NON-PROFIT CULTURAL GRANT AGREEMENTNON-PROFIT CULTURAL GRANT AGREEMENT
This Non -Profit Cultural Grant or Partnership Agreement ("Agreement") is made as
December a 2- , 2023 ("the Effective Date"), by and between THE CITY OF
CLEARWATER, a municipal corporation ("City"), and Artz 4 Life Academy("Applicant)
(collectively, "Parties").
WITNESSETH:
WHEREAS, on March 11, 2021, President Joseph Biden signed into law the
American Rescue Plan Act of 2021 ("ARPA"), Pub. L. 117-2, a $1.9 trillion economic
stimulus bill passed by the 117th United States Congress to aid the country with the
economic and health effects of the COVID-19 pandemic; and
WHEREAS, ARPA included a $350 billion Coronavirus State and Local Fiscal
Recovery Funds ("SLFRF") program designed to assist state, local, and tribunal
governments in their response to the COVID-19 pandemic; and
WHEREAS, the City received a total of $22,483,893.00 under the SLFRF program
in two equal tranches on May 19, 2021 and June 6, 2022; and
WHEREAS, on August 4, 2022, at a duly -noticed City Council meeting, the
Clearwater City Council approved funding allocations from the SLFRF program for twelve
proposed project and program types; and
WHEREAS, one such funding allocation was in the amount of $1,000,000.00 and
made for non-profitcu ltural grants orpartnersh ips ("the Program")wh ich was intended to be
used to provide grant funding to non profits and govem ment entities for programs focused
on arts and cultural opportunities in the community whose programming, services and/or
attendance was negatively impacted because of the COVID-19 pandemic; and
WHEREAS, on July20,2023,the Citymade available a second round of applications
for the Program; and
WHEREAS, on October2, 2023, the City received an application ("the Application")
from the Applicant, a true and correct copy of which is attached to th is Agreement as Exhibit
"A", requesting financial assistance under the program to facilitate The Family Blessing
Experience to include 12 workshops over 2 years (4 director, 4 choreographer and 4
costume designer workshops) as well as 20 training sessions and community classes
offered at Artz 4 Life over 2 years, and 1 trip and/or festival within Clearwater annually,
for a total of 2 over 2 years.("the Project"); and
WHEREAS, the Application was evaluated and scored by a review committee who
recommended approval of the Applicant's financial assistance for the Project request to the
Clearwater City Council; and
WHEREAS, on December 7, 2023, at a City Council meeting, the Clearwater City
Council approved the review committee's recommendation and authorized the City's staff
to negotiate a definitive grant agreement with the Applicant; and
WHEREAS, the City finds that providing financial assistance for the Project is a
permissible expenditure under the Program; and
WHEREAS, the City finds that the Project promotes the general public welfare of the
citizens of Clearwater;
NOW, THEREFORE, in consideration of the mutual promises and covenants
contained herein, the parties hereby agree as follows:
I. GENERAL
1. Recitals. The foregoing recitals are true and correct and are incorporated in and
form a part of this Agreement.
2. Intents Purpose of Agreement. The purpose of this Agreement is to further the
implementation of the Program by providing for financial assistance to the non-profit for
programs that focus on arts and culture including programming, targeting organizations
that have been negatively impacted due to the COVID-19 pandemic.
II. APPLICANT RESPONSIBILITIES
1. Implementation of the Proiect. The Applicant shall implement the Project in
substantial conformity with the Application.
2. Bi -annual Reporting. The Applicant shall submit bi-annual reports accounting for
all Program grant funds disbursed to the Applicant and subsequently used by the
Applicant for purposes of the Project. Any Program grant funds disbursed by the City but
not used by the Applicant by the Termination Date found in Section 9 shall be returned to
the City 14 days after the Termination Date.
III. CITY RESPONSIBILITIES
1. Grant Funding. The City shall provide grant funding in the amount of $66,850.00
(sixty-six thousand eight hundred fifty dollars) within 14 days after the Effective Date of
this Agreement.
2. City Manager Word Final. The City Manager retains sole discretion to determine
whether the Applicant has successfully submitted bi-annual reports as required by
Section II(2) If the City Manager or designee finds the Applicant has not successfully
submitted one bi-annual report in compliance with Section 11(2), then the Parties agree
that the City Manager's decision is final, this Agreement shall be null and void, the City
shall not owe any additional grant money to the Applicant under the Program, the
Applicant shall return the initial $66,850.00 originally disbursed to it plus default interest
at rate of 10%, and the Applicant shall have no recourse against the City.
IV. APPLICANT DEFAULT
1. Failure to Implement the Program. If the Applicant fails to implement the Project
in substantial compliance with the Application as required by Section 11(1), then the
Parties agree that the Applicant shall be in default under this Agreement.
2. Failure to Submit Bi -Annual Reporting. If the Applicant fails to submit bi-annual
reports as required by Section 11(2), then the Parties agree that the Applicant shall be in
default under this Agreement.
3. Application Misrepresentations. If the City determines, at any time and in the City's
sole discretion, that any portion of the Application constituted a material
misrepresentation, then the Parties agree that the Applicant shall be in default under this
Agreement.
4. Other Events of Default. In addition to the foregoing, the occurrence of any one or
more of the following after the Effective Date shall also constitute an event of default by
the Applicant:
A. The Applicant shall make a general assignment for the benefit of its creditors,
or shall admit in writing its inability to pay its debts as they become due or shall
file a petition in bankruptcy, or shall be adjudicated a bankrupt or insolvent, or
shall file a petition seeking any reorganization, arrangement, composition,
readjustment, liquidation, dissolution or similar relief under any present or
future statute, law or regulation or shall file an answer admitting, or shall fail
reasonably to contest, the material allegations of a petition filed against it in any
such proceeding, or shall seek or consent to or acquiesce in the appointment
of any trustee, receiver or liquidator of the Applicant or any material part of such
entity's properties; or
B. Within 60 days after the commencement of any proceeding by or against the
Applicant seeking any reorganization, arrangement, composition,
readjustment, liquidation, dissolution or similar relief under any present or
future statute, law or regulation, such proceeding shall not have been
dismissed or otherwise terminated, or if, within 60 days after the appointment
without the consent or acquiescence of the Applicant of any trustee, receiver
or liquidator of any of such entities or of any material part of any of such entity's
properties, such appointment shall not have been vacated.
5. Notice of Default and Opportunity to Cure. The City shall provide written notice of
any default under this Agreement and provide the Applicant 30 days from the date the
notice is sent to cure the default. This notice will be deemed sent when sent by first class
mail to the Applicant's notice address or when delivered to the Applicant if sent by a
different means.
6. City Remedies. If, after notice and an opportunity to cure, the Applicant fails to cure
any of the events of default listed in Section IV of this Agreement, then the Parties agree
that: a) this Agreement shall be null and void; b) that the City will have no further
responsibility to the Applicant, including the responsibility to tender any remaining
Program grant funds to the Applicant; c) that any Program grant funds actually tendered
by the City to the Applicant shall be retumed to City along with default interest at a rate
of 10% starting from the date of default; and d) the Applicant shall have no recourse
against the City.
V. MISCELLANEOUS
1. Notices. All notices, demands, requests for approvals or other communications
given by either party to another shall be in writing, and shall be sent to the office for each
party indicated below and addressed as follows:
To the Applicant:
Artz 4 Life Academy
1751 Kings Highway
Clearwater, FL 33755
Attention: Director
To the City:
City of Clearwater
P.O. Box 4748
Clearwater, Florida 33758
Attention: City Clerk
with copies to:
City of Clearwater
P.O. Box 4748
Clearwater, Florida 33758
Attention: City Attomey
2. Unavoidable Delay. Any delay in performance of or inability to perform any
obligation under this Agreement (other than an obligation to pay money) due to any event
or condition described in this Section as an event of "Unavoidable Delay" shall be excused
in the manner provided in this Section.
"Unavoidable Delay" means any of the following events or conditions or any
combination thereof: acts of God, acts of the public enemy, riot, insurrection, war,
pestilence, archaeological excavations required by law, unavailability of materials after
timely ordering of same, building moratoria, epidemics, quarantine restrictions, freight
embargoes, fire, lightning, hurricanes, earthquakes, tomadoes, floods, extremely
abnormal and excessively inclement weather (as indicated by the records of the local
weather bureau for a five year period preceding the Effective Date), strikes or labor
disturbances, delays due to proceedings under Chapters 73 and 74, Florida Statutes,
restoration in connection with any of the foregoing or any other cause beyond the
reasonable control of the party performing the obligation in question, including, without
limitation, such causes as may arise from the act of the other party to this Agreement, or
acts of any governmental authority (except that acts of the City shall not constitute an
Unavoidable Delay with respect to performance by the City).
An application by any party hereto for an extension of time pursuant to this Section
must be in writing, must set forth in detail the reasons and causes of delay, and must be
filed with the other party to this Agreement within 30 days following the occurrence of the
event or condition causing the Unavoidable Delay or 30 days following the party becoming
aware (or with the exercise of reasonable diligence should have become aware) of such
occurrence.
The party shall be entitled to an extension of time for an Unavoidable Delay only
for the number of days of delay due solely to the occurrence of the event or condition
causing such Unavoidable Delay and only to the extent that any such occurrence actually
delays that party from proceeding with its rights, duties and obligations under this
Agreement affected by such occurrence.
3. Indemnification. The Applicant agrees to assume all risks of inherent in this
Agreement and all liability therefore, and shall defend, indemnify, and hold harmless the
City and the City's officers, agents, and employees from and against any and all claims
of loss, liability and damages of whatever nature, to persons and property, including,
without limiting the generality of the foregoing, death of any person and loss of the use of
any property. This includes, but is not limited to, matters arising out of or claimed to have
been caused by or in any manner related to the Applicant's activities or those of any
approved or unapproved invitee, contractor, subcontractor, or other person approved,
authorized, or permitted by the Applicant whether or not based on negligence. Nothing
herein shall be construed as consent by the City to be sued by third parties, or as a waiver
or modification of the provisions or limits of Section 768.28, Florida Statutes or the
Doctrine of Sovereign Immunity.
4. Assignability: Complete Agreement. This Agreement is non -assignable by either
party and constitutes the entire Agreement between the Applicant and the City and all
prior or contemporaneous oral and written agreements or representations of any nature
with reference to the subject of the agreement are canceled and superseded by the
provisions of this agreement.
5. Applicable Law and Construction. The laws of the State of Florida shall govern the
validity, performance, and enforcement of this Agreement. This Agreement has been
negotiated by the City and the Applicant, and the Agreement, including, without limitation,
the Exhibits, shall not be deemed to have been prepared by the City or the Applicant, but
by all equally.
6. Severability. Should any section or part of any section of this Agreement be
rendered void, invalid, or unenforceable by any court of law, for any reason, such a
determination shall not render void, invalid, or unenforceable any other section or any
part of any section in this Agreement.
7. Amendments. This Agreement cannot be changed or revised except by written
amendment signed by all parties hereto.
8. Jurisdiction and Venue. For purposes of any suit, action or other proceeding
arising out of or relating to this Agreement, the parties hereto do acknowledge, consent
and agree that venue thereof is Pinellas County, Florida.
Each party to this Agreement hereby submits to the jurisdiction of the State of
Florida, Pinellas County and the courts thereof and to the jurisdiction of the United States
District Court for the Middle District of Florida, for the purposes of any suit, action or other
proceeding arising out of or relating to this Agreement and hereby agrees not to assert
by way of a motion as a defense or otherwise that such action is brought in an
inconvenient forum or that the venue of such action is improper or that the subject matter
thereof may not be enforced in or by such courts.
If, at any time during the term of this Agreement, the Applicant is not a resident of
the State of Florida or has no office, employee, City, registered agent or general partner
thereof available for service of process as a resident of the State of Florida, or if any
permitted assignee thereof shall be a foreign corporation, partnership or other entity or
shall have no officer, employee, agent, or general partner available for service of process
in the State of Florida, the Applicant hereby designates the Secretary of State, State of
Florida, its agent for the service of process in any court action between it and the City
arising out of or relating to this Agreement and such service shall be made as provided
by the laws of the State of Florida for service upon a nonresident; provided, however, that
at the time of service on the Florida Secretary of State, a copy of such service shall be
delivered to the Applicant at the address for notices as provided in Section V(1).
9. Termination. If not earlier terminated as provided in this Agreement, the term of
this Agreement shall expire and this Agreement shall no longer be of any force and effect
on December 1, 2026.
[Remainder of Page Left Blank Intentionally]
IN WITNESS WHEREOF, the Parties have caused this Agreement to be signed in its
corporate/legal name by its authorized representative or persons authorized to execute
this Agreement on the date and year first above written.
Artz for Life Academy
By: '
Jai Hinson
Executive Director
STATE OF FLORIDA ]
COUNTY OF PINELLAS ]
The foregoing instrument was acknowledged before me this /6 day of rk«.her,
2023 byJac%u.ti,we 140 Son , who is personally known to me or who
has produced a driver's license as identification.
My Commission expires:,,,r ?,? 9 -
Notary Public (:\l" -A
THE CITY OF CLEARWATER, a municipal corporation
By:
RYAN SACCO
NOTARY PUBUC
STATE OF COLORADO
NOTARY ID 20234033374
MY COMMISSION EXPIRES AUG. 30, 2027
Jennifer Panner
City Manager
O en Kohler -hi, Rose ane Call
City Clerk
Lead Assistant City Attorney
B. General Information
Completed by jaihinson@artz4life.org on 9/29/2023 2:04 PM
Case Id: 16000
Name: Artz 4 Life Academy - 2023
Address: *No Address Assigned
B. General Information
Please provide the following information.
B.1. Legal Name of Organization (as shown in Line 1 of REPRESENTATIVE CONTACT INFORMATION
W-9)
Artz 4 Life Academy B.10. First Name
Jai
B.2. DBA (if applicable — as shown in Line 2 of W-9)
B.11. Last Name
Hinson
B.3. Type of Agency
Arts and Education B.12. Title of Position
Executive Director
B.4. Physical Address of Organization
1751 kings highway clearwater, FL 33755 B.13. Primary Email
jaihinson@artz4life.org
B.5. Taxpayer ID (TIN) (if sole proprietorship, enter
social security number of sole proprietor) (As shown in
Part 1 of W-9)
59-3483799
B.6. Organization Legal Entity Type (as shown in Line 3
of W-9)
Artz 4 Life Academy
B.7. Mailing Address for Grant Check (As shown in Line 5
& 6 of W-9)
1751 Kings highway Clearwater, FL 33755-55
B.8. Mission Statement of Organization
Our mission is to reinforce resilience to life's challenges
by enhancing education, promoting diversity and
developing life skills through cultural and performing arts
for youth, adults and families.
B.9. Applicant Discipline (select all that apply)
Culture
QEducation
B.14. Phone Number
(727) 237-1632
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LJ History
IZI Literary Arts
❑ Museum
RIPerforming Arts
Q Visual Arts
❑ Other
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C. Project Information
Completed by jaihinson@artz4life.org on 10/2/2023 9:01 PM
Case Id: 16000
Name: Artz 4 Life Academy - 2023
Address: *No Address Assigned
C. Project Information
Please provide the following information.
C.1. Project Description
The Family Blessing Experience
ARTZ 4 Life is a multidisciplinary arts education organization that has a consistent history of providing diverse cultural
dance, performing arts, folklore, and music programming on a grass roots level to our community for the past 32
years. Commonly referred to in the media as a "cultural jewel," ARTZ 4 Life is committed to providing Pinellas County
and the Clearwater community with authentic cultural, musical and creative experiences for all ages, sizes and
ethnicities. ARTZ 4 Life Academy respectfully submits this proposal to fund our ongoing educational and community
offerings under the "Family Blessing Experience." Funding from this application will be used to support three
components of our programming strategy, which is to preserve cultural artforms, educate youth in the arts and
promote lifelong learning in the arts through hands on experiences and performances. For two years, During the 2023
— 2025 seasons, A4L will continue to offer our African Dance, music, percussion and folklore classes in Clearwater, as
well as behind the scenes including fundamentals in rehearsal and performance extending to Family Involvement
Nights with our "Behind the Curtain: The Family Blessing Experience in the Community" programs. Designed to
increase the impact and learning for Artz 4 Families who are interested in pursuing serious arts -related careers, The
Family Blessing Experience will bring professional choreographers, dancers, costumer designers, set designers and
other production professional in conversation with family and community to offer impactful experiences that extend
the production beyond the stage performance. These funds will also be used to support the costs related to the
annual community production of "The Family Blessing," multicultural, intergenerational performance in December
2023. Through these programs and activities, Artz 4 Life will provide an opportunity for community members of all
ages to explore arts, expand horizons and live out their dreams of performances and lifelong learning in the arts.
C.2. Project Goals (minimum 3 required)
The goals of the Family Blessing Experience are:
1. Offering youth, families and communities greater insight into the training, perseverance, goal setting, and resilience
necessary to create a sustainable career in the arts through interaction with professional artists;
2. Create experiences and opportunities for youth, families and communities to take part in hands-on arts activities
and in-person artistic engagements focusing on community health and well-being that encourage life-long learning in
the arts.
3. To bring professional choreographers, dancers, costumer designers, set designers and other production
professionals to Artz 4 Life in preparation for the Family Blessing production and community ensemble presentations.
C.3. Project Activities
The Family Blessing Experience
Behind the Curtain: The Family Blessing Experience in the Community": Meet the Director Workshops; 2 annually,
total of 4 over 2 years
The Family Blessing Experience in the Community": Meet the Choreographer Workshops @ Artz 4 Life; 2 annually,
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total of 4 over 2 years
The Family Blessing Experience in the Community": Meet the Costume Designer Workshops @ Artz 4 Life; 2 annually,
total of 4 over 2 years
"Artrepreneur Bookkeeping and Best Practices" Training Series with UpEmpowerment
Community and youth in rehearsal for "The Family Blessing" and community presentations throughout Clearwater
and Pinellas County, 16 training sessions and community classes offered at Artz 4 Life annually, 32 over two years.
Additional workshops and experiences for families, youth and community, including 2 trips and or festivals within
Clearwater annually, for a total of 4 over 2 years.
C.4. Project Impact — Describe how the project/program benefits the Clearwater community.
Many of the lifelong programs at ARTZ 4 Life began in 1991 and continue as an essential part of the community,
positively influencing thousands of youth throughout the Tampa Bay area. Dundu Dole African Ballet has a 30+year
tradition. ARTZ 4 Life is an economic arts engine, employing numerous Florida artists. ART) has been a part of
Theater's highly respected program School Class Act performances for over 2 decades. Many youth have been
inspired to pursue higher education, careers in the arts, creation of community productions, performance activities &
have been challenged to share their creativity with the world. Countless youth from our programs have gone on to
pursue the arts as a profession & have graduated from Julliard, Boston Conservatory of Music & Dance, arts -based
colleges such as Sante Fe College, Slippery Rock Univ., FAMU, Bethune Univ., Univ. of Hartford, Fordham & Alvin
Ailey's Dance Program in NYC. Graduates from ARTZ 4 Life have been selected to perform with professional
companies such as American Ballet Theater, Forces of Nature, Cleo Parker -Robinson Dance, Complexions and many
more. Our Alumni have commanded the stage in productions like "Katunga" (Busch Gardens), the Rockefeller Center
"Rockettes" "So You Think You Can Dance", "America's Got Talent, Tampa Auditions", American Ballet Theater,
"Motown Musical", "Hamilton" & many more. ARTZ 4 Life partners & collaborates with many venues, institutions &
organizations throughout the year This project will impact an estimated 150 Artz 4 Life children and caregivers in
engagements throughout the year, or 300 Artz 4 Life family members engagements over 2 years; plus, an estimated
100 additional North Greenwood community members annually by partnering with community organizations and
schools for approximately 500 community member engagements over 2 years. Additionally, a larger population
throughout the City of Clearwater, Pinellas County, and Tampa Bay will have access to the experiences and
engagements offered through our related CASEP video series, which will be available on the YouTube channels of Artz
4 Life, as well as our social media platforms.
C.S. Project Alignment with Cultural Arts Strategic Plan (select one or more of the following)
❑ Strengthen the identity of neighborhoods through an investment in public art at the neighborhood level.
O Invest in iconic public art in strategic locations to bolster the public art experience.
❑ Implement programs that build the capacities of the arts and culture sector to be more unified in their vision
toward the same goal.
❑ Define spaces in Clearwater that an investment in the arts can be concentrated for maximum impact.
IZSupport neighborhoods through broadening and diversifying arts experiences.
C.6. Project Alignment with Greenprint 2.0 — Describe how the project/program supports the goals and objectives
of Clearwater Greenprint 2.0 as it pertains to the following:
• Education and Awareness
• Green Energy and Buildings
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• Transportation
• Livability
• Water Conservation
• Waste Reduction
• Local Food
• Green Economy
The Family Blessing Experience aligns with the Greenprint 2.0 project goals and objectives by adding to the Artz 4 Life
youth and community's education and awareness about what it means to contribute to and create sustainable
communities by increasing education and awareness of the real life strategies, challenges, and economic realities of
pursuing a career in the arts; increased education on the roles, responsibilities and activities of professionals in the
performance field; and awareness of how the artist contributes to the lifestyles and experiences of people around the
world. It promotes the appreciation of the rich cultures, music, food, colors and all the tapestries that weave together
to help support a green economy.
C.7. Project Evaluation
• Describe how you will determine goals of the project are achieved.
• Who will conduct the evaluation?
• Who or what will the evaluation target?
• What methods will be used to collect participant feedback? (surveys, evaluation forms, interviews, etc.)
• When will you collect this information?
• How will you use this information for future programs?
ARTZ 4 Life uses various methods and processes to gather and analyze data to evaluate program accomplishments
and necessary improvements.
ARTZ 4 Life utilizes an enrollment process that includes completing an application that contains demographic
information on child, family, experience an history. All students are required to sign -in when participating in classes
and staff/volunteers keep records of attendance, including enrollment, demographics & presence logs.
A pre/post questionnaire will be administered to adult family members and community participants to measure
insight and knowledge gained of basic arts business and career principles, strategies, and goal setting.
Parents, family members, friends and guests at performances are provided opportunity to complete an evaluation
form after performances. Performances are video taped to notate progress of the students and annual skill level
evaluations are conducted to denote the advancement and evaluation of each student.
C.B. Identify the timeline for implementation of the proposed project/program.
August - Promotions of auditions, production dates
September - Bring in Choreographers for workshops and choreography sessions, Partner with schools and other
performing arts organizations and institutions, Conduct weekly community classes and workshops,
October -Participate in community events such as Clearwater Jazz Holiday, engage in social media on Facebook,
Instagram, Tik Tok and Twitter, emails, Constant Contact, Linked -IN, Youtube and will continue grassroots efforts by
distributing flyers at community centers, email blasts, and word of mouth. Artz 4 Life will continue to use free media
sources such as EPinellas, Pinellas Arts links, chambers of commerce, Bay News 9, Tampa Bay on Demand, WUSF
Radio, The Weekly Challenger, the Parent Guide Magazine, Women's Magazine, and Powerbroker Magazine.
November - Continue community classes and workshops with community youth, parents and partnering
organizations.
December -Promotion through 95.7 The BEAT and other radio stations will continue to promote the performance and
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other activities being presented in the area.
January - Participate in community events, festivals and activities. Prepare youth for community performances and
workshops,
February - Conduct evaluations and presentations of programs and activities conducted. From January through June,
ARTZ 4 Life concentrates on promoting its ensemble live performances and tours.
C.9. Sustainability — Describe plans to sustain the project/program after grant funds are expended.
At the end of the two-year project, we should have successfully trained a minimum of (25) twenty-five Artz 4 Life
staff, youth and/or family members who are fully trained in conducting workshops, demonstrations and/or
participating in community performances. Selected students will participate in video lessons that will be marketed
and sold to share instructional information with interested parties who would like to continue learning the craft.
Many products can be sold online and at weekend markets, festivals and cultural events during performances. The
CASEP Video series will foster video -making skills while helping Artz 4 Life build its online video presence. Our video
project will equip Artz 4 Life staff, youth, and or family members with the skills to produce future videos, which will
enable us to apply for a number of media and arts grants.
C.10. Routine Maintenance and Utility Costs — If funding is requested for a capital or infrastructure project, provide
the anticipated routine maintenance, including utility costs.
n/a
C.11. Fiscal Condition — Describe the fiscal condition of your organization as it relates to the successful completion
of the project/program proposed.
Our organization is in the process of conducting our 2 year audit which will be completed by December 31, 2023.
C.12. Organization's Fiscal Year
Oct 1- Sept 30
C.13. Organizational Operating Budget Summa
Expenses
Total Cash Expenses
in -Kind Contributions
Tonal. rating nses
550000
$570,000.00
$20,000.00
$570,000.00
income
Total Cash Income
in -Kind Contributions
Total Opr rat1 gi e
550000
$570,000.00
$20,000.00
$570,000.00
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D. Funding Request
Completed by jaihinson@artz4life.org on 10/2/2023 9:38 PM
Case Id: 16000
Name: Artz 4 Life Academy - 2023
Address: *No Address Assigned
D. Funding Request
Please provide the following information.
D.1. Funding Request Table
If you selected "Other" please provide expenses in detail
N/A
D.2. City of Clearwater Cultural Affairs Nonprofit grant funds requested? Note: Allocation of the grant funds will be
paid on a case-by-case basis after consulting with awardees their need for the funds.
$80,000.00
D.3. Does this project/program anticipate the use of funds or assistance from other organizations?
N/A
D.4. Describe your plans to use other funds on this project. In this section, only describe funds that are secured.
Provide the source of funds, amounts, and how these funds will be used.
N/A
D.5. Describe your plans to seek new funding to supplement ARPA funding. Describe the sources to which you will
apply, the amounts sought, and the proposed use of those funds.
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Project Estimate
Funding Request
Amount From Other
Funding Sources
Sc rce:of K ther
Funding
Personnel:
Administrative
$10,000.00
$10,000.00
$0.00
0
Personnel:
Programmatic
$4,500.00
$4,500.00
$0.00
0.00
Outside Fees and
Services:
Administrative
$4,500.00
$4,500.00
$0.00
0.00
Outside Fees and
Services:
Programmatic
$16,600.00
$16,600.00
$0.00
0
Outside Fees and
Services: Other
$0.00
$0.00
$0.00
0
Space Rental
$2,500.00
$2,500.00
$0.00
0.00
Marketing
$2,000.00
$2,000.00
$0.00
0.00
Other
$0.00
$0.00
$0.00
For Projects: Utility
Costs
$0.00
$0.00
$0.00
$40,100.00
$40,100.00
$0.00
If you selected "Other" please provide expenses in detail
N/A
D.2. City of Clearwater Cultural Affairs Nonprofit grant funds requested? Note: Allocation of the grant funds will be
paid on a case-by-case basis after consulting with awardees their need for the funds.
$80,000.00
D.3. Does this project/program anticipate the use of funds or assistance from other organizations?
N/A
D.4. Describe your plans to use other funds on this project. In this section, only describe funds that are secured.
Provide the source of funds, amounts, and how these funds will be used.
N/A
D.5. Describe your plans to seek new funding to supplement ARPA funding. Describe the sources to which you will
apply, the amounts sought, and the proposed use of those funds.
Printed By: Amber Brice on 12/22/2023
NNeighborly Software
1 of 2
We will seek funding from Culture Builds Florida $40,000, Pinellas Community Foundation $10,000.
D.6. What will happen if this project is not funded?
We will continue to fundraise and apply for additional funding.
D.7. What will happen if this project is partially funded?
We will continue to fundraise and apply for additional funding.
Printed By: Amber Brice on 12/22/2023
NNeighborly Software
2 of 2
Form w-9
(Rev. October 2018)
Department of the Treasury
Internal Revenue Service
Request for Taxpayer
Identification Number and Certification
I. Go to wwv.irs.gov/FonnW9 for instructions and the latest information.
Give Form to the
requester. Do not
send to the IRS.
co
0
0.
c
0
05o
E
a`0
E
to
1 Name (as shown on your income tax retum). Name Is required on this line; do not leave this line blank.
JAI HINSON
2 Business name/disregarded entity name, If different from above
ARTZ 4 LIFE ACADEMY INC
3 Check appropriate box for federal tax classification of the person whose name is entered on line 1. Check only one of the
following seven boxes.
❑ Indlvidual/sole proprietor or C Corporation ❑ S Corporation 0 Partnership ❑ Trust/estate
single -member LLC
❑ Limited liability company. Enter the tax classification (C=C corporation, S=S corporation, P=Partnership) ►
Note: Check the appropriate box in the line above for the tax classification of the single -member owner. Do not check
LLC if the LLC is classified as a single -member LLC that Is disregarded from the owner unless the owner of the LLC is
another LLC that is not disregarded from the owner for U.S. federal tax purposes. Otherwise, a single -member LLC that
is disregarded from the owner should check the appropriate box for the tax classification of its owner.
❑ Other (see instructions) ►
4 Exemptions (codes apply only to
certain entities, not individuals; see
instructions on page 3):
Exempt payee code (if any)
Exemption from FATCA reporting
code (if any)
(Applies to acwimb wed outside the U.S.)
5 Address (number, street, and apt. or suite no.) See instructions.
1751 KINGS HIGHWAY
6 City, state, and ZIP code
CLEARWATER, FLORIDA 33755
Requester's name and address (optional)
7 List account number(s) here (optional)
Part 1
Taxpayer Identification Number (TIN)
Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid
backup withholding. For individuals, this is generally your social security number (SSN). However, for a
resident alien, sole proprietor, or disregarded entity, see the instructions for Part I, later. For other
entities, it is your employer identification number (EIN). If you do not have a number, see How to get a
TIN, later.
Note: If the account is in more than one name, see the instructions for line 1. Also see What Name and
Number To Give the Requester for guidelines on whose number to enter.
Part 11
Social security num
or
Employer identification number
5
9
3
4
8
3
7
9
9
Certification
Under penalties of perjury, I certify that:
1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me); and
2.1 am not subject to backup withholding because: (a) I an exempt from backup withholding, or (b) I have not been notified by the Internal Revenue
Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am
no longer subject to backup withholding; and
3. I am a U.S. citizen or other U.S. person (defined below); and
4. The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct.
Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because
you have failed to report all interest and dividends on your tax retum. For real estate transactions, item 2 does not apply. For mortgage interest paid,
acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments
other than interest and dividends, you aa.not required to sign the certification, but you must provide your correct TIN. See the instructions for Part II, later.
Sign
Here
Signature of
U.S. person ►
Date ►
General Instruction
Section references are to the Internal Revenue Code unless otherwise
noted.
Future developments. For the latest information about developments
related to Form W-9 and its instructions, such as legislation enacted
after they were published, go to www.irs.gov/FormW9.
Purpose of Form
An individual or entity (Form W-9 requester) who is required to file an
information retum with the IRS must obtain your correct taxpayer
identification number (TIN) which may be your social security number
(SSN), individual taxpayer identification number (ITIN), adoption
taxpayer identification number (ATIN), or employer identification number
(EIN), to report on an information retum the amount paid to you, or other
amount reportable on an information retum. Examples of information
returns include, but are not limited to, the following.
• Form 1099 -INT (interest eamed or paid)
//i
262Z
• Form 1099 -DIV (dividends, including those from stocks or mutual
funds)
• Form 1099-MISC (various types of income, prizes, awards, or gross
proceeds)
• Form 1099-B (stock or mutual fund sales and certain other
transactions by brokers)
• Form 1099-S (proceeds from real estate transactions)
• Form 1099-K (merchant card and third party network transactions)
• Form 1098 (home mortgage interest), 1098-E (student loan interest),
1098-T (tuition)
• Form 1099-C (canceled debt)
• Form 1099-A (acquisition or abandonment of secured property)
Use Form W-9 only if you are a U.S. person (including a resident
alien), to provide your correct TIN.
If you do not retum Form W-9 to the requester with a 17N, you might
be subject to backup withholding. See What is backup withholding,
later.
Cat. No. 10231X
Form W-9 (Rev. 10-2018)
e CERTIFICATE OF LIABILITY INSURANCE
A�b•
DATE (MWDD/YYYY)
10/3/2022
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION 1S WANED, subject to
the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
certificate holder in lieu of such endorsement(s).
PRODUCER
ARCit insurance
9067 Belcher Road
CIRITACT Yids Rivero
PHONE { . Ertl: (727)544-8841 FAX
No1. (727) 544-8142
A $8,yida@arcwinsurance.com
DD
Pinellas Park FL 33782
INSURER(S) AFFORDING COVERAGE
NAI 0
Wsu RA:Philadelphia Indemnity Insurance Cogger
P18058
INSURED
Artz 4 Life Academy Inc.
1751 Kings Hwy
Clearwater FL 33755
INSURERB:Philadelphia Insurance Companies
06777
INSURERC:
CLAIMS -MADE X OCCUR
INSURER D :
$ 5,000
WSURERE:
INSURER F:
$ 1,000,000
NUMBER:22/23 Master Cert
REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCR BED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR-SUSR
TYPE OF INSURANCE
OM
X
MD
POLICY NUMBER
PSPX24611300
POUCY EFF
IMMIDOIYYYY)
10/1/2022
POLICY EXP
IMMIDDIWYY)
10/1/2023
LIMITS
EACH OCCURRENCE
$ 1,000,000
A
X
COMMERCIAL GENERAL LIABILITY
AMAO RENTED
PR SES �Earence)
$ 300 , 000
CLAIMS -MADE X OCCUR
MED EXP (My one person)
$ 5,000
PERSONAL & ADV INJURY
$ 1,000,000
GENERAL AGGREGATE
$ 3,000,000
GEML
X
AGGREGATELIAIT APPLIES PER:
POLICY n QCT n LOC
OTHER:$
PRODUCTS - COMP/OPAGG
$ 3,000,000
A
AUTOMOBILE
-�
X
—
LIABILEY
ANY AUTO
ALL OWNED
AUTOS
HIRED AUTOS
,--r—
—
X
SCHEDULED
AUTOS
NON -OWNED
AUTOS
- -
X
WM24613300
10/1/2022
10/1/2023
COMBINED SINGLE LIMIT
(Ee accident)
$ 1,000,000
BODILY INJURY (Per person)
$
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
{Per accident)
$
$
B
X
UMBRELLALIAB
EXCESS IJAB
OCCUR
CLAIMS -MADE
PRUBe33753
10/1/2022
10/1/2023
EACH OCCURRENCE
$ 4 000 000
AGGREGATE
$ 4,000, 000
$
DED RETENTION $
WORKERS COMPENSATION
ANO EMPLOYERS' LIABILITYY / N
ANY PROPRIETORIPARTNERIEXECUTNE
OFFICER/MEMBER EXCLUDED? n
(Mandatory in NN)
if yes, describe under
DESCRIPTION OF OPERATIONS below
N 1 A
- MR
STATUTE
OTH-
ER
E.L. EACH ACCIDENT
$
E.L. DISEASE - EA EMPLOYEE
$
E.L. DISEASE - POUCY LIMIT
$
A
Professional Liability
Deductible $1,000
X
PHR12466300
10/1/2022
10/1/2023
Eed+Occurmnce 1,000,000
Aggregate 1,000,000
DESCRIPTION OF OPERATIONS 1 LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached I more space Is required)
CERTIFICATE HOLDER
CANCELLATION
City of Clearwater
100 S. Myrtle Avenue
Clearwater, FL 33756
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
James Parenti/SHWATT
s
ACORD 25 (2014/01)
IWRn9c r,n+dn11
®1988-2014 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
Additional Named Insureds
Other Named Insureds
Life Force Cultural Arts Academy, Inc. Not for profit org, Insured Multiple Names
OFAPPINF (02/2007) COPYRIGHT 2007, AMS SERVICES INC
COMMENTS/REMARKS
1)Cyber Liability
Insurer: Evolve
NAIC: See Attached
Policy #:ESL0239511-955
Policy Effective Date:8/19/22 to 8/19/23
$500,000 Each Claim
$500,000 Annual Aggregate
$2,500 Self -Insured Retention
Retroactive Date: 8/19/19
2) Accident policy Philadelphia policy # PHPA114383
Effective Date 10/01/2022 to 10/01/2023; $50,000 maximum Benefit
2)Abuse and Molestation Liability
Insurer: Philadelphia Indemnity Ins Co.
NAIC: 18058
Policy #:PHPK2333216
Policy Effective Date:10/01/22 to 10/01/23
$1,000,000 Each Claim
$3,000,000 Anuual Aggregate
$0 Deductible
3)Directors and Officers/Employment Practices Liability
Insurer: Philadelphia Indemnity Ins Co.
NAIC: 18058
Policy #:PHSD1665535
Policy Effective Date:10/01/22 to 10/01/23
$1,000,000 Each Claim
$1,000,000 Aggregate
$25,000 Self -Insured Retention
Retroactive Date: 01/01/2002
$0 Deductible
4)Crime Insurance
Insurer: Travelers
NAIC: 19046
Policy #107139057
Policy Effective Dates:8/19/22 to 8/19/23
$300,000 Employee Dishonesty $1,000 deductible
$300,000 Forgery or Aleration $1,000 deductible
$300,000 Robbery (on or off premises) $1,000 deductible
$300,000 Computer Fraud $1,000 deductible
$300,000 Funds Transfer Fraud $1,000 deductible
Accident Policy Philadelphia Policy #PHPA114383
Policy Dates 10/01/2022-2023; $50,000 maximum Benefit
OFREMARK COPYRIGHT 2000, AMS SERVICES INC.
INTERNAL REVENUE SERVICE
P. O. BOX 2508
CINCINNATI, OH 45201
Date: JAN 0 4 2001
DUNDU DOLE INC
1606 N HIGHLAND AVE
CLEARWATER, FL 33755
Dear Applicant:
DEPARTMENT OF THE TREASURY
Employer Identification Number:
59-3483799
DLN:
17053279027040
Contact Person:
ROBERrA VAN METER ID# 52624
Contact Telephone Number:
(877) 829-5500
Accounting Period Ending:
September 30
Form 990 Required:
Yes
Addendum Applies:
No
Based on information supplied, and assuming your operations v411 be as
stated in your application for recognition of exemption we have determined
you are exempt from federal income tax under section 501(a) of the Internal
Revenue Code as an organization described in section 501(c)(3).
We have further determined that you are not a private foundation within
the meaning of section 509(a) of the Code, because you are an organization
described in section 509(a)(2).
If your sources of support, or your purposes, character, or method of
operation change, please let us know so we can consider the effect of the
change on your exempt status and foundation :status. In the case of an amend-
ment to your organizational document or bylaws, please send us a copy of the
amended document or bylaws. Also, you should inform us of all changes in your
name or address.
As of January 1, 1984, you are liable for taxes under the Federal
Insurance Contributions Act (social security taxes) on remuneration of $100
or more you pay to each of your employees du:-ing a calendar year. You are
not liable for the tax imposed under the Federal Unemployment Tax Act (FUTA).
Since you are not a private foundation, you are not subject to the excise
taxes under Chapter 42 of the Code. However if you are involved :_n an excess
3enefit transaction, that transaction might be subject to the excise taxes of
section 4958. Additionally, you are not automatically exempt from other
`ederal excise taxes. If you have any quest:.ons about excise, employment, or
)ther federal taxes, please contact your key district office.
Grantors and contributors may rely on this determination unless the
ncernal Revenue Service publishes notice to the contrary. However, if you
ose your section 509(a)(2) status, a grantor or contributor may nc.t rely
n this determination if he or she was in part responsible for, or was aware
f, the act or failure to act, or the substantial or material change on the
Letter 947 (DO/CG)
-441,y Tr 1k \ Is. re ".c, • ti -1111/ • 7/%?•1.,..! •!..+.1•1/•.!,#1.,\:!#,T:.,!;.41# t!:..1.107!L',*4.! • s...k • # 'e' ‘.T
.: 080): 0.-.ZI"`: 00 "0•0 ' _ ‘1. : 00 WS • IV. 40••• 0•0!, 6141. 11/1. • Z.; 41,4'
;1-ril .1.74 ;i7i,(Ce•,.."•"( \ "‘-ed $ \-;i1111C;', • i*:;•1 • • , * 4,7,10 ,k--,10 ;.:7-..i;• 1..."10 0 Is. ri • ; • • • „:
It
•
,„
SVC *0
tepartnumt of OM?
I certify the attached is a true and correct copy of the Articles of Amendment,
filed on May 13, 2002, to Articles of Incorporation for DUNDU DOLE, INC.
which changed its name to LIFE FORCE CULTURAL ARTS ACADEMY, INC., a
Florida corporation, as shown by the records of this office.
The document number of this corporation is N97000006454.
CR2E022 (1-99)
• #
" • , e's,1 ,
• OM*
i .0'it mot* oc
Given under my hand and the
Great Seal of the State of Florida
at Tallahassee, the Capitol, this the
Seventeenth day of May, 2002
Iithi1!L'rinc
-*.s-.---:lerretaro of.
•
•
•
• •
•.:
`1 "A!irti\lr,-�t•;1r,.,•he%I.i/s.�11/rt;ll �Ir' i7rti lrrxlit (\ilr�tltr�tlTry�l���7«t.�t tii �7 i7 it ii iJr�ti7.,�ti�..^!i1+.,��t• \ $Ir l:�
•. �•��••'�� I►• :, M\`. igR1 .-:, r� •i': , ��t i �' .nM 1►•.'.. i.` ,00 f ... •`\ *0 ...o`\ 1 / romp' ►i Ora .* •. .0 .i ,! •0
71; el!}wd(i}ti=.'111 11•h.'111tir1•}Edi•}.?
State of Florida
Department of State
I certify from the records of this office that ARTZ 4 LIFE ACADEMY, INC. is
a corporation organized under the laws of the State of Florida, filed on
November 17, 1997.
The document number of this corporation is N97000006454.
I further certify that said corporation has paid all fees due this office through
December 31, 2017, that its most recent annual report/uniform business report
was filed on February 14, 2017, and that its status is active.
I further certify that said corporation has not filed Articles of Dissolution.
Given under my hand and the
Great Seal of the State of Florida
at Tallahassee, the Capital, this
the Fourteenth day of February,
2017
04,44,0‘
Secretary of State
Tracking Number: CC4592306131
To authenticate this certiflcate,visit the following site,enter this number, and then
follow the instructions displayed.
haps://services.sunbiz.org/Filings/Certificateot5tatus/CertificateAuthentication
Form 990
Department of the Treasury
Internal Revenue Service
Return of Organization Exempt From Income Tax
Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except private foundations)
► Do not enter social security numbers on this form as it may be made public.
► Go to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
20021
Open to Public
Inspection
A For the 2021 calendar year, or tax year beginning 10/01/2021 and ending 09/30/2022
B Check if applicable:
❑ Address change
❑ Name change
❑ Initial return
❑ Final return/terminated
O Amended return
❑ Application pending
C Name of organization ARTZ 4 LIFE ACADEMY INC
Doing business as
D Employer identification number
59-3483799
Number and street (or P.O. box if mail is not delivered to street address)
1751 Kings Hwy
Room/suite
E Telephone number
727-216-3519
City or town, state or province, country, and ZIP or foreign postal code
Clearwater, FL 33755
F Name and address of principal officer: Jacqueline Hinson
1751 Kings Hwy, Clearwater, FL 33755
1 Tax-exempt status: ❑✓ 501(c)(3) ❑ 501(c) ( ) 4 (insert no.) ❑ 4947(a)(1) or ❑ 527
J Website: ► www.artz4lifeacademy.org
K Form of organization: ❑✓ Corporation ❑ Trust ❑ Association ❑ Other ►
L Year of formation:
G Gross receipts $ 636,048
H(a) Is thi etum for subordinates? 0 Yes ❑✓ No
�'
H(b) � .inates included? 0 Yes ❑ No
If r ch a list. See instructions.
up exemption number ►
97 1 M State of legal domicile:
FL
Activities & Governance la
1
Summary _
1
2
3
4
5
6
7a
b
Briefly describe the organization's mission or most significant activities: _
affirming activities and opportunities foryouth and adults of all ages. The
-(Continued on Schedule 0, Statement 2) ,a
cademy, Inc.
Artz 4 Life Academy
of more than 25%
. . . .
offers
of
3
positive life
is to celebrate
its net assets.
6
Check this box ► • if the organization discontinued its operations or ' ed
Number of voting members of the governing body (Part VI, line 1 a)
Number of independent voting members of the governing body (I, line 1b)
Total number of individuals employed in calendar year 2021 (P line 2a)
Total number of volunteers (estimate if necessary) . . >
Total unrelated business revenue from Part VIII, column (r2
Net unrelated business taxable income from Form 990-T, Paul, line 11
4
5
5
9
6
20
7a
0
7b
0
IRevenue
8
9
10
11
12
Contributions and grants (Part VIII, line 1 h) •
Program service revenue (Part VIII, line 2g) ° "'
Investment income (Part VIII, column (A), lines and 7d)
Other revenue (Part VIII, column (A), lines 5, ,, , 9c, 10c, and 11 e) . .
Total revenue—add lines 8 through 11 (must egia Part VIII, column (A), line 12)
Prior Year
Current Year
99,637
57,773
390,418
578,275
0
0
3,730
0
493,785
636,048
Expenses
13
14
15
16a
b
17
18
19
Grants and similar amounts paid (Part IX, lumn (A), lines 1-3)
Benefits paid to or for members (Pac n (A), line 4)
Salaries, other compensation, empl t nefits (Part IX, column (A), lines 5-10)
Professional fundraising fees part IX, Column (A), line 11e)
Total fundraising expenses artg, column D line 25) ► 0
Other expenses (Part IX, umn (A), lines 11a -11d, 11f -24e)
Total expenses. Add lines 17 (must equal Part IX, column (A), line 25)
Revenue less expens -tract line 18 from line 12
0
0
0
0
332,917
338,898
0
0
;'w
k
170,750
228,385
503,667
567,283
-9,882
68,765
Net Assets or
Fund Balances
20
21
22
Total assets (P 16)
Total liabilitie line 26)
Net assets fun', alances. Subtract line 21 from line 20
Beginning of Current Year
End of Year
94,348
467,088
220,505
526,488
-126,157
-59,400
Part
11
Signature k
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is
true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.
Sign
Here
Signature of officer
Lahteefah Bryant, Treasurer
Date
Type or print name and title
Paid
Preparer
Use Only
Print/Type preparer's name
Preparer's signature
Date
Check 0 if
self-employed
PTIN
Firm's name ►
Firm's address ►
Firm's EIN ►
Phone no.
May the IRS discuss this return with the preparer shown above? See instructions
For Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y
❑ Yes ❑ No
Form 990 (2021)
Form 990 (2021)
Part III
Page 2
Statement of Program Service Accomplishments
Check if Schedule 0 contains a response or note to any line in this Part III
1 Briefly describe the organization's mission:
The Academy offers positive life affirming services and opportunities toyouth and adults of all ages. The mission of the Academy
is to reinforce resilience to life challenges by enhancing education, promoting diversity, developing life skills through cultural and
_performing arts foryouth, adults, and families.
2 Did the organization undertake any significant program services during the year which were
prior Form 990 or 990-EZ9
If "Yes," describe these new services on Schedule O.
3 Did the organization cease conducting, or make significant changes in
services?
If "Yes," describe these changes on Schedule O.
4 Describe the organization's program service accomplishments for each of its three larg
expenses. Section 501(c)(3) and 501(c)(4) organizations are required to report the am
the total expenses, and revenue, if any, for each program service reported.
not listed on the
how it conducts,
4a (Code: ) (Expenses $ 68,121 including grants of $
Performing Arts: This includes all of ourperforming arts programs. Specificall
Academy, Inc. continues to exceed expectations and budget under the directi
currentyear, the organization rebranded the annual production of the Choc
Blessing and continued to receive the highest accolades for theproducti
Bay community families, based on weekend long sold out performance
any program
❑ Yes 1 No
❑ Yes ❑� No
gram services, as measured by
f grants and allocations to others,
(Revenue $ 95,031 )
illy Blessing and Dundu Dole. Artz 4 Life
under/Executive Director, Jai Hinson. In the
cracker to The Nutcracker Twist to The Famity
eproduction reached approximately 6,000 Tampa
4 Life Academy continued to collaborate with
Mahaffey Theater and the City of St.Petersburg to provide a state of t -"venue for the annual production. Artz 4 Life Academy,
Inc. established a semi-professionalperformina outlet for common th that performs a variety of genres; such as West African
Dance, Jazz, Ballet, Modern, and Caribbean. The youth use the fessional company as a foundation for future endeavors.
Many of our students have been accepted for summer intensivesw =; schools such as: Alvin Ailey, The Rock and Jacobs Pillow.
Several have receivedperforming art scholarships and re-•"`: s awards. We havegraduates attending on scholarship to Sante
Fe College, University of Hartford, Gainesville, Slipper nnsylvania and Boston Conservatory and one former dancer
(Continued on Schedule 0, Statement 3)
4b (Code: ) (Expenses $ 422,854 i
Arts, Culture & Humanities Programs: The progra
)ng grants of $ ) (Revenue $
438,244 )
he Academy provide youth with opportunities to explore the arts and
develop skills they can use to express themsel es in I aspects of their live, now, and as they chart a course for their future.
Studies have shown that art education, as a nsion of the classroom and an academic resource, increases learning by
enhancing math, readingand writing_sl 11 a ation, expressed conce_ptualty andpractically in various forms and discPlines,
choolyear, and throughout their summer hiatus. Youth who takepart in our
stimulates intelligence in ouryouth duri
_programs achieve higher educatio
developpersonal values and ch
Academic and Cultural Enric
andpersonal aspirations through activities that reach beyond the classroom to identify and
uilding assets, increasing their effectiveness, resiliency, and academic performance. The
after school program, Explore the Arts summer camp, Angelina Ballerina, which was featured
in conjunction with the Univer f South Florida and local news programs, and the Community Through our eyes; which helped
communityyouth underst egacy and history of the local community.
4c (Code:
nses $ including grants of $ ) (Revenue $
4d Other program services (Describe on Schedule 0.)
(Expenses $ 0 including grants of $
0 ) (Revenue $ 0 )
4e Total program service expenses ► 490,975
Form 990 (2021)
Form 990 (2021)
Page 3
Part IV
Checklist of Required Schedules
1 Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If "Yes,"
complete Schedule A
2 Is the organization required to complete Schedule B, Schedule of Contributors? See instructions . . .
3 Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to
candidates for public office? If "Yes," complete Schedule C, Part I
4 Section 501(c)(3) 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 II
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 Ill . .
6 Did the organization maintain any donor advised funds or any similar funds or accounts f , h donors
have the right to provide advice on the distribution or investment of amounts in such fun unts? If
"Yes," complete Schedule D, Part I
7 Did the organization receive or hold a conservation easement, including easements to
the environment, historic land areas, or historic structures? If "Yes," complete Sch dule , art 11 . . .
8 Did the organization maintain collections of works of art, historical treasures, or
complete Schedule D, Part 111
9 Did the organization report an amount in Part X, line 21, for escrow or cu
custodian for amounts not listed in Part X; or provide credit counseling,
debt negotiation services? If "Yes," complete Schedule D, Part IV . .
10 Did the organization, directly or through a related organization, hold
or in quasi endowments? If "Yes," complete Schedule D, Part V
11 If the organization's answer to any of the following questions is " , t
VII, VIII, IX, or X, as applicable.
a Did the organization report an amount for land, building
complete Schedule D, Part VI
b Did the organization report an amount for investments—
of its total assets reported in Part X, line 16? If "Yes,"
c Did the organization report an amount for investm
of its total assets reported in Part X, line 16? If "Yeg;
d Did the organization report an amount for other
reported in Part X, line 16? If "Yes," complete Sc
rve open space,
e Did the organization report an amount for of
f Did the organization's separate or consolid
the organization's liability for uncertain t
12a Did the organization obtain separa
Schedule D, Parts XI and XII .
liar assets? If "Yes,"
count liability, serve as a
anagement, credit repair, or
s donor -restricted endowments
en complete Schedule D, Parts VI,
quipment in Part X, line 10? If "Yes,"
securities in Part X, line 12, that is 5% or more
e Schedule D, Part VII
gram related in Part X, line 13, that is 5% or more
plete Schedule D, Part Vlll
in Part X, line 15, that is 5% or more of its total assets
le D, Part IX
bilities in Part X, line 25? If "Yes," complete Schedule D, Part X
ficial statements for the tax year include a footnote that addresses
son `under FIN 48 (ASC 740)? If "Yes," complete Schedule D, Part X
independent audited financial statements for the tax year? If "Yes," complete
b Was the organization includ irk consolidated, independent audited financial statements for the tax year? If
"Yes," and if the organization ered "No" to line 12a, then completing Schedule D, Parts XI and XII is optional
13 Is the organization a sch
14a Did the organization
b Did the organizati
fundraising, busi
foreign investrr
bed in section 170(b)(1)(A)(ii)? If "Yes," complete Schedule E . . .
an office, employees, or agents outside of the United States?
aggregate revenues or expenses of more than $10,000 from grantmaking,
vestment, and program service activities outside the United States, or aggregate
ud at $100,000 or more? If "Yes," complete Schedule F, Parts 1 and IV
15 Did the organiza port 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 1l 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 Ill 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 11 e? If "Yes," complete Schedule G, Part 1. 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 11
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 111
20a Did the organization operate one or more hospital facilities? If "Yes," complete Schedule H
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 government on Part IX, column (A), line 1? If "Yes," complete Schedule 1, Parts 1 and 11 . . . .
Yes
No
1
2
3
4
5
6
7
8
9
10
11a
11b
11c
11d
Ile
111
12a
12b
13
14a
14b
15
16
17
18
19
20a
20b
21
Form 990 (2021)
Form 990 (2021)
Page 4
Part IV
Checklist of Required Schedules (continued)
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? If "Yes," complete Schedule 1, Parts I and 111
23 Did the organization answer "Yes" to Part VII, Section A, line 3, 4, or 5, about compensation of the
organization's current and former officers, directors, trustees, key employees, and highest compensated
employees? If "Yes," complete Schedule J
24a Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than
$100,000 as of the last day of the year, that was issued after December 31, 2002? If "Yes," answer lines 24b
through 24d and complete Schedule K. If "No," go to line 25a
b Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exce•tion? .
c Did the organization maintain an escrow account other than a refunding escrow at any time ^ • the year
to defease any tax-exempt bonds?
d Did the organization act as an "on behalf of" issuer for bonds outstanding at any time du ' ,F , year? . .
25a Section 501(c)(3), 501(c)(4), and 501(c)(29) organizations. Did the organization engag ; n excess benefit
transaction with a disqualified person during the year? If "Yes," complete Schedul L, Pa
b Is the organization aware that it engaged in an excess benefit transaction with a led person in a prior
year, and that the transaction has not been reported on any of the organizati orms 990 or 990 -EZ?
If "Yes," complete Schedule L, Part I
26 Did the organization report any amount on Part X, line 5 or 22, for receive s m or payables to any current
or former officer, director, trustee, key employee, creator or found s tantial contributor, or 35%
controlled entity or family member of any of these persons? If "Yes," c / Schedule L, Part 11 . . .
27 Did the organization provide a grant or other assistance to any curr former officer, director, trustee, key
employee, creator or founder, substantial contributor or emplo hereof, a grant selection committee
member, or to a 35% controlled entity (including an employe eof) or family member of any of these
persons? If "Yes," complete Schedule L, Part 111 y �
st
28 Was the organization a party to a business transaction with onenf the following parties (see the Schedule L,
Part IV, instructions for applicable filing thresholds, condiliaris, end exceptions):
a A current or former officer, director, trustee, key a reator or founder, or substantial contributor? If
"Yes," complete Schedule L, Part IV
b A family member of any individual described in lin 9 If "Yes," complete Schedule L, Part IV
c A 35% controlled entity of one or more indivi and/or organizations described in line 28a or 28b? If
"Yes," complete Schedule L, Part IV
29 Did the organization receive more than $2
30 Did the organization receive contributi
conservation contributions? If "Yes," dC
in non-cash contributions? If "Yes," complete Schedule M
, historical treasures, or other similar assets, or qualified
e Schedule M
31 Did the organization liquidate, ter ate, or'dissolve and cease operations? If "Yes," complete Schedule N, Part I
32 Did the organization sell, exchr`t dispose of, or transfer more than 25% of its net assets? If "Yes,"
complete Schedule N, Part II
33 Did the organization own 10 f f an entity disregarded as separate from the organization under Regulations
sections 301.7701-2 and *'9 -3? If "Yes," complete Schedule R, Part I
34 Was the organization )at to any tax-exempt or taxable entity'? If "Yes," complete Schedule R, Part Il, 111,
or IV, and Part V, lint
35a Did the organizat A `"" a controlled entity within the meaning of section 512(b)(13)'?
b If "Yes" to lin the organization receive any payment from or engage in any transaction with a
controlled entity the meaning of section 512(b)(13)? If "Yes," complete Schedule R, Part V, line 2 . .
36 Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non -charitable
related organization? If "Yes," complete Schedule R, Part V, line 2
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 VI
38 Did the organization complete Schedule 0 and provide explanations on Schedule 0 for Part VI, lines 11 b and
19? Note: All Form 990 filers are required to complete Schedule 0
Yes
No
22
23
24a
24b
24c
24d
25a
25b
26
27
28a
28b
28c
29
30
31
32
33
34
35a
35b
36
37
38
Part V
Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule 0 contains a response or note to any line in this Part V
la Enter the number reported in box 3 of Form 1096. Enter -0- if not applicable
la 37430
b Enter the number of Forms W -2G included on line 1 a. Enter -0- if not applicable . . . 1 b 0
c Did the organization comply with backup withholding rules for reportable payments to vendors and
reportable gaming (gambling) winnings to prize winners"
Yes No
lc ✓
Form 990 (2021)
Form 990 (2021)
Part V
2a
b
3a
b
4a
b
5a
b
c
6a
b
7
a
b
c
d
e
f
g
h
8
9
a
b
10
a
b
11
a
b
12a
b
13
a
b
c
14a
b
15
16
17
Page 5
Statements Regarding Other IRS Filings and Tax Compliance (continued)
Enter the number of employees reported on Form W-3, Transmittal of Wage and Tax
Statements, filed for the calendar year ending with or within the year covered by this return
If at least one is reported on line 2a, did the organization file all required federal employment tax returns? .
Note: If the sum of lines 1 a and 2a is greater than 250, you may be required to e -file. See instructions.
Did the organization have unrelated business gross income of $1,000 or more during the year?
If "Yes," has it filed a Form 990-T for this year? If "No" to line 3b, provide an explanation on Schedule 0 .
At any time during the calendar year, did the organization have an interest in, or a signature or other authority over,
a financial account in a foreign country (such as a bank account, securities account, or other financial account)?
If "Yes," enter the name of the foreign country ►
See instructions for filing requirements for FinCEN Form 114, Report of Foreign Bank and Financial Ac ounts (FBAR).
Was the organization a party to a prohibited tax shelter transaction at any time during the tax . .
Did any taxable party notify the organization that it was or is a party to a prohibited tax shel ction?
If "Yes" to line 5a or 5b, did the organization file Form 8886-T? . . .
Does the organization have annual gross receipts that are normally greater than $ s i' i0, and did the
organization solicit any contributions that were not tax deductible as charitable co tribut
If "Yes," did the organization include with every solicitation an express stateme ; sr ich contributions or
gifts were not tax deductible?
Organizations that may receive deductible contributions under sectio
Did the organization receive a payment in excess of $75 made partly as
and services provided to the payor?
If "Yes," did the organization notify the donor of the value of the goods
Did the organization sell, exchange, or otherwise dispose of tan
required to file Form 8282?
2a
ution and partly for goods
ices provided?
rsonal property for which it was
If "Yes," indicate the number of Forms 8282 filed during the year a 17d 1
Did the organization receive any funds, directly or indirectly, a remiums on a personal benefit contract?
Did the organization, during the year, pay premiums, directly or irlhirectly, on a personal benefit contract? .
If the organization received a contribution of qualified intellectu pierty, did the organization file Form 8899 as required?
If the organization received a contribution of cars, boats, airr14 ` ther vehicles, did the organization file a Form 1098-C?
Sponsoring organizations maintaining donor a �'' ` ,•finds. Did a donor advised fund maintained by the
sponsoring organization have excess business hol t any time during the year?
Sponsoring organizations maintaining donor
Did the sponsoring organization make any taxabl
Did the sponsoring organization make a distr
Section 501(c)(7) organizations. Enter
Initiation fees and capital contributions „ ledon Part VIII, line 12
Gross receipts, included on Forrn190, Pa VIII, line 12, for public use of club facilities
Section 501(c)(12) organizations:jter:
Gross income from members r shareholders
Gross income from other s es. (Do not net
ed funds.
stributions under section 4966?
tion to a donor, donor advisor, or related person?
amounts due or paid to other sources
against amounts due or from them )
Section 4947(a)(1) nq�
If "Yes," enter the
Section 501(c)(2
Is the organiza
Note: See the ins
1
11a
11b
pt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041?
ax -exempt interest received or accrued during the year . . 112b1
ed nonprofit health insurance issuers.
sed to issue qualified health plans in more than one state?
ons for additional information the organization must report on Schedule O.
Enter the amount of reserves the organization is required to maintain by the states in which
the organization is licensed to issue qualified health plans
13b
Enter the amount of reserves on hand 13c
Did the organization receive any payments for indoor tanning services during the tax year?
If "Yes," has it filed a Form 720 to report these payments? If "No," provide an explanation on Schedule 0
Is the organization subject to the section 4960 tax on payment(s) of more than $1,000,000 in remuneration or
excess parachute payment(s) during the year?
If "Yes," see the instructions and file Form 4720, Schedule N.
Is the organization an educational institution subject to the section 4968 excise tax on net investment income?
If "Yes," complete Form 4720, Schedule O.
Section 501(c)(21) organizations. Did the trust, any disqualified person, or mine operator engage in any
activities that would result in the imposition of an excise tax under section 4951, 4952 or 4953? . . . .
If "Yes," complete Form 6069.
Form 990 (2021)
Form 990 (2021)
Part VI
Page 6
Governance, Management, and Disclosure. For each "Yes" response to lines 2 through 7b below, and for a "No"
response to line 8a, 8b, or 10b below, describe the circumstances, processes, or changes on Schedule 0. See instructions.
Check if Schedule 0 contains a response or note to any line in this Part VI El
Section A. Governing Body and Management
is Enter the number of voting members of the governing body at the end of the tax year . .
If there are material differences in voting rights among members of the governing body, or
if the governing body delegated broad authority to an executive committee or similar
committee, explain on Schedule 0.
b Enter the number of voting members included on line 1 a, above, who are independent .
2 Did any officer, director, trustee, or key employee have a family relationship or a business
any other officer, director, trustee, or key employee?
3 Did the organization delegate control over management duties customarily performed by
supervision of officers, directors, trustees, or key employees to a management company
4 Did the organization make any significant changes to its governing documents since the pri
5 Did the organization become aware during the year of a significant diversion of th gani
6 Did the organization have members or stockholders?
7a Did the organization have members, stockholders, or other persons who ha
one or more members of the governing body?
b Are any governance decisions of the organization reserved to (or s ` to approval by) members,
stockholders, or persons other than the governing body?
8 Did the organization contemporaneously document the meetings hel
the year by the following:
a The governing body?
b Each committee with authority to act on behalf of the govern',
9 Is there any officer, director, trustee, or key employee listed
the organization's mailing address? If "Yes," provide the names
relationship with
r e direct
erson? .
m 990 was filed?
ion's assets? .
er to elect or appoint
vitten actions undertaken during
II, Section A, who cannot be reached at
d addresses on Schedule 0 . . . .
Section B. Policies (This Section B requests information $t policies not required by the Internal Revenue Code.)
10a Did the organization have local chapters, branche i tes?
b If "Yes," did the organization have written policies" «,,procedures governing the activities of such chapters,
affiliates, and branches to ensure their operatio consistent with the organization's exempt purposes'?
11a Has the organization provided a complete copy of this affii 990 to all members of its governing body before filing the form?
b Describe on Schedule 0 the process, if any d by the organization to review this Form 990.
12a Did the organization have a written conflj, rest policy'? If "No," go to line 13
b Were officers, directors, or trustees, and key j ees required to disclose annually interests that could give rise to conflicts?
c Did the organization regularly a consi ently monitor and enforce compliance with the policy? If "Yes,"
describe on Schedule 0 how thi. done
13 Did the organization have a q�n whistleblower policy?
14 Did the organization have a n document retention and destruction policy?
15 Did the process for det compensation of the following persons include a review and approval by
independent persons, Qpm bility data, and contemporaneous substantiation of the deliberation and decision?
a The organization's utive Director, or top management official
b Other officers or loyees of the organization
If "Yes" to line
16a Did the organiza
5b, describe the process on Schedule 0. See instructions.
vest in, contribute assets to, or participate in a joint venture or similar arrangement
with a taxable entity during the year?
b If "Yes," did the organization follow a written policy or procedure requiring the organization 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?
Yes No
10a
10b
11a ✓
12c ✓
13 ✓
14 ✓
15a ✓
15b ✓
16a
16b
Section C. Disclosure
17 List the states with which a copy of this Form 990 is required to be filed ► None
18 Section 6104 requires an organization to make its Forms 1023 (1024 or 1024-A, if 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.
El Own website El Another's website 0 Upon request El Other (explain on Schedule 0)
19 Describe on Schedule 0 whether (and if so, how) the organization made its goveming 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 ►
Lahteefah Parramore, (727)216-3519
1751 Kings Hwy, Clearwater, FL 33755
Form 990 (2021)
Form 990 (2021)
Compensation of Officers, Directors, Trustees, Key Employees, Highest Compensated Employees, and
Independent Contractors
Check if Schedule 0 contains a response or note to any line in this Part VII ❑
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
la Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the
organization'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 (D), (E), and (F) if no compensation was paid.
• List all of the organization's current key employees, if any. See the instructions for definition of "key employee."
• List the organization's five current highest compensated employees (other than an officer, director, trustee, or key employee)
who received reportable compensation (box 5 of Form W-2, Form 1099-MISC, and/or box 1 of Form 1099 -NEC) of more than
$100,000 from the organization and any related organizations.
• List all of the organization's former officers, key employees, and highest compensated ewho received more than
$100,000 of reportable compensation from the organization and any related organizations.
• List all of the organization's former directors or trustees that received, in the capaci }a former director or trustee of the
organization, more than $10,000 of reportable compensation from the organization and arrela organizations.
See the instructions for the order in which to list the persons above.
Page 7
Part VII
heck this box if neither the organization nor any related organization compensa
rrent officer, director, or trustee.
(A)
Name and title
(B)
Average
hours
per week
(list any
hours for
related
organizations
below
dotted line)
(C)
Position
(do not check more than o
box, unless person is bo
officer and a director/t
(D)
Reportable
compensation
from the
organization (W-21
1099-MISC/
1099 -NEC)
(E)
Reportable
compensation
from related
organizations (W-2/
1099-MISC/
1099 -NEC)
(9
Estimated amount
of other
compensation
from the
organization and
related organizations
Individual trustee
or director
Institutional truste.
Officer
m
CD '
tocompensated
Former
Jai Hinson _
Executive Director/CEO
60.00
0.00
✓
60,320
0
0
Lahteefah Parramore _
Treasurer
100
0 0o
✓
0
0
0
Thomas Blauvelt
Board President
.00 `.
^ •
✓
0
0
0
Darius Carter
Board Member
,;0.00
✓
0
0
0
17
Glorida Campbell _
Vice President
1.00
0.00
✓
0
0
0
Sandy Tabor _
Board Member
1.00
0.00
✓
0
0
0
#411. 4N
Form 990 (2021)
Form 990 (2021)
Page 8
Part VII Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (contmuea)
(A)
Name and title
(B)
Average
hours
per week
(list any
hours for
related
organizations
below
dotted line)
(c)
Position
(do not check more than one
box, unless person is both an
officer and a director/trustee)
(D)
Reportable
compensation
from the
organization (W-2/
1099-MISC/
1099 -NEC)
(E)
Reportable
compensation
from related
organizations (W-2/
1099-MISC/
1099 -NEC)
(F)
Estimated amount
of other
compensation
from the
organization and
related organizations
Individual trustee
or director
Institutional trustee
Officer
Key employee
Highest compensated
employee
Former
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 ► 0
{
RV
kl
-
1b Subtotal
c Total from continuation sheets to P , tion A
d Total (add lines lb and lc) . .i
►
P.
►
60,320
0
0
60,320
0
0
2 Total number of individuals (inclucing but'ot limited to those listed above) who received more than $100,000 of
reportable compensation from tanization ► 0
3 Did the organization list an
employee on line 1 a? If "
4 For any individual list
organization and r
individual . . .
5 Did any person.
for services ren
rmer officer, director, trustee, key employee, or highest compensated
plete Schedule J for such individual
e la, is the sum of reportable compensation and other compensation from the
anizations greater than $150,000? If "Yes," complete Schedule J for such
n' line 1 a receive or accrue compensation from any unrelated organization or individual
o the organization? If "Yes," complete Schedule J for such person
Section B. Independent Contractors
1 Complete this table for your five highest compensated independent contractors that received more than $100,000 of
compensation from the organization. Report compensation for the calendar year ending with or within the organization's tax year.
(A)
Name and business address
(B)
Description of services
(C)
Compensation
None
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 ► 0
Form 990 (2021)
Form 990 (2021)
Part VIII
Page 9
Statement of Revenue
heck if Schedule 0 contains a response or note to any line in this Part VIII
Form 990 (2021)
(A)
Total revenue
(B)
Related or exempt
function revenue
(C) (D)
Unrelated Revenue excluded
business revenue from tax under
sections 512-514
Contributions, Gifts, Grants,
and Other Similar Amounts
la Federated campaigns . . .
b Membership dues
c Fundraising events
d Related organizations . . .
e Government grants (contributions)
f All other contributions, gifts, grants,
and similar amounts not included above
g Noncash contributions included in
lines 1a -1f
h Total. Add lines 1 a-1 f
is
1b
lc
0
3�
3
"
m
8,492
0
1d
0
le
if
1g
4.9,281
$ 31 500
►
57,773
Program Service
Revenue l
2a Afterschool Program
and Summer camp
Business Code.
483,244
95,03 '
3,244
95,031
0
0
0
0
624110
711190
b Performance Arts
c
e
f All other program service revenue . .
g Total. Add lines 2a -2f
t
0
0
0
►
, 75'"
Other Revenue
3 Investment income
other similar amounts)
4 Income from investment
5 Royalties
6a Gross rents . .
b Less: rental expenses
c Rental income or (loss)
d Net rental income or
7a Gross amount from
sales of assets
other than inventory
b Less: cost or other basis
and sales expenses .
c Gain or (loss) . .
d Net gain or (loss)
8a Gross income from
events (not including
of contributions
1c). See Part l
b Less: directs
c Net Inco or (s)
9a Gross ince;. from
activities. See Part
b Less: direct expenses
c Net income or (loss)
10a Gross sales of inventory,
returns and allowances
b Less: cost of goods
c Net income or (loss)
(including dividends, interest, and
►
of tax-exempt bond proceeds
►
6a
6b
(i) Real
(ii) Perso,,
'
6c
Toss ►
7a
(i) securities
other
v'
_
A
r k
7b
-
7c
f
.
from
IV, line
.
from
sold
from
aisin
0
on line
. . .
. . .
fundraising
gaming
19 .
. . .
gaming activities
less.
. . .
. . .
sales of inventory
►�
8a
,
a
t
r;
8b
events ►
r7
ga
t'..
9b..
. ►
10a�
10bo
. . . I, -
Miscellaneous
Revenue
11a
Business
Business Code'
x,
b
c
d All other revenue
e Total. Add lines 11a -11d
►
0
k
12 Total revenue. See instructions ►
636,048
578,275
0
0
Form 990 (2021)
Form 990 (2021)
Page 10
Statement of Functional Expenses
Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A).
❑r
Check if Schedule 0 contains a response or note to any line in this Part IX
Do not include amounts reported on lines 6b, 7b,
8b, 9b, and 10b of Part Vlll.
(A)
Total expenses
(B)
Program service
expenses
(C)
Management and
general expenses
(D)
Fundraising
expenses
1
2
3
4
5
6
7
8
9
10
11
a
b
c
d
e
f
g
12
13
14
15
16
17
18
19
20
21
22
23
24
a
b
c
d
e
25
Grants and other assistance to domestic organizations
and domestic governments. See Part IV, line 21 .
Grants and other assistance to domestic
individuals. See Part IV, line 22
Grants and other assistance to foreign
organizations, foreign governments, and
foreign individuals. See Part IV, lines 15 and 16
Benefits paid to or for members . . .
Compensation of current officers, directors,
trustees, and key employees
Compensation not included above to disqualified
persons (as defined under section 4958(0(1)) and
persons described in section 4958(c)(3)(B) .
Other salaries and wages
Pension plan accruals and contributions (include
section 401(k) and 403(b) employer contributions)
Other employee benefits
Payroll taxes
Fees for services (nonemployees):
Management
Legal
Accounting
Lobbying
Professional fundraising services. See Part IV, line 17
Investment management fees
Other. (If line 11g amount exceeds 10% of line 25, column
(A), amount, list line 11g expenses on Schedule O.) h,
Advertising and promotion
Office expenses
Information technology ,,�
Royalties
Occupancy .
Travel
Payments of travel or entert nt fitxpenses
for any federal, state, or loca lic officials
Conferences, convention (fleet ngs .
Interest650
Payments to affiliat
Depreciation, de nd amortization .
Insurance .."k
Other expenses. e expenses not covered
above. (List miscellaneous expenses on line 24e. If
line 24e amount exceeds 10% of line 25, column
(A), amount, list line 24e expenses on Schedule 0.)
0
0
k�
30,117
A
'�
0
0
0
0
0c
0
0
60,327
30,210
220,181
4`
0
0
0
0
0
0
0
0
0
0
0
0
0
58,3904
58,390
0
0
,
0
0
0
0
0
0
16 039
0
16,039
0
" 0
0
0
0
0
r
.„��
0
0
0
0
0
fi
0
0
0
0
'
26,050
23,021
3,029
0
8,540
2,039
6,501
0
0
0
0
0
0
0
0
0
44,813
39,411
5,402
0
15,040
12,019
3,021
0
0
0
0
0
1,421
1,029
392
0
0
650
0
0
0
0
0
9,302
0
9,302
0
27,393
26,192
1,201
0
��"#Y,S.
i�
tai#- �
Vi'�� �{�• `L sc
�-s�f:""'�S
$�'
��� .Gd x.::
I Y�`S
All other expenses
79,137
78,483
654
0
Total functional expenses. Add lines 1 through 24e
567,283
490,975
76,308
0
26
Joint costs. Complete this line only if the
organization reported in column (B) joint costs
from a combined educational campaign and
fundraising solicitation. Check here ► ■ if
following SOP 98-2 (ASC 958-720) .
Form 990 (2021)
Form 990 (2021)
Part X
Page 11
Balance Sheet
Check if Schedule 0 contains a response or note to any line in this Part X
(A)
Beginning of year
(B)
End of year
d
y
to
J
Assets or Fund Balances
z
1 Cash—non-interest-bearing
2 Savings and temporary cash investments
3 Pledges and grants receivable, net
4 Accounts receivable, net
5 Loans and other receivables from 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
6 Loans and other receivables from other disqualified persons (as defined
under section 4958(f)(1)), and persons described in section 4958(c)(3)(B) .
7 Notes and loans receivable, net
8 Inventories for sale or use
9 Prepaid expenses and deferred charges
10a Land, buildings, and equipment: cost or other
basis. Complete Part VI of Schedule D . .
b Less: accumulated depreciation
11 Investments—publicly traded securities
12 Investments—other securities. See Part IV, line 11
13 Investments—program-related. See Part IV, line 11
14 Intangible assets
15 Other assets. See Part IV, line 11
16 Total assets. Add lines 1 through 15 (must equal line 33)
17 Accounts payable and accrued expenses
18 Grants payable
19 Deferred revenue
20 Tax-exempt bond liabilities
21 Escrow or custodial account liability. Complet V1 f Schedule D . .
22 Loans and other payables to any current .`"' er officer, director,
trustee, key employee, creator or founder s tial contributor, or 35%
controlled entity or family member of any of t persons
23 Secured mortgages and notes payableV related third parties
24 Unsecured notes and loans payable n ted third parties . . . .
25 Other liabilities (including federal o , payables to related third
parties, and other liabilities no,4nclu on lines 17-24). Complete Part X
of Schedule D . . . .
26 Total liabilities. Add line 7, throUgh 25
Organizations that folio
and complete lines
SB ASC 958, check here ►
, and 33.
27 Net assets withoutr restrictions
28 Net assets with rictions
Organization o not follow FASB ASC 958, check here ► ❑
and compl h 29 through 33.
29 Capital stock : st principal, or current funds
30
31
32
33
Paid -in or capital surplus, or land, building, or equipment fund . .
Retained earnings, endowment, accumulated income, or other funds
Total net assets or fund balances
Total liabilities and net assets/fund balances
94,348 16 467,088
17,377 17
18
19
20
21
26,588
22
0 23
24
203,128 25
499,900
220,505
26
526,488
-126,157 27
-59,400
0
28
0
94,348 33
467,088
Form 990 (2021)
Form 990 (2021)
Part XI
Page 12
Reconciliation of Net Assets
Check if Schedule 0 contains a response or note to any line in this Part XI
1 Total revenue (must equal Part VIII, column (A), line 12)
2 Total expenses (must equal Part IX, column (A), line 25)
3 Revenue less expenses. Subtract line 2 from line 1
4 Net assets or fund balances at beginning of year (must equal Part X, line 32, column (A)) .
5 Net unrealized gains (losses) on investments
6 Donated services and use of facilities
7 Investment expenses
8 Prior period adjustments
9 Other changes in net assets or fund balances (explain on Schedule 0)
10 Net assets or fund balances at end of year. Combine lines 3 through 9 (must equal Part X,
32, column (B))
Part XII
Financial Statements and Reporting
Check if Schedule 0 contains a response or note to any line in this Part XII .
1 Accounting method used to prepare the Form 990: ❑ Cash 0 Accrual ❑
If the organization changed its method of accounting from a prior year
Schedule O.
1
2
3
4
636,048
567,283
68,765
-126,157
5
6
7
8
0
0
0
0
9
-2,008
10
"Other," explain on
2a Were the organization's financial statements compiled or reviewed by an dent accountant? . . .
If "Yes," check a box below to indicate whether the financial statem for the year were compiled or
reviewed on a separate basis, consolidated basis, or both:`
❑ Separate basis ❑ Consolidated basis ❑ Both consolidated parate basis
b Were the organization's financial statements audited by an indepe accountant?
If "Yes," check a box below to indicate whether the financial t ments for the year were audited on a
separate basis, consolidated basis, or both:
❑ Separate basis El Consolidated basis ❑ Both consolidad and separate basis
c If "Yes" to line 2a or 2b, does the organization have a c . e that assumes responsibility for oversight of
the audit, review, or compilation of its financial state selection of an independent accountant? .
If the organization changed either its oversight pric 8r selection process during the tax year, explain on
Schedule O.
3a As a result of a federal award, was the organiz equired to undergo an audit or audits as set forth in the
Single Audit Act and OMB Circular A-133?
b If "Yes," did the organization undergo the required audit or audits? If the organization did not undergo the
required audit or audits, explain why on 0 and describe any steps taken to undergo such audits .
-59,400
Yes No
2b ✓
2c ✓
3a
3b
Form 990 (2021)
SCHEDULE A
(Form 990 or 990 -EZ)
Department of the Treasury
Internal Revenue Service
Public Charity Status and Public Support
Complete if the organization is a section 501(c)(3) organization or a section 4947(a)(1) nonexempt charitable trust.
► Attach to Form 990 or Form 990 -EZ.
► Go to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
20021
Open to Public
Ins • ection
Name of the organization
ARTZ 4 LIFE ACADEMY INC
Part I
Employer identification number
59-3483799
Reason for Public Charity Status. (All organizations must complete this part.) See instructions.
The organization is not a private foundation because it is: (For lines 1 through 12, check only one box.)
1 ❑ A church, convention of churches, or association of churches described in section 170(b)(1)(A)(i).
2 ❑ A school described in section 170(b)(1)(A)(ii). (Attach Schedule E (Form 990).)
3 ❑ A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii).
4 ❑ A medical research organization operated in conjunction with a hospital described in sectio
hospital's name, city, and state:
b)(1)(A)(iii). Enter the
5 ❑ An organization operated for the benefit of a college or university owned or operate governmental unit described in
section 170(b)(1)(A)(iv). (Complete Part II.)
6 ❑ A federal, state, or local government or governmental unit described in section • (b) )(v).
7 ❑ An organization that normally receives a substantial part of its support from nnental unit or from the general public
described in section 170(b)(1)(A)(vi). (Complete Part II.)
8 ❑ A community trust described in section 170(b)(1)(A)(vi). (Complete Part I
9 ❑ An agricultural research organization described in section 170(b)(1)(A)(i ted in conjunction with a land-grant college
or university or a non -land-grant college of agriculture (see instructions t the name, city, and state of the college or
university:
10 An organization that normally receives (1) more than 331/3% of its r from contributions, membership fees, and gross
receipts from activities related to its exempt functions, subject to = a exceptions; and (2) no more than 331/3% of its
support from gross investment income and unrelated business income (less section 511 tax) from businesses
acquired by the organization after June 30, 1975. See sect n )(2). (Complete Part III.)
11 ❑ An organization organized and operated exclusively to test "". • • lc safety. See section 509(a)(4).
12 ❑ An organization organized and operated exclusively for the bene of, to perform the functions of, or to carry out the purposes of
one or more publicly supported organizations described ion 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check
the box on lines 12a through 12d that describes the pporting organization and complete lines 12e, 12f, and 12g.
a ❑ Type 1. A supporting organization operated i d, or controlled by its supported organization(s), typically by giving
I appointor elect a majority the supported organization(s) the power to re• y j ty of the directors or trustees of the
supporting organization. You must compl ``a- rt 11/, Sections A and B.
b ❑ Type yp supporting organization supervised' 'r controlled in connection with its supported organization(s), by having
control or management of the suppor in organization vested in the same persons that control or manage the supported
organization(s). You must comple , Sections A and C.
c ❑ Type III functionally integrated"' x uporting organization operated in connection with, and functionally integrated with,
its supported organization(see in uctions). You must complete Part IV, Sections A, D, and E.
d ❑ Type III non -functionally ated. A supporting organization operated in connection with its supported organization(s)
that is not functionally i grate' . The organization generally must satisfy a distribution requirement and an attentiveness
requirement (see instru
e ❑ Check this box if th
functionally inte• .;te
f Enter the number o
g Provide the folio
s). You must complete Part IV, Sections A and D, and Part V.
ation received a written determination from the IRS that it is a Type I, Type II, Type III
r Type III non -functionally integrated supporting organization.
d organizations
rmation about the supported organization(s).
(i) Name of support rgan '' tion
(i) EIN
(iii) Type of organization
(described on lines 1-10
above (see instructions))
(iv) Is the organization
listed in your governing
document?
(v) Amount of monetary
support (see
instructions)
(vi) Amount of
other support (see
instructions)
Yes
No
(A)
(B)
(C)
(D)
(E)
Total"
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990 -EZ.
Cat. No. 11285F
Schedule A (Form 990 or 990 -EZ) 2021
Schedule A (Form 990 or 990 -EZ) 2021
Part II
Page 2
Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under
Part III. If the organization fails to qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year (or fiscal year beginning in) 10-
1
1 Gifts, grants, contributions, and
membership fees received. (Do not
include any "unusual grants.") . .
2 Tax revenues levied for the
organization's benefit and either paid to
or expended on its behalf
3 The value of services or facilities
furnished by a governmental unit to the
organization without charge . . .
4 Total. Add lines 1 through 3 . . .
5 The portion of total contributions by
each person (other than a
governmental unit or publicly
supported organization) included on
line 1 that exceeds 2% of the amount
shown on line 11, column (f) . . . .
6 Public support. Subtract line 5 from line 4
Section B. Total Support
Calendar year (or fiscal year beginning in) ► (a) 2017
7 Amounts from line 4 502,280
8 Gross income from interest, dividends,
payments received on securities loans,
rents, royalties, and income from
similar sources
9 Net income from unrelated business
activities, whether or not the business
is regularly carried on
10 Other income. Do not include gain or
loss from the sale of capital assets
(Explain in Part VI.)
11 Total support. Add lines 7 through 1d
12 Gross receipts from related activits, etc.see instructions)
13
(a) 2017
(b) 2018 (c) 2019 (d) 2020 (e) 2021
(f) Total
502,280
594,090 432,540 503,667 636,048
2,668,625
502,280
594,090 432,540
3,667
636,048
2,668,625
(b) 201
(c) 2019
(d) 2020
(e) 2021
First 5 years. If the Form 990,the organization's first,
organization, check this box d stoplere
432,540
503,667
12
636,048
2,668,625
(f) Total
2,668,625
2,668,625
second, third, fourth, or fifth tax year as a section 501(c)(3)
► ❑
Section C. Computation of Pu
Support Percentage
14 Public support percenta
15 Public support perce
16a 331/3% support to
box and stop her
b 331/3% suppo
this box and stoi
1 (line 6, column (f), divided by line
m 2020 Schedule A, Part II, line 14
f the organization did not check the box on line 13, and line 14
organization qualifies as a publicly supported organization
2.20. If the organization did not check a box on line 13 or 16a, and line 15 is 331/3% or more, check
. The organization qualifies as a publicly supported organization ►
11, column (f)) . .
14
15
is 331/3% or more,
100 %
100 %
check this
17a 10% -facts -and -circumstances test -2021. If the organization did not check a box on line 13, 16a, or 16b, and line 14 is
10% or more, and if the organization meets the facts -and -circumstances test, check this box and stop here. Explain in
Part VI how the organization meets the facts -and -circumstances test. The organization qualifies as a publicly supported
organization ►
b 10% -facts -and -circumstances test -2020. If the organization 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 -circumstances test, check this box and stop here. Explain
in Part VI how the organization meets the facts -and -circumstances test. The organization qualifies as a publicly supported
organization ►
18 Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions ►
Schedule A (Form 990 or 990 -EZ) 2021
Schedule A (Form 990 or 990 -EZ) 2021
Part III
Support Schedule for Organizations Described in Section 509(a)(2)
Page 3
(Complete only if you checked the box on line 10 of Part I or if the organization failed to qualify under Part II.
If the organization fails to qualify under the tests listed below, please complete Part II.)
Section A. Public Support
Calendar year (or fiscal year beginning in) ►
1 Gifts, grants, contributions, and membership fees
received. (Do not include any "unusual grants.")
2 Gross receipts from admissions, merchandise
sold or services performed, or facilities
furnished in any activity that is related to the
organization's tax-exempt purpose . . .
3 Gross receipts from activities that are not an
unrelated trade or business under section 513
4 Tax revenues levied for the
organization's benefit and either paid to
or expended on its behalf . . . .
5 The value of services or facilities
furnished by a governmental unit to the
organization 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 lines 2 and 3
received from other than disqualified
persons that exceed the greater of $5,000
or 1% of the amount on line 13 for the year
c Add lines 7a and 7b
8 Public support. (Subtract line 7c from
line 6.)
(a) 2017
(b) 2018
(c) 2019
(d) 2020
(e) 2021
(f) Total
502,280
594,090
441,198
503,667
636,048
2,677,283
0
0
0
0
..E
0
502,280
594,090
503,667
636,048
2,677,283
594,090
441,198
503,667
636,048
2,677,283
ax "
y
2,677,283
ection B. Total Support
Calendar year (or fiscal year beginning in) ►
9 Amounts from line 6
10a Gross income from interest, dividends,
payments received on securities loans, rents,
royalties, and income from similar sources .
b Unrelated business taxable income (less
section 511 taxes) from businesses
acquired after June 30, 1975 .
c Add lines 10a and 10b . .
11 Net income from unrelated bus
activities not included on line 1 1`r,hether
or not the business is regul t on
12 Other income. Do note e I gain or
loss from the sale o ssets
(Explain in Part VI
13 Total support. dd%es 9, 10c, 11,
and 12.) . .�.
14 First 5 years. If the Form 990 is for th
organization, check this box and stop here
(a) 2
'(b) 2018
(c) 2019
(d) 2020
(e) 2021
(f) Total
0
594,090
441,198
503,667
636,048
2,677,283
0
0
0
0
0
0
502,280
594,090
441,198
503,667
636,048
2,677,283
► ❑
Section C. Computation of Public Support Percentage
15 Public support percentage for 2021 (line 8, column (f), divided by line 13, column (f))
16 Public support percentage from 2020 Schedule A, Part III, line 15
Section D. Computation of Investment Income Percentage
17 Investment income percentage for 2021 (line 10c, column (f), divided by line 13, column (f))
18 Investment income percentage from 2020 Schedule A, Part III, line 17
19a 331/3% support tests -2021. If 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 331/3%, check this box and stop here. The organization qualifies as a publicly supported organization ► ❑
b 331,3% support tests -2020. If the organization did not check a box on line 14 or line 19a, 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 qualifies as a publicly supported organization 0-
20
20 Private foundation. If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions ► ❑
15
100 %
16
100 %
17
0
18
Schedule A (Form 990 or 990 -EZ) 2021
Schedule A (Form 990 or 990 -EZ) 2021
Part IV
Page 4
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, complete
Sections A, D, and E. If you checked box 12d, Part I, complete Sections A and D, and complete Part V.)
Section A. All Supporting Organizations
1 Are all of the organization's supported organizations listed by name in the organization's governing
documents? If "No," describe in Part VI how the supported organizations are designated. If designated by
class or purpose, describe the designation. 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 (2)? If "Yes," explain in Part VI how the organization determined that the supported
organization was described in section 509(a)(1) or (2).
3a Did the organization have a supported organization described in section 501(c)(4), (5), or (66jib answer
lines 3b and 3c below.
b Did the organization confirm that each supported organization qualified under section ` 4), (5), or (6) and
satisfied the public support tests under section 509(a)(2)? If "Yes," describe in rt en and how the
organization made the determination.
c Did the organization ensure that all support to such organizations was used a or section 170(c)(2)(B)
purposes? If "Yes," explain in Part VI what controls the organization put in pl ure such use.
4a Was any supported organization not organized in the United States ("f supported organization")? If
"Yes," and if you checked box 12a or 12b in Part I, answer lines 4b and 4
b Did the organization have ultimate control and discretion in deciding
supported organization? If "Yes," describe in Part VI how the org
despite being controlled or supervised by or in connection with its s
her to make grants to the foreign
ii had such control and discretion
orted organizations.
c Did the organization support any foreign supported organi ti t does not have an IRS determination
under sections 501(c)(3) and 509(a)(1) or (2)? If "Yes," expla VI what controls the organization used
to ensure that all support to the foreign supported organization ' as used exclusively for section 170(c)(2)(B)
purposes.
5a Did the organization add, substitute, or remove arw ed organizations during the tax year? If "Yes,"
answer lines 5b and 5c below (if applicable). AIs "' detail in Part VI, including (1) the names and EIN
numbers of the supported organizations added, su ed, or removed, (1i) the reasons for each such action;
(iii) the authority under the organization's organiz :'•.•cument authorizing such action; and (iv) how the action
was accomplished (such as by amendment to th ` anizing document).
b Type I or Type II only. Was any adde• #• , substituted supported organization part of a class already
designated in the organization's organizi ent?
c Substitutions only. Was the substitute result of an event beyond the organization's control?
6 Did the organization provide sup '' (whe er in the form of grants or the provision of services or facilities) to
anyone other than (i) its suppo ' • anizations, (ii) individuals that are part of the charitable class benefited
by one or more of its supp ed organizations, or (iii) other supporting organizations that also support or
benefit one or more of the fi rganization's supported organizations? If "Yes," provide detail in Part VI.
7 Did the organization pront, loan, compensation, or other similar payment to a substantial contributor
(as defined in section 5 1( o
(3)(C)), a family member of a substantial contributor, or a 35% controlled entity
with regard to a sub ". ntributor? If "Yes," complete Part I of Schedule L (Form 990).
8 Did the organiza ; e a loan to a disqualified person (as defined in section 4958) not described on line
7? If "Yes," co a G'alt I of Schedule L (Form 990).
9a Was the organiz controlled directly or indirectly at any time during the tax year by one or more
disqualified persons, as defined in section 4946 (other than foundation managers and organizations
described in section 509(a)(1) or (2))? If "Yes," provide detail in Part VI.
b Did one or more disqualified persons (as defined on line 9a) hold a controlling interest in any entity in which
the supporting organization had an interest? If "Yes," provide detail in Part VL
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? If "Yes," provide detail in Part VL
10a Was the organization subject to the excess business holdings rules of section 4943 because of section
4943(0 (regarding certain Type II supporting organizations, and all Type III non -functionally integrated
supporting organizations)? If "Yes," answer line 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.)
Schedule A (Form 990 or 990 -EZ) 2021
Schedule A (Form 990 or 990 -EZ) 2021
Part IV
Page 5
Supporting Organizations (continued)
11 Has the organization accepted a gift or contribution from any of the following persons?
a A person who directly or indirectly controls, either alone or together with persons described on lines 11 b and
11c below, the governing body of a supported organization?
b A family member of a person described on line 11 a above?
c A 35% controlled entity of a person described on line 11 a or 11b above? If "Yes" to line Ila, 11b, or 1l c,
provide detail in Part VI.
Section B. Type 1 Supporting Organizations
1 Did the governing body, members of the governing body, officers acting in their official capacity, or membhip of one or
more supported organizations have the power to regularly appoint or elect at least a majority of the orga 's officers,
directors, or trustees at all times during the tax year? If "No," describe in Part VI how the supported or :`s)
effectively operated, supervised or controlled the organization's activities. If the organization had m. one supported
organization, describe how the powers to appoint and/or remove officers, directors, or trustees we ated among the
supported organizations and what conditions or restrictions, if any, applied to such powers d ing t'" year.
2 Did the organization operate for the benefit of any supported organization other t supported
organization(s) that operated, supervised, or controlled the supporting organi `Yes,"explain in Part
VI how providing such benefit carried out the purposes of the supported or i (s) that operated,
supervised, or controlled the supporting organization.
Section C. Type II Supporting Organizations
1 Were a majority of the organization's directors or trustees during th
or trustees of each of the organization's supported organization(s
or management of the supporting organization was vested in
the supported organization(s).
Section D. All Type III Supporting Organizations
ar also a majority of the directors
o," describe in Part VI how control
persons that controlled or managed
1 Did the organization provide to each of its supported .:.. ns, by the last day of the fifth month of the
organization's tax year, (i) a written notice descnbin.+ •hand amount of support provided during the prior tax
year, (ii) a copy of the Form 990 that was most recen ° . as of the date of notification, and (iii) copies of the
organization's governing documents in effect on t • : of notification, to the extent not previously provided?
2 Were any of the organization's officers, directors, o'f•rustees either (i) appointed or elected by the supported
organization(s) or (ii) serving on the governirl { ; dy of a supported organization'? If "No," explain in Part VI how
the organization maintained a close and c i s working relationship with the supported organization(s).
3 By reason of the relationship describee 2, above, did the organization's supported organizations have
a significant voice in the organiz n's inv6stment policies and in directing the use of the organization's
income or assets at all times d e tax year'? If "Yes," describe in Part VI the role the organization's
supported organizations play i(I thisegard.
Section E. Type III Functional egrated Supporting Organizations
Yes
1
1 Check the box next to th .*.: that the organization used to satisfy the Integral Part Test during the year (see instructions).
a ❑ The organization sfithe Activities Test. Complete line 2 below.
b El The organizatio rent of each of its supported organizations. Complete line 3 below.
c 0 The organizati •rted a govemmental entity. Describe in Part VI how you supported a govemmental entity (see instructions).
2 Activities Test. $ `'"' lines 2a and 2b below. Yes No
a Did substantially ,F the organization's activities during the tax year directly further the exempt purposes of
the supported organization(s) to which the organization was responsive? If "Yes," then in Part VI identify
those supported organizations and explain how these activities directly furthered their exempt purposes,
how the organization was responsive to those supported organizations, and how the organization determined
that these activities constituted substantially all of its activities.
b Did the activities described on line 2a, above, constitute activities that, but for the organization's
involvement, one or more of the organization's supported organization(s) would have been engaged in? If
"Yes," explain in Part VI the reasons for the organization's position that its supported organization(s) would
have engaged in these activities but for the organization's involvement.
3 Parent of Supported Organizations. Answer lines 3a and 3b below.
a Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or
trustees of each of the supported organizations? If "Yes" or "No," provide details in Part VI.
b Did the organization exercise a substantial degree of direction over the policies, programs, and activities of each
of its supported organizations? If "Yes," describe in Part VI the role played by the organization in this regard. 3b
Schedule A (Form 990 or 990 -EZ) 2021
Schedule A (Form 990 or 990 -EZ) 2021
Part V
Page 6
Type 111 Non -Functionally Integrated 509(a)(3) Supporting Organizations
1 0 Check here if the organization satisfied the Integral Part Test as a qualifying trust on Nov. 20, 1970 (explain in Part VI). See
instructions. All other Type III non -functionally integrated supporting organizations must complete Sections A through E.
Section A—Adjusted Net Income
(A) Prior Year
(B) Current Year
(optional)
1 Net short-term capital gain
1
2 Recoveries of prior -year distributions
2
3 Other gross income (see instructions)
3
4 Add lines 1 through 3.
4
5 Depreciation and depletion
5
6 Portion of operating expenses paid or incurred for production or collection
of gross income or for management, conservation, or maintenance of
property held for production of income (see instructions)
6
7 Other expenses (see instructions)
7
8 Adjusted Net Income (subtract lines 5, 6, and 7 from line 4)
8
Section B—Minimum Asset Amount
(A) Prior Year
(B) Current Year
(optional)
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
c Fair market value of other non -exempt -use assets
1c
d Total (add lines 1a, 1b, and 1c)
1 d
e Discount claimed for blockage or other factors
(explain in detail in Part VI):��`'
2 Acquisition indebtedness applicable to non -exempt -use ass
2
3 Subtract line 2 from line 1d.
3
4 Cash deemed held for exempt use. Enter 0.015 of line3 ater amount,
see instructions). µ
4
5 Net value of non -exempt -use assets (subtract line a 3)
5
6 Multiply line 5 by 0.035.
6
7 Recoveries of prior -year distributions
7
8 Minimum Asset Amount (add line 7 to line 6
8
Section C—Distributable Amount,,
v
� �.,' s ��=
Current Year
1 Adjusted net income for prior year (fro ion A, line 8, column A)
1
2 Enter 0.85 of line 1. 4t=
2
3 Minimum asset amount for pri r from Section B, line 8, column A)
3
4 Enter greater of line 2 or line . �,:
4a;t
5 Income tax imposed in prior
5
6 Distributable Amount. ine 5 from line 4, unless subject to
emergency tempora d on (see instructions).
7 ❑ Check here if t
(see instructio
ear is the organization's first as a non -functionally integrated Type III supporting organization
Schedule A (Form 990 or 990 -EZ) 2021
Schedule A (Form 990 or 990 -EZ) 2021
Part V
Page 7
Type 111 Non -Functionally Integrated 509(a)(3) Supporting Organizations (continued)
Section D—Distributions
Current Year
1 Amounts paid to supported organizations to accomplish exempt purposes
1
2 Amounts paid to perform activity that directly furthers exempt purposes of supported
organizations, in excess of income from activity
2
3 Administrative expenses paid to accomplish exempt purposes of supported organizations
3
4 Amounts paid to acquire exempt -use assets
4
5 Qualified set-aside amounts (prior IRS approval required—provide details in Part VI)
5
6 Other distributions (describe in Part VI). See instructions.
6
7 Total annual distributions. Add lines 1 through 6.
7
8 Distributions to attentive supported organizations to which the organization is responsive
(provide details in Part VI). See instructions.
8
9 Distributable amount for 2021 from Section C, line 6
9
10 Line 8 amount divided by line 9 amount
10
Section E—Distribution Allocations see instructions
( )
(i)
Excess Distribution
ii)
i�istributions
Pre -2021
(iii)
Distributable
Amount for 2021
1 Distributable amount for 2021 from Section C, line 6
2 Underdistributions, if any, for years prior to 2021€
(reasonable cause required—explain in Part VI). See
instructions.
3 Excess distributions carryover, if any, to 2021
a From 2016
b From 2017•
x
;
c From 2018
d From 2019
r.
II
e From 2020
"K
p
f Total of lines 3a through 3e
..,.
9 Applied to underdistributions of prior yearsre,
h Applied to 2021 distributable amount
.
i Carryover from 2016 not applied (see instructio
i Remainder. Subtract lines 3g, 3h, and 3i from
,line
4 Distributions for 2021 from
Section D, line 7:4rN1
a Applied to underdistributions of prior „se
b Applied to 2021 distributable am " t
c Remainder. Subtract lines 4a a om line 4.
Remaining underdistribution otwears prior to 2021, if
5 any. Subtract lines 3g and 4a line 2. For result
greater than zero, explai I. See instructions
r
6 Remaining underdistr' lo" for 2021. Subtract lines 3h
and 4b from line 1. For , greater than zero, explain in
Part VI. See instr I"
7 Excess distri on carryover to 2022. Add lines 3j
and 4c.`
8 Breakdown of line 7:
a Excess from 2017. .����.
v
b Excess from 2018 . .
c Excess from 2019 . .
d Excess from 2020 .
e Excess from 2021 . .
Schedule A (Form 990 or 990 -EZ) 2021
Schedule A (Form 990 or 990 -EZ) 2021
Part VI
Page 8
Supplemental Information. Provide the explanations required by Part II, line 10; Part II, line 1 7a or 1 7b; Part
III, line 12; Part IV, Section A, lines 1, 2, 3b, 3c, 4b, 4c, 5a, 6, 9a, 9b, 9c, 11 a, 11 b, and 11 c; 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, lines 1 c, 2a, 2b,
3a, and 3b; Part V, line 1; Part V, Section B, line 1 e; Part V, Section D, lines 5, 6, and 8; and Part V, Section E,
lines 2, 5, and 6. Also complete this part for any additional information. (See instructions.)
Schedule A (Form 990 or 990 -EZ) 2021
SCHEDULE D
(Form 990)
Department of the Treasury
Internal Revenue Service
Name of the organization
ARTZ 4 LIFE ACADEMY INC
Part 1
Supplemental Financial Statements
► Complete if the organization answered "Yes" on Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b.
► Attach to Form 990.
► Go to www.irs.gov/Fonn990 for instructions and the latest information.
OMB No. 1545-0047
20021
Open to Public
Inspection
Employer identification number
59-3483799
or Accounts.
Organizations
Maintaining Donor Advised Funds or Other Similar Funds
Complete if the organization answered "Yes" on Form 990, Part IV, line 6.
(a) Donor advised funds
(b) Funds and other accounts
1 Total number at end of year
2 Aggregate value of contributions to (during year)
3 Aggregate value of grants from (during year) .
4 Aggregate value at end of year
5 Did the organization inform all donors and donor advisors in writing that the assets h
funds are the organization's property, subject to the organization's exclusive legal contr
6 Did the organization inform all grantees, donors, and donor advisors in writing th.t gra
only for charitable purposes and not for the benefit of the donor or donor advi 31 f
conferring impermissible private benefit?
Part 11
Conservation Easements.
Complete if the organization answered "Yes" on Form 990,
1 Purpose(s) of conservation easements held by the organization (check al
O Preservation of land for public use (for example, recreation or education)
0 Protection of natural habitat
O Preservation of open space
2 Complete lines 2a through 2d if the organization held a qualifj
easement on the last day of the tax year.
a Total number of conservation easements
3
4
5
6
7
8
9
b Total acreage restricted by conservation easements .
c Number of conservation easements on a certified hist
d Number of conservation easements included in
historic structure listed in the National Register .
Number of conservation easements modified, t
tax year ►
Number of states where property subject t�
Does the organization have a written
violations, and enforcement of the co
Staff and volunteer hours devoted t
►
Amount of expenses incu
► $
Does each conservation
and section 170(h)(4)(
In Part XIII, describ
balance sheet, an
organization's
Part 111
Ply).
servation of a historically important land area
reservation of a certified historic structure
ado or advised
nds can be used
any other purpose
❑ Yes ❑ No
D Yes ❑ No
d nervation contribution in the form of a conservation
cture included in (a) . . . .
fired after 7/25/06, and not on a
rred, released, extinguished, or terminated by the organization during the
servation easement is located ►
egarding the periodic monitoring, inspection, handling of
ortasements it holds? 0 Yes 0 No
onitoriltg, inspecting, handling of violations, and enforcing conservation easements during the year
rred rripnitoring, inspecting, handling of violations, and enforcing conservation easements during the year
reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i)
O Yes 0 No
organization reports conservation easements in its revenue and expense statement and
de, if applicable, the text of the footnote to the organization's financial statements that describes the
for conservation easements.
Organiza Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" on Form 990, Part IV, line 8.
la If the organization elected, as permitted under FASB ASC 958, not to report in its revenue statement and balance sheet works
of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public
service, provide in Part XIII the text of the footnote to its financial statements that describes these items.
b If the organization elected, as permitted under FASB ASC 958, to report in its revenue statement and balance sheet works of
art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service,
provide the following amounts relating to these items:
(i) Revenue included on Form 990, Part VIII, line 1 ► $
(ii) Assets included in Form 990, Part X ► $
2 If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under FASB ASC 958 relating to these items:
a Revenue included on Form 990, Part VIII, line 1 ► $
b Assets included in Form 990, Part X ► $
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 52283D Schedule D (Form 990) 2021
Schedule D (Form 990) 2021
Part III
Page 2
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)
3 Using the organization's acquisition, accession, and other records, check any of the following that make significant use of its
collection items (check all that apply):
a ❑ Public exhibition
b ❑ Scholarly research
c ❑ Preservation for future generations
4 Provide a description of the organization's collections and explain how they further the organization's exempt purpose in Part
XIII.
5 During the year, did the organization solicit or receive donations of art, historical treasures, or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization's collection? . .
d ❑ Loan or exchange program
e ❑ Other
Part IV
O Yes ❑ No
Escrow and Custodial Arrangements.
Complete if the organization answered "Yes" on Form 990, Part IV, line 9, or r
990, Part X, line 21.
la Is the organization an agent, trustee, custodian or other intermediary for contributions
included on Form 990, Part X?
b If "Yes," explain the arrangement in Part XIII and complete the following table:
c Beginning balance
d Additions during the year
e Distributions during the year
f Ending balance
2a
b
Part
d an amount on Form
er assets not
❑ Yes ❑ No
Did the organization include an amount on Form 990, Part X, line 21, f raw or custodial account liability? ❑ Yes ❑ No
If "Yes," explain the arrangement in Part XIII. Check here if the expl as been provided on Part XIII . . . . ❑
V Endowment Funds.
Complete if the organization answered "Yes" on 0 0
la Beginning of year balance . .
b Contributions
c Net investment earnings, gains, and
losses
d Grants or scholarships . . .
e Other expenditures for facilities and
programs
f Administrative expenses .
g End of year balance
2 Provide the estimated percentage of t
a Board designated or quasi -endo ent
b Permanent endowment ► M
c Term endowment ►
The percentages on lines 2a, and 2c should equal 100%.
3a Are there endowment fu ' ` the possession of the organization that are held and administered for the
organization by:
(i) Unrelated ora ' a
, Part IV, line 10.
(a) Current year
( o" `"" r
(c) Two years back
(d) Three years back
(e) Four years back
la Land
b Buildings
c Leasehold improvements
d Equipment
e Other
0
0
0
0
0
0
0
0
0
576
0
576
0
104,622
0
94,693
9,929
Total. Add lines 1 a through 1 e. (Column (d) must equal Form 990, Part X, column (B), line 10c.) ►
9,929
(ii) Related orga
b If "Yes" on line e the related organizations listed as required on Schedule R?
4 Describe in Part e intended uses of the organization's endowment funds.
Part VI
of year end balance (line 1 g, column (a)) held as:
%
Yes
No
3a(i)
3a(ii)
3b
Land, Buildings, and Equipment.
Complete if the organization answered "Yes" on Form 990, Part IV, line 11a. See Form 990, Part X, line 10.
Description of property
(a) Cost or other basis
(investment)
(b) Cost or other basis
(other)
(c) Accumulated
depreciation
(d) Book value
la Land
b Buildings
c Leasehold improvements
d Equipment
e Other
0
0
0
0
0
0
0
0
0
576
0
576
0
104,622
0
94,693
9,929
Total. Add lines 1 a through 1 e. (Column (d) must equal Form 990, Part X, column (B), line 10c.) ►
9,929
Schedule D (Form 990) 2021
Schedule D (Form 990) 2021
Part VII
Page 3
Investments—Other Securities.
Complete if the organization answered "Yes" on Form 990, Part IV, line 11b. See Form 990, Part X, line 12.
(a) Description of security or category (b) Book value (c) Method of valuation:
(including name of security) Cost or end -of -year market value
(1) Financial derivatives
(2) Closely held equity interests
(3) Other
(A)
(B)
(C)
(D)
(E)
(F)
(G)
(H)
Total. (Column (b) must equal Form 990, Part X, col. (8) line 12.) . ►
Investments—Program Related.
Complete if the organization answered "Yes" on Form 990, Part,
Part VIII
•
lc. See F
rm 990, Part X, line 13.
art
ther Assets.
Complete if the organization answere
(a) Description of investment
(b) Book value
) Book value
(c) Method of valuation:
Cost or end -of -year market value
(1)
(1)
499,900
(3)
(2)
(2)
(3)
(3)
(4)
(7)
(4)
(9)
(6)
►
499,900
m
(6)
(8)
(9)
(8
Total.
(b) must equal Form 990, Part X, col. (8) li
►
(9)
art
ther Assets.
Complete if the organization answere
Vtnerl
Complf
line 25.
organization answered "Yes" on Form 990, Part IV, line 11e or 11f. See Form 990, Part X,
1. (a) Description of liability
(b) Book value
De tion
(b) Book value
(1)
499,900
(3)
(2)
(5)
(3)
(7)
(4)
(9)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 25)
►
499,900
(6)
(8
(9)
Total. (Column (b) must e •
l
•:
90, Part X, col. (8) line 15)
►
Vtnerl
Complf
line 25.
organization answered "Yes" on Form 990, Part IV, line 11e or 11f. See Form 990, Part X,
1. (a) Description of liability
(b) Book value
(1) Federal income taxes
0
(2) SBA
499,900
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 25)
►
499,900
2. Liability for uncertain tax positions. In Part XIII, provide the text of the footnote to the organization's financial statements that reports the
organization's liability for uncertain tax positions under FASB ASC 740. Check here if the text of the footnote has been provided in Part XIII . 111
Schedule D (Form 990) 2021
Schedule D (Form 990) 2021
Part XI
Page 4
Reconciliation of Revenue per Audited Financial Statements With Revenue per Return.
Complete if the organization answered "Yes" on Form 990, Part IV, line 12a.
1 Total revenue, gains, and other support per audited financial statements
2 Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a Net unrealized gains (losses) on investments
b Donated services and use of facilities
c Recoveries of prior year grants
d Other (Describe in Part XIII.)
e Add lines 2a through 2d
3 Subtract line 2e from line 1
4 Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b .
b Other (Describe in Part XIII.)
c Add lines 4a and 4b
2a
2b
2c
5 Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part 1, line 12.) . .
Reconciliation of Expenses per Audited Financial Statements Wj
Complete if the organization answered "Yes" on Form 990, Part IV,
Part XII
Total expenses and losses per audited financial statements
2 Amounts included on line 1 but not on Form 990, Part IX, line 25:
Donated services and use of facilities
Prior year adjustments
Other losses
Other (Describe in Part XIII.)
Add lines 2a through 2d
Subtract line 2e from line 1
Amounts included on Form 990, Part IX, line 25, but not on li
Investment expenses not included on Form 990, Part VIII, line 7
Other (Describe in Part XIII.)
Add lines 4a and 4b
a
b
c
d
e
3
4
a
b
c
5
ses per Return.
Total expenses. Add lines 3 and 4c. (This must eq
Part XIII
Supplemental Information.
Provide the descriptions required for Part ll, lines 3, 5, part III, lines 1a and 4; Part IV, lines 1 b and 2b; Part V, line 4; Part X line
2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b: complete this part to provide any additional information.
Schedule D, Part X, Line 2 - Disclosure related to fmancil statements,
90, Part 1, line 18.)
636,048
0
0
636,048
567,283
567,283
Schedule D (Form 990) 2021
SCHEDULE 0
(Form 990 or 990 -EZ)
Department of the Treasury
Internal Revenue Service
Supplemental Information to Form 990 or 990 -EZ
Complete to provide information for responses to specific questions on
Form 990 or 990 -EZ or to provide any additional information.
► Attach to Form 990 or Form 990 -EZ.
O. Go to www.its.gov/Form990 for the latest information.
OMB No. 1545-0047
Name of the organization
ARTZ 4 LIFE ACADEMY INC
20021
Open to Public
Inspection
Employer identification number
59-3483799
Form 990, Part VI, Section A, Line 2 - The Board Treasurer and Executive Director are related party's however , no conflict of interest or
independence exists.
Form 990, Part VI, Section B, Line 11b - All board members obtain a copy of the 990 to review during a special session. Each board
member reviews and approves for final sign off and filing.
Form 990, Part VI, Section B, Line 12c - Each board member is required to sign and review a conflict of j
Form 990, Part VI, Section B, Line 15 - The board performs an annual review of the executive direct
and potential compensation increases or changes.
licy and disclosure.
ormance and provides feedback
Form 990, Part VI, Section C, Line 19 - The board of directors review and govern all of th ce and entity level control items, such
as conflict of interest, whistle blower policy and over all record retention.
Form 990, Part IX, Line 24e - subcontractors
Form 990, Part XI, Line 9 - change in balance
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990 -EZ. Cat. No. 51056K
Schedule 0 (Form 990 or 990 -EZ) 2021
Schedule 0, Statement 1 ARTZ 4 LIFE ACADEMY INC
Form: Form 990 (2021) EIN: 59-3483799
Page: 1 Header Section
Reasonable Cause Explanations
Explanation
Change in auditors
Page: 1
Schedule 0, Statement 2 ARTZ 4 LIFE ACADEMY INC
Form: Form 990 (2021) EIN: 59-3483799
Page: 1 Part I, Line 1
Activity Or Mission Description
Description
cultural diversity by presenting the finest in cultural performing arts to broaden the educational, social and artistic perspectives of an entire community of
youth, adults, and families.
Page: 2
Schedule 0, Statement 3 ARTZ 4 LIFE ACADEMY INC
Form: Form 990 (2021) EIN: 59-3483799
Page: 2 Part III, Line 4a
First Program Service Accomplishments Description
Description
graduated from Julliard and is currently a premier dancer with Alvin Ailey Dance Company and American Ballet Company. Six former members are now
performing in Katunga, and Dance With The Music at Busch Gardens and one male is the performance dance captain. Three former Dundu Dole
members have recently received invitations to Las Vegas from the So You Think You Can Dance" Television show. Other former dancers recently were
winners on the BET television show 106 & Park. In addition, the semi-professional program continued to expand the community outreach, expanding the
outreach to two additional counties in the Tampa Bay area.
Page: 3
9/30/23, 3:00 PM Detail by Entity Name
DIVISION OF CORPORATIONS
' ,',i(,;'ll
g(
or J rr)1, _ _��,
Department of State / Division of Corporations / Search Records / Search by Entity Name /
Detail by Entity Name
Florida Not For Profit Corporation
ARTZ 4 LIFE ACADEMY, INC.
Filing Information
Document Number N97000006454
FEI/EIN Number 59-3483799
Date Filed 11/17/1997
State FL
Status ACTIVE
Last Event NAME CHANGE AMENDMENT
Event Date Filed 05/29/2012
Event Effective Date NONE
Principal Address
1751 KINGS HIGHWAY
CLEARWATER, FL 33755
Changed: 03/02/2010
Mailing Address
1751 Kings Highway
Clearwater, FL 33755
Changed: 04/12/2022
Registered Agent Name & Address
HINSON, JAI
1606 NORTH HIGHLAND AVENUE
CLEARWATER, FL 33755
Address Changed: 05/21/2007
Officer/Director Detail
Name & Address
Title PD
BLAUVELT, THOMAS
5683 CALAIS LANE
ST. PETERSBURG, FL 33714
https://search.sunbiz.org/Inquiry/CorporationSearch/SearchResultDetail?inquirytype=EntityName&directionType=Initial&searchNameOrder=ARTZ4L IF.. 1/3
9/30/23, 3:00 PM
Title D
DARIUS, CARTER
1990 Ratcliff Drive North
Clearwater, FL 33763
Title STD
BRYANT, LAHTEEFAH
1750 N. BAYSHORE DRIVE
MIAMI, FL 33132
Title Executive Director
hinson, jacqueline
1751 Kings Highway
Clearwater, FL 33755
Title Board Member
Campbell, Gloria
1751 KINGS HIGHWAY
CLEARWATER, FL 33755
Title MEMBER
TABOR, SANDY
1751 KINGS HWY
CLEARWATER, FL 33755-2026
Annual Reports
Report Year Filed Date
2021 01/26/2021
2022 04/12/2022
2023 03/01/2023
Document Images
03/01/2023 --ANNUAL REPORT
04/12/2022 --ANNUAL REPORT
12/06/2021 -- AMENDED ANNUAL REPORT
01/26/2021 --ANNUAL REPORT
01/15/2020 --ANNUAL REPORT
05/01/2019 --ANNUAL REPORT
03/14/2018 -- ANNUAL REPORT
02/14/2017 --ANNUAL REPORT
03/30/2016 -- ANNUAL REPORT
03/06/2015 --ANNUAL REPORT
02/26/2014 --ANNUAL REPORT
05/03/2013 -- ANNUAL REPORT
Detail by Entity Name
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https://search.su n biz.org/Inquiry/CorporationSearch/SearchResultDetai I? inqu irytype=EntityName&directionType=l n itial&searchNameOrder=ARTZ4L IF.. 2/3
9/30/23, 3:00 PM
05/29/2012 -- Name Change
04/11/2012 --ANNUAL REPORT
04/19/2011 --ANNUAL REPORT
03/02/2010 --ANNUAL REPORT
05/19/2009 --ANNUAL REPORT
09/11/2008 --ANNUAL REPORT
05/21/2007 --ANNUAL REPORT
10/19/2006 -- REINSTATEMENT
09/30/2005 -- REINSTATEMENT
07/05/2004 --ANNUAL REPORT
05/29/2003 --ANNUAL REPORT
06/04/2002 --ANNUAL REPORT
05/13/2002 -- Name Change
09/14/2001 --ANNUAL REPORT
12/19/2000 -- Amendment
05/30/2000 -- ANNUAL REPORT
09/20/1999 --ANNUAL REPORT
08/27/1998 --ANNUAL REPORT
11/17/1997 -- Domestic Non -Profit
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