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Resolution 2023-32726RESOLUTION NO. 2023-32726 A RESOLUTION OF THE MAYOR AND CITY COMMISSION OF THE CITY OF MIAMI BEACH, FLORIDA, APPROVING A WAIVER OF MIAMI BEACH CONVENTION CENTER RENTAL FEES FOR THE 5000 ROLE MODELS OF EXCELLENCE PROJECT, INC., IN AN AMOUNT NOT -TO - EXCEED $20,871, FOR USE OF THE GRAND BALLROOM FOR THE 2024 ANNUAL DR. MARTIN LUTHER KING, JR. UNITY SCHOLARSHIP BREAKFAST TO BE HELD ON JANUARY 14-15, 2024. WHEREAS, the City has received an application from 5000 Role Models of Excellence, Inc. (5000 Role Models) for waiver of rental fees for the use of the Miami Beach Convention Center; and WHEREAS, the 5000 Role Models Annual Dr. Martin Luther King, Jr. Unity Scholarship Breakfast ("Scholarship Breakfast") is a mentoring program committed to closing the minority male achievement gap; and WHEREAS, the primary goal of 5000 Role Models is to guide minority male students along a carefully charted path through grades K-12 and college or ensuring the attainment of other post -secondary credentials, and increasing their employability in higher wage, high skills jobs with high demand industries; and WHEREAS, the Scholarship Breakfast is a fundraising program to fund scholarships to 50 young minority males mentored through the 5000 Role Models annual program; and WHEREAS, the Scholarship Breakfast will host more than 2,500 attendees from the Miami -Dade County community; and WHEREAS, the Scholarship Breakfast will be held in the Grand Ballroom of the Miami Beach Convention Center on January 14-15, 2024, including load -in and load out; and WHEREAS, the 5000 Role Models requested that the City waive Miami Beach Convention Center ("MBCC") rental fees in an amount not to exceed $20,871; and WHEREAS, the 5000 Role Models Scholarship Breakfast provides a civic and social benefit and satisfies the MBCC rental waiver application criteria of by providing a resident community impact by delivering services to the residents of Miami Beach. NOW, THEREFORE, BE IT DULY RESOLVED BY THE MAYOR AND CITY COMMISSION OF THE CITY OF MIAMI BEACH, FLORIDA, that the Mayor and City Commission hereby approve a waiver of Miami Beach Convention Center rental fees for the 5000 Role Models of Excellence Project, Inc., in an amount not -to -exceed $20,871, for the use of the Grand Ballroom for the 5000 Role Models of Excellence Project 2024 Annual Dr. Martin Luther King, Jr. Unity Scholarship Breakfast held on January 14-15, 2024. PASSED and ADOPTED this /3 day of6Y 2023. ATTEST: SEP 2 0 2023 Rafael E. Granado, City Clerk �.INLORP�ORATE Dan Gelber, Mayor APPROVED AS TO FORM & LANGUAGE & FOR EXECUTION Cv--�r' I -6 - Z3 MIAMI BEACH COMMISSION MEMORANDUM TO: Honorable Mayor and Members of the City Commission FROM: Alina T. Hudak, City Manager DATE: September 13, 2023 SUBJECT:A RESOLUTION OF THE MAYOR AND CITY COMMISSION OF THE CITY OF MIAMI BEACH, FLORIDA, APPROVING A WAIVER OF MIAMI BEACH CONVENTION CENTER RENTAL FEES FOR THE 5000 ROLE MODELS OF EXCELLENCE PROJECT, INC., IN AN AMOUNT NOT -TO -EXCEED $20,871, FOR USE OF THE GRAND BALLROOM FOR THE 2024 ANNUAL DR. MARTIN LUTHER KING, JR. UNITY SCHOLARSHIP BREAKFAST TO BE HELD ON JANUARY 14-15, 2024. The Administration recommends the approval of the Resolution authorizing waiver of the Miami Beach Convention Center rental fee for the 5000 Role Models of Excellence Project, Inc. 2024 Annual Dr. Martin Luther King, Jr. Unity Scholarship Breakfast. In November 2018, the City of Miami Beach established Miami Beach Convention Center ("MBCC") Rental Waiver Guidelines including an application, review and approval process. The waiver is administered by the Administration, with a recommendation to the Mayor and City Commission. The rental discounttwaiver is specific to room and space rental fees only. The event producer/organizer is solely responsible for any and all other associated MBCC fees as assessed for the event, including but not limited to, audio, visual, utilities, furniture rentals, equipment, security, food and beverage, corkage fees, room set-up and cleaning. The City received an application from 5000 Role Models of Excellence Project, Inc. for a rental fee waiver for the use of the MBCC. The application has a resident community impact and/or a civic or social benefit to the residents of Miami Beach. The 5000 Role Models of Excellence Project Annual Dr. Martin Luther King, Jr. Unity Scholarship Breakfast ("Scholarship Breakfast") is a mentoring program committed to closing the minority male achievement gap. The primary goals of 5000 Role Models of Excellence Project, Inc. ("5000 Role Models") is to guide minority male students along a carefully charted path through grades K-12 and college or ensuring the attainment of other post -secondary credentials, and increasing their employability in higher wage, high skill jobs within high demand Page 551 of 293E industries. The Scholarship Breakfast is a fundraising program to fund scholarships to 50 young minority males mentored through the 5000 Role Models annual program, which in prior years has included students at Miami Beach Senior High School. The Scholarship Breakfast will host more than 2,500 attendees from the Miami -Dade County community and will be held in the Grand Ballroom of the MBCC on January 14-15, 2024, including event load -in and load -out. The 5000 Role Models organization requested that the City waive MBCC rental fees in an amount not to exceed $20,871. The 5000 Role Models has satisfied the MBCC rental waiver application criteria by providing a resident community impact through its delivery of services to the residents of Miami Beach. MBCC rental waiver application documents and requirements include, but are not limited to proof of not -for -profit status, recent tax returns, and additional sponsors. Additionally, the event must be either a major countywide special event, demonstrate Priority 1 room night generation in Miami Beach hotels, be produced by an organization based in Miami Beach or provide most services to the residents of Miami Beach. If ticketed, the event provides free entry or a discounted rate to Miami Beach residents, students and/or seniors and the City receives sponsorship recognition. FINANCIAL INFORMATION The waiver, if approved, is valued at $20,871, and reflects a loss of MBCC revenue. Amount(s)/Account(s): $20,871 The Administration recommends the approval and authorization of the MBCC rental fee waiver for the 5000 Role Models of Excellence Project, Inc. 2024 Annual Dr. Martin Luther King, Jr. Unity Scholarship Breakfast. Applicable Area South Beach No Strategic Connection Prosperity - Balance residents' quality of life with tourism and special events. Legislative Tracking Economic Development Page 552 of 2938 ATTACHMENTS: Description ❑ Rental Waiver Application ❑ 501c3 ❑ 2021 Tax Year ❑ Event Sponsors ❑ Resolution Page 553 of 2938 ,il��IIiIINll�ll�l�i!!i ((►fllflli►Illii,i„t,.,. Ii1tNu iMIAMIBEACH C O N V E N T I O N C E N T E R RENTAL DISCOUNT / WAIVER APPLICATION On Novembe, 9, 2011, the City of Mlarii Beach approved rental fee waiver guidellrtes for ne Miami Beach Cnmrerbon Center ('MBCC') 'he waterer will be administered by the Economic Development Department whirl+ vnN review and recommend qualifying appilcations to the City of Miami Beaci City Manager, who may then make a recommendation to the Mayor and City Commission. The rental discount/wafwr is speciflic to room and spa" rental fees only. The event produr-ar/orpniaer will be solely responsible for any and all outer associated MBCC fees as assessed for the event, induding but not limited to, audio, vtwal, utilities, funniture rentals, security, food and beverage, corkage fees, room set-up and deaning. NOTE: Incomplete applications will not be considered until all requested Information is provided. An application received less than 120 daye/four ;4) months prior to the event will be deemed a late application and may not be considered. Events may only apply w'tthln a 180 days /six (6) monttis prior to the event. DATE OF REQUEST: Friday, July 21, 2023 NAME OF EVENT: Or. Martin Wther King Jr. Scholarship Breakfast DATE(S) OF EVENT! Monday, :anuary 15, 2024 TIME OF EVENT: 8:30 am ESTIMATED ATTENDANCE: 2,500 REQUESTED MBCC ROOMS) AND PREFUNCTiON SPACE(S): Grand Ballroom, fi VIP Rooms NON-PROFIT S01(Q3 Oft"NiZATION NAME: (as it appears on Articles of Incorporation) : 5000 Role Models of Excellence Project FEDERAL IDJI 65-057SO14 fXECIJTNVE DfRECTOR::aKesha Wlison-Rochelle PHONE: 305-995-1612 EMAJL: Iwllson-rocheile@dadeschools.net MAILING ADDRESS: 1450 NE Z' Ave CITY: Miami STATE: FL ZIP CODE: 33132 TOTAL EVENT ROOM/SPACE RENTAL FEE: $100, 000 Updated )* 2a23 - Page 1 Page 554 of 2938 REQUESTED ROOM/SPACE RENTAL FEE WAIVER AMOUNT: $100,000 TICKET PAICE(S): S100 NUMBER OF FREE OR DISCOUNT RATE TICKETS FOR MIAMI BEACH RESIDENTS: Upon Request WHAT IS THE DISCOUNT TICKET RATE, IF APPLICABLE: N/A PLEASE PROVIDE WHAT OTHER LOCATIONS HAVE HOSTED YOUR EVENT(S) BEFORE AND WHY THE EVENT WILL NOT BE HOSTED AT THAT LOCAT*N: Fontainebleau Miami Beach Radisson Hotel intercontinental Hotel -Over Capacity PLEASE PROVIDE AN EXPLANATION WHY A MIAMI BEACH HOTEL OR OTHER VENUE CANNOT ACCOMMODATE THE EVENT: Over Capacity PLEASE DESCRIBE THE EVENT, ITS HISTORY, AND THE PUBLIC BENEFIT TO MIAMI BEACH RESIDENTS: Plains are underway for our 31" Annual Dr. Martin Luther King Jr. Scholarship Breakfast, the largest of Its kind In the nation, on Monday, January 21, 2024 — Miami Beach Convention Center. We are exb n>tfy proud that for 30 Years, the program has continued to succe9fully fulfill our mission of guiding minority boys along a carefully chiortered path to manhood and sending them to college. The audience is a large mutli-cultural cross-section of our othnlolly rich community and Is comprised of elected officials, community organimfons, religious Institutions, and Robe Model mentors and Role Model scholars* recipients. Over the course of our existence, miNbns of dollars in scholarships have been raised primarily from proceeds from our annual Dr. Martin Luther RJng Jr. Scholarship Breakfast and awarded to young men who never dreamed that coRegt would be a part of their future. CERTIFICATION / SIGNATURE I certify that all nfcrmation contained in this application and attachments are true and accurate, and that I am authorized by the applicant hereto to execute this application. Further, I agree to cover all MBCC out-of-pocket costs as outlined in the MBCC estimate attached. NAME TITLE AdMinlstratfve Director (PI e SIGNATURE DATE REQUIRED ATTACHMENTS: • A copy of 501(c)3 letter of determination, drted within the past two (2) yars. Updated lousy can be obtained from the Internal Revenue Service. • Most recent audited financial statement or IRS Form 990 • CPA prepared Compliatlon, Review or Audited financial statement for the same period as the Farm 990, above. The financial stotarnsrrt must include a Balance Sheet, Profit and Lass and Statement of Cash Flew, Updated July 2023 - " 2 Page 555 of 2938 • Event budget far the requested discount or waiver. The budget must disclose all sources and uses of funds related to the event, including the use of the requested rent discount or waiver. • Llst of all corporate and private sponsorships and In -kind contributions to be used for the event. Backup materials for the sponsorships and Irrkind contributions must be Included. SPONSORSNIP RECOGNITION: 1. City shall receive ipwisorship recognition on all media or promotional platforms related to the Event, at the same sponsorship level as ether sponsors providing f'nanclal or other support comparable to the Cill sponsorship. Event Organizer will also tag City on ail Event -related postings on digital distribution plaecrms, also referred to as soda media platforms. Event Organizer's Event -related postings shall include high quality content relevant to the Event and its targeted audiences Digital distributlon postings shall be Issued n English and Spanish, wherever relevant 2. Event Orgari;aer will use logo provided by City on all Evertt-reseed advertising. This includes Local television partners, social media campaigns, radio efforts, and local newspapers 3. All promotional rraterlals which include the CiWi name or logo, including, without limitatson, advertising, telecasts, signage and social media publkaltoro shall be subject to Cty's Dr!il W!M +fin mgmval, which approval may be w thheld at City's discretion. Event Organizer shall cease using all logos or other City marts upon the expirat'cn of the Term. Addltionaify, City reserves the right to require the removal of its '.oqo/marks from any promotional materials. Th!s paragraph shall survive the expwawn of this Agreement. Phase submit comdated appikoWn with rgpy,lred attachMcills Sq; Clty of Will Beads 1755 Meridian Avenue, 2"a Floor Miami !teach, Florida 33119 Ertl NeatherShawonslamibeedtfl.gov 'Any :hanger to tfie event detaAs in thisappacat,on (tkken pilots, datrs, dncaunts, etc.) must be approved n w+hng prior to ,he event. Farlar► to secure approval will result in revocation of the Melts Waiver. An arganuill may apply more than once per calendar year. !his watver coven IABCC rental fees only. All events must provide equal access and equal opportunity in employment and services and may not d urim.nate on the basis of disability, race or tihnicky, cold, creed, national origin, rvill , age, gender or sexual preference, in accordance with Tile VI and Tile VII of :he CPO Litti s Act of 1964, the Age Diu imination Act of 1375 and Ttle tx of the Educator Amendments or 1972 as amended (42 u.S.C. 2000 et seq.! the Americans with, Dhal lxs AR (ADA) oill and Section 504 of re i1eh4bilR8bon Att of 1973 'If waiver is approved, event must Acknowledge the City of Warn i Beach as a sponsor, uxlud ng:icy logl all marketing and oubiiii meteflals, as wetl as the fo M1ow+ng credit line in all promotional and martet.ng materials. -WNh the support of the City of Marini Beach Failure I o include :he credit fine and/w logo will reYA In revocation of the warver •..... u....... u...s••e....•.r..•................. ...•..•... •..... •a...•.....♦••e. •..... ►.. FOR MBCC ONLY: DATE(S) OF EVENT AVAttA8LE: / N TIME OF EVENT AVAILABLE: Y / N Finand;J 10VIltstioEt •i -M.0 t/ Provided Form signed try an entity officer, not dated more than one year, and has an afFrmat;en for fie preparer that tibas glint timefy filed with the Internal Revenue Service. Provided j.Vd I pja'rfed Compilation, Review or Audited financial statement for the same period as t`se Form 990, above. The financial statement must include a Balance Sheet, Profit and Loss and Statement of Cash / Flow. Provided the event budget for the requested discount or waiver The budget must disclose all sources and uses of funds related to tine event, including the use of the requested rent discount or waiver. Disdose all corporate and prvate sponsorships and it -bind contributions to be used for the event. Bacx-up materials for the sponsorships and in -kind contributions must be included. Resident Comm fty Impact Criteria for CRMWeraitlil L% Event is a major countywide special event. updated luN 2023 - Page 3 Page 556 of 2938 Event demonstrates Priority 1 room night generation to Miami Beach hotets. Event Is produced by an organization based in Miami Beach or provides most services to the residents of Miami Beau. if a ticketed event, the event provides free entry or a discounted rate to Miami Beach residents, studerts, and/or seniors. CividSoclai BWnef t Demonstrated no other venue is avaibble due to size. Demonstrated previous venues utilized for event are not suitable or available. Date ipp►ovadibenled StsM Initisls comments � al � j 10, (61 t city min naier aa►proyal/dectine date City CommWlgin aoorovalidjOlne date: _ I r l ,►�.r�i� fir'; I Page 557 of 2938 Updated luiy 2023 - Pw 4 Ju1-31-98 03:12P i►liikMAt UCilUlti &r uici: UI$li.iCI $IRECIQR C. '0. -BOX 2503 f.IMC%MMAXi • .OW 4F5#Z01 Gate: JUL % 3 1998 nOO ROLE MODELS OF EXCELLENCE PROJECT INC 1450 NE 21,113 AVE STE 700 MIAMI, FL 33132 _Dear Applicant: OEMAt4I6 NT 0f IIaE IREASURY Employer Identification Number: 6r--0575014 OLN: 170G3199019048 Contact Persone D. A. DOWNING Contact Telephone Number: (513) 241-5199 Accounting Period Ending: December 31 Form 990 Roquired: Yes Addendum Applies: Yes Based on Information supplied, and assuming your operations "III be as stated In your application for recognition of exemption, 1<e have determined you are exempt from federal income tax under section 6010) of the Internal Revenue Code- as an organization d4ucrlbed In section 601(c)(3). We have further determined that you are not a private foundation olthin the weaning of cectlon 509(a) of the Code, because you are an organlzation described in sections 509(a)(1) and 170(b)(1)(A)(vI). If your sources of support,, or your purposes, character, or method of operation change, please let us knot+ so ste can cl)nslder the effect of the change on your exempt status and foundation status. In the case of an anend-- ment to your organizational document or bylalts, please send us a copy of the amended document or bylaws. Also, you should Inform us of a I I changes In your name or address_ As of January 19 19941 you are liable for taxes under the Federal Insurance Contributions Act (social security taxes) on rEmuneratlon of $100 or more you pay to each of your edmployees during a calendar, year. You are n,:,t Ilable for the tax Imposed under the Federal Unemployment Tax Art (FUTA). Since you are not a private foundation, you are not subject to the exclse taxes under Chapter 42 of the Code. However, If you are involved In an excess benefit trancar.tion, that transaction night be subject to the eixclse taxes of section 4958. Additionally, you are not automatically exempt from other federal excise taxes. If you have any questions about excise, employ4ent, or other federal taxes, please contact your key district office. Grantors and contributor; may rely on this determination unless the Internal Revenue Service publlslies notice to the contrary. 1-11014ever,_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 aateria( change on the part of the organization that resulted In your loss of such status, or If he or she acquired knowledge that the Internal Revenue Service hdd given notice that yc•e WOUld no ;.)nger be clascifjed as a section 509(a)(1) organtzati•)n. Letter 947 M/Co) 1 Gip Page 558 of 2938 P . 02 Jul-31-98 03:13P P_03 -2- 500 ROLE MOOELS OF EXCELLENCE Donors may deduct contributions to you as provided In section 170 ),f the Code. Bequests, legacies, devises, transfers, or gifts to you or for your use are daductible for federal estate and gift tax purposes if they meet the applicable provisions of Code sections 2055, 2106, and 2522. Contribution deductions are allokable to donora only to the extent that their contributions are glftsv 14ith no consideration recelved. Ticket pur- chases and similar payments In conjunction with fundralsing oVents may not necessarily qualify as deductible contrlbutlons, depending on the circum- stances. See Revenue Ruling 67-2461 published In Cumulative Bulletin 1967-2t on page 1041 iihich sets forth guidelines regarding the deductiblllty, its charl- table contributions, of payments made by taxpayers for adailsslon to or other participation in fundralsing activitles for charity. In the heeding of this letter tie have Indicated whether you must file For% 990, Return of Organization £Kenpt Fran Iucoitle Tax. If Yes Is indicatedt you are required to file Fora 990 only If your gross receipts each year are normally more than $25000. However, If you receive a Form 990 package in the mall, please file the return even If you do not exceed the gross receipts test. If you are not required to fife, simply attach the label provided, check the box in the heading to indicate that your annual grass receipts are normally $215,000 or less, and sign the return. % If a return Is required, It roust bQ filed by the 15th day of the fifth month after the end of your annual accounting per•lod. A penalty of $20 a day is charged when a return Is filed tata, unless there fs reasonable cause for the delay. However, the aiaxlmum penalty charged cannot exceed $10000 or 6 percent of your gross receipts fur the year, whichever is le5u. For organizations ,tith gross receipts exceeding $1,000,000 in any year, the penalty is $100 per day per return, unless there is reasonable cause for the delay. The maximum penalty for an organization with gross receipts exceeding t1,000,000 shall not exceed $50,000. This penalty may also be charged if a return Is not coniplete, 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 suliporting documents, and this exemption letter. Failure to make these documents available for public inspection may subject you to a penalty of $20 per day f*r each day there Is a failure to comply (up to a maxiauw of $10000 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 rust file an Intone tax return on Fora 990-T, Exempt Organization Eusiness Income Tax Return. In this letter we are not determining whether any of your preseat or proposed activities are unre- lated trade or business as defined r section 513 of the Code. Latter 947 (OQ/CG) Page 559 of 2938 Ju-t-31-98 03: 13P P.04 -S- 600 ROLE MODELS OF EXCELLENCE You need an employer identification number even If you have no tlrployees. If an employer Identification number Sias not entered on your application, a number ►il11 be assigned to you and you will be advised of It. H ease use that number on all returns you file and In all correspondence W th the Internal Revenue Service. phis determination Is based on evidence that your funds are dedicated to the purposes listed In section B01(c)(3) of the Cvda. TO assure your continued Exemption, you should keep records to shcxl that funds are expeeded only for those purposes. If you distribute funds to other org#nizatlons, your records should nhost whether they are ererApt under section 501(c)(3). -In cases slhere the recipient organization Is not exempt under section C101 (c) (3), there should be evidence that the funds will remaln 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 nares, addresses► purposes of aslards, manner of selection, relationship (if any) to members, officers, trustees or donors of funds to you, xa that any and all distributions made to Individuals can be aubstantlated upon request by the Internal Revenue Service. (Revenue, RuIisg 56-3041 C.B. 1956-2, page 306.) If Re have Indicated In the heading of this letter that an addendum applles, the enclosed addendum Is an Integral part of this letter. Be -Cause this letter could help resolve any questions about your ek*mpt status and foundation status, you should keep It In your permanent records. If you have any questions, please contact the person mhose name and telephone number are sho,in in the heading of this letter. Enclosure(6)1 Addendum Sincerely yours, District Director Page 560 of 2938 LYtter 947 (Do/CG) C�Oo [P�t7 0U 1-31-Lits VJ 1•+r Y-V� t 500 ROLE MODELS OF EXCELLENCE The value of time or personal services c!,ntrlbuted to your organization by volunteers Is not deductible by those volunteers as a charitable contributlon for Federal Income tax purposes. You should advise your volunteers to this effect. Letter 947 (00/CG) Page 561 of 2938 t tb �d-GN43T 23:29 IRS i Department of the Treasury interns[ Revenue Service Ogden, UT 84201 5000 ROLE MODELS OF EXCELLENCE PROJECT INC % LYNN C WASHINGTON 1450 NE 2ND AVE STE 227 MIA►Mi FL 33132-1308 501 Taxpayer Identification Number: 65-0575014 Form(s): Dear Taxpayer: This letter is in response to your telephone inquiry of February 23rd, 2007. 510 637 3225 P.02 In reply refer to: Change Your ID] Feb 23, 2007 LTR 147C 65-0575014 -Tba Employer Identification Number ($1N) shown abovt5has been assigned to you for business Federal tax purposes, Please include it when making Fedoral tax deposits, filing tax returns, and when corresponding with, or speaking to, the Internal Revenue Service, If you have any questions regarding this letter, please call our Customer Service Department at 1-800-829- 0115 between the hours of 7,00 AM and 10:00 PM. If you profer, you may writ© to us at the address shown at the top of the first page of this letter. When you write, please include a telephone number where you may be reached and the best time to call. Sincerely, J -�', S Williams 9430617 Customer Service Representativc Page 562 of 2938 TUTAI_ P. 02 Four 8879-TE IRS "Ie Signature Authorization for a Tar. Exempt Entity For calendar year 2021, or fiscal year beg+,onln0 , 2021, and ending , 20 Dewy of ttx Treasvy ► Do not said to the IRS. Keep for your records- IMenel Reverxie Service ► Go to www.ln.gov/Forn8MTE for the latest Information. Name of low - — EN or SSN 5000 Role Models of Excellence Project, Inc 65-05?5014 Name and h;ie of officer or person subject to tax OMB No 1545-0047 22'�21 Wilbert 7 Holloway, Chairman EMSEV Type of Return and Return Information Check the box for the return for which you are using this Form 8879-TE and enter the applicable amount, if any, from the return. Form 8038- CP and Form 5330 filers may enter dollars and cents. For all other forms, enter whole dollars only. If you check the box on line Is, 2a, 3s, 4a, 5s, 6a, 7s, 8s, 9a, or 10s below, and the amount on that line for the return being filed with this form was blank, then leave line 1b, 2b, 3b, 4b, 5b, 6b, 7b, 8b, 9b, or 10b, whichever is applicable, blank (do not enter -0-). But, if you entered -0- on the return, then enter -0- on the applicable line below. Do not complete more than one line in Part I. 1a Form 900 check here . . ► ® b Total revenue, if any (Form 9%, Part VIII, column (A), line 12) 1b 485,054. 2a Form 990-FZ check here . ► ❑ b Total revenue, if any (Form 9%-EZ. line 9) . . . . . . . . 2b 3a Form /120-POL check here 0- ❑ b Total tax (Form 1120-POL. line 22) . . . . . . . . . . 3b 4a Form 990-PF check here - i► ❑ b Tax based on irrwstrwnt Income (Form 990-PF. Part V, line 5) . 4b 5a Form 8868 check here. ► ❑ b Balance due (Form 8868, line 3c) . . . . . . . . 5b 6a Form 990-T check here ► ❑ b Total tax (Form 990-T, Part III, line 4) . . . . . . . . . 6b 7a Form 4720 check here . ► ❑ b Total tax (Form 4720. Part III, line 1) . . . . . . . . . . 7b 8a Form SW check here. ► ❑ b FMV of assets at snd of tax year (Form 5227, Item D) . . 8b 9a Form S330 check here. ► ❑ b Tax due (Form 5330, Part 11, fine 19) . . . . . . . . 9b 10a Form 8038-CP check here No, ❑ b Amount of credit payrinertt requested Form 8038-CP, Part III, lire 22 tOb Declaration and Signature Authorization of Officer or Person Subject to Tax Under penalties of perjury, I declare that ® 1 am an officer of the above entity or ❑ I am a person subject to tax with respect to (name of entity) , (E,N) and that I have examined a copy of the 2021 electronic return and accompanying schedules and statements, and, to the best of my knowledge and belief, they are true, correct, and complete. I further declare that the amount in Part I above is the amount shown on the copy of the electronic return. I consent to allow my intermediate service provider, transmitter, or electronic return originator (ERO) to send the return to the IRS and to receive from the IRS (a) an acknowledgement of receipt or reason for rejection of the transmission, (b) the reason for any delay in processing the return or refund, and (c) the date of any refund. If applicable, I authorize the U.S. Treasury and its designated Financial Agent to initiate an electronic funds withdrawal (direct debit) entry to the financial institution account indicated in the tax preparation software for payment of the federal taxes owed on this return, and the financial institution to debit the entry to this account. To revoke a payment, I must contact the U.S. Treasury Financial Agent at 1-BBB-353-4537 no later than 2 business days prior to the payment (settlement) date. I also authorize the financial institutions involved in the processing of the electronic payment of taxes to receive confidential information necessary to answer inquiries and resolve issues related to the payment. I have selected a personal identification number (PIN) as my signature for the electronic return and, if applicable, the consent to electronic funds withdrawal. PIN: check one box ony ®i authorize Nei l ly Financial Services Inc _ to enter my PIN 1 2 3 4 5 as my signature ERO firm name _ Enter five numbers, but do not entar all zeros on the tax year 2021 electronically filed retum. If I have indicated within this return that a copy of the return is being filed with a state agency(ies) regulating charities as part of the IRS Fed/State program, I also authorize the aforementioned ERO to enter my PIN on the return's disclosure consent screen. ❑ As an officer or person subject to tax with respect to the entity, I will enter my PIN as my signature on the tax year 2021 electronically filed return. If I have indicated within this return that a copy of the return is being filed with a state agency(ies) regulating charities as part of the IRS Fed/State program. I will enter my PIN on the return's disclosure consent screen. —A Sqnftre of officer or person subject to tax ► Date► 11/15/2022 Certification and Authentication ERO's EFIN/PIN. Enter your six -digit electronic filing identification number (EFIN) followed by your five -digit self-selected PIN. 6 0 9 8 7 9 I 2 3 4 5 Do not emw aY zaroe I certify that the above numeric entry is my PIN, which is my signature on the 2021 electronically, filed return indicated above.: confirm that I am submitting this return in accordance with the requirements of Pub. 4163, Modernized e-File (MeF) Information for Authorized IRS a -file Providers for Business Returns. ERO's s+gnsturs ► Date ► 11 / 15 / 2 02 2 ERO Must Retain This Form — See Instructions Do Not Submit This Form to the IRS Unless Requested To Do So For Privacy Act and Paperwork Reduction Act Notice, see , Of V 07r2S,-n aRo Form 8879-TE (2021) RAA Farm 990 1 Return of Organization Exempt From Income Tax Under section 501(c), 527, or 4847(mgl) of the Internal Revenue Code (except pr;vate foundrbons) Departrnertt of the Treasury ► Do not enter social severity numbers on this forth as it may be made public. IrRernal Revenue Service ► Go to www.irs.gov/Forr?i6W for instructions end the Latest information. OMB No, 1545-OD47 I 2021 A For the 2021 calendar year, or tax year beginning 2D21, and ending .20 s Check +fapplicable: CNarneoforganimticn5000 Role Models of Excellence Protect :nc oEttltpioyaklentificedwnuntber ❑ Asdrwschange Doirpbusinessas 500C Rc::e vodeis of Exce:_ence P-o'ect Inc 65-0575014 Name change Number and street W P.O born if mail is not delivered to street address) Roornrauite E TMsphone number [) nihal return 1450 NE 2rd Avenue 4227 t 3C5' 995-2452 Fnal retrrrnermnated City or town, state or province, country. and LP or foreign postal code A nerx>Ad return 'Miami, FL 33132 O Gross receipts S 4 8<<^ 5 4 C Applrcat,on pending F Name and address of principal officer: H(a) is the a grow ream for sibordrAes' _ ] Yee E No lWi-iDert T lio-loway, 1450 NE 2nd Avenue Miami EL 33132 H(b)Amall subordinates included? ❑ Yee [; No I Tax-exempt status: ® 501(c)(3) ❑ 501(C) ( ) A (insert no.) ❑ 4947WX1) or ❑ 527 If -No,- attach a list. See instructions d web«b: ► www, 5000rolemode.s.cam H(c)Groupexemption number ► K Form oloroenQsti n Coroorahon nTrust n Assocrefion n Other► l Year of fomratron: 19 9 41 M State of I..I domc le FL summary 1 Bnefly describe theorganization's mission or most significant activities: Tic pro;Ec's mission is to interfere ir.::e ........................ ........................... ' _ives of at risk boys, :_order to orcvide then with alternatives that will lead them away. ...............................-----------------------------•- .. .. .- - - from afe•me and vio;ence. 2 _•14 _of•_cr -----------------------------------------------------•------ Check this box► ❑ Nthe organization discontinued rts operations or disposed of more than 25% of its net assets. t°y 3 Number of voting members of the governing body (Part VI, line ta) . 3 3 4 Number of independent voting members of the governing body (Part VI, line 1 b) . . . . 4 3 j I 5 6 7a Total number of individuals employed in calendar year 2021 (Part V, line 2a) Total number of volunteers (estimate if necessary) . . . Total unrelated business revenue from Part V111, column (C), line 12 . . . . . . . . . . . . S d 7a _ 0 0 `1 , b Net unrelated business taxable income from Form 990-T, Part I, tine 11 7b 0 , Prior year Current Year e 8 9 10 11 Contnbutlons and grants (Part VI 11, line th) , . . Program service revenue (Part VIII, line 2g) investment income (Part VIII, column (A), lines 3, 4, and 7d) Other revenue (Part Vill, column (A), lines 5, Sid, 8c, 9c, 1Oc, and 11 e) . . . 636 683. 411 722 . 3 124. 3 332 . 639 807. 485 054. 12 Total revenue —add lines 8 through 11 (must equal Part VIII, column (A), line 12) 13 Grants and similar amounts paid (Part IX, column (A), lines 1-3) 241,428. 185 421 . 14 Benefits paid to or for members (Part IX, column {A), line 4) . . . . . . ■ 15 Salaries, other compensation, employee benefits (Part lX, column (A), lines 5-10) 16a Professional fundraising fees (Part IX, column (A), line 1 le) b Total fundraising expenses (Part IX, column (D), line 25) ► C, < 4d 17 ....................-t-- Other expenses (Part IX, column (A), lines 1la-11d, 1lf-24e) . . . . . 92, 2.7' 66, 604. 333 701 . 252 025. 18 Total expenses. Add lines 13-17 (must equal Part IX, column (A), line 25) 306 106. 233 029. 19 Revenue less expenses. Subtract line 18 from line 12 i 20 Total assets (Part X, line 16) . . . . . . . . . . . . . Beelis ittp of Curerd Year End of rear 2, 194 889. 2 431 187, -3 2: 0, 58. 21 22 Total liabilities (Part X, line 26) . . - . . . . . Net assets or fund balances. Subtract line 21 from line 20 1 98 , 099 . 1431,129a nature Block under penatties of perjury. I declare that I have exarwed then retum, rSudv+g etxorrpsnyng schedules and statements, and to the Dent of my xnowledge and belief it is MR correct, and complete Declaration of preperer !o than officer) is based on all Wftmebwhich on of prepareMA . has any knoedge- wIll /1z/2022 Sign / Signaturillid officer Date Here � Wilbert 7 ficiioway, Chairman Type or print name and title Print/Type preparers name Preperer, t Date Check ❑ if I FrnN Paid Renay Pciite-Neill Rera e-Nel-Iy" 11/15/2022 sett -employed Preparer UseOniy Firms name 111" Neilly Financial Services Inc iFI)oneno irtn'sEIN► 46-1735836 F,—saes _ddrs 0-5030 M1 163rd Street Miami .. 33055 '305 625-0625 May the IRS discuss this return with the preparer shown above? See instructions ®Yes ❑ No For Paperwork Reduction Act Notice, see the separate instructions. SAA REV 07rn112 P R 0 Form 990 (2021) Page 564 of 2938 Fd.- 990 -r_-z 1 page 2 Fra—ff III Statement of Program Service Accomplishrr►ents Check if Schedule O contains a response or note to any line m this Part !!I ❑ 1 Briefly describe the organization's mission: Tre••pro;ect's m ss:.o_r._ is -o intervene _n_ the lives of at risk boys,_-__.-_.____- _ _-____--_,___. - -- -- -• - - -----------•••-----•-----•-••-- in•_order to provide_-them__wth,_a=erra=_ves,-that wi::,,lead-,them-away -------- from a life of crime ar-— ---•------._...._.._.__..._._...___._....._................... ------- 2 Did the organization undertake any significant program services during the year which were not listed on the pnor Form 990 or 990•EZ? . . . . . . . . . . . . . . . . . . . ❑ Yea No f "Yes," descrbe these new services on Schedule 0. 3 Did the organization cease conducting, or make significant changes in how it conducts, any program services? . . . . . . . . . . . . . . . . . . . . . . . . . . (] Yen No ;f "Yes," describe these changes on Schedule 0. 4 Descrbe no organization's program service accompl shments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported. 4a (Code: ...............1 (Expenses S 25 02 5 _ includng grants of S _.__---____--____Q__.) (Revenue S ..._..:. ) ei_3.:.irt.i�__��u»ti7._.�.:��lr4Ct�ii.r.�_�..__.:+.:=:•,n�_::•_._..—:::.::a...... ..•�1 �j a e h11_.tI,9Y_�t__YlL_CatY__Yf..ni.: f.Y._t s+Y.. ��:Y Yt��.L ..: AiRYY.YATtLY._!:l .R.�<fA�A_SYn flY �ll.•r_... The--fpSARX_.R�3g�ilf4__Ss__3e�Y�&�D9__Q3feJC._$AQ4__studgnts................. _.............. _............. —. ... _.. • •------------------------I............ .. --------------------------------------------•-•--•-----...._.............__.-----•--------•-•------•---•--------•-...__................................_........._.. .......I—---............... •..... •----------------------------- —------------ —-------------------------------------- —.................................................. 4b (Code:---------------) (Expenses S............. -.... ---_including grants of S.................... ... ) (Revenue S - ) ..................................................._....--•--------•--------------._.._......._....._ _...--• •_. _..._.............. _._......... _.. _.......-_ -------_... .................................. . ....-•--.......... _ ....... 4c (Code: ......) (Expanssa s including grants of $ ................ ) (Revenue $ .. ........ .................. ............... --------- ---•-I......_......... .. 4d Other program services (Describe on Schedule 0.) (Expenses $ including grants of $ ) (Revenue $ ) 4e Total program service expenses ► 2 52 , 025. aw a7r25r22 PRO ;:0" 990 p02t) Page 565 of 2938 Toren 9% (K2 1) Pare 3 Fart Checklist of Required Schedules Yrs No 1 Is the organization descrbed in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If "Yes," complete Schedule A . . . . . . . . . . . . . . . . . . . . . . t x 2 !s the organization required to complete Schedule B, Schedule of Contnbutors? See instructions . . . . 3 Did the organization engage in direct or indirect political campaign activ ties on behaf of or in opposition to candidates for public office? If 'Yes," complete Schedule C, Part I . . . . . . . . . . . . . . 4 Smtion 501(cH3) organizations. Did the organization engage in lobbying activities, or have a section 501(h) election in effect during the tax year? If 'Yes," complete Schedule C, Part 1f . . . 5 is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Rev. Proc. 98-19? If "Yes," complete Schedule C. Part 111 . . 6 Did the organization maintain any donor advised funds or any s.milar funds or accounts for which donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If 'Yes,' complete Schedule D, Part 1 . . . . . . . . . . . . . . . . . 7 Did the organization receive or hold a conservation easement, including easements to preserve open space, the environment, historic land areas, or Nstonc structures? If "Yes," complete Schedule D, Part II . . . 8 Did the organization maintain collections of works of art, historical treasures, or other similar assets? If "Yes," complete Schedule D, Part 111 . . . . . . . . . . . . . . . . . . . . 9 Did the organization report an arnount in Part X, line 21, for escrow or custodial account liability, serve as a custodian for amounts not listed in Part X; or provide credit Counseling, debt management, credit repair, or debt negotiation services? If "Yes,' complete Schedule D, Part IV . . . . . . . . . . . . . 10 Did the organization, directly or through a related organization, hold assets in donor -restricted endowments or in quasi endowments? If "Yes," complete Schedule D, Part V . . . . . . . . . 11 !f the organization's answer to any of the fol'.owing questions is "Yes," ther complete Schedule D, Parts VI, VIi, VIII, DC, or X. as applicable. a Did the organization report an amount for land, buildings, and equ;pmert in Part X, line 10? If "Yes," complete Schedule D. Part VI . . . . . . . . . . . . . . . . . . b Did the organization report an amount for investments —other securities in Part X, line 12, that is 5Yo or mots of its total assets reported in Part X, line 16? if 'Yes,' complete Schedule D, Part VN . . . . . . . . c Did the organization report an amount for investments —program related in Part X, line 13. that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part Oil . . . . . . . . d Did the organization report an amount for other assets in Part X, 'ine 15, that is 5% or more of its total assets reported in Part X, line 16? If "Yes,' complete Schedule D, Part IX . . . . . . . . . . . . . a Did the organization report an amount for other liabilities in Part X, line 25? If "Yes," complete Schedule D. Part X f Did the organizallion's separate or consolidated financial statements for the tax yew include a footnote that addresses the organization's liability for uncertain tax positions under FIN 48 (ASC 7401? if "Yes," complete Schedule D, Part X 12a Did the organization obtain separate, ndependent audited financial statements for the tax year? If "Yes," complete Schedule D, Pacts Xl and XII . . . . . . . . . . . . . . . . . . . . . . . b Was the organization included in consolidated, independent audited financial statements for the tax year? If 'Yes,' and if the organization answered 'No' to line 12a, then completing Schedule D, Parts XI and Xff is optional 13 Is the organization a school described in section 170(b)(1)(A)(ii)? If 'Yes,' complete Schedule E . . . . 14a Did the organization maintain an office, employees, or agents outside of the United States? . . . . . b Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, investment, and program service activities outside the United States, or aggregate foreign investments valued at S100,000 or more? N'Yes,' complete Schedule F, Parts f and IV. . . . . 15 Did the organization repot on Part IX, column (A), line 3, more than $5,000 of grants or other assistance to or for any foreign organization? If "Yes, " complete Schedule F Parts 11 and IV . , . . . . 16 Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or other assistance to or for foreign individuals? If "Yes," complete Schedule F, Parts III and IV. . . . . . . . 17 Did the organization report a total of more than $15,000 of expenses for professional fundraising services on Part IX, column (A), lines 6 and I le? If "Yes." complete Schedule G, Part I. See instructions . . . . . 18 Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines 1 c and 8a? If 'Yes,' complete Schedule G, Part f! . . . . . . . . . . . . . . . 19 Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? If'Yes,"Complete Schedule G, Part ill . . . . . . . . 20a Did the organization operate one or more hospital facilities? tf'Yes," complete Schedule Fl . . . . . . b If "Yes" to line 20a, did the organization attach a copy of its audited financial statements to this return? . 21 Did the organization report more than $5,000 of grants or other assistance to any domestic organization or domestic 0overnment on Part IX, column (A), line 1? if `Yes,' complete Schedule f, Parts I and It . . . . REV CMZ5r= Pao Page 566 of 2938 4 1 X 5 x i 6 X 7 x 8 x 9 x 10 X 11a x 11b x 11c x lld x 11e x 1111' x 12e X 12b X 13 X 14a x 14b x 15 x 16 X 17 x 18 x 19 x 3M x 20b Form, 990 :202i; Form 99J rK21; Face 4 Check)ist of uired Schedules(confinuecq Yes 22 Did the organization report more than $5,000 of grants or other assistance to or for domestic individuals on Part IX, column (A), line 2? Il 'Yes," complete Schedule 1, Parts I and ill . . . . . . . . . 22 23 Did the organization answer "Yes" to Part VII, Section A, line 3, 4, or 5, about compensation of the organization's current and former officers, directors, trustees, key employees, and highest compensated employees? If "Yes," complete Schedule J . . . . . . . . . . . . . . . . . . . . 23 24a Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $10C,000 as of the last day of the year, that was issued after December 31, 20027 If 'Yes," answer lines 24b through 24d and complete Schedule K. If "No, " go to line 25a . . . . . . . . . . . . 249 24b b Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception? 24c c Did the organization maintain an escrow account other than a refunding escrow at any time during the year to ciefease any tax-exempt bonds? . . . . . . . . . . . . . . . . . . . . . . . 24d d Did the organization act as an "on behalf of" issuer for bonds outstanding at any time during the year? . , 25s Section 501(c)(3), 501(c)(4), and 501(cX20) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If "Yes,' complete Schedule L. Part I . . . . . 25e b Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organlzation's prior Forms 990 or 990-EZ? If 'Yes,' complete Schedule L. Part l . . . . . . . 25b 26 Did the organization report any amount on Part X line 5 or 22, for receivables from or payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons? if "Yes," complete Schedule L, Pert U . . . 26 27 Did the organization provide a grant or other assistance to any current or former officer, director, trustee, key r -- employee, creator or founder, substantial contributor or employee thereof, a grant selection committee member, or to a 35% controlled entity (including an employee thereof) or family member of any of these persons? If "Yes,' complete Schedule L, Part U/ . . . . . . . . . . . . . . . . . . . . 27 28 Was the organization a party to a business transaction with one of the following parties (see the Schedule L, Part IV, instructions for applicable filing thresholds, conditions, and exceptions): a A current or former officer, director, trustee, key employee, creator or founder, or substantial contributor? If 'Yes,' complete Schedule L, Part IV . . . . . . . . . . . . . . . . . . . 28a 28b b A family member of any individual described in line 28a? If'Yes,' complete Schedule L, Part IV . . . . 28c c A 35% controlled entity of one or more individuals and/or organizations described n line 28a or 28b? If Yes " complete Schedule L, Part IV . . . . . . . . . . . . . . . . 29 Did the organization receive more than $25,000 in non -cash contributions? If "Yes, " complete Schedule M 29 30 Did the organization receive contributions of art, historical treasures, or other similar assets. or qualified conservation contributions? If "Yes, " complete Schedule M . . . . . . . . . . . . . . . 30 31 31 Did the organization liquidate, tenrmate, or dissolve and cease operations? ff "Yes," complete Schedule N, Part 1 32 Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If "Yeas," complete Schedule N, Part 11 . . . . . . . . . . . . . . . . . . . . . . . . . 32 33 Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301-7701-37If "Yes,' complete Schedule R, Part I . . . . . . . . . . . 33 34 Was the organization related to any tax-exempt or taxable entity? tf "Yes," complete Schedule R, Part 11, 111, or IV, and Part V, line f . . . . . . . . . . . . . . . . . . . . . . . 34 36a Did the organization have a controlled entity within the meaning of section 512(t*13)? . . . . . . . 35e 35b b If "Yee" to line 35a, did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If `Yes,' complete Scheatrle R, Part V, line 2 . . 38 Section 501(c)(3) organizations, Did the organization make any transfers to an exempt inn -charitable related organization? If "Yes,' complete Schedule P, Part V, line 2 . . . . . . . . . . . . . 36 37 Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes? If 'Yes,' complete Schedule R, Part 0 37 38 Did the organization complete Schedule 0 and provide explanations on Schedule O for Part VI, lines 1lb and 19? Note- All Form 990 filers are required to complete Schedule 0 . . . . . . . . . . . . 38 1 X X X X X X X X X X X X X X X X W X X Check if Schedule 0 contains a response or note to any line in this Part V . L Yes I No to Enter the number reported in box 3 of Form 1096. Enter -0- if not applicable . . . Ila 0 b Enter the number of Forms W-20 included online 1a Enter -0- if not applicable 1b 0 c Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? . . . . . . . . . . . . . . . . . REV 0725rn PRo Page 567 of 2938 =orm WdFU V021i Form 9% Z 2' page 5 IMW Statements Regarding Mill IRS Rings and Tax Com fence (continued) yes No 28 Enter the number of employees reported on Form W-3, Transmittal of Wage and Tax Statemerts, filed for the calendar year ending with or within the year covered by this return ' 0 b If at least one is reported on line 2a, did the organization file all required federal employment tax returns? 2b Note: '1 the sum of lines 1 a and 2a is greater than 250, you may be required to a-lrie. See instructions. 3a Did tie organization have unrelated business gross income of $1,DOC or more during the year? . I 3a X b If "Yes," has it filed a Form 990-T for this year? If "No" to line 3b, provide an wplanaton on Scheduie O j 3b 4a At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a fnancial account in a foreign country (such as a bank accoul securities account, or other financial account)? 4a X b if "Yes," enter the name of the foreign country ► See instructions fa ding requirements for FinCEN Form 114. Report of Foreign Bank and Finanaai Accounts {FEAR). 5a Was the organization a party to a prohibited tax sheiter transaction at any time during the tax year? . . tie X b Did any taxable party notify the organization that it was or is a party to a prohibited tax shetter transaction? 5b X C If "Yes" to line 5a or 5b, did the organization fie Form 8886-T? . . . . . . . I . . . 5c 6a Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contnbubons that were not tax deductible as charitable contributions? . . . . X b If "Yes," did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible? 61b 7 Organizations that may receive deductible contributions under section 170(c). a Did the organization receive a payment in excess of $75 made partly as a contnbution and partly for goods and sere ces provided to the payort 7a X b f "Yes," did the organization notfy the donor of the value of the goods or services provided? . . . . . 7b c Did the organization sell, exchange, or otherwise d,spose of tangible personal property for which it was required to file Form 8282? . . . . . . . . . . . . . . . . . . 7c . X d If "Yes," indicate the number of Forms 8282 filed durng the year . . . . . . L7d e Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract? 7e X f Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract? 71 X g If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required? 7g X h It the organization received a contribution of cars. boats, airplanes, or other veincles, did the organization fie a Form 1098-C? 7h X 8 Sponsoring organizations maintaining donor advised funds. Did a donor advised fund maintained by the sponsoring organization have excess business holdings at any brae during the year? g X 9 Sponsoring organizations maintaining donor advised funds. a Did the sponsoring organization make any taxable distributions under section 4966? 9a X b Did the sponsonng organization make a distribution to a donor, donor advisor, or related person? 9b X 10 Section 501(cXn organizations. Enter a Initiation fees and capital contnouitions included on Part Vl 1, i:ne 12 . . . . . . . 1 108 b Gross receipts, included on Form 990, Part VIII, line 12, for public use of dub facilities 10b 11 Section 501(c)(12) organizations. Enter a Gross income from members or shareholders 11a b Gross income from other sources. (Do not net amounts due or paid to other sources against amounts due or received from them.) . . . . . . . . 11 b 129 Section 4947(aXl) non --exempt chartable trusts. 's the organization fling Form 9% in lieu of Form 1041? 12a b f "Yes," enter the amount of tax-exempt interest received or accrued during the year. . Iffi 13 Secton 501(cHW) qualified nonprofit heath insurance issuers. a Is the organization licensed to issue qualified health plans in more than one state? . . . . . . . . 13a Note: See the instructions for additional information the organization must report on Schedule 0. b Enter the amount of reserves the organization is required to maintain by the states in which I the organization is licensed to issue quaGfied'tealth plans 13b' c Enter the amount of reserves on hand 13c 11 14a Did the organization receive any payments for indoor tanning services during the tax year? . . . 140 X b If "Yes," has it filed a Form 720 to report these payments? If •No.' provide an explanation on Schedule O 14b 15 is the organization sutpct to the section 4960 tax on payment(s) of more than $1,000,000 in remuneration or excess parachute payment(s) during the year? . . . . . . . . . . . . . . . 1s If "Yes," see the instructions and file Form 4720, Schedule N. MMM 16 s the organization an educational institution subject to the section 4968 excise tax on net nvestment income? 16 If "Yea," complete Form 4720, Schedule 0. 17 Section 501(c)(21) organizations. Did the trust, any disqualified person, or mine operator engage it any activities that would result in the,mposition of an excise tax under section 4951, 4952 or 4953? . . . 17 l REV �7R'Y22 PRO Page 568 of 2938 Form VM 9021i -OrTr 99C2,2- PapeB Governance, Management, and Disclosure, For each "Yes" response to Imes 2 through 7b below, and for a 'No" response to line Be, 8b, or 10b below, describe the circumstances, processes, or changes on Schedule 0. See instructiorts Check if Schedule 0 contains a response or note to any line in this Part A Section A. Governing Body and Management Yes No I Enter then umber of voting members of the goveming body at the end of the tax year �la If there are material differences in voting rights among members of the goveming body, or if the goveming body delegated broad authority to an executive committee or similar committee, explain on Schedule 0. b Enter the number of voting members .nduded on line la, above, who are independent lb J 3 2 Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee? . . . . . . . . . . . 2 3 Did the organization delegate control over management duties customarily performed by or under the direct supervision of Officers, directors, trustees, or key employees to a management company or other person? . 3 4 Did the organization make any sign,ficant charm changes to its goveming documents since the prior Form 990 was filed? 4 5 Did the organization become aware during the year of a significant diversion of the organization's assets? 5 6 Did the organization have members or stockholders? . . . . . . . . . . 6 7a Did the organization have members, stockholders, or other persons who had the power to elect or appoint one or more members of the governing body? . . . . . . . . . . . . . . . 70 b Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or parsons other than the goveming body? . . . . . . . . . . . . . 7b 8 Did the organization contemporaneousty document the meetings held or written actions undertaken during the year by the following: a The governing body? . . . Be b Each committee with authority to act on behalf of the governing body? 8b 9 Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization's mailing address? If "Yes, " provide the names and addresses on Schedule O g j T !a oy me inrernaf revenue t, e.) Vyy T No 10o Did the organization have local chapters, branches, or affiliates? 10e x b If Wes," did the organizabon have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with the organization's exempt purposes? 10b Ile Has the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form? 11e x b Describe on Schedule 0 the process, if any, used by the organization to review !his Form 990. MMM 12a Did the organization have a written conflict of interest policy? If 'No," go to fine 13 . . . . . . 12e x b Were officers, directors, or trustees. and key eriployees required to disclose annually ;nIwests that could give rise to conflicts? 12b x c Did the organization regularly and consistently mon for and enforce compliance with the policy? If "Yes,' describe on Schedule 0 how rNs was done. 12c x 13 Did the organization have a written whistleblower policy? . . . . . . . . . . . . . . . . . 13 x 14 Did the organization have a wntten document retention and destruct on policy? . . . . . . 14 x 15 Did the process for determining compensation of the following persons include a review and approval by independent persons, comparability data, and contemporaneous sibstantiation of the deliberation and decision? a The organization's CEO, Executive Director, or top management official 15e x b Other officers or key employees of the organization 15b x If "Yes" to line 15a or 15b, describe the process on Schedule 0. See instructions. 16a Did the organization invest in, oontnbute assets to, or participate in a joint venture or similar arrangement with a taxable entity during the year? . . . . . . . . 16e x b If 'Yes," did the organization follow a written policy or procedure requiring the organizabon to evaluate its participation in joint venture arrangements under applicable federal tax law, and take steps to safeguard the organization's exempt status with respect to such arrangements? . . . . . . . . - . . . . 16b Disclosure 17 moist the states with which a copy of this Form 990 is required to be filed Or 18 Section 6104 requires an equ organization to make its Farris 1023 ;1024 or +024-A, H applicable), 990, and 990-T (section 501(c} (3)s only) available for public inspection. Indicate how you made these available. Check all that apply. ❑ Own website ❑ Another's webade ❑ Upon request ❑ Other (explain on Schedule Oj 19 Describe on Schedule 0 whether (and if so, how) the organization made its governing documents, conflict of interest policy, and financial statements available to the public during the tax year. 20 State the name, address, and telephone number of the person who possesses the organization's books and records ► Pamela Jones, 1450 NE 2nd Ave $221, Miami, FL 33132 305)995-2452 afv cl;?,vz PRO : or•n 990 2c2 - I Page 569 of 2938 Fort 990 k2021 Pape 7 WaffWM Compensation of Officers, Directors, Trustees, Key Employees, Highest Compensated Employees, and kwlependent Contraotors Check if Schedule 0 contains a response or note to any line in this Part Vfl Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employee• la Complete this table for ail persons required to be listed Report compensation for the calendar year ending ,tenth or within the organ,zaton's tax year • List all of the organization's current officers, directors, trustees (whether individuals or organizations), regardless of amount of compensation. Enter -0- in columns Q), (E), and (F) if no compensation was paid. • List Al of the organization's current key employeas, if any. See the instructions for definition of `key employee." • List the organization's I've current highest compensated employees (other than an officer, director, trustee, or key employees who received reportable compensation ;box 5 of Form W-2, Form 1099-MISC, and/or box ' of Form 1099-NEC) of more than $100,000 from the organization and any related organizations. • List ail of the organization's former officers, key employees, and highest compensated employees who received more than $100,000 of reportable compensatior from the ongarization and any related organizations. • List all of the organization's former directors or trustees that received, in the capacity as a former director or trustee of the organization, more than $10,000 of reportable compensation from the organization and any related organizations. See the instructions for the order in which to list the persons above. ® Check this box if neither the organization nor any related organization compensated any current officer, director, or trustee. fell (A)191 Pce�tion tW (El fFl po rof check more Man one Narne and n14 Average Dox ,wkm persor is bon an Reportabie Fteportablo Esknntod amount nours officer and ad irectoritr,ls*aw compersatror cornDens Wicin of O W Per Wow from the '-om related cemDensalion Q n L i ,� 3 a o Fist any orpan.e'ton NY-2/ aganizaborx Na-2i 'rom Me h a.m fo( m * 1099-M'Sci 1099-Y SC/ organ ID7on and •elaled 1099-NEC`, 1098 NM rela'Bd orpan'ratKX* buloa Boned i no) g' (1)Wilbert T. Holloway.__-_____-_____•__ .................. 1:00 Chairman on Patters.._-...--. -------------- ------------ 1:-00 President x x (3)Timothy_Belcher----------------------- i.00 i ----------- Director - -(4) ........... -.............. ............... ............................... - - 15)---------- ------------ ------------------ ---............................. 16)........... ------------------------------ -.............................. --........ -.................. -......... -............................... ........................................------------ ... ......... j11}- ---- ------ --------------------- ------------- Nk----------------------........... ---------- (t3) .... _.... .... . Oq- _. _--------------- --------------- -- REV cTMIM PRO Iorm W0,2021; Page 570 of 2938 Gone 990 L2a21 ` Pago 8 MyerME Section A. Officers, Directors, Trustees. Kev Emdovess. and Hiahest Compensated Emdovees (continued) (c) W (al Positon (U) f4 (Fl bm o -CI uecx ora ;liar one Name and 't'a Average box. un ass porno" ,s bolt an Reportable Reowkie Esti -iate0 amours: hours OM-er and a alrector/trus'ae) cornaerneUon compersa;icn 01 o'hw Pei +eert from the 'rom elated compensai on _ g 3 ,� d g Qist any agan.zehon W-2/ orgarnzeoon9 AN-2/ 'rom the ho; is for ; z s R $ g 1099-MISC/ 1093VSC! organ maon and related '_- B 8 1099-NEC) 1099-NEC) rolatedorganiza,ions YW MimsQ to below p g (lotted Ino) g g ----------- _--- ----------------------- --------- --- --- ---------------------------------------------_.__.-------- ------------- ('�------------------- - ---------- ------------------- ('�-----------------------------------------.............................. ------------------------------------------------------- ------------- --------------------------------------------------------- ------------- ------------------------------------------------------- ------------- 95)_ - - - -------------------------------- --- ....-- ------- ---- , b Subtotal . . . . . . . . . . . . . . ► c Total from continuation shoats to Part Vll, Section A ► d Total (add lines 1b arid IC) . - ► - r — - 2 1 otal numDer 01 nwiGuais (incluaing Dut not Ilnmeo to muse listea above) wno recelvea more man 101UU,UVU OT reportable compensation from the organization ► T roe No 3 Did the organizatior list any former officer, director, trustee, key employee, or highest compensated employee on line la? If 'Yes,' complete Schedula J for such individuai . . . . . . . . . . . . 3 x 4 For any individuai listed on line 1a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000? If "Yes," complete Schedule J for such individual . . . . . . . . . . . . . . . . . . . . . . . 4 x 5 Did any person listed on line 1 a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? If "Yes," complete Schedule J for such person . . . . . . 5 x Complete this We for your Five highest compensated independent contractors that receved more flan $1 W,000 o compensation from the organization. Report compensation for the calendar yew ending with or within the organiza0on's tax year. -- Al (e) (c) Name and business address DeGCvwn of WNICBS Compersation 2 Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization ► REV 07.7_.?2 PRO %rm990:?C2') Page 571 of 2938 Form M P021) Pape 8tet•ment of Revenue Check if Schedule O contains a response or note to any line In this Part VIII . . p (A) (a) (c) lDl Totsl revenue "gated orexemo: unrelated Revenueexc,udad function WON$ ousrness reveru. torn tat( uz sectnrn 512-51 A +�{ 1e Federated campaigns 1a b Membership dues . 1b c Fundraising events 1c d Related organizations . . . . 1d s Government grants (contributions) to 1 AN other contributions, gifts, grants, and similar amounts not included above If 4 8. 7 2 2 . g Noncash contributions included in 9 lines 1 a-1 f . . . . . . . . 1 c� h Total. Add lines 1a-1f ► 481 722. Bue.. Code • 2e -- b s c m d s f AJ1 other program service revenue . p 3 Total Add lines 2a-2f ► Investment income (including dividends, interest, and other similar amounts) . . . . . . . . . . ► 3 332. 3 332. 0. 0. 4 Income from investment of tax-exempt bond proceeds No- s Royalties . . . ► A Pad 11) Personal 6a Gross rents Se b Less: rental expenses 8b c Rental income or poss) Sc d Net rental income or(Ioss ► 7e Gross amount from i seeurrtes ii: other Was of assets other than inventory 7a b Less: cost or ether basis aM sales GxPw 7b c Gain or foss) . 7c d Net gain or (loss) . ► Be Gross income from fundraising events (not including $ of contributions reported cn line 1c). See Part IV, line 18 . . . 8a b Less: direct expenses . . . . 8b c Net income or poss) from fund'aisi events ► es Gross income from gaming activities. See Part IV, line 19 . pa b Lass: direct expenses . . . . 9b c Net income or poss) from gaming activities ► 10• Gross sales of inventory, less returns and allowances . . . t0a b Less: cost of goods sold . . . 10b c Net income or (loss) from sales of inventory . . ► Bua+ness code tie b------ -------•-----------------•--•-•---••-•----- m c d Aill other revenue • TotaL Add Ines 11a-11d . . ► 12 Total revenue. See instnxiicns ► 1 485,054. REV craves PRO Page 572 of 2938 2.1 0.', 0. Forth W0,202 1) =one w09 Lit" Page 10 Statement of Functional Expenses Section 501(c)(3) and 501(c)(4) o Waaeons must complete all columns. All ofh r orgsnr ffons must compfefe column (A). Check if Schedule Q contains a response or note to any line in this Part IX . Ic) Managarren: an:)rjndrarsing en ere oxpensen . [� Do not Include amounts reported on ►free lib, 7b, 8b, 8b, and 10b of Part VIIL (N ola! expenses�y (e` P--an se 'Ce ezpensee lot exvonses 1 Grants and other assistance to domestic organizatans and domestic govemmertts. See Part IV, Isle 21 19 , 4 2 = . 1 d 5 , 421. 2 Grants and other assistance to domestic individuals. See Part IV, line 22 . . . . . 3 Grants and other assistance to foreign organizations, foreign governments, and foreign noviduais. See Part IV, lines 15 and 16 4 Benefits paid to or for members . . . . 5 Compensation of current officers, directors, trustees, and key employees 6 Compensation not included above to disqualified persons (as defined under section 495SM(')) and persons described in section 4958(c)(3)(8) 7 Other salaries and wages . . . . . 8 Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) 9 Other employee benefits . . . . . 10 Payroll taxes . . . . . . . . 11 Fees for services (nonempioyees): a Management b Legal . . . - 2 40 C . 0. C . c Accounting . . . . . . . . . 2 400 . d Lobbying . . . . . . . . . e Professanai fundrasng services. See Pall IV, line 17 f nvestmernt management fees . g Omer ,1 ne 1 ' g ar-ou- exceeds 10% of line 25, column A;, want, s, �9 11 g expenses on Schowe C.) . 22,500. 22,500. 0 . 0 . 12 Advertising and promotion . . . . . . 175. 175. 0 . C . 13 Office expenses . . . . . . . . . 4,875. 4,875. 0. 0. 14 nformation technology . . . . . . . 15 Royalties + 16 Occupancy - 17 Travel . 18 Payments of travei or entertainment expenses for any federal, state, or local public officials 12,600. 0. 0. 19 Conferences, conventions, and meetings 12,630. 20 Interest . 21 Payments to affiliates . . . . . . . . 22 Depreciation, depletion, and amortization 23 insurance . . . r . . . . . . . . 24 Other expenses- Itemize expenses not covered above. (Ljst miscellaneous expenses on line 24e. If line 24e amount exceeds 10% of line 25, column (4 amount, list line 24e expenses on Schedule 0.) S Luncheon 22,895. .... ..................... . 22,095. 0. 0. 70. 0. 0. b Business Registsaition 70. --------- ...... -- 1 099. 0. 0. c x-i_ sting_and Copy_inq _ _ _ 1 .389. _ d e Al other expenses ----------------------- - 252, 025. 0. 0. 25 Total functional ex see Add lirtae 1 th h 24e 252, 025. 26 Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educabonal campaign and fundraising solicitation. Check here 0-if fdlowin SOP 9&2 ASC 958-720 REV %7f2°.d1 Pao worm woml) Page 573 of 2938 =ar ev_ r_2', Pape 11 Balance Shoot Check if Schedule O cortarns a response or note to any line in this Part X . F W (a) ElWinnng of year End of year 1 Cash --non-intefest-bearing - 240 6?7. i 242 294. _ 1,954,292. 2 2 l88 843. 2 Savings and temporary cash investments . . . . . . . . . 3 3 Pledges and grants ,eceivabe, net 4 4 Accounts receivable. net 5 Loans and other receivables from any current or'ormer officer, director, trustee, key employee, creator or founder, substantial contributor. or 35% controlled entity or famity member of any of these persons . . . . . 5 6 -oans and other receivables from other disqualified persons (as defined 6 under section 4958M,1)), and persons described in section 4958(c)(3)(9) . 7 7 8 Notes and loans receivable, net . . . . . . . . inventories for sale or use . . . . . . 17 9 9 Prepaid expenses and deferred charges 10a Land, buildings, and equ pment: cost or other imm basis. Complete Part VI of Schedule D . . . k.1 b _ass: accumulated depreciation 1101161 10c 11 11 nvestments-publicly traded securities . . . . . . . . . . . 12 12 nvestments-other securities. See Part IV, line 11 . . . . . . . . 13 13 Investments -program -related. See Part IV, line 11 14 14 Intarigibe assets . . . . . . . 15 15 Other assets. See Part IV, line 11 . . . . . . . . . . . . . 4 16 Total assets. Add lines 1 through 15 (must equal I.ne33) _ 2, 194, 889. 16 2, 431, 187 , 17 Accounts payable and acc ued expenses . . . . . . 17 18 18 Grants payable . . . . . . . . 19 19 Deferred revenue 20 20 Tax-exempt bond4abilites . . . . 21 21 Escrow or custodial account I ability, Complete Part IV of Schedule D . 22 Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contnt>Aor. or 35% A -+ 23 controlled entity or family member of any of these persons . . . . Secured mortgages and notes payable to unrelated third parties 22 23 24 Jr secured notes and loans payable to unrelated third parties - 3 , 2 _ 3 . 24 58. 25 Other liabilities Including (ederal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D . . . . . . . . . . 25 26 Total liabliiries. Add lines 17 through 25 Organizations that follow FASB ASC 968, check here ► -3,21-0.1 26 1 58. and complete fires 27, 28, 32, and 33. 27 28 Net assets without donor restrictions . . . . . . . . . . . . Net assets with donor restrictions Net assetsi At that r not follow FAS . A. 95. check hero ► L1 2 198 099. 27 1 2 43 _ 129. *=*� ii and complete Ines 29 through 33. 8 .0 29 30 31 Capital stock or trust principal, or current funds aaid-in or capital surpius, or land, building, or equipment fund Retained earnings, endowment, accumulated income, or other funds 30 ! 31 32 2,431,129. 32 Total net assets or fund balances . . . . . . . . . . . . . . 2 198 099. 2,194,889. 33 2,431,187. Z 33 Total liabilities and net assets/fund balances REV L1,7Y1 PRO Page 574 of 2938 F Orin 9W (2021) Form 99C 2'.21 vgpo 12 Reconciliation of Net Assets Check if Schedule O contains a response or note to any line in this Part Xf . 1 Total revenue must equal Part Vill, column (A), line 12) . . . . . . . . . . . . . . 1 485,054. 2 Total expenses ,must equal Part IX, column (A), line 25) . . . . . . . . , . . . ! 2 252 025. 3 Revenue less expenses. Subtract line 2 from line 1 . . . . . . . . . . . . . . . 3 233 029. 4 Net assets or fund balances at beginning of year (must equal Part X, line 32, column (A)) . . 4 2,198,099. 5 Net unrealized gains Qosses) on investments . . . . . . . . . . . . . . . . . 5 8 Donated services and use of facilities . . . . . . . . . . . . . . . . . . . 6 7 Investment expenses . . . . . . 7 8 Prior period adjustments . . . . . . . . . . . . . . . . . . 8 9 Other changes in net assets or fund balances (explain on Schedule 0) . . . . . . . . . 9 1. 10 Not assets or fund balances at end of year. Combine lines 3 through 9 (must equal Part X, line 32, column (B)) . . . . . . . . . . . . . . . . . . . . . . . . 10 2, 4 3 , 129. ffrairm Financial Statements and Reporting - -- -- ------ Check if Schedule O contains a response or note to any line in this Part XI -- — . ❑ Yw No 1 Accounting method used to prepare the form 990: �- Cash X Accrual ❑ other _ If the organization changed its method of accounting from a poor year or checked "Other," explain on Schedule 0. 2a Were the organization's financial statements compiled or reviewed by ar independent accountant? . 2a X If "Yes," check a box below to indicate whether the financial statements for the year were compiled or reviewed on a separate basis, consolidated basis, or both: K Separate basis C Consolidated basis ; i Both consolidated and separate basis b Were the organ zation's financial statements audited by an independent accountant? 2b X if "Yes," check a box below to indicate whether the financial statements for the year were audited on a separate basis, consolidated basis, or both [_' Separate bass ( l Consolidated basis [ J Both consolidated and separate basis c If "Yes" to line 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit, review, or compilation of its financial statements and selection of an independent accountant? 2c X If the organization changed either its oversight process or selection process during the tau year, explain on Schedule 0. 3a As a result of a federal award, was the organization required to undergo an audit or audits as set north in the Single Audit Act and OMB Circular A-133? . . . . . . . . . . . . . . . . . . . . 3e X b if "Yes," did the organization undergo the required audit or audits? If the organization did 'tot undergo the required audit or audits, explain why on Schedule 0 and describe any steps taken to undergo such audits . 3b REV cr.25122mo =Y� 990 2c2. Page 575 of 2938 SCHEDULE A Public Charity Status and Public Support (Form 9W Cfrnpifis M M orgW&allm M a 1{alClirxl 6U1(rip OfyKllfbdl or a seCtisn 4W7tai(1 ) rkonslcsrspf diarilahM ttutt. Devertr*p^' o, M14 _, ,7, ► Attach to Form OW or Forth Goo-EZ. n;er^ei aae-'e Sawa ►do to www.k'a.gov1Form000 for Instructlorn and the latest infomution. Kill me of Cn orgn"bn I Employer ldei*ffl atbn r urn . 550� Ro-e Models cf Exce::en.:e Pro,ec_ :nc t5-�'575Ci4 eason for Public Charity Status. (All organizations must complete this part.) See instructions_ The organization is not a prvate foundation because t is: For Imes 1 through 12, check only one box.) 1 ❑ A church, convention of churches, or association of churches described in section 170(bX1XA)(i). 2 ❑ A school described n section 170(b)(1HA)(iii). (Attach Schedule E (Form 990).) 3 ❑ A hospital or a cooperative howrtal service organization described in section 170(b)(1HNGIi 4 ❑ A mackaJ research organization operated in conjunction wit a hospital described in section 170(b)(1Wii). Enter the hospital's name, city, and state: 5 ❑ An organization operated for the benefit of a college or university owned or operated by a govemmentai unlit described in section 170(b)(1XMirv). (Complete Part II.) 6 ❑ A federai, state, or local government or governmental unit descrbed ,i section 170(b)(1)(A)(v). 7 ® An organization that normally receives a substantial part of its support from a govemmental unit or from the general public described .n section 170(b)(IlXi vi), (Complete Part ;I) 8 ❑ A community trust described in section 170(b)(1}(AKvf). (Complete Part II.) 9 ❑ An agricultural research organization described in section 170(b)(INA)(bt) operated in conjunction with a land-grant college or university or a non -land-grant college of agriculture (see instructions). Enter the name, city, and state of the college or university: 10 ❑ An organization that normally receives (1) more than 331.-3% of its support from contnbutions, membership fees, and gross receipts from activities related to its exempt functions, subject to certain exceptions; and (2) no more than 331:3% of its support from gross investment income and unrelated business taxable income(loss section 511 tax) from businesses acquired by the organization after June 30, 1975. See section 50O(ax2). (Compilete Part II.) 11 ❑ An organization organized and operated exclusively to test for pubic safety. See section 500(a)(4). 12 ❑ An organization organized and operated exclusively for the oeneftt of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizMionsi described in section 50o(a)(1) or section 509(s)(2). See section 509(ai(3). Check the box on Fnes 12a through 12d that describes the type of supporting organization and complete lines 12e, 12f, and 12g. a ❑ Type I. A supporting organization operated, supervised, or controlled by its supported organization(s), typically by giving the supported organizations) the power to regularly appoint or elect a majority of the directors or trustees of the supporting organization. You must complete Part IV, Sections A and B. b ❑ Type II. A supporting organization supervised or controlled in connection with its supported organization(s), by having control or management of the supporting organization vested in the same persons that control or manage the supported organizatcri(s). You must complete Part ?V, Sections A and C. c [ ] Type III functionally integrated A supporting organization operated in connection with, and functionally integrated with, its supported organization(s) (see instructions). You must complete Part IV, Sections A, D, and E d [l Type III non -functionally Integrated. A supporting organization operated in connection with its supported orgarization(s) that is not functionally integrated. The organization generally must satisfy a distribution requirement and an attentiveness requirement (see instructions). You must complete Part IV, Sections A and D, and Part V. e ❑ Check this box if the organization received a written determination from the IRS that it is a Type I, Type II, Type III functionally integrated, or Type III non -functionally integrated supporting organization. 1 Enter the number of supported organizations . . . . . . . . . . . . . . . . . . . . . g Provide the following information about the supported organization(s). (1) Hams o' sit OpOr%o orl;w zat Or, . IN E N -7(14 Type of org"zjc�cn "*6CrMW Oft I nss 1-10 above (she instmi:tpnsJ) M) h ms o%w,mbw beW r your govem,ng docur win, (v) Ar.Kxrt cf nuo wv support ,tin ostructOM tvQ &Thum d 01W sUOPWL (tee !nstn,Cti n Yes No (B) (C} (D} (E) Total - For Paperwork Reductlon Act Hobo*, »ee to Irstructione for Forth OW or ON-EZ. BAA Page 576 of 2938 REV 07r' 22 PQO Schedule A (Form W% 2G21 Sc.nadwe A 99p12C21 ;'p'De 2 jUdiiiM Support Schedule for Organizations Described in Sections 170(b)(1)(A)(m) and 170(b)(1)(A)(vi) (Complete only if you checked the box on Eire 5, 7, or 6 of -'art I or rf the organization failed to qualify under Dart III. If the orgarizat on fails to qualify under the tests listed below, please complete Part 111.) Section A. Public Support Calendar year (or focal year beginning in) No, 1 Gifts, grants, contributions, and membership fees received. (Do not indide any "unusual grants."} - - 2 Tax revenues levied for the organizabon's benefit and either paid to or expended or its behalf 3 The value of services or facilities furnished by a gavemmentad unit to the organization without charge . . . . 4 Total. Add lines 1 through 3 . . a 2017 2018 - 513,897. c 2019 d 2020 a 2021 M Total r I 377,064. - 431 610636 693. 481,722. ?-c Calendar year (or fiscal year begdnning dn) ► a 2017 2018 c 2019 2020 • 2021 Taal 513,897. 431,610, 636,f43. 48_,722. _' ;_: 3-5 7 Amounts from l,ne4 . . . . . . 377,064. 8 Gross income hom interest, dividends, payments received on securities loans, rents, royalties, and income from sinilarsources . . . . . . . . 1 428. 1,708. 2,394. 3,332. 8,862. 9 Net income from unrelated business activities, whether or not the business is regularly carved on . . . . . . 10 Other income. Do not include gain or loss from the sale of capital assets (E)plain in Part VI.) . 11 Total support Add lines 7 through 10 12 Gross rece{pts from related activities, etc. (see instructions) . . . . . . . . . . . 1 12 j 13 First 5 years. If the Form 990 is for the or ian,zation's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organ,zabon, check this box and stop here ► ❑ Section C. Computation of Public Support Percentage 14 aublic support percentage for 2021 Qine 6, column (f), oivided by line 11. column (1) 14 99. 64 % 15 Public support percentage from 2020 Schedule A, Part Id, line 14 . . . . . . . . 1S I 9 9 . -, % 16e 331t3% support test-2021. If the organization did not check the box on fine 13, and line 14 is 331n% or more, check this box and stop hen. The organization quaffles as a publicly supported organization . . . . . . . . . . . ► b 33'r3% support test-2020. If the organization did rat check a box on line 13 or 15a, and line 15 is 331r+010 or more, check this box and stop hen. The organization qualifies as a publicly supported organization . . . . . . . . ► ❑ 17a 10%-facts-and- dreumstances test-2021. If the organization did not check a box on lire 13, 16a, or 16b, and line 14 is 10% or more, and if the organization meets the facts-and-urcumstances test, check this box and "here, Explain in Pert VI how the organization meets the facts -and -circumstances test. The organization qualifies as a publicly supported organization . . . . . . . . . . . . . . . . . . . . . ► U b 10%-facts-and-circumstances test-2020. bf the organuabon did not check a box on line 13, 16a, 16b, or 17a, and line 15 is 10% or more, and if the organization meets the facts-and-Cirzumstances test, Bieck this box and stop hem. Explain in Part VA how the organization meets the facts -and- arcumstances test. The organization qualifies as a publicly supported organization . . . . . . . . . ► C 18 Private foundation. If the organization ddd not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see instructions . . . . . . . . . . . . . . . . . . ► ❑ REV 7.:..T PRO schedule A (Fam 9W 2M Page 577 of 2938 Sct'&dj4 A .ram 99012W' Gape 3 Support Schedule for Organizations Described in Section 509(a)(2) (Complete only if you checked the box on line'0 of Part I or if the organization failed to quality under Part 'I ft the organization fails to qualify under the tests listed below, please complete Part IL) Section A Public Suppirt Calendaryear (or fiscal year beginning in) ► a 2017 2018 c 2019 2020 (e) 2021 Total 1 Ws, grarts, coritnbutrons, and membership fees received. (Do not tnc ude any 'jnus 4 ;rants. 2 Gross receipts from admissions, merchandise - sold or services perksmied, or facilities fumshed in any activity that is related to the organizations tax-exempt purpose . 3 Gross rompts from activities that are not an unrelated trade or business ruder section 513 4 Tax revenues levied for the organization's benefit and either pail to or expended on its behalf 5 The value of services or faci,ities furnished by a governmental unit to the organization without charge . 6 Total. Add lines 1 through 5 . 7a Amounts included on lines 1, 2, and 3 received from disqualified persons b Amounts included on Imes 2 and 3 received from other than disquaiffied persons that exceed the greater o` $5,000 or'. % of the amount on iine 13 for the year c Add lines 7a and 7b . . . . . 8 Pubtic support (Subtract line 7c from line 6.) . Calendar year (or fiscal year beginning in) ► a 2017 2018 c 2019 2020 a 2021 TotaJ 9 Amounts from I re 6 10a Gross Income from interest, divdends - - - - - payments received on securitties loans, rents, royalties, and income from similar sources b Unre all business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975 I c Add lines 10a and 10b . . . . . 11 Net income from unrelated business activities not included on line 10b, whether or not the business is regularly carried on 12 Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) . . . 13 Total support (Add Iines9, 10c. 11, and 12.) . . . . . . . . . i l 14 First 5 years. If the Form 990 is for tf'1e organization's first, second, third, fourth, c, fifth tax year as a section 501(c)(3) organization, check this box and stop here . . . . . . . . . ► Section C. Computation of Public Support Percentage T 15 PuUic support percentage for 202' (line 8, column (i), divided by line 13, column (1)) 15 % 16 PLbK support percentage from 2020 Schedule A, Part III, line 15 16 % 17 Investment Income percentage for 2021 (line 10c, column (f), divided by line 13, column (f)) , 17 _ 18 Investment income percentage from 2020 Schedule A, Part III, line 17 , . . . . . . . . 18 % 19e 331n3% support testl ff the organization did not check the box on line 14, and line 15 is more than 331,3%, and line 17 is not more than 33' %, check this box and atop here. The organization qualifies as a publicly supported orgarizalion . ► b 331rr% support tests-2020. ff the organization did not chectx a box on line 14 or line 19& and line 16 is more than 331-3%, and line 18 is not more than 331 �3%, check this box and stop here. The organization quaiifies as a publicly supported organization ► ) 20 Private foundation. If the organization did not check a box on line 14. 19a, of 19b. check this box and see instnictions 0- RE 1W 0r F"to SdhWr• A (Form WM 2D21 Page 578 of 2938 Scrwd, e Aram 99U 20,2r Papa 4 Part M Supporting Organizations (Complete only if you checked a box in line 12 on Part I. If you checked box 12a, Part I, complete Sections A and B. if you checked box 12b, Part I, complete Sections A and C. If you checked box 12c, Part I, compete Sections A, D, and E. If you checked box 12d, Part I, complete Sections A and D, and complete Part V.) Section a A113upportn9 0"wizations — — — --- Yes No 1 Are all of the organizabon's supported organizations listed by name in the organization's goveming documents? If `No,' describe in Part VI how the supported organizations are designated. If designated by class or purpose, describe the desrgnafron. if historic and continuing relationship, explain. 2 Did the organization have any supported organization that does not have an IRS determination of status under section 509(a)(1) or a)? ff `Yes,' explain in Part Vi how the organization determined that the supported organization was described in section 509(a)(1) or r2). 2 3a Did the organization have a supported organization described in section 501(c)(4), (5). or (6)? It 'Yes, " answer lines 3b and 3c below. a. b Did the organization confirm that each supported organization qualified under section 501,(c)(4), (5), or (6) and satisfied the public support tests under section 509(a)(2)? if "Yes," describe in Part W when and how the organization made the determination. c Did the organization ensure that all support to such organizations was used exclusively for section 170(cOffl) purposes? if "Yes,' explain in Part Vi what confrols me organization put in piece to ensure such use. 4a Was any supported organization not organized in the United States ("foreign supported organization'}? If 'Yes,' and if you checked box 12a or 12b in Part 1, answer lines 4b and 4c below. b Did the organization have ultimate control and discretion in deciding whether to make grants to the foreign supported organization? If Wes," describe in Part V1 how the organization had such control and discretion despite being controlled or supervised by or in connection with its supported organizations, c Did the organization support any foreign supported organization that does not have an IRS determination under sections 50'(c)(3) and 509(a)(1) or (2)? ff 'Yes," explain in Part VI what controls the organization used to ensure that all support to the foreign supported organization was used exclusively for section 170(c)(2)(9) purposes. 5a Did the organization add, substitute, or remove any supported organizations during the tax year? if "Yes," answer lines 5b and 5c below (if applicabiai, Also, provide detail in Part V1, including (r the names and EIN numbers of the supported organizations added, substituted, or removed; (ii) the reasons for each such action; (iih) the authority under the organization's organizing document authorfzng such action; and {rv) how the action was accomplished (such as by amendment to the organizing documeno. b Type I or Type 11 only. Was any added or substituted supported organization part of a class &ready designated in the organization's organizing document? c Substitutions only. Was the substitution the result of an event beyond the organization's control? 6 Did the organization provide support (whether in the form of grants or the provision of services or facilities) to anyone other than f its supported organizations, (ii) individuals that are part of the charitable class benefited by one or more of its supported organizations, or (i) other supporting organizations that also support or benefit one or more of the filing organization's supported organizations? If "Yes,' provide detail in Part V1. 7 Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor (as defined in section 4958(cX3XC)), a family member of a substantial contributor, or a 35% controlled entity with regard to a substantial contributor? If "Yes," complete Part I of Schedule L (Form 990). 8 Did the organization make a loan to a disqualified person (as defined in section 4958) not described on line 7? ff 'Yes,' complete Part I of Schedule L (Form 990 9a Was the organization controlled directly or indirectly at any time during the tax year by one or more disqualified persons, as defined in section 4W (other than foundation managers and organizations described in section 509(aXl) or (2))? If "Yes,' provide detail in Part V1. b Did one or more disqualified persons (as defined on line 94 hold a controlling interest in any entity in which the supporting organization had an interest? if'Yes;' provide detail in Part Vi. c Did a disqualified person (as defined on line 9a) have an ownership interest in, or derive any personal benefit from, assets in which the supporting organization also had an interest? It 'Yes,' provide detail in Part VL 10a Was the organization subject to the excess business holdings rules of section 4943 because of section 4943M (regarding certain Type II supporting organizations, and all Type IiI non -functionally integrated supporting organizations)? If'Yecs,"answerkne 10b below. b Did the organization have any excess business holdings in the tax year? (Use Schedule C, Form 4720, to determine whether the organization had excess business holdings.) Ev 1)rr25-W PRO GGhedulle A fkrm NM 2M Page 579 of 2938 Sc haC -e A XOm. 99C1 2021 page s Wart U—Supporting Organiz*jons (contmued tb No 11 Has the organization accepted a gift or contribution from any of the following persons? a A person who directly or indirectly controls, either alone or together with persons described on lines 1 15 and 1 to below, the goveming body of a supported organization? b A family member of a person described on line I I above? c A 35% controlled entity or a person described on line 11a or 11b above? If' Yes' to line 1 Ia. 1 tb, or t tc, provide detail in Part VI. Section B. Type I Supporting Organizations Yes No 1 Did the governing body, members of the governing body, officers acting in their official capacity. or membership of one or more supported organizations have the power to regularly appoint or elect at least a maloaty of the organizabon s officers, directors, or trustees at all times during the tax year? It "No," descnbe,n Pert Vt how the supported organization(s) Oecti,* operated, supervised, or contro0ed the organization's activites. If the organization had more than one supported organization, describe how the powers to appoint and/or remove officers, directors, or trustees were aloocated among the supported organzabons and what conditions or restrictws, if any, applied to such powers during the tax year 1 2 Did the organization operate for the benefit of any supported organization other than the supported organization(s) that operated, supervised, or controlled the supporting organization? If "Yes,' wfain in Part W how providing such benefit carved out the purposes of the supported orWritz0orys} that operated. supervised, or controlled the supporting organization 2 ...F:.... r� T....., 11 C........ �1:.... n........:....�:...... No 1 Were a majority of the organ;zation's directors or trusteas during the tax year also a majority of the directors or trustees of each of the organization's supported organization(s;? If "No," describe in Part VI how control or management of the supporting organ¢abon was vested in the same persons that controlled or managed the supported organization(s) No 1 Did the organization provide to each of its supported organizatiors, by the last day of the fifth morHh of the organization's tax year, () a vrrtten notice describing the type and amount of support provided doing the pnor tax year, (,) a copy of the Form 990 that was most recertty filed as of the date of notification, and fim) copies of the organzation's governing documents in effect on the date of notification, to the extent not previously provided? 2 Were any of the organization's officers, directors, or trustees either (i) appointed or elected by the supported orgarization(s) or {n) serving on the governing body of a supported organization? If 'No, " explain in Part VI how the organization maintained a close and continuous working rerationsh+p with the supported orgariaation(s). 3 By reason of the relationship described on line 2, above, did the organization's supported organizal,ons have a significant voice in the organiza4ion's investment po icies and in directing the use of the organization's income or assets at all times during the tax year? if "Yes,' desaibe in Part Vt the rote the organization's supported organizations played in this regard. 1 Check the box next to the method that the organization used to satisfy the Integra! Part Test dunng the year (sae instructions). a ] '-he organization satisfied the Activities Test. Complete line 2 below b ::1 -he organization is the parent of each of its supported organizations. Complete line 3 below c El The organization supported a governmental entity. Describe in Pert VI how you supported a governmental entity (see instructio 2 Activities Test. Answer lines 2a and 2b below. FyesT a Did substantially all of the organization's activities during the tax year directly further the exempt purposes of the supported organization(s) to which the organization was reapons ve? !f `Yes," then in Pali VI identity those supported oryianmetion s and aAplam how these activities directly furthered their exempt purposes, how the organization was responsive to fhose supported organizations, and how the organization determined that these activities constituted substantially all of its activities. b Did the activrtes described on line 2a, above, constitute activities that, but for the organization's invoivemert, one or more of the orgarnzation's supported organizabon(s) would have been engaged in? If 'Yes,' explain in Part Vf the reasons for the organization's position that Rs supported organizations) would have engaged in these activities but for the organization's involvernent. 3 Parent of Supported Organizations. Answer lines 3a and 3b babw. a Did the organization have the power to regularly appoint or elect a m*nty of the officers, directors, or trustees of each of the supported organizations? If 'Yes' or 'No," provide details in Pan Vt. b Did the organization exercise a substantial degree of direction over the policies, programs, and activities of eac.n of its supported organizations? If 'Yes, " describe in Pert Vi the role played by the organization in this regard. REV C'. R.VZ' %to 6cheduN A (Form WM 2D211 Page 580 of 2938 scr>ad,4 A To" 99o� 2021 Pop T III Non- uncilianalf Integrated a Supporfing Orgnizations 1 ❑ Check hers if the organization satisfied the integral Part Test as a qualifying trust on Nov. 20, 1970 OVIlail Gt Part". See instructions. All other Type III non-functional) y integrated supporting organizations must complete Sections A through E. Section A—Ad}usted Not Incom• 1 Net short-term capital gain — -- — W Pgor Year (B) Cunent Year (optionao 1 2 2 Recoveries of prior -year distributions 3 Other gross income (see instructions) 4 Add lines 1 through 3. 3 4 5 6 5 Depreciation and depletion 6 Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions) 7 Other expenses (see instructions) _ 8 Adjusted Net Income subtract lines 5, 6 and 7 from line 4 7 8 Section B—Minimum Asset Amount 1 Aggregate fair market value of all non -exempt -use assets (see instructions for short tax year or assets held for part of year , a Average monthly value of securities_ b Average monthly cash balances 1a (A) Prior Year (B) Current Year (optionaQ 1 b c Fair market value of other non -exempt -use assets lc d Total (add lines 1 a, t b, and 1 c) e Discount claimed for blockage or other factors (iii in in detail in Part g: 1 d 2 2 Acquisition indebtedness applicable to non -exempt -use assets 3 Subtract line 2 from line 1d, 3 T 4 Cash deemed held for exempt use, Enter 0.015 of line 3 (for greater amount, see instructions). 4 Net value of non -attempt -use assets (subtract line 4 from line 3) S - _5 6 Multiply line 5 by 0 035 __ -- 7 Recoveries of pnor-year distr b4Aons 8 Minimum Asset Amount add line 7 to line 6 6 7 8 Section C—Distributable Amount Mccumentyew 1 Adjusted net income for pnot year from Section A, line 8, column A 1 2 Enter 0.85 of line 1_ 2 3 _ Minimum asset amount for prior year (from Section 8, line 8, column A) 3 4 Enter greater of line 2 or line 3. _ 4 5- Income tau imposed in prior year 5 6 Distributable Amount Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions). 6 _ 7 ❑ Check here if the current year is tine organization's first as a non -functionally integrated Type III supporting organization (see instructions). SchodkM A (Form QM 2M ary ),ram Pao Page 581 of 2938 Schodoie A Tam 9901 ?W' Section D—Diistribubons 1 Amounts peed to supported organizations to accomplish exempt purposes 2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity 3 Administrative expenses paid to accomplish exempt purposes of supported o1pnizations 4 Amounts paid to acquire exempt -use assets _ 5 Qualified set -aside amounts (prior IRS approval required —provide details in Part Vl 6 Other distributions describe in Part V�. See instructions. 7 Total annual distributions. Add lines 1 through 6. 8 Distributions to attentive supported organizations to which the organization is responsive ;provide details in Part R. See instructions. 9 Distributable amount for 2021 from Section C, line 6 -- 10 Line 8 amount divided by line 9 amount Section E—Distribution Allocations (see instructions) 1 Disfibutable amount for 2021 from Section 0, line 6 _ 2 Underdistnbutions, if any, for years prior to 2021 (reasonable cause required—a0ain in Para ". See instructions- 3 Excess distributions carryover, I any, to 2021 a From 2016 _ b From 2017 c From 2018 d From 2019 e From 2020 . . f Total of lines 3a through 3e 9 Applied to underdistnbutions of prior years h Applied to 2021 distrbutable amount i Carryover from 2016 not applied (see instructions) j Remainder. Subtract lines 3g, 3h, and 3i from line 3f. 4 Distributions for 2D21 from Section D, line 7: $ e AARN ed to underdistributions of prior years b Applied to 2021 distributable amount _ c Remainder. Subtract lines 4a and 4b from line 4. 5 Remaining underdistributions for years prior to 2021, if any. Subtract vines 39 and 4a from Ire 2. For result greater than zero, axplain in Part Vt. See instructions. 6 Romanung underdistributions for 2021. Subtract lines 3h and 4b from line 1. For result greater than zero, eosin it Part W. See instructions. 7 Excess distributions carryover to 2022. Add lines 3j and 4c. 8 Breakdown of line 7- a Excess from 2017 b Excess from 2018 — — — - — c Excess from 2019 d Excess from 2020 . e Excess from 2021 vage 7 Current Year 1 2 3 — 4 5 6 7 8 (i) Di) 01 Excess Distributions Un derdistlibutions Distributable Pro-2021 Amount for 2021 REV 07Q'YZ PRO Page 582 of 2938 Schedule A (Form On 2021 Scnocule A,;Fortr 9%)?(VI p&je 8 Lo" Suppiennntal Information. Provide the explanations required by Part Il, line 10; Part il, line 17a or 17b; Part III, line 12; Part V, Section A, liras 1, 2, 3b, 3c, 4b, 4c, 5a, 6, 9a, 9b, 9c, 11a, 11b, and 11c; Part IV, Section B, lines 1 and 2, Part IV, Section C, line 1; Part IV, Section D, lines 2 and 3; Part IV, Section E, Imes 1 c. 2a, 2b, 3a, and 3b; Part V, line 1; Part V, Section B, line 18, Part V, Section D, lines 5, 6, and 6; and Part V, Section E. lines 2, 5, and 6. Also complete this part for ary additional information. ;See instructions.) ............ .. -- - _ ................... ..................... ------ _ I.................... --------------------------------- -_.........................--------------------....----------- --......................-------------------------- REV Q7r2%M PRO SUrduie A (Form 9M 2M Page 583 of 2938 SCHEDULE O 1 Supplemental Information to Form 990 or 990 EZ (Form 9W) I Complete to provide inforrnation for responses to specific questions on Form wa or NO-EZ or to provide airy additional trnformabon Deputnient of ftw'rescury ► Attach to Form 990 or Form 960-EZ. intemr Rwanus Servos 1 ► Go to www.rrs.pov/Form000 for the latest infortnstiorL OM6 No. 1545-0G47 1 2 0021 Name of the orpenrm:on Errp"w Weatlttertbn numbv 5000 Role Models cf Excel--ence Pro;ec:, :nc 65-05750:9 Pt VI, Lire -lb: The 500C Role Modes of Excellence Project, Inc process begin ..----------. ........... .......... ......... . with the initial review and approval being done by board member Wilbert T. Holloway. ............. .......... ........... ......... ......... _A copy__of the Formis then provided to all other board members for review and approval. Pt VI, Line 12c: 5000 Role Models of Excellence Project, Inc. adopted -an extensive conflict of interest policy which is designed to prevent the personal, professional, financial and political interest of Board Members or Officers from interfering _ with the performance of their duties to the 5000 Role Models of Excellence Project, Inc. or from resulting in persona _, financial, professional or political gains on the part of Board Members oz Officers at the expense of 5000 Role Models, its clients, and the community it serves. They monitor and enforce compliance through its various required disclosure forms and procedures for handling suspected conflicts. Potentia: and current Board members are required to complete and date conflict of interest disclosure forms annually. -- .._..----•----•----_...._.........-•----•-•-•-•-•......-----••-•-•-----•-•----•----------------•-•--•••-•-•---•--- Pt V Line :5a: Based on the organizational structure, the top management personnel .. ...........--------- ....... . of 5000 Role Models of Excellence Project, Inc are not directly compensated by the orQen:zation. Pt VI, Line 15b: Based on the organizational structure, the 5000 Role Models of Excellence Project, :nc does not directly compensate other officers or key — --_..........__-...............•-••--•-•-- - _ _ __..__.--•--._.--•--------•---•----••-----------•--..........__.----•-.._.--•----- employees. Pt VI, Line 19: 500C Role Models of Excellence Project, Inc. makes all of this information available at its local office and a third party website makes some of this information available also. Pt XI: LINE 9, ROUNDING --------------------------- ----- ---------- -------------------- ------------------------------------------------------------------------------------------------------------ F•or Paperwork Reduction Act Notice, see the Instructions for Forth 990 or 900-EZ SAA Schedule o (Form 9" 2M 4Eti G7.75/µ PRO Page 584 of 2938 SON Rocs Modals of Excellence Project, Inc 6"676014 Additional information from your 2021 Federal Exempt Tax Return Form 990: Return of Organization Exempt from Income Tax Otter amt. not Included Direct Pub1c Support Individ, Business Contr buttons Indirect Public Support:United Way, CFC Contributions Total Form 990: Return of Organization Exempt from Income Tax Line 27, column (B) ti Total I Page 585 of 2938 Itemization Statement Amount 457, 7V 24,915. 481,722. Itemization Statement Amount 2,431,129. 2.431,129. Name Sponsorship Level Commissioner Kionnie McGee Premier Commissioner Oliver Gilbert Premier City of Miami Beach Premier Gent Row Premier Miami Dolphins Premier Miami Herald Premier Onyx Magazine Premier UPS Premier Amscot Prestigious Bank of America Prestigious Baptist Health Systems Prestigious Children's Trust Prestigious City of North Miami Prestigious Florida Lottery Prestigious Port Miami Prestigious Florida Power & Light/ Nextera Energy Prestigious Page 586 of 2938 26 Health Diamond Star Apple Diamond AFSCME Diamond Amazon Diamond American Airlines Diamond Carrie Meek Foundation Diamond Circle of Brotherhood Diamond City of Miami Diamond City of Miami Gardens Diamond Comcast Diamond Commissioner Danielle Cohen -Higgins Diamond Commissioner Marliene Bastien District 2 Diamond Cruise Industry Charitable Foundation Diamond Deloitte Diamond Dorsal Diamond Ed Fed Credit Union Diamond Fed EX Diamond Florida Memorial University Diamond Greater Miami Visitors Bureau Diamond Jackson Health Systems Diamond United Property Management: A Milton Family Company Diamond Miami Dade Aviation Department Diamond Mount Sinai Diamond Page 587 of 293E Star Apple Diamond State Farm Diamond Thelma Gibson Health Initiative Diamond UM John P. Hussman Inst. for Human Genomics Diamond United Teachers of Dade (UTD) Diamond Walmart Diamond Antioch Missionary Baptist Church of Miami Gardens Platinum Boys & Girls Club Platinum Borinquen Health Platinum Chabad of Miami Gardens Platinum Carnival Cruise Lines Platinum Foundation for New Education Initiatives, Inc. Platinum Gardner -Smith Family Foundation Platinum Grant Cardone Platinum Jessie Trice Community Health Platinum Macy's Platinum Marlins Platinum Mayor Danielle Levine -Cava Platinum Transport Workers Local 291 Platinum Pillsbury Law- Markenzy Lapointe Platinum Pegs 588 of 2938 17 Robert Parker Foundation Platinum is Reynolds Family Platinum 93rd Street Baptist Church Silver American Postal Workers Union AFL-CIO Silver Antioch of Brownsville, Miami Silver CBS Miami for Darryll Green Silver Calder of Churchill Downs Silver Circle of One Marketing Silver City of North Miami Beach Silver City of Opa Locka Silver Coastal Construction/Costal Cares Silver Community Health of South Florida, Inc. (CHI) Silver Community Police Relations Foundation Silver Florida A&M University Silver Florida International University Silver Gull -Tree Investments LLC/G-Mac Corp) Silver Marilyn Holifield Esq. Partner, Holland & Knight Law Silver Hosanna Community Church Silver International Longshoremen's Union Local 1416 Silver Jesus People Ministries Silver Page 589 of 2938 Greater Miami Jewish Federation Silver Koonce Family Silver Macedonia Missionary Baptist Church of Miami Silver Miami -Dade College -Homestead Silver Miami-Ddade College -North Silver Messam Construction Silver Miami Black Nurses Association paid by Sharon Rogers Silver Miami Jewish Health Silver Mount Calvary Mg Church, Miami Silver National Association of Black Hotel Owners, Operators Devl. Silver North Miami Police Dept. Silver Parents of Murdered Children (Paid for by City of Miami) Silver Onyx Magazine Silver StarApple of Fort Lauderdale Silver Second Baptist Church Silver South Florida AFL-CIO Silver The Children's Movement of Florida Silver Trinity CME Church Silver W.I.S.H. Foundation Silver WPLG - Channel 10 Silver Vernique Williams - AKA Cluster Coordinator Silver Village of El Portal Silver Page 590 of 2938 Sororities and Fraternities Devine 9 Alpha Phi Alpha Fraternity, Inc., - Iota Pi Lambda Chapter Sivler Alpha Kappa Alpha Sorority Inc., Gamma Zeta Omega Chapter Silver Alpha Kappa Alpha Sorority Inc., Veranique Williams Silver Alpha Kappa Alpha Sorority, Inc. - Pi Delta Omega Chapter Silver Alpha Phi Alpha Fraternity Inc., - Beta Beta Lambda Chapter Silver Alpha Rho Boule Fraternity Inc. Silver Delta Sigma Theta Sorority, Inc. - Dade County Alumnae Chapter Silver Delta Sigma Theta Sorority, Inc. - Miami Alumnae Chapter Silver Kappa Alpha Psi Fraternity, Inc. Miami Alumni Chapter Silver Links Inc. - Greater Miami FL Chapter Silver Links, Inc. - Dade County FL Chapter Silver Links, Inc. - Miami -Biscayne Bay (FL) Chapter Silver Omega Psi Phi Fraternity Inc. - Sigma Alpha Chapter Silver Phi Beta Sigma Fraternity Inc.,(Rho Sigma chapter)1 Silver Sigma Gamma Rho Sorority, Inc. - Gamma Delta Sigma Chapter Silver Sigma Gamma Rho Sorority, Inc. - Lambda Tau Sigma Chapter Silver Zeta Phi Beta Sorority Inc. - Beta Tau Zeta Chapter Silver Wall Mentors Page 591 of 2938 i Captain James Mesidor Wall Mentor Barrington Irving Wall Mentor Captain Keith Bell Wall Mentor Chief Larry Juriga Wall Mentor Chief Maurice Kemp Wall Mentor Dale Johnson Wall Mentor Daniel Junior Wall Mentor Darryl Hosendolph Wall Mentor Dexter Bridgeman Wall Mentor Dr. Rudolph Moise Wall Mentor Dr. George Koonce, Jr. Wall Mentor Dr. Nelson Adams Wall Mentor Dwight Jackson Wall Mentor Ed Haynes Wall Mentor Eric Accime Wall Mentor Eric Knowles Wall Mentor George Ray III Wall Mentor i Harold Floyd Wall Mentor 1 D Patterson Wall Mentor i James Hawkins Wall Mentor James Williams Wall Mentor Judge Darrin Gayle Wall Mentor Judge Daryl Trawick Wall Mentor Page 592 of 2938 Judge Donald Graham Wall Mentor Judge Gordon Murray Wall Mentor Judge Rodney Smith Wall Mentor Kionne McGhee Wall Mentor Kyron Parker Wall Mentor Larry Handfield Wall Mentor Levitcus Gillard Wall Mentor Marcus Dixon Wall Mentor Michael Joseph Wall Mentor McKenzie Fleurimond Wall Mentor Oliver Gilbert Wall Mentor Oliver Gross Wall Mentor Paul Wilson Wall Mentor Ralph Renzi Wall Mentor Reggie Leon Wall Mentor Rev. Carl Johnson Wall Mentor Rev. Author Jackson III Wall Mentor Rev. Dr. Alphonso Jackson, Sr. Wall Mentor Rev. Larrie Lovett Wall Mentor Rich Black Wall Mentor Rick Holton Wall Mentor Robert Lewis Parker Jr. Wall Mentor Roderick Vereen Wall Mentor Page 593 of 2938 Samuel Gbadebo Wall Mentor Senator Kendrick Meek Wall Mentor Senator Shervin Jones Wall Mentor Shelly Rochelle Wall Mentor Tim Belcher Wall Mentor Willie Williams Wall Mentor Page 594 of 2938