by an invoice and/or a copy of the canceled check . Any expense not documented properly to the satisfaction of the Office of Management & Budget and/or the County Administrator may not be reimbursed . If an agency repeatedly fails to provide adequate documentation , this may be reported to the Board of Commissioners . In the event an agency provides inadequate documentation on a consistent basis , funding may be discontinued immediately. Additionally , this may adversely affect future funding requests . Expenditures may only be reimbursed from the fiscal year for which funding was awarded . For example , no expenditures prior to October 1St may be reimbursed with funds from the following year. Additionally, if any funds are unexpended at the end of a fiscal year, these funds are not carried over to the next year unless expressly authorized by the Board of Commissioners . All requests for reimbursement at fiscal year end (September 30th) must be submitted on a timely basis . Each year, the Office of Management & Budget will send a letter to all nonprofit agencies advising of the deadline for reimbursement requests for the fiscal year. This deadline is typically early to mid October, since the Finance Department does not process checks for the prior fiscal year beyond that point . Each reimbursement request must include a summary of expenses by type . These summaries should be broken down into salaries , benefits , supplies , contractual services , etc . If Indian River County is reimbursing an agency for only a portion of an expense (e . g . salary of an employee) , then the method for this portion should be disclosed on the summary. The Office of Management & Budget has summary forms available . Indian River County will not reimburse certain types of expenditures . These expenditure types are listed below. a . Travel expenses for travel outside the County including but not limited to ; mileage reimbursement, hotel rooms , meals , meal allowances , per Diem , and tolls . Mileage reimbursement for local travel (within Indian River County) is allowable . b . Sick or Vacation payments for employees . Since agencies may have various sick and vacation pay policies , these must be provided from other sources . c . Any expenses not associated with the provision of the program for which the County has awarded funding . d . Any expense not outlined in the agency's funding application . The County reserves the right to decline reimbursement for any expense as deemed necessary. " - 1 - EXHIBIT C STANDARD TERMS FOR GRANT CONTRACT 1 . Notices : Any notice , request, demand , consent , approval or other communication required or permitted by this Contract shall be given or made in writing , by any of the following methods : facsimile transmission ; hand delivery to the other party; delivery by commercial overnight courier service ; or mailed by registered or certified mail (postage prepaid ) , return receipt requested at the addresses of the parties shown below: County : Joyce Johnston - Carlson , Director Indian River County Human Services 184025 th Street Vero Beach , Florida 32960-3365 Recipient : Pastor Andrew Jefferson St . Peters Human Services 425038 1h Avenue Gifford , Florida 32967 2 . Venue : Choice of Law: The validity , interpretation , construction , and effect of this Contract shall be in accordance with and governed by the laws of the State of Florida , only. The location for settlement of any and all claims , controversies , or disputes , arising out of or relating to any part of this Contract , or any breach hereof, as well as any litigation between the parties , shall be Indian River County , Florida for claims brought in state court, and the Southern District of Florida for those claims justifiable in federal court . 3 . Entirety of Agreement : This Contract incorporates and includes all prior and contemporaneous negotiations , correspondence , conversations , agreements , and understandings applicable to the matters contained herein and the parties agree that there are no commitments , agreements , or understandings concerning the subject matter of this Contract that are not contained herein . Accordingly , it is agreed that no deviation from the terms hereof shall be predicated upon any prior representations or agreements , whether oral or written . It is further agreed that no modification , amendment or alteration in the terms and conditions contained herein shall be effective unless contained in a written document signed by both parties . 4 . Severability: In the event any provision of this Contract is determined to be unenforceable or invalid , such unenforceability or invalidity shall not affect the remaining provisions of this Contract , and every other term and provision of this Contract shall be deemed valid and enforceable to the extent permitted by law. To that extent, this Contract is deemed severable . 5 . Captions and Interpretations : Captions in this Contract are included for convenience only and are not to be considered in any construction or interpretation of this Contract or any of its provisions . Unless the context indicates otherwise , words importing the singular number include the plural - 1 - number, and vice versa . Words of any gender include the correlative words of the other genders , unless the sense indicates otherwise . 6 . Independent Contractor. The Recipient is and shall be an independent contractor for all purposes under this Contract. The Recipient is not an agent or employee of the County, and any and all persons engaged in any of the services or activities funded in whole or in part performed pursuant to this Contract shall at all times and in all places be subject to the Recipient' s sole direction , supervision , and control . 7 . Assignment. This Contract may not be assigned by the Recipient without the prior written consent of the County . 2 - 4 C, - - ACORD. CERTIFICATE OF LIABILITY INSURANCE GR ICI DATE- (MMIOCIYYYY) STPETEA 091233 / 03 'RODUG@R THIS CERTII' ICATE IS ISSUED AS A MATTER OF INFORMATIO ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Hatcher Insurance , Tnc . HOLDER, THIS CERTIFICATE DOES NOT AMEND , EXTEND OR P . O . Box 540659 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW Orlando FL 32654 - 0684 Phone : 407 - 841 -2686 Fax : 407 - 841 -2688 ; INSURERS AFFORDING COVERAGE NAIL # l.N$URED N'SUFCRA: Philadelphia Indemn:.j. Ins . ! Co hi5URER s: American International Group St . Peters Academy Charter 3C'.1 - -- —" - St . Peters Human ServLces , Inc NSURGIRC: 4250 38th Avenue rMSURERO Vero Beach FL 32967 - 1711 - - -------- - -- INbJRER E: COVERAGES THE POUC(ES OF ASURANCE LISTED BELDVV HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE PO —ICY PERIOD INDICATED, NOTWI THSTPJIUING ANY REQUIF.EMEN T TERM OR CONDITICN OF ANY C014TFZACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIF.CATE MAY BE ISSUED OR MAY PERTAIN , THE INSURANCE AFFORDED BY THE POLICIES CESCRIHEC HEREIN IS SUBJECT TO ALL THE TERIVS , EXCLUSIONS AND CONDITIONS OF SUCH POLICIES , AGGREGATE LIN44ITS SHOWN MAY HAVE BEEN REDUCED OY PAID CLAIM , T?GIICPEFFE:7TfJE • POLI r AT)ON .� LTR INSRD TYPE Or: INSURANCE POL !CYNVMGER DATEImMJODlYY1 I DATE ( MM!CC/YY) I L(M .TS 3ENE11ALLIA51UTY i i EACHcccmRErvGE 3 1000130 0 Af IX IccMr�cR IA: GENERh'_ LIA21LfT1 i PHPX060275 09 / 17 / 03 i 09 / 17 / 04 rRcrns=_s ;e3u:u ;on«) s 100000 _ -- I CLAIMSN<Cc I X C CUR i =G6Y-- ;AnYere per 5 5000 _. .._ I PEHSCI•JAL d AGV INJURY 15 10010 () 00 CENEs2000000 (JA _ AGC �RECA 'E __ ... .._. Coc JL AG �$cuA' . LIVIT APPUE:= F=R RO"'UC:TS CGtIP+ov- A:)G s � OCQOQO JEC ! AUTOb1OBILE LIAHIUTV _ CCM3:rv „ G SINGLE L' MI & S I rV (EA ncmge.M; r... .I ANY A1UTG I I ALL OWNED A_rM5 i - I Fcor, .Y INJU? v S j BCFJ=C U..ED AUTOG (Per pereon) F— hIREDAUTL'S I . PCCILY INJURY I S ! I NON-C.WNED AUTOS I i (Pcr accilldn: I ? R ^PER'Y DAMAGE S {?C: aGGItlW :) I GARAGE L!ABILITV AUTC DN.Y . ,EP. ACCIDENT - ', S ANYAJ'O 0T i I` u'ERTHAN BAA =C . � AQT0 ONLY. AGG I $ -... . .. -- j I EXCE45AI618RFLLA UAeLITY I EACH CCCURR'cNCE ! S 1000000 A X - I OCCUR I C: Aatilv � ADE RENEWAL OP PHUB012211909 / 17 / 03 ! 09 / 17 / 04 AGGREGATE Y IS1000000 Is T ' j DEDUCTIUL E — X RETEN1' 014 £ 10000 i UTH5 I WORKERS COOFFNSATION AND .Ya iTORY 'Ik� ' 1'S I _ VI $ IEMPLOYERS' LIABILITI i WC782937 09 / 17 / 03 09 / 17 / 04 f " — 100000 ANY PROPP,ISTCM'PARTN=.RF�iEM, TN'E ' R. L . rA CH AC:tZENT .. ._ _._. = CPPICCWtAEM8:: . EXCLUDE]. L . CISEASE - EA SbIP�C_F..q S 100000 _ . Ill Wa, flpxcr,ta urpgr , f - .— S3EC; 4LPRD%ISO.NShE!Gr. j I _ F� LCISEASE POLICYL!MiT 1 S 500000 OTHER ' ( I I i I k I _ DESCRiPTiON OF OPERATIONS I LOCATIONS 1 VEHIC ES I EXCLUSIONS ADDED B'/ ENDORSEMENT 18PEGIA� PROVISIONS Certificate holder is included as additional insured applicable General Liability Coveragc 0 *zxcept as required by Florida Statute . CERTIFICATE HOLDER CANCELLATION SCH0IrI3 SHOULD ANY OF THC ABOVE OESCRiSED PDLICIES 5E CANCE..LEO BEFORE 'HE EXPIRATION School District Of Indian DATE THEREOF ThEISSUINO INSURER WILL ENDEAVOR TO MAIL 30 * 'DAYS WRITTEN River Co / Judy Bartlett NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT . BUT FAI _URG TO GO SO SHALL :'Y, 772 - 569 - 4139 IMPOSE NC D13LIGATID R LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR 1990 25th Street Ve .O Beach FL $ 2960 REPRESENTATIVES AUTHORIZE O REP YE ?Iwo Ole A OC RD 25 (2001 /03 ) JWACORD CORPORATION 1 TCITA_ P . 01 To : 561562902C Fram : State Fara Fax : State Farm LTOPCALL at : OCT-02-2003-08: 11 Doc : 767 Fage: 002 CERTIFICATE OF INSURANCE SUCH INSURANCE AS RESPECTS THE INTEREST OF THE CERTIFICATE HOLDER WILL NOT BE CANCELED OR OTHERWIS TERMINATED WITHOUT GIVING 10 DAYS PRIOR WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED BELOW, BUT IN Nt EVENT SHALL THIS CERTIFICATE BE VALID MORE THAN 30 DAYS FROM THE DATE WRITTEN . THIS CERTIFICATE OF INSURANCi DOES NOT CHANGE THE CCVERAGE PROVIDED BY ANY POLICY DESCRIBED BELOW. This certif es that: 0 STATE FARM MLIT LIA'L AUTOMOBILE INSURANCE COMPANY of Bloomington , Illinois , or ❑ STATE FARM FIRE AND CASUALTYCONPANYof Bloomington. Illinois has coverage in force for the fodoMng Named insured as shown below : Named Insureci St Peter's Misslopiary Baptist Chl. rch Inc Address of Named Insured 4250 38 ' Ave Vero Beach , FL 32967 POLICY NUMBER 3402832DO959F EFFECTIVE UA.'E OF j 04108103. 10f09103 - - -- - -- - - -- - - - - -�- - - ----- - -- - - - ---- ----- -- --. POLICY 1994 DODGE 6350 VAN DESCRIPT: ONOF I VEHICLE j LIABILITY CO wES ❑NO YES LIMITS OF LABILITY ❑N-O— -- � []YES_ _ ❑NO ❑ YES ❑ NO -t---. a . Bocily Injury -Each Person a. Bodily Irpry ----- - - ----- - ----- - ---Each Accident b. Property Damage f— — ------ t - -- — — - ---- + --- -- c . Bodi ly Injuryi — -r -- ----- - --- - --- ---- - ----- - — - --- - Property Damage $ 1 ,000,C00 .00 Single Jmit Each Accident ❑ PHYSICAL DAMAGE -t--- -- - --+ -- 1 - --- L - -- - _YES ❑ NO ❑ YES --- ---❑ NO -- I -- >ayEc COVERAGES � NO ❑YES [ NO 5250 OC Deductible Deductible Deductibie a_ Comprehens,ve Deductible b . Collison $ OAO Deduc�Cbie Deductible O '� ❑ NO ❑YES ��NO Deductible Deductible EMPLOYER'S NON-OVVNERSHIP wE5 OND ❑YES ❑ NO ❑YES ❑ NC OYES 0 N HIRED CAR COVERAGE - --- - EYES [,INC EYES [INC) --- --- -- - - ONO I ----�------�Y-ES ❑ NG i Agent 2733 10/02/03 Signature cf Authcnzed Representative Title Agent' s Code Number Date Name and Add •ess of Certificate Holder Name and Address of Agent Indian P, iverCounty David E Hedges, State Farm Insurance Agency 1990 25`' Street 2601 2UStreet Suite B Vero Beach , FL 32960 Verc Beach FL 32960 i -- ---- -- ------ -- - eck if a permanent Certificate of Insurance for lability coverages needed ❑ Check if the Cer6f bate Holder should be added as an Additonal Insured : ❑ Remarks: ---- ----- --- — -- -- - - 1584302 Rco. 9-94 Ffin:eC in J .SA. - -- -- ---- -------- - HAL REVENUE SERVICE DEPARTMENT OF rHE rREASURY 0IgTRICT OIRECTOR WW P. Q BOX Me , tNCU" I' l , OH 45Z01 _ •; Employer Identification Number : 7 Date : 31 - 14806C3 - DLN : 17053042275008 ST PETERS HUMAN SERVICES Contact Person : INCORPORATED D _ A . DONNING C/ 0 REV ANDREW JEFFERSON Contact Telephone Number : 4250 38TH AVE t ( 511 ) 241 - 5199 GIFFORD , FL 32967 Accounting Period Ending : August 31 Fare 990 Required : Yes Addendum Applies : Yes Dear Applicant : Based on information supplied , and assuming your operations will be as stated in your application for recognition of exemption , we have determined you are exempt from federal income tax under section 501 ( a ) of the Internal Revenue Cade as an organization described in section 501 ( c ) ( Z ) . We have further determined that you are not a private foundation within the wean inq of section 509 ( a ) of the Cade , becau ie you are an organization described in sections 509 ( a ) ( 1 ) and 170 ( b ) ( 1 ) ( A ) ( ii ) . If your sources of support , or your purposes , character , or method of operation change , please let us know so we can consider the effect of the change on your exempt status and foundation status . Ia the case of an amend - ment to your organizational document or bylaws , please send us. A. copy of the amended document or bylaws . Also , you should inform us of all changes in your name or address . do •a : 'Ja:: uary 1 , 190-x _ ;c:: are liable for taxes tinder the Fewderal insurance Coy tributions Act ( social security taxes ) on - re•munerativn of S100 or more you pay to each of your employees during a calendar year. You are not liable for the tax imposed under the Federal Unemployment Tax Act ( FUTA ) . Since you are not a private foundation , you are not subject to the excise taxes under Chapter 42 of the Code . However , if you are involved in an excess benefit transaction , that transaction might be subject to the excise taxes of section 4958 . Additionally , you are not automatically exempt from other federal excise taxes . If you have any questions about excise , employment , or other federal taxes , please contact your key district office . Grantors and contributors may rely on this detervination unless the Internal Revenue Service publishes notice to the contrary . However , if you lose your section 509 ( a ) ( 1 ) status , a grantor or contributor may not rsiy on this determination if he or she was in part responsible for , or was aware of , the act or failure to act , or the substantial or material change - on tho part of the organization that resulted in your loss of such status , or itf he or she acquired knowledge that the Internal Revenue Service had given notice• that Letter 947 ( D( / CG ) 4ST PETERS HUMAN SERVICcS you would no lonqer be classified as a section 509 ( a ) ( 1 ) organization . Donors may deduct contributions to you as provided in section 170 of the { Cade _ Bequests , legacies , devises , transfers , or gifts to you or for your use are deductible for federal estate and gift tax purposes if they meet the ! applicable provisions of Code sections 2055 , 2106 , and 2522 . 1 Contribution deductions are allowable to donors only to the extent that their contributions are gifts , with no consideration received . Ticket pur -_ chases and similar payments in conjunction with fundraisinq events may not necessarily qualify as deductible contributions , depending on the circus - !I stances . See Revenue Ruling 67 - 246 , published in Cumulative Bulletin 1967 - 2 , an page 104 , which sets forth guidelines regarding the deductibility , as chari - table contributions , of payments made by taxpayers for admission to or other { participation in fundraising activities for charity . In the heading of this letter re have indicated whether you must file Form 990 , Return of Organization Exespt From Income Tax . If Yes is indicated , you are required to file Form 990 only if your gross receipts each year are normally mare than $25 , 000 . However , if you receive a Form 990 package in the mail , please file the return even if you do not exceed the gross receipts test . If you are not required to file , simply attach the label provided , check the box in the heading to indicate that your annual gross receipts are normally $25 , 000 or less , and sign the return . If a return is required , it , must be filed by the 15th day of the fifth month after the end of your annual accounting period . A penalty of $ 20 a day is charged when a return is filed late , unless there is reasonable cause for the delay . However , the maximum penalty charged cannot exceed $ 10 , 000 or 5 percent of your gross receipts for the year , whichever is less . For - organizations with gross receipts exceeding $ 1 , 000 , 000 in any year , the penalty is $ 100 per day per return , unless there is reasonable cause far the delay . The maximum penalty for an organization with gross receipts exceeding 61 , 000 , 000 shall not exceed $ 50 , 000 . This penalty may also be charged if a • return is not complete , so be sure your return is complete before you file it . You are required to make your annual return available for public inspection for three years after the return is due . You are also required to make available a copy of your exemption application , any supporting documents , and this exemption letter . Failure to make these documents available for public inspection say subject you to a penalty of • 620 per day for each day there is a failure to comply ( up to a maximum of $ 10 , 000 in the case of an annual return ) . You are not required to file federal income tax returns unless you are subject to the tax on unrelated business income under section 511 of the Code . If you are subject to this tax , you must file an income tax return an Form 990 - T , Exempt Organization Business Income Tax Return . In this letter we are not determining wnether any of your present or proposed activities are unre- lated trade or business as defined in section 513 of the Code . Letter 947 ( DO / CG ) f / ♦ L - 3 - ' ST PETERS HUMAN SERVICES You need an employer identification number even if you have no employees . If an employer identification number was not entered on your application , a number will be assigned to you and you will be advised of it . Please use that number on all returns you file and in all correspondence with the Internal Revenue Service . This determination is based on evidence that your funds are dedicated to the purposes listed in section 501 ( c ) ( 3 ) of the Code . To assure your continued exemption , you should keep records to show that funds are expended only for those purposes . If you distribute funds to other organizations , your records should show whether they are exempt under section 501 ( c ) ( 3 ) . In cases where the recipient organization is not exempt under section 501 ( c ) ( 3 ) , there should be evidence that the funds will remain dedicated to the required purposes and that they will be used for those purposes by the recipient . . If distributions are made to individuals , use histories regarding the recipients should be kept showing names , addresses , purposes of awards , manner of selection , relationship ( if any ) to members , officers , trustees or donors of funds to you , so that any and all distributions made to individuals can be substantiated upon request by the Internal Revenue Service . ( Revenue Ruling 56 -3041 C . B . 1956 - 2 , page 3076 . ) If we have indicated in the heading of this letter that an addendum Applies , the enclosed addendum is an integral part of this letter . Because this letter could help resolve any questions about your exempt status and foundation status , you should keep .it in your permanent records . If you have any questions , please contact the person whose name and telephone number are shown in the heading of this letter . Sincerely yours , 00 � District Director Enclosure ( s ) : Addendum Letter 947 ( DO / CG ) 00025 Consumer ' s Certificate of Exemption DR- 14 R . 01 /02 DEPARTMENT p Issued Pursuant to Chapter 212 , Florida Statutes OF REVENUE 85 -8012583781 C -6 10/07/2003 10/31 /2008 501 ( C) (3) ORGANIZATION Certificate Number Effective Date Expiration Date Exempfion Category This certifies that ST PETERS HUMAN SERVICES INCORPORATED 4250 38TH AVE VERO BEACH FL 32967 is exempt from the payment of Florida sales and use tax on real property rented , transient rental property rented , tangible personal property purchased or rented , or services purchased . Important Information for Exempt Organizations DR - 14 R . 01 /02 DEPARTMENT OF REVENUE 1 . You must provide all vendors and suppliers with an exemption certificate before making tax -exempt purchases . See Rule 12A - 1 . 039 , Florida Administrative Code ( FAC) . 2 . Your Consumer 's Certificate of Exemption is to be used solely by your organization for your organization 's customary nonprofit activities . 3 . Purchases made by an individual on behalf of the organization are taxable , even if the individual will be reimbursed by the organization . 4 . This exemption applies only to purchases your organization makes . The sale or lease to others by your organization of tangible personal property, sleeping accommodations or other real property is taxable . Your organization must register, and collect and remit sales and use tax on such taxable transactions . Note : Churches are exempt from this requirement except when they are the lessor of real property ( Rule 12A - 1 . 070 , FAC) . 5 . It is a criminal offense to fraudulently present this certificate to evade the payment of sales tax . Under no circumstances should this certificate be used for the personal benefit of any individual . Violators will be liable for payment of the sales tax plus a penalty of 200% of the tax , and may be subject to conviction of a third degree felony. Any violation will necessitate the revocation of this certificate . 6 . If you have questions regarding your exemption certificate , please contact the Exemption Unit of Central Registration at 850-487-4130 . The mailing address is 5050 West Tennessee Street , Tallahassee , FL 32399 - 0100 . V"y - a ' i 'in LZ r angy ` iari.' t e4er s I aimn Services, Inca Program. Boys' DI veiopment aii 1 raining Institute Funder. Children's Services Council PROGRAM COVER PAGE Organization Name : St . Peter' s Human Services, Inc. Executive Director : Pastor Andrew Jefferson Email - Address : 4250 38`x' Avenue Telephone : 772-562-6863 Vero Beach FL 32967 Fax : 772- 562- 8920 Program Manager : Edward Coney Email : Address : Same as above Telephone : same as above Fax : same as above ;M Program Title : Boys Development and Training Institute PA Priority Need Area Addressed: To reduce juvenile delinquency and crime r. Brief Description of the Program : The program seeks to provide for school age children and teens f . access to a weekend training program that offers recreation academic support, self esteem, character ,.. building and community services experience The program also provides positive role models through LL aFP investors to equip the boys with knowledge about substance abuse , violence and gang activity. -oto Amount Requested from Funder for 2003 / 04 : $ 562449 Total Proposed Program Budget for 2003 / 04 : $ 56 , 449 Percent of Total Program Budget : 100 . 0 % Current Funding (2002 /03 ) : $ 302000 Dollar increase/( decrease) in request : $ 26 , 449 F Percent increase/( decrease) in request : 88 . 2 % Unduplicated Number of Children to be served Individually : 45 F Unduplicated Number of Adults to be served Individually : - Unduplicated Number to be served via Group settings : 45 �s Total Program Cost per Client : 1254 . 41 Will these funds be used to match another source? No i ` If yes , name the source : VILI I'i + $ k . .; Amount : - , Y The Organization 's Board of Directors has approved this application on (date). 2.Z 200 3 � �Npi"Fr� � EF�F2s�l Name of President/Chair of the Board ignatur w M", x ' e ' Name of Executive Director/CEO Signature rf , p a � se 3 t .9 ' hr . r n A 6f'4Mµ - t St. Petees human Services, Inc. Program: Boys' Development and Training Institute Funder: Children's Services Council PROPOSAL NARRATIVE Please respond to each question in the allotted space for each section. In responding to each section of the proposal narrative, please retain the section-label and/or question you are addressing. Type using 12 pt . Font on 8 '/z X 11 paper and number each page . These directions and the graphic boxes may be deleted if space is needed . A. ORGANIZATION CAPABILITY (Entire Section A not to exceed one page) M 1 . Provide the mission statement and vision of your organization. �, 1e p Mission Statement: St. Peter's Human Services Inc . is to provide assistance to the elderly, increase the success rate of high risk students, provide drug awareness, a public school of choice , work cooperatively with established social programs and assist the targeted population and others of Indian River County to IN become self sufficient Vision : The St Peter's H . S. Inc . is a non religious , non denominational organization since 12/96. The Agency's vision is to address social problems and needs in targeted areas of Indian River County, Florida. yr The agency is designed to provide short and long term services in the areas of affordable quality child/day care services, before and after school childcare, public school of choice for children with special needs and children who are not successful in the regular system, youth intervention programs and assisted living care for certain targeted groups . 2. Provide a brief summary of your organization including areas of expertise, accomplishments and population served. �s Since its incorporation , the agency has provided quality daycare services for families with children ages zero to five years of age. The center also serves children who are Title 20 and ALPI Certified . The agency has a chartered public school of choice, serving 90 to 100 students of Indian River County. The Agency has also successfully implemented a Boys' Development and Training Program from the targeted population , y ages 7 to 14. The program's highlights include organized drills, academic support, self esteem/character building , exploration and exposure to educational and recreational activities through field trips and workshops . The Program is the only one of its kind in Indian River County, r : S 4, t J c 4 Ir �, ��3 a 16"x' F T„ rte., } t a. •y ny„ "1" { ' yd9t� .` � t n �mza 6fi: r 3 eces, enc. �'rogun. oys e+vc g k tate Funder: Otildren s Services conn Be PROGRAM NEED STATEMENT (Entire Section B not to exceed one page) 1 . a) What is the unacceptable condition requiring change? b) Who has the need ? c) Where do they live? d) Provide local, state or national trend data, with reference r ` source, that corroborates that this is an area of need. a . The unacceptable condition is juvenile delinquency that leads to further lives of crime , truancy, dropping N out of school , low self esteem, etc, because the approach has been only to lock up the offenders without changing the behaviors . b . The ones in need are at risk males between the ages of 7 and 14 who have exhibited problem ,4 behaviors, such as but not limited to the following : school disciplinary referrals, chronic school truancy, repeated school suspensions, poor academic performance , a history of alcohol , tobacco and other drugs , rebellion , running away, mental and emotional health issues and those with a history of delinquent SI Y. behavior. c. In Indian River County, 90% of the at risk males involved in the program are from the surrounding . x community. 4zx d . DJJ's Key Juvenile Crime Trends and Conditions states "In Fiscal Year 1999-2000, 104, 176 juveniles l were referred for delinquency. They were charged with committing 150, 747 crimes . . . There was a 229 percent increase over the last decade in juvenile offenders referred for drug use . . . Florida, the fourth largest state, still tries more juveniles as adults than most states . . . 14 percent of juvenile offenders can be gclassified as chronic . , 'The high mobility of youth and families in Florida, who frequently change home IA neighborhoods and schools, is a risk factor that increases delinquency. . . young people don't feel like they have consistent positive community ties . . . Juvenile offenders in Florida typically come from single parent a r households and are truants, dropouts or are doing poorly in school . . three out of four youth in treatment M1 programs admit to alcohol or drug use, 29% are emotionally disturbed , 20% have a diagnosed serious N mental illness, 9% are sex offenders and 5% have developmental disabilities ! Bill Bankhead , DJJ N Secretary stated , "We know from research the high risk factors for delinquency — and they include poor school performance, truancy, family instability and running away. " 1p LL 2. a) Identify similar programs that are currently serving the needs of your targeted population ; b) Explain how these existing programs are under-serving the targeted r population of your program. JI There are two programs that serve the targeted population , neither of which serve the whole child : 1 a. Gifford Youth Activity Center provides a day program for all youth , not just males . 1 b . The program does not provide man of the services rendered b our program, i . e. drinks, meals , overnight stay at the site, one- �y4 p Y Y p 9 9 Y r on-one parent and children discussions , tracking the boys for six months after successful completion through DJJ , etc . <r 2a. Hope Academy provides an alternative program for suspended students from public schools while Boy's Institute serves the total child , making sure that no child will be left behind . 2b . Hope Academy is not designed to meet the needs of the total child . Vk . w kXt Fa ,r n 5 W `fi s' anrices,�iic. l�togram ays3ev' a � rating Tnsi�fue Funder: Children's Services Council C. PROGRAM DESCRIPTION (Entire Section C, I — 6, not to exceed two pages) 1 . List Priority Needs area addressed . To reduce juvenile delinquency and crimes 2. Briefly describe program activities including location of services. Activities . Results and Program Requirements : The following services will be provided/required by the program : tutoring and academic instruction , counseling (rehabilitative , social , mental and emotional) , drills for discipline training , character and self esteem building classes , conflict resolution and life skills classes, rap sessions to develop communication skills, recreational activities, field trips, mentoring , guest speakers, etc. Overall results: reduced juvenile delinquency and increased self esteem and responsibility. Process and Intended Outcomes — Client Involvement from start to finish : Referrals are made by local churches , parents of enrolled boys and from other partnering agencies . The boy is accepted into the program and must participate on every level while attending . The boy's school attendance, records, etc . , are closely a monitored and discussed during the duration of the program. Above is a list of those areas in which the boy will participate . Expected Outcomes and Changes : The outcomes generally include increased academic Yf< performance , decreased negative behavior, improved relationships among peers, increased community f awareness and increased awareness of substance abuse addiction and HIV risk factors. The outcomes r that would benefit the community include reduced juvenile delinquency, reduced crimes, increased ` responsibility as a citizen of the community, etc. Follow- up : After successful discharge, the boys are followed up on a monthly basis through DJJ for a total of six months . In addition, a concerned parent/school official is encouraged to contact the program director if there are any situations that arise that might be handled by the program director or counselors. The services are provided at St Peter's Church , 4250 3r Avenue, GiffordNero Beach, FL 32967. The hours of operation are from Friday, 4: 30 PM through Saturday, 5: 00 PM . L� 3. Briefly describe how your program intends to address the stated need/problem. Include reference to any studies or evidence that indicate proposed strategies are ¢ ' effective with target population. The Boy's Development and Training Program addresses the need to reduce juvenile delinquency by providing a program for at risk males who are affected by chemical addictions, violence, poor family environment, lack of social and academic skills, poor self esteem and other areas in need of improvement in a male youth's life. The focus of this program centers on addressing these young male issues along the same lines as DJJ , as indicated in the editorial written by the Secretary of DJJ , Bill Bankhead , where he stated (concerning the DJJ programs) , "Individualized resources that meet the needs of the particular juvenile and his or her family are provided . These can include mental health counseling , substance abuse FF treatment and tutoring . . .to get everyone working together positively on issues and to give the kids a way up . and out of failure . " When looking at the Boy's Institute, these areas have been addressed through a variety F of mediums; mentors, discipline training , academic accountability, tutoring , parental involvement, community involvement (which increases ties to the community) , mental health assessment and counseling , substance abuse awareness and referral (if necessary) , etc . The DJJ report on Community � . Involvement indicated that evidence shows that communities can deter juvenile crime by targeting the key risk factors of truancy, school failure, access to weapons , not enough positive activities to keep kids bus It Y A 9 P P Y� indicated that . . . some of the same strategies that can prevent delinquency from ever happening in a child's life also can stop a juvenile offender from re-offending and recycling back into the delinquency � rt r: system . " The articles closes with this statement: "No matter how good an individual juvenile justice program AIIII 6 F ax' M' �r 4 l7 . .;.�111 r ri e e s urnan er ces, Iiutnsfitute ri dren's Seivices '(`onneil strives to be, a young person soon or later returns to his home community. " St. Peter's Boy's Development and Training Program assists in diverting the boys' lives away from crime in their communities . It is a community program that develops community attachments for the youth while addressing the needs that placed the child at risk in the first place . According to DJJ Secretary, Bill Bankhead , " . . . outreach must be done in the neighborhoods where juvenile crime is high . " Governor Bush said of the successful outreaches, " . . . they focus on preserving the unity and integrity of the family and emphasizing parental responsibility in dealing with troubled youth . " (www. djj .state ,fl . us/features/runaways . htrnl . ) Delinquency prevention is paramount to DJJ's plan , which includes three elements : targeting the most at risk, cooperation between community- based programs working with the government to approach families , and accountability through data collection and measurement of program success. The Boys Institute does all three and goes beyond in preventing or reversing the pafterns and risk factors associated with delinquency. 4. List staffing needed for your program, including required experience and estimated hours per week in program for each staff member and/or volunteers (This section should conform with the information in the Position Listing on the Budget Narrative Worksheet). 1 — Program Director (PT, BA degree preferred , 2 yrs.' experience working with at risk kids. ) Oversees the operation of the program, including data collection , quarterly reporting and financial management of the <` program . Will supervise and oversee all staff. 1 — Program Operations Manager (PT. Minimum HS diploma/equivalency, training in child development, at least 2 years of experience in working with at risk children . ) Responsible for overall operation of program . r Will assist institute trainers in development of appropriate materials addressing the needs of the enrollees, ensuring a safe, nurturing environment conducive to learning . Will assist with discipline of enrollees, drills , activities and planning of activities . Also work with institute staff, mentors and volunteers. 2 — Institute Trainers/Teachers (Part time. Must have experience in working with at risk children . ) Will provide appropriate materials addressing social and educational needs of enrollees . Will also preside * ° overall educational and recreational activities during program hours including computer instruction and reading clinic; will conduct parent meetings and assure that the data is collected in a timely manner. 1 — Institute Prevention Coordinator (BA degree in related field and/or 2 years of experience in social setting working with youth . Knowledge of children and teaching basic skills. ) Recruitment and new referrals- handle data, planning , parent training , discipline, counseling and assist with data collection from schools including school visits — on-site monitoring and coordination with teachers . 1 — Mental Health PsychologistlBehavior Analyst (BA degree required in mental health field ; minimum 2 years of experience working with mental health issues of at risk children . ) Responsible for assessment and counseling of enrollees with mental health issues; data collection from mental health workers at school , mental health centers, etc. 5. How will the target population be made aware of the program ? The program continues to provide awareness through word-of-mouth , local churches, parents of enrolled boys and through our collaboration with our partnering agencies . 6. How will the program be accessible to target population (i. e. location, transportation, hours of operation) ? The St, Peter's Boys Development and Training Institute is located in the heart of 90% of the targeted population . The address is St. Peter's Missionary Baptist Church , 4250 38' Avenue , Vero Beach , FL . Transportation is provided by the parents . The program is open from Friday, 4: 30 pm to Saturday, 5 : 00 pm. 7 f d MreT a ' n r *d•+ l ,,py f a ze - Xj atvzattofY " eters l uinan Ser aces, c. 1'r0grairid'`I`raining Institute Funder: Children's Services Council D. MEASURABLE OUTCOMES (Entire Section D not to exceed two pages) OUTCOMES ACTIVITIES Add all the elements or the Measurable Outcome(s) Add the tasks to accomplish the Outcomes) 1 . To increase the academic performance of 1 . Provide tutoring each week to enrolled enrolled boys by 75% as reported by the boys, including a designated study hour IRC progress notes/report cards . each week. 2 . To decrease negative/disruptive behavior of 2 . Provide rap sessions to enrolled boys enrolled boys by 50% as reported by weekly. Provide mentoring with positive parents and IRC schools' Conduct Code. role models on a weekly basis ; provide character/self esteem building through Improve relationships among boys as reported weekly class sessions . by The Boy's Development and Training Staff — baseline" 200212003 — staff and parents Weekly — Demonstrate and role play positive and friendly behaviors towards Increase community awareness — baseline: adults and peers . 2002/2003 — staff and parents Monthly — recreational activities that are service oriented . 3. Raise awareness level of chemical 3 . Invite and schedule guest speakers addictions, STD and HIV for enrolled boys from Substance Abuse Council to le by 90% as reported by pre and post tests . discuss chemical addiction . Invite guest speakers from the IRC Health Department to discuss STD and HIV at least once during the program year. Participate and attend seminars sponsored by community agencies pertaining to alcohol and drug abuse and abstinence . 4. To increase mental health services 4. Contact Indian River Mental Health accessibility for enrolled boys with mental Center to have speakers address the health issues by 80% as reported by enrolled boys . schedules appointments attended and as reported by mental health workers . Connect appropriate boys with mental health services in the community. Follow up with mental health professionals concerning boys' progress . 8 [ �c x 717 T w 2F ''- �!„ sz 7 =FY•*'�Et t F s3a ?+ t .y F Owe ! � i . „,.� .nA � §�a�ri �eiwiees,`�nc: �rgiar�t. §'° ` o � rdmra�nglns�ta�e under: Chiidcenfs 5etwices 66iic3l „ _ E. COLLABORATION (Entire Section E not to exceed one page) 1 . List your program ' s collaborative partners and the resources they are providing to the program beyond referrals and support. (See individual funder requirements for inclusion of collaborative agreement letters. Collaborative Agency Resources provided to the program Substance Abuse Council Druq Awareness Sheriffs Department Scared Straight Jail Tour IRC Health Department Sexually Transmitted Diseases Gifford Youth Acbvi Center Seminar, "Raisin Them Chaste" Black Faith- Based Or anizabon , Inc. Basketball Tournament IRC Mental Health Center Seminars :a E rC 9 organization: 5t Peter's Human Services, Inc. Program: Boys' Development and Training Institute Funder: Children's Services Council F. PROGRAM EVALUATION (Entire Section F not to exceed two pages) r 1 . DEMOGRAPHICS : What information (data elements) will you need to collect in order to accurately describe your target population including demographics (age, gender and ethnic background) required by the funder in Section H? What are the pieces of information that qualify them for your target population ? How do you document their need for services or their "unacceptable condition requiring change" from Section B19 The information to be collected includes : name, age , ethnic background , birth date and grade . To qualify for the target population , a prospective enrollee will be at risk for at least two of the following conditions : At risk x males between the ages of 7 and 14 who have exhibited at least two problem behaviors, such as but not limited to the following : school disciplinary referrals , chronic school truancy, repeated school suspensions , poor academic performance, a history of alcohol , tobacco and other drugs, rebellion , running away, mental and emotional health issues and those with a history of delinquent behavior. The unacceptable condition is juvenile delinquency and is documented through DJJ reports , school reports , parent reports , etc . This shall be documented and maintained through a database and spreadsheet programs . 2. MEASURES : What data elements will you need to collect to show that you have achieved (or made progress toward) your Measurable Outcomes in Section D ? What tools or items are you using as measures (grades, survey scores, attendance, absences, skill levels) for your program ? Are you getting baseline information from a source on your Collaboration List in Section E ? Are there results from your Activities in Section D that need to be documented ? How often do you need to collect or follow-up on this data? Data will be collected from participants via progress reports/report cards on a nine week basis. Copies of schedules of activities listing the study hour, rap sessions and dates and times of guest speakers will be maintained on location . An entrance description of behaviors will be maintained and reviewed quarterly for improvement. Upon exiting a program, a summary of progress made while attending the program will be document. Measurement items include grades , attendance sheets, progress reports , school conduct codes report, pre and post test reports , counselor reports, prevention activity attendance sheets, etc . The progress reporttreport cards will be collected every nine weeks and at the end of each semester. The schedule of activities will be collected on an ongoing basis . The entrance and exit behavior description will be collected upon entering and exiting the program . Progress notes on behavior improvement will be documented quarterly or as needed . After successful discharge, there will be a monthly follow-up for six months via parents, school and DJJ . r, 10 F< ? '1p ` Organization: St. Peter's Human Services, Inc. Program: Boys' Development and Training Institute Funder: Children's Services Council 3. REPORTING: What will you do with this information to show that change has occurred ? How will you use or present these results to the consumer, the funder, the h. program , and the community? How will you use this information to improve your program ? The date will be compiled in a notebook under each activity and also copies of the progress/report cards will 51 be placed in each enrollee' s file. The information will be provided upon request to any requesting agency, collaborative partners and the Human Service Board of Directors . In areas where the increase in a positive attribute is low or minimal , the program director and board will determine and research new ways to implement a more substantial increase in the positive attribute. It will also be utilized to determine what is working so that it can be continued . .r ol Jzl 11 Organization: St Peter's Human Services, Inc. Program: Boys' Development and Training Institute Funder: Children's Services Council G. TIMETABLE (Section G not to exceed one page) f:al la 1 . List the major action steps, activities or cycles of events that will occur within the program year. New programs should include any start-up planning that may occur outside the funding year. In completing the timetable, review information detailed in prior sections. Month/Period Activities Weekly Tutoring — study hour Weekly Character/self esteem building sessions; community activities ; conflict resolution As needed - ongoing Life Skills sessions; rap sessions Each nine weeks Academic improvement (progress reports and report cards) Weekly — ongoing Reducing negative behaviors — through rap sessions , field trips , seminars Recreational activities and drills Ile Weekly Institute counseling , including mental health Weekly 12 k � S Or ization: St. Peter's Human Services, Inc. Pro ' gun es, gram: Boys Development and Training Institute Funder: Children's Services Council H. PROJECTIONS FOR UNDUPLICATED CLIENTS in= Current Fiscal Year Location In ocat o Bud et 2002 /03 Unduplicated Clients Unduplicated Clients Unduplicated Clients N. Indian River County 30 43 45 S . Indian River County - - - Indian River Co. Total 30 43 45 Greater Stuart - - - Hobe Sound - - Indiantown - - Jensen Beach - - - Palm City - - - Martin County Total - - - Fort Pierce - - Port Saint Lucie - St. Lucie Co. Total Okeechobee County - - Palm Beach County - - - TOTAL SERVED 30 43 45 � Z fit} Type the Organization and Program Name UNIFORM GRANT APPLICATION BUDGET NARRATIVE WORKSHEET IMPORTANT: The Budget Narrative should provide details to justify the amount requested in each line item of the budget for your program. From this worksheet, your figures will be linked to the Total Agency Budget, Total Program Budget and Funder Specific Budget Fonns. y AGENCYIPROGRAM NAME : St. Peter's Human Services, Inc . Boys ' Development & Train. Inst. FUNDER: Children's Services Council I CAUTION : Do not enter any figures where a cell is colored in dark blue - Formulas and/or links are in place. Gray areas should I Abe used for calculations and to write information only. RL� YENtI S /iaxcrusteoi�v Iaroposed Total Program FunderSpecrfic 71 bMI Agency {aeiwrorr ;• r .: cueucnrio Budget: �udgef Budget 1 Children's Services Councll-St. Lucie 2 Children's Services Council-Martin 3 Children's Services Council-Okeechobee 4 Advisory Committee-Indlan River 56,669.2356,669.23 56,669.23 5 United WaySt. Lucie County 6 United Way-Martin County 7 United Way-Okeechobee County 8 United Way-Indian River County 9 Department of Children & Families 10 County Funds 11 Contributions-Cash 12 Program Fees 13 Fund Raising Events-Net 14 Sales to Public - Net 15 Membership Dues 16 Investment Income 17 Miscellaneous 17 18 Legacies & Bequests 19 Funds from Other Sources 20a Reserve Funds Used for Operating 20b in-Kind Donations (Not Included In total) 21 TOTAL REVENUES doesn't Include line 20b1 $56,669.23 $56,669.231 $56,669.23 A D EXPE11fDtTURES oie� iwasr >tt eruaaorax Total Program Fundy 5peclfic Total Agency apwccua �oxp Budget Btrdgef 8u 22 Salaries - (must complete chart on next page} 50,552.00 50,552.00 50.552.00 > ._ Sala rn!. . ; . 23 FICA - Total salaries x 0.0765 7:tf5° 3 867.23 24 Retirement - Annual pension for qualified staff 0,00 25 Life/Health - Medical/Dental/Short-term Disab 0.00 26 Workers Compensation - # employees x rate 0,00 Florlda unemployment " 9 projected 27 employees x $7,000 x UCT-6 rate 0.00 5/27x"3 15 Type the Organization and Program Name SALARIES '� B a POSITION CISTl1Vfa Gross Anrtuet t: t=udder t'ort/orr oftery on Prop6sed 'l. cfGroas dnrwat` r 5aterl' Progrent SJR ec7 c tlgei "afy Rajuested(GA) Posi�fott TitlelTotaiHrstvk (Agency] 70:000 00 a Program Director/Administrator - 6 hrs 61800.00 6,800.00 69800.00 100.00% Program Operations Manager / 25 hours 151500.00 15,500.00 15 ,500.00 100.00% D Institute Prevention Coordinator/SGT -20 hr 14,040.00 14 ,040.00 14 ,040.00 100.00% Institute Counselor / Psychologist / 12 hrs 10,000.00 10,000.00 101000.00 100.00% (2) Institute Trainers/Teachers 6 hrs 49212.00 41212.00 4212.00 100.00 #DIV/0! #DIV/01 #DIV/0! #DIV/01 #DIV/0! #DIV/O! #DIV/0! #DIV/0! #DIV/01 #DIV/01 #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/01 Remaining positions throughout the ency Total Salaries $50.552.00 $50,552.00 $50,552.00 100.00% FRINGE �EnIEFlTSI MIAMA (Fundt3r SlIfit: tt�dget Fun.II IIder pertsiott v Wa►kzr's tlrternplayiYte Total FHdgs funder Colbliillt tiff , front`l�leeZ: tri 27 5pecfifo; FICA �5% Nealtir Ins. , } (Axl) Campers ogpoI. Posit/an T7Ne /iTot� Hthvk _ . . Sudget : _ _ _ . _ . . � Example: �e9rsAtaneper7y(Ohrswr o00 38280 30A00 ;:811 00 : . . . 300.00 2011.00 1,58? 50 Program Director/Administrator - 6 hrs 69800.00 520.20 520.2 Program Operations Manager / 25 hours 15,500.00 11185.75 1 , 185.7 Institute Prevention Coordinator/SGT -20 hr 14,040.00 11074.06 1 ,074. Institute Counselor / Psychologist / 12 hrs 10,000.00 765.00 765.00 (2) Institute Trainers/Teachers 6 hrs 4,212.00 322.22 322.22 0 0.00 0.00 0 0.00 0.00 0. 0 0.00 0.00 0.00 0 0.00 0.00 FOO 0 0.00 0.00 1 0.00 0 0.00 0.00 0.00 0 0.00 0.00 0.00 0 0.00 0.00 0.00 0 0.00 0.00 0.00 0 0.00 0.00 0.0 0 0.00 0.00 0.00 0 0.00 0.00 0.00 0 0.00 0.00 0.00 0 0.00 0.00 0.00 0 0.00 0.00 0. � l Total Funder Request Fringe Benefits $5Ov552 .001 $3,867.23 $0.001 $0.00 $0.001 sawl $3,867.2 527/1003 16 f: Y Type the Organization and Program Name EXPENDRURES sirArArAW Fort A B C lropatd Total ProgramundBrptflc � otal gerrcy A6lIICY1NEdMYtO :. s�troerag Budget Budg¢t Budget _ . . 28 Travel-0aily # of Staff x average # of miles/wk x 50 wks x $ ' = Estimated Daily TraveUMileage Reimb. 29 TraveUConferences/Training National Conference (cost per staff) �' • Training/Seminar (cost per staff) z Other Trainm n (cost of travel, lodging, registration, food) 30 Office Supplies x Office supplies (monthly average x 12 months = estimated cost of office supplies based on - ; . . present history. 31 Telephone # Phone lines x average cost per month x 12 months = local phone cost • Average long distance calls x 12 months = Estimated cost of long distance 32 PostagelShipping Quarterly Mailing of Newsletter • Special events, etc. . . • Bulk mailings - appeals . ._ . 33 Utilities • Electricity ($ x 12 months) . . . ... • Water/Sewer ($ x 12 months) ` • Garbage ($ x 12 months) 34 Occupancy (Building & Grounds) Mortgage/Rent ($ x 12 months) " ' Janitorial ($ x 12 months) : • Grounds Maint. ($ x 12 months) • Real Estate Taxes _ . . . . . _ . 35 Printing 8: Publications 250.00 250.00 • Quarterly Newsletter ($ x 4) . Letterheads, Envelopes, etc. ":' : Fundraising materials Other 36 Subscription/Dues/Memberships • Membership to National Organization Dues • Subscriptions to Newspapers/magazines, etc 37 Insurance . Directors/Officers Liab. Commercial/General Insurance . Bond Ins. . : Auto Insurance _ . . . 38 Equipment: Rental & Maintenance Copier lease ($ x 12 months) - • Meter lease ($ x 12 months) • Copier Maintenance ($ x 12 months) Computer Maintenance ( $ x 12 months) r : Other .. .: . 39 Advertising • Newspaper ads • Fundraising ads/promotions Other (vacancies) 40 Equipment Purchases:Capital Expense Computer/monitor (# x $) . ...... La er 1.. Type the Organization and Program Name 41 Professional Fees (Legal, Consulting) Legal advice ( estimated #hrs x $) w Consultant fees Other 42 Books/Educational Materials 500.00 500.00 500.00 Bookstvideos Materials ($ x staff) f 43 Food & Nutrition • Meals ( # meals x clients x 5days x 50 wks) • Snacks 44 Administrative Costs Admin. Cost (% of total budget) 45 Audit Expense 19500.00 1 .500.00 1 ,500.00 Independent Audit Review 46 Specific Assistance to Individuals Medical assistance Meals/Food Rent Assistance Other . .. 47 Other/Miscellaneous • Background check/drug test . .. • Other 48 Other/Contract Sub-contrail for program services 49 TOTAL EXPENSES $56,669.23 356.669.23 $56.669.23 If J Type LM OrgwyawM 1381 PWM wA UNIFORM GRANT APPLICATION TOTAL AGENCY BUDGET AGENCYIPROGRAM NAME : FY 01102 FY 02103 FY 03104 % INCREASE FYE FYE FYE CURRENT VS. NEXT FY BUDGET A B C D ACTUAL TOTAL PROPOSED (col. C<oL 9ycol. 8 REVENUES BUDGETED BUDGETED 1 Children's Services Council-St Lucie 0.00 #DIV/O! 2 Children's Services Council-Martin 0.00 #DMO! 3 Children's Services Council&Okeechobee 0.00 #DIV/O! 4 Advisory Committee-Indian River 20 000.00 30 000.00 53 528.53 78.43% s United Wa St Lucie County 0.00 #DIV/Ol s United Way-Martin County 0.00 #DIV/O! 7 United Wa -Okeechobee County 0.00 #DIV/01 8 United Way-Indian River County 0.00 #DIV/OI 9 Department of Children & Families 0.00 #DIV/Ol 10 County Funds 0.00 #DN/01 11 Contributions-Cash 0.00 #DIV/OI 12 Program Fees 0.00 t&ON/0! 13 Fund Raising Events-Net 0.00 #DIV/OI 14 Sales to Public-Net 0.00 #DN/01 is Membership Dues 0.00 #DN/O! Li 16 Investment Income 0.00 #DN/O! 17 Miscellaneous 0.00 #DN/01 18 Legacies & Bequests 0.00 #DN/O! 19 Funds from Other Sources 0.00 #DIVI01 20a Reserve Funds Used for Operating 0.00 #DIV/01 2013In4QndDonations (tktimko-d.dintctw) 0.00 #DIV/OI 21 TOTAL 20 000.00 30 000.00 5352863 78.43% EXPENDITURES 22 Salaries 60 552.00 #D!V/O! 23 FICA 3,867,231 #DIV/O! 24 Retirement 0.00 #DIV/O! 25 Life/Health 0.00 #DNIO! 26 Workers Compensation 0.00 #DIV/01 27 Florida Unemployment 0.00 #DIV/01 28 Travel-Dail 0.00 #DN/01 29 Travel/Conferencesi'Trainin 0.00 #DMO! 30 Office Supplies 0.00 #DN/O! 31 Telephone 0.00 #DIV/01 32 Postage/Shipping 0.00 #DIV/Ol 114 33 Utilities 0.00 #DIVIO! 34 Occupancy (Building & Grounds 0.00 #DIV/01 35 Printing & Publications 250.00 #DIV/O! 36 Subscription/Dues/Memberships 0.00 #DIV/O! 37 Insurance 0.00 #DN/01 38 E ui ment:Rental & Maintenance 0.00 #DIV/O! 39 Advertising 0.00 #DIV/Ol 40 Equipment Purchases:Ca ital Expense 0.00 #DIV/O! 41 Professional Fees al Consulting) 0.00 #tDiV/O! 42 Books/Educational Materials 600.00 #DIV/O! 43 Food & Nutrition 0.00 #DIV/01 44 Administrative Costs 0.00 #DIV/O! 45 Audit Expense 1 t5OO.00 #DIV/Ol 46 Specific Assistance to Individuals 0.00 #DN/O! 47 Other/Miscellaneous 0.00 #DN/Ol 48 Other/Contract 0.00 #DIV/Ol r 49 TOTAL 0.00 0.00 56 669.23 #DIV/O! s0 REVENUES OVER/ UNDER EXPENDITURES 01001 0.00 0.00 #DIV/0! 19 Type aro WgeriMm end Proven Nam . UNIFORM GRANT APPLICATION TOTAL PROGRAM BUDGET A. AGENCYIPROGRAM NAME: FY 01102 FY 02/03 FY 03104 % INCREASE ; c FYE FYE FYE CURRENT VS. NEXT FY BUDGET A B C D ACTUAL TOTAL PROPOSED (C*L C."IL BYCOL B REVENUES BUDGETED BUDGETED 1 Children's Services Councih4t Lucie #DIV/O! 2 Children's Services CounciWartin 0.00 #DIV/01 3 Children's Services Council-Okeechobee 0.00 #D1V/0l 4 Advisory Committee-Indian River 56 669.23 #DN/01 5 United Wa St Lucie County 0.00 #DNI01 Is United Way-Martin County 0.00 #DN/01 7 United Wa -0keechobee County 0.00 #DN/01 WIN e United Way-Indian River County 0.00 #DNIOI 9 Department of Children & Families 0.00 #IDIV/01 t6 County Funds 0.00 #DIV/O! 11 Contributions Cash 0.00 #DIV/0l 12 P rogram Fees 0.00 #DN/Ol 13 Fund Raising Events-let 0.00 #DN101 14 Sales to Public44et 0.00 #DN10! 15 Membership Dues 0.00 #DN/01 NEW is Investment Income 0.00 #DN/0l 17 Miscellaneous 0.00 #DIV/01 Is Legacies 8 Bequests 0.00 #DN/O! 19 Funds from Other Sources 0.00 #DIV/Ot WIN 20a Reserve Funds Used for Operating 0.00 #DN/O! NEW 20b In-Kind Donations (ea imkaad in tot,4 0.00 #DN/O! NEW 21 TOTAL 0.00 0.00 56 669.23 #DN/01 EXPENDITURES 22 Salaries NINEW NOUN 50 562.00 #DN/0l 23 FICA 39807.23 #DIV/OI 24 Retirement 0.00 #DN/O! 25 LifeMealth 0.00 #DIV/Of 2s Workers Compensation 0.00 #DN/01 27 Florida Unemployment 0.00 #DIV/01 29 Travel-Dail0.00 #DI1/101 29 Travel/Conferences/Training 0.00 #DIW 30 Office Supplies 0.00 #DN/01 31 Telephone 0.00 #DIV/01 32 Postage/Shipping 0.00 #DN101 33 Utilities 0.00 #DIV/01 34 Occupancy (Building & Grounds 0.00 ODIVI01 35 Printing & Publications 250.00 #DN/01 36 SubscritionlDues/Membershi s 0.00 #DN101 37 Insurance 0.00 #DIV/01 38MEquipment:RentalRental & Maintenance 0.00 #DIV/01 39 0.00 #DN/01 40Purchases:Ca ital Ex nse 0.00 #DN/01 4il Fees L t Consulti0.00 #DN/01 a MIAMI= 42cational Materials 500.00 #DN/O! 43rition 0.00 #DTVI 44 Administrative Costs 0.00 #DIVI01 45 Audit Expense 19500,001 #DN/0l 46 Specific Assistance to Individuals 0.00 #DN/O! ILI 47 Other/Miscellaneous 0.00 #DN/O1 4e Other/Contract 0.00 #DN/OI 49 TOTAL 0.00 0.00 669"9123 #DN/0I so REVENUES OVE UNDER EXPENDITURES 0.00 0.00 0.00 #DN/OI YlTlXQi 20 h F , yV 4 { r< ell Type the Orgarizeton and Program Name UNIFORM GRANT APPLICATION FUNDER SPECIFIC BUDGET PROGRAM EXPENSES AGENCY/PROGRAM NAME : FUNDER • A B c FY 03104 FY 03/04 % INCREASE TOTAL FUNDER TOTAL VS. PROGRAM SPECIFIC FUNDER REQUEST BUDGET BUDGET col. B/col. A EXPENDITURES 22 Salaries 50 552.00 #DN/01 23 FICA 3 ,867.23 #DN/01 24 Retirement 0 .00 0.00 #DIVI01 25 Life/Health 0200 0.00 #DN/01 26 Workers Compensation 0.00 0.00 #DN/01 27 Florida Unemployment 0.00 0.00 #DN/01 28 TravelmDaily 0.00 0.00 #DN/01 29 Travel/Conferences/Training 0.00 0.00 #DN/01 30 Office Supplies 0.00 0.00 #DN/01 31 Telephone #REFI 0.00 #REFI 32 PostageiShipping 0.00 0.00 #DN/01 33 Utilities 0 .00 0.00 #DIV/01 34 Occupancy (Building & Grounds 0.00 0.00 #DIVI01 35 Printing & Publications 250.00 0.00% 36 Subscription/Dues/Memberships 0 .00 0.00 #DN/0l 37 Insurance 0.00 0.00 #DN/01 36 Equipment: Rental & Maintenance 0.00 0200 #DN101 39 Advertising 0.00 0.00 #DIV/01 40 Equipment Purchases : Ca ital Expense 0 .00 0.00 #DN/01 41 Professional Fees ( Legal, Consulting) 0.00 0.00 #DN/01 42 Books/Educational Materials 500 .00 0.00% 43 Food & Nutrition 0.00 0.00 #DN/01 44 Administrative Costs 0 .00 0.00 #DIV/01 45 Audit Expense 19500.00 0.00% 46 Specific Assistance to Individuals 0.00 0.00 #DN/01 47 Other/Miscellaneous 0.00 0.00 #DN/01 48 Other/Contract 0 .00 0.00 #DN/01 49 TOTAL $569669.23 $569669 .23 $1 .00 21 7yRM0lWNd0@ nWWPro¢M0P4 I UNIFORM GRANT APPLICATION EXPLANATION FOR VARIANCES OF 15% OR MORE TOTAL PROGRAM BUDGET AGENCYIPROGRAM NAME : FUNDER: ::::•:::::::::<•:::: �N . . ::. . .:::::::: . . . .:::::::::: ::::::: . .. #DN/Ol #DIVA" #DN/01 #DN/0l #DIV/01 rol AW101 #D /0! #DN/Ot #DNroI #DIVrot #[)N/O! /Ol #DN/ol #ON/0! #DN/01 #DIV101 #[)N/01 #DIV/01 #[)N/0! #DIV/0! #DIV/01 #DIVr0l #DIV/01 #DN/0l #DN ! WIV101 #ON/Ot #DN101 /Ot #DN/O! #D %o! #DIV101 #DNro! MIMI #DN101 #D Vro! N #DN/Ol #DN/O! N/01 #DN/01 #DN/01 Nrol #DIVl0l #[XN101 WIV101 /0! i` 0!27/1003 22 F P `. j , NOT FOR PROFIT AGENCY CERTIFICATION The County of Indian River requires , as a matter of policy, that any Consultant or firm receiving a contract or award resulting from the Request for Qualifications issued by the County of Indian River, Florida , shall make certification as below. Receipt of such certification , under oath , shall be a prerequisite to the award of contract and payment thereof. 17, I (we ) hereby certify that if the contract is awarded to me, our firm , partnership , or corporation , that no members of the elected governing body of Indian River County, nor any professional management, administrative official or employee of the County, nor members of his or her immediate family, including spouse, parents , or children , nor any person representing or purporting to represent any member or members of the elected governing body or other official , has solicited , has received or has been promised , directly or indirectly, any financial benefit, including but not limited to a fee , commission , finder's fee, political contribution , goods or services in return for favorable review of any Proposal submitted in response to the Request for Qualifications or in return for execution of a contract for performance or provision of services for F which Proposals are herein sought. The undersigned certifies that he/she is a principal or officer of the firm applying for consideration and is authorized to make the above acknowledgments and certifications for and on behalf of the applicant, The undersigned certifies that the Applicant has not been convicted of a public entity crime within the past 36 months , as set forth in Section 287 . 133 , Florida Statutes . Failure to sign this form will result in disqualification, Handwritten Signature of Authorized Principal (s ) : DAT Z �_ NAME : Andrew Jefferson TITLE : President NAME OF FIRM/PARTNERSHIP/CORPORATION : St . Peter ' s Human Services , Inc . FOR ON BEHALF THE APPLICANT: Sworn to and su scribed to r _Notary Pu lic, this j -t day of 2003 . kot 1 J� (SEAL) (TYPE NAME & TITLE ) n. Y •.y , RUTFI !_ JEFFERSON MY C:OMMISSION # DD 199000 -z EXPIRES: May 6, 2007 ;1j,�° Bonded ''hru Notary Pt"Ic Undwwrbfs X "F Sg 4 Indian River Board of County Commissioners 1840 25th Street Vero Beach , FL 32960 AUTHORIZATION FOR RELEASE OF INFORMATION Pt . Peter ' s Human Services , Inc . Indian River County and (Agency/Individual are in the process of negotiation of a contract for St _ Peterfc Sola nevelopment & Training Institute Indian River County is authorized to make an investigation of the Agency/ Individual regarding its experience and qualifications . The Agency/ Individual authorized the release of all relevant information concerning prior services furnished , contracts and background information of the Agency/Individual . The Agency/Individual authorizes any individual or organization that is in possession of relevant factual contract and background 4 information , to release such data to Indian River County in response of the County' s request. When an individual employee of the Agency signs Authorization for Release of Information , such individual authorizes the County to obtain relevant background information concerning such employee ' s criminal record , if any , and such other information that may be relevant to employee' s good character and work experience . Authorization is given here by the Agency/Individual and such employees who execute this authorization with the understanding and limitation that Indian River County will utilize the information obtained for the purposes set forth herein and that such information shall not be disclosed to third parties except as provided by law . Name Agency/Individual S4. Peborl s Human cora ; Cos Inc Print name Name Employee Providing aut i ' on not name Signature ( in blue ink) Date q_' SWORN STATEMENT UNDER SECTION 105 . 08 , INDIAN RIVER COUNTY CODE , ON DISCLOSURE OF RELATIONSHIPS THIS FORM MUST BE SIGNED IN THE PRESENCE OF A NOTARY PUBLIC OR OTHER OFFICER AUTHORIZED TO ADMINISTER OATHS , 1 . This sworn statement is submitted with RFP No . 4046 for St . Peter ' s Boy ' s Development & Training Institute j - 2 . This sworn statement is submitted by: St . Peter ' s Human Services , Inc . ( Name of entity submitting Statement) whose business address is : 4250 38th Avenue , Vero Beach , FL 32967 and (if applicable ) its Federal Employer Identification Number ( FEIN ) IS 31 - 1. 480611 ( If the entity has no FEIN , include the Social Security Number of the individual signing this sworn statement 3 . My name is Andrew Jefferson ( Please print name of individual signing ) and my relationship to the entity named above is President 4 . 1 understand that an "affiliate " as defined in Section 105 . 08 , Indian River County Code , means : The term "affiliate" includes those officers , directors , executives , partners , shareholders , employees , members , and agents who are active in the management of the entity. { � 5 . 1 understand that the relationship with a County Commissioner or County �r employee that must be disclosed as follows : Father, mother, son , daughter, brother, sister, uncle , aunt , first cousin , nephew , niece , husband , wife , father4i law , mother4i law , daughter- in -law, son -in-law, brother- in -law , sister- in -law, stepfather, stepmother, stepson , stepdaughter, stepbrother, stepsister, half brother, half sister, grandparent, or grandchild . 6 . Based on information and belief, the statement which I have marked below is true in relation to the entity submitting this sworn statement. [Please indicate which statement applies . ] X Neither the entity submitting this sworn statement , nor any officers , directors , executives , partners , shareholders , employees , members , or agents who are active in management of the entity , have any relationships as defined in section 105 . 08 , Indian River County Code , with any County Commissioner or County employee . The entity submitting this sworn statement, or one or more of the officers , directors , executives , partners , shareholders , employees , members , or agents , who are active in management of the entity have the following relationships with a County Commissioner or County employee : Name of Affiliate Name of County Commissioner Relationship or entity or employee a XIII , E i r ; signature ) 4 '.. (date ) STATE OF FLORIDA COUNTY OF Indian River The foregoing instrument was acknowle ged before me this 90il day of 20 "7 ,, by who is personally known to me or who has produceas identification . NOTAR UBLIC SIGN : PRINT : State of Florida at Large My Commission Expires : (Seal ) RUTH L JEFFERSON ' :- MY COMMISSION # DD 199000 a= EXPIRES: May 6, 2007 Bonded Thru Notary Public Und(lmlftrs 111 v e *Y. ST . PETER' S HUMAN SERVICES, INC . 4 , ORGANIZATIONAL LAYOUT BOY' S TRAINING AND DEVELOPMENT INSTITUTE BOARD OF DIRECTORS ADMINISTRATOR/PROGRAM DIRECTOR PROGRAM MANAGER INSTITUTE PREVENTION INSTITUTE TRAINERS MEN'I'AL HEALTH COORDINATOR & TEACHERS PSYCHOLOGIST VOLUNTEERS MENTORS uk '. 34 , T k 8 INA r• f'{c. a `° ST. PETER ' S HUMAN SERVICES, INC . f.' qd . BOY ' S DEVELOPMENT & . TRAINING INSTITUTE Y = key GRANT APPLICATION x FISCAL YEAR 2003 -04 k -- F i-- b Sw' l " 5i G: St . Peter' s Human Services, Inc . 4250 38th Avenue Vero Beach, FL 32967 F: 411 k ,�---==- % F C�rganizafion. St l�eterfs Guinan Services, Inc. Program: boys' Development and Training Institute ! under: Children's Services Council ORGANIZATION : St. Peter' s Human Services PROGRAM : Boys Development and Training Institute TABLE OF CONTENTS Please 'X " the parts of the grant application to indicate they are included. Also, please put the page number where the information can be located. X Section of the Proposal Page # X TABLE OF CONTENTS (Check list) 1 -2 X COVER PAGE (with signatures) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 X A. ORGANIZATION CAPABILITY (one page maximum) X 1 . Mission and Vision of organization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 X 2 . Summary of expertise, accomplishments, and population served . . . . . . . . . . . . . . . . 4 X B. PROGRAM NEED STATEMENT (one page maximum) X 1 . Program Need Statement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 X 2 . Programs that address need and gaps in service . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 X C. PROGRAM DESCRIPTION (two pages maximum) X1 . Funding priority . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 X 2 . Description of program activities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 X 3 . Evidence that program strategy will work . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-7 X4 . Staffing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 X 5 . Awareness of program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 X 6 . Accessibility of program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . X D. MEASURABLE OUTCOMES (two pages maximum) . . . . . . . . . . . . . . . . . . . . . . . . . 8 X E. COLLABORATION (one page maximum) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 X F. PROGRAM EVALUATION (two pages maximum) X1 . Demographics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 X2 . Measures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 X3 . Reporting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 X G. TIMETABLE (one page maximum) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 X H. UNDUPLICATED CLIENT COUNT 1 . Projections by Location . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 2 . Projections by Age Group . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 1 ;Ys x^ IE}I gEj P,Fy� ' ,R -s11 1 a rc5 a �itgnsfu�e '' under C �ren's Service`s ': X I. BUDGET FORMS X 1 . Budget Narrative Worksheet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 - 18 X 2 . Total Agency Budget . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I . . . . . . . . . . . . 15 - 18 X 3 . Total Program Budget . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 - 18 X 4 . Funder Specific Budget . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 - 18 X 5 . Explanation for Variances — Total Program Budget . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 . Explanation for Variances — Funder Specific Budget . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . X J. FUNDER SPECIFIC/ADDITIONAL SHEETS X K. APPENDIX �rt y r vr( �y r� 3a s �Y* t n ../>V . . s� y, ' ST . PETER ' S ACADEMY BOARD OF DIRECTORS NAME ADDRESS TELEPHONE NUMBER 4236 57t Avenue Reverend Andrew Jefferson Vero Beach , FL 32967 772 - 567 - 7057 461043 rCourt Mr . Reuben Lane Vero Beach , FL 32967 772 -567 -9571 P . O . Box 5064 Mr . Robert Temple Vero Beach , FL 32961 772 -567 - 6771 4206 58th Avenue Ms . Mary McKinney Vero Beach , FL 32967 772 = 562 = 7105 6439 55t Square Mrs . Terry Hurley Vero Beach , FL 32967 772 - 562 -9975 4180 47t Place Mrs . Elizabeth McGriff Vero Beach , FL 32967 772 -562 - 1100 h i ST . PETERS HUMAN SERVICES , INCORPORATED (A Component Unit of the Indian River County District School Board) Annual Financial Report June 30, 2002 (With Independent Auditors' Report Thereon) E ST. PETERS HUMAN SERVICES , INCORPORATED (A Component Unit of the Indian River County District School Board) Annual Financial Report June 30 , 2002 Table of Contents Pages Independent Auditors' Report I Management ' s Discussion and Analysis 2 - 6 Basic Financial Statements : Statement of Net Assets 7 Statement of Activities 8 - 9 Balance Sheet — Governmental Funds 10 Statement of Revenues , Expenditures and Changes in Fund Balances - Governmental Funds 11 Balance Sheet — Proprietary Fund 12 Statement of Revenues , Expenses and Changes in Fund Net Assets — Proprietary Fund 13 Statement of Cash Flows — Proprietary Fund 14 Statement of Fiduciary Net Assets — Agency Fund 15 Notes to Basic Financial Statements 16 - 23 Required Supplementary Information Other Than Management ' s Discussion and Analysis : Statement of Revenues , Expenditures and Changes in Fund Balances — Budget and Actual — General Fund 24 Statement of Revenues , Expenditures and Changes in Fund Balances — Budget and Actual — Special Revenue Fund 25 Independent Auditors ' Report on Compliance and on Internal Control 26 Management Letter 27 - 29 an • Jacoby • Thum • Boyle Morg Jill & Associates , P.A. Certified Public Accountants Independent Auditors ' Report The Board of Directors St. Peters Human Services , Incorporated : We have audited the accompanying basic financial statements of St. Peters Human Services , Incorporated (the Academy) as of and for the year ended June 30 , 2002 , as listed in the table of contents . These basic financial statements are the responsibility of the Academy ' s management. Our responsibility is to express an opinion on these basic financial statements based on our audit. We conducted our audit in accordance with auditing standards generally accepted in the United States of America and Government Auditing Standards, issued by the Comptroller General of the United States . Those standards require that we plan and perform the audit to obtain reasonable assurance about whether the financial statements are free of material misstatement . An audit includes examining , on a test basis , evidence supporting the amounts and disclosures in the financial statements . An audit also includes assessing the accounting principles used and significant estimates made by management, as well as evaluating the overall financial statement presentation. We believe that our audit provides a reasonable basis for our opinion. In our opinion, the basic financial statements referred to above present fairly, in all material respects , the financial position of St. Peters Human Services, Incorporated, at June 30 , 2002 , and the results of its operations and the cash flows of its proprietary fund for the year then ended in conformity with accounting principles generally accepted in the United States of America. As described in note 1 , the Academy adopted the provisions of Governmental Accounting Standards Board Statement No . 34, Basic Financial Statements — and Management 's Discussion and Analysis — For State and Local Governments, as of July 1 , 2001 . In accordance with Government Auditing Standards, we have also issued a report dated September 17, 2002 on our consideration of St. Peters Human Services , Incorporated ' s compliance and internal control over financial reporting . The management ' s discussion and analysis and the required supplementary information other than management ' s discussion and analysis on pages 2 through 6 and pages 24 and 25 , respectively , are not a required part of the basic financial statements but is supplementary information required by the Governmental Auditing Standards Board . We have applied certain limited procedures , which consisted principally of inquiries of management regarding the methods of measurement and presentation of the supplemental information. However, we did not audit the information and express no opinion on it. aRM; 00, September 17, 2002 , 700 - 20th Street • Vero Beach, Florida 32960 • Phone 561 -562 -4158 • Telefax 561 -563 -2024 ST. PETERS HUMAN SERVICES, INCORPORATED (A Component Unit of the Indian River County District School Board) Management ' s Discussion and Analysis This section of the St . Peters Human Services , Incorporated ' s (the Academy) annual financial report presents our discussion and analysis of the Academy ' s financial performance during the fiscal year that ended on June 30 , 2002 . Please read it in conjunction with the Academy ' s basic financial statements , which immediately follow this section . Financial Highlights The Academy ' s financial condition changed modestly as discussed below: • Most of the Academy ' s net assets (85 . 5 %) continue to consist of capital outlay funds held in anticipation of the construction of a new multipurpose educational building, scheduled for completion in 2003 . • Just $ 12 , 153 of the net assets at June 30 , 2002 is held by the Academy for operational purposes, as the Academy continues to operate on a near break-even basis . The Academy ' s general fund experienced a $ 8 , 123 decrease in net assets (2 . 0% of total revenues) as the slight decline in operational revenues outpaced the reduction in related expenditures . • Total governmental revenues for the year fell $ 153 , 535 , or 20 . 0% , primarily as a result of state cutbacks in the revenue allocations for capital outlays as capital outlay revenues fell $ 143 , 052 from the prior year. Overview of the Financial Statements This annual report consists of three parts — management ' s discussion and analysis (this section), the basic financial statements, and required supplementary information. The basic financial statements include two kinds of statements that present different views of the Academy : • The first two statements are Academy-Wide financial statements that provide both short- term and long-term information about the Academy ' s overall financial status . • The remaining statements are fund financial statements that focus on individual parts of the Academy, reporting the Academy ' s operations in more detail than the Academy-Wide statements . • The governmental funds statements tell how basic services like regular and special education were financed in the short term as well as what remains for future spending . • Proprietary funds statements offer short-term and long-term financial information about activities that are operated like businesses . • Fiduciary funds statements provide information about the financial relationships in which the Academy acts solely as agent for the benefit of others . 2 The financial statements also include notes that explain some of the information in the statements and provide more detailed data. The statements are followed by a section of required supplementary information that further explains and supports the financial statements with a comparison of the Academy ' s budgets for the year. Academy- Wide Statements The Academy- Wide statements report information about the Academy as a whole using accounting methods similar to those used by private-sector companies . The statement of net assets includes all of the Academy ' s assets and liabilities . All of the current year ' s revenues and expenses are accounted for in the statement of activities regardless of when cash is received or paid . The two Academy- Wide statements report the Academy ' s net assets and how they have changed . Net assets — the difference between the Academy ' s assets and liabilities — are one way to measure the Academy ' s financial health or position. • Over time, increases or decreases in the Academy ' s net assets are an indicator of whether its financial position is improving or deteriorating . • To assess the overall health of the Academy, you need to consider additional nonfinancial factors such as the grade assessed under the State of Florida' s Academy grading system and the number of full-time equivalents of students attending the Academy. In the Academy-Wide financial statements, the Academy ' s activities are divided into two categories : • Governmental activities — The Academy ' s basic services are included here , such as regular and special education, transportation, and administration. Intergovernmental revenues from the Indian River County School Board (initially funded by property taxes) finance most of these activities . • Business -type activities — These activities charge fees to help cover the costs of services provided . The Academy ' s child care and child development program is included in this activity . Fund Financial Statements The fund financial statements provide more detailed information about the Academy ' s funds, focusing on its most significant or "major" funds — not the Academy as a whole . Funds are accounting devices the Academy uses to keep track of specific sources of funding and spending on particular programs : • Some funds are required by State law. • The Academy establishes other funds to control and manage money for particular purposes or to show that it is properly using certain revenues (like federal grants) . 3 There are three kinds of funds : • Governmental funds — The Academy ' s basic services are included in governmental funds , which generally focus on how cash and other financial assets that can readily be converted to cash flow in and out, and, the balances left at year-end that are available for spending . Consequently , the governmental funds statements provide a detailed short-term view that helps you determine whether there are more or fewer financial resources that can be spent in the near future to finance the Academy ' s programs . Because this information does not encompass the additional long-term focus of the Academy-Wide statements , we provide additional information with the governmental funds statements that explains the relationship or differences between them . • Proprietary funds — Services for which a fee is charged are generally reported in proprietary funds . Proprietary funds are reported in the same way as the Academy- Wide financial statements, but provides an additional cash flows statement. • Fiduciary funds — The Academy is the trustee, or fiduciary, for assets that belong to others , such as the student activities funds . The Academy is responsible for ensuring that the assets reported in these funds are used only for their intended purposes and by those to whom the assets belong. We exclude these activities from the Academy- Wide financial statements because the Academy cannot use these assets to finance its operations . Financial Analysis of the Academy as a Whole Net assets of the Academy ' s governmental assets consisted of the following as of June 30 , 2002 and 2001 : Net Assets — Governmental Activities 2002 2001 Current and other assets $ 641 , 163 593 , 762 Capital assets , net 78 , 589 48 , 827 Total assets 719 , 752 642 , 589 Current liabilities 10 , 623 Net assets : Invested in capital assets 787589 485827 Restricted 618 ,387 573 ,486 Unrestricted 12, 153 20 ,276 Total net assets $ 709 , 129 642 , 589 The Academy ' s governmental net assets grew by $ 66 , 540 , or 10 .4% over the prior year. Most of the increase was due to the Academy ' s increase in capital assets and capital outlay funding available for future purchases of capital assets . The Academy ' s business-type assets, consisting primarily of cash and receivables , totaled $ 33 , 011 and $ 38 , 403 as of June 30, 2002 and 2001 , respectively . 4 The following schedule compares revenues and expenses during the years ended June 30 , 2002 and 2001 : Change in Net Assets — Governmental Activities 2002 2001 Revenues : Program revenues — federal grants $ 130 , 922 133 , 829 General revenues : Intergovernmental 4425742 5945613 Other 37 , 147 35 , 904 Total revenues 610 , 811 764 , 346 Expenses : Instruction related 263 , 329 265 , 253 Administration 126 ,216 137 , 156 Food services 645160 575468 Transportation 22 ,978 17 , 846 Maintenance and operations 555800 71 , 630 Other 11 ,788 64633 Total expenses 544 ,271 555 , 986 Increase in net assets $ 66 , 540 208 , 360 Total governmental revenues for the year fell $ 153 , 535 , or 20 . 0% , primarily as a result of state cutbacks in the revenue allocations for capital outlays as capital outlay revenues fell $ 143 ,052 from the prior year. The Academy ' s operational revenues allocated on a per- student basis (FTE revenues) fell $29 ,678 , or 7 . 3 % from the prior year, generally due to a 5 . 1 % decrease in the number of students enrolled at the Academy. Total governmental expenses decreased $ 11 ,715 , or 2 . 1 % as the Academy held expenses in line to match the decline in operational revenues . Financial Analysis of the Academy ' s Funds The Academy ' s general fund net assets decreased $ 8 , 123 during the year ended June 30 , 2002 to $ 12 , 153 as the Academy ' s decline in revenues outpaced the reduction in expenses, as noted above. The Academy ' s special revenue fund consisted of a $ 50 , 000 federal dissemination grant, whose purpose was to disseminate information regarding the Academy ' s best practices and teaching strategies for at-risk students , $ 49 , 820 in Title 1 funding, and $43 , 338 for food services at the Academy . The dissemination grant provided total available funds of $ 50 , 000 , although the Academy expended $ 33 ,941 during the year ended June 30 , 2002 . The remaining $ 16 ,059 under the grant will be expended through September 30 , 2002 . The $ 33 , 184 increase in the Academy ' s capital projects fund reflects an excess in funding over capital outlay expenditures necessary during the year, despite the reduction in the per-student allocation revenues from the State of Florida. As further discussed below, the Academy plans on using these accumulated funds to construct a multipurpose educational building during the year ended June 30 , 2003 . 5 Capital Asset and Debt Administration Capital Assets As of June 30 , 2002 , the Academy had invested $ 78 , 589 in a variety of capital assets, as reflected in the following schedule , which represents a net increase (additions less depreciation) of $29 ,762 , or 61 . 0% from the end of last year. 2002 2001 Improvements other than buildings $ 7 ,411 85309 Buildings and improvements 791 856 Furniture , fixtures , and equipment 493521 327774 Computer software 41051 1 , 888 Construction in progress 16 , 815 51000 Governmental capital assets , net $ 781589 48 , 827 Long-term Debt As of June 30 , 2002 , the Academy had no long-term debt financing . Factors Bearing on the Academy ' s Future At the time these financial statements were prepared and audited, the Academy was aware of the following circumstances that could significantly affect its financial health in the future : • The Academy has previously entered into a new lease for additional property for the purpose of constructing a new multipurpose educational facility . The lease calls for an initial payment of $ 364, 875 to cover the lease of the property and construction costs of the new facility . The actual construction costs are subject to change , possibly resulting in a change in the amount of the lease, upon completion, which is anticipated to occur during 2003 . Contacting the Academy ' s Financial Management This financial report is designed to provide our citizens , taxpayers, customers , and investors and creditors with a general overview of the Academy ' s finances and to demonstrate the Academy ' s accountability for the money it receives . If you have any questions about this report or need additional information, contact the Administrator ' s Office, St. Peters Human Services , Incorporated, 4250 38`'' Avenue, Vero Beach, FL 32967 . 6 ST. PETERS HUMAN SERVICES , INCORPORATED (A Component Unit of the Indian River County District School Board) Statement of Net Assets June 30, 2002 Governmental Business-type Activities Activities Total Assets : Cash $ 395 , 361 24 , 623 419,984 Due from primary government (note 2) 234, 085 — 234 , 085 Other receivables — 82388 8 ,388 Deposits 11 , 717 — 11 ,717 Capital assets, net of accumulated depreciation of $29 , 826 (note 3 ) 784589 — 78 , 589 Total assets 7194752 33 , 011 7529763 Liabilities : Accounts payable 8 , 879 — 87879 Accrued expenses 1 , 744 174 11918 Total liabilities 10, 623 174 10,797 Net Assets : Invested in capital assets 78 , 589 — 78,589 Restricted for: Special revenues 11 ,717 — 112717 Capital projects 606 , 670 — 606, 670 Unrestricted 12 , 153 32 , 837 444990 Total net assets $ 709. 129 32 , 837 7411966 See accompanying notes to basic financial statements . 7 Net (Expense) Revenue and Changes in Net Assets Governmental Business-type Activities Activities Total $ (202 ,464) — (202 ,464) (99 ,497) — (99,497) (36 , 148) — (36) 148) (20, 822) — (20 , 822) (222978 ) — (227978 ) ( 19 , 652) — ( 19, 652) 11 1 , 788 ) — 1� 1 , 788 ) 41( 3 , 349) — 41( 3 , 349) 6) 89.6) 413 349) (3 , 896) 417 245 377, 572 — 3773572 95406 — 95406 55 , 764 — 55 , 764 15 ,425 — 155425 21 ,722 — 21 , 722 479 , 889 — 479 , 889 663540 (39896) 62 ,644 642 , 589 36 ,733 679, 322 $ 709 , 129 32 , 837 741 , 966 9 ST . PETERS HUMAN SERVICES , INCORPORATED (A Component Unit of the Indian River County District School Board) Balance Sheet Governmental Funds June 30 , 2002 Special Capital Total General Revenue Projects Governmental Assets Fund Fund Fund Funds Cash $ 68 , 953 — 3265408 395 , 361 Due from primary government (note 2) — 32823 230 ,262 234, 085 Due from other funds (note 2) — — 5000 50 ,000 Deposits — 11 , 717 — 114717 $ 684953 15 , 540 6061670 691 , 163 Liabilities and Fund Balances Liabilities : Accounts payable 55056 37823 — 81879 Accrued expenses 1 , 744 — — 1 , 744 Due to other fund (note 2) 50 , 000 — — 50 , 000 Total liabilities 56 , 800 31823 — 60 , 623 Fund Balances : Unreserved 12 , 153 11 , 717 606 , 670 630 , 540 Total fund balances 12 , 153 11 , 717 606 , 670 630, 540 $ 68 , 953 15 , 540 606 , 670 Reconciliation of governmental fund balances to entity-wide government activities net assets Amounts reported for governmental activities in the statement of net assets are different because : Capital assets used in governmental activities are not financial resources and therefore are not reported as assets in governmental funds . The cost of the assets is $ 108 ,415 and the accumulated depreciation is $29 , 826 78 , 589 Total net assets — governmental activities $ 709 , 129 See accompanying notes to basic financial statements . 10 ST. PETERS HUMAN SERVICES , INCORPORATED (A Component Unit of the Indian River County District School Board) Statement of Revenues , Expenditures and Changes in Fund Balances Governmental Funds Year Ended June 30 , 2002 Special Capital Total General Revenue Projects Governmental Fund Fund Fund Funds Revenues : Federal through local $ - 1305922 - 130 , 922 State through local 9 , 406 - 55 , 764 65 , 170 Local (note 4) 377 , 572 - - 377 , 572 Other 21 , 722 - 154425 37 , 147 Total revenues 408 , 700 130 , 922 71 , 189 610 , 811 Expenditures : Current - education : Instruction 202 ,464 60 , 865 - 2633329 School administration 117 , 907 8 , 309 - 126 ,216 Facilities acquisition and construction 33 , 000 - 3 , 148 36 , 148 Food services 20 , 822 43 , 338 - 645160 Pupil transportation services 22 , 978 - - 22 ,978 Operation of plant 19 , 652 - - 19 ,652 Capital outlay : Facilities acquisition and construction - 6 , 693 34 , 857 41 , 550 Total expenditures 416 , 823 119 ,205 38 , 005 574 , 033 Net change in fund balances (8 , 123 ) 113717 335184 367778 Fund balances , beginning of year 204276 - 573 ,486 593 , 762 Fund balances , end of year $ 12 , 153 11 , 717 606 , 670 630 , 540 Net change in fund balances - total governmental funds 367778 Amounts reported for governmental activities in the statement of activities are different because : Governmental funds report capital outlays as expenditures . However, in the statement of activities, the cost of those assets is allocated over their estimated useful lives as depreciation expense . This is the amount by which capital outlays ($ 41 , 550) exceed depreciation expense ($ 11 , 788 ) 29 , 762 Change in net assets of governmental activities $ 66 , 540 See accompanying notes to basic financial statements . 11 ST. PETERS HUMAN SERVICES , INCORPORATED (A Component Unit of the Indian River County District School Board) Balance Sheet Proprietary Fund — Child Development June 30 , 2002 Total Pro rietary Assets bunds Cash $ 24 , 623 Accounts receivable 7 , 293 Employee loans receivable 1 , 095 $ 33 , 011 Liabilities and Net Assets Liabilities : Accrued expenses 174 Total liabilities 174 Net assets : Unreserved 32 , 837 Total fund balances 32 , 837 $ 33 , 011 See accompanying notes to basic financial statements , 12 ST. PETERS HUMAN SERVICES , INCORPORATED (A Component Unit of the Indian River County District School Board) Statement of Revenues, Expenses and Changes in Fund Net Assets Proprietary Fund — Child Development Year Ended June 30 , 2002 Total Proprietary Funds Revenues : Charges for child care services $ 1595115 Other 28 , 351 Total revenues 187 ,466 Expenses : Personnel expenses 134 , 594 Facility operations 26 ,050 Supplies 9, 321 Other 21 , 397 Total expenditures 191 , 362 Operating loss (3 , 896) Net assets, beginning of year 36 , 733 Net assets, end of year $ 32 , 837 See accompanying notes to basic financial statements , 13 ST . PETERS HUMAN SERVICES , INCORPORATED (A Component Unit of the Indian River County District School Board) Statement of Cash Flows Proprietary Fund — Child Development Year Ended June 30 , 2002 Total Proprietary Funds Cash flows from operating activities : Receipts from customers and others $ 180 , 173 Payments to suppliers and employees 193 953 ) Net cash used in operating activities ( 13 , 780) Cash flows from investing activities — Cash flows from financing activities Net decrease in cash ( 137780) Cash, beginning of year 389403 Cash, end of year $ 24 , 623 Reconciliation of operating loss to net cash used by operating activities : Operating loss (31896) Adjustments to reconcile operating loss to net cash used by operating activities : Increase in accounts receivable (7 , 293 ) Increase in employee receivables ( 1 , 095 ) Decrease in accrued expenses ( 11496) Net cash used in operating activities $ 13 780) See accompanying notes to basic financial statements . 14 ST. PETERS HUMAN SERVICES , INCORPORATED (A Component Unit of the Indian River County District School Board) Statement of Fiduciary Net Assets Agency Fund — Student Activities June 30 , 2002 Agency bund Assets : Cash $ 348 Total assets $ 348 Liabilities : Amounts held for others 348 Total liabilities $ 348 See accompanying notes to basic financial statements . 15 ST. PETERS HUMAN SERVICES , INCORPORATED (A Component Unit of the Indian River County District School Board) Notes to Basic Financial Statements June 30 , 2002 (1) Organization and Summary of Significant Accounting Policies St . Peters Human Services , Incorporated (the Academy) is a not- for-profit corporation organized pursuant to Chapter 617 , Florida Statutes , the Florida Not For Profit Corporation Act, and Section 228 . 056 , Florida Statutes . The Academy operates under the fictitious name of St . Peters Academy and was incorporated on August 7 , 1996 . The Academy is governed by a Board of Directors . The general operating authority of the Academy is contained in Section 228 . 056 , Florida Statutes . The Academy operates under a charter of the sponsoring school district, the Indian River County District School Board (the District) . The current charter was amended and renewed on May 22 , 2001 and is effective until June 30 , 2006 , and may be renewed annually by mutual written agreement between the Academy and the District. At the end of the term of the charter, the District may choose not to renew the charter under grounds specified in the charter in which case the District is required to notify the Academy in writing at least 90 days prior to the charter ' s expiration . During the term of the charter, the District may also terminate the charter if good cause is shown . The Academy is considered a component unit of the District. The accounting policies of the Academy conform to generally accepted accounting principles applicable to governmental units . The Governmental Accounting Standards Board (GASB) is the standard-setting body for governmental accounting and financial reporting . Pronouncements of the .Financial Accounting Standards Board (FASB ) issued after November 30 , 1989 are not applied in the preparation of the financial statements of the proprietary fund types in accordance with GASB Statement No . 20 . The following is a summary of the more significant policies . In June 1999 , the GASB approved Statement No . 34, " Basic Financial Statements — Management ' s Discussion and Analysis — for State and Local Governments" (Statement 34) , which has established a new reporting model , as more fully discussed below. The Academy adopted the provisions of Statement No . 34 as of July 1 , 2001 in coordination with the District' s requirement to implement this statement for the year ended June 30 , 2002 . (a) Reporting Entity The reporting entity is based primarily on the notion of financial accountability . A primary government is financially accountable for the organizations that make up its legal entity . It is also financially accountable for legally separate organizations if its officials appoint a voting majority of an organization ' s governing body and either it is able to impose its will on that organization or there is a potential for the organization to provide specific financial benefits to , or to impose specific financial burdens on, the primary government. (Continued) 16 ST . PETERS HUMAN SERVICES , INCORPORATED (A Component Unit of the Indian River County District School Board) Notes to Basic Financial Statements A primary government has the ability to impose its will on an organization if it can significantly influence the programs , projects, or activities of, or the level of services performed or provided by the organization . A financial benefit or burden relationship exists if the primary government (a) is entitled to the organization ' s resources ; (b) is legally obligated or has otherwise assumed the obligation to finance the deficits of, or provide financial support to the organization ; or (c) is obligated in some manner for the debt of the organization . There are no component units of the Academy . (b) Basic Financial Statements — GASB Statement 34 The basic financial statements include both Academy-Wide (based on the Academy as a whole) and fund financial statements . While the previous reporting model emphasized fund types , in the new financial reporting model the focus is on either the Academy as a whole, or major individual funds within the fund financial statements . Both the Academy- Wide and fund financial statements categorize primary activities as either governmental or business type . In the Academy- Wide statement of net assets , governmental and business- type activities are presented separately and are reflected on a full accrual , economic resource basis , which incorporates long-term assets as well as long-term debt. The Academy-Wide statement of activities reflects both the gross and net costs per functional category (instruction, administration, maintenance , etc . ), which are otherwise being supported by general government revenues , such as property taxes and intergovernmental revenues . The statement of activities reduces gross expenses , including depreciation, by related program revenues such as discretionary grants that can be used for either operating or capital purposes . The net cost by function is normally covered by general revenues while the previous financial reporting model did not summarize or present net cost by function or activity . This Academy-Wide focus is more on the sustainability of the Academy as an entity and the change in aggregate financial position resulting from the activities of the fiscal period. The fund financial statements are, in substance, very similar to the financial statements presented in the previous financial reporting model . Emphasis here is on the major funds . As of and for the year ended June 30 , 2002 , the Academy considered all of its funds to be major funds . The governmental funds in the fund statements are presented on a current financial resource and modified accrual basis of accounting . This is the manner in which these funds are normally budgeted . This presentation is deemed most appropriate to demonstrate legal compliance and the source and use of liquid resources . Since the governmental fund statements are presented on a different measurement focus and basis of accounting than the Academy-Wide statements , a reconciliation is presented on each of the fund financial statements , which briefly explains the adjustment necessary to transform the fund based financial statements into the total governmental column of the Academy-Wide presentation. (Continued) 17 ST. PETERS HUMAN SERVICES, INCORPORATED (A Component Unit of the Indian River County District School Board) Notes to Basic Financial Statements The Academy ' s fiduciary funds are presented in the fund financial statements and since , by definition, these assets are being held for the benefit of others and cannot be used to address activities or obligations of the Academy , these funds are not incorporated into the Academy - Wide financial statements . The focus of the Statement 34 model is on the Academy as a whole and the fund financial statements . The focus of the fund financial statements is on the major individual funds of the governmental and business-type categories, as well as the fiduciary funds . (c) Basis of Presentation The financial transactions of the Academy are recorded in individual funds . Each fund is accounted for by providing a separate set of self-balancing accounts that records cash and other financial resources , liabilities, reserves , fund equity, revenues, and expenditures . Statement 34 establishes minimum criteria based on percentage relationships of the funds for the determination of major funds . In addition, the Academy can identify additional funds to be major funds . The Academy has determined all of its funds to be major funds , as described below. Governmental Funds General Fund The General Fund is the general operating fund of the Academy . It is used to account for all financial resources except those required to be accounted for in another fund . Special Revenue Fund A Special revenue funds are used to account for the proceeds of specific revenue sources that are legally or administratively restricted to expenditure for specific purposes . During the year ended June 30 , 2002 , the Academy used the special revenue fund to account for the federal dissemination grant program, the Title 1 program, and the food services program . Capital Projects Fund Capital projects funds are used to account for the financial resources to be used for educational capital outlay needs , including new construction and renovation and remodeling projects . During the year ended June 30 , 2002, the Academy used the capital projects fund to account for capital outlays funded by capital outlay revenues and the School Infrastructure Thrift grant. (Continued) 18 ST. PETERS HUMAN SERVICES , INCORPORATED (A Component Unit of the Indian River County District School Board) Notes to Basic Financial Statements Proprietary Funds The focus of proprietary fund measurement is upon determination of operating income , changes in fund net assets , financial position, and cash flows , which is similar to businesses . During the year ended June 30 , 2002 , the Academy used a proprietary fund to account for its child-care program, which consists of child care for pre-school aged children and a " boot camp" for young boys . During the year ended June 30, 2002 , the Academy received $ 8 , 726 under an Indian River County Commission grant and $ 10 , 856 under a Florida Department of Juvenile Justice grant to fund the boot camp . Fiduciary Funds — Agency Fund The Academy accounts for the student activities funds in the agency fund. Non-Current Governmental Assets and Liabilities GASB Statement 34 eliminates the presentation of Account Groups , but provides for these amounts to be maintained and incorporates the information into the governmental column in the Academy- Wide statement of net assets . Previously, the General Fixed Asset Account Group was used to account for all fixed assets of the Academy . (d) Basis of Accounting Basis of accounting refers to the point at which revenues or expenditures/expenses are recognized in the accounts and reported in the financial statements . It relates to the timing of the measurements made, regardless of the measurement focus applied. The Academy- Wide financial statements are presented on an accrual basis of accounting, while the governmental funds in the fund financial statements are presented on a modified accrual basis . Under the accrual method, revenues are recognized when earned and expenses are recognized when incurred . Under the modified accrual basis of accounting , revenues , except for certain grant revenues, are recognized when they are susceptible to accrual ; when they become measurable and available to finance the Academy's operations . " Available" means collectible within the current period or soon enough thereafter to be used to pay liabilities of the current period . Expenditures are generally recorded when the liabilities are incurred. In applying the " susceptible to accrual" concept to intergovernmental revenues, the Academy may recognize receivables and revenue when the applicable eligibility requirements including time requirements have been met . Revenues for certain grants, such as the federal dissemination grant, are recognized when the expenditures are made when grant terms provide that the expenditure of resources is the prime factor for determining eligibility for federal , state , and other grant resources . Resources provided before eligibility requirements are met are reported as deferred revenues . The Academy had no deferred revenues as of June 30 , 2002 . (Continued) 19 ST. PETERS HUMAN SERVICES , INCORPORATED (A Component Unit of the Indian River County District School Board) Notes to Basic Financial Statements (e) Budgets and Budgetary Accounting The Academy annually adopts a budget for all governmental funds . Budgets are presented on the modified accrual basis of accounting . All budget amounts presented in the accompanying supplementary information reflect the original budget and the amended budget, which has been adjusted for authorized revisions during the year. (� Encumbrances Encumbrances, if any , outstanding at year-end represent the estimated amount of expenditures to result if unperformed purchase orders and other commitments at year-end are completed. The Academy generally intends to honor purchase orders and other commitments in process . As a result, encumbrances outstanding at year-end are reported as reservations of fund balances since they do not constitute expenditures or liabilities . (g) Cash The Academy ' s cash consists of demand deposits with financial institutions , which are insured by Federal depository insurance . As of June 30 , 2002 , uncollateralized and uninsured deposits in the Academy ' s cash accounts that exceeded Federal deposit insurance amounted to $ 333 , 707 . (h) Capital Assets Property and equipment purchased are recorded at historical cost. Contributed property and equipment are recorded at the fair market value at the time received . The Academy ' s capitalization level is $ 750 . Other costs incurred for repair and maintenance are expensed as incurred . Depreciation on all assets is recorded in the Academy-Wide financial statements only and is provided on a straight-line basis over the following estimated useful lives : Years Improvements other than buildings 10 - 20 Buildings and improvements 10 - 40 Furniture , fixtures, and equipment 5 - 10 Computer software 3 (i) Compensated Absences Compensated absences for vacation, sick, and other personal leave are provided for all regular, full-time employees . An employee may accrue leave based on the number of years served. However, employees are not entitled to cash payment in lieu of taking leave or upon termination. Compensated absences are recorded as expenditures when leave is used and no liability for compensated absences is reflected in the financial statements . (Continued) 20 ST. PETERS HUMAN SERVICES , INCORPORATED (A Component Unit of the Indian River County District School Board) Notes to Basic Financial Statements (j) Revenue Sources Revenues for current operations are received primarily from the District pursuant to the funding provisions included in the Academy ' s charter. In accordance with the funding provisions of the charter and Section 228 . 056 ( 13 ) , Florida Statutes, the Academy reports the number of full -time equivalent (FTE) students and related data to the District. Under provisions of Section 236 . 081 , Florida Statutes , the District reports the number of FTE students and related data to the Florida Department of Education (FDOE) for funding through the Florida Education Finance Program. Funding for the Academy is adjusted during the year to reflect the revised calculations by the FDOE and the actual weighted FTE students reported by the Academy during the designated FTE student survey periods . (2) Receivables As of June 30 , 2002 , due from primary government includes $ 105 , 962 of funding under the Capital Outlay allocation, and $ 124, 300 of funding under the School Infrastructure Thrift (SIT) program, which are accounted for in the capital projects fund . Such funds are held in an investment account by the Indian River County School District on behalf of the Academy . As of June 30 , 2002 , due from primary government includes $ 3 , 823 of funding under the federal dissemination grant to be reimbursed to the Academy for expenditures incurred under the grant during the year ended June 30 , 2002 . The Academy ' s capital projects fund made advances to the general fund during the year ended June 30 , 2002 . As of June 30 , 2002, the Academy ' s capital projects fund was due $ 50 ,000 from the general fund. (3) General Fixed Assets The following is a summary of the changes in the Academy' s governmental capital assets for the year ended June 30 , 2002 : Balance Balance 2001 Additions Retirements 2002 Improvements other than buildings $ 91393 — — 9 , 393 Buildings and improvements 15023 — — 1 ,023 Furniture , fixtures , and equipment 47 , 737 26 , 396 — 741133 Computer software 3 ,712 39339 — 71051 Construction in progress 5 , 000 11 , 815 — 16 , 815 Total capital assets 66 , 865 41 , 550 — 108 ,415 Less accumulated depreciation for: Improvements other than buildings 1 , 084 898 — 1 ,982 Buildings and improvements 167 65 — 232 Furniture, fixtures , and equipment 14 , 963 91649 — 24,612 Computer software 11824 1376 — 3 , 000 Total accumulated depreciation 18 ,038 11 ,788 — 29 , 826 Governmental capital assets, net $ 489827 29 ,762 — 78 , 589 ( ontinued) 21 ST. PETERS HUMAN SERVICES , INCORPORATED (A Component Unit of the Indian River County District School Board) Notes to Basic Financial Statements (4) Schedule of Local Revenue Sources The following is a schedule of local revenue sources and amounts : Sources Amount Indian River County District School Board : Florida Education Finance Program $ 277 ,043 Guaranteed ESE 28 ,939 Discretionary millage funds 25 ,641 Discretionary lottery funds 7 ,297 School academic improvement 115872 Instructional materials and teacher training 8 ,682 Student transportation 7 ,648 Sparsity 33 Public school technology 2 , 137 Safe schools 2 ,330 Florida Teachers Lead Program 5 , 950 Total $ 377, 572 (5) Related Party Transactions The Academy leases its facilities under an annually renewable lease agreement with St. Peter' s Missionary Baptist Church (the Church) for $2 , 650 per month. In addition, the Academy rents the Church ' s bus for $ 600 per month. Several of the members of the Academy ' s Board of Directors are associated with the Church. Total rent expense incurred during the year ended June 30 , 2002 amounted to $43 ,080 . Effective July 1 , 2000, the Academy entered into a new lease with the Church for additional property . Under the lease terms, the Church will construct and provide a new multipurpose education facility . The lease term covers five years through June 30, 2005 and provides for an initial payment of $ 364 , 875 in July 2000 , with monthly payments of $ 1 thereafter. As of June 30 , 2002, no payments have been made to the Church and will be postponed pending construction of the underlying facilities . The $ 364, 875 funding of the new lease was received from the District in July 2000 as part of the Academy ' s SIT allocation (see note 2) , which was awarded from the State of Florida during the year ended June 30 , 2000 . On July 7 , 2000 , the Academy was awarded an additional SIT allocation from the State of Florida in the amount of $ 108 ,918 . These funds will be available for additional capital outlay expenditures associated with the new education facility . (Continued) 22 r ST. PETERS HUMAN SERVICES , INCORPORATED (A Component Unit of the Indian River County District School Board) Statement of Revenues , Expenditures and Changes in Fund Balances - Budget and Actual General Fund Year Ended June 30 , 2002 Favorable (Unfavorable) Budgeted Amounts Variance with Original Final Actual Final Budget Revenues : State through local $ - 99406 9,406 - Local 390 ,600 377, 572 377, 572 - Other - 74 , 000 21 , 722 52 278) Total revenues 390 , 600 460 , 978 408 , 70052 278 ) Expenditures : Current - education : Instruction 187,657 262 , 139 202 ,464 59, 675 School administration 134, 186 119, 044 1175907 1 , 137 Facilities acquisition and construction 32,000 33 , 000 33 , 000 - Food services 13 , 370 18 , 602 20, 822 (2 ,220) Pupil transportation services 17 , 876 202474 22 , 978 (2 , 504) Operation of plant 17 ,948 19 , 982 19 , 652 330 Total expenditures 4034037 473 , 241 416 , 823 56 ,418 Excess (deficiency) of revenues over (under) expenditures ( 123437) ( 12 ,263 ) (83123 ) 4 , 140 Fund balances , beginning of year 20,276 20 ,276 204276 - Fund balances , end of year $ 7 , 839 8 , 013 12 , 153 4 , 140 24 ST. PETERS HUMAN SERVICES , INCORPORATED (A Component Unit of the Indian River County District School Board) Statement of Revenues , Expenditures and Changes in Fund Balances — Budget and Actual Special Revenue Fund Year Ended June 30, 2002 Favorable (Unfavorable) Budgeted Amounts Variance with Original Final Actual Final Budget Revenues : Federal through local $ 143 , 338 143 , 338 130 , 922 LLL416 Total revenues 143338 143 , 338 130,9221( 2 ,416) Expenditures : Current — education: Instruction 67, 000 67 ,000 60 , 865 6 , 135 School administration 139100 13 , 100 8 , 309 41791 Food services 43 ,338 43 ,338 43 , 338 — Fixed capital outlay : Facilities acquisition and construction 194900 19 ,900 69693 13 ,207 Total expenditures 143 , 338 143 , 338 119 ,205 24, 133 Excess of revenues over expenditures — — 113717 11 ,717 Fund balances, beginning of year — — — — Fund balances, end of year $ — — 11 , 717 11 ,717 25 lulMorgan • Jacoby • Thum • Boyle j & Associates , P.A. Certified Public Accountants Management Letter The Board of Directors St. Peters Human Services , Incorporated : We have audited the financial statements of St. Peters Human Services, Incorporated . , as of and for the year ended June 30 , 2002 , and have issued our report thereon dated September 17 , 2002 . We have issued our Independent Auditors ' Report on Compliance and Internal Control over Financial Reporting dated September 17 , 2002 . Disclosures in that report, if any , should be considered in conjunction with this management letter. We conducted our audit in accordance with auditing standards generally accepted in the United States of America and Government Auditing Standards, issued by the Comptroller General of the United States . Additionally, our audit was conducted in accordance with the provisions of Chapter 10 . 850 , Rules of the Auditor General , which govern the conduct of local governmental entity audits performed in the State of Florida and require that certain items be addressed in this letter. The Rules of the Auditor General (Section 10 . 854 ( 1 ) (d) 2 . ), require disclosure as to whether or not prior recommendations made in the preceding annual financial report have been followed. In connection with our audit, we determined that the Academy has satisfactorily resolved all comments made in the annual financial report for the year ended June 30 , 2001 . The Rules of the Auditor General (Sections 10 . 854 ( 1 ) (d) 3 . , 4 . , 5 . , 6 . ) require disclosure in the management letter of the following matters if not already addressed in the auditors ' report on compliance and internal control over financial reporting : recommendations to improve financial management, accounting procedures, and internal controls ; violations of laws, rules , regulations , and contractual provisions which may or may not materially affect the financial statements ; illegal or improper expenditures which may or may not materially affect the financial statements ; improper or inadequate accounting procedures ; failures to properly record financial transactions ; and other inaccuracies , shortages, defalcations , and instances of fraud discovered by the auditor. Our audit disclosed the following matters : Consider Hiring a Qualified Bookkeeper The Academy ' s Administrator currently performs all bookkeeping procedures on the Quickbooks accounting software, in addition to all other administrative functions required of that position. Certain filing and recordkeeping duties have been delegated to the administrative assistant, however, all of the bookkeeping responsibilities are retained by the Administrator. We suggest hiring a qualified bookkeeper to maintain the general ledger in accordance with the Red Book and to prepare all appropriate account detail and reconciliations . This could be accomplished by hiring a part-time or full-time assistant, as may be necessary, or by training the current administrative assistant to use the Quickbooks software . We believe this will ensure all transactions are recorded, in accordance with the Red Book, in the proper accounts, that they are reconciled on a timely basis, and that all reconciling differences are investigated and resolved in a timely manner and this will facilitate a more effective utilization of the Administrator' s time and skills. 700 - 20th Street 9 Vero Beach, Florida 32960 9 Phone 561 - 562 -4158 • Telefax 561 -563 -2024 lull Enhance Recordkeeping of Bank Accounts The Academy currently uses the Quickbooks accounting software to maintain its general ledger and its bank accounts . However, the monthly bank reconciliations are performed manually by hand rather than using the software reconciliation features . As a result, numerous errors and unreconciled differences occurred and we noted the following : • Several checks issued during the period were not recorded in the accounting software ; • Several checks were recorded in the wrong accounting period; • Checks were used out of sequence ; i Interest income was not recorded in the accounting software ; and, • Bank service charges were not recorded in the accounting software . We recommend that the Academy use the reconciliation feature of the accounting software to prepare all monthly bank reconcilations . To ensure that all items posted to the bank statements are recorded in the general ledger, each balance should be fully reconciled on a monthly basis and all unreconciled differences should be investigated, cleared, and recorded prior to closing out the reconciliation. Record Teacher Retention Bonus as Wages The Academy ' s teachers received a bonus during the year, referred to as the " Teacher Retention and Recruitment Bonus . " The Academy recorded these payments as professional fees and did not reflect the payments as wages for income tax reporting purposes . Any payments made to employees in the form of a bonus are considered wages and should be treated as such for income tax reporting purposes. Improve Accounting for Child Development Program The Academy maintains the Child Development Program as a separate company on the Quickbooks accounting software and was maintained separately from the Academy. We noted certain accounts in the general ledger detail were not supported by the underlying details in immaterial amounts, and in some cases certain amounts, such as receivables from others and from employees, were not properly recorded in the general ledger. We recommend the same individual maintaining the Academy ' s accounting records, as noted above, maintain the Child Development accounting records to ensure all transactions are properly recorded in the general ledger. Update General Ledger Account Codes During the past year, the State of Florida updated the " Red Book" accounting manual to be in compliance with the new accounting standard issued by the Governmental Accounting Standards Board . The updated version of the Red Book changed certain general ledger account codes. We recommend the Academy compare each of the general ledger account codes to the updated Red Book and make changes to the general ledger where necessary . 28 loll Interface Budgets with Accounting The Academy prepares annual budgets each year for certain funds and periodically amends the budgets as circumstances warrant. However, there is no comparison of actual results with the budgeted figures on a periodic basis . We recommend the budgets be prepared in the same manner as the general ledger account and function codes and loaded into Quickbooks software for monthly comparison. Update Accounting Policies and Procedures Manual Over the past several years , the Academy has implemented various policies and procedures relating to the accounting function. We recommend the Academy update the written manual addressing these policies and procedures to ensure proper application of these procedures . Obtain Fingerprinting and Drug Test Documentation We noted the Academy ' s bus driver did not have the proper fingerprinting and drug test documentation on file at the District ' s offices . In addition, a teacher did not have the proper drug test documentation on file . We recommend the Academy obtain and maintain the proper documentation on file for each employee as of the date of hiring . This report is intended for the information of the Board of Directors, management, the Indian River County District School Board, and the Auditor General of the State of Florida. This restriction is not intended to limit the distribution of this report, which is a matter of public record . September 17, 2002 , 29 f � 7 , t CHILDREN'S SERVICES ADVISORY COMMITTEE C/O Human Services 1840 25th Street Vero Beach , Florida 32960-3394 Phone: 561 -567-8000 (Ext. 467 or 524) Fax: 978-1798 E-Mail : Jcarlsonabcc. co. indian-river.fl . us Mmastersonobcc. co. indian-river.fl. us To : Beth Jordan From : Joyce Johnston- Carlson Date : October 23 , 2003 Re : Grant Contracts 2003 -04 The attached is a Children ' s Service Advisory Committee Grant Contract for : St. Peter' s Human Services Please review the insurance certificate and verify that it is adequate by signing on the line below. Contact me if you have any questions . Thank you . Ise � Beth Jordan Date OC:T- 13-2003 10z 18 HATCHER INSUN: PNI__ I lC . 407 841 2688 P . 01 •' 101 ,AI.CORD, CERTIFICATE OF LIABILITY INSURANCE OPIO Fy DATE (N � STPETEA 10 / 13 / 03 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER. OF INFORMATI0 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Hatcher Insurance , Inc . HOLDER , THIS CERTIFICATE DOES NOT AMEND , EXTEND OR P . C . Bax 6406$ 9 ALTER THE COVERAGE AFFORDED DY THE POLICIES BELOW Orlando FL 32854 - 0589 Phone : 407 - 847. - 2686 Fax : 907 - 891 - 2688 j INSURERS AFFORDING COVERAGE NAIL # ... - ....- ---- - . _... .. - -- -- _. .. .- ._. . . ! .. . . .. .... _ . INSURED INSUREIIA: Philadelphia Indemnity Ins . lCo IF.ER [3 Amer_ can International. Group St . Peters Academy Charter 5ch r— c -- - - --ter-- -- Sw . Peters H%L ariervicesr Inc 4254 39th Avenue � -- — - ._ Ver. p Beach FL 32967- 1711 IN.JREH L ' IN�UR.R E COVERAGES THE POLICIES OF INSURANCE LISTED BFLDW HAVE BEEN ISSUED -: U TrIE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDIG0kTC0 NOTWITHSTANDING ANY REO'JIREMENT , TERM OR CONDITION OF ANY CONTRACT OR OTHER OCCJMENT W ITH RESPECT TO WF!ICH 71ILS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN , THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN iS SUBJECT TO ALL THE TERMS , EXCLUSIONS AND CONOITIONIS OF SUCH POLICIES. AGGREGATE L!MITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS DD _ f- CYEF 'EC NE IT . PJ _ _ iCYERPTkiT6FT _. ,_ _. ..._-.-- LTR NGR� TYPE OF INSURANCE POLICY NUMBER DATE IMMiDDIYYI DATE MMIDD1YY I LIMITS GENERAL LIABILITY EACH OCCURRENCE s 1000000 $ . OMCCAI IAL OEPJER ( M ° "! f PREMISES REMS( RcNTEfj ! I ^ � A „ ' IA.�Iu I PHPx060275 I 09 / 17 / 03 09 / 17 / 04 ' PR=MI5=5 (tapcouron:rj s 144440 _ -x ) Ft:uuRi PHPKOfi0275 j 09 17 / 03 I McJ.EXP /hnypnepers9�? ' s 5000 X ( Educators prc � 09 /' 1 "7 / 04 ; 'CREONAL & ADV ;NJUR” $ 100Dfl04 GENERAL AUGREG,Qff5 J 5 2OOOODO { ,FML AGGREGATE LIMIT APPI. E81=ER: DRODUGTS - COMP(OPAOG & 2000000 PRO- 1 POL ICf CT j, LOC I { AUTOMOBILE LIABILITY i—� COMBINED SACLE UMI 5 ...� ANY ALTO ; Ea accior: d) ! I ALL OWNEDAJTOS ' I ROPLYINJL'Rv SCHEDULFI'� AUTOS ! :f Of pCrFonj �' HIRED AUTOS ' =O LY INJURY NOha-hwNED AU'Os ;Per accideht) -...: _. . ._... .... .... . .. . . PKJPFRT7 JA%AAGL $ (Par acaiaam; —� GARAGE LIA6ILIYY HUTC ONLY - ACCIDENT S ANY AUTO OTHI�RTHAN BA ACC ! .AGCo �_.S . . . ......-. ..__..— '. I AUTO ONLY EXC I --- I ESSIUMBRELLA LIAe'LITY � ' I EACH Orr - RRENI;E5 ZI 4QQO04 yT}, OCCJR { C:AIMSVA0EE. !,i RENEWAL OF PHUB012211909 / 17 / 03 1 09 / 17 / 04 FAGGRELATE .. .-._. _ ' S 1000000 — .. i I , 4EOL;^vT19LE }; i RETENTION $ 10000 I S WORKERS COMPENSATION AND _ I RY LIMITS _ emPLDY8R5' LIABILITY X ! TOI .. . .. . .........____ __.__ i ANYPRGPRIETORIPARTNCRtC-)(F.CUTIVE 9QG7829377 09 / 17 / 03 4917 / 04 LE. L D4E...... 'F.MPLOVE $ 100444 t .. I � ---------._ ! — - Fs 100000 FFi..tRfMEI.,BER E%CLUCEO? I I It yyes. descNee unser – - SpSGIAL PROVISIONS tsekw,' I � i LF D3EiA5E • PDLIGV uIM1T 13500000 OTHER I - - - -- — I i 1c�2021 ??�3 GESS. RIPrIQN OF OPERATIONS + LOCATIONS ! VEHICLES t EKCLUSIONS ADOEC) 13Y ENDORSEMENT ! SPECIAL PKUV151QNS Certificate holder is included as additional ,insured applicable \cpm `� sr-3 general liability only . * Except as required by Florida Statute . a 007 r'3, C+4 f � CERTIFICATC HOLDER CANCELLATION ZLIRIV SHOULD ANY OF THE ABOVE DESCRIDEP ppl-ICSES } ilN EL.LE6 86F0 i - PIfiATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVO �, L9 S WRITTEN I NPTICE TO THE CERTIFIGATR HOLDER NAMED 74 YHE LEFT• SUT FAILURE TO DO SO SHALL Inds an River County , Florida IMPOSE NOODLI^ATION OR LIABILITYOFANY KIND UPON THE INSURER , ITSA.iCNTS UR 1944 25th Street Vero Beach FIS 32960 - 3365 REPRESENT 1 S. AUTHORI Izem4h SENTA ORD 25 (2401106) ��. Q ACORD CORPORATION 1 TOTAL P , 01 Please Note : Transportation is NOT necessary to operate this program . COPY TA TAY TAX RETURN FILING INSTRUCTIONS FORM 990 FOR THE YEAR ENDING . . . . . JUNE. . . . 3. 0. .: . . . . 2. Q. Q. 2. . . . . . . Prepared for ST PETERS HUMAN SERVICES INCORPORATED 4250 38TH AVENUE GIFFORD , FL 32967 Prepared by MORGAN , JACOBY , THURN , BOYLE & ASSOC PA 700 20TH ST VERO BEACH , FL 32960 Amount due NOT APPLICABLE or refund Make check NOT APPLICABLE payable to Mail tax return and check (if INTERNAL REVENUE SERVICE CENTER applicable) to OGDEN , UT 84201 - 0027 Return must be mailed on FEBRUARY 18 , 2003 or before Special Instructions THE RETURN SHOULD BE SIGNED AND DATED . 100941 07- 18-01 Form 990 Return of Organization Exempt From Income Tax DMB No. 1545-0047 Under section 501 ( c ) , 527 , or 4947 ( a )( 1 ) of the Internal Revenue Code ( except black lung 2001 benefit trust or private foundation ) DepartmentottheTreasury Open to Public Intennal Revenue Service ► The organization may have to use a copy of this return to satisfy state reporting requirements. Inspection A For the 2001 calendar year, or tax year period beginning JUL 1 2001 and ending JUN 30v 2002 B check if please C Name of organization D Employer identification number applicable: use IRS Address label or change print or ST PETERS HUMAN SERVICES INCORPORATED 31 - 1480633 0Name�ange `see Number and street ( or P.O. box if mail is not delivered to street address ) Room/suite E Telephone number DretIniur 4250 38TH AVENUE 772 562 - 1963 return Specific 42450 Final Instruc- return tions. City or town, state or country, and ZIP + 4 F Accounting method: Cash ® Accrual =re urnded I FFORD FL 32967 0 0t amity) ► [=]pendin ttion • Section 501 (c )( 3 ) organizations and 4947( a )( 1 ) nonexempt charitable trusts Hand 1 are not applicable to section 527 organizations. must attach a completed Schedule A ( Form 990 or 990 EZ) . H ( a ) Is this a group return for affiliates? Q Yes ® No G Web site: ► HTTP : STPETERS . INDIAN — RIVER . K12 . FL . US H ( b ) If 'Yes; enter number of affiliates pop H ( c ) Are all affiliates included? N / A 0 Yes F No J Organization type (check only one) ► ® 501 ( c) ( 3 ) (insert no.) 0 4947( a)( 1 ) or 0 527 ( If 'No; attach a list. ) K Check here ► 0 if the organization ' s gross receipts are normally not more than $25,000. The H ( d ) Is this a separate return filed by an or- organization need not file a return with the IRS; but if the organization received a Form 990 Package ganization covered by a group ruling? Yes ® No in the mail, it should file a return without financial data. Some states require a complete return . I Enter 4-digit GEN ► M Check ► 0 if the organization is not required to attach L Gross receipts: Add lines 6b , 8b, 9b, and 10b to line 12 ► 783 , 691 * Sch. B (Form 990, 990-EZ, or 990-PF). Part I Revenue , Expenses , and Changes in Net Assets or Fund Balances 1 Contributions, gifts, grants, and similar amounts received: a Direct public support . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . i s 5 , 375 e b Indirect public support . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1b c Government contributions (grants ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1c 596 , 617 . d Total (add lines 1a through 1c) (cash $ 6 01 , 9 9 2 . noncash $ ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 d 601 , 992 * 2 Program service revenue including government fees and contracts ( from Part VII, line 93 ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 160 f 951 . 3 Membership dues and assessments . . . . . . . . . . . . . 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 Interest on savings and temporary cash investments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 15 42 5 . 5 Dividends and interest from securities 5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 a Gross rents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6a b Less: rental expenses . . . . . . . . . . . . . . . . 6b . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . _ . . . . . . . . . . . . c Net rental income or ( loss ) ( subtract line 6b from line 6a) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6c 'c 7 Other investment income ( describe ► 7 m > 8 a Gross amount from sale of assets other A Securities B Other m °C than inventor 8a b Less: cost or other basis and sales expenses . . . . . . . . . 8b c Gain or ( loss) (attach schedule ) . . . . . . . . . . . . . . . . . . . . . . . . . . . 8c d Net gain or ( loss ) ( combine line 8c, columns (A) and ( B)) 8d . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 Special events and activities (attach schedule ) a Gross revenue ( not including $ 0 . of contributions reported on line 1a) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9a15 , 323a b Less: direct expenses other than fundraising expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9b c Net income or ( loss ) from special events (subtract line 9b from line 9a) . . . . . . . I . . . . SEE . _ STATEMENT . . _ 1. . . . 9c 5 , 323a 10 a Gross sales of inventory, less returns and allowances . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10a b Less: cost of goods sold . . . . 10b . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . _ . . c Gross profit or ( loss ) from sales of inventory (attach schedule ) (subtract line 10b from tine 10a) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10c 11 Other revenue (from Part VII , line 103 ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 . . . . . . . . . . . . . . . . . . 11 12 Total revenue add lines 1d 2 3 4 5 6c 7 8d9 9c 10c and 11 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 783 , 691 * 13 Program services ( from line 44, column ( B )) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 597 455 . y 14 Management and general ( from line 44 , column (C ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 123 592 . CL 15 Fundraising (from line 44 , column ( D )) . . . . . . . . . . . . . . . . . . . . . . . . . 15 X 16 Payments to affiliates (attach schedule ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 17 Total expenses add lines 16 and 44 column A . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 721 t 047 e 18 Excess or ( deficit) for the year ( subtract line 17 from line 12 ) 18 62 644 . W 19 Net assets or fund balances at beginning of year (from line 73, column (A)) 19 697 360 . Z N 20 Other changes in net assets or fund balances (attach explanation ) SEE . . . $ TATEMENT 2. . . . 20 < 18 038 . > a . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 Net assets or fund balances at end of year (combine lines 18, 19, and 20 ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ... . . 21 741 966 . 123001 01 -04-02 LHA For Paperwork Reduction Act Notice , see the separate instructionsl Form 990 (2001 ) 09411209 781701 ST . PETER 2001 . 06020 ST PETERS HUMAN SERVICES IN ST PETE1 Form 990 (200 1 ) ST PETERS HUMAN SERVICES INCORPORATED 31 - 1480633 Page 2 ' Part 11 tatement o All organizations must complete column (A). Columns ( B ), ( C ), and ( D ) are required for section 501 ( c )(3) and (I—� Functional Expenses ( 4 ) organizations and section 4947(a )( 1 ) nonexempt charitable trusts but optional for others. Do not include amounts reported on line ( B ) Program ( C ) Management ( D ) Fundraising 6b, 8b, 9b, 10b, or 16 of Part 1. (A) Total services and eneral 22 Grants and allocations (attach schedule ) . cash $ noncash $ 22 23 Specific assistance to individuals (attach schedule ) 23 24 Benefits paid to or for members (attach schedule ) 24 25 Compensation of officers, directors, etc. . . . . . . . . . . . . 25 45 r 963 * 1 500 . 44 463 * 0 . 26 other salaries and wages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 345 460 * 3 3 4 3 4 2 . 11 f 118 . 27 Pension plan contributions . . . . . . . . . . . . . . . . . . . . . . . . . . . . „ 27 3 233 o 3 r 233 e 28 Other employee benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 2 0 8 9 0 . 6 2 4 . 2 0 2 6 6 . 29 Payroll taxes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 14 975 . 1011390 4 r 836 . 30 Professional fundraising fees . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 31 Accounting fees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 6 250 a 1 0 0 0 . 5 r 250 e 32 Legal fees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 100 . 1000 33 Supplies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 35 f 674 . 351 177 . 497 . 34 Telephone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 35 Postage and shipping . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 36 Occupancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 44 1 540 . 44r 540 . 37 Equipment rental and maintenance . . . . . . . . . . . . . . . 37 26 280 * 2 4 075 * 2 205 * 38 Printing and publications 38 39 Travel . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 904 . 163 . 741 . 40 Conferences, conventions, and meetings . . . . . . . . . . . . 40 41 Interest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 42 Depreciation, depletion , etc. (attach schedule ) . . . 42 11 7 8 9 . 11 1 409 . 380 e 43 Other expenses not covered above ( itemize ): a 43a b 43b c 43c d 43d e SEE STATEMENT 3 43e 164f989 * 134 386 . 30 , 603 * 44 Total functional expenses (add lines 22 through 43) Organizations completing columns (B}(D), carry these totals to lines 13- 15 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44 7 21 0 4 7 . 5 9 7 4 5 5 . 123t592 * 0 . Joint Costs . Check ► E:] if you are following SOP 98-2. Are any joint costs from a combined educational campaign and fundraising solicitation reported in ( B ) Program services? . . . . . . . . . . . . . . . . . . . . . ► 0 Yes ® No If 'Yes; enter ( i ) the aggregate amount of these joint costs $ ; ( ii ) the amount allocated to Program services $ ; ( iii ) the amount allocated to Management and general $ and iv the amount allocated to Fundraising $ Part 111 I Statement of Program Service Accomplishments What is the organization 's primary exempt purpose? ► SEE STATEMENT 4 Program Service Expenses All organizations must describe their exempt purpose achievements in a clear and concise manner. State the number of clients served, publications issued, etc. Discuss (Required for 501(cX3) and achievements that are not measurable- (Section 501(cX3) and (4) organizations and 4947(aX1) nonexempt charitable trusts must also enter the amount of grants and (4) orgs. , and 4947(aXt) allocations to others.) trusts; but optional for others.) a PROVIDE AN EDUCATION FOR CHILDREN GRADES K - 4 AS A CHARTER SCHOOL IN THE INDIAN RIVER COUNTY SCHOOL DISTRICT . Grants and allocations $ 406 , 093 * b OPERATE A DAY CARE FACILITY WHICH PROVIDES A DEVELOPMENTAL CURRICULUM EDUCATION NUTURE AND CARE FOR CHILDREN Grants and allocations $ 191 , 3629 C Grants and allocations $ d Grants and allocations $ e Other program services attach schedule ( Grants and allocations $ f Total of Program Service Expenses ( should equal line 44 column ( B ), Program services) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ► 597 , 455 . 123011 2 Form 990 (2001 ) 01 -02-02 n0A11 ono 7 q 1 7 n 1 CT nF' TFTJ omni _ ngn ? n PT PFTFRG T-TUMAM CZP. M7TCF. S TN RT PFTF1 Form 990 (2001 ) ST PETERS HUMAN SERVICES INCORPORATED 31 - 1480633 Page 3 , Part IV Balance Sheets Note : Where required, attached schedules and amounts within the description column (A) ( B ) should be for end-of-year amounts only. Beginning of year End of year 45 Cash - non- interest-bearing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 436 769 . 45 419 , 984o 46 Savings and temporary cash investments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46 47 a Accounts receivable47a 242 , 474o . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . b Less: allowance for doubtful accounts 47b 195 396 47c 242 , 474o . . . . . . . . . . . . . . . . . . 48 a Pledges receivable . . . . . . . . . . . . . . . . . . . . . . 48a b Less: allowance for doubtful accounts 48b 48c . . . . . . . . . . . . . . . . . . 49 Grants receivable 49 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50 Receivables from officers, directors, trustees, andkey employees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50 N a, 51 a Other notes and loans receivable 51a a b Less: allowance for doubtful accounts . . . . . . . . . . . . . . . . . . 51b 51c 52 Inventories for sale or use 52 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53 Prepaid expenses and deferred charges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53 54 Investments - securities ► Cost FMV 54 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 . . . . . . . . . . . . . 55 a Investments - land, buildings, and equipment: basis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55a b Less: accumulated depreciation . . . . . . . . . . . . . . . . . . . . . . . . . . . 55b 55c 56 Investments - other 56 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57 a Land, buildings, and equipment: basis . . . . . . . . . . . . . . . . . . 57a 108 , 4150 b Less: accumulated depreciation . . . . . . . . . . . . . . . . . . . . . . . . . . . 57b 2 9 8 2 7 . 66 , 865a 57c 78j588 * 58 Other assets ( describe ► DEPOSITS ) 58 11 717 . 59 Total assets add lines 45 through 58 must equal line 74 . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . .. . . . . 699 , 030 * 59 752f763 * 60 Accounts payable and accrued expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 , 670 . 60 10 7 9 7 . 61 Grants payable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61 m62 Deferred revenue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62 a 63 Loans from officers, directors, trustees, and key employees . . . . . 63 J 64 a Tax-exempt bond liabilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64 a b Mortgages and other notes payable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64b 65 Other liabilities ( describe ► ) 65 66 Total liabilities add lines 60 through 65 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 t 670 . 66 10f797 * Organizations that follow SFAS 117 , check here ► and complete lines 67 through 69 and lines 73 and 74. 67 Unrestricted v . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67 2 68 Temporarily restricted . . . . . . . 68 m . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . m 69 Permanently restricted . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69 00 Organizations that do not follow SFAS 117 , check here ► ® and complete lines LL 70 through 74. H 70 Capital stock, trust principal, or current funds . . . . y STATEMENT 8. . . . . . . . . . . . . . . . 0 . 70 0 . a 71 Paid -in or capital surplus, or land, building, and equipment fund . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 0 6 41 . 71 78 , 5890 a 72 Retained earnings, endowment, accumulated income, or other funds . . . . . .STMT . . . 5. . . . 6361719 * 72 663 , 377o Z 73 Total net assets or fund balances (add lines 67 through 69 OR lines 70 through 72; column (A) must equal line 19; column ( B ) must equal line 21 ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 697 , 360 * 73 7 41 9 6 6 . 74 Total liabilities and net assets / fund balances (add lines 66 and 73 ) . . . . . . . . . . . . . . . . . . . . . . . . 699 0 3 0 . 74 752 , 763 * Form 990 is available for public inspection and, for some people, serves as the primary or sole source of information about a particular organization . How the public perceives an organization in such cases may be determined by the information presented on its return. Therefore, please make sure the return is complete and accurate and fully describes, in Part 111 , the organization 's programs and accomplishments. 123021 01 -02 -02 3 . 10251210 781701 ST . PETER 2001 . 06020 ST PETERS HUMAN SERVICES IN ST PETE1 Form 990 (2001 ) ST PETERS HUMAN SERVICES INCORPORATED 31 - 1480633 Page 4 Part IV-A Reconciliation of Revenue per Audited Part IV- 13 Reconciliation of Expenses per Audited Financial Statements with Revenue per Financial Statements With Expenses per Return Return a Total revenue, gains, and other support a Total expenses and losses per per audited financial statements . . . . . . . . . . . . . . . . . . ► a 798 , 277 * audited financial statements . . . . . . . . . . . . . . . . . . . . . ► a 735 , 633 * b Amounts included on line a but not on b Amounts included on line a but not on line 17, Form 990: line 12, Form 990: ( 1 ) Donated services ( 1 ) Net unrealized gains and use of facilities . . . $ on investments . . . . . . $ ( 2 ) Prior year adjustments (2 ) Donated services reported on line 20, and use of facilities . . . $ Form 990 . . . . . . . . . . . . . . $ (3 ) Recoveries of prior (3 ) Losses reported on year grants . . . . . . . . . . . . $ line 20, Form 990 . . . $ ( 4 ) Other ( specify): ( 4 ) Other (specify): STMT 6 $ 14 , 586 . STMT 7 $ 14 , 586 . Add amounts on lines ( 1 ) through ( 4 ) . . . . . . . . . No. b 14 5 8 6 . Add amounts on lines ( 1 ) through ( 4 ) . . . . . . . . . ► b 14 , 586o c Line a minus line b . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Now 783f691 * c Line a minus line b . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00- c 7 21 0 4 7 . d Amounts included on line 12, Form d Amounts included on line 17, Form 990 but not on line a : 990 but not on line a : ( 1 ) Investment expenses ( 1 ) Investment expenses not included on not included on line 6b, Form 990 . . . $ line 6b , Form 990 . . . $ (2 ) Other ( specify): (2 ) Other (specify): Add amounts on lines ( 1 ) and ( 2 ) . . . . . . . . . . . . . . . ► d 0 . Add amounts on lines ( 1 ) and (2 ) _ , . . . . , . . . . . . . , ► d 0 . e Total revenue per line 12, Form 990 a Total expenses per line 17, Form 990 ( line c plus line d) . I . . . . . . . . pop, Ie I 7 8 3 6 91 . ( line c plus line d) . . . . . . . . ► e 721r047 * Part V List of Officers , Directors, Trustees, and Key Employees (List each one even if not compensated.) ( 8 ) Title and average hours (C) Compensation ( D ) Contributions to ( E ) Expense A Name and address per week devoted to (If not paid , enter employee benefit account and ( ) plans 3 e benefit position .0- 1 compensation other allowances REVEREND ANDREW JEFFERSON _ HAIRMAN 4236 57TH_ AVE_NUE_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ VERO BEACH FL 32967 0 . 0 . 0 . 0 . MR . REUBEN_ LANEDIRECTOR _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 4610 43RD_ COURT _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ VERO BEACH FL 32967 0 . 0 . 0 . 0 . MISS MARY MCKINNEY DIRECTOR - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 4206 58TH_ AVENUE _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ VERO BEACH FL 32967 0 . 0 . 0 . 0 . MR . ROBERT TEMPLE DIRECTOR - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 1395 18TH- AVENUE SW _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ VERO BEACH FL 32962 0 . 0 . 0 . 0 . MR . TERRY_ HURLEY IRECTOR _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 6439 55TH_ SQUARE VERO BEACH FL 32967 0 . 0 . 0 . 0 . MR . ADAM HARDEN _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ DIRECTOR 4745 34TH- AVENUE - - - - - - - - - - - - - - - - - - VERO BEACH FL 32967 0 . 0 . 0 . 0 . MRS . ELIZABETH MCGRIFFIRECTOR 4180 47TH PLACE - - - - - - - - - - - - - - - VERO BEACH FL 32967 0 . 0 . 0 . 0 . RUTH L . JEFFERSON ADMINISTATOR - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 4236 57TH_ AVENUE VERO BEACH FL 32967 40 44 , 463a 0 . 0 . - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 75 Did any officer, director, trustee, or key employee receive aggregate compensation of more than $ 100,000 from your organization and all related organizations, of which more than $ 10,000 was provided by the related organizations? If "Yes," attach schedule. ► Yes ® No Form 990 (2001 ) Form 990 (2001 ) ST PETERS HUMAN SERVICES INCORPORATED 31 - 1480633 Page 5 + Part VI I Other Information Yes No 76 Did the organization engage in any activity not previously reported to the IRS? If "yes; attach a detailed description of each activity . . . . . . . . . . . . 76 X 77 Were any changes made in the organizing or governing documents but not reported to the IRS? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77 X If "Yes,' attach a conformed copy of the changes. 78 a Did the organization have unrelated business gross income of $ 1 ,000 or more during the year covered by this return? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78a X b If "Yes; has it filed a tax return on Form 990-T for this year? . . . . . . . . . . . . . . . . . N / A . . . . . . . . . 78b 79 Was there a liquidation, dissolution, termination, or substantial contraction during the year? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79 X If "Yes,' attach a statement 80 a Is the organization related ( other than by association with a statewide or nationwide organization ) through common membership , governing bodies, trustees, officers, etc., to any other exempt or nonexempt organization? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80a X b If "Yes; enter the name of the organization ► and check whether it is 0 exempt OR ED nonexempt 81 a Enter direct or indirect political expenditures. See line 81 instructions . . . . . . . . . . . . . . 81a 0 . b Did the organization file Form 1120-POL for this year? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81b X 82 a Did the organization receive donated services or the use of materials, equipment, or facilities at no charge or at substantially less than fairrental value? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82a X b If "Yes; you may indicate the value of these items here. Do not include this amount as revenue in Part I or as an expense in Part ll. (See instructions in Part III.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82b N / A 83 a Did the organization comply with the public inspection requirements for returns and exemption applications? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83a X b Did the organization comply with the disclosure requirements relating to quid pro quo contributions? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83b X 84 a Did the organization solicit any contributions or gifts that were not tax deductible? . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 . . . . . _ . . . . _ . . _ . . . . . . . 84a X b If "Yes; did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible? 85 501 (c)(4), (5), or (6) organizations. a Were substantially all dues nondeductible by members? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . N / A . . . . . 4 . . . 85a b Did the organization make only in-house lobbying expenditures of $2 ,000 or less? . . . . . . . . . . . . N / A . . . . . . , . . 85b If "Yes' was answered to either 85a or 85b, do not complete 85c through 85h below unless the organization received a waiver for proxy tax owed for the prior year. c Dues, assessments, and similar amounts from members . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85c N / A d Section 162( e ) lobbying and political expenditures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 . . . . 4 . . . . . . . . . . . . . 85d N / A e Aggregate nondeductible amount of section 6033(e )( 1 )(A) dues notices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85e N / A f Taxable amount of lobbying and political expenditures (line 85d less 85e ) „ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85f N / A g Does the organization elect to pay the section 6033(e) tax on the amount in 85f? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . N /A . . . . . . . . . 85 h If section 6033(e )( 1 ) (A) dues notices were sent, does the organization agree to add the amount in 85f to its reasonable estimate of dues allocable to nondeductible lobbying and political expenditures for the following tax year? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . N / A . . . . . . . . . 85h 86 501 (c)(7) organizations. Enter: a Initiation fees and capital contributions included on line 12 . . . . . . , . . . . . 86a N / A b Gross receipts, included on line 12, for public use of club facilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86b N / A 87 501 (c)(12) organizations. Enter: a Gross income from members or shareholders . . _ . . . . . . 87a N / A b Gross income from other sources. ( Do not net amounts due or paid to other sources against amounts due or received from them. ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87b N / A 88 At any time during the year, did the organization own a 50% or greater interest in a taxable corporation or partnership, or an entity disregarded as separate from the organization under Regulations sections 301 .7701 -2 and 301 .7701 -3? If "Yes; complete Part IX . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88 X . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89 a 501 (c)(3) organizations. Enter: Amount of tax imposed on the organization during the year under: section 4911 ► 0 . ; section 4912 ► 0 . ; section 4955 ► 0 . b 501 (c)(3) and 501 (c)(4) organizations. Did the organization engage in any section 4958 excess benefit transaction during the year or did it become aware of an excess benefit transaction from a prior year? If "Yes; attach a statement explaining each transaction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89b X c Enter: Amount of tax imposed on the organization managers or disqualified persons during the year under sections4912, 4955, and 4958 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ► 0 . d Enter: Amount of tax on line 89c, above , reimbursed by the organization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ► 0 90 a List the states with which a copy of this return is filed ► FLORIDA b Number of employees employed in the pay period that includes March 12, 2001 . . . . . . . . . . . . . . . . . . . . . 90b 24 91 The books are in care of ► RUTH JEFFERSON Telephone no. ► ( 7 7 2 ) 562 - 1963 Located at ► 4250 3 8TH AVENUE GI FFORD FL ZIP + 4 ► 32967 92 Section 4947(a)(1) nonexempt charitable trusts filing Form 990 in lieu of Form 1041 - Check here . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ► 0 and enter the amount of tax-exempt interest received or accrued during the tax year . . . . . . . . . . . . . . . . . . . . . ► 92 N / A of of o2 5 Form 990 (2001 ) 10471209 781701 ST . PETER 2001 . 06020 ST PETERS HUMAN SERVICES IN ST PETE1 Form 990 (2001 ) ST PETERS HUMAN SERVICES INCORPORATED 31 - 1480633 Page 6 Part VII Analysis of Income - Producing Activities (See Specific Instructions on page 32. ) . Note : Enter gross amounts unless otherwise Unrelated business income Excluded by section 512, 513, or 514 ( E ) indicated. (A) ( B ) EP ( D ) Related or exempt B siness Amount coon Amount 93 Program service revenue: function income a CHILD CARE FEES 159f115 * b UNIFORM FEES 202 . c FIELD TRIP FEES 1 , 634o d e f Medicare/Medicaid payments . . . . . . . . . . . . . . . . . . . . g Fees and contracts from government agencies . . . . . . . . . . . . 94 Membership dues and assessments . . . . . . . . . . . . . . . . . . . . . . . . 95 Interest on savings and temporary cash investments 14 15 , 425 * . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96 Dividends and interest from securities . . . . . . . . . . . . . . . . • , , , , 97 Net rental income or (loss ) from real estate: a debt-financed property . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . b not debt-financed property . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98 Net rental income or ( loss ) from personal property . . . . . . 99 Other investment income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100 Gain or (loss) from sales of assets other than inventory . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101 Net income or (loss) from special events . . . . . . . . . . . . . . . . . . 5 , 323 * 102 Gross profit or (loss ) from sales of inventory . . . . . . . . . . . . 103 Other revenue: a b c d e 104 Subtotal (add columns ( B ), ( D ), and ( E ) ) . . . . . . . . . . . . . . . . 0 . 15 , 425o 16 6 2 7 4 " 105 Total (add line 104 , columns ( B ), ( D), and ( E ) ) . . . . . . . . * * . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . pop 181 , 699 * Note : Line 105 plus line 1d, Part 1, should equal the amount on line 12, Part 1. Part VIII I Relationship of Activities to the Accomplishment of Exempt Purposes (See Specific Instructions on page 32. ) Line No . Explain how each activity for which income is reported in column ( E ) of Part VII contributed importantly to the accomplishment of the organization ' s V exempt purposes ( other than by providing funds for such purposes). HESE ACTIVITIES ARE DIRECTLY RELATED TO PROVIDING SERVICES TO THE STUDENTS OF THE SCHOOL . Part IX Information Regarding Taxable Subsidiaries and Disregarded Entities (See Specific Instructions on page 33. ) A 8 C D E Name, address, and )EIN of corporation, Percentage ) ge of Nature (C) factivities Total income End-of-year partnership, or disre arded entity ownership interest assets N / A % Part X Information Regarding Transfers Associated with Personal Benefit Contracts (See Specific Instructions on page 33.) ( a ) Did the organization, during the year, receive any funds, directly or indirectly, to pay premiums on a personal benefit contract? . . . . . . . . . . . . 0 Yes ® No (b ) Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract? . . . . . . . . 0 Yes ® No Note : If " Yes " to b file Form 8870 and Form 4720 see instructions). Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge. Please "( Y � ; J �z Sign 3 1� .C'i. � Ek Z) Here ' Signature of officer Date ' Type or print name and title Preparer's ¢ Date ? s�f ck if Preparer's SSN or PTIN Paid signature C �` 1 112 � %7 '� ployed ► 0 Preparer's Firm's name (or yo11rair "F1 J COBY , THURN , BOYLE & ASSOC PA EIN ►Use Only self-employed), T T 123161 address, and 0 , -02-02 zIP + 4 VERO EACH , FL 3 2 9 6 0 Phone no. - ( 772 ) 562 - 4158 6 Form 990 (2001 ) 09411209 781701 ST . PETER 2001 . 06020 ST PETERS HUMAN SERVICES IN ST PETE1 Form 8868 Application for Extension of Time To File an (December 2000) Exempt Organization Return OMB No . 1545 - 1709 Department of the Treasury Internal Revenue Service Op� File a separate application for each return . • If you are filing for an Automatic 3-Month Extension , complete only Part I and check this box . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . • If you are filing for an Additional (not automatic) 3-Month Extension , complete only Part II (on page 2 of this form) . Note: Do not complete Part II unless you have already been granted an automatic 3- month extension on a previously filed Form 8868. Part l Automatic 3- Month Extension of Time - Only submit original (no copies needed) Note: Form 990-T corporations requesting an automatic 6-month extension - check this box and complete Part 1 only . . . . . . . . . . . . . . . . . . . . . . . . . . 1 All other corporations (including Form 990-C filers) must use Form 7004 to request an extension of time to file income tax returns. Partnerships, REM1Cs and trusts must use Form 8736 to request an extension of time to file Form 1065, 1066, or 1041 . Type or Name of Exempt Organization Employer identification number print ST PETERS HUMAN SERVICES INCORPORATED 31 - 1480633 File by the due date for Number, street , and room or suite no . If a P.O. box, see instructions . filing your 4250 3 8TH AVENUE return. See instructions. City, town or post office , state, and ZIP code . For a foreign address , see instructions . GIFFORD FL 32967 Check type of return to be filed (file a separate application for each return): ® Form 990 0 Form 990-T (corporation) 0 Form 4720 0 Form 990-BL Form 990-T (sec. 401 (a) or 408(a) trust) Form 5227 Form 990-EZ Form 990-T (trust other than above) Form 6069 0 Form 990-PF 0 Form 1041 -A E::] Form 8870 • If the organization does not have an office or place of business in the United States , check this box . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 • If this is for a Group Return, enter the organization 's four digit Group Exemption Number (GEN) . If this is for the whole group , check this box )► = . If it is for part of the group , check this box lo- Q and attach a list with the names and EINs of all members the extension will cover. 1 1 request an automatic 3-month (6-month , for 990-T corporation ) extension of time until FEBRUARY 18 , 2003 . to file the exempt organization return for the organization named above . The extension is for the organization 's return for: )► 0 calendar year or 1110 ® tax year beginning JUL 1 . 2001 and ending JUN 3 0 , 2 0 0 2 2 If this tax year is for less than 12 months , check reason : E::] Initial return = Final return Change in accounting period 3a If this application is for Form 990-BL, 990-PF, 990-T, 4720, or 6069 , enter the tentative tax, less any nonrefundable credits. See instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ b If this application is for Form 990-PF or 990-T, enter any refundable credits and estimated tax payments made . Include any prior year overpayment allowed as a credit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ c Balance Due. Subtract line 3b from line 3a. Include your payment with this form , or, if required , deposit with FTD coupon or, if required, by using EFTPS (Electronic Federal Tax Payment System) . See instructions . . . . . . . . . . . . . . . . . . . . . . . . $ N / A Signature and Verification Under penalties of perjury, I declare that I have examined this form, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete, and that I am authorized to prepare this form. /� -LJ L(F Signature Title ► v Date It LHA For Pa It edu i Act Notice, see instruction Form 8868 ( 12 -2000) 123831 07 - 18-01 L0121114 781701 ST . PETER 2001 . 06020 ST PETERS HUMAN SERVICES IN ST_PETE1 4562 OMB No 1545 -0172 Form Depreciation and Amortization ( Rev. March 2002 ) (Including Information on Listed Property) 990 200 01 Department of the Treasury Attachment Internal Revenue Service ► See separate instructions. ► Attach to your tax return . sequence No. 67 Name(s) shown on return Business or activity to which this form relates Identifying number ST PETERS HUMAN SERVICES INCORPORATED ORM 990 PAGE 2 31 - 1480633 Part ! I Election To Expense Certain Tangible Property Under Section 179 Note : If you have any listed property, complete Part V before you complete Part [. 1 Maximum amount . See instructions for a higher limit for certain businesses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 2 4 0 0 0 . 2 Total cost of section 179 property placed in service (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 2 9 7 3 6 . 3 Threshold cost of section 179 property before reduction in limitation 3 $200 ,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 0 4 . 4 . . . . . . . . . . . 4 Reduction in limitation . Subtract line 3 from line 2 . If zero or less, enter -0. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 0 . 5 Dollar limitation for tax ear. Subtract line 4 from line 1 . If zero or less enter -0-. If married filin separately, see instructions 5 2 4 , 000 . 6 (a) Description of property (b) Cost (business use only) (c) Elected cost 7 Listed property. Enter amount from line 29 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6666 7 8 Total elected cost of section 179 property. Add amounts in column (c) , lines 6 and 7 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 9 Tentative deduction . Enter the smaller of line 5 or line 8 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 10 Carryover of disallowed deduction from line 13 of your 2000 Form 4562 . . . . . . . . . . . . . . . . . . . . . . . . . . . 666 , 6 - - 6666 . - . . . . . . . * . . . 4 . - 0004 - - 10 11 Business income limitation . Enter the smaller of business income (not less than zero) or line 5 . . . . . . . . . . . . . . . . . . . . . . . . 11 24 , 000 * 12 Section 179 expense deduction . Add lines 9 and 10, but do not enter more than line 11 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . F 12 13 Carryover of disallowed deduction to 2002 . Add lines 9 and 10, less line 12 . . . . . . . ► 13 Note: Do not use Part 11 or Part 111 below for listed property. Instead, use Part V. Part 111 Special Depreciation Allowance and Other Depreciation Do not include listed property. 14 Special depreciation allowance for certain property (other than listed property) acquired after September 10, 2001 (see instructions) . . . . . . . . . . . . . . . . . . . . . 14 15 Property subject to section 168(0(1 ) election (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 16 Other depreciation (including ACRS see instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 Part 1111 MACRS Depreciation Do not include listed property. ) (See instructions . Section A 17 MACRS deductions for assets placed in service in tax years beginning before 2001 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 8 2 7 4 . 18 If you are electing under section 168(1)(4) to group any assets placed in service during the tax year into one or more general asset accounts, check here . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Section B - Assets Placed in Service During 2001 Tax Year Using the General De reciation S stem (b) Month and (c) Basis for depreciation (d) Recovery (a) Classification of property year placed (businessfinvestment use period (e) Convention (f) Method (g) Depreciation deduction in service only - see instructions) 19a 3-year property 3 , 340o 3 . 0 MM SL 93 * b 5-year property 21 7 0 2 . 5 . 0 MM SL 2 , 808 * c 7-year property 4 , 694 * 7 . 0 MM SL 614 * d 10 ear property e 15 ear property f 20 ear property 25 ear property 25 yrs. S/L / 27 .5 yrs . MM S/L h Residential rental property / 27 .5 yrs . MM S/L / 39 rs . MM S/L i Nonresidential real property MM S/L Section C - Assets Placed in Service During 2001 Tax Year Using the Alternative Depreciation System 20a Class life S/L b 12 ear 12 yrs . S/L C 40-year / 40 yrs . MM S/L Part ! Summary (See instructions .) 21 Listed property. Enter amount from line 28 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 22 Total . Add amounts from line 12 , lines 14 through 17 , lines 19 and 20 in column (g) , and line 21 . Enter here and on the appropriate lines of your return . Partnerships and S corporations - see instr. . . . . . . . . . . . . . . . . . . . . . 22 11 7 8 9 . 23 For assets shown above and placed in service during the current year, enter the portion of the basis attributable to section 263A costs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 7 116251 03-21 -02 LHA For Paperwork Reduction Act Notice, see separate instructions. Form 4562 (2001 ) (Rev. 3-2002) 17 12361121 781701 ST . PETER 2001 . 06020 ST PETERS HUMAN SERVICES IN ST PETE1 Form 4562 (2001 ) (Rev . 3-2002) Page 2 Part V Listed Property (Include automobiles, certain other vehicles, cellular telephones, certain computers, and property used for entertainment, recreation , or amusement.) Note: Forany vehicle for which you are using the standard mileage rate ordeducting lease expense, complete only 24a, 24b, columns (a) through (c) of Section A all of Section 8 and Section C if applicable. Section A - Depreciation and Other Information (Caution: See instructions for limits for passenger automobiles.) 24a Do you have evidence to support the business/investment use claimed? 0 Yes [::] No 24b If "Yes , " is the evidence written? EJ Yes ED No (a) rpla te (c) (d) (e) M (g) (h) (i)Type of property d in Business/ Cost or Basis fordepreciation Recovery Method/ Depreciation Elected ( list vehicles first ) ice investment other basis (businesslnvestment period Convention deduction section 179 use only) cost 25 Special depreciation allowance for listed property acquired after September 10, 2001 , and used more than 50% in a qualified business use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 725 , 26 Property used more than 50% in a qualified business use : % % % 27 Property used 50% or less in a qualified business use : % S/L - % S/L - % S/L - 28 Add amounts in column (h) , lines 25 through 27 . Enter here and on line 21 , page 1 . . . . . . . . . . . . . . . . . . . 28 29 Add amounts in column (i) , line 26. Enter here and on line 7 , page 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 Section B - Information on Use of Vehicles Complete this section for vehicles used by a sole proprietor, partner, or other " more than 5% owner, " or related person . If you provided vehicles to your employees, first answer the questions in Section C to see if you meet an exception to completing this section for those vehicles. (a) (b) (c) (d) (e) (f) 30 Total business/investment miles driven during the Vehicle Vehicle Vehicle Vehicle Vehicle Vehicle year (do not include commuting miles ) . . . . . . . . . . . . . . . . . . 31 Total commuting miles driven during the year . _ . 32 Total other personal (noncommuting) miles driven 33 Total miles driven during the year. Add lines 30 through 32 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 Was the vehicle available for personal use Yes No Yes No Yes No Yes No Yes No Yes No during off-duty hours? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 Was the vehicle used primarily by a more than 5% owner or related person? . . . . . . . . . . . . . . . . . . 36 Is another vehicle available for personal use? Section C - Questions for Employers Who Provide Vehicles for Use by Their Employees Answer these questions to determine if you meet an exception to completing Section B for vehicles used by employees who are not more than 5% owners or related persons . 37 Do you maintain a written policy statement that prohibits all personal use of vehicles , including commuting , by your Yes No employees? . . . . . . . . . . . . . . . . . . . . . . . 38 Do you maintain a written policy statement that prohibits personal use of vehicles , except commuting, by your employees? See instructions for vehicles used by corporate officers, directors , or 1 % or more owners . . . . . . . . . . . . . . . . . . . . 39 Do you treat all use of vehicles by employees as personal use? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40 Do you provide more than five vehicles to your employees , obtain information from your employees about the use of the vehicles , and retain the information received ? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 Do you meet the requirements concerning qualified automobile demonstration use? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 . . . . . . . . . . . . . . . . . . . . . Note: If your answer to 37, 38, 39, 40, or 41 is " Yes, " do not complete Section 8 for the covered vehicles. Part VI I Amortization (a) (b) (c) (d) (e) (f) Description of costs Date amoru:ation Amortizable Code Amortiratlon Amortization begins I mount section period or percentage for this year 42 Amortization of costs that begins during your 2001 tax year: 43 Amortization of costs that began before your 2001 tax year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43 44 Total. Add amounts in column (f) . See instructions for where to report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44 Form 4562 (200 1 ) (Rev. 3-2002) 116252 03-20-02 18 12361121 781701 ST " PETER 2001 . 06020 ST PETERS HUMAN SERVICES IN ST PETE1 STPETERS St . Peters Human Services 11 /21 /2002 11 : 52 AM Book Asset Detail 7/ 01 / 01 - 6/30/02 Page 1 FYE : 6/30/2002 Date In Book Book Sec Book Sal Book Prior Book Current Book End Book Net Book Book Asset Property Description Service Cost 179 Exp c Value Deprec Depreciation Depreciation Book Value Method Period Group : 1320-Improv not Buildines 2 Playground Equipment 12/31 /98 1 ,414 . 50 0 . 00 0 . 00 353 . 63 141 .45 495 . 08 919 . 42 S/L 10 . 0 30 Playground Equipment 6/ 13 /00 1 ,322 . 34 0 . 00 0 . 00 143 . 25 132 . 23 275 .48 1 ,046 . 86 S/L 10 . 0 31 Playground Equipment 5/24/00 11885 . 00 0 . 00 0 . 00 204 . 21 188 . 50 392 . 71 1 ,492 . 29 S/L 10 . 0 32 Signs 8/ 10/00 1 ,770 . 00 0 . 00 0 . 00 162 . 25 177 . 00 339 . 25 1 ,430 . 75 S/L 10 . 0 33 Signs 8/ 10/00 1 ,770 . 00 0 . 00 0 . 00 162 . 25 177 . 00 339 . 25 1 ,430 . 75 S/L 10 . 0 40 Chain Link Fence 7/06/00 848 . 00 0 . 00 0 . 00 56 . 53 56 . 53 113 . 06 734 . 94 S/L 15 . 0 41 Chain Link Fence 6/04/01 383 . 00 0 . 00 0 . 00 2 . 13 25 . 53 27 . 66 355 . 34 S/L 15 . 0 13204mprov not Buildings 9 ,392 . 84 0 . 00c 0 . 00 11084 . 25 898 . 24 11982 .49 71410 . 35 Group : 1330-Buildines & Equip. 26 Renovations 8/ 15 /98 273 . 09 0 . 00 0 . 00 79 . 65 27 . 31 106 . 96 166 . 13 S/L 10 . 0 29 Room Addition - Wall 3/ 11 /99 750 . 00 0. 00 0 . 00 87 . 50 37 . 50 125 . 00 625 . 00 S/L 20 . 0 1330-Buildings & Equip. 1 , 023 . 09 0. 000 0 . 00 167 . 15 64 . 81 231 . 96 791 . 13 Group : 1340-Furn, Fix , & Equip I Nimbus 7/27/98 858 . 00 0 . 00 0 . 00 250 . 25 85 . 80 336 . 05 521 . 95 S/L 10 . 0 3 TV & VCR 10/ 19/98 348 . 96 0 . 00 0 . 00 132 . 93 49 . 85 182 . 78 166 . 18 S/L 7 . 0 4 Student Desks 8/02/98 3 , 137 . 28 0 . 00 0 . 00 915 . 04 313 .73 11228 . 77 1 , 908 . 51 S/L 10 . 0 5 Lunch Tables 9/30/98 2 ,448 . 00 0. 00 0 . 00 673 . 20 244 . 80 918 . 00 11530 . 00 S/L 10. 0 6 Student Chairs 8/ 12/98 1 ,324 . 30 0 . 00 0 . 00 386 . 25 132 .43 518 . 68 805 . 62 S/L 10 . 0 7 Activity Tables 9/30/98 565 .44 0 . 00 0 . 00 155 . 49 56 . 54 212 . 03 353 . 41 S/L 10 . 0 8 Teacher's Desks 9/30/98 794 . 96 0 . 00 0 . 00 218 . 62 79 . 50 298 . 12 496 . 84 S/L 10 . 0 9 Armrest Kit for Teacher Chairs 9/30/98 136 . 12 0. 00 0 . 00 37 . 43 13 . 61 51 . 04 85 . 08 S/L 10 . 0 10 Operators Egg Chairs 8/ 12/98 555 . 96 0 . 00 0 . 00 162 . 16 55 . 60 217 . 76 338 . 20 S/L 10 . 0 11 Administrative Desk 8/ 11 /98 512 . 97 0 . 00 0 . 00 149 . 62 51 . 30 200. 92 312 . 05 S/L 10 . 0 12 Bookcase 7/08/98 179 . 99 0. 00 0 . 00 54 . 00 18 . 00 72 . 00 107 . 99 S/L 10 . 0 13 Storage Cabinets 7/08/98 299 . 97 0 . 00 0 . 00 90. 00 30. 00 120 . 00 179 . 97 S/L 10 . 0 14 File Cabinets 7/08/98 559 . 96 0 . 00 0 . 00 168 . 00 56 . 00 224 . 00 335 . 96 S/L 10 . 0 15 4 Drawer Files 7/08/98 299 . 99 0 . 00 0 . 00 90. 00 30 . 00 120 . 00 179 . 99 S/L 10 . 0 16 Overhead Projector 10/ 19/98 189 . 99 0 . 00 0 . 00 72 . 37 27 . 14 99 . 51 90 . 48 S/L 7 . 0 17 U-shaped Work Center 7/08/98 359 . 99 0 . 00 0 . 00 108 . 00 36 . 00 144 . 00 215 . 99 S/L 10 . 0 18 Leather Chair 7/08/98 159 . 99 0 . 00 0 . 00 48 . 00 16 . 00 64 . 00 95 . 99 S/L 10 . 0 19 Tables 11 /23/98 455 . 85 0. 00 0 . 00 117 . 77 45 . 59 163 . 36 292 . 49 S/L 10 . 0 20 Corner Connector 7/08/98 89 . 99 0. 00 0 . 00 27 . 00 9 . 00 36 . 00 53 . 99 S/ L 10 . 0 21 Student Desks 8/02/98 1 , 322 . 25 0 . 00 0. 00 385 . 67 132 . 23 517 . 90 804 . 35 S/L 10 . 0 22 Student Chairs 8/02/98 977 . 85 0 . 00 0 . 00 285 . 22 97 . 79 383 . 01 594 . 84 S/L 10 . 0 23 Board 7/08/98 269 . 97 0 . 00 0 . 00 81 . 00 27 . 00 108 . 00 161 . 97 S/ L 10 . 0 24 Telephone 7/08/98 119 . 98 0 . 00 0 . 00 51 . 42 17 . 14 68 . 56 51 . 42 S/L 7 . 0 25 Storage Cabinets 7/08/98 249 . 99 0 . 00 0 . 00 75 . 00 25 . 00 100 . 00 149 . 99 S/L 10 . 0 27 Shelves 9/01 /98 179 . 99 0. 00 0 . 00 51 . 00 18 . 00 69 . 00 110 . 99 S/L 10 . 0 28 Fax Machine 8/ 11 /98 199 . 99 0 . 00 0 . 00 83 . 33 28 . 57 111 . 90 88 . 09 S/L 7 . 0 34 53 " TV 10/04/00 2 , 374 . 99 0 . 00 0 . 00 254 . 46 339 . 28 593 . 74 11781 . 25 S/L 7 . 0 35 40 Desks 9/27/00 2 , 132 . 00 0 . 00 0 . 00 0 . 00 0 . 00 0 . 00 2 , 132 . 00 Memo 10 . 0 36 40 Chairs 9/27/00 644 . 00 0 . 00 0 . 00 0 . 00 0 . 00 0 . 00 644 . 00 Memo 10 . 0 37 30 Chairs 9/27/00 2 , 640. 00 0 . 00 0 . 00 0 . 00 0 . 00 0 . 00 2 , 640 . 00 Memo 10 . 0 STPETERS St . Peters Human Services 11 /21 /2002 11 : 52 AM Book Asset Detail 7/01 / 01 - 6/30/02 Page 2 FYE $ 6/30/2002 Date In Book Book Sec Book Sal Book Prior Book Current Book End Book Net Book Book Asset Property Description Service Cost 179 Exp c Value Deprec Depreciation Depreciation Book Value Method Period Group : 1340-Furn, Fix, & Equip (continued) 38 6 Teacher Desks 9/27/00 1 ,443 . 60 0 . 00 0 . 00 0. 00 0 . 00 0 . 00 1 ,443 . 60 Memo 10 . 0 39 6 Teacher Chairs 9/27/00 952. 20 0. 00 0 . 00 0 . 00 0 . 00 0. 00 952 . 20 Memo 10 . 0 42 Computer 7/27/98 13 ,490. 00 0 . 00 0 . 00 7 , 869 . 17 2 , 698 . 00 10 , 567 . 17 21922 . 83 S/L 5 . 0 43 Printer 8/ 11 /98 769 . 99 0 . 00 0 . 00 449 . 16 154. 00 603 . 16 166 . 83 S/L 5 . 0 44 Computers 3/08/00 859 . 98 0 . 00 0. 00 229 . 33 172 . 00 401 . 33 458 . 65 S/L 5 . 0 45 Computers 3/23/00 859 . 98 0 . 00 0. 00 215 . 00 172 . 00 387 . 00 472 . 98 S/L 5 . 0 46 Computers 5/22/00 4 ,972 . 73 0 . 00 0. 00 1 ,077 .43 994 . 55 2 ,071 . 98 2 ,900 . 75 S/L 5 . 0 51 Telephone System 8/ 13 /01 4 , 693 . 58 0 . 000 0. 00 0. 00 614 . 64 614 . 64 4 ,078 . 94 S/L 7 . 0 54 10 Computers 10/ 15/01 162970. 01 0 . 00c 0. 00 0. 00 2, 545 . 50 2, 545 . 50 14 ,424 . 51 S/L 5 . 0 55 Dell Computer 10/ 15/01 1 , 378 . 00 0 . 000 0. 00 0 . 00 206 . 70 206 . 70 11171 . 30 S/L 5 . 0 57 Laptop Computer 6/01 /02 1 ,908 . 98 0 . 00c 0. 00 0. 00 31 . 82 31 . 82 1 , 877 . 16 S/L 5 . 0 58 Desktop Computer 6/01 /02 1 ,444. 95 0 . 00c 0 . 00 0. 00 24 . 08 24 . 08 1 ,420. 87 S/L 5 . 0 1340-Furn, Fix , & Equip 74, 132. 72 0 . 00c 0 . 00 14 ,963 . 32 9 , 649 . 19 24 , 612 . 51 49 , 520 . 21 Group : 1360-Const. in Proeess 50 Site Design 8/ 15/00 5 ,000. 00 0 . 00 0. 00 0 . 00 0 . 00 0 . 00 5 ,000 . 00 Memo 40 . 0 59 Permits, Site Plan , Engineering & A 1 / 15/02 11 , 815 . 00 0 . 00c 0 . 00 0. 00 0 . 00 0 . 00 11 , 815 . 00 Memo 0 . 0 1360-Const. in Progess 16 , 815 . 00 0 . 00c 0 . 00 0. 00 0 . 00 0. 00 16 , 815 . 00 Group : 1382-Computer Software 47 Instructional Software 10/31 /98 615 . 18 0 . 00 0 . 00 563 . 91 51 . 27 615 . 18 0 . 00 Amort 3 . 0 48 Instructional Software 5/22/00 2 ,436 . 98 0 . 00 0 . 00 947 . 72 812 . 33 12760 . 05 676 . 93 Amort 3 . 0 49 Software 2/24/00 659 . 97 0 . 00 0 . 00 311 . 65 219 . 99 531 . 64 128 . 33 Amort 3 . 0 60 Website 6/ 17/02 3 ,339 . 52 0 . 000 0.00 0 . 00 92 . 76 92 . 76 3 , 246 . 76 Amort 3 . 0 1382-Computer Software 7 , 051 . 65 0 . 00c 0. 00 1 , 823 . 28 1 , 176 . 35 21999 . 63 41052 . 02 Grand Total 108 ,415 . 30 0 . 00c 0 . 00 18 ,038 . 00 11 ,788 . 59 293826 . 59 78 , 588 . 71 St. Peters Human Services , Inc . 31 - 1480633 2001 Form 990 STATEMENT TO ELECT OUT OF BONUS DEPRECIATION The taxpayer hereby elects to not deduct the additional 30 % bonus depreciation as provided for by the Job Creation and Worker Assistance Act of 2002 . This election is effective for all applicable classes of property placed in service during the current year . SCHEDULE AOrganization Exempt Under Section 501 (c) (3) OMB1545-004 ' (Form 990 or 990-EZ) ( Except Private Foundation ) and Section 501 ( e ) , 501 ( f) , 501 (k ) , 501 ( n ) , or Section 4947( a )( 1 ) Nonexempt Charitable Trust Department of the Treasury Supplementary Information - (See separate instructions .) 2001 Internal Revenue Service jo. MUST be completed by the above organizations and attached to their Form 990 or 990-EZ. Name of the organization Employer identification number ST PETERS HUMAN SERVICES INCORPORATED 31 1480633 Part I Compensation of the Five Highest Paid Employees Other Than Officers, Directors , and Trustees (See page 1 of the instructions. List each one. If there are none, enter "None.") (a ) Name and address of each employee paid ( b ) Title and average hours (d) Contributions to ( e ) Expense more than $50,000 per week devoted to (cj Compensation plans & deferredee positionaccount and other position compensation allowances NONE - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Total number of other employees paid over $50,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I► 0 Part Il Compensation of the Five Highest Paid Independent Contractors for Professional Services (See page 2 of the instructions. List each one (whether individuals or firms). If there are none, enter "None.") ( a ) Name and address of each independent contractor paid more than $50,000 ( b ) Type of service (c ) Compensation NONE - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Total number of others receiving over $50,000 for professional services . . . . . . . . . . . . . . 0 LHA For Paperwork Reduction Act Notice , see the Instructions for Form 990 and Form 990-EZ. Schedule A ( Form 990 or 990-EZ) 2001 123101 12-29-01 7 09411209 781701 ST " PETER 2001 . 06020 ST PETERS HUMAN SERVICES IN ST PETE1 Schedule A (Form 990 or 990 -EZ) 2001 ST PETERS HUMAN SERVICES INCORPORATED 31 - 1480633 Page 2 Part III Statements About Activities (See page 2 of the instructions. ) Yes No 1 During the year, has the organization attempted to influence national, state, or local legislation , including any attempt to influence public opinion on a legislative matter or referendum? If "Yes; enter the total expenses paid or incurred in connection with the lobbying activites ► $ $ ( Must equal amounts on line 38 , Part VI-A , or line i of Part VI-B . ) 1 X Organizations that made an election under section 501 ( h ) by filing Form 5768 must complete Part VI -A. Other organizations checking "Yes; must complete Part VI-B AND attach a statement giving a detailed description of the lobbying activities. 2 During the year, has the organization, either directly or indirectly, engaged in any of the following acts with any substantial contributors, trustees, directors, officers, creators, key employees, or members of their families, or with any taxable organization with which any such person is affiliated as an officer, director, trustee, majority owner, or principal beneficiary? (If the answer to any question is " Yes, " attach a detailed statement explaining the transactions.) a Sale, exchange, or leasing of property? . . . . . . . . . . . . . . . . . . . . 2a X . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . b Lending of money or other extension of credit? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 215 X c Furnishing of goods, services, or facilities? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2c X d Payment of compensation ( or payment or reimbursement of expenses if more than $ 1 ,000 )? . . . . . . . . . . . . . . 2d X e Transfer of any part of its income or assets? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2e X 3 Does the organization make grants for scholarships, fellowships, student loans, etc.? (See Note below.) _ . . . . . 3 rX 4 Do you have a section 403(b ) annul ty plan for employees?ees . _ 4 X . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Note : Attach a statement to explain how the organization determines that individuals or organizations receiving grants orloans from it in furtherance of its chartable programs "qualify" to receive payments. Part IV I Reason for Non - Private Foundation Status (See pages 3 through 6 of the instructions. ) The organization is not a private foundation because it is: (Please check only ONE applicable box. ) 5 A church, convention of churches, or association of churches. Section 170( b)( 1 )(A)( i ). 6 ® A school. Section 170( b ) ( 1 )(A)( ii). (Also complete Part V. ) 7 0 A hospital or a cooperative hospital service organization. Section 170 (b )( 1 )(A) ( iii). 8 0 A Federal, state, or local government or governmental unit. Section 170(b )( 1 )(A)(v). 9 ED A medical research organization operated in conjunction with a hospital. Section 170( b )( 1 )(A)( iii). Enter the hospital's name , city, and state ► 10 EJ An organization operated for the benefit of a college or university owned or operated by a governmental unit. Section 170 ( b )( 1 )(A)( iv). (Also complete the Support Schedule in Part IV-A. ) Ila An organization that normally receives a substantial part of its support from a governmental unit or from the general public. Section 170( b )( 1 )(A)(vi). (Also complete the Support Schedule in Part IV-A. ) 11b 0 A community trust. Section 170( b )( 1 ) (A)(vi). (Also complete the Support Schedule in Part IV-A.) 12 El An organization that normally receives: ( 1 ) more than 33 1/3% of its support from contributions, membership fees, and gross receipts from activities related to its charitable, etc., 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(x)(2 ). (Also complete the Support Schedule in Part IV-A. ) 13 E::] An organization that is not controlled by any disqualified persons (other than foundation managers) and supports organizations described in: ( 1 ) lines 5 through 12 above' or (2 ) section 501 (c)(4 ) (5 ) or (6) if they meet the test of section 509(a )(2 ) ( See section 509(a )(3 ). ) Provide the following information about the supported organizations. (See page 5 of the instructions. ) ( a ) Name(s ) of supported organization(s ) (b ) Line number from above 14 An organization organized and operated to test for public safety. Section 509(a )( 4 ). (See page 6 of the instructions. ) Schedule A ( Form 990 or 990-EZ) 2001 123111 01 -07-02 8 09411209 781701 ST . PETER 2001 . 06020 ST PETERS HUMAN SERVICES IN ST PETE1 Schedule A (Form 990 or 990-EZ) 2001 ST PETERS HUMAN SERVICES INCORPORATED 31 - 1480633 Page 3 Part IV-A Support Schedule (Complete only if you checked a box on line 10, 11 , or 12 .) Use cash method of accounting. N / A Note: You may use the worksheet in the instructions for convertin from the accrual to the cash method of accountin . Calendar year (or fiscal year be innin in . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100 ( a ) 2000 ( b ) 1999 (c ) 1998 ( d ) 1997 ( e ) Total 15 Gifts, grants, and contributions received. (Do not include unusual grants. See line 28. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 Membership fees received . . . _ . . . . . 17 Gross receipts from admissions, merchandise sold or services performed, or furnishing of facilities in any activity that is related to the organization ' s charitable, etc., purpose . . . . . . . . . . . . 18 Gross income from interest, dividends, amounts received from payments on securities loans (sec- tion 512(a)( 5) ), rents, royalties, and unrelated business taxable income ( less section 511 taxes) from businesses acquired by the organization after June 30, 1975 19 Net income from unrelated business activities not included in line 18 20 Tax revenues levied for the organization's benefit and either paid to it or expended on its behalf . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 The value of services or facilities furnished to the organization by a governmental unit without charge. Do not include the value of services or facilities generally furnished to the public without charge _ . . . . ._ _ . . Y2 Other income. Attach a schedule. Do not include gain or (loss) from sale of capital assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 Total of lines 15 through 22 00 0 " 00 " 0 " 24 Line 23 minus line 17 " . . . . . . . . . . . . . . . 25 Enter 1 % of line 23 26 Organizations described on lines 10 or 11 : a Enter 2% of amount in column (e ), line 24 . . ► 26a N / A b Prepare a list for your records to show the name of and amount contributed by each person (other than a governmental unit or publicly supported organization ) whose total gifts for 1997 through 2000 exceeded the amount shown in line 26a. Do not file this list with your return . Enter the total of all these excess amounts c Total support for section 509(a)( 1 ) test: Enter line 24, column (e) . . ► 26c N / A d Add: Amounts from column (e ) for lines: 18 19 22 26b ► 26d N / A e Public support ( line 26c minus line 26d total) . 00- 26e N / A . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . f Public s ort ercenta a line 26e numerator divided b line 26c. . . .deno. . . . . . mi.nator . . . . . 27 Organizations described on line 12: a For amounts included in lines 15, 16, and 17 that were received from a "disqualified person; prepare a list for your records to show the name of, and total amounts received in each year from, each "disqualified person' Do not file this list with your return . Enter the sum of such amounts for each year: 2000 ( 1999) ( ) ( 1998 ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1997 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . b For any amount included in line 17 that was received from each peson (other than "disqualified persons"), prepare a list for your records to show the name of, and amount received for each year, that was more than the larger of ( 1 ) the amount on line 25 for the year or (2) $5,000. ( Include in the list organizations described in lines 5 through 11 , as well as individuals. ) Do not file this list with your return . After computing the difference between the amount received and the larger amount described in ( 1 ) or (21 enter the sum of these differences (the excess amounts) for each year: (2000) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ( 1999) ( 1998 ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ( 1997) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . c Add: Amounts from column (e ) for lines: 15 16 17 20 21 ► 27c N / A d Add: Line 27a total . . and line 27b total . . . . . . . . . . . . . ► 27d N / A e Public support ( line 27c total minus line 27d total) . ► 27e N A . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . f Total support for section 509(a)( 2) test: Enter amount on line 23, column (e ) . . . . . . . . . ► 27f . . . .N A g Public support percentage (line 27e (numerator) divided by line 27f (denominator)) . 10- 27 N / A % . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . h Investment income percentage line 18 column a numerator divided b line 27f denominator ► 27h N / A % 28 Unusual Grants : For an organization described in line 10, 11 , or 12, that received any unusual grants during 1997 through 2000, prepare a list for your records to show, for each year, the name of the contributor, the date and amount of the grant, and a brief description of the nature of the grant. Do not file this list with your return . Do not include these grants in line 15. ,zsizt , z -zs-o , 9 Schedule A ( Form 990 or 990-EZ) 2001 09411209 781701 ST " PETER 2001 . 06020 ST PETERS HUMAN SERVICES IN ST PETE1 Schedule A (Form 990 or 990 EZ) 2001 ST PETERS HUMAN SERVICES INCORPORATED 31 - 1480633 Page 4 Part V Private School Questionnaire (See page 7 of the instructions. ) (To be completed ONLY by schools that checked the box on line 6 in Part I� 29 Does the organization have a racially nondiscriminatory policy toward students by statement in its charter, bylaws, other governing Yes No instrument, or in a resolution of its governing body? . . , . - . . . . . . . . . . . . . . . 29 X . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 Does the organization include a statement of its racially nondiscriminatory policy toward students in all its brochures, catalogues, and other written communications with the public dealing with student admissions, programs, and scholarships? 30 X 31 Has the organization publicized its racially nondiscriminatory policy through newspaper or broadcast media during the period of solicitation for students, or during the registration period if it has no solicitation program , in a way that makes the policy known to all parts of the general community it serves? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 X If "Yes, please describe; if "No," please explain. ( If you need more space, attach a separate statement. ) A NEWSPAPER ADVERTISEMENT CONTAINING THE NONDISCRIMINATORY POLICY OF THE SCHOOL WAS PLACED IN THE LOCAL NEWSPAPER BEFORE ENROLLMENT BEGAN . 32 Does the organization maintain the following: a Records indicating the racial composition of the student body, faculty, and administrative staff? . . . . . . 32a X b Records documenting that scholarships and other financial assistance are awarded on a racially nondiscriminatory basis? 32b X c Copies of all catalogues, brochures, announcements, and other written communications to the public dealing with student admissions, programs, and scholarships? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32c X d Copies of all material used by the organization or on its behalf to solicit contributions? . . . . . _ . _ 32d X If you answered "No" to any of the above, please explain. ( If you need more space, attach a se. parate statement ) 33 Does the organization discriminate by race in any way with respect to: aStudents ' rights or privileges? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33a X bAdmissions policies? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33b X . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . c Employment of faculty or administrative staff? 33c X . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . d Scholarships or other financial assistance? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33d X eEducational policies? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33e X f Use of facilities? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . g Athletic programs? 33f h Other extracurricular activities? . . . . . . . . . . . . . . . . . . . . . . . . 33h X . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . If you answered "Yes' to any of the above, please explain. ( If you need more space, attach a separate statement ) 34 a Does the organization receive any financial aid or assistance from a governmental agency? . . . . . . . . . . . . . . . . . STATEMENT. . . .8 . . . . . . . . . . . . . . . . . 34a X b Has the organization 's right to such aid ever been revoked or suspended? If you answered "Yes' to either 34a or b, please explain using an attached statement. 35 Does the organization certify that it has complied with the applicable requirements of sections 4.01 through 4 .05 of Rev. Proc. 75-50, 1975-2 C. B. 587, covering racial nondiscrimination? If "No; attach an explanation Schedule A ( Form 990 or 990-EZ) 2001 123131 12 -29-01 10 09411209 781701 ST . PFTER 2001 . 06020 ST PETERS HUMAN SERVICES IN ST PETE1 Schedule A (Form 990 or 990 -EZ) 2001 ST PETERS HUMAN SERVICES INCORPORATED 31 - 1480633 Page 5 . Part WA Lobbying Expenditures by Electing Public Charities (See page 9 of the instructions. ) N / A (To be completed ONLY by an eligible organization that filed Form 5768 ) Check ► a E if the or anization belongs to an affiliated group . Check ► b if ou checked "a " and "limited control" provisions apply. Limits on Lobbying Expenditures ( a ) ( b ) Affiliated group To be completed for ALL ( The term "expenditures" means amounts paid or incurred. ) totals electing organizations 36 Total lobbying expenditures to influence public opinion (grassroots lobbying ) . . . 36 N / A 37 Total lobbying expenditures to influence a legislative body (direct lobbying ) . . . _ 37 38 Total lobbying expenditures (add lines 36 and 37 ) . 39 Other exempt purpose expenditures . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40 Total exempt purpose expenditures (add lines 38 and 39 ) . . 40 . . . . . . . . . . . . 41 Lobbying nontaxable amount. Enter the amount from the following table - If the amount on line 40 is - The lobbying nontaxable amount is - Not over $500,0002006 of the amount on line 40 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Over $500,000 but not over $ 1 ,000,000 $ 100,000 plus 15% of the excess over $500,000 Over $ 1 ,000,000 but not over $ 1 ,500,000 $ 175,000 plus 10% of the excess over $ 1 ,00o,000 41 Over $ 1 ,500,000 but not over $ 17,aoo,000 $225,000 plus 5% of the excess over $ 1 ,500,000 Over $ 17,000,000 $ t ,000,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42 Grassroots nontaxable amount (enter 25% of line 41 ) . _ 42 43 Subtract line 42 from line 36. Enter -0- if line 42 is more than line 3643 . . . . . . 44 Subtract line 41 from line 38. Enter -0- if line 41 is more than line 38 . . . . . . . . . . . . . . . . . . . . . . . . . 44 Caution : If there is an amount on either line 43 or line 44, you must file Form 4720. 4-Year Averaging Period Under Section 501 ( h ) (Some organizations that made a section 501 ( h ) election do not have to complete all of the five columns below. See the instructions for lines 45 through 50 on page 11 of the instructions.) Lobbying Expenditures During 4-Year Averaging Period N / A Calendar year (or ( a ) ( b ) (c) (d ) ( e ) fiscal year beginning in ) ► 2001 2000 1999 1998 Total 45 Lobbying nontaxable amount . . . . . . . . . . . . . . . . . . . . . . . . 0 46 Lobbying ceiling amount 150% of line 45( e ) ) . . 47 Total lobbying 0 expenditures . . . . . . . . . . . . . . . . . . 0 . 48 Grassroots nontaxable amount . . . . . . . . . . . . . . . . . . . . . . . . 49 Grassroots ceiling amount 0 150% of line 48(e ) ) 50 Grassroots lobbying 0 expenditures 0 . Part VI - B Lobbying Activity by Nonelecting Public Charities (For reporting only by organizations that did not complete Part VI -A) (See page 12 of the instructions. ) N A During the year, did the organization attempt to influence national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of: Yes No Amount a Volunteers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . b Paid staff or management ( Include compensation in expenses reported on lines c through h . ) . . . . . . . . . . . . . c Media advertisements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . d Mailings to members, legislators, or the public . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . e Publications, or published or broadcast statements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . If Grants to other organizations for lobbying purposes . . . . . . . . . . . g Direct contact with legislators, their staffs, government officials, or a legislative body . . . . . . . . . . . . . . . . . . . . . . . . h Rallies, demonstrations, seminars, conventions, speeches, lectures, or any other means9 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I Total lobbying expenditures (Add lines through h . ) _ . _ . _ . If "Yes" to any of the above, also attach a statement giving a detailed description of the lobbying activities. 123141 12-29-01 Schedule A ( Form 990 or 990-EZ) 2001 11 09411209 781701 ST " PETER 2. 001 . 06020 ST PETERS HUMAN SERVICES IN ST PETE1 Schedule A (Form 990 or 990- EZ) 2001 ST PETERS HUMAN SERVICES INCORPORATED 31 - 1480633 Page 6 Part VII Information Regarding Transfers To and Transactions and Relationships With Noncharitable Exempt Organizations (See page 12 of the instructions. ) 51 Did the reporting organization directly or indirectly engage in any of the following with any other organization described in section 501 ( c ) of the Code ( other than section 501 (c) (3 ) organizations ) or in section 527, relating to political organizations? a Transfers from the reporting organization to a noncharitable exempt organization of. Yes No ( i ) Cash _ ( ii ) Other assets51a i . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ( ) X b Other transactions: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . a ( ii ) X ( i) Sales or exchanges of assets with a noncharitable exempt organization . . . . . . . . . b ( i ) X . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ( ii ) Purchases of assets from a noncharitable exempt organization b ( ii ) X . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ( iii ) Rental of facilities, equipment, or other assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (iv) Reimbursement arrangements b ( iii ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Xb ( iv) X . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (v) Loans or loan guarantees b (v ) X . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (vi ) Performance of services or membership or fundraising solicitations b (vi ) X . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . c Sharing of facilities, equipment, mailing lists, other assets, or paid employees c X d If the answer to any of the above is ' Yes, complete the following schedule. Column ( b ) should always show the fair market value of the goods, other assets, or services given by the reporting organization. If the organization received less than fair market value in any transaction or sharing arrangement, show in column (d ) the value of the goods, other assets, or services received: N A ( a ) ( b ) (c ) ( d ) Line no. Amount involved Name of noncharitable exempt organization Description of transfers, transactions, and sharing arrangements 52 a Is the organization directly or indirectly affiliated with, or related to, one or more tax-exempt organizations described in section 501 (c) of the Code (other than section 501 (c)(3 ) ) or in section 527? b IfuYes, complete the following schedule: . . . . . . . . . . . . . . ®. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No . . . . . . . . . . . . . . . . . . . . . . . . . . . N A ( a ) ( b ) (c) Name of organization Type of organization Description of relationship 123151 12-29-01 12 Schedule A (Form 990 or 990-EZ) 2001 09411209 781701 ST . PETER 2001 . 06020 ST PETERS HUMAN SERVICES IN ST PETE1 Schedule B Schedule of Contributors (Form 990, 9M-EZ, or OMB No. 1545-0047 990-PF) Supplementary Information for DepartmentrealRevenue of Treasury line 1 of Form 990 2001 Internal Revenue Service , 990-EZ and 990-PF (see instructions) Name of organization Employer identification number ST PETERS HUMAN SERVICES INCORPORATED 31 - 1480633 Organization type (check one) : Filers of: Section: Form 990 or 990- EZ ® 501 (c)( 3 ) (enter number) organization 0 4947(a)(1 ) nonexempt charitable trust not treated as a private foundation 0 527 political organization Form 990-PF 501 (c)(3) exempt private foundation 4947(a)( 1 ) nonexempt charitable trust treated as a private foundation 501 (c)(3) taxable private foundation Check if your organization is covered by the General rule or a Special rule. (Note: Only a section 501 (c)(7), (8), or (10) organization can check box(es) for both the General rule and a Special rule-see instructions.) General Rule- ® For organizations filing Form 990, 990-EZ, or 990-PF that received , during the year, $5 ,000 or more (in money or property) from any one contributor. (Complete Parts I and 11 .) Special Rules- 0 For a section 501 (c)(3) organization filing Form 990, or Form 990-EZ, that met the 33 1 /3% support test of the regulations under sections 509(a)(1 )/170(b)(1 ) (A)(vi) and received from any one contributor, during the year, a contribution of the greater of $5 ,000 or 2% of the amount on line 1 of these forms. (Complete Parts I and 11 .) For a section 501 (c)(7), (8), or (10) organization filing Form 990, or Form 990-EZ, that received from any one contributor, during the year, aggregate contributions or bequests of more than $ 1 ,000 for use exclusively for religious, charitable, scientific, literary, or educational purposes, or the prevention of cruelty to children or animals . (Complete Parts I , 11 , and III .) 0 For a section 501 (c) (7) , (8), or (10) organization filing Form 990, or Form 990- EZ, that received from any one contributor, during the year, some contributions for use exclusively for religious, charitable, etc ., purposes, but these contributions did not aggregate to more than $ 1 ,000. (If this box is checked , enter here the total contributions that were received during the year for an exclusively religious, charitable , etc . , purpose . Do not complete any of the Parts unless the General rule applies to this organization because it received nonexclusively religious , charitable, etc. , contributions of $5,000 or more during the year.) 100. $ Caution: Organizations that are not covered by the General rule and/or the Special rules do not file Schedule B (Form 990, 990-EZ, or 990-PF), but they must check the box in the heading of their Form 990, Form 990-EZ, or on line 1 of their Form 990-PF, to certify that they do not meet the filing requirements of Schedule B (Form 990, 990-EZ, or 990-PF). Schedule B ( Form 990 , 990-EZ, or 990-PF ) (2001 ) 123451 12-29-01 Schedule B (Form 99o, 990-EZ, or 990-P9 (200 1 ) Page 1 to 1 of Part I Name of organization Employer identification number ST PETERS HUMAN SERVICESINCORPORATED 31 - 1480633 Part I Contributors (See Specific Instructions .) (a) (b) (c) No. Name, address and ZIP + 4 (d) Aggregate contributions Type of contribution FEDERAL FUNDS THROUGH INDIAN RIVER 1 COUNTY SCHOOL BOARD Person 1990 25TH STREET Payroll $ 152r234o Noncash [� VERO BEACH FL 32960 (Complete Part II if there is a noncash contribution .) (a) (b) (c) No. Name, address and ZIP + 4 (d) Aggregate contributions Type of contribution 2 INDIAN RIVER COUNTY SCHOOL BOARD Person 1990 25TH STREET Payroll $ 388 , 6190 Noncash 0 VERO BEACHr FL 32960 (Complete Part II if there is a noncash contribution .) (a) (b) (c) (d) No. Name, address and ZIP + 4 Aggregate contributions Type of contribution STATE OF FLORIDA FUNDS THROUGH INDIAN 3 RIVER COUNTY SCHOOL BO Person 1990 25TH STREET Payroll F-1 $ 55 , 764 * Noncash VERO BEACH FL 32960 (Complete Part Il if there is a noncash contribution .) (a) (b) (c) No. Name, address and ZIP + 4 Aggregate contributions T ype of (d) contribution Person Payroll $ Noncash (Complete Part II if there is a noncash contribution .) (a) (b) (c) NO Name, address and ZIP + 4 Aggregate contributions Type of c(d) ontribution Person 0 Payroll $ Noncash (Complete Part II if there is a noncash contribution .) (a) (b) (c) No. Name, address and ZIP + 4 Aggregate contributions Type of contribution Person Payroll $ Noncash (Complete Part 11 if there is a noncash contribution .) 123452 12-29-01 - 14 Schedule B (Form 990 , 990-EZ, or 990-PF ) (2001 ) 10101209 781701 ST . PETER 2001 . 06020 ST PETERS HUMAN SERVICES IN ST PETE1 ST PETERS HUMAN SERVICES INCORPORATED 31 - 1480633 FORM 990 SPECIAL EVENTS AND ACTIVITIES STATEMENT 1 GROSS NTRIBUT GROSS DIRECT NET DESCRIPTION OF EVENT RECEIPTS CONCLUDED . REVENUE EXPENSES INCOME FUNDRAISING ACTIVITIES 5 , 323 . 51323 . 5 , 323 . TO FM 990 , PART I , LINE 9 5 , 323 . 5 , 323 . 5 , 323 . FORM 990 OTHER CHANGES IN NET ASSETS OR FUND BALANCES STATEMENT 2 DESCRIPTION AMOUNT PRIOR PERIOD ADJUSTMENT - DEPRECIATION < 18 , 038 . > TOTAL TO FORM 990 , PART I , LINE 20 < 18 , 038 . > FORM 990 OTHER EXPENSES STATEMENT 3 ( A ) ( B ) ( C ) ( D ) PROGRAM MANAGEMENT DESCRIPTION TOTAL SERVICES AND GENERAL FUNDRAISING PROFESSIONAL AND TECH SERVICES 100 , 616 . 100 , 616 . OTHER PURCHASED SERVICES 1 , 176 . 42 . 1 , 134 . TEXTBOOKS 41400 . 4 , 400 . DUES AND FEES 20 , 732 . 11330 . 19 , 402 . INSURANCE 11 , 275 . 11424 . 9 , 851 . UTILITIES 14 , 314 . 14 , 314 . COMMUNICATIONS 41976 . 41760 . 216 . MISCELLANEOUS 7 , 204 . 71204 . LIBRARY BOOKS 70 . 70 . LICENSES AND PERMITS 226 . 226 . TOTAL TO FM 990 , LN 43 164 , 989 . 134 , 386 . 30 , 603 . 15 STATEMENT ( S ) 1 , 2 , 3 09411209 781701 ST . PETER 2001 . 06020 ST PETERS HUMAN SERVICES IN ST PETE1 ST PETERS HUMAN SERVICES INCORPORATED 31 - 1480633 FORM 990 STATEMENT OF ORGANIZATION ' S PRIMARY EXEMPT PURPOSE STATEMENT 4 PART III EXPLANATION TO IMPROVE THE ACADEMIC PERFORMANCE OF " AT RISK " ELEMENTARY SCHOOL STUDENTS FROM ECONOMICALLY DISADVANTAGED FAMILIES IN INDIAN RIVER COUNTY . FORM 990 OTHER FUNDS STATEMENT 5 ( A ) ( B ) DESCRIPTION BEGINNING OF END OF YEAR YEAR ACCUMULATED SURPLUS 636 , 719 . 663 , 377 . TOTAL INCLUDED ON FORM 990 , LINE 72 636 , 719 . 663 , 377 . FORM 990 OTHER REVENUE NOT INCLUDED ON FORM 990 STATEMENT 6 DESCRIPTION AMOUNT REIMBURSED EXPENSES REPORTED AS REVENUES ON AUDITED FINANCIAL STATEMENTS 14 , 586 . TOTAL TO FORM 990 , PART IV - A 14 , 586 . FORM 990 OTHER EXPENSES NOT INCLUDED ON FORM 990 STATEMENT 7 DESCRIPTION AMOUNT REIMBURSED EXPENSES REPORTED AS REVENUES ON AUDITED FINANCIAL STATEMENTS 14 , 586 . TOTAL TO FORM 990 , PART IV - B 14 , 586 . FOOTNOTES STATEMENT 8 SCHEDULE A , PART V - EXPLANATION FOR LINE 34A THE SCHOOL OPERATES UNDER A CHARTER FROM THE INDIAN RIVER COUNTY SCHOOL DISTRICT AND RECEIVES THE BULK OF ITS FUNDING FROM GOVERNMENTAL SOURCES THAT PASSES THROUGH THE SPONSORING 09411209 781701 ST . PETER 2001 . 06020 ST6PETERS HUE MANSERVICES41N5ST6PETE18 ST PETERS HUMAN SERVICES INCORPORATED 0 31 - 1480633 SCHOOL DISTRICT . FORM 990 , PART IV - EXPLANATION OF NET ASSET PRESENTATION DUE TO THE FACT THAT ST PETERS IS A SCHOOL THAT IS REQUIRED TO STATE NET ASSETS PER GASB 34 , SFAS 117 DOES NOT APPLY . IN PRIOR YEARS , NET ASSETS WERE PRESENTED AS IF SFAS 117 WAS APPLICABLE . WE WILL CHANGE THE PRIOR YEAR PRESENTATION ACCORDINGLY , AND THIS STATEMENT IS MEANT TO SERVE AS NOTICE OF SUCH CHANGE . 10381209 781701 ST . PETER 2001 . 06020 ST7PETERS HUMAN SERVICES TINESN TPETEIB 11 :08 AM ST. PETER'S ACADEMY 05/28/03 Custom Summary Report Accrual Basis July 2002 through April 2003 Jul '02 - Apr ... Ordinary Income/Expense Income CHILDREN SERVICES GRANT 249896.24 DISSEMINATION GRANT DIST. AD... 0.00 REIMBURSED EXPENSE 699.17 STATE FOOD SERVICE 19,940.00 STATE NATIONAL SCHOOL LUNCH 39,637.00 STUDENT ALLOCATION 387,643.60 SUMMER CAMP TUITION 510.00 TITLE ONE REIMBURSEMENT 309628.37 Total Income 5039954.38 Gross Profit 5039954.38 Expense 5002400-100-51004000 -TEAL SAL 2259099.36 5002-00400-5100-2200- FICA -20,265.16 5002-00-100-5100-3100-PROF SEV 19838.50 5002-0040065100-3300 -TRAVEL 291 .60 5002-00400-5100-5100-LEAD TEA 4903 5002-O0.100-5100-5100 -SUPPLIES 8,455.48 5002-00400410065200-TEXTBOOK 10,670.00 5002400-100-5100-6410- CAP FURN 9,523.21 5002-00.100.5100-6420-NONCP FUR -990.03 5002-00.100-5100-6440 NONCP HAR 19872.05 5002-00-100-5200-1000.ESE SALR 4,998.80 5002400-100.5200.1300.ESE THRP 5,387.50 500240.100.5200.2200-FICA 673.44 5002-00.100-73004000.ADM SALRI 21100.00 5002400.100.7300.1000-SALARIES 76,774.66 5002400-100.7300.2100 -RETIRMNT 2,143.68 5002410.100-7300.220 -LIABILITY 4,972.79 5002-00400.7300.2200.FICA 41205.60 5002-00.100.7300.2300-MEALTHINS 14,082.92 500240400.7300.2400-WORK CMP 69528.00 5002-00.100.7300.2500-UNEMP CMP 939.30 500200.1004300.3100-PROF SERV 7,597.00 500200.100.7300-3300.TRAVEL 323.68 5002-00-100.73003600-COPIER 80315.92 5002400.100.7300.3700-POSTAGE 259.00 5002-00-i00-7300.3900 -PRIN/MIS 11383.54 5002-00-100.7300-5100 -SUPLS 430.93 500240-100-7300.7300 -DUES/FES 535.38 500200-10067400.3600-BLD LEASE 28,130.00 5002-00.100.76004000-FOOD SAL 16,522.68 5002-00.100-7600-2200-FICA 941 .79 5002400-100.7600.3100 -PROF SEV 100.00 5002-00.100.7600-3300-TRAVEL 166.18 5002-00400-7600.5100.FOODSUP 33,239.67 5002400-100.7800.1000.13I13 SAL 8,553.96 5002-00-100.7800.2200.FICA 654.37 5002-00.100.7800.5400 -OIL/GRE 19961 .46 500240.100.7800.5500 -BUS REP 5,206.70 5002-00.100.78004510.BUS LEASE 6,000.00 50024006100.7900.1000 -OUST SAL 5,015.50 5002-00-100.7900.2200. FICA 383.69 5002400-100-7900.3100.PROF SERV 19990.70 5002-006100-7900-3500 -BLD REPR 1 ,528.57 5002400-100.7900.3700 -TELE 2,976.21 5002-00.100.7900-4300 -UTILIES 70500.00 5002-00.100.7900-6300-BLDIFIXED 1 ,092.03 Page 1 s 11 :08 AM ST. PETER'S ACADEMY 05/28/03 Custom Summary Report Accrual Basis July 2002 through April 2003 Jul '02 = Apr ... S.W.A.T. 422.11 6999 • Uncategorized Expenses 774.00 Total Expense 5019356.20 Net Ordinary Income 2,598.18 Net Income 21598.18 Page 2 1l ` 11 :07 AM ST. PETER'S ACADEMY 05/28/03 Balance Sheet Accrual Basis As of April 30, 2003 Apr 30, ... ASSETS Current Assets Cbecking/Savings RIVERSIDE NATIONAL0243 77,571 .96 Total Checking/Savings 77,571 .96 Total Current Assets 77,571 .96 TOTAL ASSETS 779571 .96 LIABILITIES & EQUITY Liabilities Current Liabilities Other Current Liabilities 2100 • Payroll Liabilities 5,930.78 Total Other Current Liabili... 5,930.78 Total Current Liabilities 5,930.78 Total Liabilities 59930.78 Equity 1110 • Retained Earnings 699621 .55 3000 • Opening Bal Equity -578.55 Net Income 29598.18 Total Equity 71 ,641 .18 TOTAL LIABILITIES & EQUITY 77,571 .96 Page 1 TgtWL REVENUE SERVICc DEPARTMENT OF THE TREASURY .x pi.TRICT DIRECTOR • . P. BOX 2708 1N" TI , OH 45201 - . : Employer Identification i'4U . ber : Date : 11 - 1480633 DLN : 1705042275008 ST PETERS HUtfAN SERVICcS Contact Person : INCORPORATED D . A . DOWNING C/O REV 0MREW JEFFERSDN Contact Telephone Number : 4250 38TH AVE " ( 513 ) 241 - 5199 • GIFFORD , FL 32967 Accounting Period Endinq : August 31 Form 990 Required : Yes Addendum Applies : Yes Dear Applicant : Based on information supplied , and assuming your operations will be as stated in your application for recognition of exemption , we have determined you are exempt from federal income tax under section 501 ( a ) of the Internal Revenue Code as an organization described in section 501 ( c ) ( Z ) . We have further determined that you are not a private foundation within the weaning of section 509 ( a ) of the Cade , becau =e you are an organization described in sections 509 ( a ) ( 1 ) and 170 ( b ) ( 1 ) ( A ) ( ii ) . If your sources of support , or your purposes , character , or method of operation change , please let us know so we can consider the effect of the change an your exempt status and foundation status . In the case of an amend - ment to your organizational document or bylaws , please send us. a• copy of the amended document or bylaws . Also , you should inform us of all changes in your name or address . An ,-2 ; 1 , 1904 . ;ca .ire liable far taxes ander the Federal insurance Contributions Act ( social security taxes ) on . remuneration cif 3100 or more you pay to each of your employees durinq a calendar year. You are not liable for the tax imposed under the Federal Unemployment Tax Act ( FUTA ) . Since you are not a private foundation , you are not subject to the excise taxes under Chapter 42 of the Code . However , if you are involved in an excess benefit transaction , that transaction might be subject to the excise taxes of section 4958 . Additionally , you are not automati u11y exempt from other federal excise taxes . If you have any questions about excise , employment , or other federal taxes , please contact your key district office . Grantors and contributors may rely an this determination unless the Internal Revenue Service publishes notice to the contrary . However , if you lose your section 509 ( a ) ( 1 ) status , a grantor or contributor may not rely an this determination if he or site was in part responsible far , or was a"re of , the act or failure to act , or the substantial or material change, on tho part of the organization that resulted in your loss of such status , ar U he or she acquired knowledge that the Internal Revenue Service had given noticr that Letter 947 ( DO/ CS ) 'T PETERS HUMAN SERVICES � • •mow you would no longer be classified as a section 509 ( a ) ( 1 ) organization . l Donors may deduct contributions to you as provided in section 170 of the Code . Bequests , legacies , devises , transfers , or gifts to you or for your use are deductible for federal estate and gift tax purposes if they meet the applicable provisions of Code sections 2055 , 2106 , and 2522 . Contribution deductions are allowable to donors only to the extent that their contributions are gifts , with no consideration received . Ticket pur - chases and similar payments in conjunction with fundraisinq events may not necessarily qualify as deductible contributions , depending on the circum - stances . See Revenue Ruling 67 -246 , published in Cumulative Bulletin 1967 - 2 , on page 104 , which sets forth guidelines regarding the deductibility , as chari - table contributions , of payments made by taxpayers for admission to or other participation in fundraisinq activities for charity . In the heading of this letter me have indicated whether you must file Form 990 , Return of Organization Exempt From Income Tax . If Yes is indicated , you are required to file Form 990 only if your gross receipts each year are normally more than $25 , 000 . However , if you receive a Form 990 package in the mail , please file the return even if you do not exceed the gross receipts test . If you are not required to file , simply attach the label provided , check the box in the heading to indicate that your annual gross receipts are norm-ally 625 , 000 or less , and sign the return . If a return is required , it - must be filed by the 15th day of the fifth month after the end of your annual accounting period . A penalty of 620 a day is charged when a return is filed late , unless there is reasonable cause for the delay . However , the maximum penalty charged cannot exceed 610 , 000 or 5 percent of your gross receipts for the year , whichever is less . For organizations with gross receipts exceeding $ 1 , 000 , 000 in any year , the penalty is % 100 per day per return , unless there is reasonable cause far the delay . The maximum penalty for an organization with gross receipts exceedinq $ 1 , 000 , 000 shall not exceed % 50 , 000 . This penalty may also be charged if a • return is not complete , so be sure your return is complete before you file it . You are required to make your annual return available for public inspection for three years after the return is due . You are also required to make available a copy of your exemption application , any supporting documents , and this exemption letter . Failure to make these documents available for public inspection may subject you to a penalty of •620 per day for each day there is a failure to comply ( up to a maximum of $ 10 , 000 in the case of an annual return ) . You are not required to file federal income tax returns unless you are subject to the tax on unrelated business income under section 511 of the Code . If you are subject to this tax , you must file an income tax return on Form 990 - T , Exempt Organization Business Income Tax Return . In this letter we are not determining whether any of your present or proposed activities are unre- lated trade or business as defined in section 513 of the Code . Letter 947 ( DO / CG ) - 3 - ST PETERS HUMAN SERVICES You need an employer identification number even if you have no employees . If an employer identification number was not entered on your application , a number will be assigned to you and you will be advised of it . Please use that number on all returns you file and in all correspondence with the Internal Revenue Service . This determination is based on evidence that your funds are dedicated to the purposes listed in section 501 ( [ ) ( 3 ) of the Code . To assure your continued exemption , you should keep records to show that funds are expended only for those purposes . If you distribute funds to other organizations , your records should show whether they are exempt under section 501 ( [ ) ( 3 ) . In cases where the recipient organization is not exempt under section 501 ( [ ) ( 3 ) , there should be evidence that the funds will remain dedicated to the required purposes and that they will be used for those purposes by the recipient . . If distributions are made to individuals , case histories regarding the recipients should be kept showing names , addresses , purposes of awards , manner of selection , relationship ( if any ) to members , officers , trustees or donors of funds to you , so that any and all distributions made to individuals can be substantiated upon request by the Internal Revenue Service . ( Revenue Ruling U6 3041 C . B . 1956 -2 , page 306 . ) If we have indicated in the heading of this letter that an addendum applies , the enclosed addendum is an integral part of this letter . Because this letter could help resolve any questions about your exempt status and foundation status , you should keep .it in your • permaneint records . If you have any questions , please contact the person whose name and telephone number are shown in the heading of this letter . Sincerely yours , W • , District Director v Enclosure ( s ) . Addendum Letter 947 ( D0 /Cf ) WS FLORIDA DEPARTMENT OF STATE Ken Detzner Secretary of State January 2003 PETERS HUMAN • INCORPORATED• • • , 4250 • t AVENUE GIFFORD, 1 HUMANSUBJECTO ST . PETERS INCORPORATED. • DOCUMENT NUMBER * N96000004183 In compliance with the requeston yourAnnual Report/UniformBusmiess Report, the certificate of status for the subject corporation is enclosed , Should you have any questions regardingplease tel " • • i 48 & 90000 Division of Corporations �vOvOvOvOvOvOv�v�v�v�v�U�v�U�v�vv�v�v�v�v�v�v�vOvOvOvOvOvOvO• : n��n� 'n��n �ns47nN-�nT-*7nT-oyn;-on oft. 4 �n��n��nr�n��nR�nnR 'n �nson��rns _ L IQs of = c • - 041# �� g�� • L S SOC quw ' '_ `• 4D �O� I i ,�• S • L • • 4OC _ P . . I t 40 _ ��c 40 -40 - 40t I certifyMAN SERVICES , 40 = t • • INCORPORATED is a corporation organized • - - laws of • = F jOC • . • " . • ' 1996 � • 40 40 •C SOL - document numberof • • • • n is N9600000 .4183 . �•C L : F further certify that said corporation has • . • all feesdue this office through • iF December11 • st recent annual report/uniformbusiness reportVis • OL �OR • - • on N I further certify that said corporation has not filed �L i1 F OFAArticles of Dissolution . Given � • under • and thelip Zs Great Seal of the State of Florida Oat Tallahassee , the Capitol , this the :%, ate. `i/-,'i �• • OL eighth • • of January, 2003 ./ • • Twenty A Pew SOS CCR2EO22 SOC _ � 4. - y LYv:GYvit-Yv�GYvt-1v`Yv(GYvG1v,GYv�GYvLYvLYv(GYv;6Yv(aYv(aYV(aY • `1 • �GY • iGY • (GY • <-1 • !Y • �GY • <-1 Lti • tY • ! V • LY • = L � OUOOOOOOOOOOUOOOOvOU»vOUwOU�Uw�Uwww0v0. • �n<rP•��nsonsrnsfn��nR terns ins on��n< �n�.,nsanS J AMENDED ARTICLES OF INCORPORATION OF ST . PETERS HUMAN SERVICES , INCORPORATED The undersigned, acting as incorporator(s) of a corporation pursuant to chapter 617 . 0202 Florida Statutes, adopt(s) the following Articles of Incorporation : ARTICLE I Name The name of the corporation shall be : St. Peters Human Services , Incorporated ARTICLE II Principal place of business and mailing address The principal place of business and mailing address of this corporation shall be : 4250 38th Avenue Gifford, Florida 32967 ARTICLE III Purpose(s) This corporation is being organized as a nonreligious, nondenominational organization whose purpose is to address social problems and needs of the State of Florida and particularly those of Indian River County, Florida, exclusively for charitable and educational purposes, within the meaning of section 501 (c)(3 ) of the Internal Revenue Code (or corresponding section of any future Federal tax code .) ARTICLE IV Manner of election of directors The manner in which the election of directors will be as follows ; the chairman of the board shall be elected by the membership. The remaining board members will be appointed by the chairman for 0 staggered terms as reflected on the board member roster in the documents of incorporation . In lieu thereof, the method of election of directors are stated in the corporations bylaws : ARTICLE V Earnings No part of the net earning of the corporation shall inure to the benefit of, or be distributable to its members , trustees , directors , officers or other private persons , except that the corporation shall be authorized and empowered to pay reasonable compensation for services rendered to make payments and distributions in furtherance of Section 501 (c)(3 ) purposes . No substantial part of the activities of the corporation shall be the carrying on of propaganda, or otherwise attempting to influence legislation, and the corporation shall not participate in, or intervene in (including the publishing or distribution of statements) any political campaign on behalf of or in opposition of any candidate for public office . Notwithstanding any other provision of these articles , the corporation shall not carry on any other activities not permitted to be carried on (a) by a corporation exempt from Federal income tax under Section 501 (c)(3) of the Internal Revenue Code (or corresponding section of any future federal tax code) or (b) by a corporation, contributions to which are deductible under Section 170(c)(2) of the Internal Revenue Code (or corresponding section of any future Federal tax code . ) ARTICLE VI Assets Upon dissolution of this corporation, assets shall be distributed for one or more exempt purposes within the meaning of Section 501 (c) (3 ) of the Internal Revenue Code, i . e . charitable, education, religious or corresponding section of any future federal tax code , or shall be distributed to the Federal government, or to a state or local government for a public purpose. However, if the named recipient is not then in existence or no longer a qualified distributee, or unwilling or unable to accept the distribution, then the assets of this corporation shall be distributed to a fund, foundation or corporation organized and operated exclusively for the purposes specified in Section 501 (c)(3 ) of the Internal Revenue Code (or corresponding section of any future Federal tax code) . ARTICLE VII Initial registered agenda and street address Rev . Andrew Jefferson 4250 38th Avenue Gifford, FL 32967 • . ARTICLE VIII Incorporators Rev. Andrew Jefferson Reuben Lane 4236 57th Avenue 4610 43rd Court Gifford, FL 32967 Gifford, FL 32967 The undersigned incorporator has executed these Articles of Incorporation this day of . 1997. Rev. ANDREW JEFFERSON Typed name of incorporator signing ARTICLES OF AMENDMENT to ARTICLES OF INCORPORATION Of ST . PETER ' S HUMAN SERVICES , INC . 4250 38th Avenue Vero Beach , FL 32967 Pursuant to the provisions of section 617. 1006, Florida Statutes, the undersigned Florida nonprofit corporation adopts the following articles of amendment to its articles of incorporation. FIRST: Amendment(s) adopted : (IIVDICATE ARTICLE NUMBERS) BEING AMENDED, ADDED OR DELETED. ) ARTICLE III : This corporation, is being organized as a nonreligious , non - denominational organization whose purpose is to address social problems , and needs of the State of Florida and particularly those of Indian, River County , Florida , exclusively for chari - table and educational purposes , within the meaning of Section 501 ( c ) ( 3 ) of the Internal Revenue Code ( or corresponding section of any future Federal tax code . ) ARTICLE VII : Incorporators Rev . Andrew Jefferson Reuben Lane 4236 57th AVenue 4610 43rd Court Gifford , FL 32967 Gifford , FL 32967 SECOND : The date of adoption of the amendment(s) was : August 7 , 1996 'THIRD : Adoption of Amendment (CHECK ONE) ® The amendment(s) was(were) adopted by the members and the ngmber of votes cast for the amendment was sufficient for approval . ❑ There are no members or members entitled to vote on the amendment. The amendment(s) was(were) adopted by the board of directors . ST . PETER " S HUMAN SERVICES , INC . Corporation N Signature of ►,\0 Vice—Chairman, Presi t or other officer ANDREW JEFFERSON Typed or printed name Title Date ARTICLES OF AMENDMENT to ARTICLES OF INCORPORATION of ST. PETER' S HUMAN SERVICES, INC . 4250 38THAVENUE GIFFORD, FL 32967 Pursuant to the provisions of section 617. 1006, Florida Statutes, the undersigned FTorula non profit corporation adopts the following articles of amendment to its articles o,f incorporation. ARTICLE III Purpose(s) This corporation is being organized as a nonreligious, nondenominational organization whose purpose is to address social problems and needs of the, State of Florida and particularly those of Indian River County, Florida, exclusively for charitable and educational purposes, within the meaning of section 501 (c)(3 ) of the Internal Revenue Code (or corresponding section of any future Federal tax code. ) ARTICLE IV Manner of election of directors The manner in which the election of directors will be as follows; the chairman of the board shall be elected by the membership . The remaining board members will be appointed by the chairman for staggered terms as reflected on the board member roster in the documents of incorporation. In lieu thereof, the method of election of directors are stated in the corporations bylaws : ARTICLE V Earnings No part of the net earning of the corporation shall inure to the benefit of or be distributable to its members, trustees, directors, officers or other private persons, except that the corporation shall be authorized and empowered to pay reasonable compensation for services rendered to make f Payments and distributions in furtherance of Section 501 (c)(3 ) purposes. No substantial part of the activities of the corporation shall be the carrying on of propaganda, or otherwise attempting to influence legislation, and the corporation shall not participate in, or intervene in (including the publishing or distribution of statements) any political campaign on behalf of or in opposition of any candidate for public office. Notwithstanding any other provision of these articles, the corporation shall not carry on any other activities not permitted to be carried on (a) by a corporation exempt from Federal income tax under Section 501 (c)(3 ) of the Internal Revenue Code (or corresponding section of any future federal tax code) or (b) by a corporation, contributions to which are deductible under Section 170(c)(2) of the Internal Revenue Code (or corresponding section of any future Federal tax code. ) ARTICLE VI Assets Upon dissolution of this corporation, assets shall be distributed for one or more exempt purposes within the meaning of Section 501 (c)(3 ) of the Internal Revenue Code, i . e. charitable, education, religious or corresponding section of any future federal tax code, or shall be distributed to the Federal government, or to a state or local government for a public purpose. However, if the named recipient is not then in existence or no longer a qualified distributee, or unwilling or unable to accept the distribution, then the assets of this corporation shall be distributed to i fund, foundation or corporation organized and operated exclusively for the purposes specified in Section 501 (cx3 ) of the Internal Revenue Code (or corresponding section of any future Federal tax code). ARTICLE VII Incorporators Rev. Andrew Jefferson Mr. Reuben Lane 4236 57* Avenue 4610 43rd Court Gifford, FL 32967 Gifford, FL 32967 The date of adoption of the amendments was : 7 1996 The amendments were adopted by the members and the number of votes cast for the amendment was sufficient for approval . ST. PETER' S HUMAN SERVICES, INC . Corporation Name Signature of Chairman, Vice Chai an, sident or other officer ANDREW JEFFERSON Typed or printed name Director Dat Title y r a ST . PETER ' S HUMAN SERVICES , INC 4250 38T11 AVENUE VERO BEACH , FL 32967 PHONE : ( 561 ) 562 - 6863 ST . PETER ' S HUMAN SERVICES BY LAWS ARTICLE 1 : A Board of Directors shall be the governing body of the St . Peter ' s Human Services Corporation . The chairman of the Board of Directors shall be elected by the membership of St . Peter ' s Missionary Baptist Church . The remaining board members will be appointed by the chairman for staggered terms as reflected on the board member roster in the papers of incorporation . ARTICLE 2 . The Board of Directors shall hold at least two meetings each quarter . ARTICLE 3 . The Board of Directors shall have as its officers a chairman , vice - chairman , secretary and treasurer . The chairman ' s duties will include presiding over all meetings , appointing new board members , and insuring the integrity of all programs in the agency . The vice - chairman shall serve in the absence of the chairman . The secretary shall record and maintain all minutes and agency records . The treasurer shall collect , and deposit all income as well as maintain all financial records . ARTICLE 4 . The officers of the Board of Directors shall be known as the Executive Committee . All legal documents must be signed by the chairman plus one other member of the Executive Committee . ARTICLE 5 . The fiscal year of the Agency will begin on the first day of July and end on the last day of June in the following year . A financial audit must be completed within 90 days of the completion of each fiscal year . ARTICLE 6 . In accordance with Article III of the Articles of Incorporation , the St . Peter ' s Human Services Agency will have as one of its goals to develop , sponsor , own , and manage decent housing that is affordable to low and moderate income persons . This service will be provided to residents in Indian River County . As a part of this service , the agency will provide screening , marketing , review and certification of tenant income , and counseling to potential purchasers or tenants . Services A that provide juvenile assistance and programs in accordance with the guidelines of HRS authorities and the State of Florida , which will provide Alternative Education , Before and After school assistance , and Foster care programs to increase marketability of high risk adolescents . Rehabilitative services and care for substance abuse victims and their families . ARTICLE 7 : The agency will have standards of financial accountability that conform to Attachment F of OMB Circular A - 110 ( Rev ) " Standards for Financial Management Systems . " ARTICLE 8 : The agency will contract with consultants who have expertise in housing development and management for low and moderate income residents . ARTICLE 9 : No part of the agency ' s earnings will be used to benefit any members , founders , contributors , or individuals . ARTICLE 10 : Membership in the agency will include the Board of Directors , contributors , and residents assisted by the agency ' s programs . ARTICLE 11 : The agency will hold quarterly community open forums where program beneficiaries will be encouraged to give advice concerning design , sitting , development and management of all affordable housing projects . ARTICLE 12 : The State of Florida may not appoint more than one - third of the agency ' s membership to the Board of Directors and no more than one - third of the Board of Directors will be public officials . ARTICLE 13 : The agency will not be controlled or seeks direction from any individual or entity seeking profit from the agency . ARTICLE 14 : The agency shall be free to contract for goods and services from vendors of its own choosing .