Related Less Than Arm’s Length Transaction Disclosure Form – Organization Name Early Start Early Learning, LLC Agreement Number X0334 (ON) Principals Delegated Principal Bright Young (DP) Board Chairperson Ledger Balance (BC) Board Member Earl Startlings (BM1) Board Member (BM2) Member (BM3) Ands_______________________________ Principal of Holding Firm (HF) ____Theo Title (Initials) Name _______________________________________________________________________________ Title (Initials) Name Person, Place Internal Use Cost Category/Budget (Address), or PROJECTED Only Principal Relationship Line Item Thing/Function or COST (ANNUAL) Usage Food Service Labor Earlie Startlings/Cook BMI Spouse/Wife $35,000 and Benefits 123 LearningBoulevard Space Owner of Atlanta, GA/ DP $2,000 Cost/Rental/Lease Property Childcare Facility Contracted/Professional The CPC Firm, Partner in CPA BC $5,000 Services LLC/Accountant Firm Theadora Ands/ Salaries and Benefits HF Daughter $40,000 Program Contact I certify that the information I have provided above is complete, true and correct. ___Demont Caring____________ ___Owner/Delegated Principal__ September 30, 2015 Signature Title Date
Related – Less Than Arm’s Length Transaction Disclosure Form Organization Name (ON) Early Start Early Learning, LLC Agreement Number X0334 Principals Delegated Principal (DP) Bright Young Board Chairperson (BC) Ledger Balance Board Member (BM1) Earl Startlings Board Member (BM2) Member (BM3) Principal of Holding Firm (HF) ____Theo Ands_______________________________ Title (Initials) Name _______________________________________________________________________________ Title (Initials) Name Cost Category/Budget Line Item Person, Place (Address), or Thing/Function or Usage Principal Relationship PROJECTED COST (ANNUAL) Internal Use Only Food Service Labor and Benefits Earlie Startlings/Cook BMI Spouse/Wife $35,000 Space Cost/Rental/Lease 123 LearningBoulevard Atlanta, GA/ Childcare Facility DP Owner of Property $2,000 Contracted/Professional Services The CPC Firm, LLC/Accountant BC Partner in CPA Firm $5,000 Salaries and Benefits Theadora Ands/ Program Contact HF Daughter $40,000 I certify that the information I have provided above is complete, true and correct. ___Demont Caring____________ ___Owner/Delegated Principal__ September 30, 2015 Signature Title Date
RelatedPartyDisclosureForm.docx