NORFOLK COMMISSION ON THE ARTS AND HUMANITIES
208 East Main Street, Norfolk, VA 23510
artscommission@norfolk.gov
(757) 664-4330
Fax: 664-6810
FY 12 FINAL REPORT
DUE SEPTEMBER 28, 2012, 5:00 p.m.
EDT
ORGANIZATION/PROJECT TITLE
GRANT AMOUNT
MAILING ADDRESS/CITY/STATE/ZIP
EXECUTIVE DIRECTOR
GRANT ADMINISTRATOR
TELEPHONE
NUMBER
Provide 2011-2012 season schedule and audience figures for grant-supported Norfolk activities.
PLEASE GROUP AND SUBTOTAL ACTIVITIES/PERFORMANCES BY TYPE, for example: mainstage productions, inschool programs, arts instruction, community outreach programs, exhibitions, etc.
Dates
Activity/Performance
Norfolk
Venue
# of
Perfs.
# Paid
Admission
# Comp.
Admission
Total
Attendance
Totals:
INDICATE NUMBER OF SPECIAL INDIVIDUALS SERVED (IF EXACT NUMBERS ARE UNKNOWN, PLEASE GIVE
ESTIMATE AND INDICATE WITH *) BY GRANT SUPPORTED ACTIVITY
Children ____________ Racial Minorities ____________ People with disabilities ____________
Senior Citizens ____________ Military ____________
Others (Describe)
_________________________________ Number of Participating Artists ______________
FY 12 OVERALL ACTIVITY OF YOUR ORGANIZATION IN NORFOLK:
NUMBER OF DISTINCT CULTURAL EVENTS offered in Norfolk by your organization during the granting period (9/1/118/31/12) open to the public:
Number of free events ___________ Number of events with an admission charge __________
OVERALL ATTENDANCE at your organization’s cultural events in Norfolk:
Total attending free events ___________ Total attending events with admission charge ___________
FY 12 EDUCATION and OUTREACH ACTIVITY OF YOUR ORGANIZATION IN NORFOLK—please note that these
figures are a subset of, not an addition to, figures above:
Number of the free or ticketed events listed above that are in-school or student activities _________
Total attending these activities _______________
Number of the free or ticketed events listed above that are community outreach activities ____________
Total attending these activities ___________________
FY 12 EMPLOYMENT
Number of full time employees __________ Number of part-time employees ____________
FY 12 BOARD OF DIRECTORS PARTICIPATION:
Number of board members __________ Percent of board members contributing financially ______________
DESCRIBE EFFECT OF GRANT, especially any specific, notable outcomes. Attach letters, reviews, news clippings, etc.
Indicate method of grant acknowledgment (attach program, ads, etc.) Can be continued on back of page 3.
ORGANIZATION / PROJECT BUDGET SUMMARY: Grant Guidelines require a copy of the organization’s most recent
annual audited financial statement. If the audit is not yet available, an unaudited statement should be attached, and the
audit should be submitted when it becomes available. If the organization is not audited, the unaudited statement should be
attached. In either case, the budget should be summarized below (i.e., please fill in both parts of this form).
FY 11-12 FINAL
Revenue
A. Contributed
1. Norfolk Commission
2. Local Grants
a. Chesapeake
b. Hampton
c. Newport News
d. Portsmouth
e. Suffolk
f. Virginia Beach
g. Williamsburg
h. York County
3. State
4. Federal
5. Membership Fees
6. Individual Contributions
7. Corporate Contributions
8. Other (specify)_______________________
B. Earned
9. Admissions/Ticket sales (inc. Tax)
10. Concessions/Product Sales
11. Interest
12. Other (specify)_______________________
13. Other (specify)_______________________
C. Fundraising Events/Activities (gross income)
14. (specify)____________________________
15. (specify)____________________________
D. Other
16. (specify)____________________________
17. (specify)____________________________
E. Total Income
In-kind Contributions (dollar value, do include
above
a. Services
b. Goods and Materials
c. Space
F. Total In-Kind
Organization
Project
$
FY 11-12 Final
Expenses
A. Salaries/Wages/Honoraria*
1. Principal Administrators
a. Administrative Support
2. Principal Artistic Staff
a. Artists/Performers/Lecturers
3. Consultants
4. Other (specify)_______________________
B. Non-Personnel
5. Office Rental
6. Utilities and Telephones
7. Insurance and Bonding
8. Office Supplies
9. Travel/Lodging/Meals
10. Materials
11. Printing and Duplicating
12. Postage
13. Advertising
14. Equipment Purchase
15. Equipment Rental
16. Repairs and Maintenance
17. Facility Rental (all)**
18. Real Estate Taxes (all)**
19. Personal Property Taxes (all)**
20. Interest Expense
21. Bank Service Charges
22. Admission Taxes (all)**
23. Fundraising Expenses
24. Parking paid by organization (all) **
25. Other (specify)_______________________
26. Other (specify)_______________________
Organization
Project
$
27. TOTAL EXPENSES
28. NET INCOME <DEFICIT>
* Include fringe benefits and payroll taxes
**For items 17-19, and 22, 24, list Norfolk
amounts only below
DIRECT REVENUES RETURNED TO NORFOLK UNDER THIS GRANT (IF PARKING IS ESTIMATED, INDICATE WITH AN
ASTERISK
ADMISSION TAXES $_______________ REAL ESTATE TAXES $_______________ SALES TAXES $_______________
BUSINESS LICENSES $_______________ FACILITIES RENTALS (NOT SERVICES) PAID TO CITY* $_______________
STAFF/PERFORMER/PATRON PARKING $____________/____________/____________
OTHER (DESCRIBE) $_______________
TOTAL RETURNED TO NORFOLK IN FY 12 $_______________
*Note that facilities rentals refers to City-owned facilities, not university, church, or private venues.
I HEREBY CERTIFY THAT, TO THE BEST OF MY KNOWLEDGE, ALL INFORMATION IN THIS FINAL REPORT IS COMPLETE AND
ACCURATE.
NAME AND TITLE OF AUTHORIZED OFFICIAL (PRINT OR TYPE) ____________________________________________________
SIGNATURE / DATE _________________________________________________________________________________________
H:\Arts (NCAH files)\GRANTS\FY 12 Grants\FY12 FINAL REPORT.doc