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HomeMy WebLinkAbout112310 CC Agenda In compliance with the Americans with Disabilities Act, if you need special assistance to participate in this meeting, please contact the office of the City Clerk(951)694-6444. Notification 48 hours prior to a meeting will enable the City to make reasonable arrangements to ensure accessibility to that meeting [28 CFR 35.102.35.104 ADA Title ii] AGENDA TEMECULA CITY COUNCIL A REGULAR MEETING CITY COUNCIL CHAMBERS 43200 BUSINESS PARK DRIVE NOVEMBER 23, 2010 - 7:00 PM At approximately 9:45 P.M., the City Council will determine which of the remaining agenda items can be considered and acted upon prior to 10:00 P.M. and may continue all other items on which additional time is required until a future meeting. All meetings are scheduled to end at 10:00 P.M. 6:00 .P.M. Closed Session of the City' ,Council/Temecula Redevelopment .Agency pursuant to Government Code Section: . 1) Conference with City;Attorney pursuant to Government:Code Section 54956.9(a) with,respect to one matter.of pending litigation to which the.City is a defendant. The title of the litigation, is•Alissa Gross et al. v. Landscape Structures, Inc. and City of Temecula, Riverside County Superior Court • Case No. RIC 538128 (tort litigation). 2) Conference with City Attorney pursuant to Government Code Section 1. 549569(a)with respect to one matter of pending litigation to which the City is a plaintiff. The title of the litigation is City of Temecula, et al. V. . Tovey%Shultz Construction,•.'Inc.,,et: al., Riverside-County Superior Court Case No.,RIC 541908.(Old Town Community Theater construction`litigation): . • 3), Conference with`City Attorney pursuant to Government Code Section 54956:9(b) with.respect to.one matter of potential litigation. With respect to such matter, the City Attorney has determined that a.point has been reached where there is a significant'exposure to litigation involving the City, • and,City related entities based on existing fact&and circumstances:. With : ,: • respect to such matter, theCity Council will meet pursuant to Government Cede Section 54956.9(c) to decide whether to initiate litigation. Public Information concerning existing litigation between the .City and:various parties maybe acquired.byreviewing.the public documents held theCity.Clerk: Next in Order: Ordinance: 10-15 Resolution: 10-84 CALL TO ORDER: Mayor Jeff Comerchero Prelude Music: To Be Announced 1 Invocation: Pastor John Wells of Mountain View Community Church Flag Salute: Council Member Washington ROLL CALL: Edwards, Naggar, Roberts, Washington, Comerchero PRESENTATIONS/PROCLAMATIONS Introduction of California Highway Patrol Commander Ernie Sanchez Presentation to the City by the Riverside County Office of Aging - recognizing the Senior Center Eleventh Annual Community Candlelight Tribute Proclamation PUBLIC COMMENTS A total of 30 minutes is provided so members of the public may address the Council on items that appear within the Consent Calendar or ones that are not listed on the agenda. Speakers are limited to two (2) minutes each. If you desire to speak to the Council on an item which is listed on the Consent Calendar or a matter not listed on the agenda, a pink "Request to Speak" form should be filled out and filed with the City Clerk. When you are called to speak, please come forward and state your name for the record. For all Public Hearing or Council Business matters on the agenda, a "Request to Speak" form must be filed with the City Clerk prior to the Council addressing that item. There is a five minute (5) time limit for individual speakers. CITY COUNCIL REPORTS Reports by the members of the City Council on matters not on the agenda will be made at this time. A total, not to exceed, ten (10) minutes will be devoted to these reports. CONSENT CALENDAR NOTICE TO THE PUBLIC All matters listed under Consent Calendar are considered to be routine and all will be enacted by one roll call vote. There will be no discussion of these items unless Members of the City Council request specific items be removed from the Consent Calendar for separate action. 1 Standard Ordinance and Resolution Adoption Procedure RECOMMENDATION: 1.1 Motion to waive the reading of the text of all ordinances and resolutions included in the agenda. 2 2 Action Minutes RECOMMENDATION: 2.1 Approve the action minutes of November 9, 2010. 3 Change in Location for the City Council Meetings RECOMMENDATION: 3.1 Adopt a resolution entitled: RESOLUTION NO. 10- A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF TEMECULA DESIGNATING A NEW LOCATION FOR CITY COUNCIL MEETINGS 4 List of Demands RECOMMENDATION: 4.1 Adopt a resolution entitled: RESOLUTION NO. 10- A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF TEMECULA ALLOWING CERTAIN CLAIMS AND DEMANDS AS SET FORTH IN EXHIBIT A 5 Community Service Funding Program for Fiscal Year 2010-11 RECOMMENDATION: 5.1 Review and approve the fiscal year 2010-11 Community Service Funding Program grants pursuant to the attached spreadsheet outlining the Ad Hoc Subcommittee's recommendations of$47,000 to 15 organizations. 6 General Liability Insurance Renewal RECOMMENDATION: 6.1 Approve the insurance policy renewal for general and excess liability insurance with St. Paul Fire and Marine Insurance Company and Ironshore Specialty Insurance Company, in the amount $204,284, for the period of December 1, 2010 through December 1, 2011. 3 7 Agreement establishing the Twin Cities of Southern California Marketing Partnership between the cities of Murrieta and Temecula (at the request of the Temecula/Murrieta Subcommittee, Nagger/Washington) RECOMMENDATION: 7.1 Adopt a resolution entitled: RESOLUTION NO. 10- A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF TEMECULA APPROVING THE "AGREEMENT ESTABLISHING THE TWIN CITIES OF SOUTHERN CALIFORNIA MARKETING PARTNERSHIP BETWEEN THE CITIES OF MURRIETA AND TEMECULA" 8 Substitute Agreements and Bonds for Public Improvements in Tract No. 24188-3 (located southwesterly of the intersection of Pauba Road and Butterfield Stage Road) RECOMMENDATION: 8.1 Accept substitute Subdivision Improvement Agreement and Subdivision Faithful Performance and Labor and Materials Bonds as security for improvements and labor and materials for Tract Map 24188-3; 8.2 Accept substitute Subdivision Monument Agreement and Subdivision Monument Bond as security for monumentation for Tract Map 24188-3; 8.3 Authorize the release of the existing Faithful Performance, Labor& Materials, and Monumentation Bonds for Tract Map 24188-3; 8.4 Direct the City Clerk to so advise the developer and surety. 9 Regional Water Quality Control Board Tentative Order Appeal Authority RECOMMENDATION: 9.1 Authorize the City Manager to submit an appeal of the San Diego Regional Water Quality Control Board's adoption of Tentative Order R9-2010-0016, covering NPDES waste discharges from the Municipal Separate Storm Sewer Systems (MS4s), to the State Water Resources Control Board within the 30-day appeal period. 10 Piano Donation RECOMMENDATION: 10.1 Approve the Agreement between the City of Temecula and the Theater Foundation accepting the donation of a Steinway Model "0" Piano for the Merc. 4 TEMECULA COMMUNITY SERVICES DISTRICT MEETING Next in Order: Ordinance: No. CSD 10-01 Resolution: No. CSD 10-05 CALL TO ORDER: President Chuck Washington ROLL CALL: DIRECTORS: Comerchero, Edwards, Naggar, Roberts, Washington CSD PUBLIC COMMENTS A total of 15 minutes is provided so members of the public may address the Board of Directors on items that are not listed on the agenda or on the Consent Calendar. Speakers are limited to two (2) minutes each. If you decide to speak to the Board of Directors on an item not on the agenda or on the Consent Calendar, a pink "Request to Speak" form should be filled out and filed with the City Clerk. When you are called to speak, please come forward and state your name for the record. For all other agenda items, a "Request to Speak" form must be filed with the City Clerk Prior to the Board of Directors addressing that item. There is a five (5) minute time limit for individual speakers. Anyone wishing to address the Board of Directors should present a completed pink "Request to Speak" form to the City Clerk. When you are called to speak, please come forward and state your name for the record. CSD CONSENT CALENDAR 11 Action Minutes RECOMMENDATION: 11.1 Approve the action minutes of November 9, 2010. 12 Change in Location for the Community Services District Meetings RECOMMENDATION: 12.1 Adopt a resolution entitled: RESOLUTION NO. CSD 10- A RESOLUTION OF THE BOARD OF DIRECTORS OF THE TEMECULA COMMUNITY SERVICES DISTRICT OF THE CITY OF TEMECULA, DESIGNATING A NEW LOCATION, AND SETTING THE REGULAR MEETINGS FOR THE SECOND AND FOURTH TUESDAY OF EACH MONTH, AT 7:00 P.M. 5 13 Award of a Construction Contract for Ronald Reagan Sports Park Desiltinq Basin Environmental Mitigation, Project No. PW05-13 RECOMMENDATION: 13.1 Award a construction contract for Project No. PW05-13, Ronald Reagan Sports Park Desilting Basin Environmental Mitigation, to Pacific Restoration Group, Inc. in the amount of$70,086.72; 13.2 Authorize the City Manager to approve change orders not to exceed the contingency amount of$7,008.67, which is equal to 10% of the contract amount; 13.3 Make a finding that the Ronald Reagan Sports Park Desilting Basin Environmental Mitigation project is exempt from Multiple Species Habitat Conservation Plan (MSHCP) fees. CSD BUSINESS 14 ArtsConnection Recap and 2010-2011 Season Preview RECOMMENDATION: 14.1 Receive and file the report recapping the ArtsConnection shows during previous seasons at the Old Town Temecula Community Theater and previewing the upcoming ArtsConnection 2010-2011 season. CSD DEPARTMENTAL REPORT 15 Community Services Department Monthly Report CSD DIRECTOR OF COMMUNITY SERVICES REPORT CSD GENERAL MANAGERS REPORT CSD BOARD OF DIRECTORS REPORTS CSD ADJOURNMENT Next regular meeting: Tuesday, December 14, 2010, 2010, at 5:30 P.M., for a Closed Session, with regular session commencing at 7:00 PM., Temecula Civic Center, City Council Chambers, 41000 Main Street, Temecula, California. 6 TEMECULA REDEVELOPMENT AGENCY MEETING Next in Order: Ordinance: No. RDA 10-01 Resolution: No. RDA 10-11 CALL TO ORDER: Chair Person Mike Naggar ROLL CALL: AGENCY MEMBERS: Comerchero, Edwards, Roberts, Washington, Naggar RDA PUBLIC COMMENTS A total of 15 minutes is provided so members of the public may address the Redevelopment Agency on items that are not listed on the agenda or on the Consent Calendar. Speakers are limited to two (2) minutes each. If you decide to speak to the Board of Directors on an item not on the agenda or on the Consent Calendar, a pink "Request to Speak" form should be filled out and filed with the City Clerk. When you are called to speak, please come forward and state your name for the record. For all other agenda items, a "Request to Speak" form must be filed with the City Clerk Prior to the Board of Directors addressing that item. There is a five (5) minute time limit for individual speakers. Anyone wishing to address the Board of Directors should present a completed pink "Request to Speak" form to the City Clerk. When you are called to speak, please come forward and state your name for the record. RDA CONSENT CALENDAR 16 Action Minutes RECOMMENDATION: 16.1 Approve the action minutes of November 9, 2010. 17 Change in Location of Temecula Redevelopment Agency Meetings RECOMMENDATION: 17.1 Adopt a resolution entitled: 7 RESOLUTION NO. RDA 10- A RESOLUTION OF THE REDEVELOPMENT AGENCY OF THE CITY OF TEMECULA DESIGNATING A NEW LOCATION, AND SETTING THE REGULAR MEETINGS FOR THE SECOND AND FOURTH TUESDAY OF EACH MONTH, AT 7:00 P.M. RDA DEPARTMENTAL REPORT 18 Redevelopment Department Monthly Report RDA EXECUTIVE DIRECTORS REPORT RDA AGENCY MEMBERS REPORTS RDA ADJOURNMENT Next regular meeting: Tuesday, December 14, 2010, at 5:30 P.M., for a Closed Session, with regular session commencing at 7:00 PM., Temecula Civic Center, City Council Chambers, 41000 Main Street, Temecula, California. 8 RECONVENE TEMECULA CITY COUNCIL CITY COUNCIL BUSINESS 19 Public/Traffic Safety Commission Appointments RECOMMENDATION: 19.1 Appoint two applicants to serve full three-year terms on the Public/Traffic Safety Commission through October 10, 2013. DEPARTMENTAL REPORTS 20 Planning Department Monthly Report 21 Police Department Monthly Report 22 Public Works Department Monthly Report CITY MANAGER REPORT CITY ATTORNEY REPORT ADJOURNMENT Next regular meeting: Tuesday, December 14, 2010, at 5:30 PM, for a Closed Session, with regular session commencing at 7:00 PM, Temecula Civic Center, City Council Chambers, 41000 Main Street, Temecula, California. 9 PRESENTATIONS 4. 75N-i A bA b�A N bA cz cz 4Z4 on 0 cC "a "a O O a O O is a !• v cz 7--i cz 3-a u c iti O H 0 N o U p O 4. � w cz 3 -tea > cz w cz Y sy U ° by YV w ft CC ti ti cz �/ V ✓ % cz cz cz w iy cz ,Sy cz cz cz JS W o aa) ra U cz ct cz Po cz > �4 ��1 ct cz cz 3 �wcz c cz o Ct cz o i N U cz O cz T cz cz CONSENT CALENDAR Item No. 1 Item No. 2 ACTION MINUTES TEMECULA CITY COUNCIL A REGULAR MEETING CITY COUNCIL CHAMBERS 43200 BUSINESS PARK DRIVE NOVEMBER 9, 2010 — 7:00 PM 6:00 P.M. - Closed Session of the City Council /Temecula Redevelopment Agency pursuant to Government Code Section: 1) Conference with real property negotiators pursuant to Government Code Section 54956.8 regarding approximately .47 acres of real property located at the northeast corner of Old Town Front Street and Third Street (28693 Old Town Front Street, Temecula; APN 922046010 and 922 - 046 -011) The parties to the negotiations are: Front Street Plaza Partners, LLC; Redevelopment Agency of the City of Temecula. Negotiators for the Redevelopment Agency of the City of Temecula are: Bob Johnson; Patrick Richardson; and Luke Watson. Under negotiation are the terms of the Owner Participation Agreement for the potential development of affordable housing. 2) Conference with City Attorney pursuant to Government Code Section 64966.9(a) with respect to one matter of pending litigation to which the City is a defendant. The title of the litigation is Judy Angle et al. v. City of Temecula, et. al., Riverside County Superior Court Case No. RIC 535656. 3) Conference with City Attorney pursuant to Government Code Section 64966.9(a) with respect to one matter of pending litigation to which the City is a defendant. The title of the litigation is "in the Matter of the Application of SOUTHERN CALIFORNIA EDISON COMPANY (U338E) for a Permit to Construct Electrical Facilities With Voltages Between 50kV and 200k: Triton Substation Project. With respect to such matter, the City Council will also meet pursuant to Government Code Section 64966.9(c) to decide whether to initiate litigation. Public Information concerning existing litigation between the City and various parties may be acquired by reviewing the public documents held by the City Clerk. At 6:00 P.M., Mayor Comerchero called the City Council meeting to order and recessed the meeting to Closed Session to consider the matter described on the Closed Session agenda. The City Council meeting convened at 7:00 P.M. CALL TO ORDER: Mayor Jeff Comerchero e[aMM MMIS"WHO Prelude Music: Leilani Kilgore Invocation: Pastor Bill Savage of True Vine Pentecostal Church Flag Salute: Temecula Valley Young Marines ROLL CALL: Edwards, Naggar, Roberts, Washington, Comerchero Absent: Edwards Certificate of Congratulations to Naomi Daisy Young for her 100th Birthday Certificate of Appreciation to Bryna Bunderson for naming the Chapel of Memories Family Night in Temecula Proclamation PUBLIC COMMENTS George Rombach, Temecula, submitted a document to the City Council entitled Concerned American Citizens. CITY COUNCIL REPORTS CONSENT CALENDAR Standard Ordinance and Resolution Adoption Procedure - Approved Staff Recommendation (4 -0 -1) — Council Member Washington made the motion; it was seconded by Council Member Naggar; and electronic vote reflected approval with the exception of Council Member Edwards who was absent. RECOMMENDATION: 1.1 Motion to waive the reading of the text of all ordinances and resolutions included in the agenda. 2 Action Minutes - Approved Staff Recommendation (4 -0 -1) — Council Member Washington made the motion; it was seconded by Council Member Naggar; and electronic vote reflected approval with the exception of Council Member Edwards who was absent. RECOMMENDATION: 2.1 Approve the action minutes of October 26, 2010. e[aMM MMINWHO 3 List of Demands - Approved Staff Recommendation (4 -0 -1) — Council Member Washington made the motion; it was seconded by Council Member Naggar; and electronic vote reflected approval with the exception of Council Member Edwards who was absent. RECOMMENDATION: 3.1 Adopt a resolution entitled: RESOLUTION NO. 10 -77 A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF TEMECULA ALLOWING CERTAIN CLAIMS AND DEMANDS AS SET FORTH IN EXHIBIT A 4 City Treasurer's Report as of September 30, 2010 - Approved Staff Recommendation (4 -0 -1) — Council Member Washington made the motion; it was seconded by Council Member Naggar; and electronic vote reflected approval with the exception of Council Member Edwards who was absent. RECOMMENDATION: 4.1 Approve and file the City Treasurer's Report as of September 30, 2010. 5 Review of City Conflict of Interest Code - Approved Staff Recommendation (4 -0 -1) — Council Member Washington made the motion; it was seconded by Council Member Naggar; and electronic vote reflected approval with the exception of Council Member Edwards who was absent. RECOMMENDATION: 5.1 Adopt a resolution entitled: RESOLUTION NO. 10 -78 A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF TEMECULA AMENDING THE CITY'S CONFLICT OF INTEREST CODE 6 December Schedule for City Council Meetings - Approved Staff Recommendation (4- 0-1) — Council Member Washington made the motion; it was seconded by Council Member Naggar; and electronic vote reflected approval with the exception of Council Member Edwards who was absent. RECOMMENDATION: 6.1 Direct the City Clerk to cancel the regularly scheduled City Council Meeting of December 28, 2010 and perform the appropriate postings and noticing requirements of the Government Code. e[aMM MMIN"WHO 7 Fourth Amendment to the Aareement with the Friends of the Temecula Children's Museum - Approved Staff Recommendation (3- 0 -1 -1) — Council Member Washington made the motion; it was seconded by Council Member Naggar; and electronic vote reflected approval with the exception of Council Member Edwards who was absent and Mayor Comerchero who abstained. RECOMMENDATION: 7.1 Approve the "Fourth Amendment to Cooperation Agreement between the City of Temecula and Friends of the Temecula Children's Museum for the Support of the Temecula Children's Museum and Operation of the Children's Museum Gift Shop ". 8 Third Amendment to the Joint Powers Agreement between the County of Riverside and the City of Canyon Lake; City of Lake Elsinore; City of Murrieta; City of Temecula; and City of Wildomar creating the Southwest Communities Financing Authority (Animal Shelter ) - Approved Staff Recommendation (4 -0 -1) — Council Member Washington made the motion; it was seconded by Council Member Naggar; and electronic vote reflected approval with the exception of Council Member Edwards who was absent RECOMMENDATION: 8.1 Approve the Third Amendment to the Joint Powers Agreement (JPA) between the County of Riverside and the City of Canyon Lake; City of Lake Elsinore; City of Murrieta; City of Temecula; and the City of Wildomar. 9 Riverside County Mortgage Credit Certificate Program - Approved Staff Recommendation (4 -0 -1) — Council Member Washington made the motion; it was seconded by Council Member Naggar; and electronic vote reflected approval with the exception of Council Member Edwards who was absent RECOMMENDATION: 9.1 Adopt a resolution entitled: RESOLUTION NO. 10 -79 A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF TEMECULA APPROVING PARTICIPATION IN THE RIVERSIDE COUNTY MORTGAGE CREDIT CERTIFICATE (MCC) PROGRAM e[aMM MMIN"WHO 10 Temporary Street Closures for 2010 -2011 Winterfest Events - Approved Staff Recommendation (4 -0 -1) — Council Member Washington made the motion; it was seconded by Council Member Naggar; and electronic vote reflected approval with the exception of Council Member Edwards who was absent RECOMMENDATION: 10.1 Receive and file the following proposed action by the City Manager: Temporarily close certain streets for the following 2010 -2011 Winterfest Events: 'ICE SKATING RINK AT TOWN SQUARE' 'SANTA'S ELECTRIC LIGHT PARADE' 'WINTER WONDERLAND' 'NEW YEARS EVE CELEBRATION' 11 Parcel Map 30404. located at the north west corner of Santiaao Road and Ormsbv Road - Approved Staff Recommendation (4 -0 -1) — Council Member Washington made the motion; it was seconded by Council Member Naggar; and electronic vote reflected approval with the exception of Council Member Edwards who was absent RECOMMENDATION: 11.1 Approve Parcel Map 30404 in conformance with the Conditions of Approval. 12 Award a Construction Contract for Traffic Sianal Installation: Rancho California Road at Yukon Road /Asteroid Way — Proiect No. PW09 -07 - Approved Staff Recommendation (4 -0 -1) — Council Member Washington made the motion; it was seconded by Council Member Naggar; and electronic vote reflected approval with the exception of Council Member Edwards who was absent RECOMMENDATION: 12.1 Award a construction contract for Project No. PW09 -07, Traffic Signal Installation; Rancho California Road at Yukon Road /Asteroid Way, to Sierra Pacific Electrical Contracting in the amount of $187,339.40; 12.2 Authorize the City Manager to approve change orders up to 10% of the contract amount, $18,733.94; 12.3 Make a finding that the Traffic Signal Installation; Rancho California Road at Yukon Road /Asteroid Way Project is exempt from Multiple Species Habitat Conservation Plan (MSHCP) fees. e[aMM MMIN"WHO 13 ADDroval of Amendment No. 1 to the Professional Services Aareement with IRC Technologies, Inc. DBA Independent Roofing Consultants (IRC) for Additional Roofing and Waterproofing Inspection & Testing Services Associated with the Old Town Civic Center Project — PW 06 -07 - Approved Staff Recommendation (4 -0 -1) — Council Member Washington made the motion; it was seconded by Council Member Naggar; and electronic vote reflected approval with the exception of Council Member Edwards who was absent RECOMMENDATION: 13.1 Approve Amendment No. 1 to the Professional Services Agreement with IRC Technologies, Inc. DBA Independent Roofing Consultants (IRC) for additional services associated with roofing and waterproofing inspection & testing services for the Old Town Civic Center Project in the amount of $10,000 and authorize the Mayor to execute the Amendment. 14 ADDroval of the Plans and Specifications and Authorization to Solicit Construction Bids for the Pavement Rehabilitation Program — Nicolas Road — Project No. PW10 -05C - Approved Staff Recommendation (4 -0 -1) — Council Member Washington made the motion; it was seconded by Council Member Naggar; and electronic vote reflected approval with the exception of Council Member Edwards who was absent RECOMMENDATION: 14.1 Approve the plans and specifications and authorize the Department of Public Works to solicit construction bids for the Pavement Rehabilitation Program — Nicolas Road — Project No. PW10 -05C. 15 ADDroval of Purchase and Sale and Donation Aareement between the Citv of Temecula and Borchard - Temecula, LP, regarding the Real Properties identified as Riverside County Tax Assessor's Parcel Numbers 961- 440 -007, 961- 440 -008, 961- 440 -009, 961- 440 -012, and 961- 450 -014 - Approved Staff Recommendation (4 -0 -1) — Council Member Washington made the motion; it was seconded by Council Member Naggar; and electronic vote reflected approval with the exception of Council Member Edwards who was absent RECOMMENDATION: 15.1 Adopt a resolution entitled: RESOLUTION NO. 10 -80 A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF TEMECULA APPROVING, IN SUBSTANTIALLY THE FORM ATTACHED, THAT CERTAIN AGREEMENT ENTITLED "PURCHASE AND SALE AND DONATION AGREEMENT AND JOINT ESCROW INSTRUCTIONS BETWEEN THE CITY OF TEMECULA AND BORCHARD- TEMECULA, L.P. REGARDING THE REAL PROPERTIES IDENTIFIED AS RIVERSIDE COUNTY TAX ASSESSOR'S PARCEL NUMBERS 961 -440 -007, 961 - 440 -008, 961 -440 -009, 961 -440 -012, AND 961 - 450 -014 (CONVEYANCE OF OPEN SPACE LAND)" e[aMM MMIN"WHO 15.2 Authorize the City Manager to approve and execute any necessary documents and to take all necessary actions to complete this acquisition, including without limitation, all escrow instructions; 15.3 Authorize the Finance Director to issue a warrant for the sum of $1.00 for deposit with the Escrow Holder First American Title Insurance to complete the transaction; 15.4 Authorize the Finance Director to issue a warrant for an amount up to, and including, $30,000 for deposit with the Escrow Holder to clear title to the Subject Property if the City Manager authorizes the clearance of the monetary encumbrances and special assessments to clear title to the Subject Property described in the Agreement. 16 Roripaugh Ranch — Approval of Fifth Operating Memorandum - Approved Staff Recommendation (4 -0 -1) — Council Member Washington made the motion; it was seconded by Council Member Naggar; and electronic vote reflected approval with the exception of Council Member Edwards who was absent RECOMMENDATION: 16.1 Adopt a resolution entitled: RESOLUTION NO. 10 -81 A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF TEMECULA APPROVING THE FIFTH OPERATING MEMORANDUM FOR THE DEVELOPMENT AGREEMENT BETWEEN ASHBY USA, LLC AND THE CITY OF TEMECULA FOR HRA RORIPAUGH 1 LLC AND HRA RORIPAUGH 2 LLC, OWNERS OF TRACTS 29661 -3 AND 29661 -4 WITHIN THE RORIPAUGH RANCH PROJECT At 7:25 P.M., the City Council convened as the Temecula Community Services District and the Redevelopment Agency. At 8:03 P.M., the City Council resumed with regular business. PUBLIC HEARING 20 Amendment of the California Building Codes - Approved Staff Recommendation (4 -0- 1) — Council Member Washington made the motion; it was seconded by Council Member Roberts; and electronic vote reflected approval with the exception of Council Member Edwards who was absent. RECOMMENDATION 20.1 Adopt a resolution entitled: e[aMM MMIN"WHO RESOLUTION NO. 10- 82 A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF TEMECULA MAKING EXPRESS FINDINGS AND DETERMINATIONS THAT MODIFICATIONS TO THE 2010 CALIFORNIA BUILDING, PLUMBING, MECHANICAL, AND ELECTRICAL CODES, AS ADOPTED BY THE CITY OF TEMECULA, ARE REASONABLY NECESSARY BECAUSE OF LOCAL CLIMATIC, GEOLOGICAL, OR TOPOGRAPHICAL CONDITIONS 20.2 Second reading and adoption of the Ordinance introduced October 12, 2010 entitled: ORDINANCE NO. 10 -13 AN ORDINANCE OF THE CITY COUNCIL OF THE CITY OF TEMECULA ADOPTING BY REFERENCE THE 2010 EDITION OF THE CALIFORNIA BUILDING CODE; THE 2010 EDITION OF THE CALIFORNIA MECHANICAL CODE; THE 2010 EDITION OF THE CALIFORNIA PLUMBING CODE; THE 2010 EDITION OF THE CALIFORNIA ELECTRICAL CODE; THE 2010 EDITION OF THE CALIFORNIA ADMINISTRATIVE CODE; AND THE 2010 CALIFORNIA ENERGY CODE, 2010 CALIFORNIA GREEN BUILDING STANDARDS CODE, 2010 CALIFORNIA REFERENCED STANDARDS CODE, 2010 CALIFORNIA RESIDENTIAL CODE, TOGETHER WITH CERTAIN AMENDMENTS AND DELETIONS, AND AMENDING TITLE 15 OF THE TEMECULA MUNICIPAL CODE 21 Amendment of the California Fire Code - Approved Staff Recommendation (4 -0 -1) — Council Member Naggar made the motion; it was seconded by Council Member Washington; and electronic vote reflected approval with the exception of Council Member Edwards who was absent. RECOMMENDATION: 21.1 Adopt a resolution entitled: RESOLUTION NO. 10 -83 A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF TEMECULA SETTING FORTH THE LOCAL CONDITIONS UPON WHICH A DETERMINATION HAS BEEN MADE BY THE CITY COUNCIL THAT MODIFICATIONS TO CHAPTER 15.16 OF THE TEMECULA MUNICIPAL CODE, AMENDING THE CALIFORNIA FIRE CODE, CCR TITLE 24 PART 9, 2010 EDITION, ARE REASONABLE AND NECESSARY TO PROTECT THE PUBLIC HEALTH, SAFETY, AND WELFARE 21.2 Second Reading and adoption of the ordinance introduced October 12, 2010 entitled: e[aMM MMIN"WHO ORDINANCE NO. 10 -14 AN ORDINANCE OF THE CITY COUNCIL OF THE CITY OF TEMECULA ADOPTING BY REFERENCE THE 2010 EDITION OF THE CALIFORNIA FIRE CODE BASED ON THE 2009 INTERNATIONAL FIRE CODE, IN ITS ENTIRETY, REGULATING AND GOVERNING THE SAFEGUARD OF LIFE AND PROPERTY FROM FIRE AND EXPLOSION HAZARDS ARISING FROM THE STORAGE, HANDLING, AND USE OF HAZARDOUS SUBSTANCES, MATERIALS, AND DEVICES, AND FROM CONDITIONS HAZARDOUS TO LIFE OR PROPERTY IN THE OCCCUPANCY OF BUILDINGS AND PREMISES IN THE CITY OF TEMECULA, INCLUDING CERTAIN AMENDMENTS, ADDITIONS, AND DELETIONS, AND PROVIDING FOR THE ISSUANCE OF PERMITS AND THE COLLECTION OF FEES CITY COUNCIL BUSINESS 22 Community Services Commission Appointments — Reappointed Commissioners Hogan and McCracken to serve full three -year terms through October 10, 2013 — (4 -0 -1) — Council Member Naggar made the motion; it was seconded by Council Member Roberts; and electronic vote reflected approval with the exception of Council Member Edwards who was absent. RECOMMENDATION: 22.1 Appoint two applicants to serve full three -year terms on the Community Services Commission through October 10, 2013. CITY MANAGER REPORT CITY ATTORNEY REPORT City Attorney Thorson advised that under the Brown Act, there was nothing to report from the Closed Session but noted that with regard to Item No. 1 (real estate negotiations), no final action will be taken on that item unless in an open meeting of the Agency and the City Council. With respect to Item No. 3 (Southern California Edison Company — Triton Substation project), Mr. Thorson stated that Mr. Nelson did not participate in the discussion nor was he present in the room due to his wife's employment with Southern California Edison. e[aMM MMIN"WHO ADJOURNMENT At 8:12 P.M., the City Council meeting was formally adjourned to Tuesday, November 23, 2010, at 5:30 PM, for a Closed Session, with regular session commencing at 7:00 PM, City Council Chambers, 43200 Business Park Drive, Temecula, California. This meeting was adjourned in Honor of Naomi Davis Jeff Comerchero, Mayor ATTEST: Susan W. Jones, MMC City Clerk [SEAL] Action Minutes \110910 10 Item No. 3 Approvals City Attorney Director of Finance City Manager CITY OF TEMECULA AGENDA REPORT TO: City Manager /City Council FROM: Susan W. Jones, City Clerk/Director of Support Services DATE: November 23, 2010 SUBJECT: Change in Location for the City Council Meetings RECOMMENDATION: That the City Council: 1. Adopt a resolution entitled: RESOLUTION NO. 10- A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF TEMECULA DESIGNATING A NEW LOCATION FOR CITY COUNCIL MEETINGS II / �I�I) BACKGROUND: Due to the recent completion of the new Civic Center, the City Council Meetings will now be held in the Council Chambers at 41000 Main Street, Temecula, California. This change will constitute a permanent move for the location of the City Council Meetings. The time of the regularly scheduled meeting will not change and will be held at the normal 7:00 p.m. hour. FISCAL IMPACT: None ATTACHMENTS: Resolution 10- RESOLUTION NO. 10- A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF TEMECULA DESIGNATING A NEW LOCATION FOR CITY COUNCIL MEETINGS THE CITY COUNCIL OF THE CITY OF TEMECULA DOES HEREBY RESOLVE AS FOLLOWS: Section 1. The Offices of the City of Temecula have been relocated to a new Civic Center facility located at 41000 Main Street, Temecula, California. Section 2. This facility has been designed to house the City Council Chambers. Section 3. Pursuant to the authority of Section 1.04.020.8. of the Temecula Municipal Code, regular meetings of the Temecula City Council shall be held in the Council Chambers located at the Civic Center, 41000 Main Street, Temecula, California. The date and time of the regular meetings shall remain the same as in Section 2.04.020.A. of the Temecula Municipal Code. Section 4. The City Clerk shall certify to the passage and adoption of this resolution. PASSED, APPROVED, AND ADOPTED by the City Council of the City of Temecula this 23rd day of November, 2010. Jeff Comerchero, Mayor ATTEST: Susan W. Jones, MMC City Clerk [SEAL] STATE OF CALIFORNIA ) COUNTY OF RIVERSIDE ) ss CITY OF TEMECULA ) I, Susan W. Jones, MMC, City Clerk of the City of Temecula, do hereby certify that the foregoing Resolution No. 10- was duly and regularly adopted by the City Council of the City of Temecula at a meeting thereof held on the 23rd day of November, 2010, by the following vote: AYES: COUNCIL MEMBERS: NOES: COUNCIL MEMBERS: ABSENT: COUNCIL MEMBERS: IG1: i. ��G11►�K�1�1►Nll�dil�dil:l�:i.� Susan W. Jones, MMC City Clerk z Item No. 4 Approvals City Attorney Director of Finance City Manager CITY OF TEMECULA AGENDA REPORT TO: City Manager /City Council FROM: Genie Roberts, Director of Finance DATE: November 23, 2010 SUBJECT: List of Demands PREPARED BY: Pascale Brown, Accounting Manager Jada Yonker, Accounting Specialist RECOMMENDATION: That the City Council: 1. Adopt a resolution entitled: RESOLUTION NO. 10- A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF TEMECULA ALLOWING CERTAIN CLAIMS AND DEMANDS AS SET FORTH IN EXHIBIT A fl / BACKGROUND: All claims and demands are reported and summarized for review and approval by the City Council on a routine basis at each City Council meeting. The attached claims represent the paid claims and demands since the last City Council meeting. FISCAL IMPACT: All claims and demands were paid from appropriated funds or authorized resources of the City and have been recorded in accordance with the City's policies and procedures. ATTACHMENTS: Resolution List of Demands RESOLUTION NO. 10- A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF TEMECULA ALLOWING CERTAIN CLAIMS AND DEMANDS AS SET FORTH IN EXHIBIT A THE CITY COUNCIL OF THE CITY OF TEMECULA DOES HEREBY RESOLVE AS FOLLOWS: Section 1. That the following claims and demands as set forth in Exhibit A, on file in the office of the City Clerk, has been reviewed by the City Manager's Office and that the same are hereby allowed in the amount of $2,530,629.00. Section 2. The City Clerk shall certify the adoption of this resolution. PASSED, APPROVED, AND ADOPTED by the City Council of the City of Temecula this 23rd day of November, 2010. Jeff Comerchero, Mayor r_T40r:61n Susan W. Jones, MMC City Clerk [SEAL] STATE OF CALIFORNIA ) COUNTY OF RIVERSIDE ) ss CITY OF TEMECULA ) I, Susan W. Jones, MMC, City Clerk of the City of Temecula, do hereby certify that the foregoing Resolution No. 10- was duly and regularly adopted by the City Council of the City of Temecula at a meeting thereof held on the 23rd day of November, 2010, by the following vote: F-A y d :. K o 1 l 1► [MIN i I A i 1: 7 4: 6 3 NOES: COUNCIL MEMBERS: ABSENT: COUNCIL MEMBERS: ABSTAIN: COUNCIL MEMBERS: Susan W. Jones, MMC City Clerk CITY OF TEMECULA LIST OF DEMANDS 11/04/2010 TOTAL CHECK RUN 11/10/2010 TOTAL CHECK RUN 11/10/2010 TOTAL PAYROLL RUN: $ 612,729.46 1,486,516.66 431,382.88 TOTAL LIST OF DEMANDS FOR 11/23/2010 COUNCIL MEETING: $ 2,530,629.00 DISBURSEMENTS BY FUND CHECKS: 001 GENERAL FUND $ 578,336.83 130 RECOVERY ACT JAG FUNDING 219.54 165 AFFORDABLE HOUSING 451,815.85 170 MEASURE A FUND 10,715.00 190 TEMECULA COMMUNITY SERVICES DISTRICT 202,343.72 192 TCSD SERVICE LEVEL B 153.70 194 TCSD SERVICE LEVEL D 887.83 196 TCSD SERVICE LEVEL "L" LAKE PARK MAINT. 4,622.86 197 TEMECULA LIBRARY FUND 12,389.22 210 CAPITAL IMPROVEMENT PROJECTS FUND 608,983.83 280 REDEVELOPMENT AGENCY - CIP PROJECT 104,681.46 300 INSURANCE FUND 28,006.17 320 INFORMATION SYSTEMS 45,680.64 330 SUPPORT SERVICES 3,696.31 340 FACILITIES 18,524.51 375 SUMMER YOUTH EMPLOYMENT PROGRAM 7,989.49 390 TCSD DEBT SERVICE 3,850.00 477 CFD- RORIPAUGH 6,388.32 501 SERVICE LEVEL "C "ZONE 1 SADDLEWOOD 128.99 502 SERVICE LEVEL "C "ZONE 2 WINCHESTER CREEK 125.96 503 SERVICE LEVEL "C "ZONE 3 RANCHO HIGHLANDS 180.12 504 SERVICE LEVEL "C "ZONE 4 THE VINEYARDS 36.12 505 SERVICE LEVEL "C "ZONE 5 SIGNET SERIES 234.68 506 SERVICE LEVEL "C "ZONE 6 WOODCREST COUNTRY 38.18 507 SERVICE LEVEL "C "ZONE 7 RIDGEVIEW 101.36 508 SERVICE LEVEL "C "ZONE 8 VILLAGE GROVE 1,483.79 509 SERVICE LEVEL "C "ZONE 9 RANCHO SOLANA 25.23 510 SERVICE LEVEL "C "ZONE 10 MARTINIQUE 31.67 511 SERVICE LEVEL "C "ZONE 11 MEADOWVIEW 29.99 512 SERVICE LEVEL "C "ZONE 12 VINTAGE HILLS 578.96 513 SERVICE LEVEL "C "ZONE 13 PRESLEY DEVELOP. 191.73 514 SERVICE LEVEL "C "ZONE 14 MORRISON HOMES 64.86 515 SERVICE LEVEL "C "ZONE 15 BARCLAY ESTATES 39.46 516 SERVICE LEVEL "C "ZONE 16 TRADEIN NDS 84.74 517 SERVICE LEVEL "C "ZONE 17 MONTE VISTA 24.40 518 SERVICE LEVEL "C "ZONE 18 TEMEKU HILLS 284.04 519 SERVICE LEVEL "C "ZONE 19 CHANTEMAR 127.41 520 SERVICE LEVEL "C "ZONE 20 CROWNE HILL 472.34 521 SERVICE LEVEL "C "ZONE 21 VAIL RANCH 538.88 522 SERVICE LEVEL "C "ZONE 22 SUTTON PLACE 33.68 523 SERVICE LEVEL "C "ZONE 23 PHEASENT RUN 32.30 524 SERVICE LEVEL "C "ZONE 24 HARVESTON 361.20 525 SERVICE LEVEL "C "ZONE 25 SERENA HILLS 71.06 526 SERVICE LEVEL "C "ZONE 26 GALLERYTRADITION 26.81 527 SERVICE LEVEL "C "ZONE 27 AVONDALE 32.63 528 SERVICE LEVEL "C "ZONE 28 WOLF CREEK 490.04 529 SERVICE LEVEL "C "ZONE 29 GALLERY PORTRAIT 5.40 700 CERBT CALIFORNIA BE RETIREE- GASB45 4,084.81 $ 2,099,246.12 CITY OF TEMECULA LIST OF DEMANDS 001 GENERAL FUND $ 244,947.45 165 AFFORDABLE HOUSING 10,958.71 190 TEMECULA COMMUNITY SERVICES DISTRICT 103,635.05 192 TCSD SERVICE LEVEL B 137.76 194 TCSD SERVICE LEVEL D 910.87 196 TCSD SERVICE LEVEL "L" LAKE PARK MAINT. 903.75 197 TEMECULA LIBRARY FUND 458.75 280 REDEVELOPMENT AGENCY - CIP PROJECT 6,595.35 300 INSURANCE FUND 1,438.98 320 INFORMATION SYSTEMS 24,305.54 330 SUPPORT SERVICES 5,852.57 340 FACILITIES 8,394.09 375 SUMMER YOUTH EMPLOYMENT PROGRAM 1,427.47 501 SERVICE LEVEL "C "ZONE 1 SADDLEWOOD 89.99 502 SERVICE LEVEL "C "ZONE 2 WINCHESTER CREEK 59.97 503 SERVICE LEVEL "C "ZONE 3 RANCHO HIGHLANDS 71.12 504 SERVICE LEVEL "C "ZONE 4 THE VINEYARDS 13.12 505 SERVICE LEVEL "C "ZONE 5 SIGNET SERIES 144.80 506 SERVICE LEVEL "C "ZONE 6 WOODCREST COUNTRY 26.15 507 SERVICE LEVEL "C "ZONE 7 RIDGEVIEW 37.32 508 SERVICE LEVEL "C "ZONE 8 VILLAGE GROVE 245.85 509 SERVICE LEVEL "C "ZONE 9 RANCHO SOLANA 1.98 510 SERVICE LEVEL "C "ZONE 10 MARTINIQUE 10.85 511 SERVICE LEVEL "C "ZONE 11 MEADOWVIEW 6.85 512 SERVICE LEVEL "C "ZONE 12 VINTAGE HILLS 163.86 513 SERVICE LEVEL "C "ZONE 13 PRESLEY DEVELOP. 35.06 514 SERVICE LEVEL "C "ZONE 14 MORRISON HOMES 20.42 515 SERVICE LEVEL "C "ZONE 15 BARCLAY ESTATES 17.46 516 SERVICE LEVEL "C "ZONE 16 TRADEWINDS 40.93 517 SERVICE LEVEL "C "ZONE 17 MONTE VISTA 3.38 518 SERVICE LEVEL "C "ZONE 18 TEMEKU HILLS 151.81 519 SERVICE LEVEL "C "ZONE 19 CHANTEMAR 81.44 520 SERVICE LEVEL "C "ZONE 20 CROWNE HILL 220.34 521 SERVICE LEVEL "C "ZONE 21 VAIL RANCH 372.38 522 SERVICE LEVEL "C "ZONE 22 SUTTON PLACE 8.88 523 SERVICE LEVEL "C "ZONE 23 PHEASENT RUN 9.72 524 SERVICE LEVEL "C "ZONE 24 HARVESTON 209.75 525 SERVICE LEVEL "C "ZONE 25 SERENA HILLS 67.36 526 SERVICE LEVEL "C "ZONE 26 GALLERYTRADITION 2.91 527 SERVICE LEVEL "C "ZONE 27 AVONDALE 9.72 528 SERVICE LEVEL "C "ZONE 28 WOLF CREEK 309.32 529 SERVICE LEVEL "C "ZONE 29 GALLERY PORTRAIT 6.00 700 CERBT CALIFORNIA BE RETIREE- GASB45 18,977.80 431,382.88 TOTAL BY FUND: $ 2,530,629.00 apChkLst 11/04/2010 10:27:52AM Final Check List CITY OF TEMECULA Page: 1 Bank: union UNION BANK OF CALIFORNIA Check # Date Vendor Description Amount Paid Check Total 1577 10/26/2010 000444 INSTATAX (EDD) unemployment inst m tax 3rd gtr'10 22,249.68 22,249.68 141663 11/04/2010 004973 ABACHERLI, LIN DI TCSD instructor earnings 640.00 640.00 141664 11/04/2010 004802 ADLERHORST INTERNATIONAL Oct training: PD K -9 Rudy 141.67 INC Oct training: PD K -9 Casper 141.67 283.34 141665 11/04/2010 009374 ALLEGRO MUSICAL VENTURES piano tuning svcs: library 170.00 170.00 141666 11/04/2010 012943 ALPHA MECHANICAL SERVICE HVAC maint: harveston park 270.00 270.00 INC 141667 11/04/2010 011960 AMERICAN HEAVY MOVING release retention PW06- 07(1A) 3,112.00 3,112.00 141668 11/04/2010 002648 AUTO CLUB OF SOUTHERN Membership: 15453620 LR 48.00 48.00 CALIF 141669 11/04/2010 004205 BALLET FOLKLORICO TCSD Instructor Earnings 262.50 262.50 141670 11/04/2010 002541 BECKER CONSTRUCTION guard mil repair: rainbow cyn 2,410.00 SRVS INC pedestrian barricade rails: PW 1,744.00 4,154.00 141671 11/04/2010 004262 BIO -TOX LABORATORIES DUI & drug screenings: Police 821.80 DUI & drug screenings: Police 597.81 1,419.61 141672 11/04/2010 003048 BOYS & GIRLS CLUB '10 Harvest Carnival participant 150.00 150.00 141673 11/04/2010 009082 C B C TECHNICAL INC misc tech supplies: Theater 51.39 51.39 141674 11/04/2010 003138 CALMAT PW patch truck materials 1,231.33 1,231.33 141675 11/04/2010 011383 CAL STATE SAN MARCOS REIMB:32225 PIO PICO RD CSSM 94,324.84 94,324.84 141676 11/04/2010 004228 CAMERON WELDING SUPPLY Helium tanks rental /refill:TCSD 56.50 56.50 141677 11/04/2010 000137 CHEVRON AND TEXACO City vehicles fuel: CM 196.49 196.49 141678 11/04/2010 012627 CLEAR IMAGE ENTERPRISES window cleaning svc: CRC 665.00 665.00 INC Pagel apChkLst Final Check List Page: 2 11/04/2010 10:27:52AM CITY OF TEMECULA Bank: union UNION BANK OF CALIFORNIA (Continued) Check # Date Vendor Description Amount Paid Check Total 141679 11/04/2010 000447 COMTRONIX repair /maint: satellite phone 140.63 140.63 141680 11/04/2010 013040 CONNERS, ROBERT refund:grading dep 31011 jedediah 995.00 995.00 141681 11/04/2010 012353 CONSTRUCTION TESTING Sept geotech testing: PW CIP 7,993.00 7,993.00 141682 11/04/2010 013379 COUSSOU, CELINE TCSD Instructor Earnings 144.90 144.90 141683 11/04/2010 013016 CR STUDIO TCSD Instructor Earnings 126.00 126.00 141684 11/04/2010 007057 DERNBACH, ESTHER MARIE TCSD instructor earnings 850.50 TCSD instructor earnings 630.00 TCSD instructor earnings 262.50 1,743.00 141685 11/04/2010 003945 DIAMOND ENVIRONMENTAL septic tankpump: RRSP 320.00 320.00 SRVCS 141686 11/04/2010 004192 DOWNS COMMERCIAL Fuel for Cityvehicles: TCSD 18.65 18.65 FUELING INC 141687 11/04/2010 011202 E M H SPORTS & FITNESS TCSD instructor earnings 656.25 TCSD instructor earnings 196.00 852.25 141688 11/04/2010 011203 ENVIRONMENTAL CLEANING Oct janitorial svc:park restrooms 5,315.00 5,315.00 141689 11/04/2010 000165 FEDERAL EXPRESS INC 9/22 -10/1 city express mail svcs 476.13 476.13 141690 11/04/2010 009097 FULL COMPASS SYSTEMS MISC TECH SUPPLIES: THEATER 386.39 386.39 141691 11/04/2010 011967 FULL VALUE ENTERTAINMENT sttlmnt: Live at the Merc 10/29 395.50 395.50 141692 11/04/2010 013076 GAUDET, YVONNE M. TCSD Instructor Earnings 893.20 893.20 141693 11/04/2010 013868 GLOBAL YOUTH JUSTICE '10 Intl trn local yth court:LV 1217 -9 195.00 195.00 141694 11/04/2010 005311 H2O CERTIFIED POOL WATER Oct pool maint svc: CRC/TES 900.00 SPCL. Oct water quality /maint:fountain 175.00 1,075.00 141695 11/04/2010 002109 H D SUPPLY CONSTR. SU PPLY MISC SUPPLIES:PW MAINT DIV- 36.95 36.95 LTD Page2 apChkLst Final Check List Page: 3 11/04/2010 10:27:52AM CITY OF TEMECULA Bank: union UNION BANK OF CALIFORNIA Check # Date Vendor 141702 141696 11/04/2010 001135 HEALTHPOINTE MEDICAL GROUP INC 141697 11/04/2010 004833 IMPERIAL PAVING COMPANY KELLEY DISPLAY INC clean /store banners: old town 141704 INC 141698 11/04/2010 013695 INLAND EMPIRE SHRED IT 141699 11/04/2010 003296 INTL CODE COUNCIL 141700 11/04/2010 001186 IRWIN. JOHN (Continued) Description Amount Paid Emp industrial care svcs: HR 50.00 asphalt repair:winchester /jffisn 10/25 doc shred svc: City Hall 10/25 doc shred svc: PD mall 10/25 doc shred svc: PD OT 10/25 doc shred svc: Library 10/25 doc shred svc: CRC '09 IFC Q&A: Fire Prevention TCSD instructor earnings TCSD instructor earnings TCSD instructor earnings 141701 11/04/2010 013200 JAROTHINC Nov pay phone:duck pond,library,crc 141702 11/04/2010 013869 JOB'S DAUGHTERS, '10 Harvest Carnival participant TEMECULA 141703 11/04/2010 002424 KELLEY DISPLAY INC clean /store banners: old town 141704 11/04/2010 004024 KOCH HEATING & AIR Res Impry Prgm: Irizarry, Anita CONDITION 141705 11/04/2010 004062 KUSTOM SIGNALS INC Prolaser battery pack: Police 141706 11/04/2010 003726 LIFE ASSIST INC Medical Supplies: Paramedics 141707 11/04/2010 003782 MAIN STREET SIGNS Misc signs:PW Maint 141708 11/04/2010 004141 MAINTEX INC Cleaning & maint supplies:city fac's 141709 11/04/2010 000217 MARGARITA OFFICIALS ASSN Oct officiating swcs:CSD sports pgrm 141710 11/04/2010 011179 MC MILLIN REDHAWK LLC TCSD Instructor Earnings TCSD Instructor Earnings TCSD Instructor Earnings 141711 11/04/2010 006571 MELODY'S AD WORKS INC. Nov mktg & promo swcs:old town Reimbursements old town marketing 30,985.00 35.00 15.00 15.00 15.00 15.00 WAR 450.80 235.20 86.10 212.64 150.00 454.90 3,000.00 985.70 18.96 269.70 282.75 5,285.00 700.00 280.00 252.00 3,500.00 4.88 Check Total 50.00 30,985.00 95.00 39.15 772.10 212.64 150.00 454.90 3,000.00 985.70 18.96 269.70 282.75 5,285.00 1,232.00 3,504.88 Pages apChkLst Final Check List Page: 4 11/04/2010 10:27:52AM CITY OF TEMECULA Bank: union UNION BANK OF CALIFORNIA (Continued) Check # Date Vendor Description Amount Paid Check Total 141712 11/04/2010 013390 MILLER, JOSHUA TCSD Instructor Earnings 428.75 TCSD Instructor Earnings 70.00 498.75 141713 11/04/2010 012962 MILLER, MISTY TCSD Instructor Earnings 882.00 TCSD Instructor Earnings 227.50 1,109.50 141714 11/04/2010 013724 MITCHELL CONSTRUCTION Res Impry Prgm: Williams, Brandy 1,100.00 1,100.00 141715 11/04/2010 001892 MOBILE MODULAR 10/20 -11/18 modular bldg rental: OATC 619.88 619.88 141716 11/04/2010 010908 MR APPLIANCE OF Appliance maint&repair:mpsc 1,025.24 1,025.24 WINCHESTER 141717 11/04/2010 013319 NEW TAN GRAM LLC FURNITURE& INSTALL: CIVIC CENTER 96,068.40 96,068.40 141718 11/04/2010 013865 OASIS CAMEL DAIRY seniorexcursion 11 /9/10 200.00 200.00 141719 11/04/2010 003964 OFFICE DEPOT BUSINESS SVS office supplies:childrens museum 22.19 22.19 DIV 141720 11/04/2010 002105 OLD TOWN TIRE &SERVICE City Vehicle Maint Svcs:PW Traffic 36.57 City Vehicle Maint Svcs:PW Land Dev 703.52 740.09 141721 11/04/2010 002105 OLD TOWN TIRE &SERVICE City Vehicle Maint Svcs:TCSD 284.88 City Vehicle Maint Svcs:TCSD 161.41 446.29 141722 11/04/2010 001171 ORIENTAL TRADING COMPANY RECREATION SUPPLIES:CHILDRENS 46.94 46.94 INC MUSEUM 141723 11/04/2010 013198 ORTENZO- HAYES, KRISTINE TCSD Instructor Earnings 867.30 TCSD Instructor Earnings 660.80 TCSD Instructor Earnings 551.84 TCSD Instructor Earnings 462.00 TCSD Instructor Earnings 413.00 TCSD Instructor Earnings 308.00 TCSD Instructor Earnings 237.42 3,500.36 141724 11/04/2010 013789 PARKPACIFIC, INC. Bike Racks:Parking Structure 3,401.50 3,401.50 141725 11/04/2010 013381 PEREZ, AARON TROY TCSD Instructor Earnings 1,019.38 1,019.38 141726 11/04/2010 013115 PETERSON NUGENT, KRISTIN TCSD Instructor Earnings 403.20 TCSD Instructor Earnings 369.60 772.80 141727 11/04/2010 010338 POOL & ELECTRICAL Fountain supplies:town square 26.32 26.32 PRODUCTS INC Page:4 apChkLst Final Check List Page: 5 11/04/2010 10:27:52AM CITY OF TEMECULA Bank: union UNION BANK OF CALIFORNIA (Continued) Check # Date Vendor Description Amount Paid Check Total 141728 11/04/2010 012904 PRO ACTIVE FIRE DESIGN Sept plan check swcs:fre prev 3,565.99 3,565.99 141729 11/04/2010 013721 PROPET DISTRIBUTORS INC Pet waste stations:var park sites 2,142.95 2,142.95 141730 11/04/2010 002072 RANCHO CALIF WATER add'I inspection fees:Wnchstr Rd pw0615 2,209.61 2,209.61 DIST -FEES 141731 11/04/2010 000262 RANCHO CALIF WATER Oct var water meters:tcsd svc lev C 6,660.66 DISTRICT Oct var water meters:tcsd & pw 2,350.33 Sep var water meters:Nacke Dr 2,307.27 Sep var water meters:33411 pauba 1,483.65 Oct var water meters: 30650 pauba 473.65 Oct water meter: 30875 rancho vista 401.04 Aug DC meter:pauba rd:Library 51.05 Aug DC meter:30875 rancho vista rd 51.05 Oct varvrater meters: 30650 pauba 14.58 13,793.28 141732 11/04/2010 005062 RAWLINGS, PHIL reimb:TCC CERT supplies 60.95 60.95 141733 11/04/2010 000271 RBF CONSULTING AUG ENG SRVCS: I- 15179S ULT. 154,900.53 154,900.53 INTRCHG 141734 11/04/2010 004584 REGENCY LIGHTING Lighting supplies: town square 6,446.70 Electncal supplies:citywide 172.26 6,618.96 141735 11/04/2010 000418 RIVERSIDE CO CLERK& ntc of exemption filing fee:open space 64.00 64.00 RECORDER 141736 11/04/2010 000411 RIVERSIDE CO FLOOD plan ck deposit:Btrfld Stg Beltway pdt 10,000.00 10,000.00 CONTROL 141737 11/04/2010 000357 RIVERSIDE CO plan ck deposit:Btrfld Stg Beltway pdt 10,000.00 10,000.00 TRANSPORTATION 141738 11/04/2010 012251 ROTH, DONALD J. TCSD Instructor Earnings 315.00 TCSD Instructor Earnings 94.50 409.50 141739 11/04/2010 002226 RUSSO, MARYANNE TCSD Instructor Earnings 1,078.00 TCSD Instructor Earnings 525.00 1,603.00 141740 11/04/2010 005329 SAFE ALTERNATIVE FOR Council Community Swc Funding 2,000.00 2,000.00 EVERYONE 141741 11/04/2010 009213 SHERRY BERRY MUSIC Jazz @ the Merc 10/28/10 231.00 231.00 Pages apChkLst Final Check List Page: 6 11/04/2010 10:27:52AM CITY OF TEMECULA Bank: union UNION BANK OF CALIFORNIA Check # Date Vendor 141742 11/04/2010 009746 SIGNS BYTOMORROW 141743 11/04/2010 000645 SMART& FINAL INC 141744 11/04/2010 000537 SOCALIFEDISON 141745 11/04/2010 141746 11/04/2010 141747 11/04/2010 141748 11/04/2010 141749 11/04/2010 141750 11/04/2010 141751 11/04/2010 001212 002503 002503 000519 005724 012188 000305 SO CALIF GAS COMPANY SOUTH COAST AIR QUALITY SOUTH COAST AIR QUALITY SOUTH COUNTY PEST CONTROL INC SOUTHWEST FAMILY YMCA STRONG FAMILIES TARGET BANK BUS CARD SRVCS (Continued) Description Amount Paid Check Total SIGNAGE: RECREATION & SPCL 35.31 110.00 pest control swcs: Prkg structure EVENTS 52.00 '10 Halloween Carnival booth 150.00 SIGNAGE: RECREATION & SPCL EVENT: 23.08 42.00 58.39 RECREATION SUPPLIES: MPSC 171.36 171.36 Oct 2 -00- 397 - 5042:43200 bus pk dr #1 6,894.01 MISC SUPPLIES: MPSC 75.15 Oct 2 -32- 903 - 8293:41000 main st 4,474.13 53.64 Oct 2 -29- 224 -0173: Fire Stns 2,467.61 MISC SUPPLIES: CS CLASSES &ACTIV Oct 2 -00- 397- 5067:tcsd svc lev C 2,036.22 Oct 2- 02- 502 - 8077:43210 bus pk dr B 1,884.05 Oct 2- 31 -404- 6020:28771 OT frnt st 1,766.41 Oct 2 -29- 295 -3510: 32211 wolf vly rd 1,305.78 Oct 2 -31- 912 - 7494:28690 mercedes 1,270.95 Oct 2 -31 -536- 3226:28690 mercedes 654.44 Oct 2 -30 -520- 4414:32781 tem pkwy 473.19 Oct 2 -30- 220 - 8749:45850 N Wolf Crk 409.82 Oct 2- 29 -458- 7548:32000 mcho calif 345.73 Oct 2 -31- 936 - 3511:46488 pechanga 47.32 Oct 2 -29- 953 - 8082:31523 wolf vly rd 26.44 Oct 2 -29- 953 - 8249:46497 wolf crk PED 23.30 Oct 2 -29- 953 - 8447:31738 wolf vly rd 23.30 Oct 2 -29- 657- 2332:45538 redwood 23.30 24,126.00 Oct 129 -582- 9784- 3:43230 bus pk dr 43.70 Oct 091-085-1632-0 TES pool 13.81 57.51 emerg generator op fees:Library 293.21 293.21 FY09 /10 AQMD fee:libmry 110.00 110.00 pest control swcs: Prkg structure 52.00 52.00 '10 Halloween Carnival booth 150.00 150.00 TCSD Instructor Earnings 42.00 42.00 MISC SUPPLIES: CRC 225.16 MISC SUPPLIES: CHILDREN'S MUSEUM 137.68 MISC SUPPLIES: MPSC 75.15 MISC SUPPLIES: CHILDREN'S MUSEUM 53.64 MISC SUPPLIES: F.I.T. PRGM 51.16 MISC SUPPLIES: CS CLASSES &ACTIV 49.66 592.45 Pages apChkLst 11/04/2010 10:27:52AM Final Check List CITY OF TEMECULA Page: 7 Bank: union UNION BANK OF CALIFORNIA (Continued) Check # Date Vendor Description Amount Paid Check Total 141752 11/04/2010 008677 TEMECULA SWIM CLUB '10 Halloween Carnival booth 150.00 150.00 141753 11/04/2010 011736 TEMECULA TROPHY INC Bronze plaque:civic center 224.03 224.03 141754 11/04/2010 000515 TEMECULA VALLEY CHAMBER 2nd qtr operating agrmnt pmt 34,065.00 34,065.00 OF 141755 11/04/2010 000306 TEMECULA VALLEY PIPE& Plumbing supplies:var park sites 68.51 68.51 SUPPLY 141756 11/04/2010 008298 TEMECULA VLY MOTHERS '10 Halloween Carnival booth 150.00 150.00 MULTIPLES 141757 11/04/2010 010276 TIME WARNER CABLE Nov high speed internet:42081 main st 58.10 58.10 141758 11/04/2010 005805 URISA '11 membership dues: J. De Gange 175.00 11 membership dues: K. Beal 175.00 350.00 141759 11/04/2010 004261 VERIZON Sep xxx -9196 gen usage:TCC SAFE 169.56 Sep xxx -2016 gen usage:Reverse 911 122.08 Oct xxx -3526 gen usage:fre alarm 108.21 Oct xxx -5706 general usage 92.46 Oct xxx -5696 gen usage:sports comp 36.07 Oct xxx -2676 general usage 36.07 564.45 141760 11/04/2010 007987 WALMART Misc supplies:Public Works 19.58 19.58 141761 11/04/2010 009965 WEST, DALE ee computer purchase prgm 683.48 683.48 141762 11/04/2010 003776 ZOLL MEDICAL CORPORATION purch monitors: medics 34,816.92 34,816.92 Grand total for UNION BANK OF CALIFORNIA: 612,729.46 Page:7 apChkLst Final Check List Page: 8 11/04/2010 10:27:52AM CITY OF TEMECULA 101 checks in this report. Grand Total All Checks: 612,729.46 PageE apChkLst 11/10/2010 3:49:10PM Final Check List CITY OF TEMECULA Page: 1 Bank: union UNION BANK OF CALIFORNIA Check # Date Vendor Description Amount Paid Check Total 1578 11/10/2010 000389 NATIONWIDE RETIREMENT OBRA- Project Retirement Payment 2,775.36 2,775.36 SOLUTION 1579 11/10/2010 010349 CALIF DEPT OF CHILD Support Payment 553.84 553.84 SUPPORT 1580 11/10/2010 000245 PERS- HEALTH INSUR PERS Health Admin Cost Payment 73,321.40 73,321.40 PREMIUM 1581 11/10/2010 000246 PERS (EMPLOYEES' PERS ER Paid Member Contr Payment 124,261.95 RETIREMENT) PERS ER Paid Member Contr Payment -59.37 124,202.58 1582 11/10/2010 000444 INSTATAX (EDD) State Disability Ins Payment 24,770.98 24,770.98 1583 11/10/2010 000283 INSTATAX (IRS) Federal Income Taxes Payment 78,108.57 78,108.57 1584 11/10/2010 001065 NATIONWIDE RETIREMENT Alternate Retirement Plan Payment 176.41 SOLUTION Nationwide Retirement Payment 15,741.50 15,917.91 1585 11/10/2010 000642 TEMECULA CITY FLEXIBLE Child Care Reimbursement Payment 8,328.02 8,328.02 1586 11/04/2010 013551 SUMMERHOUSE HOUSING Dmw4:Summerhouse Dev 427,053.19 427,053.19 ASSOC 141763 11/10/2010 003552 A F L A C AFLAC Cancer Payment 3,359.40 3,359.40 141764 11/10/2010 013511 A PLUS HEATING & AIR refund:fees chrgd in error B10 -1712 96.00 96.00 CONDITION 141765 11/10/2010 013844 AECOM TECHNICAL SERVICES 10/1 data svc:lg cyn del basin 3,400.00 3,400.00 INC 141766 11/10/2010 013015 ALWAYS RELIABLE backflowtesting:haweston park 50.00 BACKFLOW backflowtesting:tcsd parks 1,750.00 1,800.00 141767 11/10/2010 004422 AMERICAN BATTERY battenes: Stn 84 3.13 3.13 CORPORATION 141768 11/10/2010 004240 AMERICAN FORENSIC NURSES DUI & DRUG SCREENINGS: POLICE 605.12 (AFN) NOV STANDBY FEE: POLICE 1,248.00 DUI & DRUG SCREENINGS: POLICE 451.88 2,305.00 141769 11/10/2010 003376 ARTSCOUNCIL,THE sttlmnt: Hot August Night 11/5 945.05 945.05 Pagel apChkLst Final Check List Page: 2 11/10/2010 3:49:10PM CITY OF TEMECULA Bank: union UNION BANK OF CALIFORNIA (Continued) Check # Date Vendor Description Amount Paid Check Total 141770 11/10/2010 011438 BAKER, BLYTHE EDEN TCSD Instructor Earnings 180.00 180.00 141771 11/10/2010 010328 BEST IMPRESSIONS promo items:senior health fair 719.25 719.25 141772 11/10/2010 012583 BLANCA Y PRICE Sept landscape pinck svc:Pln 9,610.00 9,610.00 141773 11/10/2010 013684 BLUE SHIELD OF CALIFORNIA COBRA SUBSIDY MEDICAL 836.55 836.55 COVERAGE PAYMENT 141774 11/10/2010 000128 BROWN & BROWN OF CALIF 10/11 cna surety:Yates,G 70210716 350.00 INC 11/12 cna surety:Johnson,B 70210685 350.00 11/12 cna su rety: N el son,S 68806638 350.00 1,050.00 141775 11/10/2010 005889 BROWN, PASCALE employee computer loan program 2,000.00 2,000.00 141776 11/10/2010 003138 CAL MAT PW patch truck materials 542.51 PW patch truck materials 110.66 653.17 141777 11/10/2010 001267 CALIF DEPT OF MOTOR regist: SE484714 Wanco PW trailer 23.00 23.00 VEHICLES 141778 11/10/2010 001267 CALIF DEPT OF MOTOR regist: SE484713 Wanco PW trailer 23.00 23.00 VEHICLES 141779 11/10/2010 013469 CALTEC CORP Sept const:tcc expansion 102,509.75 102,509.75 141780 11/10/2010 004971 CANON FINANCIAL SERVICES, Oct Copier Lease: Fire 182.55 182.55 INC 141781 11/10/2010 004405 COMMUNITY HEALTH Community Health Charities Payment 66.00 66.00 CHARITIES 141782 11/10/2010 013379 COUSSOU, CELINE TCSD Instructor Earnings 106.40 106.40 141783 11/10/2010 010650 CRAFTSMEN PLUMBING & plumbing svc:paloma del sol park 2,257.00 2,257.00 HVAC INC 141784 11/10/2010 013560 CROWN BUILDING MAINT CO Octjanitorial svc:harveston park 131.84 INC Octjanitorial svcs: OT Police 250.00 Octjanitorial svcs:city facilities 4,077.02 4,458.86 141785 11/10/2010 003945 DIAMOND ENVIRONMENTAL restroom svc:Community Clean Up 44.88 44.88 SRVCS Page2 apChkLst Final Check List Page: 3 11/10/2010 3:49:10PM CITY OF TEMECULA Bank: union UNION BANK OF CALIFORNIA (Continued) Check # Date Vendor Description Amount Paid Check Total 141786 11/10/2010 004192 DOWNS COMMERCIAL Fuel for City vehicles: Code Enf 297.52 FUELING INC Fuel for City vehicles: B &S 378.93 Fuel for City vehicles: Police 49.66 Fuel for City vehicles: PW Lnd Dv 133.45 Fuel for City vehicles: PW C IP 207.23 Fuel for City vehicles: PW Maint 1,507.88 Fuel for City vehicles: PW Traffic 305.02 Fuel for City vehicles: TCSD 1,497.60 Fuel for City vehicles: IS /CC 79.52 4,456.81 141787 11/10/2010 004829 ELLISON WILSON ADVOCACY Nov advocacy cnslt: CM 3,500.00 3,500.00 LLC 141788 11/10/2010 002939 ENVIRONMENTAL SYSTEMS software maint: ESRI 16,201.26 16,201.26 RESEARCH 141789 11/10/2010 004000 FENCING BY ACREY INC Res Impw Prgm: Kinter, Mary 975.00 975.00 141790 11/10/2010 010826 FERNANDEZ, MARIGOLD refund:sec dep:rm rental:CRC 150.00 150.00 141791 11/10/2010 003347 FIRST BANKCARD CENTER 006952 PAYPAL GR Verisign Pay0ow Pro Transaction 59.95 013817 SEMSONS & COMPANY INC GR car charger adapter: Police 7.98 006952 PAYPAL H P Verisign Pay0ow Pro Transaction 183.60 013876 WASHINGTON PLAZA HOTEL RR htl:NLC tis mtg Wash,DC 9/18 -10/2 1,008.48 006942 ONTARIO AIRPORT RR prkg:NLC tis mtg Wash,DC 9/28 -10/2 90.00 007287 UNITED AIRLINES RR airfare:NLC mtg Denver,CO 12/1 -2 277.40 1,627.41 141792 11/10/2010 002982 FRANCHISE TAX BOARD SUPPORT PAYMENT 50.00 50.00 141793 11/10/2010 007279 GAIL MATERIALS INC landscape material: RRSP 896.00 896.00 141794 11/10/2010 001937 GALLS INC Uniform Svc: Police Volunteers 3.81 Uniform Svc: Police Volunteers 217.50 Uniform Svc: Police Volunteers 2.00 223.31 141795 11/10/2010 013552 GANDS PRODUCTIONS LLC sttlmnt: Country at the Merc 10/30 310.50 310.50 141796 11/10/2010 000177 GLENN IES OFFICE PRODUCTS Office supplies: Finance 30.43 30.43 INC Pages apChkLst Final Check List Page: 4 11/10/2010 3:49:10PM CITY OF TEMECULA Bank: union UNION BANK OF CALIFORNIA (Continued) Check # Date Vendor Description Amount Paid Check Total 141797 11/10/2010 009608 GOLDEN VALLEY MUSIC sttlmnt: Classics at the Merc Oct '10 463.40 SOCIETY sttlmnt: Octet -ber Fest 10/30 673.33 1,136.73 141798 11/10/2010 008081 HALL & FOREMAN INC OCT DESIGN SVC:NICOLAS RD REHAB 15,613.03 15,613.03 141799 11/10/2010 000186 HANKS HARDWARE INC Hardware supplies: Parks 1,111.38 Hardware supplies: Harveston 117.29 Hardware supplies: PW Maint 833.27 HARDWARE SUPPLIES: FIRE DEPT 1,319.56 Hardware supplies: Info Sys 12.96 Hardware supplies: B &S /Code 66.94 MISC HARDWARE SUPPLIES: TVM 205.69 3,667.09 141800 11/10/2010 002109 H D SUPPLY CONSTR. SU PPLY MISC SUPPLIES: PW MAINT 1,065.32 1,065.32 LTD 141801 11/10/2010 012204 HERITAGE FAMILY MINISTRIES TCSD Instructor Earnings 364.00 TCSD Instructor Earnings 728.00 1,092.00 141802 11/10/2010 001013 HINDERLITER DE LLAMAS& 2nd qtr sales tax cnslt:fnance 1,596.85 1,596.85 ASSOC 141803 11/10/2010 007792 HINTON, BEVERLY L. TCSD instructor earnings 73.90 73.90 141804 11/10/2010 003198 HOME DEPOT, THE supplies: Santa's House OT 476.78 476.78 141805 11/10/2010 001517 HORIZON HEALTH Jul EAP svcs (167): HR 734.80 Aug EAP svcs (167): HR 734.80 1,469.60 141806 11/10/2010 002701 HUB INTL INSURANCE Oct special events premiums 2,131.61 2,131.61 SERVCSINC 141807 11/10/2010 004217 HYDROTEK COMPANY sand blast assembly kit: TCSD 403.65 403.65 141808 11/10/2010 000194 I C M A RETIREMENT -PLAN I C M A Retirement Trust 457 Payment 6,046.90 6,046.90 303355 141809 11/10/2010 004984 INDEPENDENT ROOFING OCT ROOF INSPECT: CIVIC CENTER 6,957.50 6,957.50 CONSULTANT 141810 11/10/2010 003296 INTL CODE COUNCIL Code Books: Fire Prevention 135.07 135.07 141811 11/10/2010 006924 INTL MUNICIPAL SIGNAL 10 /111MSA mb:Uribe, Richard 70.00 ASSOC. 10/11 IMSA mb: Beardshear, Jeff 70.00 140.00 Page:4 apChkLst Final Check List Page: 5 11/10/2010 3:49:10PM CITY OF TEMECULA Bank: union UNION BANK OF CALIFORNIA (Continued) Check # Date Vendor Description Amount Paid Check Total 141812 11/10/2010 012883 JACOB'S HOUSE INC Jacob's House Charity Payment 200.00 200.00 141813 11/10/2010 013200 JAROTH INC Nov pay phone:rda:OT bus depot 82.64 82.64 141814 11/10/2010 004062 KUSTOM SIGNALS INC radar lidar repair: Police 870.50 870.50 141815 11/10/2010 000945 L P S COMPUTER SERVICE equip parts /repair:dj5000 /5500 350.00 GROUP pnnter repair: DJZ 6100 125.00 pnnter repair: DJ 5000 125.00 600.00 141816 11/10/2010 012945 LABELLE- MARVIN INC 9/2/ -10/8 MATERIAL TST SVCS: PW 10,715.00 10,715.00 141817 11/10/2010 011321 LABOR LAW CENTER INC Labor Law Posters: Fire 107.82 107.82 141818 11/10/2010 000482 LEIGHTON CONSULTING INC 8/2 -10/3 GEOTECH SVC:WIN179N 154.00 154.00 141819 11/10/2010 003726 LIFE ASSIST INC Medical Supplies: Paramedics 26.17 26.17 141820 11/10/2010 013769 LIGHTSQUARED LP 10/14 -11/13 satellite svc:cm/fire 148.98 148.98 141821 11/10/2010 004230 LINCOLN EQUIPMENT INC ratchet reel replacement:Aquatics 155.54 155.54 141822 11/10/2010 004813 M & J PAUL ENTERPRISES INC Entertainment: harvest carnival 10/29 695.00 695.00 141823 11/10/2010 004307 MARINE BIOCHEMISTS Oct water maint swcs:Haw /Duck Pond 3,900.00 3,900.00 141824 11/10/2010 013448 MESA FENCE COMPANY INC Res Impw Prgm: Moreno 3,138.00 3,138.00 141825 11/10/2010 003076 MET LIFE INSURANCE MetLife Dental Insurance Payment 7,355.34 7,355.34 COMPANY 141826 11/10/2010 004002 MILNER, DAVID 2 " numbers :oatc 27.19 27.19 141827 11/10/2010 012264 MIRANDA, JULIO C. TCSD Instructor Earnings 1,050.00 TCSD Instructor Earnings 1,050.00 TCSD Instructor Earnings 168.00 2,268.00 141828 11/10/2010 013004 MOBILE TRUCK SERVICE INC City vehicle repair &maint: PW Maint 112.50 City vehicle repair &maint: PW Maint 1,368.07 1,480.57 Pages apChkLst Final Check List Page: 6 11/10/2010 3:49:10PM CITY OF TEMECULA Bank: union UNION BANK OF CALIFORNIA (Continued) Check # Date Vendor Description Amount Paid Check Total 141829 11/10/2010 010990 MOORE IACOFANO GOLTSMAN Sep prof swcs:Youth Master Plan 512.41 512.41 INC 141830 11/10/2010 003135 MOORE WALLACE Ntc /correction forms:temecula police 721.06 721.06 141831 11/10/2010 013375 MYERS- RUSSO, ERICA TCSD Instructor Earnings 151.20 TCSD Instructor Earnings 117.60 TCSD Instructor Earnings 273.00 TCSD Instructor Earnings 168.00 TCSD Instructor Earnings 14.00 723.80 141832 11/10/2010 012978 NAIOP '10 I.E. virtual bus tour: Econ Dev 1,500.00 1,500.00 141833 11/10/2010 002925 NAPA AUTO PARTS City vehicle maint parts: Fire Prev 3.28 City vehicle maintenance: Sta 92 158.63 161.91 141834 11/10/2010 008820 NEIGHBORS NEWSPAPER Nov advertising:old town quilt show 250.00 250.00 141835 11/10/2010 008528 NICHOLS, MELBURG & SEPT ENG SRVS:CIVIC CENTER PH II 1,490.14 ROSETTO SEP ENG SRVS:CIVIC CENTER PH II 13,016.85 14,506.99 141836 11/10/2010 009337 NOLTE ASSOCIATES INC Sep eng design swcs:ped badge 1,576.00 1,576.00 141837 11/10/2010 011679 OAK GROVE INSTITUTE FY 10/11 Economic Dev Sponsorship 2,500.00 2,500.00 FOUNDATION 141838 11/10/2010 001171 ORIENTAL TRADING COMPANY RECREATION SUPPLIES: C.MUSEUM 46.96 46.96 INC 141839 11/10/2010 013878 PEREZ, ALYSHA refund:sec dep:rm rental:CRC 150.00 150.00 141840 11/10/2010 000249 PETTY CASH Petty Cash Reimbursement 470.96 470.96 141841 11/10/2010 005820 PRE -PAID LEGAL SERVICES Prepaid Legal Services Payment 324.85 324.85 INC 141842 11/10/2010 009952 PRESENTATION PRODUCTS sgnl camera projectorlamp bulb:PWTrff 466.88 466.88 INC 141843 11/10/2010 009623 PUBLIC AGENCY RISK '11 membership dues:R.Cardenas 100.00 100.00 MANAGERS 141844 11/10/2010 004584 REGENCY LIGHTING Electncal supplies: various park sites 273.33 Electncal supplies: various park sites 273.33 546.66 Pages apChkLst Final Check List Page: 7 11/10/2010 3:49:10PM CITY OF TEMECULA Bank: union UNION BANK OF CALIFORNIA (Continued) Check # Date Vendor Description Amount Paid Check Total 141845 11/10/2010 004498 REPUBLIC INTELLIGENT Traffic sgnl repair Rnbw /Pechanga 5/12 556.89 556.89 141846 11/10/2010 002412 RICHARDS WATSON & Sept 2010 legal services 157,390.85 157,390.85 GERSHON 141847 11/10/2010 009196 SACRAMENTO THEATRICAL MISC LIGHTING SUPPLIES: THEATER 189.65 189.65 LIGHTING 141848 11/10/2010 007582 SAFEGUARD DENTAL & VISION SafeGuard Vision Plan Payment 870.70 870.70 141849 11/10/2010 008529 SHERIFF'S CIVIL DIV- SUPPORT PAYMENT 700.92 700.92 CENTRAL 141850 11/10/2010 008529 SHERIFF'S CIVIL DIV- SUPPORT PAYMENT 538.32 538.32 CENTRAL 141851 11/10/2010 008529 SHERIFF'S CIVIL DIV- SUPPORT PAYMENT 200.00 200.00 CENTRAL 141852 11/10/2010 008529 SHERIFF'S CIVIL DIV- SUPPORT PAYMENT 100.00 100.00 CENTRAL 141853 11/10/2010 008529 SHERIFF'S CIVIL DIV- SUPPORT PAYMENT 100.00 100.00 CENTRAL 141854 11/10/2010 009213 SHERRY BERRYMUSIC Jazz @the Merc 11 /4/10 147.00 147.00 141855 11/10/2010 010891 SLUSSER, LAWRENCE L. & refund:sec dep:rm rental:CRC 150.00 150.00 CARMA M. 141856 11/10/2010 000645 SMART &FINAL INC Hospitality su pplie s:th eater 57.42 MISC SUPPLIES: DOG HOUSE PGRM 336.81 Recognition supplies:Team PACE 347.59 741.82 141857 11/10/2010 000537 SO CALIF EDISON Oct 2 -31- 031 - 2590:28301 rncho calif 54.52 Oct 2 -29- 657- 2563:42902 buttefield 186.59 Oct 2 -28- 629 - 0507:30600 pauba rd 6,777.20 7,018.31 141858 11/10/2010 000519 SOUTH COUNTY PEST Pest control services:Pauba Ridge Park 84.00 84.00 CONTROL INC 141859 11/10/2010 012652 SOUTHERN CALIFORNIA Nov xxx- 0141,0839,2593,9305 usage 507.08 507.08 141860 11/10/2010 005786 SPRINT Sept 26- Oct 25 cellular usage /equip 5,462.67 5,462.67 Page:7 apChkLst Final Check List Page: 8 11/10/2010 3:49:10PM CITY OF TEMECULA Bank: union UNION BANK OF CALIFORNIA (Continued) Check # Date Vendor Description Amount Paid Check Total 141861 11/10/2010 000293 STADIUM PIZZA INC Refreshments: Halloween carnival 10/29 212.60 212.60 141865 11/10/2010 007762 STANDARD INSURANCE Mandatory Life Insurance Payment 9,121.45 9,121.45 COMPANY 141866 11/10/2010 012723 STANDARD INSURANCE Voluntary Supp Life Insurance Payment 596.90 596.90 COMPANY 141867 11/10/2010 013771 SUPERIOR FENCE OF CALIF, Res impw pgrm: Granzow 6,100.00 6,100.00 INC. 141868 11/10/2010 000305 TARGET BANK BUS CARD Hospitality su pplie s:th eater 13.99 SRVCS MISC SUPPLIES HIGH HOPES PRGM 13.82 27.81 141869 11/10/2010 001547 TEAMSTERS LOCAL 911 Union Dues Payment 4,862.00 4,862.00 141870 11/10/2010 010679 TEMECULAAUTO Cityveh maint & repair: csd 692.58 692.58 REPAIR /RADIATOR 141871 11/10/2010 000168 TEMECULA FLOWER CORRAL Sunshine fund 273.84 273.84 141872 11/10/2010 011736 TEMECULA TROPHY INC Explorer Advisor Plaque: Fire 81.02 81.02 141873 11/10/2010 010046 TEMECULA VALLEY Sept 10 Bus. Impry District Asmnts 87,549.50 87,549.50 CONVENTION & 141874 11/10/2010 009194 TEMECULA VALLEY NEWS Oct advertising: theater 286.40 286.40 141875 11/10/2010 000306 TEMECULA VALLEY PIPE& Plumbing supplies:var park sites 16.19 16.19 SUPPLY 141876 11/10/2010 003031 TRAFFIC CONTROL SERVICE Misc traffic control supplies:PW Maint 1,402.88 INC credit: items retumed /PW Maint - 511.56 Misc traffic control supplies:PW Maint 421.95 1,313.27 141877 11/10/2010 012344 TRANSPORTATION CONCEPTS Shuttle swcs: Rod Run 10/9/10 3,600.00 3,600.00 141878 11/10/2010 005460 U S BANK TRUSTEE ADMIN FEES COP 2001 3,850.00 3,850.00 141879 11/10/2010 000325 UNITED WAY United Way Charities Payment 62.00 62.00 141880 11/10/2010 008977 VALLEYEVENTS EQUIP RENTAL:HALLOWEEN 1,029.97 1,029.97 CARNIVAL 10/29 PageE apChkLst 11/10/2010 3:49:10PM Final Check List CITY OF TEMECULA Page: 9 Bank: union UNION BANK OF CALIFORNIA (Continued) Check # Date Vendor Description Amount Paid Check Total 141881 11/10/2010 004794 VALLEY WINDS COMMUNITY Performance 11/3/10 @Theater 537.25 537.25 141882 11/10/2010 004261 VERIZON Oct xxx- gen usage:Comerchero, J. 36.06 Oct xxx -1999 general usage 40.72 Nov xxx -5180 gen usage:79S img ctr 39.38 Nov xxx -4200 general usage 1,075.97 Nov xxx -7530 gen usage:Library 571.86 1,763.99 141883 11/10/2010 001342 WAXIE SANITARY SUPPLY INC Cleaning supplies:City fac's 1,730.10 1,730.10 141884 11/10/2010 013556 WESTERN AUDIOVISUAL Retention w/h pmt:Civic Center - 18,454.05 audio /visual integration:civic center 184,540.47 166,086.42 141885 11/10/2010 000341 WILLDAN ASSOCIATES INC Aug traffic eng sws:pw traffic 2,566.69 2,566.69 141886 11/10/2010 005249 WINSLOW, MICHELLE refund: water aerobics 3900.204 5.50 5.50 141887 11/10/2010 010193 WOOLSTENHULME, LUCIA TCSD Instructor Earnings 184.65 184.65 141888 11/10/2010 011876 WORHACK, NENITA refund:sec dep:rm rental CRC 150.00 150.00 141889 11/10/2010 000348 ZIGLER, GAIL Reimb:Team PACE promo items 487.50 487.50 Grand total for UNION BANK OF CALIFORNIA: 1,486,516.66 Page9 apChkLst Final Check List Page: 10 11/10/2010 3:49:10PM CITY OF TEMECULA 133 checks in this report. Grand Total All Checks: 1,486,516.66 Page 10 Item No. 5 Approvals City Attorney Director of Finance City Manager CITY OF TEMECULA AGENDA REPORT TO: City Manager /City Council FROM: Genie Roberts, Director of Finance DATE: November 23, 2010 SUBJECT: Community Service Funding Program for Fiscal Year 2010 -11 PREPARED BY: Judith M. McNabb, Administrative Assistant RECOMMENDATION: That the City Council review and approve the fiscal year 2010 -11 Community Service Funding Program grants pursuant to the attached spreadsheet outlining the Ad Hoc Subcommittee's recommendations of $47,000 to 15 organizations. BACKGROUND: Community Service Funding Program applications were mailed to approximately 80 non - profit organizations in the Temecula Valley area. Applications were sent to community -based organizations that were in the City's database from the last distribution period, as well as those organizations that called or stopped by City Hall requesting an application. In addition to the mailing, advertisements were placed in the local newspapers, and the application and guidelines were posted on the City's website. A total of 37 organizations submitted applications requesting $169,170 in grant funding. The Ad Hoc Subcommittee, along with Staff Members, reviewed the requests for funding based on criteria previously adopted by the entire City Council. After review and discussion, the Ad Hoc Subcommittee recommends 15 of the 37 organizations receive grants as outlined on the attached spreadsheet, totaling $47,000. Council Member Edwards did not participate in discussion and abstained from recommending funding to the Boys & Girls Club of Southwest County. The City Council appointed Council Member Maryann Edwards and Council Member Mike Naggar to the fiscal year 2010 -11 Community Service Funding Ad Hoc Subcommittee to allocate grant funds up to $5,000 per non - profit organizations that provide community services to the citizens of Temecula. FISCAL IMPACT: Adequate funds of $60,000 are available in the fiscal year 2010 -11 Community Service Funding line item budget to fund these grants totaling $47,000. ATTACHMENTS: FY 2010 -11 Community Service Funding Program Ad Hoc Subcommittee Recommendation Spreadsheet CITY OF TEMECULA FY 2010 -11 Community Service Funding Program Ad Hoc Subcommittee Recommendations Account No. 001 - 101 - 999 -5267 NAME OF 2009 -10 2010 -11 Ad Hoc APPL NO. ORGANIZATION PROJECT AWARD REQUEST Subcommittee Comments Recommendation Angels at Work - provide basic services to individuals battling cancer ANGELS AT HEART in Temecula Valley $ 1,000 N/A N/A 1 ARTS COUNCIL OF TEMECULA VALLEY Help sponsor the 11th Annual Youth Art Exhibition to be held at the Promenade Mall $ - $ 11500 _ 2 ASSISTANT LEAGUE OF TEMECULA VALLEY Painting exterior of Building which houses the thrift store and various programs $ 2,500 $ 51000 5 000 Purchase of pregnancy support and educational supplies, including brochures, materials goods, referrals, 3 BIRTH CHOICE OF TEMECULA, INC. maternity and baby clothing, newborn layettes, post - delivery supplies and educational materials $ 5,000 $ 51000 5 00o Power Hour and Project Learn After School Program - council Member 4 BOYS & GIRLS CLUB OF SOUTHWEST COUNTY goal is to enable young people to become high achieving students $ 1,000 $ 51000 Edwards Abstained 5 000 5 CAMP DEL CORAZON Purchase items necessary for campers with heart disease to $ - $ 51000 $ _ attend camp CASA (Court Appointed Special Recruitment and training of new community volunteers Advocates) for Riverside County, Inc. $ 1,000 N/A N/A CHAPARRAL HIGH SCHOOL EDUCATION FOUNDATION CHS Grad Nite - 2010 Grad Nite Celebration $ 1,000 N/A N/A CITIZEN'S SCHOLARSHIP FOUNDATION (Chaparral Provide scholarships for graduating high school seniors 6 Hi h School who have met the academic requirements $ 1,000 $ 51000 000 CITIZEN'S SCHOLARSHIP FOUNDATION (Great Oak Provide scholarships for graduating high school seniors 7 High School ) who have met the academic requirements $ 1,000 $ 5,000 $ 000 � APPL NO. NAME OF PROJECT 2009 -10 2010 -11 Ad Hoc Subcommittee Comments ORGANIZATION AWARD REQUEST Recommendation CITIZEN'S SCHOLARSHIP FOUNDATION (Rancho Vista / Provide scholarships for graduating high school seniors 8 Nelson High School ) who have met the academic requirements $ - $ 51000 000 CITIZEN'S SCHOLARSHIP FOUNDATION (Temecula Provide scholarships for graduating high school seniors 0 Valley High School) who have met the academic requirements $ 1,000 $ 5,000 � , 000 CROSSROADS CHURCH OF THE ASSEMBLIES OF GOD A local camp for abused and neglected childen - provide 10 (Royal Family Kids Camp) necessary items that are needed the campers $ - $ 51000 _ Materials, information, and supplies for the bereavement 11 EMPTY CRADLE packets provides to the families who experience infant loss � �,000 $ 2,500 000 , 1 2 GOD'S FAN CLUB (Project Touch) Homeless Outreach and Police Reponses - provide services and resources to the homeless $ 21500 $ 51000 5 000 GREAT OAKS ACADEMIC 13 LEADERSHIP SOCIETY Great Oak High School Grad Nite Celebration 2011 $ 1,000 $ 51000 _ 14 HABITAT FOR HUMANITY Phase II - building of an additional two homes $ - $ 51000 _ HEALTHY MANAGEMENT Winning at Work Program - provide increased 15 DIABETES EDUCATION community screening and initial information to 200 -500 Temecula by June 2011 $ _ $ 51000 _ residents HELPING ELMININATE THROUGH EDUCATION H.E.A.R.T. for Children's Child Care Tuition Program - ABUSE IN RANCHO through screening, provide child care tuition to those 16 TEMECULA INC. (H.E.A.R.T. parents who may have a "latch key" child or children $ 5,000 INC. FOUNDATION) - _ Children's Grief Workshop - provide counseling and 17 HOSPICE OF THE VALLEYS supportive care to children and families during and after $ 5,000 loss $ 3,000 _ NAME OF 2009 -10 2010 -11 Ad Hoc APPL NO. ORGANIZATION PROJECT AWARD REQUEST Subcommittee Comments Recommendation Eliminate Drunk Driving by providing a transportation 18 JONBOYS INC. service for any impaired driver, at any time, for any free $ - $ 5,000 _ reason, completely of charge Building Better Futures for Temecula Youth through Performing Arts & Music Education - provide educational 19 MUSICIANS WORKSHOP $ _ $ 51000 _ programs NEIGHBORHOOD Children's Healthcare - provide medication and medical 2 0 HEALTHCARE treatment for children in Temecula area whose parents $ 1,000 $ 1 000 cannot afford care and have no insurance , _ New Vision Autism Center - provide additional screenings for autism NEW VISION CHILDREN'S SERVICES and Asperger's Syndrome research $ 5,000 N/A N/A OAK GROVE INSTITUTE FOUNDATION, Performing and Literary Arts Program - help to ease the transition INC. following discharge (will prioritize Temecula students) $ 1,000 N/A N/A OUR NICHOLAS Nick's Sidekicks Peer Buddies Program - target is to 21 FOUNDATION, INC. provide games, attire, technology and more at every school to children with special needs like Autism $ - $ 5,000 $ 5,000 RIVERSIDE AREA RAPE Direct Service to Rape Victims / Rape Awareness and Prevention - provide crisis intervention, counseling, 2 CRISIS CENTER Prevention programs, followup appointments, etc. $ 1,500 $ 5,000 _ SANTA ROSA PLATEAU Third Grade Outdoor Natural History Science Program - 23 FOUNDATION provide a unique teaching environment $ - $ 51000 _ SENIOR CITIZENS SERVICE CENTER OF THE Food Bank - Provide food for over 12,000 low income 24 TEMECULA RANCHO AREA, INC. seniors and families $ 5,000 $ 51000 5 00o SMILES 4 KYLEE Smiles 4 Kylee Children's Center - provide free services 25 CHILDRENS FUND including school supplies, clothing, toys, blankets, and $ - $ 51000 books to families in financial difficulty _ NAME OF 2009 -10 2010 -11 Ad Hoc APPL NO. ORGANIZATION PROJECT AWARD REQUEST Subcommittee Comments Recommendation SPECIAL OLYMPICS OF SOUTHERN CALIFORNIA, Sports training and competition programs for athletes 26 INC. with intellectual disabilities within the City of Temecula $ 1,000 $ 51000 000 27 STUDENT OF THE MONTH Student of the Month Program - video production of the lunch for 2010 $ 3,000 $ 31000 PROGRAM, INC. nine monthly event -11 school year _ TEAM EVANGELICAL ASSISTANCE MINISTRIES Community Food Pantry - funding will be used to pay the OF RANCHO - TEMECULA- rent on the property leased from the City 28 MURRIETA VALLEY $ 5,000 $ 51000 5 000 Safety Town - a child -size town built to teach life- saving TEMECULA SUNRISE lessons to children in a free community program, ROTARY FOUNDATION including stranger danger, 9 -1 -1, fire, water, gun, poison, 29 drug and bicycle safety _ $ 51000 _ 1) Paint Temecula - purchase supplies for this event which promotes paintings and the uniqueness of TEMECULA VALLEY ART Temecula; 2) Art by the Inch Challenge - purchase LEAGUE supplies for groups to come together and paint a mural; 3) 2nd Annual Western and Wildlife Show - purchase 30 supplies $ _ $ 51000 _ TEMECULA VALLEY HIGH School Bank Uniform Drive - funds will be used to 31 SCHOOL BAND BOOSTERS replace fourteen year old uniforms $ - $ 51000 _ TEMECULA VALLEY Care to Share Program - assist other organizations to PEOPLE HELPING PEOPLE raise money, gifts, toys, food, and other items for those 32 in need for Thanksgiving and Christmas $ 5,000 $ 51000 5 000 33WARS VETERANS OF FOREIGN Adopt a Unit - provide food boxes and maternity baskets for needy families of those deployed $ 1,000 $ 51000 000 TOTAL $ -5-5,500 $ 169,170 $ 47,000 NAME OF 2009 -10 2010 -11 Ad Hoc APPL NO. ORGANIZATION PROJECT AWARD REQUEST Subcommittee Comments Recommendation Veteran Service Officer Equipment - purchase VETERANS OF FOREIGN equipment such as a laptop, printer, and hardware and software so that John Daub, Veterans Service Officer, WARS may do his job more effectively while protecting the 34 confidentiality of the veterans $ _ $ 1 250 $ _ Mourning Star Center- Murrieta(MSC) - any funds VISITING NURSE awarded will provide the initial funding to start one new ASSOCIATION OF THE support group for those who are grieving due to death of 3 INLAND COUNTIES a family member for approximately 3 to 10 children and $ _ $ 5,000 teen _ VNW CIRCLE OF CARE, INC. Holiday Spirit Program 2010 - expenses toward providing food items, toys, and gifts for children $ 5,000 $ - N/A VOLUNTEER CENTER OF 2 -1 -1 Call Center - provides information and referral 36 RIVERSIDE COUNTY resources for social services $ - $ 51000 _ $ WOMEN'S BREAST Breast Health Assistance Program - provides education, CANCER RESOURCE CENTER (Michelle's Place) information, services and awareness about breast health $ - $ 41920 L37 I _ $ TOTAL $ -5-5,500 $ 169,170 $ 47,000 Supplemental Material I CITY OF TEMECULAL J 1 SEP 1 5 2010 FISCAL YEAR 2010.1 1 AJ 1 COMMUNITY SERVICE FUNDING PROGRAM APPLICATION (Please Print or Type) I PROJECT INFORMATION I Amount Requested: $ $1,500 (Maximum allowable $5,000) Project Name: 11th Annual Youth Art Exhibition Project Start Date: October 2010 Project End Date. . 2011 I ORGANIZATION INFORMATION I Name of Organization: Arts Council of the Temecula Valley Contact Name: Jake Dickinson Title /Position: Secretary Mailing Address: 41911 5th St Ste 101B Temecula, CA Telephone: 951- 694 -9000 Year Organization Founded: 1989 Number of Paid Staff: None Number of Volunteers: 20 Geographic Area(s) Served: Temecula Valley Is this organization incorporated in California as a non - profit organization? Yes X No Effective Date: July 28, 1989 if-yes- (Must provide a copy of your statement of non - profit status from the State of California): Date of incorporation as a non - profit: July 28, 1989 Federal identification number: 33- 0364524 If "no ": State identification number: C1465903 Name of sponsoring Federal identification number: State identification number: This application has been authorized by the organization's: Executive Committee Board of Directors X Members -at -Large Application — Page I M FINANCIAL STATEMENTS �1 PLEASE ATTACH COPIES OF THE CURRENT BUDGET OF THE ORGANIZATION AND FINANCIAL STATEMENTS (BALANCE STATEMENT AND INCOME STATEMENT). It does not require a CPA's audit, but please submit if available. NIISSION STATEMENT Briefly describe the goals and objectives of your organization and community services it provides. Describe the ways your organization meets the criteria listed on page 2 of the CS Funding Policy. The Mission of the Arts Council of Temecula Valley is to cultivate, promote and preserve arts in education involving youth and youth at risk as well as the community by developing innovative programs and events, and by forming meaningful partnerships with other cultural, educational and business entities in the Temecula Valley. Goals and Objectives: To provide opportunities for arts education in schools and the overall community. To stimulate the growth of visual and performing arts in the community. To generate greater awareness and participation in arts and cultural programs. To create a network for coordination and sharing of resources. To preserve the historic legacy of the Temecula Valley. Application — Page 2 I PROJECT DESCRIPTION Z How will your organization use the funding awarded? Describe the project, project objectives, those served, area serviced, and number of volunteers involved. Be specific. Include equipment or services that would be purchased and why. Include a detailed budget and a schedule of significant activities related to this project. You may attach a maximum of one double - spaced typewritten page of information. (Please type or print legibly.) Budget Income Grant 1,500 Sponsorship 2,000 Total Est Budget 'fr 3,500,00 Expenses Supplies Listed 2,700 Labels Poster Board Art Supplies Adhesive Insurance 300 Advertising500 Total Est Expenses 3,500 The funds will help sponsor the 11th Annual Youth Art Exhibition to be held at the Promenade Mall in Temecula. This project continues the philosophy of the Arts Council of "Growing The Arts" with the Temecula Valley Youth (K through 12). Last year there were 52 schools that entered more than 640 art pieces with more than 7000 students participating. Each school picks a maximum of 15 pieces to be displayed. The Arts Council coordinates with the various school districts, both public and private throughout Temecula, Murrieta and Lake Elsinore areas. With the assistance of various service organizations (Kiwanis and Rotary Clubs) we delivered art supplies, coordinated pickups at all of the school locations, set up the art displays throughout the Promenade and organized the return of all submissions to the schools after the show. We have developed some new strategies to encourage more participation through a more robust communication campaign. We expect this project to be even bigger this year, drawing some 8,000 - 10,000 participant students displaying over 800 pieces at this years event Application — Page 3 i� I PAST PROJECT BENEFITS I If your organization received City of Temecula funding in the previous year, please explain and show how Temecula residents benefited. Application — Page 4 SIGNATURE PAGE We hereby certify the information contained in this application is true to the best of our knowledge and belief. PREPARED BY: PRESIDENT or AUTHORIZED C (Please Print or Type) (Please Print or Type) ORGANIZATION NAME: or) MAILING ADDRESS: DATED THIS K- of , 2010. (Date) (Month) BE SURE TO INCLUDE THE ORIGINAL PLUS ONE COPY AND SUBMIT TO: Mail Completed Applications to: City of Temecula Community Service Funding Program Attn: Judy McNabb Post Office Box 9033 Temecula, CA 92589 -9033 Or Deliver in Person to: City of Temecula Community Service Funding Program Attn: Judy McNabb 43200 Business Park Drive Temecula, CA 92590 Application - Page 5 3:48 PM UTS COUNCIL OF TEMECULA VALLEY 09/13/10 Profit & LOSS - cash Basis January through December 2009 Jan -.Dec 09 Ordinary Income /Expense Income Program Income Membership Dues 100.00 Total Program Income 100.00 Commissions 90.00 Contributions - Unrestricted 876.36 Entry Fees Received 1,680.00 Fund Raising 1,625.00 Grants Received - Restricted 22,622.63 Interest Income 1.22 Product/Poster /Picture Sales 185.00 Total Income 27,180.21 Gross Profit 27,180.21 Expense ARt Supplies 2,187.89 Advertising /Public Relations 100.00 Artists Reimbursement 497.35 Awards 325.00 Bank/Finance Charges 158.70 Contract Services Outside Contract Services 0.00 Accounting Fees 425.00 Total Contract Services 425.00 Dues & Subscriptions 50.00 Entertainers /Judges 300.00 Equipment Lease /Rental 503.90 Food /Drinks /Refreshments 1,059.48 Insurance 731.51 Interest Expense 40.69 Management/Professional Service 1,600.00 Operations Supplies 396.42 Postage, Mailing Service 70.00 Books, Subscriptions, Reference 0.00 Total Operations 466.42 Other Types of Expenses Insurance - Liability, D and O 819.47 Total Other Types of Expenses 819.47 Page 1 • 3:46 PM QTS COUNCIL OF TEMECULA VALLEY 09/13110 Profit & Loss Cash Basis January through December 2009 Page 2 Jan --Dec 09 Payroll Expenses Outside Labor 140.00 Executive Director 5,833.35 Payroll Taxes 584.07 Workers Comp Insurance 272.56 Total Payroll Expenses 6,829.98 Postage Expense 1,136.17 Rent -Office 2,328.61 Signs /Banners 314.25 Storage Rental 1,104.00 Supplies /Office Expense 2,006.33 Taxes 50.00 Taxes, Licenses and Permits 30.00 Telephone 1,215.43 Web Services 1,890.00 Total Expense 26,170.18 Net Ordinary Income 1,010.03 Other Income /Expense Other Expense Donated Equipment and Furniture 6,078.46 Total Other Expense 6,078.46 Net Other Income - 6,078.46 Net Income - 5,068.43 Page 2 UTS 3:47 PM COUNCIL OF TEMECULA VALLEY 09/13/10 Balance Sheet Cash Basis As of December 31, 2009 Dec 31, 09 ASSETS Current Assets Checking /Savings Checking 3,728.65 Total Checking /Savings 3,728.65 Total Current Assets 3,728.65 Fixed Assets Art Objects 1,000.00 Office Equipment and Furniture 2,000.00 Total Fixed Assets 3,000.00 TOTAL ASSETS 6,728.65 LIABILITIES &EQUITY Equity Fund Balance 11,797.08 Net Income - 5,068.43 Total Equity 6,728.65 TOTAL LIABILITIES & EQUITY 6,728.65 Page 1 CITY OF TEMECUTA- QTV Of TFMF( 2 FISCAL YEAR 2010-11 SEP 1 0 2010 COMMUNITY SERVICE FUNDING PROGRAM AP W" I (Please Print or Type) PROJECT INFORMATION Amount Requested: $_ 5.000.On (Maximum allowable $5,000) Project Name: ASSISTANCE LEAGUE OF TEMECULA VALLEY BUILDING PAINTING Project Start Date: November 30, 2010 Project End Date: June 30, 2011 ORGANIZATION INFORMATION I Name of Organization: ASSISTANCE LEAGUE OF TEMECULA VALLEY Contact Name: Electra Demos President Title /Position: Mailing Address: 28720 Via Montezuma Avenue, Temecula, CA 92590 -2510 951.694.8018 1989 Telephone: Year Organization Founded: Number of Paid Staff: none Number of Volunteers: 201 Geographic Area(s) Served: Temecula Valley Is this organization incorporated in California as a non - profit organization? Yes x No Effective Date: June 15, 1989 ivyes" (Must provide a copy of your statement of non - profit status - from the State of California): If "no ": Date of incorporation as a Federal identification number: State identification number: Name of sponsoring organization: Federal identification number: 33- 0360419 1463456 June 15, 1989 State identification number: This application has been authorized by the organization's X Executive Committee Board of Directors Members -at -Large Application — Page 1 Y FINANCIAL STATEMENTS I PLEASE ATTACH COPIES OF THE CURRENT BUDGET OF THE ORGANIZATION AND FINANCIAL STATEMENTS (BALANCE STATEMENT AND INCOME STATEMENT). It does not require a CPA's audit, but please submit if available. I MISSION STATEMENT Briefly describe the goals and objectives of your organization and community services it provides. Describe the ways your organization meets the criteria listed on page 2 of the CS Funding Policy. _....... Annlin�tinn —Donn 7 i) COMMUNITY SERVICE FUNDING PROGRAM Application — Page 2 CRITERIA: A. We area California Nonprofit Public Benefit Corporation. B. Our services include: Operation School Beil®, one of Assistance League's main philanthropic programs, last year provided new school clothing to 2,023 children including school supplies, backpacks and hygiene items. We clothed 877 children enrolled in the Temecula Valley Unified School District in preschool and grades K -8. Assisteens® This is ourjunior auxiliary has 22 members in grades 7 through 12, seeks to instill the values of volunteerism and service to the community. Each year Assisteens provide a Fall Harvest Festival and Spring Peter Rabbit event for Temecula First Five for approximately 100 children and their families. The auxiliary also provides books for Operation Book Worm, their philanthropic program supporting Operation School Bell. Kids on the Block® This program is a special troupe of eight Assistance League members who are puppeteers using life -size puppets that provide education programs to enlighten 3`" grade Valley children on issues of disability awareness, medical differences and social concerns. Last year Kids on the Block performed its skits for 1,167 third grade students. This year, in the Temecula School District, Kids on the Block presented its programs to 980 Temecula children. This unique form of communication provides young students with an environment in which to learn and develop an attitude of smart decision-making, sensitivity, and understanding that should serve them well in the future. Project SMILE: Two of our adult members run this program that provides free emergency dental care for needy children in grades K -8 who are not insured by private, state or federally funded dental programs. Operation Non - Profit Assistance: Our meeting room is available free of charge to nonprofit organizations for their meetings and events. The room will seat up to 100 people. Calendar of room usage is included in this application. Assistance League is partnering for the first time this year with Rape Crisis Unit, Southwest Family Justice Center by providing assault survivor kits to victims of sexual assault in Southwest Riverside County. C. We have been active in Temecula since 1989. Currently, we have 201 members. For our fiscal year ending May 31, 2010, our members gave 27,486 hours of service that help fund our philanthropic programs and operate the thrift store. Funds from the thrift store's proceeds support Assistance League's philanthropic programs selling gently -used items donated by the public. Donations are received from local businesses, individuals, and local governmental agencies. Thrift Store sales were $316,437, in fiscal year 2009/2010, contributing a sales tax boost of $25,320.00, to the local economy. D. Temecula Unified School District is one of four school districts served through our philanthropic programs. Recently, a letter was received from the Temecula School District Superintendent who wrote: "The many programs offered by your organization give children the extra help they need ... clothes to keep them warm and in line with their peers, dental services to keep them smiling and healthy, awareness programs so they learn an attitude of smart decision - making and sensitivity to others." E. We have an all volunteer workforce. Computerized accounting procedures and an annual independent review provide checks and balances on the accuracy of our accounting information. F. We have been in Temecula for 21+ years, and we have 201 active members. Among continuing needs of this community, there is a need to provide health and hygiene kits to serve urgent needs of some students. Often times a student comes to the health office needing a clean shirt, toothbrush, comb, water, bandage, etc., and due to recent school budget cuts, these supplies are not always available. Health Clerks refer students to Assistance League for school clothing, and these staff members are the first responders for students when there is an urgent need. Operation School Bell will give each school health office the necessary items to solve health or hygiene needs immediately. G. We provide assistance to Temecula's residents in three distinct ways: Operation School Bell clothed 877 Temecula school children; Assisteens provided special events for 100 children and families enrolled in Temecula First Five preschool program, and Project SMILE served eight children and plans to expand its program in 2011. H. Assistance League is an organization free from discrimination based on race, color, creed, nationality, sex, marital status, disability, religion or political affiliation. Assistance League is an organization that does not require attendance or participation in any political, religious or social activity. Active members are required to volunteer a minimum of 96 hours each year. Financial support from each member is required, but attendance at social events is not. J. Assistance League of Temecula Valley financial statements are included with this Application. K. Board of Directors and members of Assistance League of Temecula Valley approve the annual budget. Active members vote on required financial commitments. The budget of the organization is reviewed twice a month to ensure proper management. L. Our services are directed toward needy school age children from preschool age up to 8"' grade. Children and families are referred to Operation School Bell and Project SMILE by the health staff members and teachers from the four school districts we serve. M. Assistance League of Temecula Valley programs are evaluated internally biannually and the opposite year by National Assistance League. Our next membership evaluation is November 2, 2010. MISSION STATEMENT: Assistance League® of Temecula Valley, a chapter of National Assistance League ®, is a non - profit, volunteer philanthropic organization dedicated to serving the needs of families in the Temecula Valley area. GOALS: 1. Create and operate philanthropic programs to meet identified community needs. 2. Raise and administer adequate funds to support Assistance League of Temecula Valley's philanthropic programs and chapter administration. 3. Create an informed, enthusiastic, cohesive and committed membership throughout the chapter. 4. Strengthen our image to be identified as a recognized leader in addressing the needs of the community. X X PROJECT DESCRIPTION — Application — Page 3 Since December 1996, Assistance League of Temecula Valley has been located at 28720 Via Montezuma, Temecula. This 24,400 square foot building houses our thrift store and Operation School Bell area complete with clothing area, and administrative offices, as well as a general use meeting room that is available for reservation by non- profit organizations in the community. This building in its present condition needs exterior painting. This proposal requests $5,000.00, to be applied to the cost of painting our building. We have obtained three painting estimates from local contractors. The estimates are: Paulson Painting $6,500.00 Mike Gera Painting 8,750.00 Kilpatrick's Painting 9,200.00 Complete exterior painting of building will include: 1. Power wash entire exterior of building 2. Remove loose and peeling paint 3. Caulk and patch as needed 4. Prime substrate as needed S. Repaint metal canopy (metal paint) 6. Repaint all handrails and all doors with semi -gloss and metal paint. 7. All paints exterior flat, primers and enamel included are up to the sustainability code. The building is open six days a week and is used by many customers, members of Assistance League, and philanthropic programs' recipients. The integrity of the building is paramount to continuing the operation of the thrift store and its programs. Painting the building exterior would aid in its surface maintenance and stave off potential water damage. Enhancing the building's deteriorated physical appearance promotes community image and encourages economic benefits. Property values are maintained as well as further promoting business expansion. Should the City of Temecula Community Service Funding Program award Assistance League of Temecula Valley the requested amount of $5,000.00, a large portion of the actual cost would be covered. City of Temecula Community Service Funding Program's award will pay for most or all of the painting, and we can then proceed with additional projects that need to be done such as recoating and restriping our parking lot, repairing our dumpster enclosure to make it more sanitary and attractive, and to work on the interior of the building. Thank you for your consideration and support for our efforts to positively impact the families in our community. PAST PROJECT BENEFITS — Application —page 4 Assistance League of Temecula Valley received funding from the City of Temecula under the Fiscal Year 2009 -2010 Temecula Community Service Funding Program. Our organization was awarded $2,500 to be used for building maintenance. These funds were used to replace one set of commercial doors, overhead concealed closer, and panic push bar. We brought these doors up to Code so they will meet the City's safety requirements. SIGNATURE PAGE We hereby certify the information contained in this application is true to the best of our knowledge and belief. PREPARED BY: Ann Reese, Grants Chairman NAME and TITLE (Please Print or Type) PRESIDENT or AUTHORIZED ( Electra Demos, President or ORGANIZATION NAME: ASSISTANCE LEAGUE OF TEMECULA VALLEY MAILING ADDRESS: 28720 Via Montezuma Avenue, Temecula, CA 92590 -2510 951.694.8018 DATED THIS 9th (Date) of September 2010. (Month) BE SURE TO INCLUDE THE ORIGINAL PLUS ONE COPY AND SUBMIT TO: Mail Completed Applications to: City of Temecula Community Service Funding Program Attn: Judy McNabb Post Office Box 9033 Temecula, CA 92589 -9033 Or Deliver in Person to: City of Temecula Community Service Funding Program Attn: Judy McNabb 43200 Business Park Drive Temecula, CA 92590 Application - Page 5 ASSISTANCE LEAGUES OF TEMECULA VALLEY BUILDING AND MEETING ROOM CALENDAR June 2009 through May 2010 6/10/2009 Temecula Film Festival 7/9/2009 Temecula Film Festival 7/21/2009 Temecula Film Festival 8/3/2009 Temecula Film Festival 8/12/2009 Temecula Film Festival 8/20/2009 Temecula Film Festival 8/27/2009 Temecula Film Festival 9/3/2009 Temecula Film Festival 9/9/2009 Temecula Film Festival 9/15/2009 Temecula PTA 10/20/2009 Temecula PTA 11/4/2009 Interagency Council 11/17/2009 Temecula PTA 1/13/2010 Interagency Council 1/28/2010 Temecula Film Festival 2/16/2010 Temecula PTA 2/18/2010 Temecula Film Festival 3/10/2010 Interagency Council 3/16/2010 Temecula PTA 3/18/2010 WIC (Riverside County Dept. of Public Health Women, Infant and Children) 3/18/2010 Temecula Film Festival 3/30/2010 Women's Club /Scholarships 4/12/2010 Census Training Classes 4/13/2010 Census Training Classes 4/14/2010 Victim Services 4/15/2010 Temecula Film Festival 4/16/2010 Census Training Classes 4/2012010 Temecula PTA 4/21/2010 Census Training Classes 4/27/2010 Census Training Classes 4/28/2010 Census Training Classes 4/29/2010 Census Training Classes 4/29/2010 Women's Club /Scholarships 4/30/2010 Census Training Classes 5/3/2010 Census Training Classes 5/4/2010 Women's Club /Scholarships 5/5/2010 Census Training Classes 5/6/2010 Census Training Classes 5/12/2010 Interagency Council 5/12/2010 Prevent Child Abuse Page 1 10:67 AM Assistance League of Temecula_ Valley 02107110 Balance Sheet Accrual Bast As of May 31, 2010 May 31, 10 ASSETS. Current Asset Checking/Savings 10100 • Cash On Hand 300.00 10125 • Checking Account Commerce Bank 31,262.84 10130 • Savings Account Commerce Bank .87,125.38 10131 • Certificate of Deposit 50,000.00 10136 • PRO's Checking Acct Commerce BK 15,081.00 10145 • Assisteens Ckg Acet Commerce Bk 2,234.56 10160• Mission Oaks Checking Account 90.00 Total CheckinglSavings 186,093.78 Other Current Asset 12000 • Inventory 12100 • Inventory - Thrift Store 60,841.90 12200 • Inventory-Operation School Ball 45,928.24 Total 12000 • Inventory 106,770.14 Total Other Current Asset 106,770.14 Total Current Asset 292,863.92 Fixed Assets 15000 • Property and Equipment 16001 • Accumulated Depreciation - 523,542.00 15100 • Land 140,196.46 15200 • Building 560,786.34 15201 • Building Improvement 276,417.00 16300 • Furniture a Equipment 45,240.20 15600 • Truck - Ford 1989 11,002.50 Total 16000 • Property and Equipment 510,100.50 Total Fixed Asset 510,100.50 Other Assets 13300 • Deposit 800.00 Total Other Asset 800.00 TOTAL ASSETS 803,764A2 LIABILITIES 6 EQUITY Liabilities Current Liabilities Account Payable 16000 - Account Payable 8,329.50 Total Account Payable - 8,329.50 Credit Cards 16002 • Chase Credit Card 1,397.31 Total Credit Cards 1,397.31 Other Current Liabilities 17000 • Deferred Revenue 17200 • Deferred Membership Dues 17,000.00 ' Total 17000 • Deferred Revenue 17,000.00 Total Other Current Liabilities. 17,000.00 Total Current Liabilities 26,726.81 Total Liabilities 26,726.81 Equity 30000.Opening Balance Equity - 9,384.96 Page 1 0 10:87 AM Assistance League of Temecula Valley 08M7110 Balance Sheet Accrual Bash As of May 31, 2010 May 31, 10 .32000 • Umestrieted Net Assets 738,045.24 Net Income 47,477.33 Total Equity 777,037.61 TOTAL LIABILITIES & EQUITY. - 803,764.42 Page 2 5:55 PM 07115110 Accrual Basis Ustance League of Temecula V y Budget Overview 2010 2011 June 2010 through May 2011 Ordinary Income /Expense Income 41000 • Fundraising Revenue 41100 • Minor Event Fundraising 41200 - Major Event Fundraising 41250 • Direct Mail Campaign 41400 • Assisteens Income 41500 • PRO's Income Total 41000 • Fundraising Revenue 43000 • Direct Public Support .43410 • Corporate Contributions 43450 • Individual Contributions 43480 • Grants - Restricted 43490 • Grants - Unrestricted Total 43000 • Direct Public Support 45000 • Investments 45030 • IntemstSavings, Short-term CD Total 46000 • Investments 46400.Other Types of Income 46410 • Thrift Store Sales 46412 • Thrift Store Sales - Assisteens 46415 • Thrift Store Sales - PRO's Total 46400 • Other Types of Income 47200 •.Membership Income 47230 •. Membership Dues - 47235 • Active Member 47241 • Community Member 47250 • Sustaining Member 47260 • PALS Member 47265 • Assisteens Member 47270 • PRO's Member Total 47230 • Membership Dues Jun'10 - May 11 4,000.00 12,000.00 7,500.00 500.00 5,000.00 29,000.00 6,000.00 6,000.00 20,000.00 5,000.00 37,000.00 1,500.00 1,500.00 295,000.00 20,000.00 5,000.00 320,000.00 10,000.00 1,200.00 5,000.00 1,400.00 975.00 500.00 19,075.00 Total 47200 • Membership Income 19,075.00 Total Income .406,575.00 Gross Profit 406,575.00 Expense 60900 • Business Expenses 60915 • Bank Service Charge 300.00 60940 • Fees : &Permits 300.00 Total 60900 • Business Expenses 600.00 61000 • Contract Services 61110,•Accounting Fees 12,000.00 - Total 61000 • Contract Services 12,000.00 62000 • Facilities and Equipment 62200 • Building Repairs & Maintenance 62205 • Chapter House Improvements - - 4,000.00 62220 • Supplies 500.00 - 62240 • Janitorial Services 11,000.00 62700 • Landscape Maintenance 3,000.00 62850 • Alarm System - Security 3,000.00 62200 • Building Repairs & Maintenance - Other 18,000.00 Total 62200 • Building Repairs & Maintenance 39,500.00 62500 • Real Estate, Personal Prop Tax 12,000.00 Page 1 5:65 PM Aistance League of Temecula Valf`y 07/15/10 Budget Overview 2010 - 2011 Accrual Basis June 2010 through May 2011 Jun'10 - May 11 62600 • Utilities 62610 • Electricity 20,000.00 - 82620 • Gas 250.00 62630 • Water 3:000.00 Total :62600 • Utilities - 23,250.00 62750 • Trash 5,500.00 62800 • HOA Dues 3,600.00 62900 • Truck 500.00 Total 62000 • Facilities and Equipment 84,350.00 63000 • Administration 63100 • Postage, Mailing Service 500.00 63200 • Printing and Copying 63201 • Pamphlet Printing 000 63200 • Printing and Copying - Other 1,000.00 Total 63200 • Printing and Copying 1,000.00 63300 • Supplies 3,000.00 63400 • Telephone, Telecommunications 3,500.00 63500 • Web Site Maintenance 660.00 63600 • Copier Rental and Maintenance 3,500.00 Total 63000 • Administration 12,160.00 64100•Insurance 64120 • Directors and Officers 605.00 64130 • Property Insurance 4,818.00 64140 • Gen Liability, Auto 4,406.00 64150 • Accident Insurance 856.00 Total 64100 • Insurance 10,685.00 64200 • Membership 64201 • Newsletter . 64202 • Postage Newsletter 200.00 64203 • Newsletter Design & Printing 800.00 Total 64201 • Newsletter 1,000.00 64210 • National Organization Dues 7,000.00 64215 • Education/Orientation 1,500.00. .64220 • Roster 600.00 64230 • Membership Development 2,000.00 64235 • Member Recognition 1,445.00 64240 • Pins & Badges 250.00 64250 • Hospitality 64252 • Hospitality Supplies 1,000.00 64250 • Hospitality - Other 1,400.00 Total 64250 • Hospitality 2,400.00 64290 • Historian 300.00 64295 • Miss Sunshine 450.00 Total 64200 • Membership 16,945.00 64500 • Community Relations 64510 • Public Relations 6,135.00 64515 • Presidents Expenses 1,500.00 64520 • Community Ambassadors Committee 2,500.00 Total 64500 • Community Relations 10,135.00 64260 • Special Events Expenses 66285 • SE - Complimentary Tickets 600.00 Total 64280 •Special Events Expenses - 600.00 Page 2 J 5:65 PM Ustance League of Temecula Vy 07/16/10 Budget Overview 2010 - 2011 Accrual Basis June 2010 through May 2011 65200 • Fundraising Expenses 65220 • Thrift Store Supplies 65230 • Thrift Store Sales Tax Expense 65240 • Bank Card Fees 65250 • TS - Conference Expense Total 65200 • Fundraising Expenses 65300 • Resource Development Expenses 65350 - Major Fundraiser 65400• Minor Fundraiser 66410 • Grant Writing 65450 • RD - Conference Expense 65451 • RD - Complimentary Tickets Total 65300 • Resource Development Expenses 66100 • PROGRAM SERVICE EXPENSE 66105 •Operation School Bell 66110 •OSB Clothing 66111 •OSS -Camp Pendleton 66112 • OSB - SOS Kits 66113 .OSS Supplies 56114 • OSB Shipping & Handling 66120 • OSB Conference Expense Total 66105 • Operation School Bell 66130 • Project SMILE 66140 • Scholarships 66150 • Kids On the Block 66160 • Heart and Hand 66175 • Operation Bear Hug 66190 • Phil Chair- Conference Expense Total 66100 • PROGRAM SERVICE EXPENSE 66200 • Auxiliaries/Standing Committees 66205 • PRO's Standing Committee 66206 • PRO's Program Service Expense Total 66205 • PRO's Standing Committee 66220 • Assisteens Auxiliary 66221 • Administration Expenses 66222 • Special Events Expenses 66223 • Fundraising Expenses 66224 • Membership Expenses 66226 • National Workshops 66230 • Assisteens Program Service Exp 66231 •Operation Book Worm 66232 • Harvest Festival 66233 • Senior Pen Pal 66234 • Peter Rabbit 66235 • Assisteens Outreach Total 66230 • Assisteens Program Service Exp Total 66220 • Assisteens Auxiliary Total 66200 • Auxiliaries /Standing Committees Jun '10 - May 11 7,000.00 27,000.00 5,000.00 1,000.00 40,000.00 5,000.00 3,000.00 1,000.00 1,000.00 315.00 10,315.00 120,000.00 5,000.00 5,000.00 2,000.00 4,000.00 1,000.00 137,000.00 1,300.00 26,000.00 200.00 5,000.00 3,500.00 1,000.00 174,000.00 5,000.00 5,000.00 350.00 2,000.00 200.00 1,725.00 1,500.00 7,050.00 800.00 900.00 1,800.00 4,260.00 14,810.00 20,585.00 25,585.00 Page 3 5:96 PM A8tance League of Temecula Vaf 07115110 Budget Overview 2010 -2011 Accrual Basis June 2010 through May 2011 Jun'10 - May 11 66300 • Travel and Meetings 68310 • Conference - Executive Board 3,000.00 68311• Conference- Mbrshp Registration 4,000.00 68320 • National Workshops 2,000.00 68330 • Chapter Circle Donation 200.00 Total 68300 • Travel and Meetings 9,200.00 Total Expense 406,575.00 Net Ordinary Income 0.00 Net income 0.00 Page 0 10:57 AM Assistance League of Temecula Valley 06107110 Profit & Loss Accrual Basis June 2009 through May 2010 Ordinary IncomelEspense Income 40000-Income 40190 - RefundalCredits 40200 - Snack Jar Income 40300 - Donation Jar Income Total 40000 - Income 41000 • Fundraising Revenue 41100 - Minor Event Fundraising 41200 - Major Event Fundraising 41201 - Tickets 41202 - Sponsora/Ads 41203 - RaWAuction 41204 - Centerpieces 41206- Vendors 41200 • Major Event Fundraising - Other Total 41200 - Major Event Fundraising 41400 - Assisteens income 41402 - Assisteens Interest Income 41403 - Assisteens Teall uncheon Income 41404 - Assisteens Income Miscellaneous Total 41400 - Assisteens Income 41600 - PRO's Income 41602 - PRO's Interest Income 41600 - PRO's Income - Other Total 41500 • PRO's Income Total 41000 • Fundrasing Revenue 43000 - Direct Public Support 43410 - Corporate Contributions 43450 - Individual Contributions 43470 - Donations - Restricted 43490 • Grants - Restricted 43490 - Grants - Unrestricted Total 43000 - Direct Public Support 43491 - Gifts in Kind - Goods 43496 - Gifts in Kind - OSB 43497 - Gifts in kind - Salvation Amry 43498 - Gifts In Kind - Meeting Room 43499 - Gab In Kind -Thrift Store 43491 - Gifts In Kind - Goods -Other Total 43491 - Gifts In Kind - Goods 45000 • Investments 46030 r Interest- Savings, Short-term CO Total 46000 - Investments 46400.Other Types of Income 46410 - -Thrift Store Sales 46430 • Miscellaneous Revenue Total 46400.Other Types of Income Jun'09 - May 10 0.29 296.67 573.35 870.31 3,926.00 9,200.00 5,725.00 2,115.00 285.00 677.61 750.00 18,752.61 2.40 465.00 40.00 507.40 29.85 339A3 369.28 23,555.29 7,997.13 3,990.00 1,371.00 23,710.00 5,000.00 42,068.13 11,348.60 9,010.00 20,875.00 58,458.35 3,570.50 103,262.45 397.78 397.78 316,437.21 1,249.51 317,686.72 Page 1 } 10:57 AM Assistance League of Temecula Valley 08107110 Profit & Loss Accrual Basis June 2009 through May 2010 Page 2 Jun '09 -May 10 47200 - Membership Income 47230 - Membership Dues 47235 - Active Member 9,825.00 47241 - Community Member 1,200.00 47260 - Sustaining Member 4,800.00 47265 - Active On Limited Service 0.00 47260 • PALS Member 1,220.00 47266 - Asshdeens Member 915.00 47270- PRO's Member 381.00 Total 47230 - Membership Dues 18,341.00 Total 47200 - Membership Income 18,341.00 49000 • Special Events Income 49012 - December Luncheon 3,948.45 49013 - Xmas Party 630.00 49014 - May Luncheon 3,136.00 49020 - LmrcheomlPardeslOutside Event 660.00 49100 - National Conference 515.00 Total 49000 - Special Events Income 8,889.45 Total income 515,071.13 Cost of Goods Sob 60700 - Cost of Sales - Inventory Saks 67,179.35 Total COGS 67,179.35 Gross Prolh 447,891.78 Expense 60900 - Business Expenses 60915 • Bank Service Charge 281.97 60940 - Fees & Permits 199.29 Total 60900 - Business Expenses 481.26 61000 • Contract Services 61110 • Accounting Fees 8,632.50 Total 61000 - Contract Services 8,632.50 62000 - Facilities and Equipment 62200 - Building Repairs & Maintenance 62206 - Chapter House Improvements 5,866.75 62210 - Snacks - Kitchen 179.44 62220 - Supplies 300.02 62240 - Janitorial Services 10,87223 62700 - Landscape Maintenance 2,543.00 62650 - Alarm System - Security 2,367.00 62200 - Building Repairs & Maintenance - Other 26,140.68 Total 62200 - Building Repairs & Maintenance 48,269.02 62600 - Real Estate, Personal Prop Tax 11,979.06 62600 - Utilities 62610 - Electricity 18,744.82 62620- Gas 227.18 62630 -Water 2,645.32 Total 62600 • Utilities 21,617.32 62750 - Trash 5,519.14 62800 - HOA Dues 3,506.44 62900 • Truck 484.49 Total 62000 - Facilities and Equipment 91,375.47 63000 • Administration 63100 • Postage, Mailing Service 488.50 Page 2 0 10:67 AM Assistance League of Temecula Valley 08107110 Profit & Loss Accrual Bask June 2009 through May 2010 63200 • Printing and Copying 63201 • Pamphlet Printing 63200 • Printing and Copying - Other Total 63200 • Printing and Copying 63300 •. Supplies 63400 • Telephone, Telecommunications 63500 • Web Site Maintenance 63600 • Copier Rental and Maintenance Total 63000 • Administration 64100• Insurance 64120 • Directors and officers 64130 • Property Insurance 64140 • Gen Liability, Auto 94150 • Accident Insurance 64100 - Insurance - Other 'Total 64100 • Insurance 64200 - Membership 64201 • Nevrsletler 64202 • Postage Newsletter 64203 • Newsletter Design & Printing 64201 • Newsletrer -Other Total 64201 • Newsletter 64210 • National Organization Dues 64216 • Education/Orlentation 64220 • Roster 64230 • Membership Development 64240 • Pins S Badges 64250 - Hospitality . 64251 • Hospitality- Meetings, Etc 64262 • Hospitality Supplies 64260 • Hospitality - Other Total 64250 - Hospitality 64290 • Historian 64296 • Miss Sunshine Total 64200 • Membership 64500 • Community Relations 64510 • Public Relations 64515 • Presidents Expenses 64620 • Community Ambassadors Committee 64500 - Community Relations.- Other Total 64500 • Community Relations 64280 • Special Events Expenses 64281 • December Luncheon 64282 - Christmas Party Expense 94283 • May Luncheon 64294 • Parties andfor Luncheons 64280 • Special Events Expenses - Other Total 64280 • Special Events Expenses 65200 • Fundraising Expenses 65220 • Thrift Store Supplies 65230 • Thrift Store Sales Tax Expense 66240 • Bank Card Fees 65250 • TS - Conference Expense Total 65200 - Fundraising Expenses Jun'09 - May 10 1,576.88 911.23 2,488.11 2,841.14 3,445.04 660.00 3,495.93 13,418.72 605.00 6,259.00 3,377.40 857.00 831.60 11,930.00 126.22 533.61 0.00 659.83 7,252.50 473.11 511.78 2,004.18 433.89 1,800.00 197.79 5.21 2,003.00 132.68 152,50 13,623.47 1,602.39 1,276.37 1,201.66 54.13 4,134.55 4,310.80 588.91 3,491.82 240.00 50.04 8,681.57 5,899.18 25,320.13 4,193.47 1,337.45 36,750.23 Page 3 0 10:57 AM Assistance League of Temecula Valley 08107110 Profit & Loss Accrual Basis June 2009 through May 2010 Page 4 Jun '09 - May 10 66300 • Resource Development Expenses 65350 • Major Fundralser 66361 - Luncheon Cost 5,220.00 66352 - Printing Cost 716.56 66353 - Entertainment 50.00 66364 - Decorations - 543.75 66366 - Postage 443.40 66366.Opportunity Basket 436.24 66367 • Miscellaneous hems 4.81 66360 • Major Fundraiser - Other 820.00 Total 66360 - Major Fundraiser 8,234.76 66400. Minor Fundraiser 1,240.94 65410. Grant Writing - 318.39 65450 -RD- Conference Expense 940.16 Total 66300 - Resource Development Expenses 10,734.25 66100 - PROGRAM SERVICE EXPENSE 66106.Operation School Bell 66110.OSB Clothing 98,997.45 66113.OSB Supplies 3,119.06 66114.OSS Shipping S Handling 5,524.43 66120.OSS Conference Expense 980.58 Total 66105. Operation School Bell 108,621.52 66130 • Project SMILE - 487.87 66140 • Scholarships 18,000.00 66150 - Kids On the Block 225.88 66160 - Heart and Hand 8,588.28 66170.Operation Outreach 66171 -Gift In Kind -OSB 11,348.60 66172. Gift In Kind - Salvation Amry 9,010.00 66173 - Gift In Kind - Meeting Room 20,875.00 66170.Operation Outreach -Other 80.00 Total 66170.Operation Outreach 41,313.60 66175.Operation Bear Hug 364.53 Total 66100- PROGRAM SERVICE EXPENSE 177,601.68 66200 • AuxiliarWStnding Committees 66205 - PRO's Standing Committee 66206 - PRO's Program Service Expense 6,497.07 66210 - PRO's Fundraising Expense 216.50 66206 - PRO's Standing Committee - Other 300.00 Total 66205 • PRO's Standing Committee 7,013.57 - `66220- Assisteens Auxiliary 66221 - Administration Expenses 1,201.62 - 66222 - Special Event Expenses 1,489.62 - .66224 - Membership Expenses - 25.00 66230 - Assisteens Program Service Exp 66231 •Operation Book Worm .3,491.11 66232 - Harvest Festival 1,013.50 - 66233 - Senior Pen Pal 550.04 66234 -Peter Rabbit 1,902.97 66235 - Assisteans Outreach 1,680.09 Total 66230 - Assiateens Program Service Exp 8,637.71 'Total 66220 • Assisteens Auxiliary 11,353.95 Total 66200 - Auxillades /Standing Committees : 18,367.52 66900 • Reconciliation Discrepancies 0.00 Page 4 10:67 AM 08/07/10 Accrual Buis () 0 Assistance League of Temecula Valley Profit & Loss June 2009 through May 2010 68300 • Travel and Meetings 68310 • Conference - Executive Board 68320 • National Workshops 66330 • Chapter Circle Donation Total 69300 • Travel and Meetings Total Expense Net Ordinary Income Net Income - Jun'09 - May 10 2,545.44 1,937.79 200.00 4,683.23 400,414.45 47,477.33 47,477.33 Page 5 a" ]L- x41'7175 State 4 O Ca ifornia �.� +b}n�h�s� 5" +bh -• f:'. ��b�' �fYii�'! rY' YYiY.11YRFJ+lniil�{�ii'SiQ.lYi. OFFICE OF THE SECRETARY OF STATE CORPORATION DIVISION 1, MARCH FONG EU, Secretary of State of the State of. California, hereby certify: That the annexed transcript has been compared with the corporate record on file in this office, of which it purports to be a copy, and that same is full, true and correct. IN WITNESS WHEREOF, I execute this certificate and affix the Great Seal of the State of California this APR u Zy -72 wems, q,,u, �, secretary of State Sed47Ara FORM Cl -107 Z M 400 CERTIFICATE OF AMENDMENT OF ARTICLES OF INCORPORATION A417175 Ins tCw FILED i lfi09e ry ofawte o m omio APR 131992 LA DONNA JIMENEZ AND BETTY THOMPSON certify that: f�it�N�c�[ty� {$t�fiW 1. They are the president and the secretary, respectively, of Assistance Guild of Temecula Valley, a California Nonprofit Public Benefit Corporation. 2. Article I NAME of the articles of incorporation of this corporation is amended to read as follows: The name of the corporation is ASSISTANCE LEAGUE OF TEMECULA VALLEY. 3. The foregoing amendment of articles of incorporation has been duly approved by the board of directors. ,. 4. The foregoing amendment of articles of incorporation has been duly approved by the required vote of members. We further declare under penalty of perjury under the laws of the State of California that the matters set forth in this certificate are true and correct of our own knowledge. DATE: April 8, 1992 LA DONNA JIM i ,, President BETT THOMPSO , Secretary NONPROFIT State O � „ . Ca all }� OFFICE OF THE SECRETARY OF STATE CORPORATION DIVISION I, MARCH FONG E U, Secretary of State of the State of California, hereby certify: That the annexed transcript has been compared with the corporate record on file in this office, of which it purports to be a copy, and that same is full, true and correct. IN WITNESS WHEREOF, I execute this certificate and affix the Great Seal of the State of California this JUN 18 1989 -- S dBTwTZ Fp U CE -10> *w 2e iO8e VALLEY. Z 1463456 i- N00R --ED tr"EE, in 4'q oiiica of the �rc.._� � o/ $W ARTICLES OF INCORPORATION ei �h. sroe. a Caslem o -OF- ASSISTANCE GUILD OF TEMECULA VALLEY JUr(1 5 1989 A California Nonprofit Public Benefit Corporation I MARCH FONG EU. Seuetwy013 . NAM The name of the corporation is ASSISTANCE GUILD OF TEMECULA II. PURPOSES A. This corporation is a nonprofit public benefit corporation and is not organized for the private gain of any person. It is organized under the Nonprofit Public Benefit Corporation Law for charitable purposes. B. The specific purpose of this corporation is to carry on a program of philantropic work in the community and to control and administer at least one major philanthropic project. III. INITIAL AGENT FOR SERVICE OF PROCESS The name and address in the State of California of this corporation's initial agent of the corporation for service of process is: MARJORIE B. BARNUM, 46569 E1 Viento Seco Drive, Temecula, CA. 92390 IV. LIMITATION ON CORPORATE ACTIVITIES A. This corporation is organized and operated exclusively for charitable ,purposes within the meaning of Section 501 (c)(3) of the Internal Revenue Code or the corresponding provisions of any future United States Internal Revenue Law. Notwithstanding any other provision of these articles, this corporation shall not, except to an insubstantial degree, engage in any activities or exercise any powers that are not in furtherance of the purposes of this corporation, and the corporation shall not carry on any other activities not permitted to be carried (a) by a corporation exempt from federal income tax under Section 501(c) (3) of the Internal Revenue Code of 1986 or the corresponding provision of any future United States Internal Revenue Law, or (b) by a corporation, contributions to which are deductible under Section 170(c)(2) of the Internal Revenue Code of 1986 or the corresponding provision of any future United States. Internal Revenue Law. B. No substantial part of the activities of this corporation shall consist of carrying on propaganda, or otherwise attempting to influence legislation, and the corporation shall not participate or 1 M intervene in any political campaign (including the publishing or distribution of statements) on behalf of any candidate for public office. V. DRDICATIOU AND The property of this corporation is irrevocably dedicated to charitable purposes and no part of the net income or assets of this corporation shall ever inure to the benefit of any director, officer or member thereof or to the benefit of any private person. Upon the dissolution or winding up of the corporation, its assets remaining after payment, or provision for payment, of all debts and liabilities of this corporation shall be distributed to a nonprofit fund, foundation or corporation which is organized and operated exclusively for charitable purposes and which has established its tax exempt status under Section 501 (c) (3) of the Internal Revenue Code (or the corresponding provision of any future United States Internal Revenue law). The organization shall be National Assistance League, if it qualifies as a distributes under the provisions of this Article. IN WITNESS WHEREOF, the undersigned, being the Incorporator of ASSISTANCE GUILD OF TEMECULA VALLEY has executed these Articles of Incorporation this /16 day of June, 1999. I hereby declare that I am the person who executed the foregoing Articles of Incorporation, which execution is my act and dead- 2 X N assistance league Temecula Valley 28720 Via Montezuma Temecula, CA 92590 -2510 951.694.8018 Fax No: 951.694.8298 assistance Temecula 81 st Chapter of National Assistance League® Governing Board 2010-2011 Electra Demos President Rita O'Neill l st Vice President Membership Barbara Miller 2nd Vice President, Philanthropic Programs Georgia Reece 3rd Vice President, Resource Development Brenda Hamilton Secretary Ginny Wetzel Treasurer Elective Standing Committees Leticia Plummer Assisteens® Coordinator Sally Haserot Bylaws Margo Doski Chapter House Manager Annette Sheehy Education Kathy Laurin Finance Sumru Vance Public Relations Diana Elizondo Strategic Planning 28720 Via Montezuma Temecula, CA 92590 -2510 Tel. (951) 690.8018 Fax (951) 690.8298 E -mail: altemecula @yahoo.com n CI7V 01 TFMF1111a SEP 1 0 2010 RVANCE >JEpr, September 9, 2010 City of Temecula Community Service Funding Program Attn: Judy McNabb Post Office Box 9033 Temecula, California 92589 -9033 Dear Ms. McNabb: Assistance League of Temecula Valley requests consideration and support through this submittal of our application for the Community Service Funding Program for the exterior painting of our building. Pursuant to the instructions of this funding program policy, enclosed is one original and one copy of Assistance League of Temecula Valley's application. Assistance League meets the eligibility requirements for funding as follows: • We are a California nonprofit public benefit corporation with IRS 501(c)(3) status. • We have no paid employees. • Scholarship information is not included in this funding request. • We do not have debts as part of this funding request. • We are located in the City of Temecula, and our programs benefit Temecula residents. • We are requesting the maximum allowable funding award of $5,000.00. Sin relay yyoours, lectra Demos President ED:ar Enclosures www.temeculavalley.assistanceleague.org Caring and Commitment in Action COMMUNITY SERVICE FUNDING PROGRAM FISCAL YEAR 2010 -2011 TABLE OF CONTENTS Application —Page l — blueflog • State of California Statement of nonprofit status, State Identification No: 1463456 Application — Page 2 — green flag Financials: • Balance Sheet dated May 31, 2010 • Budget Overview 2010 -2011 • Profit & Loss dated June 2009 through May 2010 Application — Page 2 continued — yellow flog • Criteria of Community Service Funding Program • Mission Statement • Goals Application — Page 3 — orange flag Project Description • Building's Meeting Room Calendar Use Application — Page 4 — red flag Past Benefits Project Application — Page 5 Signature Page . 3 CITY OF TEMECULA city of Temecula FISCAL YEAR 201041 SEP 0 2 2010 COMMUNITY SERVICE FUNDING PROGRAM APPLICATIQN (Please Print or Type) Finance 1) enartmerz PROJECT INFORMATION Amount Requested: $ 5.000 (Maximum allowable $5,000) Project Name: Birth Choice of Temecula Pregnancy Resource Services for Community Project Start Date: November 2010 Project End Date: June 30, 201 application has been authorized by the organization's: Executive Committee Board of Directors X Members -at -Large ORGANIZATION INFORMATION I Name of Organization: BIRTH CHOICE OF TEMECULA Contact Name: Jennifer Cartel[ Title /Position: Executive Director Mailing Address: 27488 Enterprise Circle West, #4, Temecula, CA 92590 Telephone: 951- 699 -9808 Ext. 105 or cellular 951 -551 -5428 Year Organization Founded: 1989_ Number of Paid Staff. (4) 2.5 FTE Number of Volunteers: (72) + with board; (1000 with event participants)_ Geographic Area(s) Served: All Temecula area residents Is this organization incorporated in California as a non - profit organization? Yes X No Effective Date: 1990 If "yes ": Date of incorporation as a non - profit 1990 Federal identification number 33- 0302353 I C Include a COPY of year statement of non -priofit sta m front the 3Eat+e f Caftftm a. FINANCIAL STATE TS PLEASE ATTACH COPIES OF THE CURRENT BUST OF T44E ORGANIZAT40N ARID FINANGIAL STATEMENTS (BALANCE STATEMENT AND INCOME STATEMENT). tt does not require a CPA's au t, b ut please submit H available. Piewe see attactred for end year 20M and to date. Lase also see budgetfor 2M. 6':..Px.F• e.F :., a FF....P ... f .{ p. -e .. f.' F <F_£.E i i 'i : FY i' i '•� ii''i iiii < S •. i • f.. SF £ 'i ffi <t i i N 3`- 4£S :f` -i' ~v:F fr.f_ %fPFk F• R . 6 -f! Rf f .4 A. eft iitie vttlarnz*iGn =Tenitgyram-pr0fd? Yes, SiM Choice of Temecula is tuneently a rrot►- proiH Urganrzation � # 33-0383353 B. Does the organization provide a service to the oveW cDmmuniiy? Yes, Bath Chaise of Temecula provides no -cost pregnancy counseling, material goods for Pregnant Moms and (tads and for their babies and small £hildrserr. Also, referrals for aal members of our ,community who need Keiji, G. is the size and make -up of the organization equipped to provide the PMW- amfsewice to the overall comftmftity? Yes, Mdfl Choice of Temecula is currently staffed by an Executive Director, Asst. Director and greater than {SS) volunteers that provide no cost services to oar clients. We are managed by a Board. of Directors comprised of (12) Board Members from various backgrounds and educational levels. ministry, having provided most of our support. Numerous individuals, churches and business supporters have been involved in this.organization for 20 years. As seen in our newsletters, our clients are very happy that they received timely assistance that allowed them to support their baby and the other young children in their home. We have prevented homelessness on numerous occasions in the past four years. E. Does the organization have a high quality level of fiscal management? Yes, Birth Choice employs a- retired Naval Officer who holds a Masters Degree M Healthcare Administration as their Executive Director. Additionally„ the Board of Directors provides movirthly oversight with a Treasurer who has expertise m corporate- accounting. Our part -lime Accounting Secretary provides weekly oversight of the budget, tax receipts and preparation of finance[ documents for monthly Board Meetings. F. is She group well organized to ensure levity in the City of Temecula-? Yes, Birth Choice of Temecula has been existence, in Temecula for 20 years and is has recently advanced the center to include increased services with an expanded volunteer staff of receptionists, counselors, vokmteer mentors, RN's and community outreach volunteers. G. is there evidence of satisfactory Service provided to the City's citizens? Yes, Birth Choice of Temecula served 2134 clients and their families m 2008 and continues to see greater than 200clieWs per month tor counseling and material support and fefeamls. Nomefous ciient testimonials attest to our outstanding and caring support to them. In 2089, we helped a family of iT 1 to get a charity car, to avoid homeless, had jobs and chiktcam and to get enrolled pit Project Bliss through CAP Riverside. They were provided gas and foed cards, clothing, diapers and formula for their small children when their salaries were not enough to sustain them. This was done when a0 other agencies contacted had no available funds. Our .networking with nearly tli0 churches m the area allowed us to provide via generous donations of time matem is and monies from our community. This is only one of numerove sum stories at Birth Choice Temecula. H. is the orgamatren free from discrimination based on race, color, creed, nationality, sex, marital staters, disability, religion, or political atMatMI Yes, Sixth Choice of Temecula is non - denommatiorret and provides equal access to services regardless of race, mhpm, creed, amity, sex, marital status erpolitical aflifiation. f. Hoes the organization require attendance or lfwtmrpa m in any politic* religious or social actpvit36? No, Ruth dice is 1. Can the orgyaerizatim provide frnanctat statements fprepared using an appmprrate method of acr=ou»tMO W demeASirate Sound financial management? Yes, Birth VMM maintains monthly yfi lantial reports by ary Accounting Seeretarylar review by the Executive Director and Board of Directors. Also, end year statements using llu A Books for MonImfiits. Our 890 is fired yearly. K. Gan the organization provide a budget for the fiscal year of request demonstrating cost- effectiveness? Yes, the tenter has established a budget W MOM and cost controls. We have been continrrally improving our financial standing through •fundraisers, grants, church missiarts support and community ctrtreacb. L. Does the organization make its services available to alt? Yes, services are provided to an who seek ourbelp °auto zostto them. M. toes the erganizatiort possess ongoing program evaluation toots? Yes, Birth Choice of Temecula tees established Strategic ds and A leasures-of Effectiveness and the Executive iflirector reports on-the achievement of those goals each menth wito a written report 0 PROJECT DESCRIPTION I How will your organization use the funding awarded? Describe the project, project objectives, those served, area serviced, and number of volunteers involved. Be specific. Include equipment or services that would be purchased and why. Include a detailed budget and a schedule of significant activities related to this project. You may attach a maximum of one double- spaced typewritten page of information. (Please type or print legibly.) How will your organization use the funding awarded? Describe the project, project objectives, those served, area serviced, and number of volunteers involved. Be specific. Include equipment or services that would be purchased and why. Include a detailed budget and a schedule of significant activities related to this project. You may attach a maximum of one double - spaced typewritten page of information. (Please type or print legibly.) If awarded this city grant funding, Birth Choice of Temecula will use the funding to purchase pregnancy support and educational supplies for community teens, women and families facing unplanned or financially difficult pregnancies. We will provide brochures, matedua goods and referrals in support of pregnancy, maternity and baby clothing and newborn layettes. We will also provide post - delivery supplies and educational materials such as books, DVD's, pamphlets related to pregnancy and caring for new babies. All consumable supplies will help our pregnant clients with their pregnancy and post - pregnancy period as well as help their care for their child. Client families will benefit from our services on a daily basis. We will expand our operating hours by 26 %. Objective One: To be available for all teens, women and families with pregnancy resource support through a 25% increase in center operating hours and days, an after -hours hotline and website and an increased community awareness and outreach program. Objective Two: To increase our clients and outreach contacts by 100% in 2010 -2011 Objective Three: To ensure every baby born in this community and their mother has a safe bed, food and formula (preferably breast feeding) and proper clothing. (Collaboration with other organizations) Objective Four. To ensure all teens and women in this community are given educational resources regarding their options so they are not forced to give up their babies. Objective Five: To reduce the number of unplanned pregnancies and STD's in our community through a Community Based Abstinence Education Program, USDE Mentoring Program with (4) other organizations and RN counseling. See budget for project: Consumable Supplies: Quantity Cost Subtotal Total Cost Pregnancy brochures 25,000 .50 5000.00 12,500.00 Pregnancy 20 18.00 360.00 360.00 Educationalvideosflending Material goods pregnancy and Baby, (maternity, baby, food) 1,800 20.00 36000.00 36000.00 Newborn bassinetes 60 100.00 6000.00 6000.00 Supplies to support client visits 1800 1.00 1800.00 1800.00 Prenatal Care educational mtls 1800 1.00 1800.00 1800.00 Total Cost: VM. 460 I. Requested Amount: $5,000 2. Expected Program Expenses: $58,460 3. Other financial resources $15,000 estimated from fundraising events; $25,000 estimated from donors For more details on our services, please visit our website at www.birthchoicetemecula.com PAST PROJECT BENEFITS I If your organization received City of Temecula funding in the previous year, please explain and show how Temecula residents benefited. PAST PROJECT BENEFITS Application Page 5 If your organization received City of Temecula funding in the previous year, please explain and show how Temecula residents benefited. Birth Choice of Temecula received a $51K grant from the City last year. With the addition of these monies, Birth Choice of Temecula was able to provide expanded pregnancy support services to greater than 2134 people in 2009 and greater than 200 clients per month in 2010 to date. (59) babies have been saved in the past 3 years through counseling and material support for those who wished to keep their babies but needed help to do so. We have expanded our center days to include Monday -Friday and expanded our hours by 25% as per our goal. We have further added more volunteers such as receptionists and counselors to ensure that our expanded (4) phone lines are answered timely to support greater than 200 client visits and numerous phone calls each month, up 100% over the past year. We have added (7) volunteer RN's and a volunteer MD OB /GYN provider to provide medical counseling and referrals for earlier prenatal care and healthier pregnancies. We will continue to help all families until their babies are two years of age, while also helping them to make good choices for their lives and helping them to become self- sufficient. Additionally, parents are being given abstinence counseling for their teens to prevent unplanned pregnancy and life4hreatening disease such as HIV /AIDS. Greater than 5,000 people participated in Birth Choice events providing much needed community service and volunteer support to members of our community including the Walk for Life, Race for Humanity, Baby Bottle Boomerang, Community Health Fairs, Community Expos, Temecula Chamber events, Middle School, High School and correctional Community Service Programs, numerous church heakh and Missions Fairs, abstinence education to students from numerous schools, Educational Work experience for students and adults from Mount San Jacinto, University of California San Marcos, Azusa Pacific, UC Riverside, Calvary Bible College Murrieta and Adult Work Programs for the Disabled including Care Right. Birth Choice has presented a loving approach to pregnancy resource support and we remain a source of help and hope for many who have none. With your support, we can help even more. C) SIGNATURE PAGE We hereby certify the information contained in this application is true to the best of our knowledge and belief. Prepared By._ :r Cartels, Executive Director AND TITLE, (Please Print or Type) President or Authorized Officer. Dr. Paul Simeteys, President Board of Directors NAME AND TITLE (Please Print or Type) Organization Name. BIRTH CHOICE OF TEMECULA Mailing Address of Organization: 27488 Enterprise Circle West, #4, Temecula, CA 92590 Telephone:_Center: 951- 699 -9808 Ext 105; Cellular: 951-551.6428 DATED THIS _24th_ of _August, 2010. (Date) (Month) BE SURE TO INCLUDE THE ORIGINAL PLUS ONE COPY AND SUBMIT TO: Mail Completed Applications to: Or Deliver in Person to: City of Temecula Community Service Funding Program Attn: Judy McNabb Post Office Box 9033 Temecula, CA 92589 -9033 City of Temecula Community Service Funding Program Attn: Judy McNabb 43200 Business Park Drive Temecula, CA 92590 1a5 PM _ Birth Choice of Temecula 01115110 Balance Sheet Cash Basis As of December 31, 2009 Dec 31, 09 ASSETS Current Assets Checking/Savings Pacific Trust Bank Checking 19,889.90 Pacific Trust Bank Savings 593.25 Petty Cash 200.00 S.B.Grant Petty Cash 300.00 Temecula Valley Checking 33,820.24 Total Checking/Savings 54,803.39 Total Current Assets 54,803.39 TOTALASSETS 54,803.39 LIABILITIES & EQUITY Equity Opening Ball Equity 41,375.33 Unrestrict(retained earnings) 5,490.79 Net Income 7,937.27 Total Equity 54,803.39 TOTAL LIABILITIES & EQUITY 54,803.39 S �C d 01 tv 0 73 N v m m F00 46-1 0 O Ca m t z mCLw 7 Ln w Q r N q v S m$Sm f` Cl O O t0 Sf��, S 0000000 f0 N � IO N O IA c� 61 N�O r SSCro�jC(On � WOI �tOV�Pt�ol Se-N fV e x Cq1 N W N at dLL by 0 yN y g� ay C �G ��s� co &L W C$ �a E a £N m W !� i$t o 1! v�EN = N$y 6 W a C N NW T/kkJN mo w CH SS c ME c am Yg� O O Y M.4 .�.. 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O "3 O r bO'DO -W O°) CD d C-4 O r M E W m I Q o R U O L -- c % y:. c � wK c N mmmE a I- �'� Lomro m aaE d m °> ,m> o ca NU —me mock wL°ev w ui m E xwL«�S-� O� OE c o m w y $c M el_ d: m c m° > a Z �c N U F o W c o m m z m z m ° ¢ M r t M N r N o U F 11:36 AM Birth Choice of Temecula 08113110 Balance Sheet Cash Basis As of July 31, 2010 Jul 31, 10 ASSETS Current Assets Checking/Savings First Citizens Bank 72,301.29 Pacific Trust Bank Checking 30,396.15 Pacific Trust Bank Savings 594.56 Petty Cash 200.00: S.B.Grant Petty Cash 300.00 Total Checking/Savings 103,792.00 Total Current Assets 103,792.00 TOTAL ASSETS 103,792.00 LIABILITIES & EQUITY Equity Opening Bal Equity 41,375.33 Unrestrict (retained earnings) 13,428.06 Net Income 48,988.61 Total Equity 103,792.00 TOTAL LIABILITIES & EQUITY 103,792.00 Page 11:44 AM Birth Choice of Temecula 08/13110 Profit & Loss Year to Date Cash Basis January through July 2010 Jan -Jul 10 Medical Travel & Training Medical Equipment 1,591.00 Medical Travel & Training - Other 193.10 Total Medical Travel & Training 1,784.10 Total Medical 3,106.20 Rachel's Vineyard 920.00 Reconciliation Discrepancies 9.00 Travel & meetings expenses Travel 209.37 Total Travel & meetings expenses 209.37 Total Expense 91,414.50 Net Ordinary Income 48,988.61 Net Income 46,988.61 Page J �1 -` Internal Revenue S, J"ice P 0 BOX 2350 ROOM 5127 ATTN: E.O. LOS ANGELES, CA 900532350 Date: MAR. 20, 1989 BIRTHRIGHT OF TEMECULA p - 4k2890-AGENA- 5TRFEi- 28677 Front St TEMECULA, CA 92390 P.O. Eo:; 2129 Tenecula, CA. 92390 Dear Applicant: Dates Upartment of the Treasury 1. regy rc!r I.: Employer Identification Number: 33- 0302353 Case Number: 959030023 Contact Person: THORNTON, B. Contact Telephone Number: (213) 894 -4170 Accounting Period Ending: December 31 Foundation Status Classification: see attached Advance Ruling Period Ends: Dec. 31, 1992 Caveat Applies: no Based on information supplied, and assuming your operations will be as stated in your application for recognition of exemption, we have determined you are exempt from Federal income tax under section 501(c) (3) of the Internal Revenue Code. Because you are a newly created organization, He are not now making a final determination of your foundation status under section 509(a) of the Code. However, we have determined that you can reasonably be expected to be a publicly supported organization described in sections 509(a) (1) and 170 (b) (1) (A) (vi). Accordingly, you Hill be treated as a publicly supported organization, and not as a private foundation, during an advance ruling period. This advance ruling period begins on the date of your inception and ends on the date shown above. Within 90 days after the end of your advance ruling period, you must submit to us information needed to determine whether you have met the requirements of the applicable support test during the advance ruling period. If you establish that you have been a publicly supported organization, you Hill be classified as a section 509(a)(1) or 509(a)(2) organization as long as you continue to meet the requirements of the applicable support test. If you do not meet the public support requirements during the advance ruling period, you Hill be classified as a private foundation for future periods. Also, if you are classified as a private foundation, you will be treated as a private foundation from the date of your inception for purposes of sections 507(d) and 4940. Grantors and donors may rely on the determination that you are not a private foundation until 90 days after the end of your advance ruling period. If you submit the required information within the 90 days, grantors and donors 9 0+for 1045(CG) f: -3- BIRTHRIGHT OF TEMECULA 0 Because this letter could help resolve any questions about your exempt status and foundation status, you should keep it in your permanent records. If the heading of this letter indicates that a caveat applies, the caveat below or on the enclosure is an integral part of this letter. If you have any questions, please contact the person whose name and telephone number are shown in the heading of this letter. Sincerely yours, c Frederick C. Nielsen District Director biter 1045(CG) �� III 111111111111111101111111111111111111111111111111 _ Department of the ury Date of t cite: JULY 25. 1994 ber — ,i FRESNO,RCAenu93888Ce FormYer ufyingNumTaxPeriod: 33- 0303353 For assistance you may Ii1u111i11nnwn 111n1n 1Jd1n1n1141111111111111111111 call us at: 1- 800-829-1040 ST. 0 BIRTH CHOICE OF TEMECULA INC PO BOX 2129 TEMECULA CA 92593- 2129297 WE CHANGED YOUR NAME AND /OR ADDRESS THANK YOU FOR YOUR CORRESPONDENCE. AS YOU REQUESTED. WEsVE MADE THE FOLLOWIHO CHARGES TO YOUR NAME AND /OR ADDRESS' NAME AND ADDRESS PREVIOUSLY NAME AND ADDRESS NOW SHOWN ON YOUR ACCOUNT SHOWN ON YOUR ACCOUNT BIRTHRIGHT OF TEMECULA BIRTH CHOICE OF TEMECULA INC PO BOX 2129 PO BOX 2129 TEMECULA CA 92593- 2129297 TEMECULA CA 92593- 2129297 IF YOU DON'T AGREE WITH THIS CHANGE, PLEASE LET US KNOW. CERTIFICATE OF AMEN DMEIL OF ARTICLES OF INCORPORATION A44y tSj 1 CNDOR Z:7 PILED M tM offke of #W swa.Mry of sww of Qw $I m of CoGf omb �JUL 18 1994 Arlene Siroky and Margaret A. Ustick certify than TOHY MILLER. kUapSecrOgofstall 1. They are the Director and the Secretary, respectively of BIRTHRIGHT OF TEMECULA, INC. a California Corporation. 2. Article I of the articles of incorporation of this corporation is amended to read as follows: BIRTH CHOICE OF TEMECULAr INC. 3. The foregoing amendment of articles of incorporation has been duly approved by the Board of Directors. q. The corporation has no members. We further declare under penalty of perjury under the laws of the State of California that the matters set forth in this certificate are true and correct of our own knowledge. DATE: Xrleen Siroky, Director / Margaret . Ustick, Secretary NONPROFIT ) 0 State of California Secretary of State I, DEBRA BOWEN, Secretary of State of the State of California, hereby certify: That the attached transcript of I page(s) was prepared by and in this office from the record on file, of which it purports to be a copy, and that it is full, true and correct. IN WITNESS WHEREOF, I execute this certificate and affix the Great Seal of the State of California this day of JUN 17 2009 In 'S.- zm-e�� DEBRA BOWEN Secretary of State Sec /State Form CE Y08 (,REV 112007) y%^ OSP 08 111444 State of California Secretary of State n STATEMENT OF INFORMATION T (Domestic Nonprofit, Credit Union and Consumer Cooperative Corporations) Filing Fee: $20.00. If amendment, see instructions. IMPORTANT— READ INSTRUCTIONS BEFORE COMPLETING THIS FORM ,� 09-684685 FILED °t tiithedfleeoftheSecretaryotState of the State of California m JUN 0 8 2003 i (rr' � This Space For Filing Use Only 1. CORPORATE NAME (Please do not alter if name is prep(inted.) C1800935 PB NCD BIRTH CHOICE OF TEMECULA, INC. 27488 ENTERPRISE CIRCLE WEST #4 TEMECULA CA 92590 DUE DATE: 08 -31 -09 COMPLETE PRINCIPAL OFFICE ADDRESS (Do not abbreviate the name of the city. Item 2 cannot be a P.O. Box.) 2 ST�jEET ADDRESS OF PRINCIPAL OFFICE IN CALIFORNIA. IF ANY CITY STATE ZIP CODE ��Lf�C�Lif OffO '^ a p 5/y'/m-M ejAea W rI / ev CA f' 3. MAILING ADDRESS OF THE CORPORATION, IF REQUIRED I CITY STATE ZIP CODE Ad�g NAMES AND COMPLETE ADDRESSES OF THE FOLLOWING OFFICERS (The corporation must have these three officers. A comparable fil for the specific officer may be added; however, the preprinted titles on this form must not be altered.) 4. CHIEF EXECUTIVE OFFICER/ ADDRESS CITY STATE ZIP CODE �L � /�rLC Y�1 Z C'�N�S (dP4V T� it 6ww 5. SECRETARY/ ADDRESS CITY STATE ZIPCODE °4Zsc\ E. C EF FINANCIAL OFFICER/ ADDRESS CITY STATE ZIP CODE �.K DAMN X39 �io�w (lA45 ;» AGENT FOR SERVICE OF PROCESS (If the agent is an individual, the agent must reside in California and Item a must be completed with a Califr street address (a P.O- Box address is not acceptable). If the agent is another corporation, the agent must have on file with the California Secretary of Sta certificate pursuant to Corporations Code section 1505 and Item 6 must be left blank.) 7. NAME OF AGENT FOR SERVICE F PROCESS i2Tt ✓u ✓ff�4: H. STREET ADDRESS OF AGENT FOR SERVICE OF PROCESS IN CALIFr ?RNIA, IF AN INDIVIDUAL CITY STATE ZIP CODE /1 r AJ Ef CA O DAVIS -- STIRLING COMMON INTEREST DEVELOPMENT ACT (California Civil Code sectio 1350, et seq.) e. ❑ Check here if the corporation is an association formed to manage a common interest development under the is- Stirling Common IME Development Act and proceed to Items 10, 11 and 12. ti /4.. �OF NOTE: Corporations formed to manage a common interest development must also file a Statement by Common a Association IF SI -CID) as required by California Civil Code section 1363.6. Please see instructions on the reverse side 10. ADDRESS OF BUSINESS OR CORPORATE OFFICE OF THE ASSOCIATION, IF ANY CITY • ODE 11. FRONT STREET AND NEAREST CROSS STREET FOR THE PHYSICAL LOCATION OF THE COMMON INTEREST DEVEL M (t GIT ZIP CODE is Q the site of the common interest development.) �A r (Complete if the business or corporate office not on � 12. NAME AND ADDRESS OF ASSOCIATION'S MANAGING AGENT, IF ANY CITY STATE ZIP CODE 13. THE INFORMATION TAINED HEREIN IS TRUE AND CORRECT _ DATE PE10RINT NAME OF PERSON COMPLETING FORM TITLE G6rIGNATURE on CITY OF TEMECULA AUG 2 7 2010 FISCAL YEAR 20106-11 COMMUNITY SERVICE FUNDING PROGRANUU"QJ0Ar ly (Please Print or Type) 2010 -1.1 Program Submission Deadline: Wednesday, September 15, 2010 (original, plus one) PROJECT INFORMATION Amount Requested: $----!L 000 (Maximum allowable $5,000) Project Name:_ Power Hour & Project Learn Project Start Date: October 2010 Project End Date: October 2011 ORGANIZATION INFORMATION I Name of Organization: Boys & Girls Clubs of Southwest County Contact Name: Rhonda Guaderrama Title /Position: Director of Operations Mailing Address: P.Q. Box 892349, Temecula, CA 92589 Telephone: (951) 699 -1526 Year Organization Founded: 1990 Number of Paid Staff: 60 400 Number of Volunteers: GeographicArea(s)Served- Southwest Riverside County (Temecula, Murrieta, Lake Elsinore & French Valley) Is this organization incorporated in California as a non - profit organization? Yes X No _ Effective Date: September 1990 If "yes" (Must provide a copy of your statement of non - profit status from the State of California): Date of incorporation as a non - profit: September 10, 1990 Federal identification number: 33- 0475756 State identification number: 91037689 If "no" Name of sponsoring organization: Federal identification number: State identification number: This application has been authorized by the organization's: Executive Committee x Board of Directors Members -at -Large _ Application — Page I a I FINANCIAL STA'I'F.MENTS PLEASE ATTACH COPIES OF THE CURRENT BUDGET OF THE ORGANIZATION AND FINANCIAL STATEMENTS (BALANCE STATEMENT AND INCOME STATEMENT). It does not require a CPA's audit, but please submit if available. I MISSION STATEMENT I Briefly describe the goals and objectives of your organization and community services it provides. Describe the ways your organization meets the criteria listed on page 2 of the CS Funding Policy. The mission of the Boys & Girls Clubs of Southwest County (BGCSWC) is to inspire and enable all youth to realize their full potential.as productive, responsible and caring citizens by providing stimulating and challenging programs through interaction with dedicated, caring people. For 20 years, the BGCSWC has been at the forefront of youth development working with young people from all economic, social and family circumstances in support of the agency's mission. The Club has become known as "The Positive Place for Kids" because it offers a variety of programs and activities that provide youth personal growth experiences in a safe and structured environment. The BGCSWC is more than just a place for youth to play; it is also a place for learning through exploration and discovery. Children from all backgrounds participate in our programs. 55% are from diverse ethnic, cultural and racial backgrounds; 44% are from economically disadvantaged families and 28% are from single parent households. The organization offers financial scholarships to those families that are unable to obtain affordable child care. In fact, more than 40% of Club families are on some type of financial assistance, most commonly in the form of transportation scholarships. The Boys and Girls Clubs of Southwest County provides an essential service for the many commuting parents that need to leave for work early in the morning and do not return until late in the day. The Boys & Girls Clubs of Southwest County provides transportation to and from the Temecula schools for grades 1st through 8th. The organization has a large fleet of school buses and vans to offer the most updated and safe transportation possible, provided by licensed, certified drivers. The Boys & Girls Club is the only organization offering these services to middle school aged children and one of only a few that provides this service to elementary aged children. Application - Page 2 I PROJECT DESCRIPTION How will your organization use the funding awarded? Describe the project, project objectives, those served, area serviced, and number of volunteers involved. Be specific. Include equipment or services that would be purchased and why. Include a detailed budget and a schedule of significant activities related to this project. You may attach a maximum of one double- spaced typewritten page of information. (Please type or print legibly.) The Boys & Girls Clubs of Southwest County is respectfully requesting a $5,000 grant to continue to support the Power Hour /Project Learn after school programs. These programs, developed by Boys & Girls Clubs of America, supports academic enhancement during out of school hours. Research has showy: that low achieving students spend most of their non - school hours involved ir: activities that have little benefit to them in the classroom, whereas high achieving students participate in more activities that reinforce skills and knowledge they are learning in school. The goal of the Power Hour program is to assist students with their homework, provide them help with research for homework assignments and support them with adult tutors who can guide them and assist them with academic questions. The Club offers homework help and tutoring five to six hours weekly; Monday through Thursday. The Clubs state -of- the -art computer labs are open to provide supervised internet assistance and computer usage for Club members who need computer or Internet access to complete assignments. The combination of homework help, computer access and the encouragement of staff, the kids who participate in Power Hour /Project Learn get an academic edge. Research shows that the benefits are threefold: academic, behavioral and social. Project Learn is an educational enhancement program that incorporates academically enriching activities into the Club's daily schedule. These activities include creative writing, Web site development, plays and field trips. In the Around the World component of Project Learn, a different Country of the world is featured each month which gives youth the opportunity to explore the culture, recreation, geography and government of the selected country. This year, the Around the World component was so successful that Boys & Girls Clubs of America recognized us with the Gold Level Youth for Unity Leadership Award. CONTINUED Application - Page 3 Proiect Description - Continued Now, more than ever, our youth need academic support during after school hours. Many are failing to learn basic skills during the school day. We are living in difficult times and, as our families struggle, it is even more important for our youth to get the academic support that they need. The Boys & Girls Clubs of Southwest County provides a critical safety net for these children and their families. The Boys & Girls Clubs of Southwest County is prepared to respond to the challenges faced by our youth and help them succeed academically. The Power Hour and Project Learn programs are designed to provide academic support and enrichment early on, setting the stage for academic success and ensuring our youth become lifelong learners. Parent Involvement and School Collaboration: The BGCSWC has strong partnership relationships with the Temecula, Mumeta and Lake Elsinore School Districts. Our staff have worked hard to build strong relationships with parents, school Administrators, teachers and the PTA's to ensure educational continuity for Club members and to promote a strong partnership with the Boys & Girls Clubs. These relationships include open communication and mutual support. These partnerships help us to ensure that our members are successful in school. Incentives, Recognition and GoalSefting: Members and staff use recognition and goal setting to recognize effort, achievement and improvement on a daily, weekly and monthly basis. As an incentive, we offer our members the opportunity to participate in special events and field trips when the complete their assignments consistently and improve their academic performance. We also chart each youth's progress so that excellence in technology, academics, the arts and world study can be recognized. Grant funds will be used to provide computer supplies and educational software programs, educational teaching supplies, school supplies, rewards and incentives, guest speakers and other program supplies. Funds will be divided among the two Temecula Club sites to support their Power Hour /Project Learn programs. I PAST 1' o un, BENUITS If your organization received City of Temecula funding in the previous year, please explain and show how Temecula residents benefited. The grant money we received from the City of Temecula last year was critical to the success of the Power Hour /Project Learn programs. The organization was able to purchase the supplies needed to effectively run the program. Most importantly, we were able to provide the children with much needed school supplies, as well as rewards and recognition for their participation. In these difficult economic times, the grant money went a long way to ensure that the children received the support and supplies they needed to be academically successful. The programs were run at both the Pechanga Great Oak Clubhouse and the Old Town Temecula Clubhouse, with more than 500 children participating over the course of the year. For the second year, we tracked academic progress and school attendance through report cards and continued to see improvement in both. The Around the World component remains a favorite with the children and was so successful this year, that our organization was recognized by Boys & Girls Clubs of America for our efforts. The children learned about different countries and their cultures through creative writing assignments, visual maps, Internet research and, of course, a party that incorporated the food of that country. The children truly felt like they were going "Around the World." Other components of Project Learn included a field trip to the Discovery Center, designing a Club newsletter and Web design. The Power Hour programs allows the children to complete their homework before going home, giving parents and kids the chance to spend more quality time together in the evening. The Boys & Girls Clubs of Southwest County believes that grant funding for these programs helped to give Temecula students much needed support and enrichment and also helped enhance the quality of life for those families. Application - Page 4 i C) SIGNATURE PAGE We hereby certify the information contained in this application is true to the best of our knowledge and belief. PREPARED BY: Rhonda Guaderrama, Director of Operations ,�7 NAME and TITLE (Please Print or Type) PRESIDENT or AUTHORIZED OFF[ SIGNATURE: ORGANIZATION NA MAILING ADDRESS TELEPHONE: DATED THIS Maryann Edwards, CEO NAME and TITLE (Please Pi or Type) Boys & Girls Clubs of Southwest County P.O. Box 892349, Temecula, CA 92589 (951) 699 -1526 20th of August 2010. (Date) (Month) BE SURE TO INCLUDE THE ORIGINAL PLUS ONE COPY AND SUBMIT TO: Mail Completed Applications to: City of Temecula Community Service Funding Program Attn: Judy McNabb Post Office Box 9033 Temecula, CA 92589 -9033 Or Deliver in Person to: City of Temecula Community Service Funding Program Attn: Judy McNabb 43200 Business Park Drive Temecula, CA 92590 Application -- Page 5 - 0 la� CITY 0f TFMFrv1A BOYS & GHMS CLUi3s AUG 2 7 2010 OF SOUTHWEST COUNTY August 23, 2010 P.O. Box 892349 FINANCE DEPT. Temecula CA www.becswc.org .org Old Town Temecula City of Temecula Clubhouse Community Service Funding Program 28790 Pujol Street Temecula, CA 92590 Attn: Judy McNabb - Tel 951699 -1526 43200 Business Park Drive Pechanga Grad Oak Temecula, CA 92590 Clubhouse 31465 Via Cordoba Temecula, CA 92592 Tel 951695 -0181 Munieta Clubhouse Dear Ms. McNabb, 40550 Calilomia Oaks Road Munieta, CA 92562 Tel 951.6984838 Please find enclosed our CSF application for Power Hour our /Project Learn Alberhill Ranch Clubhouse programs. 3711 Nichols Road Lake Elsinore, CA 92530 Thank you for your consideration of our application and your assistance Tel 951- 2454499 With this process. dffil„s AMY MINNIEAR i Board Chair We appreciate all that the City of Temecula does to TED EN make a difference in the lives of children. Fkd 1100-Chaff ADRIA POINDEXTER Secretary Sincerely, GREG PRUDHOMME � MARY ARYAN N EDWAROS ,♦� Chief Executive Officer Rhonda Guaderrama Board wDl Director of Operations NATHAN GARIN TERRY GILMORE' BRUCE KESSMAN JEFF KURTZ BRENT LOWE CRYSTAL MAGON SCOTT MCINTIRE SILVIA PROVENZANO KAREN ROBERTS WIM SELDERS MIKE SHIRLEY - DIANE SITAR JOAN SPARKMAN VIETTRAN TIM URE ALAN WINKELSTEIN' KIMJERA WHITTINGTON 'Past Chair The Positive Place For Kids The Boys & Girts Clubs of Southwest County is a non -profit organization qualifying for tax - exempt status under Section 501(c) (3) of the Internal Revenue Code. Tax ID # 33- 0475756 no V... Wryel Vleln MIWyi xmwpmW BOYS AND GIRLS CLUBS OF SOUTHWEST COUNTY (A California Public Benefit Corporation) AUDIT REPORT For the Year Ended December 31, 2009 BOYS AND GIRLS CLUBS OF SOUTHWEST COUNTY (A CALIFORNIA PUBLIC BENEFIT CORPORATION) AUDIT REPORT For the Year Ended December 31, 2009 Table of Contents FINANCIAL SECTION EASe IndependentAuditors' Report ........ ....................................................................................................... ................. I BASIC FINANCIAL STATEMENTS Statement of Financial Position .............. ............................._ .......... ........... ............................... Statementof Activities .............................................................................................................. ..............................2 Statementof Cash Flows ............. ............................... 3 ..............................: .......... ....................... ............................... Statementof Functional Expenses ............................................................................................ ..............................4 ..............................5 Notes. to Financial Statements 6 Board of Directors Boys and Girls Clubs of Southwest County Temecula, California INDEPENDENT AUDITORS' REPORT We have audited the accompanying statement of financial position of Boys and Girls Clubs of SOUthWe4t County (A California Public Benefit Corporation) as of December 31, 2009, and the related statements of activities, cash flows, and functional expenses for the year then ended. These financial statements are the responsibility of Boys and Girls Clubs of Southwest County's management. Our responsibility is to express an opinion on these financial statements based on our audit_ We conducted our audit in accordance with auditing standards generally accepted in the United States of America. Those standards require that we plan and perform the audit to obtain reasonable assurance about whether the financial statements are free of material misstatement. An audit includes consideration of internal control over financial reporting as a basis for designing audit procedures that are appropriate in the circumstances, but not for the purpose of expressing an opinion on the effectiveness of the Club's internal control over financial reporting. Accordingly, we express no such opinion. An audit also includes examining, on a test basis, evidence supporting the anunmis and disclosures in the financial statements, assessing the accounting principles used and significant estimates made by management, as well as evaluating the overall financial statement presentation. We believe that our audit provides a reasonable basis for our opinion. In our opinion, the financial statements referred to above present fairly, in all material respects, the financial position of Boys and Girls Clubs of Southwest County as of December 31, 2009, and the change in its net assets and its cash flows for the year then ended in conformity with accounting principles generally accepted in the United States of America. Murrieta, California June 22, 2010' I BOYS AND GIRLS CLUBS OF SOUTHWEST COUNTY Statement of Financial Position December 31, 2009 ASSETS Current Assets Cash Investments Pledges receivable (Net of uncollectible amounts) Grants receivable Prepaid expenses Total Current Assets Fixed Assets (Net of accumulated depreciation) Total Capital Assets TOTAL ASSETS LIABILITIES AND NET ASSETS LIABILITIES Current Liabilities Accounts payable Accrued expenses Line of credit Vehicle loans - current portion Notes payable - current portion Total Current Liabilities Long Term Liabilities Vehicle loan Notes. payable Total Long Term Liabilities 'TOTAL LIABILITIES NET ASSETS $ 1,969,723 20,229 1,583,877 46,104 14,336 3,634,269 4,671,649 4,671,649 $ 8,305,918 $ 104,536 70,321 407,259 12,573 25,748 620,437 3,275 46,430 49,705 670,142 . Unrestricted 3,621,067 Temporarily restricted 4,014,709 TOTAL NET ASSETS 7,635,776 TOTAL LIABILITIES AND NET ASSETS $ 8,305,918 See accompanying notes to financial statements. 2 BOYS AND GIRLS CLUBS OF SOUTHWEST COUNTY Statement of Activities For the Year Ended December 31, 2009 REVENUES, GAINS, AND OTHER SUPPORT Membership income Pledge income Donations Indirect contributions (United Way) Grant income Fundraiser income Program service fees Interest income MiscellaneouS income Net assets released from restrictions: Pledge income TOTAL REVENUES, GAINS, AND OTHER SUPPORT EXPENSES Program services Supporting services Management and general Fundraising TOTAL EXPENSES - CHANGE IN NET ASSETS NET ASSETS AT BEGINNING OE YEAR NET ASSETS AT END OF YEAR See accompanying notes to financial statements. Unrestricted Temporarily Restricted _ Total $ 60,417 $ - $ 60,417 - 335,645 335,645 135,422 - 135,422 3,207 - 3,207 735,322 - 735,322 397,914 - 397,914 1,015,906 - 1,015,906 8,807 - 8,807 33,919 - 33,919 2,083,725 (2,083,725). - 4,474,639 (1,748,080) 2,726,559 1,897,601 - 1,897,601 545,321 545,321 219,786 - 219,786 2,662,708 - 2,662,708 1,811,931 (1,748,080) 63,851 1,809,136 5,762,789 7,571,925 $ 3,621,067 $ 4,014,709 $ 7,635,776 3 BOYS AND GIRLS CLUBS OF SOUTHWEST COUNTY Statement of Cash Flows For the Year Ended December 31, 2009 CASH FLOWS FROM OPERATING ACTIVITIES Change in Net Assets .Adjustments to reconcile increase (decrease) in net assets to net cash provided (used) by operating activities Depreciation expense Unrealized (gain) /loss on investments Donated common stock (Increase) decrease in: Inventories Pledges receivable Grants receivable Prepaid expenses InCrea9e (Derrease) in: Accounts payable Accrued expenses N E'T CAST -1 PROVIDED BY OI'ERATI NG ACTIVITIES CASH FLOWS FROM INVESTING ACTIVITIES Purchase of fixed assets NET CASH USED BY INVESTING ACTIVITIES CASH FLOWS FROM FINANCING ACTIVITIES Net proceeds from credit line.. Payments on notes payable Payments on vehicle loans N13TCASH PROVIDED 13Y FINANCING ACTIVITIES NEFINCREASE (DItCREASE) IN CASH BEGINNING CASH ENDING CASH UP I ER REQUIRED INFORMATION: .Interest Paid See accompanying notes to financial statements. 4 $ 63,851 141,692 (67) (10,105) 10,640 1,166,088 (46,104) 236 (55,460) 13,981 1,284,749 (111,580) (111,580) 107,259' (23,076) (14,494) 69,689 1,242,858 726,865 $ 1,969,723 $ 26,560 BOYS AND GIRLS CLUBS OF SOUTHWEST COUNTY Statement of Functional Expenses For the Year Ended December 31, 2009 EXPENSES Advertising Awards and recognition Bank charges Bad debt expense Credit card fees Community contribution Depreciation Dues and subscriptions Fundraising events Insurance Interest expense Internet services Licenses and fees Office supplies Pay no II taxes Postage and delivery Printing Professional fees Program events Rent Repair and maintenance Retirement plan Salaries Security.... Seminars - Staff uniforms Taxes Telephone Transportation Utilities Unrealized (gains) /losses i Program Services Supporting Services Management Youth and Total Services General Fundraising Expenditures, 1,0(10 $ 14,668 1,382 10,986 2,159 99,184 3,140 152,580 5,259 12,687 1,745 13,599 88,653 1,447 10,883 15,938 123,072 43,206 51,043 1,272 1,001,421 4,986 1,768 1,581 23,428 $ 18,334 42,508 15,333 24,839 21,301 12,898 8,772 5,334 21,105 22,570 19,996 2,573 13,180 232,619 11,139 166,456 1,361 51,969 1,344 6,081 - 22,718 28,220 _ 164,008 15,158 45,872 _ (67) $ 24,428 14,668 1,382 18,334 10,986 2,159 141,692 18,473 166,456 177,419 26,560 12,687 1,745 27,858 97,425 6,781 31,988 38,508 123,072 63,202 53,616 14,452 1,286,009 4,986 12,907 1,581 7,425 50,938 179,166 45,872 (67) Totals $ 1,897,601 $ 545,321 $ 219,786 $ 2,662,708 See accompanying notes to financial statements. 5 BOYS AND GIRLS CLUBS OF SOUTHWEST COUNTY Notes to Financial Statements December 31, 2009 0 NOTE 1— NATURE OF ACTIVITIES AND SIGNIFICANT ACCOUNTING POLICIES A. Nature of Activities The Boys and Girls Clubs of Southwest County (the "Club ") was established in August 1990. The Club is a member of the Boys and Girls Clubs of America chartering organization and provides services to youth, the objectives of which arc to faster and to promote the physical, social, and educational, vocational, and character development of boys and girls in or near Southwest Riverside County, California. Major classes of programs include after school care, day camp and youth sports programs. The Club operates facilities in Temecula, Murriela and Lake Elsinore The Club is funded through membership dues, performance of services for the City of Temecula (the "City ") and sponsorships from businesses and the general public in conjunction with its fundraising efforts. 13. Basis of Presentation The Club's policy is to prepare its financial statements on the accrual basis of accounting. This means that revenues are recorded when earned, rather than when received, and expenses are recorded when incurred, not when they are paid. C. Recognition of Revenue Revenues are received primarily from pledge income, fundraising, before direct expenses, and program service fees. Membership dues are recorded as revenue in the year received. Management believes that recognizing membership dues pro -rata on a monthly basis would have an immaterial effect on the Club's financial statements. Program fees represent fees related to member participation in specific day camp, youth sports, before and after school and transportation programs are recorded as revenue in the year received. Fund raising revenues, which consist of the "Our Kids Rock" dinner, golf tournament and annual giving campaign are recorded when the event occurs. Contributions received are recorded as unrestricted, temporarily restricted, or permanently restricted support depending on the existence and /or nature of any donor restrictions. The Club has not received any contributions with donor- imposed restrictions that would result in permanently restricted net assets. BOYS AND GIRLS CLUBS OF SOUTHWEST COUNTY Notes to Financial Statements December 31, 2009 NOTE 1— NATURE OF ACTIVITIES AND SIGNIFICANT ACCOUNTING POLICIES continued C. Recognition of Revenue (continued) Unrestricted: These generally result from revenues generated by receiving unrestricted contributions, providing services, and receiving interest from investments less expenses incurred in providing program related services, raising contributions and performing administrative functions. Temporarily Restricted: The Club reports gifts of cash and other assets as temporarily restricted support when they are received with donor stipulations that limit the use of the donated assets. When the donor restriction expires, i.e. the stipulated time restriction ends or the purpose of the restriction is accomplished, temporarily restricted net assets are reclassified to unrestricted net assets and reported in the Statement of Activities as net assets released from restrictions. D. Donated Services The Club's accounting policy for donated materials and equipment is to record these items as contributions at the estimated fair market value as stated by the donor at the date they are received. Contributions of donated services that create or enhance non financial assets or that require specialized skills, are provided by individuals possessing those skills, and would typically need to be Purchased if not provided by donation, are recorded at the fair values in the period received. Numerous hours of volunteer services were performed on behalf of the Club during the year ended December 31, 2009 in support of its programs. Since these services do not meet the criteria specified in Statement of Financial Accounting Standards No. 116, Accuunthlg %r Cnutributiais Received and Contributions Mack, for recognizing a monetary value of these services, no such value has been assigned to these services in the Club's financial statements. E. Property a_ nd Equipment Property with a cost of $1,000 or greater is capitalized and recorded as additions to property and equipment. Donated property is recorded at the estimated fair value at the date of the gift. Buildings and equipment are depreciated using the straight -line method over and estimated useful life of forty years and ten years, respectively. Maintenance and repair costs are charged to expense as incurred. F. Cash and Cash Equivalents The Club considers cash oil hand and certificates of deposit with maturity dates of three months or less at the dale of investment to be cash and cash equivalents. BOYS AND GIRLS CLUBS OF SOUTHWEST COUNTY Notes to Financial Statements December 31, 2009 NOTE I - NATURE OF ACTIVITIES AND SIGNIFICANT ACCOUNTING POLICIES (continued) G. Investments Investments are recorded at fair value. Unrealized gains and losses are recorded as increases or decreases on the statement of activities. H. Concentration of Risk The Club maintains its cash in various accounts at several financial institutions. At various times during the year, the amount on deposit with a single financial institution may exceed federal depository insurance limits. AI December 31, 2009, the Club had balances on deposit approximating $1,134,000 in excess of such limits. Management does not believe that this represents a significant risk to the Club. 1. Estimates The preparation of financial statements in conformity with generally accepted accounting principles requires management to make estimates and assumptions that affect certain reported amounts and disclosures. Accordingly, actual results could differ from those estimates. J. Income Taxes The Club is a non - profit public benefit corporation organized under the laws of California and, as such, is exempt from federal and state income taxes under Section 501(c)(3) of the Internal Revenue Code and con'esponding state statutes. The Club is classified as other than a "private foundation- by the IRS. Accordingly, no provision for income taxes has been provided for in the financial statements. K. Fair Value of Financial hishvmenls The following methods and assumptions were used by the Club in estimating its fair value disclosures for financial instruments: Cash and accounts payable as reported in the balance sheet approximate fair value because of the short maturities of those instruments. L. Functionall?xpenses The costs of providing the various programs and other activities have been summarized on a functional basis in the combining statement of activities. Accordingly, certain costs have been allocated among the programs and supporting services based on the benefits derived. ♦- 1 Y BOYS AND GIRLS CLUBS OF SOUTHWEST COUNTY Notes to Financial Statements December 31, 2009 NOTE 2— INVESTMENTS Investments consist of stock donated to the Club. The following discloses the aggregate carrying amount of investmen is by major types at December 31, 2009. Stock - Auriga Laboratories, Inc. Stock - Goodrich Pete Corporation Stock - Biogold Fuels Corporation Total investments at fair value Investment Return: Net unrealized gain Net unrealized loss NOTE 3 — CAPITAL ASSETS $ 435 (368) $ 67 Land, building and equipment as of December 31, 2009 consisted of the following: Capital assets not being depreciated: Land Work in progress Total capital assets not being depreciated Capital assets being depreciated: Buildings Furniture, equipment & imprnvemmnts Vehicles Total capital assets being depreciated Total accumulated depreciation Total capital assets being depreciated, net Total capital assets, nel $ 20,229 Balancv, l estimated Fair Value Shares Market Price December 31, 2009 1,450,756 0.0007 $ 1,016 400 24.35 9,740 1,052,632 0.0090 9,474 $ 435 (368) $ 67 Land, building and equipment as of December 31, 2009 consisted of the following: Capital assets not being depreciated: Land Work in progress Total capital assets not being depreciated Capital assets being depreciated: Buildings Furniture, equipment & imprnvemmnts Vehicles Total capital assets being depreciated Total accumulated depreciation Total capital assets being depreciated, net Total capital assets, nel $ 20,229 Balancv, Balance, January 1, 2009 Additions Decreases December 31, 2009 1,465,000 $ - $ - $ 1,465,000 473,823. 81,097 - 554,920 1;938,823 81,097 - 2,019,920 2,826,048 - - 2,826,1148. 362,861 1,444 - 364,305 311,612 29,039 (17,594) 323,057 3,500,521 30,483 (17,594) 3,513,410 (737,583) (141.,692) 17,594 (861,681) 2,762,938 (111,209) - 2,651,729 $ 4,701,761 $ (30,112) $ - $ 4,671.,649 9 BOYS AND GIRLS CLUBS OF SOUTHWEST COUNTY Notes to Financial Statements December 31, 2009 NOTE 4 —LINE OF CREDIT The organization has a line of credit from Pacific Western Bank available for its use. The line of credit is as follows: Pacific Western Bank Initial rate: Credit limit: Loan date: Maturity elate: Balance at year end December 31, 2009 4.20'% $ 500,000 April 13, 2009 Apql 17, 2011 $ 407,259 NOTE 5 — NOTES PAYABLE Murrieta Building During 2002 the Club borrowed $127,780 to purchase a building. Monthly payments are $1,381, with a variable interest rate through September 2012. The note is secured by the purchased building. December 31, 2009 Total loan balance $ - 42,096 Less current portion (15,558) Long -term portion $ 26,538 Future maturities of loan: .. YoarendingDecember3l, Payment 2010 $ '15,558 2011 15,647 2012 . 10,891 Total $ 42,096 M BOYS AND GIRLS CLUBS OF SOUTHWEST COUNTY Notes to Financial Statements December 31, 2009 NOTE 5— NOTES PAYABLE (continued) Puiol Land During 2007 the Club borrowed $50,258 to purchase land. Monthly payments are $1,016, including interest at a rate of 7.75 percent through September 2012. 'total loan balance Less current portion Long -term portion December 31, 2009 $ 30,082 (10,190) $ 19,892 Future maturities of loan: Year ending December 31, Payment .2010 $ 10,190 2011 11,034 2012 8,858 Total $ 30,082 NOTE 6 — VEHICLE LOANS The organization has three car loans at the end of the year. These loans have interest rate ranging from 8.51%, to 8.8 %. Future maturities of vehicle loans: Year ending December 31, Payment 2010 $ 12,573 2011 3,275 Total $ .15,848 11 BOYS AND GIRLS CLUBS OF SOUTHWEST COUNTY Notes to Financial Statements December 31, 2009 NOTE 7- LEASES The Club began . leasing the land fur its Great Oak Facility under a 40 -year lease from the City of Temecula. The term of this lease agreement extends through June 30, 2046 with an annual lease payment of $L Statement of Financial Accounting Standards No. 116 AccouutingJor Contributions Received and Contributions Made, requires recognition at fair value of such discounted lease costs. Management estimated that the fair value of such discounted lease costs is approximately $42,000 per year. This amount is included in both revenues and expenses on the statement of activities. NOTE 8 — EMPLOYEE RETIREMENT PLAN The Club maintains a defined contribution retirement plan conforming to the provisions of Section 401(k) of the Internal Revenue Code for its salaried employees. Such employees become eligible to participate in the Plan after reaching age 21 and accumulating 1,000 hours of service during the year with the Club. The Club matches employee contributions to a maximum of five percent of each employee's eligible compensation, as defined in the flan, and may also make discretionary contributions. Employee contributions are fully vested at all times. lmployer matching and discretionary contributions vest ratably over a five -year period. If an employee terminates employment prior to age 65, the distribution from employer matching and discretionary accounts is limited to the vested portion based upon years of eligible service. The Club's matching contributions were approximately $14,500 for the year ended December 31, 2009.. NOTE 9 —PLEDGE INCOME Contributions are recognized when the donor makes a promise to give to the Organization that is, in substance, unconditional. In 2005, the organization established a "Capital Campaign' which was created to fund a new facility in the City of Temecula The pledges amounted to $323,572 for the year ended December 31, 2009. In 2009, the Organization established a "Sustainability Campaign" which was created to fund another new facility in the City of Temecula. The pledges amounted to $12,073 for the year ended December 31, 2009. NOTE 10 — PLEDGES RECEIVABLE Pledges receivable are recorded when the donor makes a promise to give to the organization. The amount of the pledges receivable at December 31, 2009 amounted to $1,633,877. The Club estimates an allowance for uncollectible pledges based on management's consideration of donors, historical activity and economic conditions. The allowance for uncollectible pledges amounted to $50,000 at December 31, 2009. 12 BOYS AND GIRLS CLUBS OF SOUTHWEST COUNTY Notes to Financial Statements December 31, 2009 NOTE 11 — CONTINGENCIES Grant activities are subject to monitoring and review by the respective grantor. Asa result of Such review, costs may be questioned and subsequently disallowed. Management has not been notified of any Such disallowance. NOTE 12 — TEMPORARILY RESTRICTED Temporarily restricted net assets are comprised of file following: Capital campaign — use restriction Suslainability NOTE 13 — FUNDRAISING EVENTS The Club conducted the following fundraising events: December 31,2009 $ 4,004,269 10,440 $ 4,014,709 NOTE 14— SUBSEQUENT EVENTS Events subsequent to December 31, 2009 have been evaluated through June 22, 2010, the date at which the Organization's audited financial statements were available to be issued. No events requiring disclosures have occurred through this date. If events requiring disclosures have occurred between the balance sheet date and the date of the financial statements were available to be issued they would be disclosed here. 13 December 31, 2009 Revenues Expenses Net Auction $ 286,471 $ 125,327 $ 161,144 Golf Tournament 27,870 7,278 20,592 Field of Dreams 44,163 6,226 37,937 Other 39,410 27,625 11,785 " $ 397,914 $ 166,456 $ 231,458 NOTE 14— SUBSEQUENT EVENTS Events subsequent to December 31, 2009 have been evaluated through June 22, 2010, the date at which the Organization's audited financial statements were available to be issued. No events requiring disclosures have occurred through this date. 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O 8 8 00 8000 S S H O$ O$ S S A IV 0 W coo b ateC m W Q C M o n (p ,c. 8 0 S E o W b G C lz Internal Revenue Service Date: November 22, 2002 Boys & Girls Club of Southwest County % Donald K Engdahl 28790 Pujol Street Temecula, CA 92590 -2828 Dear Sir or Madam: Department of the Treasury P. O. Box 2508 Cincinnati, OH 45201 Person to Contact: ,. Stephanie Broach -Camp 31 -04022 Customer Service Specialist Toll Free Telephone Number: 8:00 a.m. to 6.30 p.m. EST 877- 829 -5500 Fax Number 513 - 263 -3756 Federal Identification Number: 33- 0475756 This is in response to the amendment to your organization's Articles of Incorporation filed with the state on March 7, 2001. We have updated our records to reflect the name change as indicated above. Our records indicate that a determination letter issued in July 1996 granted your organization exemption from federal income tax under section 501(c)(3) of the Internal Revenue Code. That letter is still in effect. Based on information subsequently submitted, we classified your organization as one that is not a private foundation within the meaning of section 509(a) of the Code because it is an organization described in sections 509(a)(1) and 170(b)(1)(A)(vi). This classification was based on the assumption that your organization's operations would continue as stated in the application. If your organization's sources of support, or its character, method of operations, or purposes have changed, please let us know so we can consider the effect of the change on the exempt status and foundation status of your organization. Your organization is required to file Form 990, Return of Organization Exempt from Income Tax, only if its gross receipts each year are normally more than $25,000. If a return is required, it must be filed by the 151h day of the fifth month after the end of the organization's annual accounting period. The law imposes a penalty of $20a,day, up to a maximum of $10,000, when a return is filed late, unless there is reasonable cause for the delay. All exempt organizations (unless specifically excluded) are liable for taxes under the Federal Insurance Contributions Act (social security taxes) on remuneration of $100 or more paid to each employee during a calendar year. Your organization is not liable for the tax imposed under the Federal Unemployment Tax Act (FUTA). Organizations that are not private foundations are not subject to the excise taxes under Chapter 42 of the Code. However, these organizations are not automatically exempt from other federal excise taxes. Donors may deduct contributions to your organization as provided in section 170 of the Code. Bequests, legacies, devises, transfers, or gifts to your organization or for its use are deductible for federal estate and gift tax purposes if they meet the applicable provisions of sections 2055, 2106, and 2522 of the Code. Goys : Girls Club of Southwest County ;i3- Q� :757ih Your organization is riot required to file federal income tax returns unless it is subject to the tax on unrelated business income under section 511 of the Code. If your organization is subject to this tax, it must file an income tax return on the Form 990-T, Exempt Organization Business Income fax Return in this letter, we are not determining whether any of your organization's present or proposed activities are unrelated trade or business as defined in section 513 of the Code. The law requires you to make your organization's annual return available for public inspection w thout charge for throe years after the due date of the return. You are also required to make available for public irispecnon a copy of your organization's exemption application, any supporting documents and ino exemption tatter to any Individual who requests such documents In person or in writing. You care charge only a reasonable fee for reproduction and actual postage costs for the copied materials. The law does not require you to provide copies of public inspection documents that are widely available, such as by posting there on the Internet (World Wide Web). You may be liable for a penalty of $20 a day for each day you do not make these documents available for public inspection (up to a maximum of 510,(00 in the case of an annual return). Because this letter could help resolve any questions about your organrzation's exempt status and /oundsrbari sinus, you shou:d keep it with the organization's permanent records it you have any questions, please call us at the telephone number shown in the heading of this fetter fhid letter alfurns your organization's exempt status Sincorely, John E_ Ricketts, Director, FE/GE Customer Account Services r - - t� CITYOFTEMECUTA- SEP 13 2010 FISCAL YEAR 2010-11 Fi NAKE DEPT. COMMUNITY SERVICE FUNDING PROGRAM APPLICATION (Please Prinfor Type) R PROJECT INFORMATION Amount R:este : $ ��� • "V Project Name: 7 Project Start Date: / �Q1 Proiect End Dati allowable $5,000) ao1 I ORGANIZATION INFORMATION I Name of Contact Number of Paid Geographic Are, i+LlIL /�7M "A TAX A i Y.-Jr, Orga Is this organization incorporated in California as a non - profit organization? Yes � No Effective Date: j j ti 5 if -yes- (Must provide a copy of your statement of non - profit status from the State of California): Date of incorporation as a non- pr9ft- / O Federal identification number: n. a State identification n If "no ": Name of sponsoring Federal identification number: State identification number. This application has been authorized by the organization's: Executive Committee Board of Directors Application — Page Members -at -Large • `. Descri ioo.and Mission of the Or assizati Camp del Corazon is a non - profit organization that provides a free-of-charge, medically supervised, residential summer camp for children ages 7 -17 who are living with heart disease. Our main camp is located on Catalina Island, 22 miles off the California coastline, and each year, has served approximately 300 children for the past 13 years. We have recently expanded to provide a second camp in the Malibu Mountains which has allowed many more children to experience camp, most for the first time in their lives. ?love eampl .Tbe friends 1 make there understand me. I can't evait urilrl4ext year! " Emily, age 14 • About 40,000 children are born with Congenital Heart Disease (CHD) in the United States each year, making CHD one of the most common birth defects at least 8 out of every 1,000 children born each year have a heart defect. • Funding for pediatric cancer research is 5 times higher than for children with congenital heart disease. Resources for these children are very scarce. The overwhelming amount of funds raised by Prominent charities goes. totusrd *desalts with coronary artery disease, heart attack and stroke, and of late, obesity and diabetes. There is much attention paid to adults with heart disease, but virtually.nothing for children born with damaged hearts. Then is no charge for those who attend our programi. The American Heart Association estimates that over $2,2 Billion are spent on medial care for heart disease each year in the United States alone The families that are affected by this disease already incur incredible financial burdens from medical bills and often have to seek private or home schooling due to the numerous doctors' appointments and hospital stays their children require. We understand this fact, and are reaching out to you to help us continue in our mission and to continue to grow. The majority of the children served by Cupp del Corazon are not eligible for the summer camping experience offered by other member agencies of the American Camping Association due to the fact that they require round - the -cloek medical supervision and care. Many. of these children have had several open -heart surgeries, pacemakers,.hnd/ot heart.ttansplants, and the majority face several more surgeries in their futures. 'These children and their families live everyday knowing that they are at a high -risk for mortality. We offer opportunities for these children to finally be 'normal,' to forget their ailments and connect with others who have had similar experiences and scars. For most of thesachildren, this is the only experience they have away from home, as they- Ire often too sick to go on vacations or to even stay overnight at a friend's house, away from their parents, who have to monitor their health on a 24 -hour basis. Parents of children with heart conditions are often fearful that activities enjoyed by `normal' kids could be harmful. Tber a are very few camps with the ability or medically trained steno provide for these special weds children, or places that their parents woes+ld gran, a PROJECT DESCRIPTION How will your organization use the funding awarded? Describe the project, project objectives, those served, area serviced, and number of volunteers involved. Be specific. Include equipment or services that would be purchased and why. Include a detailed budget and a schedule of significant activities related to this project You may attach a maximum of one double - spaced typewritten page of informatioh. (Please type. nr nrinf lonihly 1 Application — Page 3 s e SIGNATURE PAGE We hereby certify the information contained in this application is true to the best of our knowledge and belief. n n PRESIDENT or AUTHORIZED OFFICER: Li4A -� NAME and a Print or Type) DATED THIS of QhA 2010. (D te) 0 (Month) BE SURE TO INCLUDE THE ORIGINAL PLUS ONE COPY AND SUBMIT TO: Mail Completed Applications to: City of Temecula Community Service Funding Program Attn: Judy McNabb Post Office Box 9033 Temecula, CA 92589 -9033 Or Deliver in Person to: City of Temecula - Community Service Funding Program Attn: Judy McNabb 43200 Business Park Drive Temecula, CA 92590 Application — Page 5 4 m d d E O N C S V +p CL A w w x yh N irt. ■y 88��888 " " 8 8ss8$8$sEt$ � � s ss8/N�$$$8 S S g O N N�p A � � � r 'Ar M N N N b b M M N N N N N N N N N N N N A Al" ter. i�. R y. me C.! t tl L LL a 8 8 y4� 4 4R Q Q9 Q 4g E E 18 Q QQB Q2 4 4 i y Q9 sg � �gy ¢ LK4§ ¢$ g g B g gg Q� B B B P4 M N N N N N N N M M "'a- M M M 4 401 N N N N N N N N •a.i g h yr y yk t� +& w w ad m 1 3 S W W2G 3 yh N irt. erATK OF OAUFORNiA F94NCHDF TAR own PO wax 12*6 RANCHO CORDOVA CA 95741 -1246 In reply refer to 755;9 ;EMM July 1%? 7080 CAMP DEL CORAZON INC 9633 MALaRONT AVE ST8 10 LOS ANGELES CA 91411 Purpose ; RINICATLOW Code Section r Weld Fors of Organization COrporatlon Accounting Period endingi Octsbar 31 Organization Number : 2192099 You are exempt from state frsnshis♦* or income tax Under the section of the, Revenue end Taxa#!on•Cad* indi+teted above. This deci;llan is based on Smforpat #On you submitted and aasuaes that your Pressnt oP +rotioss oentinue ugchsnged or conform to thus: Proposed In year apalicstion. Any change in oparstfon, chareeter, or purpose, of the erganlsatlen Must be rsPorted - lsaedtatsly to *bin office so lefts% we Toy determine the Off got on your exempt etetug. Any often$* of nose or address gust sing be rgpgrtod, In the avant of a ohaho* in relevant statutory, administrative, judicial cesa laws' : ghagae in federal int0pratation of federal.iaw in vases where our opit;ign As DOSO Moen ssdh an lntorpretotian, or a change in the 00terial;fa *ta or eir4uastaneaa relating to your spolteat3sn upon which this ep'"on is bssadr this dP;s3en any no longer be applicable, It is your r0oPW0$1bi13t3P se be acid" of these•eharisea ahvyld ttiay "meewr. Thin paragraph Constitutes written advise* other then s chief counsel ruling, within the reantng of Revedee and Texatiso Cods ieption 2I012ta7tz). You say to requ3rod to file Form 3411 MONO Orgahfsetion Annual Information Poturn) an or before the lath der sf the 5th month t4 1/2 nionthil after the class of YOUt wcpeuntina period. Plosee soy annual notivatishe with forms for 0aeuirea;ent *4 You ors not ?squired to fi3a stets 'franeh1s6: or income tax returns unless you have incase subject to the unrelated buelneea lneuaa tax under !option 2z7i1 of the Code. lit this avant, You are reautred to JwIv 14, 2000 CAMP DEL CORAZON, INC. ENTITY ID a 2192099 Page Z 1 file Farm 109 (Ex■ept Orsani2atipq &Maine&* Income Tax Return) by the iBth CaY of the Oth month (4 1/2 mdnths) after the close of VILOP annual accounting Period. Please note that an exemption from federal $me*** or other taxes and other state taxes requires separate, applications, A copy of this letter has been sent to the Rap2stry of Charitable Trusts. This letter supersedes the exemptioln letter Issued on 07143/10. E AIALA EXEMPT ORSANIZAT24N SECTION PROCES8IN0 SUVICEB BUREAU TELEPHONE t93S) 848-4184 10 4 1` �..fT "v Olt WITr 6 CITYOFM MECULAL SEP 1 4 2010 FISCAL YEAR 2010-11 .31 N SCE I)E�T IT COMMUNY SERVICE FUNDING PROGRAM AP LICA ION (Please Print or Type) PROJECT INFORMATION Amount Requested: $ q., nnn nn f.,r Char arrni u; gh Rrhnnl (Maximum allowable $5,000) Project Name: Scholarship Funds For Seniors Project Start Date: September 2010 Project End Date: May 2011 ORGANIZATION INFORMATION Name of Organization: Citizen's Scholarship Foundation of Temecula Valley Contact Name: Mari 1 yn Williams Title/Position: President MailingAddress:40755 Calle Katerine, Temecula, Ca. 92591 Telephone: 951 - 795 -4617 Year Organization Founded: 1987 Number of Paid Staff: 0 Number of Volunteers: 15 Geographic Area(s)Served!'emecula Valley Unified School District Is this organization incorporated in California as a non - profit organization? Yes X No Effective Date: jul y 21, 19 7 if'yes" (Must provide a copy of your statement of non - profit status from the State of California): Date of incorporation as a non - profit: July 21, 1987 Federal identification number: 06- 1209452 If "no ": State identification number: Name of sponsoring organization: Federal identification number: State identification number: This application has been authorized by the organization's: Executive Committee Board of Directors Members -at -Large Application - Page 1 1 i ...) I FINANCIAL STATEMENTS I PLEASE ATTACH COPIES OF THE CURRENT BUDGET OF THE ORGANIZATION AND FINANCIAL STATEMENTS (BALANCE STATEMENT AND INCOME STATEMENT). It does not require a CPA's audit, but please submit if available. 1 NIISSION STATEMENT I Briefly describe the goals and objectives of your organization and community services it provides. Describe the ways your organization meets the criteria listed on page 2 of the CS Funding Policy. The mission of the Citizens Scholarship Foundation of Temecula Valley is to expand educational opportunities for resident high school students. CSF of TV is a non - profit, tax exempt (501C 3 Status ) organization charted in 1987 with the Citizens Scholarship of America, INC. Our purpose is to provide financial aid to the students of Chaparral, Temecula Valley, Great Oak and Rancho Vista /Susan Nelson high schools,that aspire to higher education, without regard to race, creed, color, sex, or national origin. The organizations membership is open to any person, firm, corporation or organization subscribing to the purpose of the foundation and making an annual voluntary contribution of funds. The funds are managed by the board of trustees. All high school seniors with a minimum G.P.A. of 3.0 or higher are encouraged to apply for scholarships. By providing scholarships; students are encouraged to seek higher education. An educated community is something the City of Temecula should strive for to ensure its bright future. Application - Page 2 PROJECT DESCRIPTION How will your organization use the funding awarded? Describe the project, project objectives, those served, area serviced, and number of volunteers involved. Be specific. Include equipment or services that would be purchased and why. Include a detailed budget and a schedule of significant activities related to this project. You may attach a maximum of one double - spaced typewritten page of information. (Please type or print legibly.) All of the funds requested will be used to provide scholarships for graduating high school students who have met the academic requirement. these funds are sent directly to the college, never to the individual students, upon receipt of proof of enrollment. The deadline for funding a scholarship is May 1, 2011. The City of Temecula is encouraged to have representatives review applications and choose its recipient(s). The persons served are the high school students of Chaparral High School. Application - Page 3, PAST PROJECT BENEFITS I If your organization received City of Temecula funding in the previous year, please explain and show how Temecula residents benefited. Last year, the City of Temecula donated $3,000.00 to qualified Temecula Valley, Chaparral and Great Oak High School seniors. Three recipients, one per high school, were selected to receive $1,000.00 scholarships. As in the past, we wait for all recipients who have been selected for the City of Temecula Scholarships to submit proof of enrollment before sending copies of the checks disbursed to you for review. The students have until May 1, 2011 to submit proof of enrollment and request disbursement of funds. On behalf of the trustees on the board of the Citizen's Scholarship Foundation of Temecula Valley, thank you for your continued support. Application - Page 4 SIGNATURE PAGE We hereby certify the information contained in this application is true to the best of our knowledge and belief. PREPAREDBY: Marilyn Williams President PRESIDENT or AUTHORIZED OFFICER :Marilyn Williams President NAME and TITLE (Please Print or Type) ORGANIZATION NAME: Citizen's Scholarship Foundation of Temecula Valley MAILINGADDRESS: 31350 Rancho Vista Rd. Temecula, Ca. 92592 TELEPHONE:951- 795 -4617 DATED THIS 13th of September . 2010. (Date) (Month) BE SURE TO INCLUDE THE ORIGINAL PLUS ONE COPY AND SUBMIT TO: Mail Completed Applications to: City of Temecula Community Service Funding Program Attn: Judy McNabb Post Office Box 9033 Temecula, CA 92589 -9033 Or Deliver in Person to: City of Temecula Community Service Funding Program Attn: Judy McNabb 43200 Business Park Drive Temecula, CA 92590 Application - Page 5 Citizen's iolarship Foundation of Te( )ecula Valley Treasurer's Report July 30, 2010 Money Market Account Balance on last statement $ 118,129.55 Interest on Money Market Acct $ 24.41 Donor Deposits this period $ 2,750.00 Other Deposits this period $ 2,520.05 Total Credits this period (donor + interest) $ 2,774.41 Total Debits this period (transfers to other accounts) $ 750.00 Money Market Account Balance on 7/30/10 $120,153.96 Roripaugh Account Balance on last statement $ 13,268.20 Interest on Roripaugh Account $ 2.73 Other Credits* Total Credits $ 2.73 Total Debits (transfers to checking) $ _ Roripaugh Account Balance on 7/30/10 $ 13,270.93 Checking Account Balance on last statement $ 8,009.86 Total Credits (transferred from MMA and /or Roripaugh) $ 7550,00 Total Debits (checks cleared) $ 6,239.81 Checking Account Balance 7/30/10 $ 2,520.05 Checking Account Balance if all checks were dear $ 200.00 respectfully submitted by Erin Simon, Treasurer Citizen's 8(-)olarship Foundation of 414�ecula Valley Treasurer's Report on Scholarships Paid August 25, 2010 Total Amount Awarded May 2010 $ 153,228.99 Money Paid to Date $ 23,173.83 Amount Unclaimed to Date $ 130,055.16 Total Number of Recipients 2010 214 Recipients Claimed to Date 37 Recipients Unclaimed to Date 177 Roripaugh Recipients are Included In the 214 Total Roripaugh Recipients Class 07 3 Recipients Claimed to Date 0 Roripaugh Recipients Class 08 4 Recipients Claimed to Date 0 Class of 09 2 Recipients Claimed to Date 0 Class of 10 6 Claimed to Date 1 California Dollars for Sc A program of Scholars September 27, 2007 City of Temecula Finance Department Attention: Judy McNabb To Whom It May Concern: This letter is to provide evidence that the chapter CSF of Temecula (CA0246) is a chapter under the direction of Scholarship America. The EIN number for CSF of Temecula is 06- 1209452. Vendors may be interested to know that Scholarship America, formerly Citizens' Scholarship Foundation of America, is a 501 (c) (3) organization recognized as income tax exempt by the I.R.S_ and our exemption letter is attached. Yours truly, Ann Worley Executive Director California Dollars for Scholars RE: Temecula Valley High School Chaparral High School Great Oak High School 17581 Irvine Blvd., # 120, Tustin, CA 92780 • Phone: 714.505.0561 or 800.335.4504 • Fax: 714.505.0562 e -mail: moil @coliformiadollarsforscholers .org • w .coliforniodollarsforscholars .org Internal Revenue Service Date: March 1. 2003 Scholarship America Inc Box 297 1505 Riverview RD ST Peter, MN 56082 -1556 Dear Sir: �i Department of the Treasury P.O. Box 2508 Cincinnati, OH 45201 Person to Contact: Ms. Dalton 31 -07425 Customer Service Representative Toll Free Telephone Number: 8:00 A.M. to 6:30 P.M. EST 877 - 829 -5500 Fax Number: 513- 263 -3756 Federal Identification Number: 04- 2296967 This is in response to the amendment to your organization's Articles of Incorporation filed with the state on January 23, 2003. We have updated our records to reflect the name as indicated above. In April 1962 we issued a determination letter that recognized your organization as exempt from federal income tax under section 501(c)(3) of the Internal Revenue Code. That letter is still in effect. Based on the information supplied, we recognized the subordinates named on the list your organization submitted as exempt from federal income tax under section 501(c)(3) of the Code. Additionally, we have classified the subordinates your organization operates, supervises, or controls, and which are covered by written notification to us, as organizations that are not private foundations because they are organizations of the type described in sections 509(a)(2) of the Code. gedingection P V Donors may deduct contributions to your organization's subordinates as prov 170 of the Code. Bequests, legacies, devises, transfers or gifts to the subordinates or for their use are deductible for federal estate and gift tax purposes if they meet the applicable provisions of sections 2055, 2106, and 2522 of the Code. Your organization and its subordinates are required to file Form 990, Return of Organization Exempt from Income Tax, only if the gross receipts each year are normally more than $25,000. If a return is required, it must be filed by the 15th day of the fifth month after the end of the organization's annual accounting period. The law imposes a penalty of $20 a day, up to a maximum of $10,000, when a return is filed late, unless there is reasonable cause for the delay. Your organization and its subordinates are not required to file federal income tax returns unless subject to the tax on unrelated business income under section 511 of the Code. If subject to this tax, the organization must file an income tax return on Form 990 -T, Exempt Organization Business Income Tax Return. In this letter, we are not determining whether any of your organization or its subordinates' present or proposed activities are ,unrelated trade or business as defined in section 513 of the Code. Scholarship America Inc 04- 2296967 -2- Unless specifically excepted, your organization and its subordinates are liable for taxes under the Federal Insurance Contributions Act (social security taxes) on remuneration of $100 or more paid to each of its employees during a calendar year. Your organization and its subordinates are not liable for the tax imposed under the Federal Unemployment Tax Act (FUTA). Each year, at least 90 days before the end of your organization's annual accounting period, please send the following items to the Internal Revenue Service Center at the address shown below: 1. A statement describing any changes during the year in the purposes, character, or method of operation of your organization's subordinates; 2. A list showing the names, mailing addresses (including Postal ZIP Codes), actual addresses if different, and employer identification numbers of subordinates that: a. Changed names or addresses; b. Were deleted from the roster. or C. Were added to the roster. I. U U 3. For subordinates to be added, attach: a. A statement that the information on which your organization's present group exemption letter is based applies to the new subordinates; b. A statement that each has given your organization written authorizationto add its name to the roster; C. A list of those to which the Service previously issued exemption rulings or determination letters; d. A statement that none of the subordinates is a private foundation as defined in section 509(a) of the Code if the group exemption lettercovers organizations described in section 501(c)(3); e. The street address of subordinates where the mailing address is a P.O. Box; and -3- Scholarship America Inc 04- 2296967 f. The information required by Revenue Procedure 75 -50, 1975 -2 C.B. 587 for each subordinate that is a school claiming exemption under section 501(c)(3). Also include any other information necessary to establish that the school is complying with the requirements of Revenue Ruling 71- 447, 1971 -2C.B. 230. This isthe same information required by Schedule A, Form 1023, Application for Recognition of Exemption Under Section 501(c)(3) of the Internal Revenue Code. 4. If applicable, a statementthat your organization's group exemption roster did not change sincethe previous report. The above information should be sent to the following address: Internal Revenue Service Center Attn: Entity Control Unit Ogden, UT 84409 The law requires you to make your organization's annual return available for public inspection without charge for three years after the due date of the return. If your organization had a copy of its application for recognition of exemption on July 15, 1987, it is also required to make available for public inspection a copy of the exemption application, any supporting documents and the exemption letter to any individual who requests such documents in person or in writing. You can charge only a reasonable fee for reproduction and actual postage costs for the copied materials. The law does not require you to provide copies of public inspection documents that are widely available, such as by posting them on the Internet (World Wide Web). You may be liablefor a penalty of $20 a day for each day you do not make these documents available for pubiic inspection (up to a maximum of $10,000 in the case of an annual return). Your organization's Group Exemption Number is 1546. If you have any questions, please call us at the telephone number shown in the heading of this letter. Sincerely, John E Ricketts, Director, TE/GE 0� 1 �i CustomerAccount Services U i v FISCAL YEAR 2010-11 . 14 2010 COMMUNITY SERVICE FUNDING PROGRAM A kTdA SON (Please Print or Type) PROJECT INFORMATION Amount Requested: $ s nnn nn r r Aar nak u gr, Schanl (Maximum allowable $5,000) Project Name: Scholarship Funds For Seniors Project Start Date: September 2010 Project End Date: May 2011 ORGANIZATION INFORMATION Name of Organization: Citizen's Scholarship Foundation of Temecula Valley Contact Name: Mari i yn ws > > ; ams Title/Position:president Mailing Address :40755 Calle Katerine, Temecula, Ca. 92591 Telephone: 951- 795 -4617 Year Organization Founded: 1987 Number of Paid Staff: 0 Number of Volunteers: 15 Geographic Area(s)Served:Temecula Valley Unified School District Is this organization incorporated in California as a non -profit organization? Yes X No Effective Date: Tu I _ 1, 19 7 If'yes" (Must provide a copy of your statement of non - profit status from the State of California): Date of incorporation as a non - profit July 21, 1987 Federal identification number: 06- 1209452 State identification number: If "no ". Name of sponsoring organization: Federal identification number: State identification number. This application has been authorized by the organization's: Executive Committee Board of Directors X Application - Page I Members -at -Large U 0 I FINANCIAL STATEMENTS I PLEASE ATTACH COPIES OF THE CURRENT BUDGET OF THE ORGANIZATION AND FINANCIAL STATEMENTS (BALANCE STATEMENT AND INCOME STATEMENT). It does not require a CPA's audit, but please submit if available. ]4IISSION STATEMENT Briefly describe the goals and objectives of your organization and community services it provides. Describe the ways your organization meets the criteria listed on page of the CS Funding Policy. The mission of the Citizen's Scholarship Foundation of Temecula Valley is tc expand educational opportunities for resident high school students. CSF of TV is a non - profit, tax exempt (501C 3 Status ) organization charted in 1987 with the Citizen's Scholarship of America, INC. Our purpose is to provide financial aid to the students of Chaparral, Temecula Valley, Great Oak and Rancho Vista /Susan Nelson high schools,that aspire to higher education, without regard to race, creed, color, sex, or national origin. The organization's membership is open to any person, firm, corporation or organization subscribing to the purpose of the foundation and making an annual voluntary contribution of funds. The funds are managed by the board of trustees. All high school seniors with a minimum G.P.A. of 3.0 or higher are encouraged to apply for scholarships. By providing scholarships, students are encouraged to seek higher education. An educated community is something the City of Temecula should strive for to ensure its bright future. Applicati6 -- Page 2 I PROJECT DESCRIPTION How will your organization use the funding awarded? Describe the project, project objectives, those served, area serviced, and number of volunteers involved. Be specific. Include equipment or services that would be purchased and why. Include a detailed budget and a schedule of significant activities related to this project. You may attach a maximum of one double - spaced typewritten page of information. (Please type or print legibly.) All of the funds requested will be used to provide scholarships for graduating high school students who have met the academic requirement. these funds are sent directly to the college, never to the individual students, upon receipt of proof of enrollment. The deadline for funding a scholarship is May 1, 2011. The City of Temecula is encouraged to have representatives review applications and choose its recipient(s). The persons served are the high school students of Great Oak High School. Application - Page 3 r I PAST PROJECT BENEFITS If your organization received City of Temecula funding in the previous year, please explain and show how Temecula residents benefited. Last year, the City of Temecula donated $3,000.00 to qualified Temecula Valley, Chaparral and Great Oak High School seniors. Three recipients, one per high school, were selected to receive $1,000.00 scholarships. As in the past, we wait for all recipients who have been selected for the City of Temecula Scholarships to submit proof of enrollment before sending copies of the checks disbursed to you for review. The students have until May 1, 2011 to submit proof of enrollment and request disbursement of funds. On behalf of the trustees on the board of the Citizen's Scholarship Foundation of Temecula Valley, thank you for your continued support. Application — Page 4 r SIGNATURE PAGE We hereby certify the information contained in this application is true to the best of our knowledge and belief. PREPAREDBY• Marilyn Williams President NAME and TITLE (Please Print or Type) PRESIDENT or AUTHORIZED OFFICER:Marilyn Williams President and TITLE (Please ORGANIZATION NAME: Citizen Is Scholarship o Founda ion of Temecula yall y MAILINGADDRESS: 31350 Rancho Vista Rd. Temecula, Ca. 92592 TELEPHONE:951- 795 -4617 DATED THIS 13th of September . 2010. (Date) (Month) BE SURE TO INCLUDE THE ORIGINAL PLUS ONE COPY AND SUBMIT TO: Mail Completed Applications to: City of Temecula Community Service Funding Program Attn: Judy McNabb Post Office Box 9033 Temecula, CA 92589 -9033 Or Deliver in Person to: City of Temecula Community Service Funding Program Attn: Judy McNabb 43200 Business Park Drive Temecula, CA 92590 Application - Page 5 Citizen's Scholarship Foundation of Terpgcula Valley t Treasurer's Report_ tt July 30, 2010 Money Market Account Balance on last statement $ 118,129.55 Interest on Money Market Acct $ 24.41 Donor Deposits this period $ 2,750.00 Other Deposits this period Total Credits this period (donor + interest) $ 2,774.41 Total Debits this period (transfers to other accounts) $ 750.00 Money Market Account Balance on 7/30110 $120,153.96 Roripaugh Account Balance on last statement $ 13,268.20 Interest on Roripaugh Account $ 2,73 Other Credits* Total Credits $ 2.73 Total Debits (transfers to checking) $ _ Roripaugh Account Balance on 7/30/10 $ 13,270.93 Checking Account Balance on last statement $ 8,009.86 Total Credits (transferred from MMA and/or Roripaugh) $ 750.00 Total Debits (checks cleared) $ 6,239.81 Checking Account Balance 7/30/10 $ 2,520.05 Checking Account Balance if all checks were clear $ 200.00 respectfully submitted by Erin Simon, Treasurer e Citizen's Sei�blarship Foundation of Terocula Valley Treasurer's Report on Scholarships Paid August 25, 2010 Total Amount Awarded May 2010 $ 153,228.99 Money Paid to Date $ 23,173.83 Amount Unclaimed to Date $ 130,056.16 Total Number of Recipients 2010 214 Recipients Claimed to Date 37 Recipients Unclaimed to Date 177 Roripaugh Recipients are Included In the 214 Total Roripaugh Recipients Class 07 Recipients Claimed to Date Roripaugh Recipients Class 08 Recipients Claimed to Date Class of 09 Recipients Claimed to Date Class of 10 Claimed to Date 3 0 4 0 2 0 6 1 California Dollars for Scholar A program of Scholarship. America° September 27, 2007 City of Temecula Finance Department Attention: Judy McNabb To Whom It May Concern: This letter is to provide evidence that the chapter CSF of Temecula (CA0246) is a chapter under the direction of Scholarship America. The EIN number for CSF of Temecula is 06- 1209452. Vendors may be interested to know that Scholarship America, formerly Citizens' Scholarship Foundation of America, is a 501 (c) (3) organization recognized as income tax exempt by the I.R.S. and our exemption letter is attached. Yours truly, 152,rvw ct'.91" . Ann Worley Executive Director California Dollars for Scholars RE: Temecula Valley High School Chaparral High School Great Oak High School 17581 Irvine Blvd., # 120, Tustin, C4 92780 • Phone: 714.505.0561 or 800.335.4504 , Fax: 714.505.0562 e -mail: mail@ califormiodollarsforscholars .org • v . coliforniodollarsforscholars .org Internal Revenue Service Date: March 1. 2003 Scholarship America Inc Box 297 1505 Riverview RD ST Peter, MN 56082 -1556 Dear Sir. Department of the Treasury P.O. Box 2508 Cincinnati, OH 45201 Person to Contact: Ms. Dalton 31 -07425 Customer Service Representative Toll Free Telephone Number: 8:00 A.M. to 6:30 P.M. EST 877- 829 -5500 Fax Number: 513- 263 -3756 Federal Identification Number: 04- 2296967 This is in response to the amendment to your organization's Articles of Incorporation filed with the state on January 23, 2003. We have updated our records to reflect the name as indicated above. In April 1962 we issued a determination letter that recognized your organization as exempt from federal income tax under section 501(c)(3) of the Internal Revenue Code. That letter is still in effect. Based on the information supplied, we recognized the subordinates named on the list your organization submitted as exempt from federal income tax under section 501(c)(3) of the Code. Additionally, we have classified the subordinates your organization operates, supervises, or controls, and which are covered by written notification to us, as organizations that are not private foundations because they are organizations of the type described in sections 509(a)(2) of the Code. l� 9 v :. Donors may deduct contributions to your organization's subordinates as providn sOecton 170 of the Code. Bequests, legacies, devises; transfers or gifts to the subordinates or for their use are deductible for federal estate and gift tax purposes if they meet the applicable provisions of sections 2055, 2106, and 2522 of the Code. Your organization and its subordinates are required to file Form 990, Return of Organization Exempt from Income Tax, only if the gross receipts each year are normally more than $25,000. If a return is required, it must be filed by the 15th day of the fifth month after the end of the organization's annual accounting period. The law imposes a penalty of $20 a day, up to a maximum of $10,000, when a return is filed late, unless there is reasonable cause for the delay. Your organization and its subordinates are not required to file federal income tax returns unless subject to the tax on unrelated business income under section 511 of the Code. If subject to this tax, the organization must file an income tax return on Form 990 -T, Exempt Organization Business Income Tax Return. In this letter, we are not determining whether any of your organization or its subordinates' present or proposed activities are unrelated trade or business as defined in section 513 of the Code. -2- Scholarship America Inc 04- 2296967 Unless specifically excepted, your organization and its subordinates are liable for taxes under the Federal Insurance Contributions Act (social security taxes) on remuneration of $100 or more paid to each of its employees during a calendar year. Your organization and its subordinates are not liable for the tax imposed under the Federal Unemployment Tax Act (FUTA). Each year, at least 90 days before the end of your organization's annual accounting period, please send the following items to the Internal Revenue Service Center at the address shown below: 1. A statement describing any changes during the year in the purposes, character, or method of operation of your organization's subordinates; 2. A list showing the names, mailing addresses (including Postal ZIP Codes), actual addresses if different, and employer identification numbers of subordinates that: a. Changed names or addresses; b. Were deleted from the roster or C. Were added to the roster. C� caj 3 F .. b d. or su or mates to be added, attach: a. Astatementthat the information on which your organization's present group exemption letter is based applies to the new ; subordinates; b- A statement that each has given your organization written authorization to add its name to the roster; C. A list of those to which the Service previously issued exemption rulings or determination letters; d. A statement that none of the subordinates is a private foundation as defined in section 509(a) of the Code if the group exemption letter covers organizations described in section 501(c)(3); e. The street address of subordinates where the mailing address is a P.O. Box; and -3- Scholarship America Inc 04- 2296967 f. The information required by Revenue Procedure 75 -50, 1975 -2 C.B. 587 for each subordinate that is a school claiming exemption under section 501(c)(3). Also include any other information necessary to establish that the school is complying with the requirements of Revenue Ruling 71 -447, 1971 -2C.B. 230. This is the same information required by Schedule A, Form 1023, Application for Recognition of Exemption Under Section 501(c)(3) of the Intemal Revenue Code. 4. If applicable, a statementthat your organization's group exemption roster did not change since the previous report. The above information should be sent to the following address: Internal Revenue Service Center Attn: Entity Control Unit Ogden, UT 84409 The law requires you to make your organization's annual return available for public inspection without charge for three years after the due date of the return. if your organization had a copy of its application for recognition of exemption on July 15, 1987, it is also required to make available for public inspection a copy of the exemption application, any supporting documents and the exemption letter to any individual who requests such documents in person or in writing. You can charge only a reasonable fee for reproduction and actual postage costs for the copied materials. The law does not require you to provide copies of public inspection documents that are widely available, such as by posting them on the Internet (World Wide Web). You may be liablefor a penalty of $20 a day for each day you do not make these documents available for pubiic inspection (up to a maximum of $10,000 in the case of an annual return). Your organization's Group Exemption Number is 1546. If you have any questions, please call us at the telephone number shown in the heading of this letter. Sincerely, C John E. Ricketts, Director, TE/GE CustomerAccount Services (/ ti .e Y w-ffl 8 SEP 1 FISCAL YEAR 2010-11 HfVANCE'VEQT IT COMMUNY SERVICE FUNDING PROGRAM APPLICATION (Please Print or Type) PROJECT INFORMATION I Amount Requested: $ c nnn nn fnr Aannhn v; ,,-m /KT lann u dMaximum allowable $5,000) Project Name: Scholarship Funds For Seniors Project Start Date: September 2010 Project End Date: May 2011 I ORGANIZATION INFORMATION I Name of Organization: Citizen' s Scholarship Foundation of Temecula Valley Contact Name: mari lm Wi I I i ams Title/Position: Presi dent Mailing Address:40755 Calle Katerine Temecula Ca. 92591 Telephone: 951- 795 -4617 Year Organization Founded: 1987 Number of Paid Staff: Number of Volunteers: 15 Geographic Area(s)ServedTemecula Valley Unified School District Is this organization incorporated in California as a non -profit organization? Yes X No Effective Date: ,T„ i y 21, 19 7 If'yes" (Must provide a copy of your statement of non - profit status from the State of California): Date of incorporation as a non - profit: July 21, 1987 If "no ": Federal identification number. 06- 1209452 State identification number. Name of sponsoring organization: Federal identification number: State identification number: This application has been authorized by the organization's: Executive Committee Board of Directors X Members -at -Large Application — Page 1 ' 1. 1 ,� J FINANCIAL STATEMENTS PLEASE ATTACH COPIES OF THE CURRENT BUDGET OF THE ORGANIZATION AND FINANCIAL STATEMENTS (BALANCE STATEMENT AND INCOME STATEMENT). It does not require a CPA's audit, but please submit if available. MISSION STATEMENT Briefly describe the goals and objectives of your organization and community services it provides. Describe the ways your organization meets the criteria listed on page 2 of the CS Funding Policy. The mission of the Citizen's Scholarship Foundation of Temecula Valley is to expand educational opportunities for resident high school students. CSF of TV is'a non - profit, tax exempt (501C 3 Status ) organization charted in 1987 with the Citizen's Scholarship of America, INC. Our purpose is to provide financial aid to the students of Chaparral, Temecula Valley, Great Oak and Rancho Vista /Susan Nelson high schools,that aspire to higher education, without regard to race, creed, color, sex, or national origin. The organization's membership is open to any person, firm, corporation or organization subscribing to the purpose of the foundation and making an annual voluntary contribution of funds. The funds are managed by the board of trustees. All high school seniors with a minimum G.P.A. of 3.0 or higher are encouraged to apply for scholarships. By providing scholarships, students are encouraged to seek higher education. An educated community is something the City of Temecula should strive for to ensure its bright future. Application - Page 2 I PROJECT DESCRIPTION I How will your organization use the funding awarded? Describe the project, project objectives, those served, area serviced, and number of volunteers involved. Be specific. Include equipment or services that would be purchased and why. Include a detailed budget and a schedule of significant activities related to this project You may attach a maximum of one double - spaced typewritten page of information. (Please type or print legibly.) All of the funds requested will be used to provide scholarships for graduating high school students who have met the academic requirement. These funds are sent directly to the college, never to the individual students, upon receipt of proof of enrollment. The deadline for funding a scholarship is May 1, 2011. The City of Temecula is encouraged to have representatives review applications and choose its recipient(s). The persons served are the high school students of Rancho Vista and Susan H. Nelson High Schools. Application — Page 3 PAST PROJECT BENEFITS If your organization received City of Temecula funding in the previous year, please explain and show how Temecula residents benefited. Last year, the City of Temecula donated $3,000.00 to qualified Temecula Valley, Chaparral and Great Oak High School seniors. Three recipients, one per high school, were selected to receive $1,000.00 scholarships. As in the past, we wait for all recipients who have been selected for the City of Temecula Scholarships to submit proof of enrollment before sending copies of the checks disbursed to you for review. The students have until May 1, 2011 to submit proof of enrollment and request disbursement of funds. On behalf of the trustees on the board of the Citizen's Scholarship Foundation of Temecula Valley, thank you for your continued support. Application - Page 4 SIGNATURE PAGE Ne hereby certify the information contained in this application is true to the best of our knowledge and belief. PREPAREDBY: Marilyn Williams President NAME and TITLE (Please Print or PRESIDENT or AUTHORIZED OFFICER: Marilyn Williams President NAME and TITLE (Please Print or Type) DRGANIZATIONNAME: Citizen's Scholarship Foundation of Temecula Valley MAILINGADDRESS: 31350 Rancho Vista Rd. Temecula, Ca. 92592 TELEPHONE:951- 795 -4617 DATED THIS 13th of September , 2010. (Date) (Month) BE SURE TO INCLUDE THE ORIGINAL PLUS ONE COPY AND SUBMIT TO: Mail Completed Applications to: City of Temecula Community Service Funding Program Attn: Judy McNabb Post Office Box 9033 Temecula, CA 92589 -9033 Or Deliver in Person to: City of Temecula Community Service Funding Program Attn: Judy McNabb 43200 Business Park Drive Temecula, CA 92590 Application - Page 5 Citizen's Srlarship Foundation of Tecula Valley Treasurer's Report- July 30, 2010 Money Market Account Balance on last statement $ 118,129.55 Interest on Money Market Acct $ 24.41 Donor Deposits this period $ 2,750.00 Other Deposits this period $ 2.73 Total Credits this period (donor + interest) $ 2,774.41 Total Debits this period (transfers to other accounts) $ 750.00 Money Market Account Balance on 7/30/10 $120,153.96 Roripaugh Account Balance on last statement $ 13,268.20 Interest on Roripaugh Account $ Other Credits* 2.73 Total Credits $ 2.73 Total Debits (transfers to checking) $ _ Roripaugh Account Balance on 7/30/10 $ 13,270.93 Checking Account Balance on last statement $ 8,009.86 Total CredltS (transferred from MMA and /or Roripaugh) . $ 750.00 Total Debits (checks cleared) Checking Account Balance 7/30/10 $ 6,2 $ 2,520.05 Checking Account Balance if all checks were clear $ 200.00 respectfully submitted by Erin Simon, Treasurer Citizen's S( )olarship Foundation of Tef �cula Valley Treasurer's Report on Scholarships Paid August 25, 2010 Total Amount Awarded May 2010 $ 153,228.99 Money Paid to Date $ 23,173.83 Amount Unclaimed to Date $ 130,055.16 Total Number of Recipients 2010 214 Recipients Claimed to Date 37 Recipients Unclaimed to Date 177 Roripaugh Recipients are Included In the 214 Total Roripaugh Recipients Class 07 3 Recipients Claimed to Date 0 Roripaugh Recipients Class 08 4 Recipients Claimed to Date 0 Class of 09 2 Recipients Claimed to Date 0 Class of 10 g Claimed to Date 1 California Dollars for Scholars® A program of Scholarship America' September 27, 2007 City of Temecula Finance Department Attention: Judy McNabb To Whom It May Concern: This letter is to provide evidence that the chapter CSF of Temecula (CA0246) is a chapter under the direction of Scholarship America. The EIN number for CSF of Temecula is 06- 1209452. Vendors may be interested to know that Scholarship America, formerly Citizens' Scholarship Foundation of America, is a 501 (c) (3) organization recognized as income tax exempt by the I.R_S. and our exemption letter is attached. Yours truly, Ann Worley Executive Director California Dollars for Scholars RE: Temecula Valley High School Chaparral High School Great Oak High School 17581 Irvine Blvd., # 120, Tustin, CA 92780 • Phone: 714.505.0561 or 800.335.4504 • Fax: 714.505.0562 e -mail: mail@ coliformiadollarsforscholars .org • w - coliforniadollars forscholars.org Internal Revenue Service Date: March 1.2003 -Scholarship America Inc Box 297 1505 Riverview RD ST Peter, MN 56082 -1556 Dear Sir: Department of the Treasury P.O. Box 2508 Cincinnati, OH 45201 Person to Contact: Ms. Dalton 31 -07425 Customer Service Representative Toll Free Telephone Number: 8:00 A.M. to 6:30 P.M. EST 877 - 829 -5500 Fax Number: 513- 263 -3756 Federal Identification Number: 04- 2296967 This is in response to the amendment to your organization's Articles of Incorporation filed with the state on January 23, 2003. We have updated our records to reflect the name as indicated above. In April 1962 we issued a determination letter that recognized your organization as exempt from federal income tax under section 501(c)(3) of the Internal Revenue Code. That letter is still in effect. Based on the information supplied, we recognized the subordinates named on the list your organization submitted as exempt from federal income tax under section 501(c)(3) of the Code. Additionally, we have classified the subordinates your organization operates, supervises, or controls, and which are covered by written notification to us, as organizations that are not private foundations because they are organizations of the type described in sections 509(a)(2) of the Code. �OU U Donors may deduct contributions to your organization's subordinates as provided in section 170 of the Code. Bequests, legacies, devises, transfers or gifts to the subordinates or for their use are deductible for federal estate and gift tax purposes if they meet the applicable provisions of sections 2055, 2106, and 2522 of the Code. Your organization and its subordinates are required to file Form 990, Return of Organization Exempt from Income Tax, only if the gross receipts each year are normally more than $25,000. If a return is required, it must be filed by the 15th day of the.fifth month after the end of the organization's annual accounting period. The law imposes a penalty of $20 a day, up to a maximum of $10,000, when a return is filed late, unless there is reasonable cause for the delay. Your organization and its subordinates are not required to file federal income tax returns unless subject to the tax on unrelated business income under section 511 of the Code. If subject to this tax, the organization must file an income tax return on Form 990 -T, Exempt Organization Business Income Tax Return. In this letter, we are not determining whether any Of your organization or its subordinates' present or proposed activities are unrelated trade or business as defined in section 513 of the Code. -2- Scholarship America Inc 042296967 Unless specifically excepted, your organization and its subordinates are liable for taxes under the Federal Insurance Contributions Act (social security taxes) on remuneration of $100 or more paid to each of its employees during a calendaryear. Your organization and its subordinates are not liable for the tax imposed underthe Federal UnemploymentTax Act (FUTA). Each year, at least 90 days before the end of your organization's annual accounting period, please send the following items to the Internal Revenue Service Center at the address shown below: 1. A statement describing any changes during the year in the purposes, character, or method of operation of your organization's subordinates; 2. A list showing the names, mailing addresses (including Postal ZIP Codes), actual addresses if different, and employer identification numbers of subordinates that: a. Changed names or addresses; b. Were deleted from the roster. or C. Were added to the roster. 3. For subordinatesto be added, attach: a. A statementthat the information on which your organization's present group exemption letter is based applies to the new subordinates; b. A statement that each has given your organization written authorization to add its name to the roster; C. A list of those to which the Service previously issued exemption rulings or determination letters; d. A statement that none of the subordinates is a private foundation as defined in section 509(a) of the Code if the group exemption lettercovers organizations described in section 501(c)(3); e. The street address of subordinates where the mailing address is a P.O. Box; and Scholarship America Inc 04- 2296967 f. The information required by Revenue Procedure 75 -50, 1975 -2 C.B.587 for each subordinate that is a school claiming exemption under section 501(c)(3). Also include any other information necessary to establish that the school is complying with the requirements of Revenue Ruling 71 -447, 1971 -2C.B. 230. This isthe same information required by Schedule A, Form 1023, Application for Recognition of Exemption Under Section 501(c)(3) of the Intemal Revenue Code. 4. If applicable, a statement that your organization's group exemption roster did not change since the previous report. The above information should be sent to the following address: Internal Revenue Service Center Attn: Entity Control Unit Ogden, UT 84409 The law requires you to make your organization's annual return available for public inspection without charge for three years after the due date of the return. If your organization had a copy of its application for recognition of exemption on July 15, 1987, it is also required to make available for public inspection a copy of the exemption application, any supporting documents and the exemption letter to any individual who requests such documents in person or in writing. You can charge only a reasonable fee for reproduction and actual postage costs for the copied materials. The law does not require you to provide copies of public inspection documents that are widely available, such as by posting them on the Internet (World Wide Web). You may be liablefor a penalty of $20 a day for each day you do not make these documents available for pubiic inspection (up to a maximum of $10,000 in the case of an annual return). Your organization's Group Exemption Number is 1546. If you have any questions, please call us at the telephone number shown in the heading of this letter. Sincerely, u/ Z< v G' John E Ricketts, Director, TE/GE 0 CustomerAccount Services [/ 1 I DIku it-IV, �- SEP 1 4 2(. FISCAL YEAR 2010-11 NNANCE UEpr, COMMUNITY SERVICE FUNDING PROGRAM APPLICATIOriI (Please Print or Type) PROJECT INFORMATION Amount Requested: $3, non no far Tpmpnnl a Val i py u R_ (Maximum allowable $5,000) Project Name: Scholarship Funds For Seniors Project Start Date: September 2010 Project End Date: May 2011 ORGANIZATION INFORMATION Name of Organization: Citizen, s Scholarship Foundation of Temecula Valley Contact Name: Mari i ya Williams Title/Position: Pr s; d n - Mailing Address :40755 Calle Katerine Temecula Ca. 92591 Telephone: 951- 795 -4617 Year Organization Founded: 1987 Number of Paid Staff: 0 Number of Volunteers: 15 Geographic Area(s)Served:Temecula Valley Unified School District Is this organization incorporated in California as a non - profit organization? Yes X No Effective Date: �Tu y 21. 1997 if ,yes,- (Must provide a copy of your statement of non - profit status from the State of California): Date of incorporation as a non - profit: July 21, 1987 If "no ": Federal identification number: 06- 1209452 State identification number: Name of sponsoring organization: Federal identification number: State identification number: This application has been authorized by the organization's: Executive Committee Board of Directors X Members -at -Large Application - Page ,I f �l I FINANCIAL STATEMENTS I PLEASE ATTACH COPIES OF THE CURRENT BUDGET OF THE ORGANIZATION AND FINANCIAL STATEMENTS (BALANCE STATEMENT AND INCOME STATEMENT). It does not require a CPA's audit, but please submit if available. 1 MISSION STATEMENT I Briefly describe the goals and objectives of your organization and community services it provides. Describe the ways your organization meets the criteria listed on page 2 of the CS Funding Policy. The mission of the Citizen's Scholarship Foundation of Temecula Valley is to expand educational opportunities for resident high school students. CSF of TV is a non - profit, tax exempt (501C 3 Status ) organization charted in 1987 with the Citizen's Scholarship of America, INC. Our purpose is to provide financial aid to the students of Chaparral, Temecula Valley, Great Oak and Rancho Vista /Susan Nelson high schools,that aspire to higher education, without regard to race, creed, color, sex, or national origin. The organization's membership is open to any person, firm, corporation or organization subscribing to the purpose of the foundation and making an annual voluntary contribution of funds. The funds are managed by the board of trustees. All high school seniors with a minimum G.P.A. of 3.0 or higher are encouraged to apply for scholarships. By providing scholarships, students are encouraged to seek higher education. An educated community is something the City of Temecula should strive for to ensure its bright future. Application - Page t I PROJECT DESCRIPTION I How will your organization use the funding awarded? Describe the project, project objectives, those served, area serviced, and number of volunteers involved. Bespecfifc. Include equipment or services that would be purchased and why. Include a detailed budget and a schedule of significant activities related to this project. You may attach a maximum of one double - spaced typewritten page of information. (Please type or print legibly.) . All of the funds requested will be used to provide scholarships for graduating high school students who have met the academic requirement. These funds are sent directly to the college, never to the individual students, upon receipt of proof of enrollment. The deadline for funding a scholarship is May 1, 2011. The City of Temecula is encouraged to have representatives review applications and choose its recipient(s). The persons served are the high school students of Temecula Valley High School. Application - Page 3 PAST PROJECT BENEFITS I If your organization received City of Temecula funding in the previous year, please explain and show howl Temecula residents benefited. Last year, the City of Temecula donated $3,000.00 to qualified Temecula Valley, Chaparral and Great Oak High School seniors. Three recipients, one per high school, were selected to receive $1,000.00 scholarships. As in the past, we wait for all recipients who have been selected for the City of Temecula Scholarships to submit proof of enrollment before sending copies of the checks disbursed to you for review. The students have until May 1, 2011 to submit proof of enrollment and request disbursement of funds. On behalf of the trustees on the board of the Citizen's Scholarship Foundation of Temecula Valley, thank you for your continued support. Application - Page 4 SIGNATURE PAGE We hereby certify the information contained in this application is true to the best of our knowledge and belief. PREPAREDBY• Marilyn Williams President NAME and TITLE (Please Print or Type) PRESIDENT or AUTHORIZED OFFICER: Marilyn Williams President NAME and TITLE (Please Print or Type) ORGANIZATION NAME: Citizen's Scholarship Foundation of Temecula Valley MAILINGADDRESS: 31350 Rancho Vista Rd. Temecula, Ca. 92592 TELEPHONE:951- 795 -4617 DATED THIS 13th of September r 2010. (Date) (Month) BE SURE TO INCLUDE COPY AND SUBMIT TO: THE ORIGINAL PLUS ONE Mail Completed Applications to: City of Temecula Community Service Funding Program Attn: Judy McNabb Post Office Box 9033 Temecula, CA 92589 -9033 Or Deliver in Person to: City of Temecula Community Service Funding Program Attn: Judy McNabb 43200 Business Park Drive Temecula, CA 92590 Application - Page 5 Citizen's Sc Iarship Foundation of Ten"ula Valley Treasurer's Report - July 30, 2010 Money Market Account Balance on last statement $ 118,129.55 Interest on Money Market Acct $ 24.41 Donor Deposits this period $ 2,750.00 Other Deposits this period Total Credits this period (donor + interest) $ 2,774.41 Total Debits this period (transfers to other accounts) $ 750.00 Money Market Account Balance on 7/30110 $120,153.96 Roripaugh Account Balance on last statement $ 13,268.20 Interest on Roripaugh Account $ 2.73 Other Credits' Total Credits $ 2.73 Total Debits (transfers to checking) $ _ Roripaugh Account Balance on 7/30/10 $ 13,270.93 Checking Account Balance on last statement Total Credits (transferred from MMA and/or Roripaugh) Total Debits (checks cleared) Checking Account Balance 7/30/10 Checking Account Balance if all checks were Gear $ $ $ $ $ 8,009.86 750.00 6,239.81 2,520.05 200.00 respectfully submitted by Erin Simon, Treasurer 'Citizen's ScQlarship Foundation of TenUula Valley Treasurer's Report on Scholarships Paid August 25, 2010 Total Amount Awarded May 2010 $ 153,228.99 Money Paid to Date $ 23,173.83 Amount Unclaimed to Date $ 130,055.16 Total Number of Recipients 2010 214 Recipients Claimed to Date 37 Recipients Unclaimed to Date 177 Roripaugh Recipients are Included In the 214 Total Roripaugh Recipients Class 07 3 Recipients Claimed to Date 0 Roripaugh Recipients Class 08 4 Recipients Claimed to Date 0 Class of 09 2 Recipients Claimed to Date 0 Class of 10 6 Claimed to Date 1 California Dollars for Scholars® A program of Scholarship America' September 27, 2007 City of Temecula Finance Department Attention: Judy McNabb To Whom It May Concern: This letter is to provide evidence that the chapter CSF of Temecula (CA0246) is a chapter under the direction of Scholarship America. The EIN number for CSF of Temecula is 06- 1209452. Vendors may be interested to know at S olarship America formerly Citizens' Scholarship Foundation of America, s a 501 (c) (3) organization recognized as income tax exempt by the I.R.S. and our exemption letter is attached. Yours truly, Ann Worley Executive Director California Dollars for Scholars RE: Temecula Valley High School Chaparral High School Great Oak High School 17581 Irvine Blvd., # 120, Tustin, CA 92780 • Phone: 714.505.0561 or 800.335.4504 . Fax: 714.505.0562 e -moil: mail @califormiadollarsforscholors .org • v .coliforniadollarsforscholars .org Internal Revenue Service Date: March 1. 2003 -Scholarship America Inc Box 2971505 Riverview RD ST Peter, MN 56082 -1556 DearSir. Department of the Treasury P.O. Box 2508 Cincinnati, OH 45201 Person to Contact: Ms. Dalton 31 -07425 Customer Service Representative Toll Free Telephone Number: 8:00 A.M. to 6:30 P.M. EST 877 -829 -5500 Fax Number: 513 - 263 -3756 Federal Identification Number: 04- 2296967 This is in response to the amendment to your organization's Articles of Incorporation filed with the state on January 23, 2003. We have updated our records to reflect the name as indicated above. In April 1962 we issued a determination letter that recognized your organization as exempt from federal income tax under section 501(c)(3) of the Internal Revenue Code. That letter is still in effect. Based on the information supplied, we recognized the subordinates named on the list your organization submitted as exempt from federal income tax under section 501(c)(3) of the Code. Additionally, we have classified the subordinates your organization operates, supervises, or controls, and which are covered by written notification to us, as organizations that are not private foundations because they are organizations of the type described in sections 509(a)(2) of the Code. O PV �O Donors may deduct contributions to your organization's subordinates as provided in section 170 of the Code. Bequests, legacies, devises, transfers or gifts to the subordinates or for their use are deductible for federal estate and gift tax purposes if they meet the applicable provisions of sections 2055, 2106, and 2522 of the Code. Your organization and its subordinates are required to file Form 990, Return of Organization Exempt from Income Tax, only if the gross receipts each year are normally more than $25,000. If a return is required, it must be filed by the 15th day of the fifth month after the end of the organization's annual accounting period. The law imposes a penalty of $20 a day, up to a maximum of $10,000, when a return is filed late, unless there is reasonable cause for the delay. Your organization and its subordinates are not required to file federal income tax returns unless subject to the tax on unrelated business income under section 511 of the Code. If subject to this tax, the organization must file an income tax return on Form 990 -T, Exempt Organization Business Income Tax Return. In this letter, we are not determining whether any of your organization or its subordinates' present or proposed activities are unrelated trade or business as defined in section 513 of the Code. _2_ Scholarship America Inc 042296967 \ � V Unless specifically excepted, your organization and its subordinates are liable for taxes under the Federal Insurance Contributions Act (social security taxes) on remuneration of $100 or more paid to each of its employees during a calendar year. Your organization and its subordinates are not liable for the tax imposed underthe Federal Unemployment Tax Act (FUTA). Each year, at least 90 days before the end of your organization's annual accounting period, please send the following items to the Internal Revenue Service Center at the address shown below: 1. A statement describing any changes during the year in the purposes, character, or method of operation of your organization's subordinates; 2. A list showing the names, mailing addresses (including Postal ZIP Codes), actual addresses if different, and employer identification numbers of subordinates that: a. Changed names or addresses; b. Were deleted from the roster. or C. Were added to the roster.' `. Li 3. For subordinates to be added, attach: a. A statementthat the information on which your organization's present group exemption letter is based applies to the new subordinates; b. A statement that each has given your organization written authorization to add its name to the roster, C. A list of those to which the Service previously issued exemption rulings or determination letters; d. A statement that none of the subordinates is a private foundation as defined in section 509(a) of the Code if the group exemption letter covers organizations described in section 501(c)(3); e. The street address of subordinates where the mailing address is a P.O: Sox; and -3- Scholarship America Inc 04- 2296967 f. The information required by Revenue Procedure 75 -50, 1975 -2 C.B. 587 for each subordinate that is a school claiming exemption under section 501(c)(3). Also include any other information necessary to establish that the school is complying with the requirements of Revenue Ruling 71 -447, 1971 -2C.B. 230. This isthe same information required by Schedule A, Form 1023, Application for Recognition of Exemption Under Section 501(c)(3) of the Internal Revenue Code. 4. If applicable, a statementthat your organization's group exemption roster did not change since the previous report. The above information should be sent to the following address: Internal Revenue Service Center Attn: Entity Control Unit Ogden, UT 84409 The law requires you to make your organization's annual return available for public inspection without chargeforthree years after the due date of the return. If your organization had a copy of its application for recognitionof exemption on July 15, 1987, it is also required to make available for public inspection a copy of the exemption application, any supporting documents and the exemption letterto any individualwho requests such documents in person or in writing. You can charge only a reasonable fee for reproduction and actual postage costs for the copied materials. The law does not require you to provide copies of public inspection documents that are widely available, such as by posting them on the Internet (World Wide Web). You may be liablefor a penalty of $20 a day for each day you do not make these documents available for public inspection (up to a maximum of $10,000 in the case of an annual return). Your organization's Group Exemption Number is 1546. If you have any questions, please call us at the telephone number shown in the heading of this letter. Sincerely, gw,Z -&ee tL;" � � John Ricketts, Director CustomerAccount Services ~ CITYOFTEMECULA QTV Cf TFMFrIJI SEP 13 2010 FISCAL YEAR 2010-11 COMMUNITY SERVICE FUNDING PROGRAM A114ik.16MUN (Please Print or Type) PROJECT INFORMATION Amount Requested: $ 5,000 (Maximum allowable $5,000) Project 10 Project Start Name Contacl Mailing ORGANIZATION INFORMA'T`ION ► ,4ve^ Telephone: QS► Year Organization Founded: RFKC — (o ear 5 ,r�s ro�y�5 Number of Paid Staff :_ Number of Volunteers: ' (� Geographic Area(s) Is this organization incorporated in California as a non - profit organization? Yes V/ No Effective Date: if "yes" (Must provide a copy of your statement of non - profit status from the State of California): V Date of incorporation as a non - profit: Y 055M005 ClU kC h Federal identification number: q Ci-�i2(J(aZ�i� If "no ": State identification number: Name of sponsoring Federal identification number: State identification This application has been authorize by the organization's: � / Executive Committee Board of Directors V Members -at -Large Application - Page 1 i(111 JON d 1) COW How will your organization use the funding awarded? Describe the project project objectives, those served, area serviced, and number of volunteers involved. Be specift. Include equipment or services that would be purchased and why. Include a detailed budget and a schedule of significant activities related to this project You may attach a maximum of one double-spaced typewritten page of information. (Please type or print legibly.) 0 NEW UPWISS AW10 �MFM Iry Mm"UM.050- M- rot A NIAAA W VIM E I N TV W 1A CIO� ADDlication — Pace 3 I We hereby certify the information contained in this application is true to the best of our knowledge and belief. n PREPARED BY: 1 V 0ta I c, V:I hS NAME and' PRESIDENT or AUTHORIZED C ORGANI2 MAILING V 1 rec4n or 474 (Please Print or S)—bIT 5 N DATED THIS q of � , 2010. (Date) (Month) BE SURE TO INCLUDE THE ORIGINAL PLUS ONE COPY AND SUBMIT TO: Mail Completed Applications to: City of Temecula Community Service Funding Program Attn: Judy McNabb Post Office Box 9033 Temecula, CA 92589 -9033 Or Deliver in Person to: City of Temecula Community Service Funding Program Attn: Judy McNabb 43200 Business Park Drive Temecula, CA 92590 Application — Page 5 } DATE OF THIOTICE: 04 -25 -90 CP 575 'f Department of the Treasury EMPLOYER ID�._IFICATION NUMBER: Internal Revenue Service TAX PERIOD ENDING: N/A Alftmw FRESNO, CA 93888 8916606071 0 For assistance you may Ulf us at: 1- 800 - 424 -1040 TEMECULA VALLEY CHRISTIAN CENTER X TIMOTHY M BUTTREY 6468 CARTER ST Or you may write to us at the address CHINO CA 91723 shown at the left. If you write, be sure to attach the bottom part of this form. TAX FORMS YOU MUST FILE: Notice of New Employer Identification Number Assigned Thank you for your Form SS-4, Application for Employer Identification Number (EIN). The number assigned to you is shown above. This number will be used to identify your business account and related tax returns and documents, even if you do not have employees. 1. Keep a copy of this number in your permanent records. 2. Use this number and your name . exactly as shown above, on all Federal tax forms. 3. Use this number on all tax payments and tax related correspondence or documents. Any variation used when filing tax returns, making FTD payments or subsequent payments may result in improper or delayed posting of payments to your account and /or the assignment of more than one EIN. The filing requirement(s) and tax period shown above have been established for your account based on information contained on your Form SS -4. If you are a trust, your tax year generally must be a calendar year, unless you are exempt from taxation under section 501(a) of the Internal Revenue Code or a charitable trust described in section 4947(a)(1) of the Code. To help you to determine your required tax year, you may obtain Publication 538, Accounting Periods and Methods. This publication is available at most IRS offices for more information. Please note that the assignment of this number does not grant tax - exempt status to nonprofit organizations. Any organization (other than a private foundation) having annst=! gross receipts normally of $5,000 or less is exempt by statute if it meets the requirements of Section 501(c)(3) of the Internal Revenue Code. These organizations are not required to file Form 1023 (Application for Recognition of Exemption) or file Form 990 (Return of Organization Exempt from Income Tax). However, if the organization wants to establish its exemption with the Internal Revenue Service and receive a ruling or determination letter recognizing its exempt status, it should file Form 1023 with the key district director. For details on how to apply for this exemption, see IRS publication 557, Tax-Exempt Status for your Organization, available at most I RS offices. Thank you for your cooperation. Keep this part for your records. CP 575 (Rev. 10 -89) Run Date 9/9/2010 CrossRoads Church Time 16:41:40` } 28753 Via Montezuma Temecula CA 92590 Income & pex- nse a em�ie TTO►' ecembar(`) 001 GENERAL FUND Current % Y -T -D 5 5k Walk -A -Thon Camp Petty Cash Corporate Donation Dinner/Auction Income Golf Tournament Income Ministry Offering Private Donations RFKC Corp. Income Sponser Income TOTAL RFKC INCOME 5k Walk -A -Thon Expense Activity Center Expense Bible Story Supplies Birthday Party Expense Camp Petty Cash Expense Camp Supplies Expense Dinner /Auction Expense Directors Enrichment Expense Drama Supplies Golf Tournament Expense Memory Books Expense Ranch Expense Registration Supply Expense RFKC Corp. Expense Staff /Counselor Development Expense Supplies Welcome Home Dinner Expense TOTAL RFKC EXP COMBINED TOTAL ROYAL FAMILY KIDS C .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 1,120.00 100.00 .00 .00 .00 .00 00 .00 1,120.00 100.00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 107.65 9.61 .00 .00 .00 .00 00 .00 200.00 17.86 00 .00 .00 .00 .00 .00 .00 .00 .00 .00 686.29 61.28 00 .00 993.94 88.74 - 126.06 -11.26 o� 13,550.32 27.91 88.65 .18 7,286.00 15.01 8,538.51 17.59 9,718.00 20.02 9,362.56 19.29 .00 .00 .00 .00 .00 .00 48,544.04 100.00 66.15 .14 670.26 1.38 .00 .00 2,236.85 4.61 1,081.20 223 6,825.93 14.06 1,759.41 3.62 1,910.14 3.93 158.08 .33 5,032.94 10.37 -81.80 -.17 20,000.00 41.20 26.57 .05 775.00 1.60 1,713.12 3.53 1,003.05 2.07 58.43 .12 43,235.33 89.06 - 5,308.71 -10.94 Page 1 18Gk69 ENDORSED FILED M the Deice of *a Seaeftry o1 %ft ARTICLES OF INCORPORATION af +n.S�of Camende DEC 3 1 1992 OF MWH FOND EU, Secretary:of We Temecula Valley Christian Center L The name of this corporation is Temecula Valley Christian Center W A- This corporation is a religious corporation and is not organized for the private gain of any person. It is organized under the Nonprofit Religious Corporation Law exclusively for religious purposes_ B. The specific purpose of this corporation is to operate a church that is affiliated with the Southern California District Council of the Assemblies of God, Inc. The name and address in the State of California of this corporation's initial agent for service of process is: IV. A- This corporation is organized and operated exclusively for religious purposes within the meaning of Section 501(c)(3) of the Internal Revenue Code, B. No substantial part of the activities of this corporation shall consist of carrying on propaganda, or otherwise attempting to influence legislation, and the corporation shall not participate or intervene in any political campaign (including the publishing or distribution of statements) on behalf of any candidate for public office_ Page Two 0 The property of this corporation is irrevocably dedicated to religious or charitable purposes, and no part of the net income or assets of this corporation shall ever inure to the benefit.of any director, officer or member thereof, or to the benefit of any private person. Upon the dissolution or winding up of the corporation, its assets remaining after payment, or provision for payment, of all debts and liabilities of this corporation shall be distributed to Southern California District Council of the Assemblies of God, Inc., which is a nonprofit corporation organized and operated exclusively for religious or charitable purposes, and which has established its tax- exempt status under section 501(c)(3) of the Internal revenue Code; provided that the Executive Presbytery of the Southern California District Council of the Assemblies of God, Inc., elects to receive such distribution. In the event the Executive Presbytery of the Southern California District Council of the Assemblies of God, Inc, does not elect to receive such distribution or in the event the Southern California District Council of the Assemblies of God, Inc., is not then exempt under section 501(c)(3) of the Internal Revenue Code, the assets shall be so distributed to another nonprofit fund, foundation or corporation which is organized and operated exclusively.for religious or charitable purposes and which has established its tax- exempt status under section 501(c)(3) of the Internal Revenue Code. The written consent of the Executive Presbytery of the Southern California District Council of the Assemblies of God, Inc., is required to amend this article. VI. These articles of incorporation may not be amended without the written consent of the Southern California District Council of the Assemblies of God, Inc. Leonard Nipper, Incorp� crafor Rra_ PROJECT INFORMATION SEP 02 2010: Amount Requested: $ �Q, C; D tD (Maximum allowable $5,000) Project Name: cm�( Cr-ci le, Project Start Date: 10- 1 -01D10 Project End Date: I D' 1'"c)�Dl I I ORGANIZATION INFORMATION I Name of Organization: �m pi 5 �rG� 1✓ Contact Name: R i 7 ct4-e� to UUPS✓ Title /Position: TV"2 0.,S u-VC v- Mailing Address: 5,=;Lc) Ra_* u Ccc Q tF (Zoe o --1 - (o 3 ors 5 )) 9'�a -� )ga Telephone:- S j 5°l s - -3 Year Organization Founded: Number of Paid Staff: Number of Volunteers: i- Geographic Area(s) Served: T�meGt�Rc<, i�lww�2�ra. j2� UP^ S Cam_, �Acn� -- Is this organization incorporated in California as a non -profit organization? Yes No Effective Date: a 00 if -yes-, (Must provide a copy of your statement of non - profit status from the State of California): Date of incorporation as a non- profit: 4 Federal identification number: 3 - (3 f( (0 V State identification number: (1 O S 3 1 7 1- )S ;)-C�(Q <( If "no ": Name of sponsoring organization: Federal identification number. State identification number: This application has been authorize 0,by the organization's: Executive Committee Board of Directors Members -at -Large Application - Page 1 Income Statement for Year Ended 6/30/10 INCOME: Donations y 1 _ 4 09/10 City Funding 1,000.00 EMPTY CRADLE 6102.79 Total Income FINANCIAL STATEMENT Balance Sheet as of 6/30/10 ASSETS: $ 1,955.75 Cash $ 12,460.89 Investments 10,258.17 Receivables 0.00 Fixed Assets 0.00 Other Assets 0.00 Total Assets $ 22,720.06 LIABILITIES: 992.23 Current Payables $ 0.00 Notes Payable 0.00 Fund Balance 22 720.06 Total Liabilities $22,720.06 Income Statement for Year Ended 6/30/10 INCOME: Donations $ 3,059.08 09/10 City Funding 1,000.00 Walk To Remember Proceeds 6102.79 Total Income $10,161.87 EXPENSES: Newsletter $ 1,955.75 Rent - Temecula 608.00 Meeting Supplies 551.66 Walk To Remember 3,947.39 Website 2,280.60 Bereavement Materials 421.40 Telephone 684.87 Training Materials 992.23 Office Supplies 285.70 Other Expenses 452.48 Total Expenses $12,180.08 Net Income: $ - 2,018.21 • .INCOME: Donations $ 4,000.00 Grants 3,000.00 Walk To Remember Proceeds 5,000.00 Interest Income 100.00 - TOTAL INCOME - $12,100.00 r EXPENSES: Bereavement Materials $ 400.00 Meeting Supplies 300.00 Memorial Boxes 5,000.00 Miscellaneous Expenses 300.00 Newsletter Printing/Postage 2,200.00 Rent — Temecula 540.00 Speakers 600.00 Telephone 600.00 Volunteer Recognition 600.00 Walk To Remember Expenses 3,000.00 Website 2.000.00 TOTAL EXPENSES `' $15,540.00 v Empty Cradle is a peer support group for parents who have experienced the loss of a baby due to miscarriage, stillbirth or infant death. The death of a baby .is -one of life's most devastating experiences.- Grieving can be. lonely because often -others don't - -- - :: understand the depth of the sorrow and the length of time needed to deal with the pain. Empty Cradle Resource Parents have faced a similar sorrow and can assist families through the normal grieving process by sharing and listening and giving them a sense of direction and hope. Because the grief process is different for each family, Empty Cradle provides a variety of options for support and healing: Monthly group meetings with a speaker or activity and sharing circles ■ Telephone resource parents for one- on-one support • A no -cost lending library of resource materials ■ A quarterly newsletter with articles, announcements and baby memorials ■ A subsequent pregnancy support group ■ Special events such as Annual Memorial Service and Walk To Remember Empty Cradle meets all the criteria for funding because: ✓ We have been designated a non - profit organization by the Internal Revenue Service. ✓ We provide a service to the overall community in that any adult who is affected by the loss of a child will find solace and support at our meetings and through our library and literature. So many pregnancies end in miscarriage and many babies die at birth or shortly after. The parents of these cherished babies live and work in our community. ✓ Our organization is well equipped to provide the services needed by the overall community with a very strong Resource Parent volunteer network to provide support to bereaved parents as well as support resources to our local hospitals and medical community. ✓ Our group is extremely well received by medical facilities in our area and is considered a life -line for many families in the community. ✓ Empty Cradle's success in San Diego County for over 25 years sets the stage for our longevity in Riverside County. Our success and growth in Temecula over the past four years is, of course, bittersweet. ✓ We are fully automated in our accounting system and fiscal management with experienced volunteers managing our finances and accounts. ✓ We do not discriminate in any way, nor do we require attendance in any of our events and /or activities. ✓ We can provide an annual budget as well as annual financial statements. ✓ Empty Cradle's services are available to anyone in the community who has a need for such support. ✓ We evaluate the effectiveness of our efforts at quarterly board meetings. EMPTY CRADLE - - PROJECT DESCRIPTION You know, if the medical community could keep the pace with technology, perhaps there wouldn't be a need for Empty Cradle. Perhaps, miscarriages, stillbirths, and infant _ death could all be prevented. In today's world we can send an electronic message to the other side of the world in an instant, but we can't save these babies. _Since this is a_ tragic reality, the only thing we can do is be ready for these suffering families and keep pace with the world we live in. As such, Empty Cradle desperately needs to come into the 21St century to provide outreach, support and information in the electronic age. Some of the costs associated with doing this include: 0 Website hosting $200.00/year 0 E- Newsletter 200.00 /year 0 Website Maintenance 600.00/year Although we're working toward reaching out electronically, we still need to provide that newsletter in the mailbox. Our members have told us they treasure it, read it over and over, and gaze at their beautiful baby's name in print. The cost of mailing the newsletter is so high we've gone from publishing 6 times a year to 4. 0 Newsletter printing $1,200.00/year 0 Newsletter postage 600.00/year 0 Newsletter handling 400.00/year Our most meaningful support, though, is face-to -face. Our meeting locations are costly. We'd like to make the environment more warm and relaxing with refreshments. And, with funding, we have so many opportunities to invite professional speakers to help our members. 0 Professional speakers 0 Facility costs 0 Meeting supplies $600.00 /year $540.00 /year $300.00 /year Of course, we always have a need for bereavement materials for our bereavement packages going out to hospitals including books, printed materials, cameras, and other necessary items. 0 Bereavement materials 400.00/year EMPTY CRADLE _ PAST PROJECT BENEFITS _ Empty Cradle has continued to have a positive impact on our community in the past year. With support from the City of Temecula, Empty Cradle was able to purchase memory boxes to include in that Bereavements Packs provided to hospitals to give to parents _ who have suffered the loss of their baby. These boxes are one of the most important elements of our bereavement packs because they are designed especially for the loss of a child. The beautiful box, tied with a ribbon, opens to reveal an embedded photo frame on one side and a footprint frame on the other. The box includes a hat, shawl and small blanket, a scented heart- shaped pillow, a wisp of hair bag, a condolence card and a lovely poem. On the outside of the box, medical personnel are provided a check- off sheet to assist them in working with these families to ensure their needs are met. These beautiful boxes most often become the treasured place to put the few mementos of the baby's short life. The boxes are placed in a lovely bag with a variety of other items such as a camera, hand -knit blanket, informational materials, an unofficial birth certificate and a booklet entitled When Hello Means Goodbye. The hospitals that receive these memorial items are so grateful to have a comprehensive packet of materials to provide to their bereaved families. If not for Empty Cradle, these families would often go home — literally empty handed. DATED THIS k (Fa ) N Of fgA f: � __ , 2010. (Momh) BE SURE TO INCLUDE THE ORIGINAL PLUS ONE COPY AND SUBMIT TO: Mail Completed Applications to. City of Temecula Community Service Funding Program Attn: Judy McNabb Post Office Box 9033 Temecula, CA 92589 -9033 Or Deliver in Person to: City of Temecula Community Service Funding Program Attn: Judy McNabb 43200 Business Park Drive Temecula, CA 92590 Application —Page 5 Our letter dated December 1991, -staked you would be exempt from Federal income tax under section 501(c)(3) of the Internal Revenue Code, and you would be treated as a public ebarity, rather than as a private foundation, during an advance ruling period. Based an the information you submitted, you are classified as a public charity under the Code section listed in the heading of this letter. Since -your exempt status was not under consideration, you continue to be classified as an organization exempt from Federal ,income tax under section 501(c)(3) of the Code. Publication 557, Tax - Exempt Status for Your Organization, provides detailed information about your rights and responsibilities as an exempt organization. You may request a copy by calling the toll -free number for forms, (800) 829 -3676. Information is also available ou our Internet Web Site at www.irs.gov. If ypu have general questions about exempt organizations, please call our toll -free number shown in the heading between 8:00 a.m. - 6:30 p.m. Eastern . time. Please keep this letter in your permanent records. Sincerely yours, Lois G. L rner . Director, Exempt Organizations Rulings and Agreements Letter 1050 (DO /CG) PROJECT INFORMATION Amount Requested: $ 51 000 ° r i /(Maximum allowable $5,000) Project Name: fbUe�"A !.�,(�.( /�. 17oYi lel)6 (OujrQ /P G// a ( < ?l1 D Project Start Date: 6dQUE -7 Project End Date: �' CAS Gfl C,ta ORGANIZATION INFORMATION Name of Organization D l —ri-)ijG N Mwdhep Our U)irfq O er / Contact Name: n L Title /) Position: ��'�15%C�$/! 1 / y1 Mailing Address: 0M _AnIs-loiciL�, OGt�J � D1C)3 /I/QniTte, () qe Telephone: q51- 6 �) . q6 61 Year Organization founded: Number of Paid Staff: C) Number of Volunteers: loo, �J J Geographic Area(s) Served: M- 12GUIZt - �O(AhWe 1VCI511 l(�U/i�1% Is this organization incorporated in California as a non -profit organization? Yes x No Effective Date: 9 If "yes" (Must provide a copy of your statement of non - profit status from the State of Date of incorporation as a Federal identification number: 73-)68 /x-193 State identification number:_ a If "no ": Name of sponsoring organization: Federal identification number. State identification number: This application has been authorized by the organization's: �I Executive Committee Board of Directors Members -at -Large Application - Page 1 Puh PROJECT, DESCRIPTION How will your organization use the funding awarded? Describe the project, project objectives, those served, area serviced, and number of volunteers involved. Be specific. Include equipment or services that would be purchased and why. Include a detailed budget and a schedule of significant activities related to this - project You may attach a maximum of one double - spaced typewritten page of information. (Please type or print legibly.) LL ," 1 o 17XLCU�G� lj& c1patf`III ) e rt.Nj a- ho -SI12a (�yr 1 WA a -hrm i-,) frl m• :r ✓�� /iva✓ f rY� -Trno i ..la ADOlication — Paoe 3 4� e PRESIDENT or AUTHORIZED O MAILING npp,_ 7 and TITLE (Please-Print or FA DATED THIS Iq4 of ICJ k w 2010. (Date) I (Month) BE SURE TO INCLUDE THE ORIGINAL PLUS ONE COPY AND SUBMIT TO: Mail Completed Applications to: City of Temecula Community Service Funding Program Attn: Judy McNabb Post Office Box 9033 Temecula, CA 92589 -9033 Or Deliver in Person to: City of Temecula Community Service Funding Program Attn: Judy McNabb 43200 Business Park Drive Temecula, CA 92590 Annlinntion — PaaP 5 STATE OF CALIFORNIA - °. FRANCHISE TAX BOARD - - - - „%: PO BOX 1286 RANCHO CORDOVA CA 95741 -1286 - In reply refer to _755:G :GRW January 13, 2010 GOD'S FAN CLUB A NON- PROFIT ORGANIZATION 30141 ANTELOPE RD STE D -103 MENIFEE CA 92584 -8066 Purpose CHARITABLE Code Section 23701d Form of Organization Corporation Accounting Period Ending: November 30 Organization Number 2553261 EXEMPT DETERMINATION LETTER This letter confirms your previous exemption from state franchise and income tax under Section 23701d, Revenue and Taxation Code. In confirming your exempt status, we have made no examination of your current activities. -If the organization has changed its operation, character, or purpose since exemption was originally granted, that change must be reported immediately to this office. To retain exempt status, organizations are required to be organized and operating for nonprofit purposes within the provisions of the above section. An inactive organization is not entitled to exemption. For filing requirements see, FTB Pub. 1068, Exempt Organizations - Requirements for Filing Returns and Paying Filing Fees is available online at www.ftb.ca.gov. Note: This exemption is for state franchise or income tax purposes only. G WALKER EXEMPT ORGANIZATIONS BUSINESS ENTITIES SECTION TELEPHONE (916) 845 -6053 FAX NUMBER (916) 845 -9501 RTF: Temecula Homeless Response - - 2010- 2011 Budget 2010-2011 Year Emergency Motel Stays $3,200:00 Food _ - $4,300.00 Gas Clothing $500.00 Utility Assistance - - $1-,800.00 - -- Transportation- Bus Passes & Auto Repairs $1;000.00 Miscellaneous $200.00 Answering Service $600.00 TOTAL $13,500.00 8:00 PM God's Fan Club, ANon- Profit Organization 09/13/10 Balance Sheet Accrual saris As of November 30, 2009 _ _.Nov 30, 09_ ASSETS.. - Current Assets_ - Checking /Savings ... - 10000 - God's Fan Club -Wells Fargo-Ck 1,432.52- - - 10001 • Men of Influence- WellsFargo -Ck - 3,009.55 - ' - 10002 - Project TOUCH- Wells Fargo- Ck 2,980.00 - - - - - - - - 10003 • The Brook- Wells Fargo- Ck 205.00 - 10100 • Hotel Hope- Wells Fargo- Saving - 420.00 Total Checking/Savings 8,047.07 - - - - - - - Total Current Assets - - - - ..8,047.07 TOTAL ASSETS - - - 8,047.07 LIABILITIES & EQUITY - Liabilities - - - Long Term Liabilities - 27100 • Loan Payable -Ann Unmacht 4,500.00 Total Long Term Liabilities 4,500.00' Total Liabilities 4,500.00 Equity 30000 • Opening Balance Equity - 519.01 32000 • Unrestricted Net Assets 830.27 Net Income 3,235.81 - Total Equity - 3,547.07 TOTAL LIABILITIES & EQUITY 8,047.07 Page 1 Page 1 Goi3's Fan Club, A Non -Profit OPg�anlzatton PM Profit & Loss 09113110 Accrual Basis December 2008 through November 2009 __ ... _. Dec'08 -Nov 09 _ - Ordinary Income/Expense .Income ... _.._ _._... _.... __ .. _...._ _ ... _.. .43400 • Direct Public Support - 43450 • Individ, Business Contributions 22,43745 Total 43400 • Direct Public Support -..... -... _ 22,437.45. -. - 49000 • Special Events Income- Fundrais 49010 • Special Events Contributions 16,475.00 - 49020 • Special Events Sales (Nongift) 25,364.91 Total 49000 • Special Events Income- Fundrais 35,839.91 Total Income_ 58,277.36 Expense 60300 - Specific Assist to Individuals - - - 60310 - Motel Stays 2,404.55 _ 60320 - Food 2,454.44 60330 - Gas - 326.53 60340 • Clothing 89.76 60360 • Misc 4,385.13 60370 - Automotive Repairs - 331.90 60380 • Utilities 566.75 Total 60300 • Specific Assist to Individuals 10,559.06. 60900 • Business Expenses 60920 - Business Registration Fees 20.00 Total 60900 • Business Expenses 20.00 62100 • Contract Services 62150 • Outside Contract Services 15,254.50 Total 62100 • Contract Services 15,254.50 62800 - Facilities and Equipment 62890 • Rent, Utilities 4.00 Total 62800 • Facilities and Equipment .4.00 65000 • Operations 65060 Payment Processing Fee 700.05 '.. 65070 Bank Service Fees 449.60 65089 Website Hosting - 697.68 65010 • Books, Subscriptions, Reference 293.59 - 65020 • Postage, Mailing Service 240.00 - 65030 - Printing and Copying 35.00 - .65040 • Supplies 2,024.20 65D50 • Telephone, Telecommunications - 718.78 Total 65000 - Operations 5,158.90 65100.Other Types of Expenses 65160 - Memberships and Dues 100.68 65160 - Other Costs 927.51 65170 • Staff Development 179.35 Total 651 D0.Other Types of Expenses 1,207.54 .� 68300 - Travel and Meetings z 68330 Business Meals 1,101.11 68320 • Travel 584.41 Total 66300 - Travel and Meetings 1,685.52 Page 1 CITY of TEW1,11A SEP 1- 5 2010 I <, R a T �NANCE f3EPT. W, Project T.O.U.C.H. "Together Our gnity Conquers Homelessness" September 14, 2010 City of Temecula Community Service Funding ATTN: Judy McNabb 43200 Business Park Drive Temecula, CA 92590 Thank you for naming our organization as a past $2500 recipient. The funds have enabled us to assist Temecula residents in bridging the gaps left by the economic crisis that has negatively impacted our region. The call volume continues to increase with Temecula residents seeking assistance and guidance as they attempt to navigate a situation they never thought of facing. We are seeking the maximum amount of $5000. We cannot stress enough how your partnership will allow us to meet the overwhelming growing needs of the citizens of Temecula who are faced with homelessness or near homelessness due to the continuing declining economy. The funds awarded will allow us to continue to meet the very basic needs- shelter, food, and clothing. Our organization continues to provide what we can to aid those in distress. However, the needs in Temecula are increasing enormously. Recently, we have seen a large increase in homeless single women between the ages of 30 -60 years old. We emplore you to grant us the maximum of $5,000. We will continue in our very best effort to meet the emergency needs of some of Temecula's most vulnerable citizens. Thank you and God Bless You, Anne Unmacht President Project T.O.U.C.H 30141 Antelope Road, Suite D -103, Menifee, CA 92584 (951) 677 -9661 Fax: (951) 677 -2753 E -mail: projecttouch7 @aol.com web site: www.projecttouch7.org t c. - CITY OF TEMECULA Fiscal Year 2010 -11 SEP 14 2010 COMMUNITY SERVICE FUNDING PROGRAM APPLICATION�INAN CE DEPT., c'( 011 Program Submission Deane• Wednesday September 15 2010 E� V E® dli A Requested:. $ 5.000.00 (Maximum allowable $5,000) 20$6 t Name: Great Oak High School Graduation After Party 2011 t Start Date: June 2010 Project End Date: June 2011 N12.ATION INFORMATION: Grczz4 cWii& A-eirac( mic..) 1 lrm6esKip of Organization: GOALS - GOHS Graduation After Party Committee A Name: Karen Martin Title /Position: GAP Co-Chair Person 1 Address: 45623 Caminito Olite, Temecula, CA 92592 tone: (951) 302 -8122 Year Organization Founded: 2006 m of Paid Staff: 0 Number of Volunteers: -150 aphic Area(s) Served: Temecula n of organization incorporated in California as a non - profit organization? at posed Yes X No Effective Date: 5/19/2004 se of at we a or Date of incorporation as a non - profit: 5/19/2004 Federal identification number: 20- 1127880 dicial as State identification number: Nonprofit Corporation # 2583221 a in pop tclude a copy of your statement of non -profit status from the State of California. ble. occur. sel Name of sponsoring organization: N/A Federal identification number: N/A t/2 State identification number: N/A ual tplication has been authorized by the organization's dive Committee Board of Directors X Members -at -Large K to January 26, 2006 GREAT OAKS ACADEMIC LEADERSHIP SOCIETY ENTITY ID : 2583221 _- Page 2 _file Form 109 (Exempt Organization Business Income Tax - Return) .by the - 15th day of the 5th month (4 1/2 months) after the close of your annual accounting period. Please note that an exemption from federal income or other taxes and other state taxes requires separate applications. - - A copy of this letter has been sent to the Registry of Charitable Trusts. E DIALA EXEMPT ORGANIZATIONS BUSINESS ENTITIES SECTION TELEPHONE (916) 845 -4186 ED : Item Amount_ Decorations $5,000.00 Entertainment $20,000.00 Food $500.00 Presents - - $10,000.00 Secudty $1,500.00 Custodial $250.00 Misc $500.00 Com Tickets $1,750.00 Total Exp $39,500.00 Car onward $2,820.00 Tickets 420 $29,400.00 Donations $10,000.00 Bingo $5,000.00 Fundraising $5,000.00 Total Inc $49,400.00 Pagel _ ....GOALS. 11:10AM __ Balance Sheet 09/13/10 Cash Basis As of June 30, 2010 _ -.. __ _. ..... ......... _: -Jun 30,10. ASSETS _.... , __. _. .. .... -- Current Assets - - CheckingiSavings. - - CA. COAST CREDIT UNION - SAVINGS 1,770.01 - - - - - -.. .... CALIFORNIA COAST- BINGO... 25.00. .- - - -- - -- _ - -- - CALIFORNIA COAST CREDIT UNION 124,656.95 MISSION OAKS -Money Market Acct 104,606.29 Total Checking/Savings 231,260.25 - Total Current Assets 231,260.25 - -... ..TOTAL ASSETS _._. -. 231,260.25 -. LIABILITIES & EQUITY Equity - Net Income 231,260.25 Total Equity 231,260.25 TOTAL LIABILITIES & EQUITY 231,260.25 Pagel Bank Interest °°° 4,573.12 '•011° 237,810.67 CmWomard Funds Donations _ _ - flovemmeM GraMf - - - 1.000.00 11.275.00 Student Donstlons 17,787.50 280,5.12 Donations -Other 2,187.00 51,44555.02 Total Donations 20.974.50 323,495.14 FundmUMO Income 0.00 concessions Merchandsa sold 328.00 328.00 $2,419.72 scrip 0.00 55,810.63 Bilklal Events -0ross Receipts 2.373.01 98,458.52 Fuadralaing IMOrne -Other 0.00 170,745.90 Total Fuadralstag Income " 2,701.61 445,250.19 Total income 28,24923 1,000.187.10 am" Profit 20.249.23 1,005,167.10 Expence Awards O.DU ,110.70 ' Contributions 1811.321.52 Donation expense 0.01) 0.00 8.337.01 Entertainment .0.00 3,000.OD . Entry Foe 0.00 22.030.00 Equipment O.DD 28,002.58 Equipment rsMela 0.0 0 150.00 Facility coati 0-00 4,281.05 Fees 0.00 509.00 Financial Hardship p 250.00 Fundralaing expense - 288.00 489.28 Adcerti111110 Conceselon suppler 0.00 25,931.59 Merchandise 00 0.00 26,734.85 Printing 0. 8.564.79 Scrip purchase 0.00 48009 55.773.80 Special Eventa-0Imct CDOU ' 49.493.43 Fundralsing expense -Other 0.00 39,903.69 Total FuadraUing expense 774.09 206,88823 General SuPPlles 0.00 4.764.11 Gifts 0.00 22.360.41 Grad this Expenses 24,225.84 24.228.84 Operating Expense 20.88 1.804.77 Bank charge 0.00 .00 311.05 0.00 75.00 Income tax expense 0.00 1,205.00 Insurance Legal and m0lass10MA exPOnee O00 40.00 Postage 175.00 supplies 0.00 224.28 Total operating Expense 2D.88 3.835.18 Outswe servkes 0.w 25.250.59 p8G hu ninoalBenquetsUnnon 82,205.01 made Re - 350.W 2,878.68 Repairs sod malMenaMe 0.00 8.6n.34 Scholarships 0.00 4,ODD.OD BaminamrO mps 0.00 0.00 38.280.28 Transfer of funds 0.00 Transportation 0.00 19,608.51 Travel 0.00 30.464.71 UnBmmsMostames Expense 0.00 90.656.50 Total Expense 25,371.78 - - - 778.906.85 Net Income 2,877.44 231,20015 MISSION STATEMENT - Application Page 3 Briefly describe the goals and objectives of your organization and community services it provides. Describe the ways your organization meets the criteria listed on page 2 of the CS Funding Policy. The Great Oak High School (GOHS) Graduation After Party Committee operates under the umbrella of Great Oak.Academic Leadership Society (GOALS), a non - profit public' benefit' corporation. The committee's goal is to provide a safe, memorable celebration for the GOHS graduates after commencement exercises. The Graduation After Party begins at approximately 9 :00 PM and continues until 5:00 AM. The evening provides a drug -, alcohol -, and tobacco -free environment for graduates to celebrate this milestone in their lives. The graduates enjoy games, dancing, food, - themed environment, and many exciting activities. This night is a- much anticipated and climatic event for our seniors to share a fun and memorable evening! For the class of 2011 at GOHS, this event continues the legacy of a drug - 'alcohol -, and tobacco -free celebrations begun by our inaugural class in 2007. As a committee, we do not discriminate based on race, color, creed, nationality, sex, marital status, disability, religion, or political affiliation. We do not require attendance or participation in any political, religious or social activity. Donations help us provide free tickets for those students that cannot afford to attend the event. Over the years, Grad Nite celebrations at Temecula high schools have received overwhelming positive feedback from both graduates and parents. Many graduates return to help with Graduation After Party after leaving high school. The planning for the fifth GOHS Graduation After Party has already begun. The event requires hundreds of parents, faculty/staff, and community volunteers coming together for one common goal: saving the lives our young adults. PAST PROJECT BENEFITS Application Page 5 If your organization received City of Temecula funding in the previous year, please explain and show how Temecula residents benefited. Over the last four years the Great Oak High School senior students experienced a safe and enjoyable evening. They created great memories of their last night as a high school student. With over a thousand graduates participating in our Graduation After Party celebration over the last four years, we know we have had an impact on the lives of young adults in Temecula. Graduation After Party celebrations keep the graduates safe and sober by keeping them away from private parties; social drinking and potentially driving under the influence of alcohol. Local reports show no accidents or arrests of our Great Oak graduates on graduation nights. We feel this can largely be attributed to our Graduation After Party celebration. We gave them an exciting alternative that kept them safe, sober and drug -free. The City grant contributes to the payment of the deposit for Jolly Jumps, which is the majority of our entertainment for the evening. In addition, we used the funds to build reusable Graduation After Party structures (Casino, Dance Club, Check -in walls). Many of these structures are reused over the years and will continue to decrease our future costs and increase efficiency for many years to come. An additional benefit derived from the success of our first four events is the buzz" that is generated and is still evident among the returning students at Great Oak. This year's senior class is full of excitement created by last year's success and is anxiously awaiting the event having purchased more than 100 tickets during back to school registration. The value of the City grant is apparent when we talk to these students. Along with the students, the Great Oak Graduation After Party Volunteers, who are by and large residents of Temecula, benefited from this event. Seeing young people enjoying themselves, not misbehaving, and acting like the adults they have just become encourages volunteerism and participation in events that involve Temecula youth. PRESIDENT or / j — AUTHORIZED OFFICER: � d'd ( / O e n r e �( �lPa 5a lee ' NAME and TITLE (Please Print orT ) SIGNATURE: DATED THIS /3 of ��o �e.°67p� r , 2010. (Date) (Month) BE SURE TO INCLUDE THE ORIGINAL PLUS ONE COPY AND SUBMIT TO: Mail Completed Applications to: City of Temecula Community Service Funding Program Attn: Judy McNabb Post Office Box 9033 Temecula, CA 92589 -9033 Or Deliver in Person to: City of Temecula Community Service Funding Program Attn: Judy McNabb 43200 Business Park Drive Temecula, CA 92590 PROJECT INFORMATION Amount Requested: $ S; o 00 . `°/ (Maximum allowable $5,000) ProjectName: koVi;4Qa- Wn.& - ? 'h o. II- Project Start Date: 2 on 9 Project End Date: a O 12 ORGANIZATION INFORMATION I Name of Oraanization` H n t..: J Contact Name: Tam nc) 1w (" rar 1 n e , Title /Position: E Xe C L rl ve: V_� i re cl o v- Mailing Address; 27g7,113 [qeZ Ro( V,:igDi 1emcC.A4 c0. cA 9a9 91 Telephone:(951 ) 296 - 2.21 b 2 Year Organization Founded: 19 9 1 Number of Paid Staff. I (o Number of Volunteers: 2000 t (� Cove, Qpe-a )2boH•Xd e:c{ on : Nor,4 }j� CCYY) c n cL Geographic Area(s) Served: LgX `✓la;nore. and San on +t.t Sou: Is this organization incorporated in California as a non - profit organization? Yes V No Effective Date: 199 I if'yes" (Must provide a copy of your statement of non - profit status from the State of California): Date of incorporation as a non - profit: 19011 Federal identification number: -.3S-C)4 f� I a O � State identification number: C I % 8 19 22 If "no ": Name of sponsoring organization: Federal identification number: State identification number. This application has been authorized by the organization's Executive Committee Board of Directors Members -at -Large Application - Page 1 PROJECT: DESCRIPTION How wiltyour organization use thefunding awarded? Describe the project, project objectives, those served, - area serviced, and number of volunteers involved. Be specific. Include equipment or services that would be purchased and why. Include a detailed budget and a schedule of significant activities related to this project You may attach a maximum of one double - spaced typewritten page of information. (Please type or print legibly.) Application — Page 3 SIGNATURE PAGE We hereby certify the information contained in this application is true to the best of our knowledge and belief. PREPARED BY: T m r a TITLE (Please Print or Type) - Iii 1,- PRESIDENT or AUTHORIZED OFFK ORGANIZATION NAME: 14 n In: / 6`I " (- , r 1-- c- or Type) MAILING ADDRESS: 27 L4 -I `J 1t o cZ !9d *1-31, 909 -Tc.,rn c r A o1 C t"'1 g a 5 9 -roi_eounuc. iQ C%\ '7 Q / _ —A I -1 DATED THIS S of , 2010. (Date) Month) p.r, p1�",./r- BE SURE TO INCLUDE THE ORIGINAL PLUS ONE COPY AND SUBMIT TO: Mail Completed Applications to: City of Temecula Community Service Funding Program Attn: Judy McNabb Post Office Box 9033 Temecula, CA 92589 -9033 Or Deliver in Person to: - City of Temecula Community Service Funding Program Attn: Judy McNabb 43200 Business Park Drive Temecula, CA 92590 Aoolication - Paae 5 MISSION STATEMENT Application Page 2 (Supplemental) Habitat for Humanity Wand Valley is an affiliate of Habitat for Humanity International; a worldwide housing mimstry located in -- Americus; Georgia:- Habitat's mission is to eliminate substandard housing and homelessness worldwide, and to make adequate, - - -- affordable shelter a matter of conscience and action. Habitat believes that every man, women and child should have a simple, decent affordable place to live in dignity and safety. Our local affiliate has adopted a mission statement that reads: The mission of Habitat for Humanity Inland Valley, in partnership with God, is to facilitate the dream of homeownership as well as improve living conditions for those in the community. Our affiliate services Southwest Riverside County including Temecula. Murrieta, Lake Elsinore, Perris, Sun City, Wildomar, and Menifee. We build or renovate simple, decent affordable houses and sell them to local low- income families at no profit with no- interest loans. This is accomplished through volunteer labor and donations of money, materials, and land. Local families are selected for Habitat houses based on three criteria: 1.) Need for adequate shelter 2.) Ability to pay 3.) And willingness to partner. Habitat for Humanity does not discriminate on the basis of race, sex, color, age, handicap, religion, national origin, family status or marital status, or because all or part of the family income is derived from any public assistance program. Applicants for Habitat houses must demonstrate their ability to pay monthly mortgage payments and have a good credit rating. They are also required to make a $1.000 down payment for the house. In addition, they must be willing to put in sweat equity hours on their own or other Habitat houses, and participate in a family support program which includes classes on budgeting, home Habitat for Humanity helps people break the cycle of poverty. Habitat homes reflect pride in ownership, enhance neighborhoods, and provide safe housing for fami &es. Habitat Partner families continue to give back to the community long after they have completed the hours they are required to spend building their own homes Statistics show that Habitat homeowners gain more than a house they gain self - esteem, are more likely to become regular voters, their children's grades improve and overall, they become more active and productive members of the community. PROJECT DESCRIPTION Application Page 3 (Supplemental) This project serves Temecula low - income residents and when completed will result in the sale of new homes to two Temecula families. some of whom are currently living in subsidized housing. Five homes have already been built and the families moved into their home in June of 2008. Phase 11 of the project will involve the building of two additional homes Two families will be selected when the land development phase nears completion for Phase H on the other parcel of land provided by the City Thanks to a partnership with the City of Temecula. Phase I of the eject was made possible by a disposition and development agreement between the City and Habitat Tentative Tract Man (TTM30990) subdivided the original three existing lots into five single lots for construction of the first five Habitat houses In September 2005 an additional parcel of land was added that has been subdivided into two more lots for an additional two homes (,Phase II). When construction begins on the next two homes it is anticipated that 1.088 square-foot houses will be built consistent with the house plans on Phase I of the project The per house cost estimate for construction is approximately $150,000. Actual costs will vary on donated material. Labor will be provided by professional tradesman as well as 300 to 500 volunteers Sponsorships for the homes in the past have included Centex Homes (to complete an entire home) Bank of America ($75,000), Thrivent Financial ($68,000), Dixieline Lumber ($100,000), Archstone -Smith ($10 000) California Bank and Trust ($10000) the City of Temecula ($20,000 from four previously awarded grants) Guidant ($15 ,000), Friends of Habitat Program ($19,700) and the Realtor® Program ($35,000) as well as cash on hand. Phase H of the project has an anticipated construction start date in late 2011. The project is being managed by the Habitat Construction Team whose members include personnel with extensive experience from from both Centex Homes and KB Homes as well as a paid Habitat Project Coordinator. Other volunteer teams supporting the project include Fundraising Family Selection Family Support. and Covenant Church relations Members of the Board of Director act in both an oversight role as well as performing as active leaders volunteers and the various teams. Members of the local Habitat for Humanity High School Affiliates (Temecula Valley Chaparral Great Oaks and Munieta Vista chapters) will also be involved PAST PROJECT BENEFITS Application Page 4 (Supplemental) Habitat for Humanity Inland Valley successfully completed construction of two Old Town Temecula houses in September 2000 and then five homes most recently in June of 2008. The seven families who bought these homes are living the American Dream of homeownership, something that would not have been possible without the hand -up from Habitat and the Chy of Temecula. The families are contributing to Temecula as responsible tax - Ravine citizens and thew well - maintained homes dismay pride in ownership Long ago they had satisfied their original commitment to Habitat the owners of both homes continued to give back to the community by volunteering their time to the affiliate. Building houses does more that help provide shelter for those in need. It fosters friendshiR, breaks down barriers and changes lives. In addition, thanks to our stringent and comprehensive application process, not only do the homeowners benefit. Even applicants that are denied gain as they get a better understanding for their financial picture and what is needed to be come a homeowner. Denied applicants report life - changes as a result of the process The benefits of the work of Habitat for Humanity ] Valley also extend to volunteers. The progjam provides people -to- people partnerships that draw families and communities together. Habitat also offers opportunities for high school students to get involved while paving the foundation for lifelong community service commitment. Habitat gives the students leadership opportunities, exposes them to local socio- economic problems and provides them with a chance to be part of the solution. With over 60 applicants in the last Family Selection process, now more than ever, it is apparent that the need for affordable housing exist in Temecula A drive down Sixth Street or Pujol Street still give the hundreds of volunteers who helped in both projects the opportunity to see direct and tangible results of their efforts — right here in Temecula. In June of 2010. Habitat for Humanity Inland valley was selected as one of 163 affiliates nationwide to participate in the Neighborhood Stabilization Program (NSP). We have already assisted 10 families with this project. Launching this new program offers a real solutions to the foreclosure crisis. Our goal as an agency has always been to improve living conditions while providing services to as many families as possible in the hiland Valley. This program main focus is on improving housing conditions while partnering with our community organizations to provide services that enhance the overall quality of life across struggling neighborhoods. PAST PROJECT BENEFITS _ Application Pao (Supplemental) In August of 2006 our affiliate sponsored a home in Jackson. Mississippi and completed a 5 -day Blitz Build to stimort a Katrina victim. Fourteen volunteers from Temecula traveled to the region and completed the home with funds raised locally. In addition, other programs have been created to assist local Temecula residents. In 2007, secondary services for denied Habitat applicants were finalized with partnerships for assistance being established. Through this effort, in the summer of 2007, a formerly denied Habitat applicant was successfully able to purchase a home as a result of these services Our Helping Hands project, a home repair and maintenance program continues to assist Temecula residents with over 15 pnojects completed to date Although the grant did not fund these programs the support received has indirectly assisted with the continuation of these programs Also in March of 2007, a new program the Building Futures Program, was initiated and continues to assist at -risk teens through the creation of a construction apprenticeship Program held in conjunction with Safe Altematives for Everyone (SAFE 1 The above programs directly benefit Temecula residents. Most recently, the organization has opened two Restores, retail outlets offering low -cost home improvement items to the public. The store provides the opportunity for those in the community pgrade their homes at a low cost while creating a revenue stream to help support future building. The mission of Habitat for Humanity inland Valley, in partnership with God, is to facilitate the dream of homeownership as well as improve living conditions for those in the community. Habitat gives a "hand -up, not a hand -out" Mission Statement (old) The mission of Habitat for Humanity Inland Valley is to provide simple, affordable housing for those in need in the community. Habitat gives "a hand -up, not a hand - out." Inland Valley_ • ' Habitat for Humanity' Current Board of Directors Executive Committee: Gary Thornhill Tierra Verde, Inc. President Ron Roberts Temecula Councilperson Vice- President Ramon Beltre Citi Bank Treasurer Lorie Schulenberg California Bank and Trust Co- Treasurer Connie French Retired Secretary Board Members: Dave Blake National University Bernie Bermante Retired Estella Cline Retired Brad Eskildsen My REO Management David French Founder/Temecula Methodist Church Luanne Jobgen Retired Christine McCusker Van Avery Prep David Neault DN Associates Vicki Puterbaugh Rancon Realty Geoff Rice Bank of America Senior Management: Tammy Marine Executive Director Page 1 12:45 PM - - Habitat for Humanity inland Valley- - — - - - 08111I410 Profit $ Loss -cash Basis - - �. -.- - July- 2009 - through -June 2010.- - -. - Jul'09 -Jun 10::: -._. -._.. Income Restore Income Sales Tax Collected 2.41 Donations/Grants _ 106.60 Sales Revenue . Resale Merchandise 1,282;00 - E-Bay Store _ -.. 279,793.54 - - - Deposits OveriShort 12,55 _ - Sales Revenue - Other. - 413,233.33 . - - Total Sales Revenue - - - - - - - _..._ _. - 694,296.32 Total Restore Income ...694,405.33....._ _ Bank Interest _ - 172.33 Donations Income - Chile Relief 47.50 Haiti Relief _ 130.03 General Donations 6,039,02 Covenant Church Donations 3,355.08 International Donations 841.60 Grants CAP Grant 59,951.89 - Grants -Other 32,697.00 Total Grants 92,648.89 Total Donations Income 103,062.12 �.. General Fundraising Income Hone for the Holidays 4,441-65 Direct Mail Campaign 3,975.00 Other 37,040.06 Total General Fundraising Income 45,456,71 Total Income 843,096.49 Expense CAP Expenses 69,144.78 NSP Expenses Contingency 35,364.89 Marketing - 6,394.51 Interim Maintenance 3,134.24 Insurance 44.00 Escrow 3,822.75 Inspections' 1,456.00 Rehabilitation Costs 53,226.77 Total NSP Expenses 97,174.68 Restore Expenses Restore Start-up Expenses Tenant improvements 4,372.04 Total Restore Start-up Expenses 4,372.04 Restore Operating Depreciation Expense 0.00. Truck Truck insurance 1,336.00 - - Vehicle Registration 543.00 - Fuel 3,139.11 Maintenance & Repairs 2,651.07 Total Truck - - - 7,669.18.: E-Bay Store Expenses .140,617.33 Telephone/Intemet 6,910.09 - Equipment Rental 28.13 AdvertisinglPromotion 21,103.05 Landscape Expense 3,000.00 Merchant Account Fees 7,682.93 Page 1 12.*" PM Habitat for Humanity Inland Valley 09"10- Profit & Loss _ Cash Basis July 2009 through June 2010 .Jul'09 -Jun 10 Repairs &.Maintenance Fire Inspections &Monitoring - _ -_ _.._. _ _._._. — 915.81 - _ - Repairs -& Maintenance - Other 2,399.05 - Total Repairs & Maintenance 3,314.86 Rerd..... - Equipment - 418.51 Building 153,400.56 Total Rent - 153,819.07...._ Utilities Trash 1,244.43 Water 2,114.00 Gas 215.67. Electric 7,441.49 Total Utilities 11,015.59 Employee Expense Training 450.00 Employee Benefits .. 401k 279.00 Supplemental Benefits -Agac. 1,518.42 ' Medical Benefits - POP 1,726.80 Employee Benefits - Other 153.85 Total Employee Benefits 3,678.07 Workers' Comp 8,745.00 Payroll Taxes 26,736.58 Wages 105,678.31 State Payroll Taxes 252.63 Federal Payroll Taxes 1,522.75 Total Employee Expense 147,063.34 Insurance 2,754.03 - - Store Supplies 5,670.17 Printing 845.00 Property Owner Assn Dues 2,658.42 Miscellaneous 48,415.76 Total ReStore Operating 562,776.95 Total ReStore Expenses 567,148.99 Construction Habitat Way Construction Miscellaneous 36.41 Total Habitat Way Construction - 38.41 Habitat Way Prebuild - Miscellaneous Development Costs - MiscellaneousDevelopmentCosts 595.00 Total Miscellaneous Development Costs - 995.00 Total Habitat Way Prebuild 595.00 Total Construction - 956.59 ' Public Relations Newsletter 756.00 Community Relations 4,500.75 Misc. Expense - 1,275.21 Recognitions 2,967.96 Supplies 1,892.14 Total Public Relations 11,412.06 Fundraising Expense Thanksgiving Letter - 508.56 - Other 21,320.46 Page 2 Other _ - - Conference & Seminars. -. - 3,045.02 Manuals 1,233.03 Misc. Expense _ - 4,423.04 _ Web Site 279.63 Total Other 8,980.72 Office Misc. Expense - 2,131.10 PO Box Rental 123.00 Postage 998,27 _ Printing & Copying 437.50 Supplies 5,637.44 Telephone - 5,309.29 Total Office 14,636.60 Insurance Directors and Officers 170.00 Property 809.97 General Liability 2,940.00 Volunteer Insurance 131.00 Builders Program 1,963.00 Officers & Directors 510.00 Total Insurance 6,523.97 Employee Expense Employee Benefits 401k 415.02 Supplemental Benefits - Afiac 201.00 Medical Benefits - POP - 4,085.73 Employee Benefits - Other 2,458.27 Total Employee Benefits 7,160.02 Payroll Fees - 3,375.55 Payroll Taxes 21,309.81 Payroll Wages 83,985.37 Federal Payl Taxes Mileage 2,894.30 Misc. Expense - 35993 State Payroll Taxes 576.62 Workers Comp. 1,739.00 Total Employee Expense 123,961.11 Total Expense 928,625.47 Net Income -85,528.98 Page 12.44 PM Habitat for Humanity Inland Valley _08104110 _. _ __ __ -. Balance Sheet Cash Basis As of June 30, 2010 -- - -'Jun 30, 10. ASSETS ..___.Current Assets _ - - ChaGdng/Savings _ _... _PayPal 5.110.82 CB Store Account _3,395.84 _CB Operating Acct. _ _91 .46697_ CB Reserve Acct 44,446.14 - - Total Checking(Savings 144,418.97 l -. Other Current Assets _ - Credit Cards Receivable -ReSto 1,804.49 Total Other Current Assets _. _ _ ...... t,804.49 Total Current Assets - 146,223.46 Fixed Assets Vehicles Accumulated Depreciation - Truc Truck - Restore Total Vehicles Equipment Accumulated Depreciation - Equi Equipment Purchases - ReStore Total Equipment Total Fixed Assets Other Assets Security Deposit - ReStore Silent Second Trust Deeds Van Worth 2nd Trust Deed Gonzalez 2nd Trust Deed Cochran 2nd Trust Deed Muro 2nd Trust Deed Alcantar 2nd Trust Deed Pleasant 2nd Trust Deed Cabulegan 2nd Trust Deed Castaneda 2nd Trust Deed Total Silent Second Trust Deeds Castaneda let Trust Deed. _ Alcantar 1st Trust Deed Cochran 1st Trust Deed Gonzalez 1st Trust Deed Van Worth 1st Trust Deed Cabulagan 1st Trust Deed Muro 1st Trust Deed Pleasant 1st Trust Deed Total Other Assets TOTAL ASSETS LIABILITIES & EQUITY Liabilities - Current Liabilities Credit Cards - California Bank and Trust VISA Total Credit Cards _ Other Current Liabilities Sales Tax Payable - ReStore Escrow Funds - Family Support Section 125 Plan - Lake Elsinore ReStore Fund Temecula ReStore Fund - 6,446.00 20,150.00 13,702.00 - 150.00 613.77 463.77 14,165.77 .rr rr 24,000.00 24,000.00 12,550.00 121,500.00 121,50D.00 121,500.00 121,500.00 121,500.00 668,050.00 92,675.00 92,675.00 41,732.00 50,560.06 52,540.10 92,935.00 92,675.00 92,950.00 1,286,392.16 1,448,781.39 4,063.23 4,063.23 6,586.57 1,505.00 - 852.78 406.08 146.68 Page 1 12:44 PM Habitat for Humanity Inland Valley - - oeiwilo Balance Sheet Cash Basis As of June 30, 2010 _Jun 30, 10 Akantar hnpound _ .. _ .. 619.09 _Castaneda Impound _655.40 - Muro brnpound 795..88 - - - Cabulagan hnlwund 480.70 _ .. -.. _. Pleasant knpound _ . 647.16 - - Vista Murrkda HS 237.80 Van Worth bnpound 330.57 - - Temecula Valley High School 1,728.51 _...._ Kanavel Impound - - 271.08 - - Great Oak High School -26.03 - - _ Gonzalez Impound .333.15 - £ _ Cochran hnpound _. - 196.42 Chaparral High School 910.80 Total Escrow Funds 6,791.37 Total Other Current Liabilities 13,377.94 Total Current Liabilities 9,314.71 Long Term Liabilities Habitat Way Street Maintenance 1,130.00 - - - Total Long Term Liabilities - 1,130.00 - Total Liabilities 10,444.71 Equity - Opening Bel Equity 1,614,584.09 Retained Earnings - 90,718.43 Net income - 85,528.98 - Total Equity 1,438,336.66 _ TOTAL LIABILITIES 8. EQUITY 1,448,781.39 Paget Gary Thornhill President Ron Roberts Vice President Judy McNabb Connie French - - Community Service Funding Secretary City of Temecula Ram6n Beltre Treasurer 43200 Business Park Drive Lorie Schulenberg Temecula, CA 92590 AssistantTreasurer Dave Blake Bernie Bramante Estella Cline Brad Eskildsen Craig Evans David French Luanne Jobgen Christine McCusker David Neault Vicki Puterbaugh Geoff Rice Tammy Marine Executive Director Federal Tax ID 33- 0461804 Dear Judy: Enclosed is our application for funds from the Fiscal Year 2010 -2011 Community Service Funding Program. We are sincerely appreciative of the support the City of Temecula provides and thank you for the opportunity to apply. If you have any questions or need further assistance, please contact me at (951) 296- 3362. Thank you for your consideration. Foes: Application and one copy 27475 Ynez Road 3390, Temecula. CA 92591 Phone: (951) 296 -3363 Fax: (95 1) 296 -3363 5ti�e�c.habdat4inlandvallep.oce PROJECT INFORMATION Amount Requested: $ $5,000 (Maximum allowable $5,000) Project Name: Winning at Work Program Project Start Date: November 2010 - Project End Date: June 2011 ORGANIZATION INFORMATION Name of Organization: Healthy Management Diabetes Education (HMDE) Contact Name: Kaishawn McDuff ie, RN, CDE Title /Position: President /CEO Mailing Address: 40335 Winchester Rd. , E240 Temecula CA 92591 Telephone: 951 -660 -5547 Year Organization Founded: 2004 Number of Paid Staff: 4 Number of Volunteers: 16 Geographic Area(s) Served: Temecula and Murrieta Is this organization incorporated in California as a non - profit organization? Yes X No Effective Date: 2004 if'yee (Must provide a copy of your statement of non - profit status from the State of California): Date of incorporation as a non - profit: November 19, 2004 Federal identification number: 43- 2068059 State identification number: 2586612 If "no ": Name of sponsoring organization: Federal identification State identification This application has been authorized by the organization's: Executive Committee Board of Directors X Members -at -Large Application - Page 1 FINANCIAL STATEMENTS - PLEASE ATTACH COPIES OF THE CURRENT BUDGET OF THE ORGANIZATION AND FINANCIAL STATEMENTS (BALANCE STATEMENT AND INCOME STATEMENT). It does not require a CPA's audit, but please submit if available. MISSION STATEMENT Briefly describe the goals and objectives of your organization and community services it provides. Describe the ways your organization meets the criteria listed on page 2 of the CS Funding Policy. _ "Educate the entire community on diabetes awareness. Empower individuals to successfully manage diabetes on a daily basis. Provide tools and re- sources to improve their quality of life by analyzing patient data and comparing it to national standards of the American Diabetes Association (ADA) . It HMDE provides diabetes management classes, support groups, on -site screenings, health fairs and online education provided to the Temecula Valley at no cost. The current staff is equipped to maintain and grow these programs and services to the overall community. Letters and success stories from City Councilman Douglas McAllister, Dr. Thomas LoBue, health professionals and people with diabetes can attest to HMDE's impact on the lives of residents. With oversight by the Board of Directors, HMDE is very careful to manage its funds and resources wisely for services provided in the present, while keeping an alert eye on the future and prudent expansion. HMDE is not affiliated with any political, religious or social activity. HMDE uses pre- and post -class evaluations to measure increases in partici- pants' health knowledge. Client surveys provide feedback, suggestions, and qualitative data about improved health and emotional well- being. Application - Page 2 PROJECT DESCRIPTION J How will your organization use the funding awarded? Describe the project, project objectives, those served, area serviced, and number of volunteers involved. Bespeciftc. Include equipment or services that would be purchased and why. Include -a detailed budget and a schedule of significant activities related to.this - - project. You may attaches maximum of one double - spaced typewritten page of information. (Please type or print legibly:) Each Winning at Work event brings vital information to a new group of residents in potential need, often people who do not even realize their risk for diabetes until provided with on -site screening results. By providing resources, information, and conducting on- the -spot diabetes screenings, HMDE can make referrals to health care providers. The cost per person is usually less than $5.00, and this community event has the real potential to increase awareness before devastating complications take effect. The Fair is staffed by a Registered Nurse /Certified Diabetes Educator and five volunteers. Objective: To provide increased community screening and initial information to 200 - 500 Temecula residents by June 2011. Supply Budget for Community Diabetes Health Fair - Total $5,000 a. Diabetes Class Handouts - 1000 x $1.00 = $1,000 b. Registered Nurse (onsite screenings /education & follow up education) 64 hours x $40 = $2,560 c. Spanish Interpreters (onsite screenings /education & follow up education) 64 hours x $16.50 = $1,056 d. Medical Supplies /Samples /Test Kits = $ 384 The 64 hours represent 8 hours for each of the four events for a total of 32 hours and a total of 32 hours for follow up education after the events. Tentative Timeline Nov. 12 - Confirm January workshop date for (Business #1) Dec. 10 - Have marketing piece to Human Resources staff Dec. 12 - Confirm February workshop date for (Business #2) Jan. 10 - Have marketing piece to Human Resources staff Jan. 2011 - Hold workshop Feb. 2011 - Hold workshop Feb. 12 - Confirm April workshop date for (Business #3) Mar. 10 - Have marketing piece to Human Resources staff Apr. 2011 - Hold workshop Apr. 12 - Confirm June workshop date for (Business #4) May 10 - Have marketing piece to Human Resources staff Jun. 2011 - Hold workshop Jul_ 1 - Complete written report of grant project Application - Page 3 Application — Page 4 SIGNATURE PAGE_ We hereby certify the information contained in this application is true to the best of our knowledge and belief. PREPARED BY: Renee Miller, writer - The Wright Image NAME and TITLE (Please Print or Type) SGNATURE: PRESIDENT or AUTHORIZED OFFICER: F MIJAP i rwn McDuffie, RN, CDE NAME and TITLE (Please Print or Type) President ORGANIZATION NAME: Healthy Management Diabetes Education MAILING ADDRESS: 40335 Winchester Rd., B240 Temecula, CA 92591 TELEPHONE: 951- 660 -5547 I DATED THIS 14th of September , 2010. (Date) (Month) BE SURE TO INCLUDE THE ORIGINAL PLUS ONE COPY AND SUBMIT TO: Mail Completed Applications to: City of Temecula Community Service Funding Program Attn: Judy McNabb Post Office Box 9033 Temecula, CA 92589 -9033 Or Deliver in Person to: City of Temecula Community Service Funding Program Attn: Judy McNabb 43200 Business Park Drive Temecula, CA 92590 Application - Page 5 City of Temecula 2010 2011 Community Service Funding Program ` Health Management Diabetes Education Supplemental Page Diabetes is ranked seventh for cause of death in Riverside County and is a significant contributor to heart disease and stroke. In many cases, people die of complications related to diabetes, more so than of the disease itself. HMDE currently provides free accurate diabetes education and maintenance through in- person classes and support groups, workplace events, and online resources to sufferers and their family members in the Temecula Valley. The diabetes classes (English & Spanish) provide those at risk and those with diabetes the knowledge and strategies needed to live healthfully with their disease. The Winning At Work Program promotes diabetes awareness and offers initial information about diabetes for those who are at risk, who have recently been diagnosed and are interested in learning about their disease. Working in collaboration with the ADA, HMDE will bring vendors and local services to the workplace, along with educational presentations, to create mini- health fairs and will include screening. During the 2010 -11 fiscal year HMDE will coordinate four presentations with the ADA based on HMDE's referrals and inquiries from local businesses with 250 or more employees in order for these presentations to have the greatest workplace impact. Targeted businesses are Abbott Vascular, Professional Hospital Supply, International Rectifier/Hexfet, Channell Commercial Corp., Milgard Manufacturing, Millipore, Opto 22, Plant CML, Tension Envelope, Southwest Traders, Magnecomp, Temecula Valley Unified School District and The Scotts Company. i x,990 -EZy R� Wised 1 MOO W�. texcapS t�rtf ' ►$gonsonrq a�n¢a6asatda�rad''.. faad" a .. - 99g. Ali o9,eronl-an�Iiwrs wdh 9nas r«eNls Stye en iaRevea+e Sery •'me agan®han mPYlaverouuacwrmUesn For the 2008 12/01 cadenclar tear,-or Ctmxk if app5cahle: (% - - Kam (Addressdange HEALTHY MANACFMI?ta't Naaedon" r ra 40335 WINCHESTtA ROAD E240 inii-al n:tum - type. - - TEMECDLA, CA 92591- n. L ... OMB Ao. 1545 -1150 From Income Tax 200$ #tbelrrtemai Revenue Code - r pdvafe foundation) asdefoW in section 512(b)(13) must file Form 0 and1 assets lea Can$2,5po'coo at na OW of the tamp tua to sa5;ly stela repartinB reWName>l� e section 'iUtteXsl OryarllTdaorrs anu v�vi {a a ,nn,cn�.,.,.. -_ CihBr ► mustattae-h a completed sdredu/e Check ► X - if the organization s not Website: ► N/A required to Schedule B (Form 990, nitation aleck one — X 501 e 3 insert +a. A947 a w 527 990-¢, or 990 -PF)- the organization is not a section 509(a)(3) supporting check ► if organization and its gross receipts are normally not more than ,0, return is not required, but if the organization chooses to file a return, sure to file a complete return. 00 d lines 5b, 6b, and 7b, to line 9 to determine gross receipts; 'd $1,000,000 or more, file Form 990 rnsbeadofFon n990- EZ ...............................:.................... ......... ...................... �$ - 57;072. Revenue E enses and Cha es in Ne# Assets or Fund Balances ee the instructions for Part 1. 1 Contributions, gifts, grants, and similar amounts received .............. ............................... 1 24 264. 2 Program service revenue including government fees and contracts ............ ... ................... .. 2 32 808. 3 Membership dues and assessments ......... 3 at -A Investment income ............ ................ ............................... 4 a Gross amount from sale of assets other than inventory .................... 5a h; b Less: cost or other basis and sales expenses ....................... ..... Sip :e Gain or (loss) from sale of assets other than inventory (Subtract In 5b from in 5a) (alt sch)....... • • ....... • • .. • . - . • - •' . • - 5e .: 6' Special events and activities (complete applicable parts of Schedule G). If. any amount is from gaming, check here...... ► El a Gross revenue (not including $ of contributions reported on line 1) ................... ............................... .... 6a *' b Less: direct expenses other than fundraising expenses......... 6b �.'. e Net income or (lass) from special events and activities (Subtract line 6b from fine 6a)....... tie 711 Gross sales of inventory, less returns and allowances ..................... 7a s -;.b Less: cost of goods sold ................. ............................... 76 ,;':•z Gross profit or (loss) from sales of inventory (Subtract line 7b from line 7a) ...... 7c OOrer revenue (describe ► _ _ ..... } .. S Total revenue add lines 1, 2, 3, 4, 5, , tic, 7c, and 8).......... ........ - 9 57 072. Grants and similar amounts paid (attach schedule) .................... ............................... 10 ..Benefits paid to or for members ...................................... ............................... 11 5-634. 'Salaries, other compensation, and employee benefits .................. ........ ....................... 12 Professional fees and other payments"to independent contractors ................ ......... . ........... 13 4; Occupancy, rent, utilities, and maintenance . ....... ............................... . 14 Printing, Publications. Postage, and shipping ....:..:..........�.... 15 5 677 ............ . ``.Other expenses (describe -► SEE STATEMENT 1 i6 57 721. <' ....... ............................... ► 17 69'032. 7 !fvtat nses (add lines 10 through 1 ............. _.. .Excess or (deficit) for the year (Subtract line 17 from line 9). ....... ... 18 — 11,960. `$ Net assets or fund balances at beginning of year (from line 27, column (A)) (must agree with end •of -year 19 4, 189.. -- - figure reported on prior year's return) .................. .. Other changes in net assets or fund balances (attach explanation )........ ................ . .. ....... 20 —7.771. - .................. 21 -A Net assets or fund balances at -end of ear. Combine fines 18 thro h 20........ - BdianCe Sheets. If Total assets on line 25, column (B ) are $2,500,000 or more, file Form 990 instead of Form 990•EZ. ,. (See the instructions for Part 11J ) B in of ear End of ear 1 2, 774. ??gash, savings, and investments .... ...:..... d and buildings .. ........... - • • • -' •' ' "' " ' at assets (describe ► SEE STATEMENT 2 } 8� - assets ........... .............................. 52. ltabitities (descnbe > SEE STATEMENT 3 ) - - -- ... .. 7 771. nd balances ine 27 of column B) must a ree with line 21)....:... Form 990-EZ (2008) _riv4r;.yctand Paperwork Reduction Act Notice, see the instructions for Form 990. TEEAOarot. 09 118!03 ration's primary exempt purse? was achieved in carrvfn9 43- 2068059 Page Expenses - (Required for 501(c)(3) mariner, and (4) organizations and - 4947 a)(1) trusts; optional iDe me services provlaeo, me numu al peiwtwusucx.j w-= vancr,c,wo,.. .,.w .......... .. ............. - title.- _. for o _. ers. . ,:._DIABETIC CODNSELING & EDUCAT ION--------------------- - - - - -- -------------------- ----- ---------- - - - --- - - - - -- rants $ If this amount includes foreign rants, check here. ......... 28a -. Mq FOUNDATION __PROVIDED_DIABETES_EDUCATION _ - -- -------------------------------------------------- ..S Grants $ - -If this amount includes foreign grants, check here....... �' 29a - = EI2I2O1 FOUNDATIOHI= PROVIDED DIABETES EDUCATION - --------- - - - - -- --------------------- - - - - -- ------ - - - - -- ---- - - - - -- -.:; Grants $ 18 000.) If this amount incikxk firei n rents, check here ................ 30a her program services (attach schedule). ,SEE • STATEMENT- .4. • .................... . .,. rants $ 6 355. If this amount includes fore" n rants, check here .. .............. 3i a 677. program service expenses (add lines 28a through 31a).. z .......... ....................... 677. List of Officers Directors Trustees and Key Em Dloyees. 'st each one even if not coin ensaled. See the instrs. " (b) Title and average hours (c) Compen sation (tf ((d) (bntrit utions to (e) F- cpense account - (a) Name and address per week devoted not paid, enter -g-.) empoyre bodit plans and and of rallowances to position, oche red w Lion I}YYlri NCDUFFIE PRESIDENT & CEO 2,739. 0. 0. _ _ _ _ _ _ _ :WINCHESTER ROAD E240 - - - - - - - - 20.00 CA--- 92591 - G_I_PSON SECRETARY 0. 0. 0. _ _ _ _ _ I�IINCB_E_S_TE_R__ROAD E240 - - - - -- - -CA 1.00 - - 92591- "BR_E_WER_ _ BOARD MEMBER 0. 0. 0. _ _ _ _ _ _ T�NCBESTER ROAD E240_ 1.00 CA 92591 LEWIS BOARD MEMBER 0. 0. 0. _ _ _ _ _ _ _ 5. WINCHESTER ROAD E240 - - -CA ---- - - - - -- 1.00 m _M_AT_TH_EWS_ BOARD MEMBE 0. 0. 0 . _ ----- TNCHESTER ROAD E240 1.00 CA 92591 MCDUFFIE BOARD MEMBER 0. 0. 0. _ _ NC$_ESTER _ROAD E240_ 1.00 CA 962 25 CKLUND BOARD MEMBER 0. 0. 0. _ _ ROAD E240 - ---------------- 1.00 -pA, CA 92591 BAYLOR BOARD MEMBER 0. 0. 0. _ _ _ _ YIINCHESTER ROAD E240 - - 1.00 CA 92591- --:----------------- T? tom. TEEA0a12L 01n4r09 Form aao-cc (26 R94D-EZ (2008) HEALTHY MANA13t ANT _ _ 43- 2068059_ Page 3 Other Information ftte the• efgetsf!a General Instruction V. Yes No Did the organization engage in any activdynnt.prevwusly reported tothe -IFtS? If -'Yes attach a detailed description of - ;each activity ......... .....::.. ..::.::.. .....:..:..33 -: X Were any changes: made to the organi ing or gareming.documerb bat not Wonted to the IRS? If' Yes; attach a- conformed coM of the changes ........ - 34 - X ;11` the organization had income from laciness activities , such as those reported on lines 2,6a, and 7a (among ottcers), fart not reported on Form .990 -T, ,:, attach -a statement explaining your reason for nut repodingthe income on Form 990 -T. -.... -. -. _.- id the organization have unrelated business gross income of $1,000 or more or 6033(e) notice reporting and - ,.proxy tax requirements? ...... ......... ....... ... ......... 1i'Yes,' has it filed a tax return on Form 9WT for this year ?. ...... . ................. 35b Was there a liquidation, dissolution, - termination, or substantial contraction during the year? �ff'Yes; complete applicable parts of Schedule N ...................... : ............ ...................... .......... 36 X " ter amount of political. expenditures, direct or indirect, as described in the instructions.. . ................ Val0 . id the organization file Form 1120 -POL for this year?.. . ......................... .................... ....... 37b X id the organization borrow from, or make any loans to, any officer, director, trustee, or key empployee or were any such loans made in a prior year and still unpaid at the start of the period covered by this retum?. . ............... 38a X 'Yes,' compplete Schedule L, Part 11 and enter the total - nountinvolved....................................... ............................... 366 NJA 1(c)(7) organizations. Enter: iiiation fees and capital contributions included on line 9 . ............................... 39a NI A loss receipts, included on line 9, for public use of club facilities ......................... 396 N/A )1(c)(3) organizations. Enter amount of tax imposed on the organization during the year under: ietion 4911 ► 0 . ; section 4912 ► 0 . ; section 4955 ► 0. 11(c)(3) and (4) organizations. Did the organization engage in any section 4956 excess benefit transaction during the ar.or did it become aware of an excess benefit transaction from a prior year? `Yes,'complete Schedule L, Part I ...................... ... .............. ............................... _....: 406 X Aer amount of tax imposed on organization managers or disqualified persons during the &7r under sections 4912, 4955, and 4958. ............. ..................... ............. ► - 0. Aer amount of tax on line 40c reimbursed by the organization ............................. ► 0. t, organizations. At any time during the tax year, was the organization a party to a prohibited tax Otertransaction? If 'Yes,' complete Form 8886- T .................................. ............................... 40e X ittne stales with which a copy of this return is filed ► NONE books are in care of ► KAISHAWN MCDIIFFIE _ Telephone no. ► 9_51_ -_ 660 -5547 ------------------- -- - - - - -- ------ ated -at► 40335 WINCHESTER ROAD E240 TEMECULA CA ZIP +4 ► 92591. any time during the calendar year, did the organization have an interest in or a signature or other authority over a Ox ),point account in a foreign country (such as a bank account, securities account, or other financial account) ?......... enter the name of the foreign country:.. etliCtistrudions for exceptions and filing requirements for Form TD F 90-22.1, Report of a Fereign Bank and Financial Accounts. aety.tima during the calendar year, did the organization maintain an office outside of the U.S.? ......... ......... iea,',enter the name of the foreign country:.. ► POOn 4947(a)(1) nonexempt charitable trusts filing Form 990 -EZ in lieu of Form 1041 - Check here........ _ ......... ► ❑ N/A - enter the amount of tax - exempt . interest received or accrued during the tax year ................ . 43 N/A ie orgganizationmaintain any donor advised funds? If 'Yes,' Form 990 must be completed instead m.990 EZ ............ ...................... .......... _ .......... .......... _ ..... 44 X 4 ! related organization a controlled entity of the organization within the meaning of section 512(6)(13)? If 'Yes,' 990 must be com feted instead of Form 990 -EZ ...... .......... .. ............................... ... .r... 45 X TEEAM73 01114roa Form 990-EZ (2008) FZC2 M HEALTHY MANAGErdlNT 43- 2068059 Page4 Section 501(c� organizations onl All ton 60t(c)(3) organizations must answer questions 46 -49 :t and complete a tables for lines 5�ai5 e; SEE STATEMENT 5 activities on behalf of or In opposition to candidates Yes No 4 She organization engage in direct or indirect p�tob#1ea1 campaign X publicoffice? If 'Yes,'_complete Schedule C, Pad l . _ _ _. the organization engage in lobbying activities? If 'Yes; complete Schedule C, Part 11 ...... 47 X- .organization operating. a. school as. described In section 170(b)(1)(A) (n ? If 'Yes,_ complete Schedule E... ..... 48 X ' '#ta organization make any transfers to an exempt non - charitable related organfzationZ . ....... ................... 49a X Yes: was the related organization(s) a section 527 organ' Ization? ..............._.. ............................... 496 _ mplete this table for the five highest compensated employees (other than officers, directors, trustees and key employees) who each Ned more than $100,000 of cont erisafion from the or Ization. If there Is none, enter 'None.' (b)Tdk and average '(c)ComPemation' '(d)C,obenedtiplans a byes (e)Fxperise - t, Name and ona addnesS Ma of each empbyee paid hours Dar week deferred Co pbnSatlon acwllo arc more than S7OOp10 devoted to Position other allowances i r, a of other employets paid over $10D,000 ...... ► .. We this table for the five highest compensated independent contractors who each received more than $100,000 of compensation Ie,organization. If there is none, enter 'None.' _ (a) Name and address of each independent conbacW paid more than $100,000 (b) Type of service (e) Compensation ______________ ____ _________ ____ ------------------------------ 91F jp _ rof other independent contractors receiving over $100,000................ - *„ under penalties of pedwy, I declare that I have examined this mturn, including accompanying schedules statements. and to be best of my knowkdga and barief, g a coned, and mmplere. Declaration of preparer�t N �[ 54 ➢ II imomafron of which prepamr i�kn °wiadge. Z based on �r .. signature of officer KAISHAWN MCDUFFIE PRESIDENT &CEO , -Type or print name and tl9e. . Date Check g mrrers 1 _ ratifying Number Frepar "e ® seff- BETTECP A 2/11/10 eempl%ed N/A Fams name (or MCLEAN, ROTHERHAM & CO, CPA' S ynPrs_dse" No- 38760 SKY CANYON DRIVE, SUITE C EIN > N/A '� Pm a w. (951) 699 -1040 21P +a MURRIETA, CA 92563 -2562 S`.;d'iscuss this return with the preparer shown above? See instructions... ......... .............. X Yes No Form 99D-EZ (2008) ..''' TEEAW12L 01/1x03 - Z) Public Chanty &tatus,ar i Pub* .Support - - - To be completed by all section 507 (�anizations and section 4947(aX1) .. nonexempt.= le trusts. n - Attach to Form 990 or Form 99D -tZ. -. See separate instructions. - -- - - - Employeiidentl IrRMRNT 43 -2068( �- -ono No. 15450047 is not a private foundation because it is: (Please check only one organization:) h, convention of churches or association of churches described in section 17U(bXIXA)(} tl described in section 170(1bX1XA)(i). (Attach Schedule E:) - - -- - - — - - - - -- - tal or cooperative hospital service organization described in section 170XIXAXlil). (Attach Schedule H.) - - cal research organization operated in conjunction with a hospital described in section 170(bXiXA)C1H). Enter the hospital's - ity, and state: _ f Mization operated for the benefit of a college or university owned or operated by a governmental unit described in section P(AXly} (Complete Part Ii.) W, state, or local government or governmental unit described in section 170(bX1XAXv). bization that normally receives a substantial part of its support from a governmental unit or from the general public described t170(bX1XAXvi). (Complete Part 11.) _... . giinity trust described in section170(bX1XAXvi). (Complete Part II.) - - -- bon that normally receives: ((1) more than 33 -i(3 % of its support from contributions, membersh!p fees, and gross receipts es related to !ts exempt functions — subject to certain exceptions, and (2) no more than 33 -1/3 %of its support from gross brit income and unrelated business taxable income (less section 511 tax) from businesses acquired by the organization after .,1975. See section 509(a)(2). (Complete Part III.) ion organized and operated exclusively to test for public safety. See section 509(aX4). (see instructions) !on organized and operated exclusively for the benefit of, to perform the functions of, or carry out the purposes of one or / supported organizations described in section 509(8)(1) or section 509(8)(2). See section 5119(8X3). Check the box that - :.type of supporting organization and complete lines I I through 11 h. b []Type II c ❑ Type III — Functionally integrated d [] Type III— Other this box, I certify that the organization is not controlled directly or indirectly by one or more disqualified persons other ion managers and other than one or more publicly supported organizations described in section 509(a)(1) or section ation received a written determination from the IRS that is a Type 1, Type II or Type III supporting organization, - K" _ ........................................ ............................... 117, 2006, has the organization accepted any gift or contribution from any of the following persons? Yes No in who directly or indirectly controls, either alone or together with persons described in (ii) and (iii) the governing body of the supported organization? ................ ............................... 11 r) y %member of a person described in (p above?................................... .... ... ...... ... controlled entity of a person described in (i) or (ii) above ?...... _ . ............................... 11 i7 01) EIN I n Type a( organrzation t abo mPC section (sea instrtwuti )) rwork Reduction Act Notice, see the Instructions TEEAn901L 1017/08 ■E■■ ONE ■■■■ ■■■■ ••1 - '•I • '•1 7 11' 609 or 990•EZ) 2008 iir n[ THY MANAGEMENT 43- 2668059 Page 2 Schedule for Organizations Described in Sections 170(b)(YXA) iv) and - 170(bX1XAXv7 only if you checked the box on line 5, 7, or8of Part I.) liscai year (a) 2004 (b) 2005 (c) 2006 (d) 2007 (e) 2008 (f) Total 3`kontnbutions and ❑ `The. organization qualifies as a publicly supported organization .. ............. ... .. ............. .. ...... ,test —2007. If the organization did not check a box on line 13, or 16a, and line 15 is 33 -1l3% or more, check this box ❑ organization qualifies as a publicly supported organization: .... .. ............ ... ................ suaI grants.').,. 115-60. 6,386. 87 458. 75,546. :- e organization meets the 'facts- and - circumstances' test, check this box and stop here. Explain in Part IV how ` "meets 170 944. ' vied for the Li K ircumstances test —2007. If the organization did not check a box on line 13,16a, 16b, or 17a, and tine 15 is 10 - mk.1he eets the 'facts- and - circumstances` test. The organization qualifies as a publicly supported organization.........: _ benefit and - - - -- �gn. If the organization did not check a box on line, 13, 16a, 16b,. 17a, or 17b, check this box and see instructions.. OH Schedule A (Form 990 or 990 -EZ) 2008 - or expended ......... 0. �5ervices or Ystted to the _ a governmental tjarge. Do not ,. ue of services or ll y furnished to ` u[. charge...... 0. es1- 3........... 1 560. 6,380. 87,458. 75,546. 0. 170 944. tal each person vernmental ippported Auded on line 1 of the amount r, column (f) ... Subtract line 5 year I (a) 2004. I (b) 2005 I (c) 2006 (d) 2007 I (e) 2008 4........... 0.1 6,380.1 87,458.1 75, 546. elated vbether or egularly 3 - ® - -- . `�* ' vm4,i ,i — v .`y�"I °� -±„yy • fwA-t xa M i bs'._cS.f...r mi. ae .'Z vts.'... -.t .......IaY L—.a .+�F.... ✓».c'...3.iF® 170 (f) Total percentage for 2008 (line 6, column (f) divided by line 11, column (f) ........................... 14 ' at;petcentage for 2007 Schedule A, Partly -A, line 26f.... ......... .... .... ....... - jest — 20011 If the organization did not check the box on line 13, and the line 14 is 33-1/3 % or more, check this box ❑ `The. organization qualifies as a publicly supported organization .. ............. ... .. ............. .. ...... ,test —2007. If the organization did not check a box on line 13, or 16a, and line 15 is 33 -1l3% or more, check this box ❑ organization qualifies as a publicly supported organization: .... .. ............ ... ................ cumstances test — 2008. If the organization did not check a box on line 13, 16a, or 16b, and line 14 is 10% :- e organization meets the 'facts- and - circumstances' test, check this box and stop here. Explain in Part IV how ` "meets ' the 'facts- and - circumstances' test. The organization qualifies as a. publicly supported organzation......... Li K ircumstances test —2007. If the organization did not check a box on line 13,16a, 16b, or 17a, and tine 15 is 10 organization meets the 'facts-and-circumstances' test, check this box and stop here. Explain in Part IV how the mk.1he eets the 'facts- and - circumstances` test. The organization qualifies as a publicly supported organization.........: _ - - -- �gn. If the organization did not check a box on line, 13, 16a, 16b,. 17a, or 17b, check this box and see instructions.. OH Schedule A (Form 990 or 990 -EZ) 2008 TEEEA0402L 12117108 i0 or 990 -EZ) 2008 h nLTHY !lAI1A�EP 43- 2068059 Page 3 rt-Schedule for Organizations Desg3l ed W $ec6on, 129(a e�only fiyou checked the box on line 9 of Part 1:.) - - yrbeginoingin)' '.(a) .2A04_. .2005. W 2006. W 2007.. :.(e.2008 mtributions and es received. (p _- - - - dsual grants.}... - from wchandise sold formed, or - ied in a activity _ o the ax- exempt activities that are ide or business -vied for the ?enefit and r expended on Tvices Of led by a wilt to the - thout charge.... Ind on lines 1, om- disqualified - led on lines 2 *om other than - - sons that 1'er of 1 % of ¢9, 10c, 11, pgar or $5,000.. . A7b ........ ... hfSubtract line inning in) ,1975... ss.rs ), 10; 11, and 12-) for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) 212—here ...................... ............................... • for 2008 (line 8, column (f) divided by line 13, column (f)) .......................... from 2007 Schedule A, Part IV-A, line 27g ..... ....... ..... ....... _-------- ...... 16 % if investment Income Percentage tage for 2008 (line 10c, column (f) divided by line 13, column (f)) .................... . 17 % tage from 2007 Schedule A, Part IV -A, line 27h .. ......... ................ ......... 18 % If the organization did not check the box on line 14, and line 15 is more than 33 -1l3 %, and line 17 is not • this box and stop here. The organization qualifies as a publicly supported organization ................. El 7. If the organization did not check a box on line 14 or 19a, and line 16 is more than 33 -1f3 %, and line: IS check this box and stop here. The organization qualifies as a publicly supported organization........... ) rganization did not check a box on line 14, 19a, or 19b, check this box and see instructions ............ 1ffAOM olr29M9 Schedule A (Form 990 or 990 -EZ) 2008 11, LINE 26 BEGINNING ENDING 'S PAYABLE AND ACCRUED EXPENSES .............. . ......... . ........ $ 1,352. $ 1,352. CARD ....................... __..-..... ....- .........................- -..... 9 024. 9 200. TOTAL 10,376. $ 10, 52. .f s _ ATEMENT I M 990 -EZ, PART 1, LINE 16 ER EXPENSES _ VERTISING AND PROMOTION......._: .. .........:...... .....::....:... ...... ........ $ 5,188. RTIZATION ........_ .............................................. ..........................:. ... 65. 0/ FUEL ......... ...............:.......:.---................. .................... ------.......... 27. CHARGE ........ ... :........... ....... ....... .. ::.........: .... :-- -- ::...- ....:..::.:..... 39. ; MEETINGS. ........................:........................ ....................- .- :.....:. 612 . KS AND VIDEOS ...........:... ..........:...:....:.. .... ..... . ....::.. . ::- ................... 9,304. UTER EXPENSE ......... ......... ........ :... :...- ...- ........ -. .................... 189. BUTIONS.......... .... . ....... ........ . ............................... . ...................... 184. pIT CARD PROCESSING .......:.......................... ....... ...:....... . ...... . .. ....... .. 1,365. S AND MEMBERSHIP.. * ..... :.. . ... ............. ................ ............ :.. ........... 439. CATION SUPPLIES .......................... . ................. -- ......... - ..................... 1,847. ATION......................... ............... ...:............ .......... . ... . ................ 346. TSRAFFLE ............ ......... ......................... ... . .. ... .......... .. .... ........... :_ 1, 092. URANCE........ ................ ................................... ...................... ......... 730. REST.................... _.......-................-...........-... ............................... 1, 288 98E AND PERMITS.. ........................................... ............................... 70 . 5 ............. ............ ......................................... . ...... ......... .......... ..... 3,957 S... . ...... ........................................ ..................... .. ........... ............. 93 . 3CAL SUPPLIES.. ..................................... ....................... ............ 435. iCE EXPENSES .................................................... ... .... ....................... 5,561. $IDE SERVICES ................. -.................... .. .......................... --- -. - -- 9,558_ ER............ ..................................................... ........ "- :..........- ......... 88 . OLL EXPENSE........ _ .......................................... ....... ............ ........... 256.' FESSIONAL FEES ...................... ..................... ................... . ...... .......... 3,600. PLIES............................................................. ............................. .. 264 OSIUMS :... ......................... ... .................................... .. .... ............... 677: PHONE............................................................ .................... ........... 3,182. SLATOR.......................................................... ............................... 120. SITE............................. ........... ............................... .................... ... 7, 145 TOTAL $ 57,721. ATEMENT 2 RM 990 -EZ, PART 11, LINE 24 HER ASSETS ,4 BEGINNING ENDING k. ANGIBLE ASSETS _ .......................... ............................ ... $ 72. $ 7. TOTAL 72: S 7. 11, LINE 26 BEGINNING ENDING 'S PAYABLE AND ACCRUED EXPENSES .............. . ......... . ........ $ 1,352. $ 1,352. CARD ....................... __..-..... ....- .........................- -..... 9 024. 9 200. TOTAL 10,376. $ 10, 52. Page 1 8 -26 PM Healthy Management Diabetes Education 08124/10 Profit & Loss Accrual Beals December 2008 through November 2008 Doc W -Now 08. Income - tlncaNgorixed Income 366,26 Even 6,166A0 - Education Gars 26,162.71 . - - - - Oran 23,300.00 - Pumiratser 62.69 symposiums 800.00 Donation 666.09 Total Income 67,07174 Expense Insurance - Liability 33140- Total Insurance 331.00 Auto Fuel 27.00 Total Auto 27.00 lank Charges 30,00 Memberships & cuts 130.00 Credit Card Vnence Charge 1.297.69 Taxes Stab 26,90 Federal 443,84 Total Taxes 466.64 Contractors ®enea Johnson 3,631.41 Carol Farris 460,00 Amt Simone 16810D Rona Eepinoxa 1,642,22 Patriala Nemandet 46,00 Janice Masser 866.00 Rarer Nonhstattor 140,00 While Sandoval-Translator 1,319.20 lernardita Olpson 340.W Joyce Berenson 1,346.00 Total Contractors 9,246.83 Reconciliation DlacrepaneNS 77.19 Board Meeting Meals V, 231.84 Board Muting • Other 380.00 Total Board Meeting 611.94 Education - Books & Videos 9,304.38 Mailing 61.81 Translator 120.00 supplies 1,84727 Masse & Dining 3,987.16 Printing 601.26 Total Education 16,781.86 - Foundation Expenses 346.87 Fundralur Expenses - supplies 264 ,21 Total Fumirakrer Expenses - 284.21 - Page 1 Page 2 6:26 Pm Healthy Management Diabetes Education 08MIO Profit & Loss Accrual cask 6ecember 2008 through November 2009 _ Doc '98. Nov 08 Oaneral Expanses -. Pager - 88.00 - Meals 93.30 Gift & Raffia 1,091.72 Promotional 1,702.88 Credit Card Processing 1,384.71 Charitable Contrubitions 183.82 Miscellaneous 44.14 - Advertising 3485.08 Computer & IMemet 106.75 Dues and Subscriptions 309.00 Llesnsea;.Pees & Permits 45.00 Medical Supplies 435.00 office Supplies 5,440M - Postage 2,287.27... Printing 2,848.80 Telephone 3,181.90 Web Sfh 7,144.80 Workers' Comp Insurance 399.07 Total general Expanses 30,311.24 outside Servlcas 312.47 Payroll Expanses Payroll Taxes 1,680.70 Salary4 icar 2,739.00 Wages 670,30 Payroll Expenses • other 266.34 Total Payroll "noes 544843 Professional Pets Bookkeeping 646.78 Accounting 91920.00 Staff Development 250.00 6egal 126,00 Photography 200.00 Professional Pass • other 41111A Total Profeesionai pats 3,699.75 Symposium expenses 878.92 Total Expense 88,966.86 Nat Income 41,896.12 Page 2 Dear Applicant: We are pleased to inform you that upon revioyi.of your appl cation for ta5c. exempt status we: ,have.determined : th you- 'dre'exempt from`•Pederal :income tax, under section 501(c).(3) _ of the Inte aal Revenue Code: Coxitr2but tiria to v' are deductible under sactiob 170. of the CodO YOu.are.also quaiified't'a receive' tax deductible be que8ts, devises; transters..or -gifts under- section ,2055:; '2806. or 252 :; 2 of the Code'; Because this etter.Co4 -a help resolve any- t�iestiona. regarding your exempt status, you should'keep..it in- your - permanent = ::records.. Organizations exempt under section 5Q1(c)(37` >of the Code 'are further 7 claw le&' ' as either public charities or private foundations. During -your aelvanee rasing period, you will be treated as a public charity. Your advance rulii;g pexaad begins with the effective date of .your exemption and ends. :with advance ruling ending :date . shown in the. headjgg Shortly before the end of your advance ruling , period, we will send you.Form 8734, Support Schedule for Advance Ruling Per3od. You will have 90 days after the end of your advance ruling period to return the completed :form.. We will then notify you, in writing, about your public charity status. Please see enclosed Information for Exempt Organizations Under Section 501(c) (3) for some helpful information about your responsibilities as an exempt organization. Letter 1045 (DO /CG)' I2SDeparts nRev ne 3erv3ee .. * s P.O. 'Box 2508 In reply refer {t[+ti�` ov Cincinnati ON 45201- N-. 06, . 2ff08 LAI R 416 Y0 `� 000 -2668059 -�o-a 6 °�o-s 43LL 1 - OOQ133.1` BOIIL.:: TE HEALTHY MANAGEMENT DIABETES X KAISHAWN MCDUFFIE 40335 wINCHESTER.RD STE E240 TEMECULA CA 92591 -5518 - F 32138 Employer Identification Number 43 2068059 Person to Contact Jeff Se.sbtt r{ • �' Toll Free Telephone Numb*t 1 a77 82 5 Dear Taxpayer: This is in response.to your request of Oct. 28, 260$r regarding your:, tax - exempt status. v"4 Our records indicate that a determination letter :was xs;$ued zfl -. November 2005, that recognized;:y*y.ou as exempt from .Federal :income, tax; and discloses that you are currently exempt under s.ectio.n.501C:c)(3)` of the Internal Revenue Code._. Our records also indicate you<are not a.private.f:oundation within thz meaning of section 509(a). of the Code because you are xiescribed i section(s) 509(a)(1) and 170(b)(1)(A)(vi). Donors.ma.y deduct contributions to you as.provided in section.. 170 of the Code.- Bequests, - legacies, devises, transfers; gifts to, you or:. for your use are deductible for Federal estate and 'gift tax Purpose-s. if they meet the applicable provisions of sections 2055, 2106,.and ; 2522 of the Code. If you have any questions, Please call us at the telephone %number shown in the heading of. this letter s t-g'g n. HEALTHY MANAGEMENT DIABETES EDUCATION 23597 - BRIGIN PL MURRIETA CA 92562 -4810 Purpose. EDUCATIONAL Code Section 23701d Form of Organization Corporation Accounting Period Ending: November 30 Organization Number 2586612 You are exempt from state franchise or 'income tax under the section.of the Revenue and Taxation Code indicated above. This decision is based on information you submitted and assumes that Your present operations continue unchanged or conform to those proposed in your application. Any change in operation, character, or purpose of the organization must be reported immediately to this office so that we may determine the effect on your exempt status. Any Chang of name or address must also be reported. In the event of a change in relevant statutory, administra case law, a change in federal interpretation of federal la where our opinion is based upon such an interpretation, or the material facts or circumstances relating to yourappli whi °ch- th -is opinion-it based thi"s"'opinion may 'no longer be It is your responsibility to be aware of these changes sho This paragraph constitutes written advice, other than a ch ruling, within the meaning of Revenue and Taxation Code Se 21012(.a)(2). ive, judicial in cases a change in anon upon applicable. ld they occur. "ef counsel tion You may be required to file Form 199 (Exempt Organization nnual Information Return) on or before the 15th day of the 5th m nth (4 1/2 months) after the close of your accounting period. Please see annual instructions with forms for requirements. You are not required to file state franchise or income tax returns March 11, 2005 -HEALTHY MANAGEMENT DIABETES EDUCATION - - -- ENTITY ID 2586612 Page 2 unless - you -have income sub]ect to the unrelated business income tax under Section 23731 of the Code. In this'event, you are required to file form 109 (Exempt Organization Business Income Tax Return) by the 15th day of the 5th month (4 1/2 months) after the close of your annual accounting period. - - - - Please note that an exemption from federal income or other taxes and _. other state taxes requires separate applications. A copy of this letter has been sent to the Registry. a.f C fig r=: #able Trusts M SIK`ICH EXEMPT ORGANIZATIONS BUSINESS ENTITIES SECTION TELEPHONE (916) 845 -4092 FAX NUMBER (916) 845 -0800 EO CC :KAISHAWN D. MCDUFFIE COP1 SEP 13'tuiu CITY OF TEMECULA FISCAL YEAR 20 10- 1 I �Ge Depal1e? COMMUNITY SERVICE FUNDING PROGRAM AP1 L7 ATION (Please Print or Type) 2010 -11 Program Submission Deadline: Wednesday, September 15, 2010 (original, plus one) PROJECT INFORMATION Amount Requested: $5000.00 (Maximum allowable $5,000) Project Name: H.E.A.R.T. for Children's Child Care Tuition Proqram Project Start Date: Project End Date: Ongoinq Program: but any City of Temecula grant funds received will be used by June 30 2011 ORGANIZATION INFORMATION Name of Organization: H.E.A.R.T. Inc. Foundation dba H.E.A.R.T. for Children Contact Name: Title /Position: Martha N Minkler, President Mailing Address: P.O. Box 1922, Temecula, CA 92593 Telephoner 951.506.3675, Minkler 951.696 4004 Year Organization Founded: 1984 Number of Paid Staff: 0 Number of Volunteers: 10 active: 20 -25 when needed Geographic Area(s) Served: Southwest Riverside County, primarily Temecula Is this organization incorporated in California as a non - profit organization? Yes Yes No Effective Date: 12 -20 -84 If "yes" (Must provide a copy of your statement of non - profit status from the State of California): Date of incorporation as a non- profit: 12 -20 -84 Federal identification number. 33- 0078707 State identification number: D1265059 If "rW: This application has been authorized by the organization's' Executive Committee Board of Directors XX Members -at -Large Application — Page 1 NIISSION STATEMENT. The Mission of H.E.A.R.T. for Children is to provide funding for services and support to abused and neglected children and families in crisis in Southwest. Riverside County- - H.E.A.R.T. for Children's goals, which translate into their four ongoing programs, are: Therapy Funding Program: to provide hours of critical therapy for abused and neglected children and families in crisis. Child Care Tuition Funding Program: to underwrite funding for quality, state licensed child care for children who would otherwise be left home or on the streets alone. Lifeline Program: to provide funding and /or services for youth who are aging out the Foster Care System Discretionary Fund: to provide specific one -time services, or fulfill a specific need, for abused and underserved children. H.E.A.R.T. for Children, a 501 (c) (3) nonprofit public benefit corporation, was founded in February 1984 as a grassroots effort to eliminate child abuse, through education, in Temecula. H.E.A.R.T. for Children is an all volunteer organization. Eighty -eight (88 %) percent of all monies raised by H.E.A.R.T. go to support programs. All monies raised stay in Temecula and Southwest Riverside County. H.E.A.R.T., although not a highly visible public organization, has received consistent and ongoing support throughout the years from the local Temecula community. A few of H.E.A.R.T.'s past and present financial supporters include: City of Temecula, Third District Riverside County Supervisor Jeff Stone, Pechanga Development Corporation, Rancon Group, Temecula Associates, DCH Group, Guidant -Abbott Foundation, The Leo /Bye Foundation, Robert McCormick Tribune Foundation (Californian Holiday Fund), The Californian, and The Press- Enterprise. However, as with many other nonprofit organizations, these past two years have been very difficult financially. This is the first year in twenty -six years of operation that H.E.A.R.T. has had to put programs on hold in order to raise funds. H.E.A.R.T. for Children is fortunate to have the services of Leslie Doherty, CPA and accountant Gloria Monchilovich, The Bookkeeper, who insure H.E.A.R.T. remains fiscally sound. H.E.A.R.T. 's leadership has included some very dedicated and well -known community philanthropists who have helped grow and sustain H.E.A.R.T. through good and bad times for the past twenty six years. During the 1980s and early 1990s, H.E.A.R.T. for Children raised money to open child care centers on Temecula elementary school sites. The first child care center opened at Vail Elementary School. H.E.A.R.T. also paid for staff salaries and supplies for that site. The second site funded by H.E.A.R.T. opened on the campus of Rancho Elementary School. The third child care center that opened at Redhawk Elementary School was a collaborative effort among Temecula Valley Unified School District, H.E.A.R.T. and the developer of Redhawk. H.E.A.R.T. has provided funding for services for thousands of Temecula's children and families in crisis over the years. Hundreds of children have benefitted from the elementary school child care centers. Over 555 abused children have received free counseling services; 191 children have benefitted from H.E.A.R.T's Child Care Tuition Funding Program; 75 Temecula high school seniors have received college scholarships, and 2 foster children have been the beneficiary's of H.E.A.R.T.'s newest Lifelines Program. H.E.A.R.T. application -Page 2, 9-10 Since its inception, H.E.A.R.T-. for Children has always been free of any type of discrimination. H.E.A.R.T. for Children does not have any political or religious affiliations. - Services are available to any child and /or family in crisis in Temecula and Southwest Riverside County as long as H.E.A.R.T. has funding available and the child and /or family meets H.E.A.R.T.'s criteria: 1) the child is a victim of child abuse defined within the categories of physical, emotional, sexual abuse, neglect or abandonment; 2) the child and /or family has no - other financial resources available to secure the needed services; 3) the child and /or family understands that therapy funding, child care tuition funding, and Life Line services are short term ... 3 to 6 months... not ongoing; 4) child care tuition funding is designed to assist families defined as 'working poor". who are suffering from economic setbacks. Funding is designed to help families through times of crisis, but not intended to be long-term. H.E.A.R.T. schedules Strategic; Planning workshops during which H.E.A.R.T.'s mission and goals are evaluated based on program outcomes. However, especially in terms of the Therapy Funding Program, the evaluation process is sometimes difficult due to confidentiality issues and logistical long -term tracking. Nevertheless, H.E.A.R.T. is often privileged to learn of success stories from thank you notes, therapists' reports, court or social service feedback and even newspaper articles. This feedback affirms H.E.A.R.T.'s belief that the work we support is desperately needed and very important to the health and welfare of Temecula residents. H.E.A.R.T. application —Page 3,9-10 PROJECT DESCRIPTION H.E.A.R.T. for Children's Child Care Tuition Funding.Program In 1989, deeply concerned about the newly identified "Latch Key Child" issue, H.E.A.R.T. for Children, in collaboration with Riverside County Child Care Consortium ( RCCCC) and the newly organized Southwest Riverside County Child Care Council (SWRCCC), established a Child Care Tuition Funding Program Children left home alone face a multitude of potentially harmful situations. Single parents, or parents with both partners working, who are barely making ends meet and often commuting long distances back and forth to work, are forced to place their children in harms way by leaving them home alone. H.E.A.R.T.'s Child Care Tuition Funding Program was designed to help parents in Temecula protect their children by providing short term, interim help. Initially a H.E.A.R.T. volunteer advertised the availability of funds, screened applicants, verified child care facilities were state licensed and paid child care tuition bills. As the program grew, H.E.A.R.T. contracted with a carefully screened applicant to administrate the program which she has done for the past tenor so years. In June 2010, when the last funds for the Child Care Tuition Funding Program were depleted, and lack of funding necessitated putting a hold on the program, six families remained on the waiting list. Although RCCCC & SWRCCC surprisingly recently discontinued the Child Care Tuition Funding collaborative, H.E.A.R.T. for Children is committed to continuing the program. With a committed administrator still willing to assist H.E.A.R.T., and a dedicated Board of Directors, the program will survive this temporary set -back. In addition to a carefully targeted directed mail campaign, grant requests, and two special events in the planning stages, H.E.A.R.T. would be very grateful for the City of Temecula's assistance in helping H.E.A.R.T. protect Temecula children who are in danger of being left home alone. C i 'O U L E W L F O a a w � 10 C p .Q LL N 9 + O C 6 Y 0 m � F C � 7 L LL � U L F u d Q ui W 7 z W W 000 0 000 0 O O O O 00o a W p. -. _. - LO _ O. l ._ _....... ._.. _ J W r H N LL O F- F L c �� U C i 'O U L E W L F O a a w � 10 C p .Q LL N 9 + O C 6 Y 0 m � F C � 7 L LL � U L F u d Q ui W 7 z W W 000 0 000 0 O O O O 00o a V) LOa o r- t- uS r C Q a) U Q- 0 •� U ECJ w U -0 > aaa ca co � c c QC7(? W z W W J H O I— o oC)C) - -0 r 6 l0 O T co O M L r T r N F L c �� 3 ^Q` W ) a O. U N E = _ a) -0 a) U w o :3 cu m C () a) f6 U a)w cu_ Q O •L N 0 Q'3 W w cma 0 0 � O 0 E E ° = •R= n m CL O `O N a3 U a a) - 0 a a) O C t0q O Q C i U +�. C fa V) Ca 'I-- 0 � N Q a U 7 ca v0- CO N a) U 0 Co LL C Q w a) (�6 0 C c a) 0 a) O (6 N W U N Co a� c c"' z o o `) 3 " E 0 c a Y°� N o > 0) E 0 U Q a) a X 3 m a) m � E oZS F- 'S N.�O)E= N L 0 a) cU6. a) 7 >n�rnUrn4)n (a c " Q@ Q ," -.� cZwUQ a o c ° j) a) O 0 c N a) W U Q a. a. a. d l- I- c o H.E.A.RT. application -Page 5, 9 -10 Current Liabilities Total Current Liabilities Long -Term Liabilities Total Long -Term Liabilities Total Liabilities Capital Retained Earnings Net Income Total Capital Total Liabilities & Capital $ 13,28716 227.87 0.00 0.00 0.00 13,515.13 $ 13,515.13 Unaudited - For Management Purposes Only HE.A.RT , INC. dba H.E.A.R.T. for Chi Balance Sheet - - July 31, 2010 ASSETS Current Assets. - Cash inBank- Rabobauk $ - 9,456.69 -Cash In Bank- Rabobank TCCS 3,998.44 Prepaid Expense - _. ...60.00._ Total Current Assets 13,515,13 Property and Equipment Total Property and Equipment 0.00 Other Assets Total Other Assets 0.00 Total Assets $ 13,515.13 LIABILITIES AND CAPITAL Current Liabilities Total Current Liabilities Long -Term Liabilities Total Long -Term Liabilities Total Liabilities Capital Retained Earnings Net Income Total Capital Total Liabilities & Capital $ 13,28716 227.87 0.00 0.00 0.00 13,515.13 $ 13,515.13 Unaudited - For Management Purposes Only For Management Purposes Only Paged__.. __.. _ H- E.A.RT., INC. dba HEAR-T. for Chi E' ... _. _..._ .__.Income Statement .. _ - For the Seven Months Ending July 31, 2010 Current Month - _ _ Year to Date -: Revenues Income- Contributions $ 0.00 0.00 $ 100.00 1.96 Income - Contribution TCCS . 0.00 0,00 5,000.00 97.98 Income- Interest 0.00 0.00 3.33 0.07 Total Revenues 0.00 0.00 5,103.33- 100.00 - - Cost of Sales Total Cost of Sales 0.00 0.00 0.00. 0.00 Gross Profit 0.00 0.00 5,103.33 100.00 Expenses Advertising Expense 0.00 0.00 1,803.08 35.33 Answering Service 60.00 0.00 380.00 7.45 Accounting Tax Preparation 0.00 0.00 100.00 1.96 Bank Service Charge 0.00 0.00 30.00 0.59 Foster Care Expense 1,001.59 0.00 1,001.59 19.63 Telephone Expense 0.00 0.00 15.79 0.31 Insurance 0.00 0.00 1,410.00 27.63 Office Expense 0.00 0.00 44.00 0.86 Permits and Fees 0.00 0.00 81.00 1.59 Taxes 0.00 0.00 10.00 020 Total Expenses 1,061.59 0.00 4,875.46 95.53 Net Income $ (1,061.59) 0.00 $ 227.87 4.47 For Management Purposes Only Annual direct mail campaign 7,500.00 Grants, Public 15,000.00 Grants, Private, Corporate 10,000.00 Interest earned 100.00 Special Event Sponsorships 10,000.00 Temecula CCS Partnership for Foster Youth, (Restricted funds) 5,000.00 TOTAL REVENUE 47,600.00 EXPENSES Accounting services, donated - Bank charges, waived by bank - Community Event participation/booth rental fees (donated) - Contingency 100.00 Fund Development expenses /Direct Mail 3,000.00 Insurance, Liability, Directors and Officers 1,410.00 Office Supplies /services (donated) - Marketing /Public Relations, donated - Permits /Fees 100.00 Postage, donated; Post office box rental 44.00 Printing /computer, donated - Programs Child Care Tuition Funding Program 15,000.00 Discretionary Fund for abused children, one -time special requests 1,676.00 Temecula CCS Partnership for Foster Youth 5,000.00 Lifeline Program for foster children aging out of system 10,000.00 Therapy Funding Program 10,000.00 Tax preparation 550.00 Telephone (answering service); Minkler home office phone donated 720.00 Website (donated) - TOTAL EXPENSES 47,600.00 INTERNAL REVENUE SERVICE ::. - .- DEPARTMENT .OF- . THE TREASURY - .. -. DISTRICT DIRECTOR - 2 CUPANIA CIRCLE - - MONTEREY PARK, CA 91754 - Employer Identi--ication Number. 2 19 33- 00787O7 Date: qUG 1 Case Number: 953215375 - -- HELPING ELIMINATE THROUGH EDUCATION - Contact Person: ABUSE IN RANCHO TEMECULA INC CAROLYN TSCHOPIK - P OBOX 1922 Contact Telephone Number:; : TEMECULA, CA 92593 -1922 - - - (213).- 725 -- 7002 _ Our Letter Dated: April 30, 1985 _ Addendum Applies: . No - Dear Applicant: - This modifies our letter of the above date in which we stated that you would be treated as an organization that is not a private foundation until the expiration of your advance ruling period. Your exempt status under section 501(a) of the Internal Revenue Code as an organization described in section 501(c) (3) is still in effect. Based on the information you submitted, we have determined that you are not a private foundation within the meaning of section 509(a) of the Code because you are an - organization of the type described in section 509(a)(2). Grantors and contributors may rely on this determination unless the Internal Revenue Service publishes notice to the contrary. However, if you lose your section 509(a)(2) status, a grantor or contributor may not rely on this determination if he or she was in part responsible for, or was aware of, the act or failure to act, or the substantial or material change on the part of the organization that resulted in your loss of such status, or if he or she acquired knowledge that the Internal Revenue Service had given notice that you would no longer be classified as a section 509.(a) (2) organization. If we have indicated in the heading of this letter that an addendum applies, the addendum enclosed is an integral part of this letter. 'Because this letter could help resolve any questions about your private foundation status, please keep it in your permanent records. If you have any questions, please contact the person whose name and telephone number are shown above. . Sin erely yours Michael J. Quinn District Director - - Letter 1050 (DO /CG) Helping Eliminate Through Education Abuse in Rancho Temecula- Inc. -p. O. Sox 1922 Temecula, CA 92390 Purpose Charitable and Educational 'Form of organization. Corporation Accounting Period Ending: D vemBe 9 31 "Organization Humber On the:basis of the information subditted and provided your present operations continue unchanged ox conform to those proposed in your application, you are exempt from state franchise or income tax under Section 23701d, Revenue and Taxation Coda. Any change in operation. character or purpose of the organization must be reported immediately to this office so that we may determine the effect on Your exempt status. Any change of name Or address also Faust be reported. you are required to fi14 Form 199 (Exempt Organization Annual aformation.Return) or Form 199B (Exempt . ofo the n 5th1month (4 li2 months )' after the close of You • -- - - instructions with forms for requirements. You are not required to file state franchise or income tax returns unless you have income subieot to the unrelated business income tax under Section 23731 of the.Code. In this event, you are required to file Form 109 (Exempt Organization Business Income Tax Return) by the 75th day of the 5th month (4 .1/2 months) after the close of your annual accounting Period. I£. the organization.is inOOrPOrating, this approval will expire unless incorporation is completed.with the Secretary of State within 60 days. Exemption from federal income or other taxes and other state taxes requires separate applications. - B. Raraid, Supervisor - Exempt Audit Unit Telephone (soo) u.52-5711 co- Kathie Gray secretary of State Registrar of Charitable Trusts FTB 4206 -ATS (REV. 10- 81/8-83) PROJECT INFORMATION Amount Requested: $ 5i 00 0 (Maximum allowable $5,000) Project Name: G{ t t (G�h�yl S C1✓i �f W of W- -GiOeS Project Start Date: /V 0Ve-rn a P%L, ot0 / 0 Project End Date: 5u``w- 3O, �p / ORGANIZATION INFORMATION Name of Organization: 't-Mb (Oh CAL, 0 - 1--rL -L , V ut LP-1 J Contact Name: k-� Title /Position: Mailing Address 2 5� `� D «' 1. c o �/ C . ACL L v-" `e� , C - ZSIe Z Telephone: C1 S 1- a"0 D— `7 9'0 0 Year Organization Founded: I i g Z Number of Paid Staff: (ol Number of Volunteers: 14,9 ac>6 ve, yc-ta n ��s Geographic Area(s) Served: 30i tnnffI Wt f VYJz in c%r✓ CO LVI% -I Is this organization incorporated in California as a non -profit organization? Yes _Y No Effective Date: 09-3 9-3 If "yes° (Must provide a copy of your statement of non - profit status from the State of California): Date of incorporation as a non - profit: Federal identification number: State identification number 30 9- -75-0 6 {P If "no ": Name of sponsoring organization: Federal identification number: State identification number. This application has been authorized by the organization's Executive Committee Board of Directors Application - Page 1 Members -at -Large �real Revenue Service Department of the Treasury - t)isfrict Director Date:. July ,. o Employer ldeen�tific /at /ion Number: 1983 Ac q�N1{uo�d December 31 - - - - foundation" Status Classification: _ 509(0(1) and 170(b)(1)(A)(vi) Advance Ruling Period Ends: - Hospice of Sun City Incorporated December 31, 1984 27851 Bradley Rd.. Person to contact. Sun City, CA 92381 I: t Telephone " contact Telephone Number: (213) 688 -4889 Dear Applicant: Based on information.5upplied, and assuming your operations will be as stated in your application for recognition o :. we have determined you are exempt from Federal income tax'under•'se on 501(c)(3) o the,Internal Revenue Code. Because you are a newly created organization, we are not now making a final- determination of your foundation status under section 509(a) of the Code. HoweVer, we have determined that you can reasonably be expected to be a publicly supported or described in seotion 509(a).(1) and 170(b)(1)(A)(vi). Accordingly,.you will be treated as a publicly supported organization, and.not. ' as a private foundation, during an advance ruling period, This advance ruling period . .begins on the date of your inception and.ends on the date shown above. Within 90 days after the end of your advance ruling period, you must.submit.to us information needed to. determine whether you have met the requirements of the applicable support test`during.the, advance ruling period. If yow establish that you have been a- publicly supported organization, you will be classified as a section 509(a)(1),or 509(a)(2,) organization as long as you continue to meet the requirements` of the applicable- support- test. If you do not meet the public support requirements during the advance ruling period, you will be classified as a private foundation for future periods: Also, if you are classified as :a private foundation, you will be treated as a private foundation from the date of your inception for purposes of sections 507(d) and 4940. Grantors and donors may rely on the determination that you are not a private foundation until 90 days after the end of your advance ruling period. If you submit the required information within the 90.days, grantors and donors may continue to rely on the advance determination until the Service makes a final determination of your foundation status. However, if notice that you will no longer be treated as a section 509(a)(i) ** organization is published in the Internal Revenue Bulletin, grantors and donors may not rely on this determination after the date of such .publication. Also, a grantor or donor may not rely on this determination if he or she was in part responsible for, or was aware of, the act or failure to act that resulted in your loss of section 509(a)(1) ** status, or acquired knowledge that the Internal Revenue Service had given notice that you would be removed from classification as a section 509(a)(1)** organization., P.O. Box 2350, Los Angeles. Calif. 90053 (over) Letter 1045(DO) (6 -77) ** and section 170(b)(1)(A)(vi). Page 1 - 10 :23 AM _ Hospice of the:Valleys os/oz/o Balance Sheet Accrual Basis - As Of June 30, 2010 - -Jun 30, 10 ... _.. -: .:ASSETS. Current Assets _.. -0hecking /Savings - 1030.- Wells Fargo Relationship - - - 689,876:82 - -1004 •.Commerce Bank Relationship ' __ 242,549.23 _.. _.. _. _.. - .0500•Petty Cash _. ._ _.:. 230.00 - - 1018 - PayPal 6,970.02 - - _ - - 1700 -1- Investments - - 266,711.86 - - - - - - Total Checking /Savings - - - - 1,206,337.93 - - - - - - Other Current Assets - -_ 1303 - Bequests & Donations Receivable - 137,000.00, _ - _ 7300 - AR Patient Accounts ,568,605.81 _ - - .1302 - AR Room & Board - -- - 7,518.72 - - - - 1330- Other Receivable : 13,867.98- - .. 1550 - Deposits - 13,887.47 1501 • Prepaid Insurance 12,960.37- - c 1500 - Prepaid Expenses 29,398.65 - _ Total Other Current Assets 783,239.00 Total Current Assets 1,989,576.93 Fixed Assets 1900 -1 • Fixed Assets 62,849.63 Total Fixed Assets 62,849.63 -TOTAL ASSETS 2,052,426.56 -. LIABILITIES & EQUITY Liabilities Current Liabilities - Accounts Payable 2000 - Accounts Payable 110,894.49 Total Accounts Payable 110,894.49 Credit Cards - 2500 - Commerce Bank Visa 7,438.11 Total Credit Cards 7,438.11 Other Current Liabilities - 2009 • Accounts Payable- Accrued 25,540.44 2110 • Accrued Payroll 152,447.18 2200 - Accrued Payroll Ben Liabilities 59,097.33 2301 - BancLease - ESI Phone System 14,157.23 - 2400• Deferred Rent 13,174.68 Total Other Current Liabilities 264,416.86 Total Current Liabilities 382,749.46 - Total Liabilities 382,749.46 Equity 2920 - Temporarily Restricted 11,275.00 2901 - Retained Earnings-- Undesignated 1,179,169.03 _ 2902 - Opening Bal Equity 39,999.36 Net Income 439,233.71 _ Total Equity 1,669,677.10 _ TOTAL LIABILITIES & EQUITY 2,052,426.56 Page 1 - 10:28 AM _ _. - Hospice of the Valleys - 09/02/10 _ ___ -- Profit -& Loss Accrual Basis January through June 2010 _. Ordinary Income/Expense - Income. - --- 3610•Physician Visit Revenue .45,639.58 - - 3000 • Medicare -Ben Routine - 2,500;442.90 - - - - - - -- 3010•MCD- Ben-Routine -- - -" 151 - ,748.40 - ' 3020 •Commercial Benefit - - -_.. . 4,822.24 3060 • Charity Income - 0.00 - Total Income _ ..2,702,653.12 Expense 4000 -1 •Salaries & Benefits -: - 1,735,682.49 - - - 5000 -1 •- Patient - Related Expenses - -- - - -- 439,194.36 - - -- _ - - - - - 6000 -1 • Facility- Related Expenses - . 72,636.24 6500 -1 • Admin. Expenses- 194,160.97 - 6950 • Depreciation Expense - -• . 9,301.73 6999 -1 Unclassified -88.66 Total Expense 2,450,886.95 Net Ordinary Income 251,766.17 Other Income /Expense - Other Income - - - - -- - - - - - 7000 -1 • Bequests, Donations & FR 184,250.40 - 7700 -1 • Interest & Investment Income - 3,217.14 Total Other Income. 187,467.54 Net Other Income 187,467.54 - - Net Income _ - 439,233.71 Page 1 16:02 AM Hospice of the Valleys 13,535 439,194 j - 19,516 Accrual Basis - Profit & Loss Budget Performance 0 194,161 January through June 2010 _ - 17,116 - - Jan - Jun 10 Budget - $ Over Budget Annual Budget - - Ordinary Income /Expense - - - .. _... - - - -- Income 2,473,950 - 23,063 3610 • Physician Visit Revenue - - 45,640 -- 34,980 _ - 10,660 -- 69,960 3000 • Medicare -Ben Routine 2,500,443 2,496,581 3,862 5,035,859 - - 3010 • MCD -Ben Routine - - - 151,748 - - 9,704 142,044 - _19,400 - - - 3020 •Commercial Benefit 4,822 44,100 - - 39,278 88,200 - 3060 • Charity Income 0 0 0 0 n 3490 • Misc. Patient Revenue 0 q 0 0 Total Income 2,702,653 2,585,365 117,288 5,213,419 Expense 4000.1 • Salaries & Benefits 5000 -1 • Patient - Related Expenses 6000 -1 • Facility - Related Expenses 6500 -1 • Admin. Expenses . 6950 • Depreciation Expense 6999 -1 • Unclassified Total Expense Net Ordinary Income Other Income /Expense Other Income 7000 -1 • Bequests, Donations & FR 7700 -1 • Interest & Investment Income Total Other Income Net Other Income Net Income 1,735,682 1,722,147 13,535 439,194 458,710 - 19,516 _ 72,636 72,636 0 194,161 211,277 - 17,116 9,302 9,180 122 -89 2,450,887 2,473,950 - 23,063 251,766 111,415 140,351 3,508;809. 934,092 146,187 402,841 18,360 5,010,289 203,130 184,250 43,598 140,652 118,200 3,217 4,500 -1,283 9,000 187,468 48,098 139,370 - 127,200 187,468 48,098 139,370 127,200 439,234 159,513 279,721 330,330 Page 1 of 1 to me board of Directors of Hospice of the Valleys SC Murrieta, California We have audited the accompanying statements of financial position of Hospice of the Valleys SC (a nonprofit corporation) as of December 31, 2009 and 2008, and the related statements of activities, and of cash flows for the years then ended. These financial statements are the responsibility of the Organization's management. Our responsibility is to express an opinion on these financial statements based on our audit. We conducted our audit in accordance with auditing standards generally accepted in the United States of America. Those standards require that we plan and perform the audit to obtain reasonable assurance about whether the financial statements are free of material misstatement. An audit includes examining, on a test basis, evidence supporting the amounts and disclosures in the financial statements. An audit also includes assessing the accounting principles, used and significant estimates made by management, as well as evaluating the overall financial statement presentation. We believe that our audit provides a reasonable basis for our opinion. In our opinion, the financial statements referred to above present fairly, in all material respects, the financial position of Hospice of the Valleys SC as of December 31, 2009 and 2008 and the changes in its net assets and its cash flows for the years then ended in conformity with accounting principles generally accepted in the United States of America. !Ii i Murrieta, California May 21, 2010 I —.. -.,,.a XAa a ruvu Ar:l AJJL'.1., CURRENT LL4BILITIES 2009 2008 . Accounts payable $ 210,635 $ 303;536 Credit card payable Accrued expenses 2,460 Accrued vacation payable 53,442 47,656 Current portion of obligation under capital lease 43,094 93;789 4,722 4,329 TOTAL CURRENT LIABILITIES 314 353 449 310 LONG -TERM LIABILITIES Capital lease payable, net of current portion TOTAL LONG -TERM LIABILITIES NETASSETS: Unrestricted net assets Temporarily restricted net assets TOTAL NET ASSETS TOTAL LIABILITIES AND NET ASSETS 3 See notes to financial statements. 11,745 16,468 11,745 16,468 1,229,998 655,110 445 15,520 1,230,443 670,630 $ 1,556,541 $ 1,136,408 b M M vl .mNOOvr O�NU l�NO dOM ObOVf " N'M N N .+ V b CO M n. d b h,q �p d V M V Vr n :M .D tD T M' n n b M. b N d d M � O M B vNi vOi .dr.0 M O b N.N N CO N .y d O� Qr U N m:o � Vl `il O O Vl d V b M v� M N d d W d n M lbD b q�� n b M b b Qr Q. N d ,�d,.NM vN NM �NN.rNU MN.NMa.n -�b ^N tifN`Ib�Nd �N V My � h � �. r � r .-i O N � � � � � O � � M' M b vl Mn O � r•t � 'V � M o b m oo n n m eo aevmi v'^i. 0 N v N - U A� , ,. vbi � V M b W .dr V ` Vr `O. -r O] � n M. • � � n N O O� Or n M o W d' d 0.Q�i N m rn Ni m d -� O M W N .� n co d Qr N yr oc a r o] h vi vi Vl F a' m W Q m Jig m %+ N Cqj' ..C1 Q v �Gr jo ra O JW+ 2 `° avi v G. vi W W Q .r„ G W u o y F ti v v p F F O A C o C. .ta: _ F W W H w W �.., A z .v. .� a �.5 env ti W 3 p R g v g � F a ,v a - .v.. O w❑ C pOaz WAQa9 -Ti3 my o. .] A'°K.mmr°akmoeo qw a°agi o m U z vi ui o Q W W W tR L b 2m2 Q d pv,a.woUUOAv. �a �o.o[CatC4I-, D x�. W W �. U O F z z p HOSPICE OF THE VALLEYS SC NOTES TO FINANCIAL STATEMENTS DECEMBER 31, 2009 AND 2008 NOTE 1- SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES - - Nature of the Business Hospice of the Valleys SC (the "Organization ") is a nonprofit provider of hospice services in Southwest Riverside County, California. Through its programs, the Organization.offers individualized care and support to people with life threatening illness and to their families during the illness and after death. Through their team of trained'professionals and volunteers, Hospice of the Valleys SC offers hospice care, bereavement, chaplain, and volunteer support services. Approximately 84 percent of the Organization's revenue is obtained through Medicare contracts. Basis of Presentation Financial statement presentation follows the recommendation of the Financial Accounting Standards Board in its Statement of Financial Accounting Standards (SFAS) No. 117, Financial Statements of Not - for -Profit Organizations. Under SFAS No. 117, the Organization is required to report information regarding its financial position and activities according to three classes of net assets: unrestricted net assets; temporarily restricted net assets, and permanently restricted net assets. The Organization has also adopted SFAS No. 116, Accounting for Contributions Received and Contributions Made. Contributions received are recorded as unrestricted, temporarily restricted, or permanently restricted support depending on the existence or nature of any donor restrictions. Contributions of in- kind goods and /or services are not included in the statement of activities unless required by SFAS No. 116; however, significant in -kind contributions are disclosed. The Organization's temporarily restricted net assets consist of an endowment account restricted for use by the donor. The balance of this temporarily restricted account at December 31, 2009 and 2008 was $445 and $15,520 respectively. Recognition of Revenues Net patient revenue is reported at the estimated net realizable amounts from third -party payors for services tendered to patients. A substantial portion of the Organization's revenue is derived from patient charges under the Federal Medicare program from which it receives a daily rate for hospice services provided to Medicare patients. The Organization also derives a portion of its revenue from patient charges under the California Medi -Cal program and has signed contracts with health maintenance organizations and insurance companies to provide services for less than standard rates. 7 HOSPICE OF THE VALLEYS Sc NOTES TO FINANCIAL STATEMENTS DECEMBER 31 2009 AND 2008 ; NOTE l — SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES CONTINUED Property and Equipment Property and equipment are capitalized at cost. It is the policy of the Organization to capitalize expenditures for these items in excess of $500. Lesser amounts are expensed. Property and equipment are depreciated using the straight -line method over their estimated useful life ranging from three to ten years. Income Taxes The Organization is a not -for -profit organization that is exempt from income taxes under Section 501(c)(3) of the Internal Revenue Code and did not conduct unrelated business activities. Therefore, the Organization has made no provision for federal income taxes in the accompanying financial statements. Functional Allocation of Expenses The costs of providing the various programs and activities have been summarized on a functional basis in the statement of activities. Accordingly, certain costs have been allocated among the programs and supporting services based on specific identification. Concentrations The Organization derives significant revenues from Medicare contracts. Loss of some or all of these contracts could have a significant detrimental effect on the Organization's operations. NOTE 2 — INVESTMENTS The Organization has adopted SFAS No. 124, Accounting for Certain Investments Held by Not - for- Profit Organizations. Under SFAS No. 124, investments in marketable securities with readily determinable fair values and all investments held in debt securities are reported at their fair values in the statement of financial position. Unrealized gains and losses are included in the change in net assets. Investment income and gains restricted by a donor are reported as increases in unrestricted net assets if the restrictions are met (either by passage of time or by use) in the reporting period in which the income and gains are recognized. E HOSPICE OF THE VALLEYS SC NOTES TO FINANCIAL STATEMENTS DECEMBER 31 2009 AND 2008 NOTE 5 OPERATING LEASES The Organization leases administrative office space and some equipment under operating leases. The administrative offices are leased under a sublease effective January 8, 2008 for a term of sixty months. A Rent expense for the current year leases, which consisted of minimum rent, management fees, and common area maintenance was $145,272 and $162,749 for the years ended December 31, 2009 and 2008 respectively. NOTE 6 — PENSION COSTS The Organization has a defined contribution 401(k) profit- sharing plan which covers substantially all employees meeting certain requirements for age and length of employment. Participants may, subject to prescribed limits, contribute to the plan. The Organization's contributions to the plan are discretionary and totaled $34,634 and $43,879 for the years ended December 31, 2009 and 2008 respectively. NOTE 7 — CONTINGENCIES Amounts received or receivable from third -party payors are subject to review by the third -party payors. Any disallowed claims, including amounts already collected, may constitute a liability of the Organization. The amount, if any, which could be disallowed by the third -party payors is not determinable. 11 Mission We foster reverence for life, relief of suffering, and compassion in loss for the terminally ill residents and their families of Southwest Riverside communities. Vision Recognized leader of excellence in comprehensive end -of -life care. Values We seek to embody the hospice philosophy in all we do, including: the affirmation of life, promotion of self- determination, education, understanding, and acceptance. We dedicate ourselves to the values of compassionate care, loving presence, and the sustenance of hope for those dealing with the many difficult challenges at the end of life. We believe that transformation and healing are a part of the dying process and change all who participate in this sacred experience. We advocate sensitivity, attentiveness, and respect of all persons as we honor each life entrusted to our care. We support a culture of teamwork and professional collaboration. We embrace the calling to work diligently to provide leadership as educators and advocates for the suffering and dying in our community. We hold ourselves accountable for the valuable resources which we have been given and vow to use them responsibly. We are committed to the highest standards of personal and professional ethics and integrity and maintain the highest standards of excellence in the provision of care. We continue our professional growth through advanced training and educational certification. 25240 HancodrAve., Suhe 120, Murdeta, fit 92562 951200.7800 mmhosplceohheva0eys oi9 PROJECT DESCRIPTION, Howwill yourorganization use the funding awarded? Describe the project, project objectives; those served, area serviced, and number of volunteers involved. Bespecffic. Include equipment orservices that Would be purchased and why. Include a detailed budget and aschedule of significant activities related to this project. You may attach a maximum of one double - spaced typewritten page of information. (Please type or print legibly.) Annlinnfinn — Pane i TOTAL $10,210 justification - Why Are They Needed: The above items are essential components of running a specialized group for children and parents. Therapeutic activities are implemented to help children affirm their feelings and work through the grieving process..Many hours are spent preparing for the day, with professional planning, volunteer training, finding appropriate space for the size group, shopping, setting up, implementation, wrap up, and clean up. Continuing education for the facilitators assures the group is aligned with best practices grief counseling. Schedule of Significant Activities: Parents and children arrive and are split into separate groups. For the children's groups, ice breaker activities are initiated to get them talking and comfortable with each other. Therapeutic activities performed with the children are designed to be age- appropriate and can include the following: storytelling, affirming feelings associated with grief, dispelling fears and myths related to grief, activities to say goodbye, talking circles, parent /child reunion and a final activity to memorialize the loved one. Breaks, snacks and a meal are provided during the time together. Hospice of the Valleys Project Description Project Objective: To provide compassionate counseling and supportive care to children and families in our community during and after loss. - Those Served: All children and families of Southwest Riverside county Area Serviced: residents of Southwest Riverside county - - - Number of Volunteers involved: 25 Equipment and Services to be Purchased with Budget: • 100 hours of prep time @ $40 per hour $4000 • Continuing educational workshop on grief for 2 facilitators $ 360 • Rental for facility, tables, chairs $ 200 • Advertisement in local newspaper, radio, TV $1000 • Supplies for 100 individuals - o Transitional objects (plant flower In loved one's memory to take home $ 500 • journals, crayons, colored pencils /pens, scrapbook materials, balloons, name tags, beads, room decorations $1000 • Family dolls, felt board, sand tray equipment, feelings game, memory boxes, children's books on death and dying $1000 • Coping tool sets, picture collage materials, memory aprons, memory stones, picture frames, talking sticks, bean bags, butcher paper for family portrait and feelings identification $1000 • Lunch, Snacks, drinks $1000 • Relaxation /Meditation CD's $ 150 TOTAL $10,210 justification - Why Are They Needed: The above items are essential components of running a specialized group for children and parents. Therapeutic activities are implemented to help children affirm their feelings and work through the grieving process..Many hours are spent preparing for the day, with professional planning, volunteer training, finding appropriate space for the size group, shopping, setting up, implementation, wrap up, and clean up. Continuing education for the facilitators assures the group is aligned with best practices grief counseling. Schedule of Significant Activities: Parents and children arrive and are split into separate groups. For the children's groups, ice breaker activities are initiated to get them talking and comfortable with each other. Therapeutic activities performed with the children are designed to be age- appropriate and can include the following: storytelling, affirming feelings associated with grief, dispelling fears and myths related to grief, activities to say goodbye, talking circles, parent /child reunion and a final activity to memorialize the loved one. Breaks, snacks and a meal are provided during the time together. Hospice of the Valleys 2009 -2010 Past Project Benefits In 2009, Hospice of the Valleys held 2 Family Grief Workshop events: one on May 30 and the other on November 14. In all, 25 children and - 20.parents/ guardians attended. Parents and children voiced they felt the workshops were highly valuable as they learned how to accept and talk openly about their feelings of grief. Parents voiced they learned skills to better help their children process their grief. So far in 2010, Hospice of the Valleys has held one Family Grief Workshop on May 23. 7 children and 6 parents /guardians attended. The smaller group size allowed children and parents to process their grief in a more deeply intimate way. They voiced sincere gratefulness for this opportunity and especially appreciated that the workshop was sponsored by the City of Temecula and was provided to them at no cost. Additionally, Hospice of the Valleys held an 8 week Teen Grief Support Group at Murrieta High School and an 8 week children's support group at Monte Vista Elementary School from March to May, 2010. 20 children and teens participated in these groups. As a note, we have found the Temecula Valley Unified School District is not as open to having Hospice of the Valleys involved in assisting with grief support their schools as the Murrieta Valley Unified School District. We will not stop trying to work with Temecula Valley Schools, as we know there is a great need there for this service. For all Hospice of the Valleys children and teen grief workshops, our Bereavement Coordinator provides education and emotional support on the stages of grief, children's developmental stages, normal grief response, and offered community resources for ongoing care. Children and teens are given an outlet to express their grief, are provided a safe environment to share their stories, and are professionally guided to move through their grief process. Transitional objects are provided so the participants can memorialize their deceased loved ones. The overwhelming response from participants in attendance was that it was a valuable experience and that they were grateful to have such a helpful resource available to them at no charge. They mentioned other friends and family members would benefit from the workshop as well, and because of this, Hospice of the Valleys will be offering another Family Grief Workshop in November, 2010. PRESIDENT or AUTHORIZED C ORGANIZATION and TITLE (Please Print or MAILINGADDRESS: 257,.Lf O tf-A, r-0 ct, ' A-V-e . 0,- u 4t-� l a-0 , %1Att wLif,i TELEPHONE: q 5(- 3- 0 0 -7 " O DATED THIS is- of &efd f . ' , 2010. (Date) (Month) BE SURE TO INCLUDE THE ORIGINAL PLUS ONE COPY AND SUBMIT TO: Mail Completed Applications to: City of Temecula Community Service Funding Program Attn: Judy McNabb Post Office Box 9033 Temecula, CA 92589 -9033 Or Deliver in Person to: City of Temecula Community Service Funding Program Attn: Judy McNabb 43200 Business Park Drive Temecula, CA 92590 4 nnlir�4inn — Penn � ' Amount Requested: $ Project Name:jtEr in,,, PROJECT INFORMATION i Project Start Date: I - ZO a o Project End Date:. N.( .ORGANIZATION Name of Orcianization- allowable $5,000) Contact Name. 1c iyy; 1, iRp J- 6 Title /Position: 1) i I- ec+-r-> O BOE r E Mailing Address: g �3 i > j -, Telephone. %- ° 5-6 - Year Organization Founded: .7ca� Number of Paid Staff :_ NS? Number of Volunteers: _1 t Geographic Area(s) Served: 6 5,b co �\1;lar"&C(Apt'YIDf�41,' " {� c Is this organization incorporated in California as a non- profitorganization? Yes No Effective Date: Z® t 0 If "yes"(Must provide a copy of your statement of non - profit status from the State of Califomial• Date of incorporation as a t-ederal identification number. State identification number: If "no ": Name of sponsoring organization: Federal identification number. State identification number. Ipplication has been authorized by the organization's: zecutive Committee Board of Directors Application -Page 1 - Members -at -Large i C041 FINANCIAL STATEWIM (( PLEASE ATTACH COPIES OF THE CURRENT BUDGET OF THE ORGANIZATION AND FINANCIAL STATEMENTS (BALANCE STATEMENT AND INCOME STATEMENT), It does not require a CPA's . audit; but please submit N available.- MISSION STATER ENT Briefly describe the goals and objectives of your organization and community services it provides. Describe__ the ways your organization meets the criteria listed on page 2 of the CS Funding Policy. Introduction and Mission My name is Edward J Varela. I appreciate this opportunity to introduce to you JONBOY'S INC.., a public non -profit agency that advocates a transportation service for any impaired driver, at any time. for any reason. completely free of charge. The project is designed to encourage our community to find altematives to driving while impaired. At JONBOY'S, we believe in excellence and integrated controls to ensure the integrity of the executive mandate and mission — keeping the impaired driver..off our highways is our goal We ask ourselves, -flow do we get from Point A to Point B ?" With restaurants and other venues encouraging the public consumption of alcoholic beverages and a troubling rise in abuse of legal and illegal substances, combined with a Califomia demographic which relies almost exclusively on private transportation, our program is vital in the effort to prevent the needless death and destruction that occurs because of impaired drivers on our streets and highways. Comments are closed. Our Sponsors http •J /www..ionboysinc.com/ ?p =36 INBOYS INC WILL SURVIVE ON BUSINESSES AND ORGANIZATION WHICH SEETHE NEED FOR OUR LIFESAVING SERVICE TOTALS - JONBOY'S 2010 Jan Feb Mar Apr - May Jun Jul Aug - Sep Oct Nov Dec =FICE RENTAL RIZON 800 # 125 125 125: 125 125 125 125: 125 125 : 125 125 125 1,500: _RIZON WIRELESS 250 250 250 250 250 250 250 250 250 250 250 - 250 3,000 - =FICE EXPENSE 200 200 200 200 200 200 200 200 200 200 200 -200 2,400 )VERTISING 150 150 150 150 150 150 150 150 150 150 150 150 1,800 ?HICLE MAINT 150 150 150 150 150 150 150 250 250 250 250 250 2,300 :HICLE FUEL 250 250 250 250 250 250 250 250 250 250 250 250 3,000 .GAL FEES 3600 3600 q 'A SERVICES 3600 3600 1SINESINSURANCE 400 400 400 400 400 400 400 400 400 400 400 400 4,800 MINING 150 150 150 150 150 150 150 150 150 150 150 150 1,800 )STAGE 50 50 50 50 50 50 50 50 50 50 50 50 600 tAVEL&EDUCATION. 350 350 350 350 350 350 350 350 350 350 350 350 .4,200 )NTRACT LABOR 200 200 200 200 200 200 200 200 200 200 200 200 2,400 rcporate Overhead 2,275 2,275 2,275 2275 2,275 2,275 2,275 2,375 2,375 2,375 2,375 9,575 35,000 INBOY'S INC. 2010 INBOYS INC WILL SURVIVE ON BUSINESSES AND ORGANIZATION WHICH SEETHE NEED FOR OUR LIFESAVING SERVICE ROJEM DESCRIP'PION How wili uro anization usethe funding awardiW? Describe the project project objectives, those served, Yo area serviced, and numberbfvolunteelsinvoive &',,Bespeciac include equipment or services thatwould be, purchased and why. Include a detailed budget and a schedule of significant activities related to this project You may attach a makimum of one double- spaced typewritten pane of info rnallon.. Mlease tvae We provide an opportunity for public and private agencies and corporations to associate their names with a program that has its finger on the pulse of the people of this state in a very_ positive, constructive, and proactive way. While there are isolated programs in other cities across the United Stated, there are no programs so complete and dedicated to removing every last excuse from the person who thinks there is no choice but to get behind the wheel of vehicle while impaired. Our program is designed to grow and expand so that every person knows THERE IS A CHOICE ... you do not have to drive while impaired. With your support, our program can become that agent for change and provide the necessary fleet of vehicles and cadre of passionate employees dedicated to this choice. Goals and Objectives i 'Y The factor for success for this program is to lower incidents of drinking and driving; driving while impaired, and impairment- related deaths within our County. The program requires cooperation between the program and State, County, and local city governments. Our program is supported by the Riverside County Sheriff's Department and the District Attorney of Riverside County. Our goal is to get government and private agencies excited about the re- introduction of the program to our community. With professionalism and minimal cost as indicated by the cost -flow analysis, we can save lives, prevent property damage, and spare countless families needless tragedy. In Temecula, we are proud of our success and very serious about our mission to keep impaired drivers off the roads of our city, our county, and beyond. We use last week's results and yesterday's experience to make improvements and corrections in the program, continually working toward the creation of a vital program worthy of duplication across our state and across America. ORGANIZATION NAME: V C? d Q S C MAILING ADDRESS: ?I t9 O 11 1 ��n E C u I X ?A-R, I-- L0aA—1 i_� TELEPHONE: g-g-& — �{ �'� C f UJ Z 6 (7 -2/5-- 1 `!3 % DATED THIS A0 of e , 2010. (Date) (Month) BE SURE TO INCLUDE THE ORIGINAL PLUS ONE COPY AND SUBMIT TO: Mail Completed Applications to: Or Deliver in Person to: City of Temecula Community Service Funding Program Attn: Judy McNabb Post Office Box 9033 Temecula, CA 92589 -9033 City of Temecula Community Service Funding Program Attn: Judy McNabb 43200 Business Park Drive Temecula, CA 92590 Annlinnfinn — Pana 5 6 13 C VD 1 �7 CrrY OF TEMECU A iTV EA, �r:r d FISCAL YEAR 2010.2011 SEP 1 5 2010 COMMUNITY SERVICE FUNDING PROGRAM APPta (Please Print or.Type) o 2010 -11 Program Submission Deadline: Wednesday, September 15, 2010 (original plus one) i PROJECT INFORMATION Amount Requested: $ 5.000 (Maximum allowable $5,000) Project Name: Building Better Futures for Temecula Youth through Performing Arts & Music Education Project Start Date: Jan..10.2010 Project End Date: June. 25, 2010 ORGANIZATION INFORMATION Name of Organization: Musicians Workshop Contact Name: Jon Laskin Title /Position: Founder/ CEO Mailing Address: 27315 Jefferson Ave. J -231 Temecula CA 92590 Telephone: (951) 678 -2517 Year Organization Founded: 1998 Number of Paid Staff: 0 Number of Volunteers: 96 Geographic Area(s) Served: Temecula Valley Is this organization incorporated in California as a non - profit organization? Yes X No Effective Date: Sept. 10, 2001___ _ If "yes" (Must provide a copy of your statement of non - profit status from the State of California): Date of incorporation as a non - profit: Sept. 10, 2001 Federal identification number: 33- 0958223 State identification number: C2359326 If "no ": Name of sponsoring organization: Federal identification number: State identification number: This application has been authorized by the organization's: Executive Committee X Board of Directors X Members -at -Large Application —Page I FINANCIAL STATEMENTS PLEASE ATTACH COPIES OF THE CURRENT BUDGET OF THE ORGANIZATION AND FINANCIAL STATEMENTS (BALANCE STATEMENT AND INCOME STATEMENT). It does not require a CPA's - audit, but please submit if available. 1VIISSION STATEMENT Briefly describe the goals and objectives of your organization and community services it provides. _Describe the ways your organization meets the criteria listed on page 2 of the CS Funding Policy. The Musicians Workshop mission is to provide a creative performance environment that will nurture and educate students from all levels of skill and abilities: to nourish and inspire individuals seeking creative musical and performing arts enrichment to provide a fundamentally sound base for learning and performing and experiencing all varieties of music and performing arts and to provide the necessary means skills presence and experience to perform professionally, and thereby empower our Youth and strengthen our community - 95% go on to Higher Education & Careers The specific and primary purpose of the corporation is to expose Youth and adults to Music and the Performing Arts: to encourage people of all ages to Perform: and provide them with the opportunity to perform, and appreciate music; "including interactive Youth Special Needs and 'At Risk" Youth Programs. Musicians Workshop utilizes contracted professional instructors for classes. Volunteers and Professional Artists in Residence are used for the implementation and development of programs including: Youth Orchestra Youth Chorus Jazz and Blues bands Musical Theater, Song writing. Media Arts, Film Making Studio Recording Hip -Hop Dance Beginning Strings Youth Fine Arts Class and Fine Arts Advanced, Private Voice & Music Lessons on any instrument - we also loan instruments to students for Free of charge. Recently nominated 2008 Temecula Valley Chamber of Commerce Charitable Organization of the Year. Additionally, along with our Board of Directors COO / /secretart Steve Phelps. Tresurer open. and financial advisor David Hale - LSL CPA providing guidance leadership and support are the Advisory Board Alicen Wong Martha Minkler, Jimmy & Peg Moore "Dove" Daniels Denny Mighell, Kirstin Vogelsang, and Joan Sparkman - This year marks Musicians Workshop's 11th year in Temecula and the recent opening of our new community facility - the TEMECULA VALLEY CULTURAL ARTS & MUSIC CENTER. Application - Page 2 PROJECT DESCRIPTION How will your organization use the funding awarded? Describe: the project, project objectives, those served, area serviced, and number of volunteers involved. Be specific. Include equipment or services that : would be purchased and why. Include a detailed budget and a schedule of significant activities related to this project. You may attach a maximum of one double - spaced typewritten page of information. (Please type or print legibly.) Funds will provide education programs (Jan -June 2011) to City of Temecula Youth residence at no charge. These programs are desinged for all ages and interest who will benefit from Arts & Music Education. In cases where students do not have musical instruments they will have the opportunity to borrow them as funds may be used to provide the necessary musical instruments and music. We offer various 10 week trimester program to typically over 1,000 students a year, with over 95% going on to higher education and/or Professional careers. We do our best to positiviv affect as many in need as possible and have never turned anyone away. It is Musicians Workshop's objective to provide a nurturing learning and performing experience for any interested musical or artistic person We are very excited to be in our new community facility - the TEMECULA VALLEY CULTURAL ARTS & MUSIC CENTER - located at 27455 Tierra Alta Way, in the same building as the Cal State San Marcos Temeucla Campus, and working with many other groups. Our Youth groups perform regularly thourghout the community, usually over 50 shows a year. Especially important in today's economic climate with music education being cut both in schools, and at home our programs help identify talent; provide a learning opportunity nurture creativity foster positive social reinforcement thru group interaction and teach skills that instill self confidence thru creative expression and performance We strive to build better futures in the community for Youth and their families by exposing them to the arts and 0000rtunities which would not have been possible Our goal is to empower youth thru diverse education programs. -We serve all youth including those in the underserved and "at- risk" population particularly those youth who have been emotionally, physically or mentally abused neglected or abandoned. With this grant we hope to serve between 60 to 100 City of Temecula Youth with education programs._ Education in Performing Arts ,& Music programs affords Youth the opportunity for growth learning creativity, and improving relationships all while becoming more employable and better citizens Application - Page 3 SIGNATURE PAGE: We hereby certify the information c ed in -thi belief, s application is true to the best of our knowledge and ._ _:. _ PREPARED BY: _Jon Laskin - Foun - -- - - - O AME and Please Print or T pe) — - - - — SIGNATURE: PRESIDENT or AUTHORIZED OFFIG Jon Laskin -Foun er EO NAME d LE (Please Print or Type) ORGANIZATION 15 Jefferson Ave. J-231—Temecula, CA 92590_ 678 -2517 DATED THIS __15______ of ____September____________, 2010. (Date) (Month) BE SURE TO INCLUDE THE ORIGINAL PLUS ONE COPY AND SUBMIT TO: Mail Completed Applications to: City of Temecula Community Service Funding Program Attn: Judy McNabb Post Office Box 9033 Temecula, CA 92589 -9033 Or Deliver in Person to: City of Temecula Community Service Funding Program Attn: Judy McNabb 43200 Business Park Drive Temecula, CA 92590 Application - Page 5 IN WITNESS WHEREOP, I execute this certiicato and affix the Great Seel of the Stale. of California this stray of Septe bec 21, =1 WiLt FOUR, Ile battle and addt in: tltta State if Cal fouda of the coqioratjont $ initial Agent ltrr service of Praac i;t, Alicen. t_t f t"N c rz t ireshartt; Sawa ; �Potaat aS Tiixten, LLP,,600 North .Knowheard A venue, smite 300, San Bemardlncri t ta. R24tyt -t l�tft; FiVf:: ibis carptrraticin is arg trued and operate cxtlust wly for elwAtable Purposes within the meaning bt iettinsi. fat {c} f3 }t?£,he itttx rnat hexer uc C ctde_ t` ot,withstatrditrg any vthet pt fvisJum of'thesc Arti #es, the c � rttirrr .s#sitll not carry an any other activities not permittcxt to he earriec? 611 Ial by a crrrporat orr exempt from federal incomo tax un&n section sof ( 0) of the Internal Revenue Code de of 1986 for the iusWnding provision of any futt United Staiem in€erttal revenue. law) or (b) t,v a t wparation, contributions to r htcitared0duCtIbie under Sw unn 1itt(c, )(2 t)i tile Inte al Rtev :ut £;tile rtf l9Six is >r the 10ttcst t ndiny, p ovi.sion of any fit€ ltv =.•`u to ? 5tatts t'I: +In winthog atlr anti dis, vh tion of aw thts u. tlr.^ttutami afio t:+, pug; Or ;uJt t}�t r<c.lti_ l tt>r itfing for the alelits and tats }rgatiuMtLx to #' the c rlvsrati rtr. t #re retnaan tt#3 :tssM. ;shall ht; s istwbuted to a trod pIrADfit fiord, sbobdattan, 'W cbrporutt(sn x hsch t5 trrganirc-d and ope- rated rxclitsivety fem claaritarife, tciuc irmaf, religious tiatlrbr cir..rf fit. puryat?wcs <ut Which has e tablistted its wx exemist Status, muter Sestitri thte hitentxst 1 -vcfru t?tu3e Du cal �._ 1. .., `? w)w llt..t� fo j lam+ ikEVfsH4t3. S6RiFlC& - 08PARMNT OP i'HS iRERStJRY - P':. �3. it177P- 2548:. CTt:CINVAIx, On 45201 £mp2oger idthti-lication 77- 058223 liatc_. AM 2 120% 1'70571)3 ?T9441C+ i '- Contact). Person: D�;St1.aiKa1? - Ustmm ti¢37 - TPI 71222 - . '28694 34ERCE im. ST - Dm R -'.WWI 11fiaECUxXf< GA 92590 Contact Telephone Number, .. , 829 -554€Y eutxli8 Cheri ty Status: 17oti3 fli tAt (viz near Applicant our - letter dated January 2063, atattd You wV416 be Oxempt frrom Federal - Cade, would - - income tax dander section 50110 i34 of the Snternal Revasue anxrl'yoxa foutidat_ion.. during be treated as a public chsrlty. rattier than as a private an advance period. i itased on the information you submitted, you are alasa3Fied as a public charity voider the Code section listed izt the heading of tfsis :lrttez. Since your 11 - exempt $tatt38 was not LiRdGr' k;OtnsittL•Y8t i9Tta you continue to bi. classifind as. -. '.,... att oaEganiaatian exempt trust Federal :incoame t'ax under sectiott' S411cI -17# of the code. _ P'ib 3catioh, 55 ?, Tax-thc ,t: Status for yoaur Organization, provides detailed - information -about .Your rights and responsibilitiea as an exempt organization. You may request a copy hg calling the toll-free nutsher for forms, 'ieb (940) 824 -3676, 1nforxttation 10 also available On ouz Internet Site at wV. ire 96w, if.. you have general. questions about rwxetalst: organizfttions, pleane calf. our - toli -Free mumbex shown is the heading_ Please keep this letter in your permanent vocordc,: Sincerely yours. - Lids G. r i . - - Oizector, Sxempt OrganiadtiOUS :. Rvl ngs and Agreements I Letter 195'7 f6i?JCGI `r hat the att ached transcript of A-, page,(s) has been compared with the record mi file in this office, Of which it purports to be a copy, and that it is full; true and correct. IN WITNESS WHEREOF I execute this v-,ffrtifleate and affix the Great Seat -4 the,State of California lhis,dz ky of SEP "I (A CALIFORNIA NON- PROFIT CORPORATION) FINANCIAL STATEMENT AND ACCOUNTANTS' REVIEW REPORT FOR THE YEAR ENDED DECEMBER 31, 2009 - MUSICIANS WORKSHOP -- - (A CALIFORNIA_ NON- PROFIT CORPORATION) TABLE OF CONTENTS Page Number ACCOUNTANTS' REVIEW REPORT ........................................................................ ..............................1 EXHIBIT A - Statement of Assets, Liabilities, and Net Assets - modified cash basis December31, 2009 ...... ........................ ........ ......... ......... .,.....,2 . EXHIBIT B - Statement of Revenues, Expenses, and Other Changes in Net Assets- modified cash basis for the Year Ended December 31, 2009 .........................3 EXH IBIT C - Schedule of Program Services Expenses - modified cash basis ........... ..............................4 EXHIBIT D - Schedule of Supporting Services Expenses- modified cash basis ....... ..............................5 NOTES TO FINANCIAL STATEMENTS .................................................................... ..............................6 LSEsee CERTIFIER PUBLIC ACCBUNTARTS -s BaM.oi/5(AV.T4NL'. -PA L. F ftr,, CPA _. 9 Mery A. Ceti. CPA - - - _... D"16C.ha:c.CPA Cip n C:r.^& ,. SWP. , CPA NO-a R Much', CPA s shory K .iacmq, CPA - -- - - - Jon Laskin, Executive Director Musicians Workshop Temecula, CA INDEPENDENT ACCOUNTANTS' REVIEW REPORT We have reviewed the accompanying Statement of Assets, Liabilities, and Net Assets - modified cash basis of Musicians Workshop (a California non -profit corporation) as of December 31, 2009; and the related Statement of Revenues, Expenses, and Other Changes in Net Assets- modified cash basis, and Schedules of Program Services - modified cash basis, and Supporting Services Expenses - modified cash basis for the year then ended, in accordance with Statements on Standards for Accounting and Review Services issued by the American Institute of Certified Public Accountants. These financial statements have been prepared on the modified cash basis of accounting. All information included in these financial statements is the representation of the management of Musicians Workshop. A review consists principally of inquiries of Organization personnel and analytical procedures applied to Financial data. It is substantially less in scope than an audit in accordance with generally accepted auditing standards, the objective of which is the expression of an opinion regarding the financial statements taken as a whole. Accordingly, we do not express such an opinion. Based on our review, we are not aware of any material modifications that should be made to the accompanying financial statements in order for them to be in conformity with the modified cash basis of accounting. The accompanying financial statements have been prepared assuming that Musicians Workshop will continue as a going concern. As discussed in Note 8 to the financial statements, Musicians Workshop has suffered declining cash donations and was unable to meet its cash flow needs, as a result, it has incurred large loans outstanding that are due and callable by its lenders within the near term that raise substantial doubt about its ability to continue as a going concern. Management's plans in regard to these matters are also described in Note 8. The financial statements do not include any adjustments that might result from the outcome of this uncertainty. June 30, 2010 LBnC &, S016 & LunghruaE, RP 2D3 i:Gli; i?raz l3aatevar:h So-;tie? 20, 3:ea. CA VIM Tom:._ 77; 672.r'r "22 r-ax: ?i ;.G72 0337 www. €air. as.en;n �': tip 00!1,.,,; iz C�,C v $ut_k s ; .du!r/ <,. CA 924662 It 551. ^< i728 Fax. 35 S(V ; >9 =1a MUSICIANS WORKSHOP - _ Exhibit A STATEMENT OF ASSETS, LIABILITIES, AND NET ASSETS- INCOME TAX BASIS DECEMBER 31, 2009 Assets: Fixed Assets: Instruments and equipment _ $ 35,765 Furniture and fixtures _ 8,156 Leasehold improvements 123,233 less: accumulated depreciation _ _ (13,882) Net Fixed Assets 153,272 Other Assets Music scores and graphs 3;474 Total Assets $ 156,746 Liabilities and Net Assets: Liabilities: Current Liabilities Cash overdraft Loans payable (current) Total Current Liabilities Long -Term Liabilities Loans payable (non - current) Total Long -Tenn Liabilities Total Liabilities Net Assets: Unrestricted Temporarily Restricted Permanently Restricted Total Net Assets Total Liabilities and Net Assets $ 513 63,465 63,978 22,801 22,801 86,779 57,256 10,911 1,800 69,967 $ 156,746 The accompanying accountants' review report and notes to the financial statements are an integral part of these financial statements. VA Tuition (net of refunds) Rent Net Assets released from restrictions: Jazz festival restriction satisfied by holding event and by use of funds for festival Scholarship donations restriction satisfied by use of funds for lesson scholarships Building fund restrictions satisfied by payments for expenses Total Revenue, Gains, and other support Expenses: Program Services (EXHIBIT C) Supporting Services (EXHIBIT D) Total Expenses (cash and in -kind) Interest income Change in Net Assets Net Assets at Beginning of Year (Note 3) Net Assets at End of Year Scholarship Fund Instrument Collection Total 2,521 1,854 196,427 7,292 (196,427) (7,292) 2,521 1,854 138,461 (138,461) MUSICIANS WORKSHOP _ __ __ _ _ Exhibit B STATEMENT OF REVENUES; EXPENSES AND OTHER - 257,662 CHANGES IN NET ASSETS- INCOME TAX BASIS - - 52,747 YEAR ENDED DECEMBER 31, 2009 - 310,409 32 - 32 , Temporarily Permanently (12,905) Unrestricted Restricted Restricted Total Revenue, Gains and Other Support: (19,132) $ 57,256 Donations (includes general in -kind) $ 5,302 $ 21,846 $ 1,800 $` 28,948 Scholarship donations - 10,248 10,248 Building fund (includes in -kind) 19,090 100,754 119,844 1n -Home concert (includes in -kind) 1,177 1,177 Jazz Festival Admission sales 38,457 - - 38,457 Sponsorships 3,865 3,865 Vendor fees 1,580 1,580 City funds 6,096 6,096 In -kind donations 184,886 184,886 Tuition (net of refunds) Rent Net Assets released from restrictions: Jazz festival restriction satisfied by holding event and by use of funds for festival Scholarship donations restriction satisfied by use of funds for lesson scholarships Building fund restrictions satisfied by payments for expenses Total Revenue, Gains, and other support Expenses: Program Services (EXHIBIT C) Supporting Services (EXHIBIT D) Total Expenses (cash and in -kind) Interest income Change in Net Assets Net Assets at Beginning of Year (Note 3) Net Assets at End of Year Scholarship Fund Instrument Collection Total 2,521 1,854 196,427 7,292 (196,427) (7,292) 2,521 1,854 138,461 (138,461) 410,581 (12,905) 1,800 399,476 257,662 - 257,662 52,747 - 52,747 310,409 - 310,409 32 - 32 100,204 (12,905) 1,800 89,099 (42,948) 23,816 (19,132) $ 57,256 $ 10,911 $ 1,800 $ 69,967 $ 10,911 $ - - 1,800 $ 10,911 $ 1,800 The accompanying accountants' review report and notes to the financial statements are an integral part of these financial statements. 3 The accompanying accountants' review report and notes to the financial statements are an integral part of these M MUSICIANS WORKSHOP.. _ Exhibit C SCHEDULE OF PROGRAM SERVICES- INCOME TAX BASIS YEAR ENDED DECEMBER 31, 2009 s Program Services _ Jazz Festival:. Entertainers $ 26,570 Executive director / production fees 6,520 Hospitality 11,585 Sound equipment rental 18,493 Advertising and promotion 172,286 Equipment rental 8,820 License and permits 1,076 Printing 1,615 security 350 Miscellaneous 2,652 Total Jazz Festival 249,967 In -Home Concert: Printing and photography - 403 Total In -Home Concert 403 Musicians Workshop Lessons: Teachers 4,608 Equipment repairs 932 Teacher tuition payment 1,752 Total Musicians Workshop 7,292 Total Program Services (cash and in -kind) $ 257,662 The accompanying accountants' review report and notes to the financial statements are an integral part of these M The accompanying accountants' review report and notes to the financial statements are an integral part of these I.7 MUSICIANS WORKSHOP _ Exhibit D _ SCHEDULE OF SUPPORTING SERVICES EXPENSES- MODIFIED CASH BASIS YEAR ENDED DECEMBER 31, 2009 Supporting Services _ Field trip expenses $ 980 Management and administration: Executive director/ production fees 7,470 Outside services 2,002 Rent 1,578 Hospitality _ 787 Promotion and advertising 2,570 Sound equipment rental 710 Equipment rental - 200 Security 239 Accounting 1,000 Bank charges 903 Dues & subscriptions 405 Insurance 2,807 Interest expense 717 Postage and delivery 292 Telephone 5,855 Utilities 2,772 Office supplies 1,558 Licenses and permits 560 Building repairs 12,299 Transportation expense 140 Printing and publication 169 Depreciation expense 4,967 Miscellaneous 1,767 Total Management and Administration 51,767 Total Supporting Services Expenses (cash and in -kind) $ 52,747 The accompanying accountants' review report and notes to the financial statements are an integral part of these I.7 Musicians Workshop was incorporated in the State of California in 2001. The purpose of the corporation is to expose children and adults to music; to encourage people of all ages to . perform music; and provide them with the opportunity to perform music, including interactive children's programs. The corporation is organized and operated exclusively for charitable purposes within the meaning of Section 501(c)(3) of the Internal Revenue Code. Note 2: Summary of Significant Accounting Policies Contributions Musicians Workshop does not receive pledges or promises to give. The Organization does not record donation as revenues until they are received. In -kind donations Many individuals volunteer their time performing a variety of tasks that assist Musicians Workshop, but these services do not meet the criteria for recognition as contributed services. During the year, Musicians Workshop received a substantial amount of in -kind donations relating to the Jazz Festival for production, promotion and advertising as well as donations relating to the construction of its tenant improvements. Other services that were recorded as in -kind donations include reduction in the fees charged by various performers relating to other program activities, reduction in accounting fees, and reduction in construction service fees. Contributed services recognized as revenue totaled $3,500 during the year ended December 31, 2009. Musicians Workshop received in -kind donations of furniture, equipment, and instruments. Donated fixed assets were recorded as revenue with a corresponding increase to assets. The remaining in -kind donations were recorded as revenue and expense for the period. In- kind donations recorded as revenue for the year,ended December 31, 2009, was $306,030. Collections Musicians Workshop recognizes donations of collection items as revenue when the items are received. The items are capitalized as nondepreciable fixed assets. Fixed Assets Purchased instruments and equipment are capitalized at cost. Donated fixed assets are capitalized at the donor's estimated value. Musicians Workshop does not imply a time restriction on donated fixed assets if the donor does not stipulate the length of time in which the asset must be used. The cost of nondepreciable assets as of December 31, 2009, was $1,800. The cost of depreciable fixed assets is being depreciated over a range of seven to 39 years using the straight -line method. Depreciation expense for the year ended December 31, 2009; was $4,967. E Musicians Workshop. Notes to Financial Statements (Continued) Note 2: of Significant Accounting Policies (Continued) - Financial Statement Presentation The financial statements are presented using the modified cash method of accounting. Musicians Workshop is required to report information _according to three classes of net assets: unrestricted, temporarily restricted and permanently restricted. Cash and Cash Equivalents For the purpose of the statements of cash flows, the company considers all highly liquid investments available for current use (i.e., money market accounts) to be cash equivalents. The Board has imposed a permanent restriction on the use of the Padberg Memorial CD principal. Due to low cash flow, Musicians Workshop used the CD principal in 2009. The CD will be replenished when the funds are available. Musicians Workshop received cash donations with donor- imposed restrictions indicating that the cash is to be used for the organization's Scholarship Fund. Due to low cash flow, the organization does not have enough cash on hand to maintain the net cash that should be available for this purpose. Income Taxes Musicians Workshop is a not - for -profit organization that is exempt from taxes under Section 501(c)(3) of the Internal Revenue Code. The organization is exempt from state taxation under Section 23701(d) of the State of California Revenue and Taxation Code. The organization has been classed as an organization that is not a private foundation under Section 509(a) of the Internal Revenue Code. Contributions to the organization qualify for deduction as charitable contributions. Income generated from activities unrelated to the organization's exempt purpose is subject to tax under Section 511 of the Internal Revenue Code. The organization did not have any unrelated business income tax liability for the year ended December 31, 2009. Accordingly, no provision has been made for income taxes in the financial statements. Financial Accounting Standards Board Accounting Standards Codification (FASB ACS) No 740, Income Taxes, formerly FASB No. 48, Accounting for Uncertainty in Income Taxes —An interpretation of FASB No. 49, was implemented by the organization as of January 1, 2009, FASB ASC 740 applies to not - for - profit organizations because their financial statements contain assertions related to the organization's tax - exempt status and determination of net earning subject to unrelated business income tax. Should the organization lose its tax- exempt status, it could be subject to income tax, interest and penalties. The organization has no unrecognized tax benefits as of December 31, 2009. No interest or penalties have been recognized for the year ended December 31 2009. No change in net assets was required as a result of applying FASB ASC 740. The following tax years remain subject to examination by major tax jurisdictions: Federal -2007, 2008, and 2009 California — 2006, 2007, 2008, and 2009 Estimates The preparation of financial statements in conformity with generally accepted accounting principles requires management to make estimates and assumptions that affect certain reported amounts and disclosures. Accordingly, actual results could differ from those estimates. 7 1 Musicians Workshop— Notes to Financial Statements (Continued)._ Note 2: Summary of Significant Accounting Policies (Continued) -- - Advertising Musicians Workshop expenses advertising costs the first time the advertising takes place. - - Total advertising costs for the year ending December -31, -2009, -was- $174,856.- Of this amount, $172,286 related to in -kind contributions for the Jazz Festival. Note 3: Restatement of Beginning Net Assets Beginning Unrestricted and Permanently Restricted Net Assets had to be restated due to the reclassification of the Padberg Memorial CD. The restriction on the use of the CD principal _ was a Board - imposed restriction, not a donor - imposed restriction. Beginning Unrestricted Net Assets has been increased by the amount of $2,105 and Beginning Unrestricted Net Assets has been reduced by the same amount. Note 4: Building Fund Campaign Musicians Workshop was engaged in the construction of its tenant improvements for use as its facilities during 2009. The organization obtained $119,844 in cash and in -kind donations for the construction of the tenant improvements during the year ended December 31, 20.09. Musicians Workshop moved into the facilities in September 2009. Note 5: Operating Lease Musicians Workshop is obligated under an operating lease for its facilities with Terra Alta, LLC. The lease is a 60 -month lease ending September 30, 2014. The lease payments due for September through December 2009, have been deferred until the remaining lease term. The organization is obligated to pay escalating monthly lease payments to start January 1, 2010. The organization paid $1,658 for rent in 2009. Future minimum expected lease payments: 2010 $ 35,374 2011 58,262 2012 60,098 2013 61,690 2014 47,369 Note 6: Loans Payable 2009 Moore loan: Personal loan from a private party in the amount of $10,000 dated November 1, 2004. Interest only payments to be made for 60 months, full note was due November 1, 2009. Interest rate is 14 percent. Balance as of December 31, 2009 was $10,000. The organization expects the tender to renew the term of the note. As part of the original loan agreement, Musicians Workshop was required to retain the lenders as officers. However, they resigned from their positions and are no longer officers of the organization as of December 31, 2009. Interest actually paid and expensed in 2009 was $233. No new loan documents have been signed as of the date of these financial statements. $ 10,000 EO Musicians Workshop _ $ 63,465 Notes to Financial Statements (Continued) 4,186 Note 6: Loans Payable (Continued) 4,400 2013 2009 -. Laskin loan: Personal loan from a private party, executed October,. 9,589 2008 in the amount of $5,000, zero percent interest, is payable on demand, and co- signed by Jane Laskin. "Principal payments have been made as funds were available. Balance as of December 31, 2003, is $3,000. This lender is a related party. $ 3,000 Garrett loan: Personal loan from a private party, executed in July, 2008 in the amount of $5,000, 5 percent interest. This is a demand loan, which is also co- signed -by Jane Laskin: - '5,000 Garrett loan for Tenant Improvements: Personal loan from a private party, dated September 14, 2009 in the amount of $26;500, 5 percent interest. The repayment of this loan is made with the monthly building rent payments. Monthly payments of $435.94 are due starting January, 2010. 26,500 Garrett loan for Utilities: Personal loan from a private party, no loan documents were signed. Verbal agreement exists between the parties that the loan will be repaid with no interest as funds are available. 2,400 Blue Wave Investment Loan: Executed August 19, 2009 in the amount of $10,000, 10 percent interest. Monthly payments of $1,000 each were due starting September 1, 2009. No payments were made in 2009. 10,000 Laskin loan: Personal loan from a private party, executed with Jane Laskin in August, 2007, in the amount of $10,000, 5 percent interest. Loan is a demand loan. Interest paid on this loan in 2009 was $484. Lender is a related party to the organization. 9,366 Laskin loan: Personal loan from a private party, executed July, 2008 in the amount of $20,000, zero percent interest, principal is payable on demand. Lender is a related party to Musicians Workshop. 20,000 Total Long -Term Notes Payable $ 86,266 Less: Current Portion (63,465) Net Long -Term Notes Payable $ 22,801 Total interest paid and expensed in 2009, was $717. Maturities of long -term debt: 2010 $ 63,465 2011 4,186 2012 4,400 2013 4,626 2014 9,589 N Musicians Workshop. Notes to Financial Statements (Continued) - 3 Note 7: Contingencies and Material Uncertainties - - Musicians Workshop is on the modified cash basis of accounting. Thus, it did not accrue estimated contingencies relating to accrued but unpaid interest on notes payable and payroll and sales tax liabilities. However, the liabilities have been incurred and can be reasonably estimated as of the date the financial statements are available to be issued. Estimated loss - from these liabilities is around $10,000 as of December 31, 2009. For were nott bing met Workshop cash donations. t The organization also dhasrlargealoians outstanding that are due and callable by its lenders within the near term. In order for the - organization to be able to continue as a going concern the organization will have to increase future donations and refinance loan obligations as they come due. Management attributes the decreased amount of cash donations due to the economic situation in the United States. The Jazz Festival generated lower than expected admissions revenue in 2009 because of the set up at the location. Management expects the apparent improvement in the economy to help the organization accumulate more cash donations. In addition, management has the following plans to increase its cash flow: it will increase admission sales to the Jazz Festival by the location of the festival, the Executive Director will apply for more grants in 2010, and the organization will continue renting space in its building to other non - profit organizations and music teachers. Note 8: Subsequent Events Subsequent events were evaluated through June 30, 2010, which is the date the financial statements are available to be issued. 10 Page 1 MUSICIANS WORKSHOP - Profit & Loss Budget - All Cash Basis For 2010 _Jan -Dec 10 Ordinary Income/Expense Income 4011- Donation 14,647.81 4012• Donation -In Kind _ 14,300.00. _.. 4018• Scholarship Donation __.._ .- __ _. ... ..... - 4025 - Scholarship 10248.50 - Total 4018 , Scholarship Donation 10,248.50 4020 • Donation 8. Grants - Building 4021 - Building Fund 13,000.00 4022 - Building Fund - In Kind - 106,844.00 Total 4020 • Donation & Grams - Building 119,844.00 .4036 • In -Home Concert -' 4036 • Admission Sales 41.38 4035 • In -Home Concert - Other 1,136.00 Total 4035 • In -Home Concert 1,177.38 4050• Jan Festival - 4061 - Jan Festival Admission Sates 175.00. 4052 - Jazz Festival Sponsorships 3,865.40 4053 - Jan Festival Vendor Fees 1,580.00 - 4055 • Jan Festival Income- in Kind 184,886.00 4050 • Jazz Festival . Other 45,752.75 Total 4050 • Jazz Festival 236,259,15 4070 • Tuition 2,521.39 4075 • Rent for Space in building 1,853.97 - 4980 - Refunds (1,375.00) Total. Income 399,477.20 Expense - 5008 - Audio 660.00 5010 - Contract Labor 5012 -Artist In Residence 1,250.00 5018 • Executive Director 13,990.00 5020 • Entertainers 5022 - Jan Festival Entertainers 24,145.00 5020 - Entertainers -Other 1,431.00 Total 5020 - Entertainers 25,576.00 5029 - Outside Labor 1,800.00 5030 - Teachers 4,554.00 Total 5010 • Contract Labor 47,170.00 5460 - Field Trip Expense 5461 • NAMM ' 980.00 Total 5460 - Field Trip Expense 980.00 5480 • Hospitality & Meals 5484 - Jan Festival . Hospitality 11,585.16 5487 - Hopitality - General 786.43 5080 - Hospitality & Meals - Other 0.00 '.. Total 6480 - Hospitality & Meals 12,371.59 6680 , Piano Tuning & Intrument Repair. 917.05 5700 . Purchase T3hirts 648.12 5730 • Security 589.30: 5750 - Sound Equipment Rental 5752 - Jazz Fest 18,043.00 5760 - Sound Equipment Rental -Other 500.00 Total 5750 - Sound Equipment Rental 18,543.00 -- 5800 - Teacher Tuition Payment _ 1,752.00 6010 - Accounting 1.000.00 Page 1 '2A4 MUSICIANS WORKSHOP.. PM - _.... __- - Statement of Financial Income and Expense 09/14110 Accrual Basis - -. _.- -: -. -. January1throughSeptember14,2010 - - -- - _ -- _ TOTAL Ordinary IncomelExpense Income 4011 • Donation - 26,190.22 - 4036 •in -Home Concert - - - - _ 4036= •Admission Sales - _ 830.00 . .4037-In -Home Sponsorships -.. _ _- _ _. _ - 1,680.00 _.. 4035 • In -Home Concert - Other 1,444.00 Total 4036 • In -Home Concert - 3,954.00 4050 • Jazz Festival 4051 - Jazz Festival Admission Sales -- 1,917.00 _.. -. _.. 4052 -; Jazz Festival: Sponsorships __... .._23,580.20..._ -.. _. 4053 • Jazz Festival Vendor Fees - 4,800.00 4050 - Jazz Festival - Other - _ - 10,195.00 Total 4050 • Jazz Festival - 40,492.20 4070 - Tuition - 802.50 4075 • Rent for Space in building 300.00 - 4980 - Refunds (40.00) 4999 • ask my accountant - income 25,502.00 Total Income. 97,200.92 Expense 5006 • Artist In Residence 2,362.26 5008 • Audio 300.00 5010 • Contract Labor 5018- Executive Director - 4,500.00 6020 - Entertainers 5022 • Jazz. Festival Entertainers 14,302.00 5023 • In Home Expense Entertainers 3,000.00 Total 5020 • Entertainers 17;302.00 6029 •Outside Labor 1,175.64 5030 - Teachers 3,159.00 Total 5010 • Contract Labor 26,136.64 5470 • Fund Raiser Expense 979.44 6480 • Hospitality & Meals 5481 • In Home Concert - Hospitality 439.11 5484 • Jazz Festival - Hospitality 7,431.97 5487 • Hopitality - General 71 -75 Total 6480.• Hospitality & Meals - 7,942.83 5500 - Library Expense 616.96 5680 - Piano Tuning & Intmment Repair 324.60 6700 • Purchase TShirts - 41425 6730'•Security .. 1,271.90 5750 • Sound Equipment Rental 8,025.00 5800 •. Teacher Tuition Payment 5,119.00 6010 • Accounting 3,164.05 6020 • Advertising & Graphics 6024 • Media 260.00 6020 • Advertising & Graphics - Other - 6,626.16 Total 6020 • Advertising & Graphics 6,866.16 6112 • Transportation 288 -46 6120 • Bank Service Charges 158.46 6160 • Dues and Subscriptions 50.00 6170 - Equipment Rental - - - 1,965.00 - 6180 • Insurance - 1,147:96 6200 - Interest Expense 6230 - Licenses and Permits _ - 284.00 6240. Miscellaneous 850.00 6245 • Moving & Storage - 869.69 6260 • Postage and Delivery 441.99 Page 1 2.44 PM - MUSICIANS WORKSHOP 09/14/10 .. _ - Statement, -of Financial Income anal Expense Accrual Basis January 7 through September 14, -2010 _ - TOTAL - _ 6260. • Printing and Reproduction - - - _..._ 6261 • In -Home Concert - - 75.75 - -.__ - 8262• Jazz Feet - __ ___. ___- 75.75 _._.. - - - -6263 • Musicians Workshop - - - - 103.66 - 6260 • Printing and Reproduction . Other - 918,97 - - Total 6260 • Printing and Reproduction - - - - - -- - -- 1,174.13 6290 • Rent - 3,788.70 6300 • Repairs - - - - 6320 • Computer &Office Equip Repairs -- 65.00- - - 6300 • Repairs -Other 421.60 Total 6300 • Repairs _ _ 486.60 6340•Telephone - 1,177.68 - 6390 • Utilities - - - - 6400 •Gas and Electric - 1,736.00 - 6410 • Water & Waste Mgmt 181.78 6390• Utilities -Other 1,118.42 - Total 6390 • Utilities- 3,036.20 6550.Office Supplies 1,16221 6999 • ask my accountant - expenses 1,615.00 Total Expense 83,141.17 Net Ordinary Income 14,059.75 Other lncomelExpense Other Expense 8010.Other Expenses - 50.00 Total Other Expense 50.00 Net Other Income (50 00) Net income - 14,009.75 Page 2 CITY OF TEMECULA �O Fiscal Year 2010-11 COMMUNITY SERVICE FUNDING PROGRAM APPLICATION -P PROJECT INFORMATION' 2010 -11 Program Submission Deadline: Wednesday, September 15, 2010 1 u; X86 Z; Amount Requested $1,00 0 Project Name: Children's Health Care Project Start Date: January 1, 2011 Project End Date: June 30, 2011 ORGANIZATION INFORMATION Name of Organization: Neighborhood Healthcare Contact Name: Lorna Hardin Title /Position: Director of Grants Mailing Address: 425 N. Date Street, Ste 203, Escondido CA 92025 Telephone: (760) 520 -8328 Year Organization Founded: 1969 Number of Paid Staff: 440 Number of Volunteers: 35 Geographic Area(s) Served: North Inland and East San Diego County and Southwest Riverside County Is this organization incorporated in California as a non - profit organization? Yes XXXX Effective Date: 1971 If "yes" (Attached is a copy of statement of non - profit status from the State of California) Date of incorporation as a non - profit: 1971 Federal identification number: 95- 2796316 State identification number: 06679350 If "no ": Name of sponsoring organization: N/A Federal identification number: N/A State identification number: NIA This application has been authorized by the organizations: Executive Committee: XXXX Board of Directors: XXXX Members -at- large: Application — Page 1 FINANCIAL STATEMENTS Attached is current organization budget, financial statements and audited financials MISSION STATEMENT ORGANIZATION SUMMARY: Neighborhood Healthcare is 'a private, non - profit community health system that has offered quality health care services since 1969. Neighborhood Healthcare operates nine health care centers, located in Escondido, Temecula, Pauma Valley Lakeside and El Cajon 68,000 patients in over 270,000 visits receive a wide - variety of services annually. Almost all patients are 200% below the federal poverty level. Among the clientele are individuals who are migrant workers, homeless, HIV positive persons, the uninsured, and others with health care access problems. There are over 440 full and part time staff members including physicians, nurse practitioners, dentists, medical and dental support staff, and administration. Approximately 35volunteers work in community_ programs, development, fundraising and clinical services. 85 % of the staff is bilingual and /or bicultural. Services are open to all ages, ethnicities and genders. No one is denied service due to inability to pay. TEMECULA SUMMARY: There are two Neighborhood Healthcare health centers in Temecula, one focusing on women's health and one on primary care and behavioral /mental health, both located at the 41715 Winchester Road. Neighborhood Healthcare is the only community health center serving the Temecula Valley area. There are no county public health facilities offering medical care and one offering very limited mental health care (for emergencies only). Therefore, Neighborhood Healthcare is Temecula's only local option for underinsured or uninsured people. Approximately 13,700 Temecula community members seek medical care from Neighborhood Healthcare annually. 54% of patients are Latino, 33% are white, 6% Asian/Pacific Islander, 5% Black and 2% Other. 97% of patients live under the federal poverty level. Patients receive the following care: pediatric and adult medicine, prenatal care, women's health, family planning for females and males, HIV /AIDS testing, diagnosis and treatment of chronic & acute illnesses for all ages, mental/behavioral health services, preventive services, and laboratory and pharmacy services, along with community focused services through outreach and health promotion programs. Temecula community health and outreach programs include: • Collaboration with the Healthy Children Connection project that provides referral services for pregnant moms and children aged 5 and under for preventive services in Southwest Riverside County. • Family planning outreach and information through the Title X California Family Health Council. • Healthy Families/Medi -Cal application assistance to help families apply for health care insurance. • Community linkages have been formed with Even Start, Head Start, Healthy Start and the Temecula Unified School District to assure that all community residents are given information on local resources and how to access these resources, whether medical or for social services. Neighborhood Healthcare and its health centers in Temecula meet all the criteria of importance to the Temecula City Council in its funding decision. There is strong executive leadership with a commitment to the organization as demonstrated by the length of time these staff members have been with the organization. The majority of support and provider staff at Neighborhood Healthcare in Temecula is bilingual and /or bicultural. Services are patient focused, assuring a high degree of customer service and patient satisfaction. Evaluation tools include patient satisfaction surveys, patient flow studies, and appointment access surveys. Financial statements are prepared monthly and reviewed by the 12 member volunteer Board of Directors. The Board includes clinic patients and mirrors the ethnic mix of the population seen. Expenses are monitored according to an annual budget. Application — Pale 2 - PROJECT, DESCRIPTION - Funds from the City of Temecula will pay for medications and medical treatment for children whose parents cannot afford care and have no health care insurance. The average cost of a medical visit for a child is $89. For approximately 500 children who are uninsured, Neighborhood Healthcare receives, on average, $65 from the child's -- family for these visits, leaving Neighborhood Healthcare responsible for the remaining costs of around $12,000: The most common medications needed are for treatment of asthma, ear infections, dehydration, and other bacterial infections that require antibiotics. Neighborhood. Healthcare provides many medications to families at a lower cost than retail, but the reduced cost may be beyond the parent's means, especially if the illness is sudden or unexpected or the parent has more than one child ill at the same time. From a medical point of view, it is critical that the child use the medication to avoid potentially more serious problems that could result in emergency room care or - hospitalization. In infants and very young children, a relatively simple illness like the flu can become life threatening if the child became dehydrated. A funding level of $1,000 will assist at least 50 needy children with medications and basic health care. Additionally, these funds enable the health center to leverage additional funds from private donors who contribute matching funds if the City of Temecula or other funding sources show support. Not only do the families benefit from the City's support, but also it helps Temecula employers whose employees don't have health insurance and miss work if their children are sick. Early health care for children prevents more serious illness through timely diagnosis and treatment, so the parent does not miss work. For families who have inadequate or no insurance, Neighborhood Healthcare has a certified application assistant (CAA) on staff. This CAA assesses families for eligibility Medi -Cal, Healthy Families and other insurance plans and helps the family complete the initial paper work. This process is essential in reducing the number of families who come to the clinic with no payer source. This process helps conserve the money from the Temecula Community Service Funding Program to meet the needs of children who are not eligible for any insurance plan. PROJECT BUDGET Cost of care for 500 visits $44,500 Cost of care paid by client through a sliding fee scale $ 32,500 City of Temecula $ 1,000 Other funding sources $ 11,000 Application — Page 3 PAST PROJECT BENEFITS The City of Temecula Community Service Funding Program has supported Neighborhood Healthcare for the past 15 years through funding medications, medical treatment and other, needed services for children_ whose families were unable to afford services_ In 20 1.0, medication purchased with the. $1,000-benefited 50 children. This funding has not only benefited the children but has also served as leverage in other proposals submitted by Neighborhood Healthcare when seeking additional funding for both clinical services and outreach/community services. The continuing support of the city of Temecula is very important in helping Neighborhood Healthcare offer quality health care for the underserved children living in Temecula. Final report for 2010 funding was sent to the City of Temecula Finance Department on September 3; 2010. Application — Page 4 SIGNATURE PAGE Signature: Organization Name: Neighborhood Healthcare Mailing Address of Organization: 425 N. Date Street, Suite 203 Escondido CA 92025 Telephone: 760 - 520 -8300 Temecula Sites: Neighborhood Healthcare - Temecula (Suite 204) and Neighborhood Healthcare - Winchester Road (Suite 106), both located at 41715 Winchester Rod. DATED THIS 8th of September, 2010 BE SURE TO INCLUDE THE ORIGINAL PLUS ONE COPY AND SUBMIT TO: Mail Completed Application to: City of Temecula Community Service Funding Program. Attn:,Judy McNabb Post Office Box 9033 Temecula, CA 92589 -9033 Or Deliver in Person to: City of Temecula Community Service Funding Program Attn: Judy McNabb 43200 Business Park Drive Temecula, CA 92590 Application — Page 5 Our records indicate that a determination letter issued in July 1973 granted your organization exemption from federal income tax under section 501(c)(3) of the Internal Revenue Code. That letter is still in effect. Based on information subsequently submitted, we classified your organization as one that is not a private foundation within the meaning of section 509(a) of the Code because it is an organization described in sections 509(a)(1) and 170(b)(1)(A)(vi). This classification was based on the assumption that your organization's operations would continue as stated in the application. If your organization's sources of support, or its character, method of operations, or purposes have changed, please let us know so we can consider the effect of the change on the exempt status and foundation status of your organization. Your organization is required to rile Form 990, Retum of Organization Exempt from income Tax, only if its gross receipts each year are normally more than $25,000. If a.return is required, it must be filed by the 15th day of the fifth month after the end of the organization's annual accounting period. The law imposes a penalty of $20 a day, up to a maximum of $10,000; when a return is filed late, unless there is reasonable cause for the delay. All exempt organizations (unless specifically excluded) are liable for taxes under the Federal Insurance Contributions Act (social security taxes) on remuneration of $100 or more paid to each employee during a calendar vear. Your organization is not liable for the tax imposed under the Federal Unemployment Tax Act (FUTA). Organizations that are not private foundations are not subject to the excise taxes under Chapter 42 of the Cooe. However, these organizations are not automatically exempt from other federal excise taxes- Donors may deduct contributions to your organization as provided in section 170 of the Code. Bequests, legacies, devises, transfers, or gifts te. your organization or For its use are deductible for federal estate and gift tax purposes if they meet the applicable provisions of sections 2055, 2106, and 2522 of the Code. Internal Revenue Service Department of the Treasury' P. O. Box 2508 Cincinnati OH 4520 -1 Date: August 3, 2002 Person to Contact. - Steve Brown 31 -07422 Customer Service Representative Neighborhood Healthcare -- Toll Free Telephone Number:_ 425 N Date St 8:00 a.m3o 6:36 p.m. EST Escondido, CA 92025 877- 829 -5500 Fax Number: - - - -- -------- - -5'f3 =263= 3756 -- - - - -- - - -- -- Federal Identification Number. 95- 2796316 Dear Sir or Madam; This is in response to the amendment to your organvaflon`s Aiticles of Incorporation filed with the state on March 18, 2002. We have updated our records to reflectthe name change as- indicated above. Our records indicate that a determination letter issued in July 1973 granted your organization exemption from federal income tax under section 501(c)(3) of the Internal Revenue Code. That letter is still in effect. Based on information subsequently submitted, we classified your organization as one that is not a private foundation within the meaning of section 509(a) of the Code because it is an organization described in sections 509(a)(1) and 170(b)(1)(A)(vi). This classification was based on the assumption that your organization's operations would continue as stated in the application. If your organization's sources of support, or its character, method of operations, or purposes have changed, please let us know so we can consider the effect of the change on the exempt status and foundation status of your organization. Your organization is required to rile Form 990, Retum of Organization Exempt from income Tax, only if its gross receipts each year are normally more than $25,000. If a.return is required, it must be filed by the 15th day of the fifth month after the end of the organization's annual accounting period. The law imposes a penalty of $20 a day, up to a maximum of $10,000; when a return is filed late, unless there is reasonable cause for the delay. All exempt organizations (unless specifically excluded) are liable for taxes under the Federal Insurance Contributions Act (social security taxes) on remuneration of $100 or more paid to each employee during a calendar vear. Your organization is not liable for the tax imposed under the Federal Unemployment Tax Act (FUTA). Organizations that are not private foundations are not subject to the excise taxes under Chapter 42 of the Cooe. However, these organizations are not automatically exempt from other federal excise taxes- Donors may deduct contributions to your organization as provided in section 170 of the Code. Bequests, legacies, devises, transfers, or gifts te. your organization or For its use are deductible for federal estate and gift tax purposes if they meet the applicable provisions of sections 2055, 2106, and 2522 of the Code. _2_ Neighborhood Healthcare 95- 2796316 Your organization is not required to file federal income tax - returns unless it is subject to the tax on unrelated business income under section 511 of the Code. If your organization is. subject to this tax, it must file an income tax return on the Form 990 -T, Exempt Organization. Business Income Tax Return. In this letter, we are not determining whether any of your organization's present or proposed activities are unrelated trade or business as defined in section 513 of the Code. The law requires you to make your organization's annual return available for public inspection without charge for three years after the due date of the return_ If your organization had a copy of its application for recognition of exemption on July 15, 1987, it is also required to make available for public inspection a copy of the exemption application, any supporting documents and the exemption letter to any individual who requests such documents in person or in writing. You can charge only a reasonable fee for reproduction and actual postage costs for the copied materials. The law does not require you to provide copies of public inspection documents that are widely available, such as by posting them on the Internet (World Wide Web). You may be liable for a penalty of $20 a day for each day you do not make these documents available for public inspection (up to a maximum of $10,000 in the case of an annual return). Because this letter could help resolve any questions about your organization's exempt status and foundation status, you should keep it with the organization's permanent records. If you have any questions, please call us at the telephone number shown in the heading of this letter. This letter affirms your organization's exempt status. Sincerely, John E. Ricketts, Director, TEGE Customer Account Services EXPENSE: SALARIES & BENEFITS CONTRACT SERVICES -- PATIENT CONTRACT SERVICES -- NON - PATIENT SUPPLIES COMMUNICATIONS TRAVEL EQUIPMENT FACILITIES INSURANCE FINANCING COSTS ADVERTISING DEPRECIATION & AMORTIZATION OTHER EXPENSES OUTREACH TOTAL EXPENSE REVENUE OVER (UNDER) EXPENSE 26,834,772 1,180,622 622,099 2,315,080 406,027 124,048 582,402 1,381,191 194,918 42,897 37,549 618,748 274,537 34,614,890 26,834,772 1,180,622 622,099 2,315,080 406,027 124,048 582,402 1,381,191 194,918 42,897 37,549 618,748 274,537 0 0 34,614,890 80,924 200,000 280,924 9/7/2010 1 page budget sum FY2011.XLS Noidhborhood Healthcare- Fiscal Year 2011 Budget Summary 09/07/10 OPERATIONS CAPITAL COMBINED REVENUE: - - BUDGET - BUDGET BUDGET - - - PATIENT FEES (Medical and Dental) 2,246,581 - 2,246,584 - MEDICAID - 9,632,058 9,6321058 MEDICARE 2,986,985 2,986,985 PUBLIC INSURANCE 3,819,237 3,819,237 PRIVATE INSURANCE 1,678,975 1,678,975, MANAGED CARE REVENUE 6,233,249 6,233,249 GRANT & CONTRACTS 7,247,893 200,000 7,447,893 DONATIONS - 330,383 330,383 OTHER INCOME 520,453 520,453 TOTAL REVENUE 34,895,814 . 200,000 34,695,814 EXPENSE: SALARIES & BENEFITS CONTRACT SERVICES -- PATIENT CONTRACT SERVICES -- NON - PATIENT SUPPLIES COMMUNICATIONS TRAVEL EQUIPMENT FACILITIES INSURANCE FINANCING COSTS ADVERTISING DEPRECIATION & AMORTIZATION OTHER EXPENSES OUTREACH TOTAL EXPENSE REVENUE OVER (UNDER) EXPENSE 26,834,772 1,180,622 622,099 2,315,080 406,027 124,048 582,402 1,381,191 194,918 42,897 37,549 618,748 274,537 34,614,890 26,834,772 1,180,622 622,099 2,315,080 406,027 124,048 582,402 1,381,191 194,918 42,897 37,549 618,748 274,537 0 0 34,614,890 80,924 200,000 280,924 9/7/2010 1 page budget sum FY2011.XLS _ - NEIGHBORHOOD HEALTHCARE - Expenses .. .. Financial Statements for the 1 ?.,Months Ended June 30, 2010 $1,161,944 - Salaries 8 Benefits $ BALANCE SHEET Foundation Grants $158,520 - Operating Expenses i. - - - - - Assets - - -- - -- Liabilities&.Fund Balance Community Services $ - ..Cash &Investments _ $.- 9,151,457 :_.. Current.payables: _ $. _.4,077000._:_ Receivables $. 4,316,700 Notes Payable $ 3,557,364 Inventory - - -- - $- 161,578 - - - -- Fund Balance - - $ 19,610,716x`. is Fixed Assets $ 13,234,427 Other Assets - $ 380,918 Total Assets $ 27,245,080 Total Liab. & Fund Balance $ 27,245,080 INCOME STATEMENT Income Expenses Donations $1,161,944 - Salaries 8 Benefits $ 25,517,402 Foundation Grants $158,520 - Operating Expenses $ 7,454,169 United Way Community Services $ - Government Funds - $ 19,889,835 National /Parent Org. Fees $ - 2009 -10 City Grants Other expenses $ 326,409 City of Temecula $ 1,000 _ Riverside County -- Uninsured $ 10,000 Other sources $15,200,120 Total Income $ 36,421,419 Total Expenses $ 33,297,980 Report on Internal Control Over Financial Reporting and on Compliance and Other Matters Based on an Audit of Financial Statements Performed in Accordance with Government Auditing Standards ......................... 15 -16 Report on Compliance with Requirements Applicable to Each Major Program and on Internal Control Over Compliance in Accordance with OMB Circular A- 133..................................... 17 -18 Schedule of Expenditures of Federal Awards ............. ............................... 19 Notes to the Schedule of Expenditures of Federal Awards ............................... 20 Schedule of Findings and Questioned Costs... ......... .................. 21 -22 Board of Directors Neighborhood Healthcare Our audit was performed-,for the - purpose of- forming -an opinion on the basic fmancial statements of Neighborhood Healthcare, taken as a whole. The accompanying schedule of expenditures of federal awards is presented for purposes of additional analysis as required by U.S. Office of Management and Budget Circular A -133, Audits of States, Local Governments and Non- Profit Organizations, and is not a required: part of the basic financial statements. Such information has been subjected to the auditing - procedures . applied in the audits of the basic financial statements and; in out opinion is fairly stated, in all material respects, in relation to the basic financial statements taken as a whole: 7e,4 ;Da4zwe4d, a.4Z September 30, 2010 2 Excess of revenues over expenses Net unrealized gains and losses Change in unrestricted net assets Net Assets: Beginning of year End of year See accompanying Notes to the Financial Statements 0 3,045,849 360,616 3,406,465 16,487,277 $ 19,893,742 2,455,531 2,455,531 14,031,746 $ 16,487,277 Neighborhood Healthcare Statements of Operations and Changes in Net Assets For the years ended June 30, 2010 and 2009 2010 2009 Change in Unrestricted Net Assets: Revenue and other support: Patient and third party revenue, net : $ 26,911,614 $ 26,854,327 Grant revenue 8,351,402 6,771,771 Contributions 1,391,703 297,987 Other 258,644 152,308 Total unrestricted revenue and other support 36,913,363 34,076,393 Expenses: Salaries & wages 22,287,200 20,886,525 Employee benefits 3,230,202 2,998,105 Contractual services 1 ,985,150 1,845,044: Supplies 2,242,239 2,105,693 Communications 407,566 422,495 Travel, conferences and meetings 103,509 129,322 Equipment costs 616,472 375,712 Facilities 1;261,266 1,185,299 Insurance 145;623 133,018 Depreciation and amortization 515,049 445,245 Provision for bad debts 548,785 563,645 Interest 135,583 132,884 Other 388,870 397,875 Total expenses 33,867,514 31,620,862 Excess of revenues over expenses Net unrealized gains and losses Change in unrestricted net assets Net Assets: Beginning of year End of year See accompanying Notes to the Financial Statements 0 3,045,849 360,616 3,406,465 16,487,277 $ 19,893,742 2,455,531 2,455,531 14,031,746 $ 16,487,277 Neighborhood, Healthcare: Notes to the Financial Statements For the years ended June 30, 2010:and 2009 Note As Organization.and Operations Neighborhood Healthcare ( "NHcare "), a nonprofit organization operates healthcare facilities at sites in San Diego and Riverside Counties. Neighborhood Healthcare provides a variety of medical, dental, mental health and health education services providing low -cost, high quality, comprehensive primary care services to residents of San Diego and Riverside Counties. Neighborhood Healthcare derives its' support through grants and contracts with the U.S. Department of Health and Human Services( "DHHS "), the State of California, the County of San Diego, and various other entities. Additionally, revenues are derived from patient fees and third party charges. Note B: Summary of Significant Accounting Policies. Presentation: The financial statements have been prepared to present the financial position, results of operations and cash. flows of Neighborhood Healthcare in accordance with the American Institute of Certified Public Accountants' Accounting and Audit Guide for Health Care Organizations, dated August 1, 2009. Cash and Cash Equivalents: For purposes of the statement of cash flows, Neighborhood Healthcare considers all highly liquid investments with a maturity of three months or less when purchased to be cash equivalents. The savings, checking and investments are on deposit with various financial institutions. As of June 30, 2010 and 2009 the carrying amount of all the accounts, net of outstanding checks, were $8,338,302 and $5,159,978. Per the various - financial institutions as of June 30, 2010 and 2009, approximately $377,325 and $250,296, respectively was covered by federal depository insurance. Accounts Receivable: Accounts receivable are recorded at gross value along with a corresponding allowance for doubtful accounts. Allowance accounts are estimated for each type of receivable based' on Neighborhood Healthcare's experience in collecting those receivables_ Third -Parry Contractual Agreements: Neighborhood Healthcare has agreements with Medicare that provide payments under a cost -based reimbursement system and with Medi -Cal that provide payments under the Prospective Payment System ( "PPS "). In the case of Medicare, reasonable estimates are made and reported in the period services are rendered, and differences between the estimates and actual receipts are included in the statement of operations in the period in which they are determined. In the case of Medi -Cal, payments under the new system are final, unless the number of reimbursable visits is changed as a result of an audit by the State of California, Department of Health Services. Use of Estimates: The preparation of financial statements in conformity with generally accepted accounting principles in the United States requires management to make estimates and assumptions that affect certain reported amounts and disclosures. Accordingly, actual results could differ from those estimates. Management believes these estimates are reasonable. 6 Neighborhood Healthcare Notes to the.FinancialStatements For the years ended; June 30; 2010 and 2009 . Note C: Disclosures About Fair Value ofAssets Neighborhood Healthcare has adopted Statement of Financial Accounting standards No. 157, ;Fair, Value Measurements (FAS 157). FAS 157 establishes a framework for measuring fair value and - expands disclosures about fair value measurements. FAS 157 defines fair value as the price that would be received to sell an asset in an orderly transaction between market participants at the measurement date. FAS 157 establishes a fair value hierarchy which requires an entity to maximize the use of observable inputs and minimize the use of unobservable inputs when measuring fair value. The standard describes three- levels of inputs that may be used to measure fair value: Level l Quoted prices in active markets for identical assets; Level 2 Observable inputs other than Level I prices, such as quoted prices for similar assets; quoted prices in markets that are not active; or other inputs that are observable or can be corroborated by observable market data for substantially the full term of the assets; Level 3 Unobservable inputs that are supported by little or no market activity and that are significant to the fair value of the assets: Pursuant to FAS 157, NHcare's investments are classified within Level 1 and Level 2 of the fair- value hierarchy. The types of securities valued based on Level 1 inputs include money market securities. Mutual funds and debt securities are valued based on Level 2 inputs. The following table presents the fair value measurements of assets recognized in the accompanying balance sheets measured at fair value on a recurring basis and the level within. the FAS 157 fair value hierarchy in which the fair value measurements fall at June 30, 2010: Fair Value Measurement Using Quoted Prices Significant Significant in Active Other Other Markets for Observable Unobservable Identical Assets Inputs Inputs .Fair Value (Level l) (Level 2) (Level 3) Money market funds $ 784,005 $ 784,005 - Mutual Funds $ 6,848,124 $ 6,848,124 Debt securities $ 396,900 $ 396,900 Note D: Board Designated Cash and Investments Board Designated Cash and Investments are designated by the board of directors. As such, these funds are unrestricted, and include checking, money market accounts and stocks and are stated at their fair market value at June 30, 2010 and 2009. Board Designated Cash and Investments at June 30; 2010 and 2009 are $711,531 and $628;595, respectively. 8 ' - Neighborhood Healthcare - Notes to the Financial Statements For the years ended June 30, 2010 and 2009 Note I Net Patient Revenue Neighborhood Healthcare has agreements with third -party payors that provide payments :to Neighborhood Healthcare at amounts different from its established rates. A summary of the payment agreements with third party payors follows; Medicare: Medical services rendered to Medicare program beneficiaries are paid under a cost- based reimbursement system at two sites. Neighborhood Healthcare is reimbursed at a tentative ( "interim ") rate, with final settlement determined after submission of the annual cost report by Neighborhood Healthcare and audit thereof by the fiscal intermediary. Medi -Cal: Medical and dental services rendered to Medi -Cal beneficiaries are paid under the Prospective Payment System (PPS) using rates established by Neighborhood Healthcare's "Base Year" cost report filed under the previous cost based reimbursement system. These rates are adjusted annually according to changes in the Medicare Economic Index and any approved changes in Neighborhood Healthcare's scope of service. Note J: Concentration of Credit Risk NHcare grants credit without collateral to its patients, most of whom are local residents and are insured under third -party agreements. The mix of accounts receivables from patients and third -party payors at June 30, 2010 and 2009 was as follows: Payor Class 2010 2009 Medi -Cal 44% 46% Medicare 15% 26% .Other third -party payors 31% 20% Private pay patients 10% 8% Total 100% 100 % Note K: Donated Services and Facilities Donated services are those services that have been received, valued and recorded. Contributed services are those services that are received but not valued or recorded. It is the policy of Neighborhood' Healthcare to encourage contributions from the residents_ of the greater San Diego and Riverside County areas. Donated services and facilities are valued at prevailing market rates. Certain immaterial services and facilities contributed to Neighborhood Healthcare have not been valued or recorded. Note L: Sliding Fee Scale Discounts As described in Note B, Neighborhood Healthcare records sliding fee discounts as a contra - revenue account. The amount of sliding fee discounts for the years ended June 30, 2010 and 2009 was approximately $4,779,829 and $3,860,670, respectively. ID] Neighborhood Healthcare Notes to the Financial, Statements For the years ended June 30, 2010 and 2009 Note M: Long -term Debt (continued) Neighborhood Healthcare has a line -of- credit with a local bank in the amount of $1,000,000. The , interest rate is the bank's reference rate (prime) plus 0.50 %. NHcare has..a line -of- credit with an investment firm at prime plus 0.75%u. As of June 30; 2010 and 2009, the outstanding balances were_$0. Note N: Deferred. Revenue Deferred revenue consisted of the following at June 30, 2010 and 2009: - 2010 2009 PPH Hospitalist Program $ $ 184,134 Blue Shield 6;667 6,667 Kaiser 19,766 13,794 San Diego County - Dental - 180,924 S.G. Komen Foundation 31261` Other 681 Total $ 26,433 $389,461 Note O: Lease Commitments Neighborhood Healthcare has commitments under operating lease agreements that range in termination dates through 2017. Total lease expense for the years ended June 30, 2010 and 2009 was $463;545 and $437,593, respectively. Following are the lease commitments based on agreements in place at June 30, 2010: Year Ending Lease Payment 2011 $ 460,736 2012 461,297 2013 91,080 2014 12,480 2015 12,480 Total $ 1,038,073 Note P: Medical Malpractice Claims Neighborhood Healthcare is deemed an employee of the federal government and is covered for malpractice insurance under the Federal Tort Claims Act ( "FTCA "). Neighborhood Healthcare also has supplemental Professional Liability coverage for individual claims up to $1,000,000 and aggregate annual claims up to $3,000,000. NHcare has on -going litigation claims as result of its normal course of operations; however, in the opinion of management, these claims will be fully covered by NHcare's insurance coverage and will not have a material adverse effect upon the financial statements. 12 SINGLE AUDIT REPORTS 14 16 Board of Directors Neighborhood Healthcare° A deficiency in internal control over compliance exists when the design or operation of a control over compliance does not allow management or employees, in the normal course.of performing their assigned functions, to prevent, or detect and correct, noncompliance with 'a type of compliance requirement of a federal program on a timely basis. A material weakness in internal control over compliance is a deficiency, or combination of deficiencies, in internal control over compliance, such that there is a reasonable possibility, that material noncompliance with a type of compliance requirement of a federal program will not be prevented, or detected and corrected, on a timely basis. Our consideration of the internal control over compliance was for the limited purpose described in the fast paragraph of this section and was not designed to identify all deficiencies in internal control over compliance that might be deficiencies, significant deficiencies, or material weaknesses. We ,did not identify any deficiencies in internal control over compliance that we consider to be material weaknesses, as defined above. This report is intended solely for the information and use of the board of directors, management, state and federal awarding agencies and pass- through entities and is not intended and should not be used by anyone other than these specified parties. September 30, 2010 18 ' Neighborhood Healthcare Notes to Schedule of Expenditures of Federal Awards For the year ended June 30, 2010 Note A: Basis of Presentation - The accompanying Schedule of Expenditures of Federal Awards . (the "Schedule ") summarizes the expenditures of Neighborhood Healthcare ( "NHcare',') under programs of the federal government for the year ended June 30, 2010. Because the Schedule presents only a selected portion of the operations of Neighborhood Healthcare, it is not intended to, and does not, present the financial position, changes in net assets, or cash flows for Neighborhood Healthcare. For purposes of the Schedule, federal awards include all grants and contracts entered into directly between Neighborhood Healthcare, agencies, and departments of the federal government. The awards are classified into major program categories in accordance with the provisions of Office of Management and Budget (OMB) Circular A -133, Audits of States, Local Government and Non - Profit Organizations. Note Bs Basis of Accounting For purposes of the Schedule, expenditures for federal programs are recognized on the accrual basis of accounting. Expenditures are determined using the cost accounting principles and procedures set forth in OMB Circular A -122, Cost Principles for Non- Profit Organizations. Note C: Relationship of Schedule of Expenditures of Federal Awards to Financial Statements Consistent with management's policy, federal awards are recorded in various revenue categories. As a result, the amount of total federal awards expended on the Schedule does not agree to total grant revenue on the Statement of Operations and Changes in Net Assets as presented in Neighborhood Healthcare's Report on Audited Financial. Statements. Pill 22 PROJECT INFORMATION Amount Requested: $671 QOtU (Maximum allowable $5,000) Project Name: N iU<S sl Dr�l= tS �� �jJpp �ILoCx Project Start Date: Project End Date: e ORGANIZATION INFORMATION Name of Contact Name: KRiM 1° 0 5Z1.1A Title /Position: Mailing Address: iC-\O1 3 c a eUc^6tA g Sv c f1� okoS I QA UAC,�- claS9J- Telephone: Year Organization Founded: 2IC705- Number of Paid Staff:_ Number of Volunteers: (_00 + GeographicArea(s) Served: (2.M.e-c.0 kck VCL�A Is this organization incorporated in California as a non -profit organization? Yes � No Effective Date: 6[2Cp5_ if -yes- provide a copy of your statement of non - profit status from the State of California): Date of incorporation as anon- profit: 1 2/23 ZZ:2 Q S Federal identification number: R0 3 3 `/ 1�3) 'io o State identification number: o � 0 4 �, If "no ": Name of sponsoring organization: Federal identification number. State identification number: This application has been authorized by the organization's: Executive Committee Board of Directors D<— Members -at -Large Application - Page 1 PROJECT DESCRIPTION Howwill yourorganization use the funding awarded? Describe the project, project objectives, those served, area serviced, and number of volunteers involved. Be specific. Include equipment or services that would be purchased and why. Include a detailed budget and a schedule of significant activities related to this project You may attach a maximum of one double- spaced typewritten page of information. (Please type or print legibly.) t)e iJo,, MC,K -S ennik< /,!mute: m 4h tnni n 'C'- , �A�.Ae- ,J -I.' 0n.r��'h_a_�5�'l�0 ,.J %kD /Two i G2a^-P- o2ai•r hM U Aodication — Paoe 3 r cruJM P s, SIGNATURE PAGE We hereby certify the information contained in this application is true to the best of our knowledge and belief. i/ D PREPARED BY: J— NAME and TITLE (Please Print or Type) PRESIDENT or AUTHORIZED C (Please !tact" ORGANIZATION NAME: 0 +Ct-\s "-n-5 Gvt'Jn6�CO MAILINGADDRESS: �t��3 ` L;ka PtLGhW 14o, A2: v5 TFI FPWONF• Q-- DATED THIS �f Of 2010. (Date) �( (Month) BE SURE TO INCLUDE THE ORIGINAL PLUS ONE COPY AND SUBMIT TO: Mail Completed Applications to: City of Temecula Community Service Funding Program Or Deliver in Person to: Attn: Judy McNabb Post Office Box 9033 Temecula, CA 92589 -9033 City of Temecula Community Service Funding Program Attn: Judy McNabb 43200 Business Park Drive Temecula, CA 92590 Annlinnfinn — Paoe 5 State of California Secretary of State I, BRUCE McPHERSON, Secretary of State of the State of California, hereby certify: That the attached transcript of page(s) has been compared with the record on file in this office, of which it purports to be a copy, and that it is full, true and correct. Sec/State Form CE -107 (REV 03/31/05) IN WITNESS WHEREOF, I execute this certificate and affix the Great Seal of the State of California this day of BRUCE McPHERSON Secretary of State UGG 1 Q 2005 The name of the corporation is Our Nicholas Foundation, Inc: IL A. This corporation is a nonprofit PUBLIC BENEFIT CORPORATION and is not organized for the private gain of any person. It is organized under the Nonprofit Public Benefit Corporation Law for public and charitable purposes. B. The specific purpose of this corporation is to: a foundation built on raising funds to be donated to specific organizations related to Autism and Special Needs programs. III. The name and address in the State of California of this corporation's initial agent for service of process is: Name: MarkAnsehno Address: 32653 Hupa Drive, Temecula, CA 92592 IV. A. This corporation is organized and operated exclusively for charitable purposes within the meaning of Section 501(c)(3) of the Internal Revenue Code. B. No substantial part of the activities of this corporation shall consist of carrying on propaganda, or otherwise attempting to influence legislation, and the corporation shall not participate or intervene in any political campaign (including the publishing or distribution of statements) on behalf of any candidate for public office. V. The property of this corporation is irrevocably dedicated to charitable purposes and no part - _ 41 . of the net income or assets of this corporation shall ever inure to the benefit of any director; officer, or member thereof or to the benefit of any private person. Upon the dissolution or winding up of the corporation, its assets remaining after payment, or provision for payment, of all debts and liabilities of this corporation shall be distributed to a nonprofit fund, foundation, or corporation which is organized and operated exclusively for charitable purposes and which has established its tag exempt status under Section 501(c)(3) of the Internal Revenue Code. IN WITNESS WHEREOF, the undersigned incorporator has executed these Articles of Incorporation on the date below. Date: August 9, 2005 LegalZoom.com, Inc., Incorporator By: 0 - %I /1 Cindy Ly, Assist Mt 3sebretary INTERNAL REVENUE:. SERVICE DEPARTMENT OF THETREASURY _P.. Q.. BOX 2.508 CINCINNATI, OH 45201 .. .. _.. ._.. Employer Identification Number: DEC 2 3 2005 Date: 20- 3348800 DLN: y 17053336009015 - -- OUR NICHOLAS- FOUNDATION INC -- - Contact Person: - 32653 RUPA DR - NANCY L HEAGNEY ID# 31306 TEMECULA, CA. 92592 Telephone- Number. _ - -- - -. (877) '829 -5500 Accounting Period Ending: - - December 31 Effective Date of Exemption: -. - August 10, 2005 - Dear: Applicant: - We are pleased to inform you that upon review of your application for tax exempt status we have determined that you are exempt from Federal income tax under section 501(c) (3) of the Internal Revenue Code. Contributions to you are deductible under section.170 of the Code. You are also qualified to receive tax deductible bequests, devises, transfers or gifts under section 2055, 2106 - or 2522 of the Code. Because this letter could help resolve any questions regarding your exempt status, you should keep it in your permanent records. Organizations exempt under section 501(c) (3) of the Code are further classified as either public charities or private foundations. We determined that you are a private foundation within the meaning of section 509(a) of the Code. You are required to file Form '990 -PP annually.' Please see enclosed Information for Private Foundations Exempt Under Section 501(c) (3) for some helpful information about your responsibilities as an exempt organization. You can obtain information about private foundation status by requesting Publication 578, Tax Information for Private Foundations and Foundation Managers_ Sincerely, Yerneroa"� Lois G. Director, Exempt Organizations Rulings and Agreements Enclosure: Information for Private Foundations Exempt Under .Section 501(c) (3) Letter 1076 (DO /CG) CITY -OF TEMECULii City ®f `ietrsecui l 22 FISCAL. YEAR 2010 -1 I SEP 0 0 2010 COMMUNITY SERVICE FUNDING PROGRAMPPL�CATIO (Please Print orTvpe) 1 anCe F Si)N 2010 -11 Program Submission Deadline: Wednesday, September 15, 2010 (original, plus one) PROJECT INFORMATION Amount Requested: $ 5,000.00 (Maximum allowable $5,000) Project Name: Direct Services to Rape Victims/ Rape Awareness and Prevention Project Start Date: July 1, 2010 Project End Date: June 30, 2011 ORGANIZATION INFORMATION Name of Organization: Riverside Area Rape Crisis Center Contact Name: Larry McAdara Title /Position: Executive Director Mailing Address: 1845 Chicago Avenue, Suite A, Riverside, CA 92507 Telephone: (951) 686 -7273 Year Organization Founded: 1973 Number of Paid Staff: 11_ Number of Volunteers: 47 Geographic Area(s) Served: All of Western Riverside County Is this organization incorporated in California as a non - profit organization? Yes X No Efective Date: May 11, 1981 If'yes',: (Must provide a copy of your statement of non - profit status from the State of California): Date of incorporation as a non - profit May 11, 1981 Federal identification number 95- 3245057 If "no ": State identification number 910 - 3448 -8 Name of sponsoring organization Federal identification State identification number This application has been authorized by the organization's: Executive Committee Board of Directors X Members-at-Large. 1 i FINANCIAL STATEMENTS PLEASE ATTACH COPIES OF THE CURRENT BUDGET OF THE ORGANIZATION AND FINANCIAL STATEMENTS (BALANCE STATEMENT AND INCOME- STATEMENT). It does not. require a CPA's audit, but please submit if available. MISSION STATEMENT Briefly describe the goals and objectives of your organization and community services it provides. Describe the ways your organization meets the criteria listed on page 2 of the CS Funding Policy. The Riverside Area Rape Crisis Center (RARCC) has been providing high quality services to survivors of sexual assault and their families in Western Riverside County for over37 years. The Mission Statement of the Center states thatthe organization ":. is committed to providing support services to survivors of sexual assault and their families..." We provide a 24 -hour crisis line; 24- hour hospital; court and law enforcement accompaniment: in- person counseling; support groups: advocacy services; and information and referrals. All services are available at no charge to rape victims and their families and are available in Spanish. The Mission Statement also states that we are committed to "providing communitv education to achieve awareness and prevention of sexual assault." This is accomplished through our Child Abuse Prevention Program in elementary schools, middle schools and high schools. Our Latino and Senior Outreach Coordinators also provide education. We work closely with law enforcement and other community omanizations to increase awareness of sexual assault. In fiscal year 2009/2010. the Riverside Area Rape Crisis Center assisted 64 victims of sexual assault and their family members in the city of Temecula. Education and awareness presentations were provided to 963 children and adults. This included presentations to elementary schools WIC Programs the Senior Center and Pechanga Reservation. With additional funding, the Riverside Area Rape Crisis Center could provide sexual assault prevention programs to more children and adults in the city of Temecula. Fiscal management of the Riverside Area Rape Crisis Center is excellent. In addition to an annual audit, financial statements are prepared monthly by an enrolled agent. Pat. Hartley. MBA. Programs are evaluated by the Board of Directors. Volunteer Committees and the Executive Director. The Center has a strong presence in the community and is supported by all segments of the population through volunteerism, financial contributions and in -kind donations. Additional funding will also assist with the implementation of our support group network in Western Riverside County. These groups meet for 1 Y2 hours for four consecutive weeks and provide the participants with expanded information and networking systems to cope with the ongoing effects of sexual assault and the commensurate toll it takes on the survivors as well as their family members. Additional funding will also help with the expansion of our self - defense programs for women and children: specifically KidPower and Women Teaching Women. With the ever - increasing population growth in the Temecula area, it has become even more essential to provide and concentrate additional resources in the area of care and prevention. We are also attempting to expand our services to include more support and resources to the significant others and family members to perhaps directly impact the 80% relationship failure rate following a sexual assault. A PROJECT DESCRIPTION How will your organization use the funding awarded? Describe the project, project objectives, those served, area serviced, and numberof volunteers involved. Bespecifrc. Include equipment or services that would be purchased and why. Include a detailed budget and a schedule of significant activities related to this project. You may attach a maximum of one double - spaced typewritten page of information. (Please type or print legibly.) The Riverside.Area Rape Crisis Center will use funding to assist sexual assault victims and provide child abuse Prevention programs in the city of Temecula. The goals for fiscal year 2010/11 include: a • To provide crisis intervention advocacy and accompaniment to 55 rape victims and their families - • To provide follow -up appointments and counseling to 40 NiictlmS and their family members- - - - -- • To provide abuse Prevention programs to 800 children and 300 adults through the Community Education Programs, Child Abuse Prevention Program, Hispanic Outreach and Senior Outreach Programs • 30 crisis line and advocacy volunteers and 11 FTE paid emplovees will be utilized to assure these goals will be reached • A minimum of two Support Groups will be hosted in the Southwest county area during the grant period • Awareness and Prevention programs will be presented in the City of Temecula Accompaniment and advocacy will be provided wherever necessary (i.e. Riverside County Regional Medical Center, Rancho Springs Medical Center, police stations in Temecula. Riverside County Courts etc.) Counseling will be provided at a place convenient to the client or via telephone • A copy of the Riverside Area Rape Crisis Center's draft Budget for fiscal vear 2010111 is attached 3 PAST - PROJECT BENEFYMS If your organization received. City of Temecula funding in the previous year, please explain and show how Temecula residents benefited; -- The City of Temecula has been financially supaortive of the Riverside Area Rape Crisis Center for the, past five years The financial support has been used to assist rape victims and their family members at the hospital (Riverside County Regional Medical Center) during evidence collection as well as assisting victims on the crisis hotline The benefit to the Temecula community is that these services are provide 24 -hours a day, 7 -days a week Temecula residents can access the services of the Riverside whenever they are needed Other services residents have used include: In person counseling information and referrals support groups and self- defense programs. Staff and volunteers from the agency travel to Temecula to assist rape victims Last year 64 residents of - Temecula were helped with direct services Rape prevention education was also provided to Temecula residents at the senior citizen center and at elementary, middle, and high schools in the Temecula area Last year a combination of 963 children and adults were provided with our Child Abuse prevention program and community education presentations that we conduct county -wide. 4 SIGNATURE PAGE We hereby certify the information contained in this application is true to the best of our knowledge and belief. _. PREPARED BY: LarryMcAdara. Executive Director - - NAME AND TITLE (Please Print or Type) SIGNATURE:L� PRESIDENT or AUTHORIZED FFICER: AND TITLE (Please Print or Type) ORGANIZATION NAME: Riverside Area Rape Crisis Center MAILING ADDRESS: 1845 Chicago Avenue, Suite A. Riverside, CA 92507 TELEPHONE: (951) 686 -7273 DATED THIS �'-/ of , 2010. (Date) (Month) BE SURE TO INCLUDE THE ORIGINAL PLUS ONE COPY AND SUBMIT TO: Mail Completed Applications to: Or Deliver in Person to: City of Temecula Community Service Funding Program Attn: Judy McNabb Post Office Box 9033 Temecula, CA 92589 -9033 City of Temecula Community Service Funding Program Attn: Judy McNabb 43200 Business Park Drive - Temecula, CA 92590 5 State of California O Secretary of State STATEMENT OF INFORMATION - .. (Domestic Nonprofit, Credit Union and Consumer Cooperative Corporations) - - - Filing Fee: $20.00.- If amendment, see instructions. - IMPORTANT — READ INSTRUCTIONS BFFORF COMPI FTINr T1141.0 FORM This Soace For Filinn I Ise ON. 1. CORPORATE NAME (Please do not alter if name is preprinted.) N C0846615 PB NCD RIVERSIDE AREA RAPE CRISIS CENTER 1845 CHICAGO AVE., STE. A ,RIVERSIDE, CA 92507 DUE DATE: COMPLETE PRINCIPAL OFFICE ADDRESS (Do not abbreviate the name of the city. Item 2 cannot be a P.O. Box.) 2: STREET ADDRESS OF PRINCIPAL OFFICE IN CALIFORNIA, IF ANY CITY STATE ZIP CODE 1845 Chicago Avenue,.Suite A Riverside CA 92507 3. MAILING ADDRESS OF THE CORPORATION, IF REQUIRED CITY - STATE ZIP CODE 1845 Chicago Avenue, Suite A Riverside CA - 92507 NAMES AND COMPLETE ADDRESSES OF THE FOLLOWING OFFICERS (The corporation must have these three officers.. A comparable title for the specific officer may be added; however, the preprinted titles on this form must not be altered.) 4. CHIEF EXECUTIVE OFFICER/ ADDRESS CITY STATE ZIP CODE Larry . McAdara, Executive Dir RARCC, 1845 Chicago Ave., Suite A Riverside CA 92507 5. SECRETARY/ ADDRESS CITY STATE ZIP CODE Ann B. Stormes, Secretary RARCC, 1845 Chicago Ave., Suite A Riverside CA 92507 6. CHIEF FINANCIAL OFFICER/ ADDRESS CITY STATE ZIP CODE Debbie Henley, Treasurer RARCC, 1845 Chicago Ave., Suite A Riverside CA 92507 AGENT FOR SERVICE OF PROCESS (If the agent is an individual, the agent must reside in California and Item 8 must be completed with a California street address (a P.O. Box address is not acceptable). If the agent is another corporation, the agent must have on file with the California Secretary of State a certificate pursuantto Corporations Code section 1505 and Item 8 must be left blank.) 7. NAME OF AGENT FOR SERVICE OF PROCESS Larry McAdara - 8. STREET ADDRESS OF AGENT FOR SERVICE OF PROCESS IN CALIFORNIA, IF AN INDIVIDUAL CITY STATE ZIP CODE 1845 Chicago Avenue, Suite A Riverside CA 92507 DAVIS-STIRLING COMMON INTEREST DEVELOPMENT ACT (California. Civil Code section 1350, at seq.) 9. 0 Check here if the corporation is an association formed to manage a common interest development under the Davis - Stirling Common Interest Development Act and proceed to Items 10, 11 and 12. NOTE: Corporations formed to manage a common interest development must also file a Statement by Common interest Development Association (Form SI -CID) as required by Califomia Civil Code section 1363.6. Please see instructions on the reverse side of this form. 10. ADDRESS OF BUSINESS OR CORPORATE OFFICE OF THE ASSOCIATION, IF ANY CITY STATE ZIP CODE 11. FRONT STREET AND NEAREST CROSS STREET FOR THE PHYSICAL LOCATION OF THE COMMON INTEREST DEVELOPMENT 9 -DIGIT ZIP CODE (Complete if the business or corporate office is not on the site of the common interest development.) 12. NAME AND ADDRESS OF ASSOCIATION 'S MANAGING AGENT, IF ANY CITY - STATE ZIP CODE - r 13. THE INFORMATION CONTAINED HEREIN IS TRUE AND CORRECT. 2/2/2010 Larry McAdara Executive Director DATE TYPE/PRINT NAME OF PERSON COMPLETING FORM TITLE SIGNATURE SI -100 (REV 01/2008) APPROVED BY SECRETARY OF STATE Internal Revenue Servlc ,I Department of tl 'Treasury District P.O. Box 2350 Los Angeles, Calif. 90053 Director. _. [ Person to Contact: D Gilda Lewis Riverside -" Area - Rape Crisis -- -- Telephone Number: Center (213) 894- 2336 2060 University Ave., Ste. 106 Refer Reply to: Riverside,. CA. 92507 EO(0215 -)n95 Date :'llRb " 1Jy`L- RE: Riverside Area Rape Crisis Center EINe_ 95- 3245057 Gentlemen: This letter is in response to your request for a copy of the determination letter for the above namedlorganization. Our records indicate that this organization was recognized to be exempt from Federal Income Tax in May 1981 as described in Internal Revenue Code Section 501(c)(3). It is further classified as an organization that is nqt a private foundation as defined in Section 509(a) of the code, because it is an organization described in Section 170(b)(1)(A)(vi). The exempt status for the determination letter issued in May 1981 continues to be in effect. If you-need further assistance, please contact our office at the above address or telephone number. Sincerely( P ILDA A LEWIS Disclosure Assistant -:._ _..._. 2010 -2011 Budget " /o.._ _ REVENUE General Income -- - - - $ -- - -- -600 -- -- `0% CaIEMA Income _ $ - 238,857 33° /u CDPH Income $ 62,446 9% City. of Temecula... $ _ 5,000 1T City of Moreno Valle (CAP) -$ 7,500 �1% City of Riverside CDBG - - $ 20,000 3% FJC Reimbursement (SARCs) $ 15,166 2% County of Riverside(DPSS) $ 10,000 1% County of Riverside CDBG $ -8,125 1% City of Riverside Police $ - 15,000 - 2% Soro ptimistClubs $ - 1,000 0% United Way Inland Valley $ - 30,818 4% Crystal Vision Grant Revenue $ 25,000 3% Larry Francis Scholarship $ 494 00 Foundation Grants $ 41,630 6% Private Donation $ 10,000 1% United Way Donor Designations $ 5,500 1% Special Events $ 130,000 18% Reimbursements Received _ $ 3,500 0% DA's SASRU Grant (8 months) $ 31,645 4% Interest Income $ 100 0% Volunteer Training Income $ 2,000 00Y. InterDe t Rent $ 19,176 3% Postage $ 1,700 0% TOTAL REVENUE $ 683,557 940/. Value of In -Kind Services $ 46,710 6% ADJUSTED TOTAL REVENUE $ 730,267 100% _. -_.... _....- 20104011 Budget -- , - EXPENSES Salaries& Wages - '- $ " -- 326,927 -- 45% SARCs Salaries &Wa es ( (2 months) $ 13,346 2% DA's SASRU Grant (8 months) $ 27,848 - 4% Direct Service Assistants.. -. $ ...15,000- - - -2% Health Benefits $ 35,034 5% Payroll Taxes (10% ) $ 36,812 5% Workers -Comp. Ins (2 %). $ 7,362 - 1% Retirement Expense $ 100 00/0 Conference Fees $ 1,500 0% Travel ,& Mileage . $ 6,200 1% Equip. Rental & Maintenance $ 8;500 1% Office Maintenance $ 1,000 0% Office Furniture & Equip. $ 1,000 0% Accounting & Auditing $ -- 19,000 3% Consultant Fee $ 6,000 1% Advertising $ 1,000 00% Annual Dinner $ - 400 0% Direct Aid $ 3,000 0% Educational Materials $ 500 00/0 Auction Expenses $ 30,000 40/. Liability &D &O Insurance $ - 8,500 1% Memberships $ 1,600 0% Clearing Services $ 2,400 - 0% Postage $ 1,700 0% Printing(Duplicating $ 3,500 0% Taxes and Licenses $ 500 00/0 Rent $ 19,176 3% Mortgage Interest $ 39,002 5% Association Fees $ 5,200 1% Meetings Expense $ 500 0% Crystal Vision/Strength/Be $ 25,000 3% Alarm Service $ 450 0% StaffDevelopment $ 1,000 0% Supplies $_ 4,000 1% Telephone & Answering Svc $ 12,500 2% Volunteer Training $ 3,500 0% Utilities $ 4,500 1 1% Internet Service $ 1,700 - 0% Volunteer Recognition $ - 2,000 0% Water Service $ 400 0% Bank Charges/Fees $ 2,000 0% Miscellaneous $ 1,500 0% Depreciation Ex ense $ 33,044 '5% Interest on Line of Credit $ .3,000 0% Loan Or ination Fees $ - 0% TOTAL EXPENSES $ - 716,601 98% Value of In -Kind Services $ 46,710 6% Less Depreciation $ - (33,044 ) -5% ADJUSTED TOTAL EXPENSES $ 730,267. 100% Change in Net Assets $ 0 0% Board Approved July 1, 2010 Dear Members of the Board, Enclosed are the Preliminary Financial Statements for the one month ended July 31, 2010. The Riverside Area Rape Crisis Center recorded a net loss of $9,343.84, with an operating cash balance of $304.61 I have compiled the accompanying statement of financial position of Riverside Area Rape Crisis Center as of July 31, 2010 and the related s tatements of activities and cash flow for the period then ended in accordance with Generally Accepted Accounting Principals (GAAP). A compilation is limited to presenting in the form of financial statements, information that is the representation of management. I have not audited or reviewed the accompanying financial statements and, accordingly, do not express an opinion or any other form of assurance on them. Management has elected to omit substantially all of the disclosures required by GAAP. If the omitted disclosures were included in financial statements, they might influence the user's conclusions about the Company's financial position, results of operations, and cash flows. Accordingly, these financial statements are not designed for those who are not informed about such matters. There is a copy of the Audited Financial Statements for the Fiscal Year Ended June 30, 2009 available at Riverside Area Rape Crisis Center. Sincerely, Patgaracy, MB.1 2890783ywater Dr Menifee, C492584 Phone. 951- 317 -0642 Fax., 800 - 641 -1851 Email., pat@accouniYngonthego.com com Property and Equipment Land Building Building Improvements Office Furniture and Equipment Computers Accumulated Depreciation Total Property and Equipment Other Assets Total Other Assets Total Assets 73,581.00 883,330.30 14,705.69 44,503.21 25,585.15 (156,160.73) 885,544.62 1 tl $ 1,031,042.84 See Accountants' Compilation Report ; - _. . _ - _. - Riverside Area Rape Crisis Center •. Statement of Financial Position... -. - July 31, 2010 ASSETS Current Assets•..: - Petty Cash $ 500.00 Cash in Checking -FNB _ _- - _ .... 304.61.. - First Nat] Bank Money Market 18,195.45 Accounts Receivable - 6,203.10 - OES Receivable 58,899.00 FJC Receivable 13,637.10 Moreno Valley Receivable 1,034.71 - -. _ City of Temecula Receivable _ 363.23 - Riverside County Receivable 571.86 - CDBG Receivable 968.73 - City CDBG Receivable 1,401.55 DHS Receivable 9,130.49 Contributions UWIV 30,818.52 Prepaid Insurance 3,469.87 k Total Current Assets .. 145,49812 - Property and Equipment Land Building Building Improvements Office Furniture and Equipment Computers Accumulated Depreciation Total Property and Equipment Other Assets Total Other Assets Total Assets 73,581.00 883,330.30 14,705.69 44,503.21 25,585.15 (156,160.73) 885,544.62 1 tl $ 1,031,042.84 See Accountants' Compilation Report Riverside Area Rape Crisis Center Statement of Financial Position _.July 31, 2010....... LIABILITIES AND CAPITAL - Current Liabilities. Accounts Payable $ _ 3,350.12 _ .. PayrollDeductionsPayabie -_. - ........._.44.00. -: Accrued Vacation 19,012.26 Total Current Liabilities 22,406.43 Long -Term Liabilities - Mortgage Payable (Building) 515,822.64 Total Long -Term Liabilities 515,822.64 Total Liabilities _ 538,229.07 - _ Net Assets Nancy Willem Fund 455.53 - - Unrestricted Net Assets - 415,000.47 - Grant Purchased Equipment 37,154.20 -. Temp. Restricted Net Assets 49,547.41 Net Income (9,343.84) Total Net Assets - 492,813.77 Total Liabilities & Net Assets $ - 1,031,042.84. See Accountants' Compilation Report •...... 29,271.46 30,724.92 (1,453.46) 29,271.46 30,724.92 Page: ] ,. _.. _ _ - _ .... _ _ ,- Riverside Area Rape Crisis- Center- 6,673.00 (519.14) - 6,673.00 Consolidated Statement of Activities -- Direct Service Assistants 821.30 1,250.00 For the One Month Ending July 31, 2010 821.30 1,250.00 (428.70) Current _.. Current .. - Variance Year. to Date _ YTD Budget._ _ _. _Variance - ... _ Month Budget Payroll Taxes 2,710.02 3,067.67 (357.65) ..._.Revenues 3,067.67 (357.65) Workers Comp. Ins. 0.00 613.50 -Generallncome- _ - -: -_ $ - -0.00 -- 50.00 (50.00) $ -- 0.00 _- - 50.00 - -. _(50.00) - - OES Income 17,555.00 19,904.75 (2,349.75) 17,555.00 19,904.75 (2,349.75) DHS Income - 4,295.71 0.00 (908.13) 4,295.71 5,203.84 (908.13) _ City of Temecula _ -. - .363.23 _5,203.84 -_ . 416.67 ... (53.44) 363.23 416.67 _.: ' .(53.44) - - - City of Moreno Valley (CAP 585.38 625.00 (39.62) 585.38 625.00 (39.62) City of Riverside CDBG 1,401.55 1,666.67 (265.12) 1,401.55 1,666.67 (265.12) Sheriffs VAW Grant 6,973.62 7,583.00 (609.38) 6,973.62 7,583.00 (609.38) County of Riverside (General 571.86 833.34 (261.48) 571.86 833.34 (261.48) County of Riverside CDBG - :968.73 812.50 156.23 - 968:73 812.50 - - 156.23 - City of Riverside Police - 0.00 1,250.00 (1,250.00) - 0.00 1,250.00 (1,250.00) - Soroptimists Club- Riverside 0.00 83.33 (83.33) 0.00 83.33 (83.33) SoToptimist International - 1,000.00 0.00 1,000.00 1,000.00 0.00 1,000.00 - UnitedWayInlandValley - 2,736.01 2,568.17 - -- 167.84 2;736.01 2,568.17 167.84 - Crystal Vision Grant Revenu 0.00 2,083.33 (2,083.33) 0.00 2,083.33 (2,083.33) Larry Francis Scholarship 0.00 41.17 (41.17) 0.00 41.17 (41.17) Foundation Grants 2,250.00 3,469.17 (1,219.17) 2,250.00 3,469.17 (1,219.17) Private Donation 370.00 833.34 (463.34) 370.00 833.34 (463.34) United Way Donor Designate 61.58 458.33 (396.75) 61.58 458.33 (396.75) Special Events 3,446.00 0.00 3,446.00 3,446.00 0.00 3,446.00 Reimbursements Received 0.00 291.67 (291.67) 0.00 291.67 (291.67) DA's SASRU Grant 3,136.57 3,955.63 (819.06) 3,136.57 3,955.63 (819.06) Interest Income 11.16 8.33 2.83 11.16 8.33 2.83 Volunteer Training Income 765.00 166.67 598.33 765.00 166.67 598.33 Safe House 150.00 0.00 150.00 150.00 0.00 150.00 InterDept Rent 1,598.00 1,598.00 0.00 1,598.00 1,598.00 0.00 '.. Total Revenues 48,239.40 53,902.91 (5,663.51) 48,239.40 53,902.91 (5,663.51) Expenses Salaries & Wages 29,271.46 30,724.92 (1,453.46) 29,271.46 30,724.92 (1,453.46) SARCs 6,153.86 6,673.00 (519.14) 6,153.86 6,673.00 (519.14) Direct Service Assistants 821.30 1,250.00 (428.70) 821.30 1,250.00 (428.70) Health Benefits 2,922.60 2,919.50 3.10 2,922.60 2,919.50 3.10 Payroll Taxes 2,710.02 3,067.67 (357.65) 2,710.02 3,067.67 (357.65) Workers Comp. Ins. 0.00 613.50 (613.50) 0.00 613.50 (613.50) Retirement Expense 0.00 8.34 (8.34) 0.00 8.34 (8.34) Counseling 0.00 0.00 0.00 0.00 0.00 0.00 Conference Fees 512.23 125.00 387.23 512.23 125.00 387.23 Travel & Mileage 1,005.63 516.67 488.96 1,005.63 516.67 488.96 Equip. Rental &Maintenanc .1,367.10 708.33 658.77 1,367.10 708.33 658.77 Office Maintenance 0.00 83.34 (83.34) 0.00 83.34 (83.34) Office Furniture & Equip. 0.00 83.34 (83.34) 0.00 83.34 (83.34) Accounting & Auditing 519.69 _ 1,583.34 (1,063.65) 519.69 1,583.34 (1,063.65) Consultant Fee 0.00 500.00 (500.00) 0.00 500.00 (500.00) Advertising 0.00 83.34 (83.34) 0.00 83.34 (83.34) Annual Dinner 0.00 33.33 (33.33) 0.00 33.33 (33.33) Direct Assistance 0.00 250.00 (250.00) 0.00 250.00 (250.00) Educational Materials 0.00 41.67 (41.67) 0.00 41.67 (41.67) - Auction Expenses - 1,228.47 0.00 1,228.47 1,228.47 0.00 1,228.47 Liability Insurance 580.20 708.33 (128.13) 580.20 708.33 (128.13) Memberships - ..0.00 133.34 (133.34) 0.00 133.34 (133.34) Cleaning Services 200.00 200.00 -0.00 200.00 200.00 0.00 Postage - - - - -61.03 141.67 - (80.64) 61.03 - 141.67 - (80.64) Printing/Duplicating - - 0.00 - - 291.67 - (291.67) 0.00 291.67 (291.67) Taxes and Licenses 0.00 41.67 (41.67) 0.00 41.67 (41.67) Rent 1,598.00 1,598.00 0.00 1,598.00 1,598.00 0.00 Mortgage Interest - 3,228.91 3,250.17 (21.26) 3,228.91 3,250.17 (21.26) Association Fees 429.45 433.33 (3.88) 429.45 433.33 (3.88) Meetings Expense 91.96 41.67 50.29 91.96 41.67 50.29 See Accountants' Compilation Report See Accountants' Compilation Report Page. 2. Riverside Area Rape Crisis Center - - - -- - - - - - Consolidated. Statement of Activities _. _ - - - For the One Month Ending July 31, 2010 - Current Current Variance Year to Date - YTD Budget Variance Month - Budget! Strength Camp 126.09 2;083.33 (1,957.24) 126.09 - 2,083.33 (1,957.24) Alarm Service __ 3695 __ 37.50. , _ _(055) _ 36.95 _ 37.50. (0.55) Staff Development 11.99 83.33 (71.34)- 11.99 83.33 (71.34) Supplies 42.78 333.33 (290.55) 42.78 333.33 (290.55) Telephone & Answering Svc - 734.41 _ _ 1,041.67 _ (307.26) 734.41 _ 1,041.67 (307.26) . - - Volunteer Training - - - - 325.68 - - 291.67 - - - 34.01 - -- -- 325.68 - -- - 291.67 - -- Utilities 399.77 375.00 24.77 399.77 375.00 24.77 Internet Service 71.93 91.67 (19.74) 71.93 91.67 (19.74) - Pagers - - - - - - - 0.00 - 0.00- - 0.00 0.00 - 0.00 0.00 Volunteer Recognition 0.00 166.67 (166.67) 0.00 166.67 (166.67) Water Service 32.61 3333 (0.72) 32.61 33.33 (0.72) BankCharges/Fees 35.45 16667 (131.22) 35.45 166.67 (131.22) Miscellaneous 310.00 125.00 185.00 310.00 125.00 185.00 Depreciation Expense _ 2,753.67. 2,753.67 0.00 2,753.67 2,753.67 0.00 Interest 0.00 250.00 (250.00) 0.00 250.00 (250.00) Total Expenses 57,583.24 63,937.98 (6,354.74) 57,583.24 63,937.98 (6,354.74) Change in Net Assets $ (9,343.84) (10,035.07) 691.23 $ (9,343.84) (10,035.07) 691.23 See Accountants' Compilation Report Cash Flows from investing activities - - - - - Used For - Net cash used in investing Cash Flows from financing activities Proceeds From Used For Mortgage Payable (Building) Net cash used in financing Net increase <decrease> in cash Summary Cash Balance at End of Period Cash Balance at Beginning of P Net Increase <Decrease> in Cash 0.00 0.00 (804.05) (804.05) (804.05) (804.05) $ (20,388.87) $ (20,388.87) $ 19,000.06 $ 19,000.06 (39,388.93) (39,388.93) $ (20,388.87) $ (20,388.87) Unaudited - For Internal Use Only. - - - Riverside AreaRapeCrisisCenter - -- - -- - -- -- P - Page: 1 - Statement of Cash Flow .. - .. _..... -. '.. For the one Month Ended July 31, 2010 Current. Month _._. Year .to- Date _... . -.. ..... _ _ -_:: - Cash Flows from operating activities Net Income.._. _ $ (9,343:$4) $ (9,341.84) Adjustments to reconcile net income to net cash provided - - - - - by operating. activities - - -.. ... .._ _.. .... Accumulated Depreciation 2,753.67 -- 2,753.67 Accounts Receivable (9,998.09) (9,998.09) Accounts Payable (2,040.56) (2,040.56) Other Current Liabilities (956.00) (956.00) - Total Adjustments (10,240.98) (10,240.98) Net Cash provided by Operations (19,584.82) (19,584.82) Cash Flows from investing activities - - - - - Used For - Net cash used in investing Cash Flows from financing activities Proceeds From Used For Mortgage Payable (Building) Net cash used in financing Net increase <decrease> in cash Summary Cash Balance at End of Period Cash Balance at Beginning of P Net Increase <Decrease> in Cash 0.00 0.00 (804.05) (804.05) (804.05) (804.05) $ (20,388.87) $ (20,388.87) $ 19,000.06 $ 19,000.06 (39,388.93) (39,388.93) $ (20,388.87) $ (20,388.87) Unaudited - For Internal Use Only. OES:Income :. $ 17,555.00. $. 17,314.92. - 240.08 DHS Income - 4,295.71 4,659.48 (363.77) - - - - City_of Temecula - 363.23- - - - -- 334.93 - _ - -- 28.30' - - - - -- - City of Moreno Valley (CAP) 58538 632.06 (46.68) City of Riverside CDBG 1,401 -.55 1,613.38 (211.83) .Sheriffs VAW Grant _ -.. 6,97162 - - - - -- 3,500.34 - - - 3,473.28 -- - - -- County of Riverside (General) 571.86 766.79 (194.93) County of Riverside CDBG 968.73 0.00 968.73 _ Soroptimist International _ _1,000.00 0.00,.. 1,000.00 United Way Inland Valley 2,736.01 2,568.21 167.80 Foundation Grants 2,250.00 0.00- - 2,250.00 - - Private Donation....._ . - _.. - 370.00. - - 0.00- - - . 370.00.. United Way Donor Designations 61.58 753.05 (691.47) - Special Events 3,446.00 0.00 3,446.00 - DA'sSASRUGrant 3,136.57 0.00 3,136.57 Interest Income 11.16 5.04 6.12 Volunteer Training Income 765.00 600.00 165.00 Safe House .150.00 0.00 150.00 InterDept Rent 1,598.00 1,598.00 0.00 Total Revenues Expenses Salaries & Wages Health Benefits Payroll Taxes Workers Comp. Ins. Retirement Expense Counseling Conference Fees Travel & Mileage Equip. Rental & Maintenance Office Maintenance Office Furniture & Equip. Accounting & Auditing Advertising Annual Dinner Direct Assistance - - Educational Materials Auction Expenses Liability Insurance Memberships Cleaning Services Postage Printing/Duplicating Rent Mortgage Interest Association Fees Meetings Expense Strength Camp Alarm Service Staff Development Supplies Telephone & Answering Svc Volunteer Training Utilities Internet Service Pagers Volunteer Recognition Water Service 48,239.40 34,346.20 36,246.62 32,863.14 2,922.60 3,273.84 2,710.02 2,478.13 0.00 445.00 0.00 0.00 0.00 0.00 512.23 458.40 - 1,005.63 275.83 1,367.10 171.31 0.00 0.00 0.00 0.00 519.69 566.16 0.00 140.00 0.00 0.00 0.00 27.19 0.00 109.00 1,228.47 0.00 580.20 640.88 0.00 0.00 200.00 683.50 61.03 72.82 0.00 49.49 1,598.00 1,598.00 3,228.91 3,283.56 429.45 458.38 91.96 133.68 126.09 0.00 36.95 36.95 11.99 28.74 42.78 199.01 734.41 823.23 325.68 555.99 399.77 436.20 71.93 65.95 0.00 0.00 0.00 0.00 32.61 32.61 See Accountants' Compilation Report 13,893.20 3,383.48 (351.24) 231.89 (445.00) 0.00 0.00 53.83 729.80 1,195.79 0.00 0.00 (46.47) (140.00) 0.00 (27.19) (109.00) 1,228.47 (60.68) 0.00 (483.50) (11.79) (49.49) 0.00 (54.65) (28.93) (41.72) 126.09 0.00 (16.75) (156.23) (88.82) (230.31) (36.43) 5.98 0.00 0.00 0.00 _Page: I. C - R Riverside Area Rap _ - - _.. C Consolidated Statement of Activities with Prior Year, Comparison . F For the One Month. Ending July 31, 2010 _ _ - ._ C Current � � .__ Prior Year _ _.. . Change - .. Revenues _ _ Total Revenues Expenses Salaries & Wages Health Benefits Payroll Taxes Workers Comp. Ins. Retirement Expense Counseling Conference Fees Travel & Mileage Equip. Rental & Maintenance Office Maintenance Office Furniture & Equip. Accounting & Auditing Advertising Annual Dinner Direct Assistance - - Educational Materials Auction Expenses Liability Insurance Memberships Cleaning Services Postage Printing/Duplicating Rent Mortgage Interest Association Fees Meetings Expense Strength Camp Alarm Service Staff Development Supplies Telephone & Answering Svc Volunteer Training Utilities Internet Service Pagers Volunteer Recognition Water Service 48,239.40 34,346.20 36,246.62 32,863.14 2,922.60 3,273.84 2,710.02 2,478.13 0.00 445.00 0.00 0.00 0.00 0.00 512.23 458.40 - 1,005.63 275.83 1,367.10 171.31 0.00 0.00 0.00 0.00 519.69 566.16 0.00 140.00 0.00 0.00 0.00 27.19 0.00 109.00 1,228.47 0.00 580.20 640.88 0.00 0.00 200.00 683.50 61.03 72.82 0.00 49.49 1,598.00 1,598.00 3,228.91 3,283.56 429.45 458.38 91.96 133.68 126.09 0.00 36.95 36.95 11.99 28.74 42.78 199.01 734.41 823.23 325.68 555.99 399.77 436.20 71.93 65.95 0.00 0.00 0.00 0.00 32.61 32.61 See Accountants' Compilation Report 13,893.20 3,383.48 (351.24) 231.89 (445.00) 0.00 0.00 53.83 729.80 1,195.79 0.00 0.00 (46.47) (140.00) 0.00 (27.19) (109.00) 1,228.47 (60.68) 0.00 (483.50) (11.79) (49.49) 0.00 (54.65) (28.93) (41.72) 126.09 0.00 (16.75) (156.23) (88.82) (230.31) (36.43) 5.98 0.00 0.00 0.00 See Accountants' Compilation Report 13,893.20 3,383.48 (351.24) 231.89 (445.00) 0.00 0.00 53.83 729.80 1,195.79 0.00 0.00 (46.47) (140.00) 0.00 (27.19) (109.00) 1,228.47 (60.68) 0.00 (483.50) (11.79) (49.49) 0.00 (54.65) (28.93) (41.72) 126.09 0.00 (16.75) (156.23) (88.82) (230.31) (36.43) 5.98 0.00 0.00 0.00 See Accountants' Compilation Report - Page: 2 ,. - ....Riverside Area Rape-Crisis Center- ... ... - _. - " - -- - Consolidated Statement of Activities with Prior Year Comparison "- For the One Month Ending July 31, 2010 - - - Current .. ... Prior Year _:. Change_ _ Bank Charges/Fees 35.45 17.50 .. 17.95 Miscellaneous - - 310.00 142.61 - -- 167.39 -. - Depreciation Expense - - _. _. - _,_.: - 2;75167 -. - 2,75367 _ _.. _ .. 0.00.... My Strength Orant 2008 -34 0.00 1,478.12 (1,478.12) Total Expenses _ .. _ 57,583.24' -- _::54,298.89 ::; 3,28435 Change in Net Assets $ (9,343.84) $ (19,952.69) 10,608.85 See Accountants' Compilation Report - Serving the Communities of Banning, Beaumont, Corona, Jurupa, Lake Elsinore, Moreno Valley, Murrieta, Norco, Perris Palley, Riverside and Temecula Board of Direcors Tracey Vackar, President Peter Famey, Vice President Debbie Henley Treasurer Ann B. Starnes, Ph.D. Secretary Debbie Arlis Laura M. Cueva- Miller, PhD. Cherie Curzon Janis Duke Larry N. Francis, M.D., FACOG Mary Anne Gill Tina D. Hambleton Valerie Hill Patty Knudson Mitchell Leveren, Esq. Mary Parks Lori Pendergraft Joey Romero Elizabeth (Betsy) Schmechel Sandra Schanck, EdD. Kristine Thomberry Immediate Past President Ronald J. McCaskOl Advisory Committee - Piya Chatme ee Donna Dahl Rod Pacheco, District Any. Steve Secalsky, D.O.J. Stan Sniff, Sheriff Tan Tavaglione Lynda W. Warren, Ph.D. Colleen Williams, NBC 4 staff Larry McAdam Executive Director Donna Carper Maury Duncan Regina Goodpaster Debora Heaps Colleen Hughes Anne Johnson Yadira Lucas Mendieta Jane]] Reed Romer San Miguel weedwayenae h1and Wave September 3, 2010 Judy McNabb City of Temecula Community Service Funding Program 43200 Business Park Dr. Temecula, CA 92590 SUBJ: Fiscal Year 2010 -11 Funding Request Dear Committee Members: On behalf of the Riverside Area Rape Crisis Center, attached please find a funding request in the amount of $ 5,000.00. The purpose of this request is to augment the cost of direct services delivery to sexual assault victims in and around the city of Temecula. Your ongoing support of this agency and the work we do is very much appreciated. Over the years, your funding has helped to make a positive impact on the lives of sexual survivors and their families living in your area. Our 24 -hour crisis hotline, our hospital advocates, our support groups, and the accessibility of the Rancho Springs Medical Center's Sexual Assault Forensic Exam center, combined with your assistance have all contributed to a much needed and heightened awareness of the challenges met by the individuals forced to make the very difficult transition from victim to survivor. Moreover, your assistance has helped with the community education programs that attempt to address the issues of sexual assault before it happens. Thank you for your help in the past and taking the time to consider this new request for your ongoing support. Sincerelours, v Larry McAdara Executive Director Mission Statement The Riverside Area Rape Crisis Center is committed to providing support and services to survivors (sexual assault and their families, and providing community education to achieve awareness and prevention (sexual assault. 1845 Chicago Ave., Ste. A, Riverside, CA 92507 * (9S1) 686 -7273 * Toll Free (866) 686 -7273 * Fax: (951) 686 -0839 *Email: info@nrw .org * Visit us online at: www.rarcc.org PROJECT INFORMATION Amount Requested: $ ,, p00 (Maximum allowable $5,000) Project Name: /rf /ed C@" 6 Z _Ac e if4plo oy �0 ea g z ¢71 %H 464- 1-/? &P ,f LKEr�✓✓i U .E co �,� sic. ��v�' Project Start Date: T �40/ D Project End Date: _.T//-0E ZD/f ORGANIZATION INFORMATION Name of Organizatiorr.�, l* Abs Contact Mailing Address: '0 Title /Position:XPL - �k12E�EPO.� Telephone:_ 07 Year Organization Founded: .7-60S Number of Paid Staff: / Number of Volunteers: Geographic Area(s) Is this organization incorporated in California as a non - profit organization? Yes No Effective Date: ..3 If "yes° (Must provide a copy of your statement of non - profit status from the State of California): Date of incorporation as a non - profit: ®20 0 Federal identification number. �% /^ rfziCalnQPj State identification number: If "no ": Name of sponsoring organiza Federal identification number: State identification number: This application has been authorized by the organization's: Executive Committee _> Board of Directors -X- Application - Page 1 Members -at -Large FINANCIAL STATEMENTS PLEASE ATTACH COPIES OF THE CURRENT BUDGET OF THE ORGANIZATION AND FINANCIAL STATEMENTS.. (BALANCE STATEMENT AND INCOME STATEMENT.) It does not require a CPA's audit, But please submit if available. MISSION STATEMENT Briefly describe the goals and objectives of your organization and community services it provides. Describe the ways - your organization meets the criteria listed on Page 2 of the CS Funding- Policy. - - - Mission Statement -Santa Rosa Plateau Foundation (SRPF). To fund education, research andpreservation programs_ and projects at the Santa Rosa Plateau Ecological Reserve. Criteria_ A. Is the organization currently non - profit? Yes. Since 2003 the SRPF has had, and continues to have, a 501( c) 3 federal tax exemption. B. Does the organization provide a service to the overall community? Since 2003, the SRPF has focused on providing funding to help educate Southwest Riverside county 3rd graders about the natural world. The Santa Rosa Plateau Ecological Reserve (SRPER) provides an ideal outdoor classroom in an environment rich in natural and human history. To date, this education program has benefited approximately 70,000 students from eight area schools districts, including the Temecula Valley Unified School District (TVUSD). Of the 70,000 students, approximately 20,000 came from TVUSD. It is SRPF's believe that the entire community benefits when children are educated about their natural environment inspiring the next generations to ensure preservation of all natural places, including the Santa Rosa Plateau Ecological Reserve, a unique natural asset to the Temecula Valley area. In addition to funding costs associated with the classrooms coming up to the Reserve, the SRPF funds a Title 1 Outreach project taking the program to the low - to-moderate income schools as well. The funds requested in this grant will cover almost all of the costs of the TVUSD busses used to bring TVUSD students to the program. C. Is the size and make -up of the organization equipped to provide the program /service to the overall community? Approximately 30 volunteer Docents led by the Rob Hicks, Reserve Interpreter for the Riverside County Regional Parks and Open Space District, teach the curriculum which meets the State of California Board of Education Science Content Standards. Each Docent has attended and graduated a 10 -day training course. These courses are held annually in order to prepare new Docents to serve /replace Docents due to attrition. The courses also service to re -train experienced Docents and include education regarding the flora, fauna, geology and geography of the Ecological Reserve. A significant proportion of Docents participating in the third grade education program are retired school teachers. New Docents are required to "shadow" those with experience before independently leading a third grade class. D. What is the public reaction to the group? The SRPF has established itself as a creditable, effective organization in the Temecula Valley. SRPF is a member of the Temecula Valley and Murrieta Chambers of Commerce, and the Temecula Valley Convention and Visitors Bureau. The Temecula Valley Unified and Murrieta Valley Unified school districts have honored the SRPF in 2009 and 2010. The Murreta Unified School District agreed to enter into an MOU of cooperation to assist the SRPF promote its education and fundraising projects_ Major financial supporters include the offices of Supervisor Jeff Stone and Bob Buster, Ace Hardware, Pechanga Band of Luiseno Indians, the Roripaugh Family Foundation, the Verizon Education Foundation and the Coeta & Donald Barker Foundation. E. Does the organization have a high quality of fiscal management? The accounting firm of Nottingham and Associates and their predecessor Doughtery and Nottingham of Temecula, have provided accounting services since the Foundation's inception. They prepare all tax returns and monthly P &L and balance sheets. Their records are reconciled by the Foundation's treasurer each month who is a retired real estate analyst /commercial real estate appraiser with a degree in accounting. Monies required to produce fundraising events are raised and /or committed in advance of the event with none being used from the general fund. The fundraising events include an annual art show, garden tour a Cowboy Jubilee and community education classes related to nature. F. Is the group well organized to ensure longevity in the City of Temecula? The Board of Directors is comprised of thirteen individuals. Two are charter embers and the remaining directors have served terms of one to four years. Longevity is ensured by a succession plan for key officers. G. Is there evidence of satisfactory service provided to the City's Citizens? The success of the program undergoes constant evaluation from the third grade teachers who accompany their classes to the Reserve. They rate the teaching manual, the effectiveness of the classroom experience, the knowledge of the Docents and the enthusiasm of the students. Students are also pre and posted tested to validate what they have learned. Results are tabulated and shared with the Foundation and the County Parks staff. Application — Paget Paget- continued 3 H. Is the organization free from discrimination based on race, color, creed, nationality, sex, marital status, disability, religion, or politicafaffiliation? Yes 1. Does the organization require attendance or participation in any political, religious or social activity? No J. Can the organization provide financial statements (prepared using an appropriate method of accounting) to demonstrate sound financial management? Yes. Current P &Land Balance Sheet attached: K. Can the organization provide a budget for the fiscal year of request demonstrating cost - effectiveness? Yes. Attached, L. Does the organization make its services available to all? Yes. E M. Does the organization possess ongoing program evaluation tools? For the third grade program,a pre and post test has been - - - developed and is being implemented to evaluate what the students learn after their participation in the program and to ensure that they are achieving an increased level of knowledge about the natural sciences. Inaddition, each teacher evaluates the program in written form. All the information is recorded, tracked and provided to the Foundation, Reserve staff and the County Parks Department for ongoing review and evaluation. PROJECT DESCRIPTION How will your organization use the funding awarded? Describe the project, project objectives, those served, area serviced, and number of volunteers involved.: Be specific. Include equipment or services that would be purchased and:why. Include a detailed budget and a schedule of significant activities related to this project. You may attach a maximum of one double- spaced typewritten page of information. (Please-type of print legibly.) Per the Nature Conservancy, The Santa Rosa Plateau is a secluded refuge in the Santa Ana Mountains —a place of rare beauty:::..., the plateau is a treasured keepsake of untrammeled Souther California. It blends the regions largest expanse of native grasslands with wetlands, coastal sage scrub, chaparral and dramatic stands of rare Engelmarm oak." Additionally, vernal pools provide habitat for -- the Santa Rosa plateau fairy shrimp and migrating birds. Natural water holes across the Reserve sustain 50 dwindling species of plants and animals, including mountain lions, burrowing owls, and southwestern pond turtles. The original ranch's adobes are the two oldest buildings in Riverside County providing visual testament to an era of the area's natural history. Archeological locations and artifacts provide further educational opportunities regarding earliest indigenous Indian life. Using this incredible outdoor classroom for its setting, the third grade education program funded by the SRPF provides a unique teaching environment for 7,000 to 8,000 students each year. Teaching materials including sections on habitats, plants, animals, geology and human history are sent at the beginning of each school year to each participating third grade teacher to be utilized in lesson planning prior to the day trip to the Santa Rosa Plateau Ecological Reserve. A very successful outreach program to Title 1 schools has been added in 2008-09 by volunteer docents that further prepares children, many of whom have never been to an undeveloped open space. Irrational fears are allayed, anticipation is built, so that the on -site program may be optimized when the students arrive at the Reserve. Once there, Rob Hicks, Park Interpreter, and his staff of approximately 20 volunteers, lead the students on a hike through various habitats. The students experience first hand their natural environment walking through time to an older, more pristine California. It allows them to learn by experiencing nature's beauty and variety first-hand so that they may appreciate its wonder and fragility. The Foundation also believes that it is through education of the community, especially the children, that preservation goals can be achieved. The Temecula area has experienced one of the highest growth rates in California with a Riverside County population reaching over 2 million. The subsequent results have been a loss of habitats and historical buildings. The SRPF believes that the basic needs of employment, housing and services can be met for humans while preserving our environment through educating children about the habitats that sustained the flora, fauna and native people of the area. The Santa Rosa Plateau Ecological Reserve provides a unique outdoor classroom for that education. The cost of this education program is approximately $120,000 per year. The SRPF has a funding commitment of $45000 to continue this vital program. The remaining costs are paid by the Riverside County Park and Open Space District. The current economic climate and resulting budget cuts along with rising transportation costs have had a negative impact on any off - campus school activity. The SRPF third grade program is the only "extra" educational opportunity many schools enjoy. Art, music, PE, and other portions of the normal school curriculum have become expendable in the drive by school districts to save money. Third graders from the Temecula Unified School District can continue to participate in the third grade natural history and science program with the Santa Rosa Plateau Foundation's continued financial support aided by a $2500 grant from the City of Temecula. Please see the following transportation costs for the Temecula Valley Unified Schools participating in the program during the 2008 -2009 school year. (Next page.) The $2500 grant request from the City of Temecula will assist the Santa Rosa Plateau Foundation to defray the ever - increasing costs of this vital educational program. Application - Page 3 (continued) } Application - Page 3 Temecula VaHev Unified Schools Transportation Costs SCHOOL _ _ . NO. X.COST OF TRIP TOTAL COST.PER SCHOOL • Alamos Elementary 3 X $250 $750 • Crown Hill Elementary 1 X $250 250 t • Helen Hunt Jackson Elementary 1 X$250 250 • Joan Sparkman Elementary __ 1 X $250 250 • Pauba Valley Elementary - 3 X $250 750 • Rancho Elementary 3 X $250 750 • Tony Tobin Elementary 3 X $250 750 • Vail Elementary 2 X$250 500 • Vintage Hills Elementary 2 X $250 500 • Ysabel Barrett Elementary 3 X 250 750 GRAND TOTAL 22 $5500 The $2500 grant request from the City of Temecula will assist the Santa Rosa Plateau Foundation to defray the ever - increasing costs of this vital educational program. Application - Page 3 (continued) ORGANIZATION NAME: 'J tiyT/t /� .y".L,��',C� 1-4W 1,6)9- T/Di✓i LVr MAILINGADDRESS: 7 �• �d ��,!/ TELEPHONE: 90q- 732 - 2 2 v DATED THIS (o ofuC/uS14 , 2010. (Date) '-Month) BE SURE TO INCLUDE THE ORIGINAL PLUS ONE COPY AND SUBMIT TO: Mail Completed Applications to: City of Temecula Community Service Funding Program Attn: Judy McNabb Post Office Box 9033 Temecula, CA 92589 -9033 Or Deliver in Person to: City of Temecula Community Service Funding Program Attn: Judy McNabb 43200 Business Park Drive Temecula, CA 92590 Application - Page 5 SRPF OPERATING EXPENSES -2010 - (Annual Budget) - - Exclusive of specific_ projects, i.e. Concerts, Garden, Tour, Art Show, Etc. Expenditures through -July 6, 2010 f 2010 _ __.PAID 2010 ._:...PAID +/- _ f ADMINISTRATION BUDGET YEAR TO DATE - PCT. UNSPENT PCT. Accounting Fees - 100.00 - Murrieta Office Furniture $ 387.00 $ - 487.00 Dest, hutch &file cabinet - CPA - Monthly Statements $ 2,400.00 $ 1,200.00 50.00% $ 1,200.00 50.00% Tax Prep $ 675.00 $ - 790.00 117.04% $ (115.00) - 17.04% Misc Tax Filing $ 250.00 $ 38.83 15.53%.$ 211.17 84.47% Annual Meeting Supplies Equip Rent $ 500.00 $ 251.11 50.22% $ 248.89 49.78% Donor Board /Awrds $ 150.00 $ 560.55 373.70% $ (410.55) - 273.70% Insurance Genral Liability $ 285.00 $ 295.00 103.51% $ (10.00) -3.51% D & O $ 1,000.00 $ 1,047.00 104.70% $ (47.00) -4.70% Office /Utilities Supplies $ 200.00 $ 554.15 277.08% $ (354.15) - 177.08% Stationary/Bus Cds $ 500.00 $ 189.19 37.84% $ 310.81 62.16% 800# $ 300.00 $ 155.16 51.72% $ 144.84 48.28% P. O, Box Rental $ 60.00 $ 56.00 93.33% $ 4.00 6.67% General Postage $ 50.00 $ 17.60 35.20% $ 32.40 64.80% TOTALADMIN. $ 6,370.00 $ 5,154.59 80.92% $ 1,215.41 19.08% MARKETING /PROMO Constant Contact $ 360.00 $ 60.00 16.67% $ 300.00 83.33% Web Site Maintenance $ 1,000.00 $ 1,000.00 100.00% $ - 0.00% Web Hosting $ 100.00 $ 50.00 50.00% $ 50.00 50.00% Foundation Membership $ - Murrieta CofC $ 200.00 $ - 0.00% $ 200.00 100.00% Temecula CofC $ 230.00 $ 230.00 100.00% $ - 0.00% Chamber Functions $ 200.00 $ 95.00 47.50% $ 105.00 52.50% TOTAL MKTG. PROMO $ 2,090.00 $ 1,435.00 68.66% $ 655.00 31.34% EDUCATION PROGRAMS 3rd Grade Program $ 45,000.00 $ 45,000.00 100.00% $ - 0.00% Outreach $ 855.00 $ - 0.00% $ 855.00 100.00% Wildlife Day $ 700.00 $ - 0.00% $ 700.00 100.00% Mt Lion Res /Educ $ - $ - 0.00% $ - Newsletter Printing/Postage Design /Format $ 5,000.00 $ 2,392.34 47.85% $ 2,607.66 52.15% $ 1,100.00 $ 825.00 75.00%1$ 275.00 25.00% TOTAL EDUCATION PROWS. $ 52,655.00 $ 48,217.34 91.57%1$ 4,437.66 8.43% ANNUAL BUDGET $ 61,115.00 $ 54,806.93 89.68%1$ 6,308.07 10.32% Non- Budgeted Expenses Amount Cumulative - N Convention & Visitors Bureau $ 100.00 $ - 100.00 - Murrieta Office Furniture $ 387.00 $ - 487.00 Dest, hutch &file cabinet - Ginger Greaves $ 78.30 $ 565.30 Membership Banner Ginger Greaves $ 35.00 $ 600.30 Print Membership Cards Debbie Graffam $ 720.00 $ 1,320.30 Administrative Assistant Debbie Graffam $ 1,200.00 $ 2,520.30 Administrative Assistant - ADMINISTRATION 2010 BUDGET - PAID 2010 YEAR TO DATE PAID PCT. UNSPENT PCT. _ Accounting Fees 387.00 $ 487.00 Dest,hukh &fife cabinet Ginger Greaves $ 7830 CPA - Monthly Statements $ 2,400.00 $ 11200.00 50.00% $ 1,200.00 50.00% Tax Prep $ 675.00 $ '790.00 - 117-04% $ (115.00) - 17.04% Misc Tax Filing $ 250.00 $ 38.83 1553% $ 211.17 84.47% Annual Meeting Supplies Equip Rent $ 500.00 $ 251.11 50.22% $ 248.89 49.78% Donor Board /Awrds $ 150.00 $ 560.55 373.70% $ (410.55) - 273.70% Insurance Genral Liability $ 285.00 $ 295.00 10351% $ (10.00) -3.51% D & O $ 1,000.00 $ 1,047.00 104.70% $ (47.00) -4.70% Office /Utilities Supplies $ 200.00 $ 554.15 277.08% $ (354.15) - 177.08% Stationary /Bus Cds $ 500.00 $ 189.19 37.84% $ 310.81 62.16% 800# $ 300.00 $ 155.16 51.72% $ 144.84 48.28% P. 0, Box Rental $ 60.00 $ 56.00 93.33% $ 4.00 6.67% General Postage $ 50.00 $ 17.60 35.20%1$ 32.40 64.80% TOTAL ADMIN. $ 6,370.00 $ 5,154.59 80.92% $ 1,215.41 19.08% MARKETING /PROMO Constant Contact $ 360.00 $ 60.00 16.67% $ 300.00 8333% Web Site Maintenance $ 1,000.00 $ 11000.00 100.00% $ - 0.00% Web Hosting $ 100.00 $ 50.00 50.00% $ 50.00 50.00% Foundation Membership $ - Murrieta COX $ 200.00 $ - 0.00% $ 200.00 100.00% Temecula COX $ 230.00 $ 230.00 100.00% $ - 0.00% Chamber Functions $ 200.00 $ 95.00 47.50% $ 105.00 52.50% TOTAL MKTG. PROMO $ 2,090.00 $ 1,435.00 68.66% $ 655.00 31.34% EDUCATION PROGRAMS 3rd Grade Program $ 45,000.00 $ 45,000.00 100.00% $ - 0,00% Outreach $ 855.00 $ - 0.00% $ 855.00 100.00% Wildlife Day $ 700.00 $ - 0.00% $ 700.00 100.00% Mt Lion Res /Educ $ - $ _ 0.00% $ - Newsletter Printing/Postage Design /Format $ 51000.00 $ 2,392.34 47.85% $ 2,607.66 52.15% $ 11100.00 $ 825.00 7S.0(rAj $ 275.001 25.00% TOTAL EDUC477ON PROG'S. $ 52,655.00 $ 48,217.34 91-57%1$ 4,437.661 8.43% ANNUAL BUDGET $ 61,115.00 $ 54,806.93 89.68%1 $ 6,308.07 1 10.32% U js=LC CRtJCrI5F:5 wnoum: cumumve - - N Convention & Visitors Bureau $ 100.00 $ 100.00 Murrieta Office Furniture $ 387.00 $ 487.00 Dest,hukh &fife cabinet Ginger Greaves $ 7830 $ 565.30 Membership Banner Ginger Greaves $ 35.00 $ 60030 Print Membership Cards Debbie Graffam $ 720.00 $ 1,32030 Administrative AssiMnt Debbie Greffam $ 1,200.00 $ 2,52030 Administrative Assistant Page 7 FOR MANAGEMENT PURPOSES ONLY 12:36 PM - Santa Rosa Plateau Foundation - 06/17/10 Balance Sheet Accrual Basis As of May 31, MO May 31, 10 ASSETS Current Assets CheckinglSavings _ - Commerce Bank 8,017.64 Temecula Valley Bank 2793 33,597.63 TVB - Trail Maintenance - 7... 5,052.91 TVB CD #1 -1823 23,758.22 TVB CD #3 - 7910 _ _ 11,656.83 TVB CD #4 - 0245 63,356.95 NB CD #6 - 2612 5,360.73 Total Checking/Savings 150,800.91 Total Current Assets 150,800.91 Fixed Assets Machinery & Equipment 4,317.70 Accumulated Depreciation - 1,716.00 Total Fixed Assets 2,601.70 TOTAL ASSETS 153,402.61 LIABILITIES & EQUITY Equity Unrestrict (retained earnings) 137,253.67 Net Income 16,148.94 Total Equity 153,402.61 TOTAL LIABILITIES & EQUITY 153,402.61 Page 7 FOR MANAGEMENT PURPOSES ONLY - - SANTA ROSA PLATEAU FOUNDATION - PROFIT AND LOSS REPORT FOR THE MONTH ENDED May 1. 2010 - INCOME: Plant Book Donations $ 67.86 Membership Income 300.00 Individual Contributions < $250 125.00 Cowboy Jubilee Sponsorships 13,000.00 Cowboy Jubilee Tickets 495.56 Cowboy Jubilee Vendor Fee 225.00 Art Show - Artists Share 171.00 Art Show - Gift Portion 114.00 Garden Tour 180.00 Insurance refund 47.00 Interest income 137.15 TOTAL INCOME 14,862.57 EXPENSE: Artist expense Bank charges 81.04 Cowboy Jubilee 2,916.99 Endowment Campaign 3.83 Garden Tour 851.96 Meeting expense 801.17 Membership 165.26 Office Supplies 34.79 Printing 450.00 Professional fees 800.00 Taxes 35.00 Telephone 27.21 Website 1,000.00` TOTAL EXPENSE 7,167.25 NET INCOME 7,695.32 PRIOR PERIOD ADJUSTMENT 0.10 PRIOR YEAR DEPREC (863.00) BEGINNING RETAINED EARNINGS 146,570.19 ENDING RETAINED EARNINGS $ 153,402.61 FOR MANAGEMENT PURPOSES ONLY Page 2 �. nwMNAL REVENUE SERVICE ._. ... DEPARTMENT OF THE TRBAMY P. O. BOX 2508 CINCINNATI, OR 45201 Number- Date; AP9 �J2 2U _ Employer Identification Number: __. 71- 0946697_.. DLNz 604077034 _.. -SANTA ROSA- PLmiku FODNDATION.. _ - Contact persons- C/O VIRGINIA GREAVES - - GERP n HOLLAND - ID# 95031 _ _.... 39400 CLINTON KEITH ROAD - Contact Telephone Number: MDRRIETA, CA 92562 -0000 (877).829 -5500 - Accounting Period Ending: December 31, -- - - - - -- -- Foundation Status - Classificatione - -- -- 509 (a) (1) ,. Advance Ruling Period Begins: Nay 10, 2003 Advance Ruling Period Ends: December 31,2007 Addendum Applies: No Dear Applicant: Based on information you supplied, and assuming your operations will be as stated in your application for recognition of exemption, we have determined you are exempt from federal income tax under section 501(a) of the Internal Revenue Code as an organization described in section 501(c)(3). .- - .Because.you- are- a- avl - mated organfzar oa,- we are no now making a - final determination of your foundation status under section 509(a)- of the Code. However, we have determined that.you can reasonably expect to be a publicly supported organization described in sections 509(a)(1) and 170 (b) (1) (A) (vi) . Accordingly, during an advance ruling period you will be treated as a Publicly supported organization, and uot:as a private foundation. This advance ruling period begins and ends on the dates shown above.. . Within 90 days after the end of your advance ruling period, you must send us the information needed to determine whether you have met the require- meats of the applicable support test during the advance ruling period. If you establish that you have been a_ publicly supported organization, we will claasi- fY You as a--- section"509(a)(1) or 509(a)(2) organization as.long as you continue to meet the requirements of the applicable support test. If yon,do not meet the public support requirements during the advance ruling period, vie will classify you as a private foundation for future.periods. Also, if -we. classify you as a Private foundation, we will treat you as a: private foundation from your beginning date for purposes of section 507(d) and 4940..: Grantors and contributors may rely on our determination that you are not a Private foundation until 90 days after the end of your advance ruling period. If you send us the required information within the 90 days.,grantors'and contributors may continue to rely on the advance determination until we make Letter 1045- (DO /CG) PROJECT INFORMATION Amount Requested: $ 5,000 (Ma)imum allowable $5,000) Project Name: Senior Citizen Service Center Food Bank Project Start Date: 2/1978 Project End Date: on Going ORGANIZATION INFORMATION Name of Organization: Senior Citizen Service Center of Temecula Rancho Area, Inc. Contact Name: Rose Vaccarino Title /Position: President /Director Mailing Address: 41538 Eastman Dr., Unit B,C, Murrieta CA 92562 Telephone: 951-600-9557 Year Organization Founded: 1978 Number of Paid Staff: 0 Number of Volunteers: 39 Geographic Area(s) Served: Southwest Riverside County: Murrieta, Temecula, Agunga, Anza, Lake Elsinore, Wildomar, Sun City, Menifee Is this organization incorporated in California as a non -profit organization? Yes x No Effective Date: 2/1978 If "yes" (Most provide a copy of your statement of non - profit status from the State of California): Date of incorporation as a non - profit: 2/1978 Federal identification number: A r_ a 9 1 a v 7 a State identification number: C- 083811 9 If "no ": Name of sponsoring organization: Federal identification number: State identification number: This application has been authorized by the organization's: Executive Committee Board of Directors x Application - Page 1 Members -at -Large 1 PROJECT DESCRIPTION How Will your organization use the funding awarded? Describe the project, project objectives those served, area serviced, and number of volunteers involved. Be specific. Include equipment or services that would be purchased and why. - Include a detailed budget and aschedule of significant activities related to this - project. You may attach a maximum of one double - spaced typewritten page of information. (Please type or print legibly.) Funding` provides for food „trr`aver't2 000• low _income- .seniors i and families, refrigeration,: and maintenance /repairs for refrigeration as needed. Over the past years, and with the economy,_ the Senior Citizen Service Center has expanded previous efforts to encompass the entire community and areas of Southwest Riverside County, including Temecula, Murrieta, Wildomar, Aguanga Lake Elsinore, and Anza picking up the slack from other community centers continuing to provide food, as well as hygiene supplies, and holiday baskets, and toys. It's primary objective to feed . the homeless and less fortunate families and senior citizens regardless of race, creed, nationality, sex, marital status, disability, religion, or political affiliation. The organization currently has six food programs: Bread, Commodities, Share, Brown -Bag, Emergency Food, and Holiday Baskets which provide homeless and low income families and seniors with a nutritional and reliable method of obtaining food. The food bank operates without any paid staff. The programs are tacilifated Vty- a dedicated staff of over 35 volunteers and managed by a Board of Trustees comprised of several retirees from the community, including some who have previously taken part in the programs. Application - Page 3 PRESIDENT or AUTHORIZED C Roselie Vaccarino President /Director NAME and TITLE (Please Print or Type) ORGANIZATION NAME: Senior Citj.zen Service Center of the T mec nl a Rancho Area, Inc MAILINGADDRESS: P.O. Box 987 Temecula CA 92590 TELEPHONE: 951- 600 -9557 1 DATED THIS 11 Of August , 2010. (Date) (Month) BE SURE TO INCLUDE THE ORIGINAL PLUS ONE COPY AND SUBMIT TO: Mail Completed Applications to: City of Temecula Community Service Funding Program Attn: Judy McNabb Post Office Box 9033 Temecula, CA 92589 -9033 Or Deliver in Person to: City of Temecula Community Service Funding Program Attn: Judy McNabb 43200 Business Park Drive Temecula, CA 92590 Annlirafinn — Panw 5 FINANCIAL INFORMATION: 1 Proposed Project Budget i FUNDS TOTALAM VITY /PROJECT BUDGET 1. Personnel A. Salaries and Wages $ N/A B. Fringe Benefits _ $ N/A C. Consultants & Contract Svcs $ N/A 2_ Non - Personnel A. Space Costs $ B. Rental, Lease $ 30,000 C. Insurance $ 1,800 D. Office Expenses $ 3,600 E. Telephone $ 1,300 F. Emergency Food and Aid $ 23,000 SUB -TOTAL $ 59,300 3. Architectural /Engineering Design $ N/A 4. Acquisition of Real Property $ N/A S. Construction /Rehabilitation $ N/A 6. Indirect Costs $ N/A TOTAL: $ 59,700 To the Board of Directors Senior Citizens Service Center of the Temecula Rancho Area, Inc. Murrieta, California -- - - - -- -- _- - _- -- Independent Auditor's Report I have audited the accompanying statement of assets and liabilities of the Senior Citizens Service Center of the Temecula Rancho Area, Inc. as of June 30, 2010 and the related statements of support, revenue,.... expenses and changes in fund balances and cash flows for the fiscal year then ended. These statements are the responsibility of the Organization's Board of Directors. My responsibility is to express an opinion on these financial statements based on my audit. I conducted my audit in accordance with generally accepted auditing standards. Those standards required that I plan and perform the audit to obtain reasonable assurance about whether the financial statements are free of material misstatement. An audit includes examining, on a test basis, evidence supporting the amount and disclosures in.the financial statements. An audit also includes assessing the accounting principles used and significant estimates made by the Board of Directors, as well as evaluating the overall financial statement presentation. I believe that my audit provides a reasonable basis for my opinion. In my opinion, the financial statements referred to above present fairly, in all material respects, the financial position of Senior Citizens Service Center of the Temecula Rancho Area, Inc. as of June 30, 2010 and the results of its operations and its cash flows for the fiscal year then ended in conformity with the cash basis method of accounting. - September 2, 2010 SENIOR CITIZEN��SERVICE CENTER -OFTHE T TEMECULA ,..iNCHO AREA, I _ - ' - -- - - -- - STATEMENT O OF ASSETS A AND LIABILITIES JUNE JUNE 30, .. 2 2010 _.... LIABILITIES AND FUND BALANCES Total Liabilities Elrod Balances Undesignated Total Fund Balances Total Liabilities and Fund Balances 38,843 38,843 38,843 - 38,843 $ 38,843 $ - $ 38,843 See accompanying notes and accountant's report Winifred A. Samstag, Certified Public Accountant Ocala, Florida OPERATING. EXPENSES Emergency food and aid Auto expense Insurance Office expense and miscellaneous Rent and utilities Telephone Total Expenses Excess of public support and revenue over expenses Fund balance, beginning of year Fund balance, end of year 11,070 11,070 181 181 r _ SENIOR CITIZENb SERVICE CENTER OF THE TEMECULA I-ACHO AREA,.. INC.. 'Y - "STATEMENT OF SUPPORT, . REVENUE,_ _ EXPENSES AND CHANGES IN FUND BALANCES - -- -- - FOR THE FISCAL .-YEAR - ENDED - JUNE -30, 2010 1,230 26,330 15,864 UNRESTRICTED RESTRICTED TOTAL' 10,547 FUND.. -. _FUND_. _.. ._FUNDS PUBLIC SUPPORT AND REVENUE _. - Public Support: - .- City grants $ 20,000 $ 20,000 - - Riverside -- CountyEDA .15,864 15;664 Gas Company -grant _ - 1,000 .. _. -. 1.000_ - - Donations -. -_ 8,073 8,073 Total Public Support _ 29,073 15,864 44,937 Revenue: Interest income 19 19 - Thrift store sales 7,254 - 7,254 Trip income (net of expenses) - 531 - - - 531 Total Revenue 7,804 7,804 - - Total Support and Revenue 36,877 15,864 52,741 OPERATING. EXPENSES Emergency food and aid Auto expense Insurance Office expense and miscellaneous Rent and utilities Telephone Total Expenses Excess of public support and revenue over expenses Fund balance, beginning of year Fund balance, end of year 11,070 11,070 181 181 1,152 1,152' 3,561 3,561 9,136 15,864 25,000 1,230 1,230 26,330 15,864 42,194 10,547 - 10,547 27,796 - 27,796 38,343 - 38,343 See accompanying notes and accountant's report Winifred A. Samstag, Certified Public Accountant Ocala, Florida CASH FLOWS FROM INVESTING ACTIVITIES Net Increase (Decrease) in cash Cash - Beginning of Year Cash - End of Year - 547 - 547 32,115 - 32,115 $ 32,662 $ - $ 32,662 See accompanying notes and accountant's report Winifred A. Samstag, Certified Public Accountant Ocala, Florida - - -- ` - SENIOR CITIZENb'SERVICE CENTER OF THE - TEMECULA 1-_.60 AREA, -INC -. STATEMENT OF CASH FLOWS.. __.. FOR THE FISCAL YEAR ENDED JUNE 30, 2010 UNRESTRICTED RESTRICTED... TOTAL .... ..'. - .FUND .FUND FUNDS - - - CASH FLOWS FROM OPERATING ACTIVITIES Excess _ of - . public . support.and - revenue over expenses $ 10,547 $ 10,547 Adjustments to reconcile net cash - - provided by operating activities - Decrease in prepaid rent 2,000 - 2,000 - (Decrease) in deferred income (12,000) (12,000) Net Cash Flows Provided .(Used) by Operating Activities 547 - 547 CASH FLOWS FROM INVESTING ACTIVITIES Net Increase (Decrease) in cash Cash - Beginning of Year Cash - End of Year - 547 - 547 32,115 - 32,115 $ 32,662 $ - $ 32,662 See accompanying notes and accountant's report Winifred A. Samstag, Certified Public Accountant Ocala, Florida SENIOR CITIZENS SERVICE CENTER OF THE TEMECULAt,,„NCHO AREA, INC. NOTES TO FINANCIAL STATEMENTS JUNE 30, 2010 Note A - Summary of Significant Accounting Policies - - The Senior Citizens Service Center of the Temecula Rancho Area;. Inc. - - was incorporated as a non- profit organization. under Internal. Revenue _ k Code Section 501(c)(3). The Service Center assistsareaneedy - senior citizens withby distributing - government commodities to the poor and - needy in the local area. The .Center also provides_.socialand -: recreational facilities and activities for senior citizens. -- -- - -- - -. " Accounting Method - - - -- - - The organization maintains its books generally on a modified cash basis of accounting. -Expenses and capital expenditures are paid as incurred. _ - Revenues are generally recorded as income as received; however, for the fiscal year ended June 30, 2010, $12,000 which was intended for the current fiscal year had been received during the prior fiscal year and was recorded as "Deferred Income" at that time. - - - - - Fund Accounting To insure observance of limitations and restrictions placed on the use of certain resources available to the Service Center, the accounts . of the Service Center are maintained in accordance with principles of fund accounting. This is the procedure by which resources for various purposes are classified for accounting and reporting purposes into funds established according to their nature and purpose. Separate accounts are maintained for each fund. The assets, liabilities and fund balances of the Service Center are reported in self - balancing groups as follows: Unrestricted funds represent the portion of expendable ..funds that is available for support . of the Service Center's. operations. Restricted funds represent resources restricted for facility rent and emergency food and medical assistance to senior citizens. During the fiscal year ended June 30, 2010 restricted funds were received from Riverside County EDA to be used for facility rent. SENIOR CITIZENS SERVICE CENTER OF THE TEMECULA RANCHO AREA, INC. NOTES TO FINANCIAL STATEMENTS - JUNE 30, 2010 :. Donated Services and - Materials - - - -.A- substantial - numberof unpaidvolunteers- have -made significant_ contributions of their time in conjunction with the Service Center �+ programs and services. These contributions have not been included in r these financial statements, -asno objective method of valuation has been determined. - In addition to volunteer time, most of the food distributed has been donated by various: agencies. No record has been kept of the value of - these donated items, therefore they are not included in these financial statements. - - All contributions are considered to be available for unrestricted use unless specifically restricted by the donor. Support donations are recorded as -they are received. All items sold in the Thrift Store have been donated. - NOTE B - Federal Income.Tax The Service Center is an organization exempt from federal income taxes under Section 501(c)(3) of the Internal Revenue Code. While the Service Center is generally exempt from income taxes, it is subject to taxes on unrelated trade or business income and on excess lobbying expenses. For the year ended June. 30, 2010, the Service Center did not incur any tax liability for unrelated tradeor.business, or lobbying activities. NOTE - Facility Lease -- - --- Theorganization is - operatingin a facility under a five year lease, with payments of $2,000 per month, which will expire in May, 2014. Dear Sir or Madam: This is in response to your request of April 13, 2007, regarding your organization's tax - exempt status. In September 1978 we issued a determination letter that recognized your organization as exempt from federal income tax. Our records indicate that your organization is currently exempt under section 501(c)(3) of the Intemal Revenue Code. Our records indicate that your organization is also classified as a public charity under sections 509(a)(1) and 170(b)(1)(A)(vi) of the Internal Revenue Code. Our records indicate that contributions to your organization are deductible under section 170 of the Code, and that you are qualified to receive tax deductible bequests, devises, transfers or gifts under section 2055,2106 or 2522 of the Internal Revenue Code. If you have any questions, please call us at.the.telephone number shown in the heading of this letter. Sincerely; Micheie:IN 'Sullivan, Oper. Mgr. Accounts Management operations 1 TOTAL P.02 OFFICE OF THE SECRETARY OF STATE ILI CERTIFICATE OF STATUS DOMESTIC CORPORATION I, MARCH FONG EU, Secretary of State of the State of California, hereby certify: That on the 2nd day of February 19 78 SENIOR CITIZENS SERVICE CENTER OF THE TEMECULA RANCHO AREA became incorporated under the laws of the State of California by filing its Articles of In- corporation in this office; and That no record exists in this office of a certificate of dissolution of said corporation nor of a court order declaring dissolution thereof, nor of a merger or consolidation which terminated its existence; and That said corporation's corporate powers, rights and privileges are not suspended on the records of this office; and That according to the records of this office, the said corporation is authorized to exer- cise all its corporate powers, rights and privileges and is in good legal standing in the State of California, and That no information is available in this office on the financial condition, business ac- tivity or practices of this corporation. That :said corporation is organized under the General Nonprofit Corporation Law IN WITNESS WHEREOF, I execute this ' certificate and affix the Great Seal of the State of California this 29th day of July, 1993 I1l/l.Y(46( Secretary of State SEC /STATE FORM CE -112 REV. 7 -87) <2D-1 87 45931 PROJECT INFORMATION Amount Requested: $ C- , 1p co S/ Maximum allowable $5,000) Project Name: 1 I d � � % Project Start Date: 1Z I ( -LO VD Project End Date: 1'7- J 1 I I c ORGANIZATION INFORMATION Name of Organization: Sm i 1 Pe) 4 Ch � "kc. 1612 - ✓n °S of Contact Name: V Ul f,16CA WN—C'10h I-Title /Position- Wr,,7A CIF rI4- Mailing Address:) I VU'_) I e rr irku lct NG Ly.( i , l a'tQ cu ioGH `'} b)' Telephone:_Ci' /y �I�� �'J� D Year Organization Founded: '11VO�1_9 Number of Paid Staff: D Number of Volunteers: LP 0 Geographic Area(s) Is this organization incorporated in California as a non - profit organization? Yes )Q_ No Effective Date: I-W'b If "yes" (Must provide a copy of your statement of non- profit status from the State of California): Date of incorporation as a non - profit: y I U U Q. J-00S Federal identification number: 21-P - 22-.3, 09 State identification number: tb`i`12- If "no ": Name of sponsoring organization: Federal identification number: State identification number: This application has been authorized by the organization's: Executive Committee x Board of Directors Application — Page I Members -at -Large 2 1 MISSION STATEMENT Smiles 4 Kylee Children's Fund is a tax exempt, non -profit established to love on those families hurting from financial hardships by providing real relief with brand new backpacks for each of their children filled with school supplies and to carry on the-legacy of one terrific young girl; Kylee Ann McCreight, who at the age of six set good examples of serving others. In addition to school accessories; gently used clothing, shoes, toys and books are available on a monthly basis to enhance children's closet options and give relief to parents/guardians strained wallets at our Smiles Center. Since the inception of Smiles 4 Kylee over 1,250 new backpacks and school supplies have been distributed to wonderful children in the region of the Inland Valley and about 300 backpacks have been distributed to other parts of the world including the Philippines, Fiji, Ethiopia, and Texas. Since our Smiles Center opened in Temecula, April 21, 2010, the focus of distribution has been on the Inland Valley area. Board members of this Fund do not receive any compensation whatsoever for their volunteer work. We all have it in our nature to serve and want to see children have the edge they need to help them have success as they progress in school. The President, Vanessa McCreight, is very skilled and disciplined in organization and accountability of the non -profit and Treasurer, Pastor Randy Ponder, is very knowledgeable in the area of taxation, finance and has the appropriate resources for legal matters. Secretary, Pam Partch, uses her extensive secretarial skills as required. All three board members are driven by sincere desire to see this non -profit help more and more children to focus on their studies and not be concerned about the essentials. Integrity of this non - profit is acknowledged by the great corporations of this community backing Smiles 4 Kylee Children's Fund such as: Kohl's, Chick- Fit -A, Office Depot, FCP Barns and Buildings, Birth Choice of Temecula, Pacific Dental Group, Air1 Radio, Valley News and The Garrett Group. We have already shown we have the capability to handle and assist the Temecula area with our services throughout the year and even our yearly outreach and fundraiser at the Ronald Reagan Sports Park is presented in a very professional businesslike manner to encourage business and non - vendors to participate with us to give them more exposure and sales while being an inexpensive fun day for families throughout the Temecula Valley. Seeing the "Smiles" and excitement on those kiddo's faces while picking out their backpacks provides the best evidence of satisfactory service provided to your city's citizens. PROJECT DESCRIPTION This award will.enable us to keep our doors open to provide ongoing free services to small and -large families in financial difficulty throughout the Inland Valley. (We have had the privilege to serve not only mom and dad families,. but single_: moms and even grandparents raising their grandchildren.) Our free services include thru ads and handing out flyers to invite families to our Smiles Center in Temecula to obtain new backpacks filled with school supplies (1 per school year), gently used clothing, jackets, shoes, toys, blankets and new and gently used books for infants through high school teens. We have been providing for children of Pepper Tree Trailer Park in Lake Elsinore for several years too. We provide positive encouragement, monthly craft days, "Smiles" and have brochures on hand of other local resources. We also have attained a reputation for outreaches in the Temecula area parks during the Easter, Harvest and Christmas time and our Annual Family Fun Day, this year scheduled for October 16, 2010. Our first Community Back to School Outreach this year where over 80 children received new backpacks was a success and we know that amount will grow next year with additional advertising and word of mouth. Over 300 new backpacks have been given out over the last several months. To date, over 1,600 new backpacks with supplies have been given away over the past four years. To accomplish these on -going needs we must be able to pay our monthly electrical bill of our 4,000 sq. ft. office/warehouse and insurance. Add more 20'+ wall hanging clothing racks and free - standing racks so we can offer more much needed clothing. (4) 6' high double -door enclosed storage cabinets for infant needs, toys, games, and hygiene products. (4) 6' high shelves for books and shoes. Sometimes it has been necessary for us to purchase out-of — pocket outreach supplies, backpacks and school supplies if our donations run low. A commercial vacuum and general sanitizing /cleaning supplies are needed. Operating and outreach activity supplies needed are foods, snacks, juices /water, craft supplies, games, (50) folding chairs, (10) E -Z ups, (4-6) six foot tables, (3) children's tables and chairs. A standard size refrigerator /freezer is needed to refrigerate foods; snacks and drinks we give away along with a heavy duty washer and dryer to clean gently used donated clothing and shoes, when applicable. A desktop computer, software and printer will enable us to track efficiently those receiving assistance and volunteers along with communicating with them via Facebook/Email. (3) Banners, Postage, P.O. Box, ink and paper for general correspondence, advertising and newsletters. Volunteers, anywhere from 2 or 3 and up to 10+ come to our Smiles Center a couple days a week to assist in time - consuming sorting of clothes, facility cleaning and stuffing the backpacks with supplies. Also, we have over 50 volunteers participate at our Family Fun Day each year. J PROJECT DESCRIPTION Howwill your organization use the funding awarded? Describe the project, project objectives,- those served, - area serviced, and number of volunteers involved. Be specific. Include equipment or ser5ices that would be purchased and why. Include a detailed budget and a schedule of significant activities related to this' project. You may attach a maximum of one double - spaced typewritten page of information. (Please type or print legibly.) Andimflon — Pam, 3 PRESIDENT or AUTHORIZED OFFICER: V W M cubEA y& , NAMM,E� and TITLE (Please Print or T e) SIGNATURE: ORGANIZATION NAME: K-U I ?xJ l�hJ d rI O n .S -Fu n (,I DATED THIS of Se> , 2010. (Date) I (Month) BE SURE TO INCLUDE THE ORIGINAL PLUS ONE COPY AND SUBMIT TO: Mail Completed Applications to: City of Temecula Community Service Funding Program Attn: Judy McNabb Post Office Box 9033 Temecula, CA 92589 -9033 Or Deliver in Person to: City of Temecula Community Service Funding Program Attn: Judy McNabb 43200 Business Park Drive Temecula, CA 92590 Annliratinn — Pana 5 Otrea bmnlioe. e.t.le.x�im 11 $1,700 II Eli 11 1000 !1 IF!P. 100 $35 ",$4,S60' - tl �a -- 1 SY.mwax 51�?DD $0 $1,2DD.. O •o •1 SnMO1a%S $i00 $135 1 e.t.le.x�im kRilpies 6ka]nc Plw DePwit 11 $1,700 II Eli 1' 1000 .._ IF!P. 100 $35 ",$4,S60' - �a -- to kRilpies 6ka]nc Plw DePwit $2.500 $1,700 X700.. Insurarce 1' 1000 .._ IF!P. 100 $35 ",$4,S60' - CnM� Walk 4 5mties 100 mom Fami Fun 1000 -- fQ00 -' Craft Fair 100 $35 100; 1 �a -- to SY.mwax 51�?DD $0 $1,2DD.. Doeraum FODd/Snalks -- mom Drinks 00 -- 200= WEEK $100 $35 $65' 1 �a -- to 1 sp O •o -e SnMO1a%S $i00 $135 .$365; Pro epel balance t DiBaPJrae Acn91 mkms pojecteM 011iae RenUl DMtMd by t V�rnnrn -- B lmiomz. -- mamma �� e -- mom -- -- 1 WEEK c -- 1 �a -- e 1 O •o -e -- B lmiomz. -- mamma �� e -- I -- I -- mom -- WEEK c -- 1 �a 1 1 O -- I -- I -- mom -® WEEK 1 -- 1 -- I -- I INTERIML REVENUE SERVICE P_ A. .BOB 2508 ._ ... CiNCiNNATI, OR 45201 Date: APR 3 o 2Q ©9 - _DEPARTMENT OF THE "UmsDRY Employer Identification Number: 26- 2237093 �- __. DLN:- 17053221325008 -- - - Contact Person: DEBORAH -C MOMON- TOMSEW - -- ID# 75070 -- - contact Telephone Number: (877) 829-5500 - Accounting Period Ending:- _ December 31 Public Charity Status: - 170Ib) (17 (Af(v�iiT- T -� Form 990 Required: _... - Yes Effective Date of Exemption: March 24 -, 2008 - - Contribution Deductibility: Yes Addendum Applies: No Dear Applicant: we are pleased to inform you that upon review of your application for tax exempt status we have determined that you are exempt from Federal income tax under section 501(c)(3) of the Internal Revenue Code. Contributions to you are deductible under section 170 of the Code. you are also qualified to receive . tax deductible bequests, devises, transfers or gifts under section 2055, 2106 or 2522 of the Code. Because this letter could help resolve any questions regarding your exempt status, you should keep it in your permanent records. Organizations: exempt under section 501(c)(3) of the Code are further classified as either public charities or private foundations. we, determined that you are a public charity under the code section(s) listed in the heading of this letter. - --` _ - _ - - -- - -- - -- - - -- — Please see enclosed Publication 4221 -PC, Compliance Guide for 501(c)(3) Public Charities, for some helpful information about your responsibilities as an exempt organization. Letter 947 (DO /CG) i _ F r. co 2C CITY OF TFMECULEl SEP 14 2010 I F ISG AL YEAR 2010- f i rRNANCE E To COMMUNITY SERVICE FUNDING PROGRAM APPLICATI N (Please Print or Type) PROJECT INFORMATION Amount Requested: $ 5,000 {Maximum allowable $5,400) Project Name: Spot training and coruaetition progams for athletes with intellectual disabilities in the City of Temecula Project Start Date: January 1, 2011 Project End Date: December 31, 2011 ORGANIZATION INFORMATION Name of Organization: Special Olympics Southern California - Temecula Valley Contact Name: Stacy Fish - Area Director Title /Position: Mailing Address: 27475 Ynez Road, Suite 174, Temecula, CA 92591 Telephone: (951)296- 3624 9 1969 Year Organization Founded: Number of Paid Staff: 0 Number of Volunteers: 250 Geographic Area(s) Served:_ Temecula Valley Is this organization incorporated in California as a non -profit organization? Yes X No Effective Date: if "Yes-, (Must provide a copy of your statement of non -profit status from the State of California): Date of incorporation as a non - profit: 1995 Federal identification number: 954538450 State identification number 189240 If "no ": Name of sponsoring organization: Federal identification number: State identification number: This application has been authorized by the organization's: Executive Committee Board of Directors X Members -at -Large x Application –Page I: PROJECT DESCRIPTION How will your organization use the funding awarded ? , Describe the _ project, project objectives, those served, area serviced, and number of volunteers involved. 96 specific. Include equipment or servicesahatwould be purchased and why. include a detailed budget and a schedule of significant activities related to this project. You may attach a maximum of one double- spaced typewritten page of information. (Please type _ or print legibly.) _ Monies received from the City of Temecula will be used to provide sports practices for'athletes, trainings for coaches and competitions held in 2011. There are over 200 athletes in our programs who train and compete in year -round sports and we recently added -the sports of softball, soccer and tennis to our fall and spring seasons. Costs associated with the project include facility rentals, sports equipment, uniforms, meals, medals, event supplies, and personnel. A handful of community organizations offer chil- dren with intellectual disabilities limited participation in mainstreamed recreation through the assistance of in aide or buddy. While this provides some degree of success for higher ability children with disabilities, those with severe disabilities have challenges fully participating. Special Olympics is the only organiza- tion in the City of Temecula which provides sports training and competition programs to persons with dis- abilities free of charge to all participants. Over 807o of our athlete's live at or 1061 ;v the poverty level, working part-time jobs and receiving government assistance to subsidize necessary living expenses such as food and rent. Most persons with intellectual disabilities could not afford costs associated with participation in sports programs if fees were assessed. As a result, Special Olympics covers all program related expenses for both training and competition, including facility rentals for trainings and competitions, sports equipment, uniforms, games fees, transportation, and training for coaches. Special Olympics could not exist without the energy, commitment, and enthusiasm of 200+ volunteers in Temecula. As a grass -roots organization, Special Olympics relies on volunteers to ensure that every athlete is offered a quality sports training and competition experience. Volunteers are involved with every aspect of our programming and often serve as coaches, tournament volunteers, and other key leadership roles. We are proud to boast ongoing involvement from Temecula -based volunteer groups, including Knights of Columbus, California Highway Patrol and Temecula Police Department. Application — Page 3 PRESIDENT or - AUTHORIZED OFFICER: Stacy Fish -Area Director antl I I i LE (Please < n ORGANIZATION NAME: Special Olympics Temecula Valley MAILING ADDRESS: 27475 Ynez Road, Suite 174 Temecula, CA 92591 k>J 1) G>V-ouzV DATED THIS 07 of September 2009. (Date) (Month) BE SURE TO INCLUDE THE ORIGINAL PLUS ONE COPY AND SUBMIT TO: Mail Completed Applicationsto: City of Temecula Community Service Funding Program Attn: Judy McNabb Post Office Box 9033 Temecula, CA 92589 -9033 Or Deliver in Person to: City of Temecula Community Service Funding Program Attn: Judy McNabb 43200 Business Park Drive Temecula, CA 92590 Application — Page 5 SPECIAL OLYMPICS SOUTHERN CALIFORNIA INC STEVEN ZELMAN 6071 BRISTOL PKWY STE.IaC _CULVER CITY CA 90230 -6601 A` Purpose CHARITABLE Code Section 2370ld Form of Organization Corporation Accounting Period Ending; December 31 Organization Number - - - - -c 1898240 - - You are exempt from state franchise or income tax under the section of the Revenue and Taxation Code indicated above. This decision is based an information you submitted and assumes that Your present operations continue unchanged or conform to those proposed In your application. Any change in operation, character, or purpose of the organization must be reported immediately to this office so that we may determine the effect an your exempt status. Any change of name or address must also be reported. In the event of a change in relevant statutory, administrative, judicial case law: a change in federal interpretation of federal law in cases where our opinion is based upon such an interpretation, or a change in the material facts or circumstances relating to your application upon Which this opinion is based, this opinion may no longer be applicable. It is your responsibility to be aware of these changes should they occur. This paragraph constitues written advice, other than a chief counsel ruling, within the meaning of Revenue and Taxation Code Section 21012.(m)(2). You may be required to file Form 199 (Exempt Organization Annual Information Return) on or before the 15th day of the 5th month (q 1/2 months) after the close of your accounting period, Please see annual instructions with forms for requirements. You are not required to file state franchise or income tax returns unless you have income subject to the unrelated business income tax under Section 23732 of the code. In this event, you are required to SPECIAL OLYMPICS SOUTHERN CALIFORNIA,JNC. (A California Nonprofit Corporation) FINANCIAL STATEMENTS YEAR ENDED DECEMBER 31, 2009 INDEPENDENT AUDITORS' REPORT To the Board of Directors Special Olympics Southern California, Inc. We have audited the accompanying statement of financial position of Special Olympics Southern California, Inc_ (SOSC), a nonprofit organization as of December 31, 2009, and the related statements of activities, functional expenses, and-cash flows for the year then ended. These financial statements are the responsibility of the management of SOSC. Our responsibility is to express an opinion on these financial statements based on our audit The prior year summarized comparative information has been derived from SOSC's 2008 financial statements and, in our report dated May 19, 2009; we expressed an unqualified opinion on those financial statements. We conducted our audit, in accordance with auditing standards generally accepted in the United States of America and the standards applicable to financial audits contained in Government AvdiSng Standards issued by the Comptroller General of the United States. Those standards require that we plan and perform the audit to obtain, reasonable assurance about whether the financial statements are free of material misstatement. An audit includes examining; on a test basis, evidence supporting the amounts and disclosures in the financial statements. An audit also includes assessing the accounting principles used and significant estimates made by management, as well as evaluating the overall financial statement presentation. We believe that our audit provides a reasonable basis for our opinion. In our opinion, the financial statements referred to above present fairly, in all material respects, the financial position of SOSC as of December 31, 2009, and the changes in its net assets and its cash flows for the year then ended, in conformity with accounting principles generally accepted in the United' States of America. In accordance, with Government Auditing Standards, we have also issued our report dated June _, 2010 on our consideration of SOSC's internal control over financial reporting and on our tests of its compliance with certain provisions' of laws, regulations, contracts, and grant agreements, and other matters. The purpose of that report is to describe the scope of our testing of internal control over financial reporting and compliance and the results of that testing and not to provide an opinion on the internal control over financial reporting or on compliance. That report is an integral part of an audit performed in accordance with Government Auditing Standards and should be considered in assessing the results of our audit. GREEN HASSON & JANKS LLP June 2010 Los Angeles, California y y v n n_ o N N �F W WW N W w� W M illm LU N . I • I O m U_ O NON Q N `° M n ^ W~ W CC U U N WY a -0m L, ,E } a a O n O:z F W M M M W U Om V O n W M o w a y.... w _ -U m Q 0 $' m W -� W A M M N a.M M W M 0nN c} E p pi°j N N } O « M 'UO fO (D F 7 -� W -1� aU M n w m t0 -GO N .. }�.. :ym.... NF MM M WMWa o. O.W� O m- WM -W MW n _M n .. il4piMV N W of C y R WMp`_ m 6:2: a�� 0 Z M .. z 0 '0 M O n( O m ' .- N N O N V N_ W W Q U N W W M O. N M N .- W N W n W M W W M O F .. - j= � :a 't.- . Q. O n c} M. W �' W n n W -M M M W V' rl: C4 N - a F nr 0..W WN n �"' •- M N N M V' O N n M ®'W �.'u..� N N .- OWW .'.Zm�.. qq m •- M N O .- N N. y y y v n n_ o N N �F W WW N W w� W M illm LU N . I • I O m U_ O NON Q N `° M n ^ W~ W CC U U N WY a -0m L, ,E } a a O N O:z F W M M M W U N 41 `m c LL) O o m o w a y.... w -U m Q 0 $' m W 0 } m N J N Q •N U E p a E N z F L y o y y v n n_ o N N �F W WW N W w� W M illm LU N . I • I O c E > m > 0 C O C V ~ o W O W h w¢ h �.. p J co o Q �' Q V to Q to 2 m y Eo m...m m a C CO ¢. 2 (n O w c E 0 E W m y ' W O y c Q y h c m q ^= O R m c ? y CO W a m m o w Z 41 to W ° -O Z) o hW o W W U m y W j W Z W ° m m c rn k W W W o W m c .R. m o w o o w X ¢ U U a O D ¢ � Z f W 2 N m n NON i` O O d' ON M ^ W M W a L6 pl: O N y W M M M W U N W O OMD't V ° W O N W c E > m > 0 C O C V ~ o W O W h w¢ h �.. p J co o Q �' Q V to Q to 2 m y Eo m...m m a C CO ¢. 2 (n O w c E 0 E W m y ' W O y c Q y h c m q ^= O R m c ? y CO W a m m o w Z 41 to W ° -O Z) o hW o W W U m y W j W Z W ° m m c rn k W W W o W m c .R. m o w o o w X ¢ U U a O D ¢ � Z f W 2 N m W m N W M W m y U C C W LL W ri p N z F y o W o. n m W W of C y R m d 0 Z M C E 0 Q U 'Q m CC F The Accompanying Notes are an Integral Part of These Financial Statements -5- 2009 2008 CASH FLOWS FROM OPERATING ACTIVITIES: Change in Net Assets $ (277,142) $ (1,566;659) Adjustments to Reconcile Change in Net Assets to Cash Used in Operating Activities: - - Depreciation 183,860 146,000 Reinvested Dividends and Interest (67,307) (91,038) Realized and Unrealized (Gains) /Losses on Investments (194,100) 698,331 Loss on Disposal of Assets 37,829 961' (Increase) Decrease in: Contributipps, and Pledges Receivable r 100,967- 309,343 - Prepaid Expenses and Deposits 19,227 (9,957) Increase (Decrease) in: Accounts Payable (11,027) 12,000 Accrued Liabilities 62,353 ' 79,879 NET CASH USED IN OPERATING ACTIVITIES` (145,350) (421,140) CASH FLOWS FROM INVESTING ACTIVITIES: Proceeds from Sale of Investments 650,000 378,456 Purchase of investments - (6,831) Purchase of Property and Equipment (204,294) (240,426) NET CASH PROVIDED BY INVESTING ACTIVITIES 445,706 131,199 NET INCREASE (DECREASE) IN CASH AND CASH EQUIVALENTS 300,356 (289,941) Cash and Cash Equivalents - Beginning of Year 293,196 583,137 CASH AND CASH EQUIVALENTS - END OF YEAR S 593,552 $ 293,196 The Accompanying Notes are an Integral Part of These Financial Statements -5- SPECIAL OLYMPICS SOUTHERN CALIF P F1iM.... DR/(f (A California Nonprofit Corporation) .It112e 2$ 2(1$0 .::;. . .. TP.a�:RETURIVED7OGREENRA6 &clN�& NOTES TO FINANCIAL STATEME �nNKS iw aNO Nbx:YasE .. _ . - flfPRODUCEDiN;ANY -FARM WtfHOUT'- .i December 31, 2009 RMI.... :' .'' NOTE 1 - ORGANIZATION (continued) Five years ago, SOSC had one of the lowest participation rates of 'any Special Olympics program in the nation, with just 10,000 athletes. To counter that status, SOSC implemented an ambitious 5 -Year Strategic Plan focused on restructuring the organization to serve a greater percentage of the estimated 550,000 individuals with' intellectual disabilities living in SOSC's geographic territory. Significant strides have been made in accomplishing these goals, most notably: • Athlete Growth and Increased Participation. More than 13,000 athletes currently participate with more being served at younger age, due primarily to'SOSctSchool Partnership Program. The new two- season, 12 -sport model will allow SOSC to accommodate more athletes and give them more time to trail and compete, while the guide- lines created to support this change will ensure an equitable experience for all SOSC athletes. • A Staff -Led, Volunteer- Driven Organization. Jn order to become a "staff -led, volunteer- driven" organization, SOSC is ramping up its volunteer training which will not only reduce costs but ensure community support of its programs. With 15,000 volunteers already on the SOSC roster, the current focus is not only on recruiting more, but also for leadership positions that will ensure the future strength of the organization. • Sustainable Revenue. A fundraising culture has been created throughout the organization to sustain future revenues that includes a focus on successful opportunities such as individual donors, online giving, Law Enforcement Torch Run activities, major SOSC -wide events, and ` opportunities utilizing service organizations /universities. To bridge the transition from a reliance on special events, direct marketing and grants, a Dream House Raffle will be implemented in 2010, along with increased focus on the current major donors, and engaging the Board of Directors on a greater scale. • Toyota's Gift of Space. -The decision was made in 2009 to relocate 15 Sports & Field Operations and Regional staff members from its former head - quarters in Culver City to a new Los Angeles /San Gabriel Valley Region Office, located in Gardena. This move was made possible by Toyota which donated` office space to help defray overhead costs, saving SOSC an estimated $200,000 over two years. • Summer Games Changes. SOSC modified its Summer Games competition in 2009 by reducing the annual championship from three to two days, at a cost savings of nearly 25 percent. At a time when several chapters in North America were forced to cancel their Summer Games, SOSC staged a salute to the athletes and its 40' Anniversary over the two days of competition. SOSC will continue to look for ways to enhance the athlete and volunteer experience while maintaining these cost savings. -7- SPECIAL OLYMPICS SOUTHERN' CALIF0j PAEUM1 (A California Nonprofit Corporation) .luue NOTE 2 - SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES (continued) (b) ACCOUNTING (continued) Restricted contributions • received and spent in the same year are treated by SOSC as unrestricted for reporting purposes. Permanently Restricted Net Assets. These net assets are received from donors who stipulate that resources are to be maintained permanently, but permit SOSC to; expend all of the income (or other economic benefits) derived from the donatedAssets: SOSC has $32,820 of permanently restricted net assets at December31, 2009. (c) CASH AND CASH EQUIVALENTS SOSC has defined cash and cash equivalents 2°s cash in banks, money market funds and certificates of deposits with original maturities less than one year. The carrying value of cash and cash equivalents at December 31, 2009 a Its rts fair value. (d) INVESTMENTS Investments in marketable securities with readily determinable fair values and all investments in debt securities are reported at fair value. interest and dividend income and gains and Josses on investments are reported on the statement of activities as increases or decreases in unrestricted net assets unless their use is temporarily or permanently restricted by donor stipulations or by law. (e) CONTRIBUTIONS AND PLEDGES RECEIVABLE Unconditional contributions, including pledges recorded at estimated net realizable value, are recognized as revenues in the period received. SOSC reports unconditional contributions as restricted support if they' are received with donor stipulations that limit the use of the donated assets. (f) PROPERTY AND EQUIPMENT Property and equipment are recorded at cost if purchased or at fair value at the date of donation if donated. Depreciation is computed on the straight -line basis over the estimated useful lives of the related assets. Maintenance and repair costs are charged to expense as incurred while renewals and betterments are capitalized. The estimated useful lives of property and equipment are as follows: Computer Equipment 5 Years Furniture and Equipment 5 Years Vehicles 5 Years Leasehold Improvements Term of Lease Sports Equipment 5 Years In SPECIAL OLYMPICS SOUTHERN CALIF PFtF�iMx11iAF3� [�,R/{fi . (A California Nonprofit Corporation) Urle :2 xO20 _. - -FOi� RET SaRNEPT'O:GREENNA6HQN:�It:.•} '. NOTES TO FINANCIAL STATEME .TANKS tr,iND Nbir Tsz9e ' REPRODUCEQJN- ANY FaR1U wrrROUT :. December 31, 2009 ....;. :PfPMISSHN4 . : . NOTE 2 - SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES (continued) G) CONTRIBUTED GOODS AND SERVICES (continued) SOSC received donated services from unpaid volunteers who made significant contributions of their time providing a broad range of support at all of the competitions and fundraising events. However, the value of these services is not reflected in the financial statements because the criteria for recognition were not met. (k) INCOME TAXES SOSC is exempt from taxation under Internal Revenue Code Section 501(c)(3) and California Revenue and Taxation Code Section 23701 d. FUNCTIONAL ALLOCATION OF EXPENSES`" The costs of providing SOSC's programs and other activities have been presented in the statement of functional expenses. During the year, such costs are accumulated into separate groupings as either direct or indirect. indirect or shared costs are allocated among program and support services by a method that best measures the relative degree of benefit. SOSC uses salary dollars to allocate indirect costs. (m) USE OF ESTIMATES The preparation of financial statements in conformity with accounting principles generally accepted in the United States of America requires management to make estimates and assumptions that affect reported amounts of assets, liabilities, revenues and expenses as of the date and for the period presented. Actual results could differ from those estimates. (n) RECLASSIFICATION For comparability, certain December 31, 2008 amounts have been reclassified, where appropriate, to conform to the financial statement presentation used at December 31, 2009. (0) COMPARATIVE TOTALS The financial statements include certain prior -year summarized comparative information in total but not by net asset class. Such information does not include sufficient detail to constitute a presentation in with accounting principles generally accepted in the United States of America. Accordingly, such information should be read in conjunction with SOSC's financial statements for the year ended December 31, 2008 from which the summarized information was derived. 11- JANKS:iI.P ANti-N4fYo9� - NOTES �TO- FINANCIAL STATEME RErROnucEb�e amr:Ad ' ' ' * .... December 31, 2009 PFpMISS�OKi:- NOTE 3 - FAIR VALUE MEASUREMENTS (continued) - The fair values of marketable securities within Level'1 inputs are'obtained based on quoted market prices at the closing. of the last business day of the fiscal year. Investment income (loss) for the year ended December 31, 2009 consists of the following: Dividend and Interest Income $ 67,307 Net Realized and Unrealized Gains on Investments 194,100 INVESTMENT INCOME $ 261,407 NOTE 4 - CONTRIBUTIONS AND PLEDGES RECEIVABLE All contributions and pledges receivable are deemed to be fully, collectible at December 31, 2009;- therefore, no- allowance for doubtful pledges has been recorded. The total amount of contributions and pledges receivable at December 31, 2009 is $266,551, all of which are expected to be collected within one year. NOTE 5 - PROPERTY AND EQUIPMENT Property and equipment at December 31, 2009 consist of the following: Computer Equipment $ 770,947 Furniture and Equipment 414,445 Vehicles 233,591 Leasehold Improvements 76,942 Sports Equipment 20,193 TOTAL 1,516,1 18 Less:- Accumulated Depreciation (1,047,409) PROPERTY AND EQUIPMENT (NET) $ 468,709 Depreciation expense for the year ended December 31, 2009 was $183,860. NOTE 6 - ACCRUED LIABILITIES Accrued liabilities at December 31, 2009 consist of the following: ' Accrued Vacation $ 160,593 Accrued Payroll 143,076 Accrued Unemployment 61,203 Accrued Payroll Taxes 13,756 TOTAL ACCRUED LIABILITIES $ 378,628 -13- NOTE 11 - TEMPORARILY RESTRICTED NET ASSETS Temporarily restricted net assets were available for the following purposes at December 31, 2009: Games and Championships 5 123,302 SPECIAL OLYMPICS ° SOUTHERN CALIF €(NA11tARk DKA ':..: Training of Athletes (A California Nonprofit Corporatio,iUr]e 2$ �b0 �.. 7,826 TOTAL TEMPORARILY L-'-..'.p TO 7IJRNEDTD:GREJN NA &6DN RESTRICTED NET ASSETS NOTES TO FINANCIAL STATEMNKSiu'ANisNOxrAE - _. 31, 2009 ULHOUT; .:December _pFhMlss : NOTE 10 - CONTRIBUTED GOOD &AND SERVICES Contributed goods, services, and use of facilities and equipment during, the year ended December 31, 2009 are - - -- Program Management - - - - Contributed: Related and General _. - Fundraising Total - _.. _...... Services S 4,836,329 $ 112,745 S 47,077 S 4,996,151 Goods 456,424 3,914 285,864. 746,202 Use of Facilities and Equipment 75,968 2,650 .,. _ 9,769 = -88 387 TOTAL CONTRIBUTED GOODS. - - AND SERVICES 5,368,721 119,309 342,710 5,830,740 . Less: Cost of Direct Benefit - to Donors - (232,896) (232 896) - - CONTRIBUTED GOOD AND - - -_ - - - SERVICES (NET) $ 5,368,721. S 119,309 S 109,814 S 5,597,844 In addition, equipment totaling $71,254 was contributed and is included in property and equipment. NOTE 11 - TEMPORARILY RESTRICTED NET ASSETS Temporarily restricted net assets were available for the following purposes at December 31, 2009: Games and Championships 5 123,302 Other Program Uses 45,353 Training of Athletes 31,070 Volunteer Activities 7,826 TOTAL TEMPORARILY RESTRICTED NET ASSETS S 207,551 NOTE 12 - BOARD DESIGNATED AND PERMANENTLY RESTRICTED NET ASSETS (ENDOWMENTS) SOSC's endowment consists of donor restricted funds and board designated funds. The donor restricted fund is included in permanently restricted net assets and consists of the Ropolo Charitable Trust with a balance of $32,820. The investment income is restricted by the donor to be used for athlete transportation, and this activity is shown in temporarily restricted net assets. The board designated funds have been established for two purposes: (1) seed money to launch donor - restricted endowments, and (2) a reserve for possible unavoidable operating deficits. These endowments are invested in mutual funds (See Note 3). -15- SPECIAL- OLYMPICS SOUTHERN CALIF P ..... I tWARY DBAFi (A California Nonprofit Corporation) ee g$I)t0 j - .: F9: �: Rk�lJRN6D1Tt:G8EeN:HA&84N• &.:•? i NOTES TO FINANCIAL STATEME ^Nlts[tedNDrNbT:Yti9E ::,:•: :: '- - -- - REPRODUCE'OIN ANY FURNI-WrrNOUT- '�; ' December 31, 2009 r txulssigy: NOTE 13 - RELATED PARTY TRANSACTIONS As an accredited chapter of SOI (see Note 1), SOSC remits accreditation fees and shares in percentages of contributions for nationwide SOI fundraising programs. SOSC incurred accreditation tees totaling $170,045 for the year ended December 31, 2009. These fees are reported as program costs in the accompanying statement of functional expenses. In addition, SOSC received _ $609,681 in contributions relating to direct mail and other fundraising campaigns from SOI during the year ended December 31, 2009. NOTE 14 - EMPLOYEE BENEFIT PLAN s: SOSC has a 403(b) defined contribution plan covering substantially all employees. After one year of service, SOSC matches 50% of the employee's contribution up to a maximum of 3% of the employee's salary annually. SOSC contributed $48,597 to the plan for the year ended December-31, 2009. —: -17- Fundmisinq Ex 8000 - FUNDRAISING 500 8030 -GOLF TOURNAMENT p 8300 - TORCH RUN .2010 - -- 1,820 - Total Fundraising Expenses 11,618 ANNUAL n 9000 - GENERAL ALLOCATED EXPENSES Budg Total General Expenses _.- _.. _...._ TOTAL REVENUE 62,312... See Revenue Report for Detail NET INCOME (LOSS) _Pro a2m FXpeftSM 1150 -AREA LEADERSHIP CONFERENCE 65 - _ 1450 - AREA COMMITTEE MEETINGS p _. _.. .... _. ... 1700. -.SOI. REGIONAL MEETINGS..... _ _.. ,p _ 1800 - OUTREACH 230 1850 - FAMILIES 0 1870 - RECREATION p 1900 - VOLUNTEERS p 2000 - PUBLIC EDUCATION _ p. 3000 - ATHLETE AREA TRAINING 1,684 - 3010 - AQUATICS 2,450 . - 3020- ATHLETICS p - 3030 - BASKETBALL`- 1,150 3040- BOWLING 3,360 3050 - CYCLING 0 3060 - EQUESTRIAN 0 3070 - FLOOR HOCKEY p 3080 - GOLF _.::,_.. _ 825 3090 - GYMNASTICS 2,760. -_ 3100 - ICE SKATING - FIGURE & SPEED 0 3120- POWERLIFTING p 3130- ROLLERSKATING .0 3160 - SKI - CROSS COUNTRY p 3160 - SOCCER 1,500 3170 - SOFTBALL 1,200 3190 - TENNIS 600 _ 3200 - VOLLEYBALL 1,250 3210 -BOCCE BALL 350 3400 - UNIFIED SPORTS 0 3500- COACHES /OFFICIALS TRAINING 400 0 4300 - SOSC SUMMER GAMES 75 4500 - SOI REGIONAL ANPL. COMPETITION p 5000 - SOSC CHAMPIONSHIPS p 5120 - SOSC - FLOOR HOCKEY 0 5180-EQUESTRIAN 0 5240 ICE SKATING p 5300 _ FALL GAMES 75 6000 - AREA COMPETTTON HOSTED 8,450 6400 - UNIFIED SPORTS COMPETNTONS 0 6500 - AREA COMPETITIONS ATTENDED 240 Total Program Expenses 26,664 Fundmisinq Ex 8000 - FUNDRAISING 500 8030 -GOLF TOURNAMENT p 8300 - TORCH RUN 9,298 8350 - TIP A COP 1,820 - Total Fundraising Expenses 11,618 - General Expenses 9000 - GENERAL ALLOCATED EXPENSES - 1,384 Total General Expenses 1,384 TOTAL EXPENSES 39,666 NET INCOME (LOSS) 22,646 ... PRINTED 9/13/2010 City of Temecula Community Services Funding Program C/O Judy McNabb PO Box 9033 Temecula, CA 92589 -9033 Dear Ms. McNabb: Courtney was hesitant about joining her local Special Olympics team. She didn't have a sports background and was painfully shy. Despite her concerns, a friend convinced her to join a local bowling team. After a few practices, she was hooked. At bowling, she met a group of people her age who quickly became her new friends. One of the coaches worked with her every week to teach her the skills necessary to compete_ Her hard work paid off when she earned a medal at her first bowling competition. Coaches later awarded her the nickname chatterbox because of her constant talking and few can believe that she was once shy. Today, Special Olympics is a regular part of Courtney s life which has resulted in a new found confidence that has transferred into other areas of her life. She plans on enrolling in community college where she will study art and hopes to find a part-time job after graduation. Throughout Temecula Valley, over 200 athletes with intellectual disabilities just like Courtney find opportunities for improved health, fitness and social interaction through their involvement in Special Olympics_ Founded on the belief that people with intellectual disabilities can learn, enjoy and grow from participation in individual and team sports, Special Olympics provides the structure and encouragement critical to their success. Through the mastery of sport, our athletes achieve new levels of self- confidence in their physical, mental, and social abilities. We respectfully request $5,000 from the City of Temecula to support our sports training and competition and programs in the city. Your support will allow Special Olympics Temecula Valley — and athletes like Courtney — to grow and thrive. On behalf of the athletes, families and volunteers of Special Olympics Southern California - Temecula Valley we would like to thank you for making opportunities such as the one presented by the City of Temecula available to assist organizations like ours achieve our goals. Sincerely, P aQ I Stacy Fish Area Director Created by the Joseph R Kennedy, Jr. Foundation Authorized and Accredited by Special Olympics Inc. for the Benefit of persons with Intellectual Disabilities PROJECT INFORMATION Amount Requested: $ 3, 000 (Maximum allowable $5,000) ..CC tom,, Project Name: 3YUJ ea-} O I T Y1C 1 on 1-1 Pro,G rave , 1-n C • l ernec�lu iii oFjram) Project Start Date: Srp }Cryi 10 e r- Z O 1 O Project End Date: `) y n e 261 1 ORGANIZATION INFORMATION Name of Organization: S -W8 e n+ of The, H onl h -Pray rcLm , T n G . Contact Name: S d 1 j V A. 1`1 y e rs Title /Position: Fz u nd e r 1�r e. S 18 en+ Mailing Address: Ll3I1 a '8 tj, ) rtes3 Park Dr. 3+e, 10 I —1 9 2 S 9 p Telephone: C°1 J 7i J' O S 2 0 Year Organization Founded: 199;k Number of Paid Staff: Number of Volunteers: i S Geographic Area(s) Served: 1 e M-e C 6 10— Is this organization incorporated in California as a non -profit organization? Yes A No Effective Date: 16J-2)]2. CO a If -yes- (Must provide a copy of your statement of non - profit status from the State of California): Date of incorporation as a non - profit: l 012.1 2 UU $ Federal identification number.._9_L4 - 3L) LI 7 9.8 a State identification number: C 3 1 Cc S 9 S a If "no ": Name of sponsoring organization: Federal identification number: State identification number: This application has been authorized by the organization's: V Executive Committee Board of Directors /\ Application - Page 1 Members -at -Large PRESIDENT or AUTHORIZED OFFICER: SIGNATURE: ri* ORGANIZATION NAME: 3- �uderij J —Me Mon-)-h PraC4 ram -TYtG. MAILINGADDRESS: L3dS1ne.SS Park Dr,, S4e -.t8i I -ew�ecsla, cp4 9D,S93 TELEPHONE: C°( S I 11 5- 0 5 2 0 i DATED THIS // -th of A "`""' keu , 2010. (Date) (Month) BE SURE TO INCLUDE THE ORIGINAL PLUS ONE COPY AND SUBMIT TO: Mail Completed Applications to: Or Deliver in Person to: City of Temecula Community Service Funding Program Attn: Judy McNabb Post Office Box 9033 Temecula, CA 92589 -9033 City of Temecula Community Service Funding Program Attn: Judy McNabb 43200 Business Park Drive Temecula, CA 92590 Aoolication — Paoe 5 Student of the Month Program,. Inc. History The Student of the Month Program (SOM) was founded in 1992 by Sally A. Myers, who has lived in Temecula since 1984. The program was endorsed by the Temecula Valley Chamber of Commerce and lends its name to the program, thus it is called the Temecula Valley Chamber of Commerce Student of the Month Program. The program is celebrating its 19" year and its goal is to recognize character, perseverance, and encourage and inspire academic excellence and scholarship to our local high school students. As the community has grown and the number of high schools have increased in Temecula, the SOM Program has actively met the growing demands. One area of growth that was imperative to the continued operation and success of the program was becoming a charitable 501 (c) 3 non -profit organization in October 2008. Financial Records The Student of the Month Program, Inc operates its recognition and scholarship program in Temecula, Murrieta, Lake Elsinore and Perris/Menifee. Each program operates independently of each other and is financially independent. We have one bank account for our General Operating Fund and one bank account for the Scholarship Fund. The Student of the Month Program, Inc. uses Quick Books, Non -Profit Edition and divides it's reporting into four classes to keep each program's income /expenses separate. For the purpose of this grant, the Temecula program is the only program under consideration. Enclosed is the Balance Sheet for the entire organization, two P &L statements: one for the entire organization and one for Temecula. The records represent the 2009 -2010 program. Mission Statement The Mission of the program as stated in the Bylaws, "is to provide a local high school recognition program which will acknowledge and honor students for their character, their love of learning, commitment to academics; in addition to, their participation in athletics, school activities, or community service; or the ability to persevere and overcome difficult life circumstances in a setting that honors God, Country, Family, Community and Free Enterprise." Sally A. Myers, Founder 43172 Business Park Drive, Suite 101 * Temecula, CA 92590 sally @bmwmanagement.com TEL 951.506.8024 * FAX 951.699.3226 * CELL 951.775.0520 _ _ r Operations & Services The SOM program operates year round. The Student Awards are presented September through June with the scholarships being fulfilled throughout the year. The summer is spent confirming sponsors, preparing budgets, - financials, and organizing the program for the next school year. The SOM Program honors students from the four comprehensive high schools in Temecula, and the three alternative /small schools in Temecula. To accomplish this task we work closely with the Temecula Valley Unified School District, The Linfield Christian School and the Temecula Valley Chamber of Commerce. The schools that participate in the SOM Program are listed below: — Linfield Christian High — Temecula Valley High — Chaparral High — Great Oak High — Rancho Vista High (Alternative School) -- Susan H. Nelson High (Alternative School) Temecula Preparatory (Charter School) How the Program Works Each school administration selects one boy and one girl each month who best demonstrates the mission of the Program and is invited to a special luncheon in their honor with their family. A total of ten students are selected each month and 90 students (September — May) are honored over the course of the school year. The students must be high school seniors and must be college bound or vocational/trade school bound. The Principal, nominating teacher, local, county, state and federal dignitaries and the sponsoring businesses attend to meet the students and hear why they were selected. The students and their families address the guests and share their personal stories. In the spring, the Students of the Month are asked to complete a competitive scholarship application which is administrated and judged by the Temecula Valley Chamber of Commerce. This special committee selects one boy and one girl from each school to be recognized as the Student of the Year and is awarded a generous Scholarship donated by our sponsors. The SOM program is well known and respected in the community for bringing a broad cross - section of the community together each month in a non - political, small town atmosphere to honor students and families for making a difference. The program honors students from all demographic backgrounds, physical abilities and family backgrounds. This is what makes our program unique, heartwarming and motivational. The community, the students and schools benefit from the program because it is video -taped and edited for viewing on Time Warner Cable TV, which means that the program is aired for the community -at -large to view. The program gives a breath of hope to the viewers as students share their personal story from their heart. Through the storytelling nature of the 1 _ program it is easy for the community to witness the close relationships that have developed during the high school years by the teachers and their students. It also demonstrates healthy relationships and reconciled relationships between parents and their children. It truly is an inspirational event to attend each month. Most of the guests leave . with tears streaming down their faces.: The SOM Program operates with an all volunteer staff. There are no full-time or part -time positions. Our volunteers enjoy working in their area of giftedness. The SOM Program presently has 16 local volunteers who share their gifts and talents in amazing way. SOM has a thoughtful and well organized organization and it's Founder, Sally Myers has been its Presidem/CEO for the 18 years its been serving the Valley. Meet our volunteers: Sally A. Myers, BMW Management/Sizzler — Founder and Administrator since 1992 Rita Massie, Board of Director — Treasurer Carolyn Mitchell, Board of Director, Secretary Kim Garcia, CFO Tamda Medical - Accountant Jennifer Cloud, TVCC — Communication Coordinator Jerri Selway, Pacific Western Bank — Gift Bag Coordinator Alisa Garrett, Pacific Western Bank — Gift Bag Coordinator Lisa Cataldo, TVUSD— Master Data Base & Donation Correspondence Melanie Norton, TVUSD - Publicity Cari Zamora, BetterWorld Trust — Scholarship Administrator Andria Donahoe, BetterWorld Trust — Scholarship Administrator Geeta Gupta, Parent of the 2008 Great Oak High Student of the Year— Greeter Shareen Dombkowski, local parent - Greeter Sue Mai — Retired Secretary of CHS. Worked on the school side of SOM for 12 years — Assist with Administration Marcia McDonnell — Retired Counselor at TVHS — Assist with Administration Karen Medley, Linfield Senior - Summer Gift Organizer Anne Taylor, Former Linfield Student & freshman at Pt. Loma — Correspondence The program and its board of directors work closely with the school district, the high school principals, the Temecula Valley Chamber of Commerce, its volunteers and its sponsors to continually evaluate its procedures, and operations to meet the recognition and scholarship needs as the community changes and school sites increase. We meet annually to discuss opportunities for improvement for the upcoming year. Our main focus is to provide a non -bias, non - political venue for honoring our outstanding students in Temecula and invest in their futures with scholarships to the academic college /university or vocational school of their choice. Project Description The Community Service Funding Grant will be used 100% for the Video Production of the 9 monthly lunches for the 2010 -2011 school year (September 2010 through May 2011). The event is video - taped by Group One Production that edits and produces the program for Time Warner Cable TV. Time Wainer airs the program each month through the generosity of the City of Temecula. The community benefits from the program and is inspired by t hearing the stories of victory and perseverance from our local youth. I receive many letters and phone calls from local residents who watch the program on Time Warner and want to know how their son or daughter can become Student of the Month. It is satisfying to hear how the stories of victory, praise and perseverance become family talking points of "how to stand fm, or how to make a difference" at time when so many families and their children need hope and positive examples of real life situations. The students of the month become `living' examples and testimonies to other students in the community. The students experience individual growth as they prepare to present their story and learn how to speak in a public setting. We ask the students to dress for success and they are required to send a hand- written thank you note to each sponsor and dignitary involved in the program. In order to be awarded the scholarship they must complete a competitive application with rigorous requirements within a deadline to be considered for the generous award. The School District benefits because the community is able to witness first hand the relationships that have been nurtured and developed over the course of the high school years between the teacher /student, principal/student, and parent/student. These relationships reveal how influential these key people are in developing the character and attributes of each child. Whether the student is a high achiever or has overcome obstacles, they are appreciative for the educational team that stands behind them, encourages them to learn and accomplish to the best of their ability and strive to pursue their future goals. The school district is grateful to the parents and family members who appreciate their support above and beyond the job description. The City benefits by being part of the program through the attendance of City Council members who take time to personally welcome the students and their families. The attending members offer words of encouragement and wisdom to the students and families. It shows that the City sincerely cares about the future of its young citizens by positively acknowledging character, service, education and perseverance. The city also encourages the students to return to Temecula after they've completed their education to find employment, open a small business or participate in community organizations that serve others and better the quality of life in Temecula. Past Project Benefits Yes, the Student of the Month has received three Community Service Grants in 2007, 2008 and 2009. The award was used for the same purpose - for the Video Production of the monthly lunches which are aired on Time Warner Cable TV. The same will apply if we are fortunate to receive the grant for this school year. Please find attached the Group One Production invoice for the 2010 -2011 school year. Temecula CA 92592 951 -676 -8980 group.one@Verizonnet grg F I 1 Please detach top portion and return with your payment. _� 1,11. �M {T 4 � G+ FE! 11- Please detach top portion and return with your payment. _� 1,11. �M {T 4 � G+ FE! 11- Y 2010 -2011 Temecula SOM Operating Budget 9 -13 -10 8;50 PM -- Student of the Month., Program, Inc: _ j2 t f ` e CA-S 09/11/10 .- - - -- Profit -& Loss by Class - - - -- - P tit ` T-e m e C J i o- — .. - Accrual Basis July 2009 through June 2010 Only NCC TOTAL Income 410 - Income Contribution -_, - - -- -- ,S -c11 od �. C/ e4 (' 410 -NCC Income Contribution 15,005.00 - 15,005.00 -- Total 410 - Income Contribution 15,005.00 15,005.00 420 - Income - Scholarship _.. -_ - .. _ .... . _. - ....... ... _._. m -. ... lar _.... - 420 -.NCC Income Scholarship 6,500.00 6,500.00 -. - - -- - - -- - -- - - ' Total 420 - Income Scholarship 6,500.00 6,500.00 - Total Income 21,505.00 - 21,505.00 Expense _. ...........610 - Expense Meals - 610 - NCC Expense Meals 9,997.50 9,997.50 - - - Total 610 - Expense Meals 9,997.50 9,997.50 - 620 - Printing - - - 620 - NCC Printing - 191.94 191.94 - Total 620 - Printing - 191.94 191.94 - 625 - Postage 625 - NCC Postage 23.45 23.45 - Total 625 - Postage 23.45 - - - 23.45 - - 630 - Videography. '.. 630 - NCC Video 3,000.00 3,000.00 - Total 630 - Videography 3,000.00 3,000.00 640 - Student of Year Gifts 640 - NCC SOY Gifts 139.95 139.95 Total 640 - Student of Year Gifts 139.95 139.95 645 - Volunteer Gifts 645 - NCC Volunteer Gifts 251.34 251.34 Total 645 - Volunteer Gifts 251.34. 251.34 675 - Scholarship Expense 675 - N Scholarship Expense 6,500.00 6,500.00 Total 675 - Scholarship Expense 6,500.00 6,500.00 655 - Accounting 659 - NCC Accounting 48.75 48.75 Total 655 - Accounting 48.75 48.75 660 - Tax Non Profit - 664 • NCC Tax Non Profit 15.00 15.00 Total 660 - Tax Non Profit 15.00 15.00 Total Expense 20,167.93 20,167.93 - Net Income 1,337.07 1,337.07. 8:49 PM _. - Student of the Month Program, Inc:' _- Re-Flec }s Ari HI TPra3ra_ms 09111/10 Balance Sheet - �emecV i[t x Accrual Basis - As of June 30, 2010 Tn Jf r i ei -c1;, -.Jun 30, 10 __ -.: - -L, c���.f� V13inore.- - - -..- ASSETS .__ Qerr; -s /Meni Fee -- Current Assets . Checking /Savings.... - - - - 110 - Income Contribution 53,616.96 - - - _..... ...120 - Scholarships Income _ _. .41,534.88 - - Total Checking /Savings 95,151.84 - Accounts Receivable - - - 11000 -- Accounts Receivable - - - 500.00 - - - Total Accounts Receivable 500.00 - _ -..... Total Current Assets.. -... 95,651.84.. - - - - - TOTAL ASSETS _ 95,651.84 .. i - LIABILITIES & EQUITY - Liabilities - Current Liabilities Other. Current Liabilities 201 - LE 08 -09 Scholarship Rese 2,000.00 n _ 201 - MV 08 -09 Scholarship Rese 500.00. - - - -- 201 - PM 08 -09 Scholarship Rese 1,500.00 - 202 - LE 09 -10 Scholarship Rese 15,629.00. 202 - MV 09 -10 Scholarship Rese 3,600.00 202 - PM 09 -10 Scholarship Rese 11,000.00 202 -TV 09 -10 Scholarship Rese 7,300.00 275 • Unredeemed Scholarships 12,351.16 Total Other Current Liabilities 53,880.16 - Total Current Liabilities 53,880.16 Total Liabilities 53,880.16 - - Equity 32000 • Retained Earnings 35,060.44 Net Income 6,711.24 Total Equity 41,771.68 TOTAL LIABILITIES & EQUITY 95,651.84 IL i 00000 N 0000 M NMVO M O O nnAd O)01 O)01 A 0000 ATV V� Q J OOOOO M0A0 Qj O t i M MO ' O G O. 0 N N N N O (31 O O N _Y. A@ N _ A N N O m r w n m o N r m cn -00000 O 0000 b OOOOm O 000'Q 00.00_N_ o 00 o - 0000 o 000rn 000a . m O.O O A C5 c; O O O O �- O O O M 0 A N ?. N O 00 N C N A N 00000 W 0000 O V 00 d' O N O O 00 A O 00 00 Oovo K V 00000 opoo �. a Ap OO o o� oprn0 OO -m O- O ON O O 0 0 0 E 0 0 O N 0 0 d' _ 00 Cli O !� m cl 0 l.= - 0 r 0 o 0o r A o M N 0 0 000 0 0 0 0 T < O M O O r N O O N O O 0 0 0 0 ov oo oopoo of 000p Ni ov000 � o ornoo omoo o1r'oo o o�oo oN oo C ;0000 N c W M A U) G N oU d 0 0000 0 a�� M '4' 00000 N 0000 a 001 N000 �- O n00.0 MOOD 0000 V O O O N L U 0 0 0 0 0 O O O O M O O.O N O 000 y LA U 00000 r 0000 M x.000 O -000 N W Y N 04- o. o m o m o o 0 0 O T O O m D7 O O O i/ o— r L. 7 N O O N<O G O O O IL ' o Ca ,J n l- rq P c t% e-Lo HIGH SCHOOL STUDENT OF THE MONTH PROGRAM um stories of character were celebrated and 27 college scholarships were awarded in June by the Valley's High School Student of the Month Progran was founded by businesswoman, Sally Myers and Sizzler R_ taurant franchisee of 27 years. Her passion to bring together God, Country, Family, Community and Free Enterprise has en- joyed strong community support since 1992. The Student of the Month Program brings the community together to honor young people for character, love of learning, making a difference and perseverance. Over $49,500 in scholarships was raised for the 27 Student of the Year winners. Over the past 18 years, the program has blossomed and now serves the 28 high schools (comprehensive, alternative and private) within Temecula, Murrieta, Lake Elsinore, and Perris/ Menifee. The program is endorsed and named respectively after the local Chambers of Commerce and works closely with each of the respective school districts. A total of 270 students are selected each school year between the four communities and over 4,000 students 38 1 Wee�',auntukeview August/September2010 ua umn „unureu since its inception. Sally is grateful for the loyal sponsors and the dedicated volunteers who assist with the program. Every month during the school year, participating high schools select a college bound or trade school bound senior to attend a special lunch or breakfast with their family. They are honored and showered with gifts from over 250 generous sponsors. The focus is on the students and their stories. The stories are honest, heartfelt, they range from adversity to victory, and many times the students and the sponsors shed a few tears. At the end of the year, the students compete for the title of Student of the Year and 27 students between the four programs are awarded up to $2,750 in college scholarships donated by the local business and the non -profit community. The program encourages the students to return to the Valley after they have completed college, seek employment, start their own business and then get involved. The first student to return from college and volunteer for the Student of the Month Program is Jennifer Pham, who was the 2002 Murrieta Valley High School Student of the Year. Jennifer started her own business, Learning with Jen, and now Co- Chairs the Murrieta Student of the Month Pmgram with Margaret Jones of A -1 Tuscany Travel. She is the perfect example of what the program stands for and promotes. Sally concludes each ceremony with a quote from her favorite author, John C. Maxwell's book, Talent is Never Enough. Maxwell encourages his readers to develop their God given talents; and adds that God given talent get you noticed, but its character and integrity that earn people respect and opportunity. If you wish for additional information about the SOM Program please contact Sally at (951) 506 -80244sJ' Abbott Vascular Square Imaging, Inc. - �'�1'CG Newslei-}er S�k.,,2o►O !. Stadium Pizza First California Bank Temecula Valley Optom- Congratulations to the 2010 Students of the Year HONORING STUDENTS SINCE 1992: Milgard Windows and Doors These ten outstanding students competed through a rigorous application and may process to be selected as the Temecula Valley Chamber of Commerce Students of theYear. Each studentreceived a college scholarship valued at $1,300 from the Temecula and Murrieta business community. The Students and - their families were treated to a formal luncheon by numerous business sponsors, awarded plaques and certificates from Local, County, State and US digni- taries, in addition to, aPromenade shopping bag full of gifts from localmerchants. The Student of the Month Program has honored students in Temecula since 1992 and is chaired by business woman Sally A. Myers. All gifts, meals and scholarships are donated by the generosity of the business community. ` The Program will resume in September. For more information please call Sally Myers at (951) 506 -8024. The 2010 Students of the Year are: Promenade Temecula La Masters of Fine Jewelry Chaparral HighSch_ School Tulips, Trophies & Treasures - Lake Elsinore Storm Baseball - - - Chris Pike - The Chamber would also like to thank the McDonald's Meredith Ritter sponsors thank contribute to the monthly Stu- Mt. San Jacinto College Great Oak High School - dent of the Month luncheons. It is with our y The Movie Experience Kyle M. Green - generous support that the program hasears. . contin- Mulligan Family Fun Center Victoria J. Hargis ued for 18 y Promenade Temecula Linfield Christian School The 200912010 Student of the Month Lunch Promotional Products Co. Postural Solutions Mitchell R. Combs Sponsors were: Richie's Real American Diner Kristy L. Ness Advanced College Solutions, Inc. Robecks Smoothies & Juices Rancho Vista High School Altura Credit Union Cal State University San Marcos Robinson Printing Adam Lee Granite Construction Company Signature Farms Sizzler Restaurant Susan H. Nelson High School Hospice of the Valleys Stadium Pizza Rachel Iversen Julie Ngo —State Farm Insurance Agent Temeku Cinemas . Temecula Valley High School Kuebler Prndhomme & Co. Mt. San Jacinto College Temecula Valley Optometry Valerie Biswas - Ouch Sports Medical Center Visterra Credit Union Karl M. Pmhsmeier Pacific Marine Credit Union A special thank you to the media sponsors The Student of the Year Luncheon would not Pacific Western Bank for assisting in promoting this event. be possible without the many sponsors that - Paradise Chevrolet Cadillac The 2009/2010 Media Sponsors were: contribute to the program. The Temecula Poindexter Consulting Group, Inc City of Temecula Valley Chamber of Commerce would like to Professional Hospital Supply CR &R- Recycling & Refuse Service thank the sponsors for seeing the importance Rancho Ford Lincoln Mercury Group One Production _ of education and the community. Riverside County Office of Education Temecula Valley Unified School District The Student of the Year Scholarship Rotary Club of Temecula Time Warner Cable _ Sponsors were: Sizzler - Abbott Vascular Square Imaging, Inc. Commerce Bank of Temecula Valley Stadium Pizza First California Bank Temecula Valley Optom- Granite Construction city Koehler Prudhomme & Co. Toyota of Temecula Valley Milgard Windows and Doors USA Federal Credit Union Pacific Western Bank Visterra Credit Union Paradise Chevrolet Cadillac Wells Fargo Bank — Promenade Temecula Butterfield Station Rancho Family Medical Group Wells Fargo —Ynez Southern California Edison Toyota of Temecula Valley 200912010 Student of Up on the Roof, Inc. the Month Gift USA Federal Credit Union Sponsors were: Student of the Year Gift Sponsors were, Costco Chick -Fil -A CR &R Recycling & Refuse Service Inland Valley Black Chamber of Commerce The Linfield Christian School Nash Dental Care pg20 July /August 20101 TEMECULA TODAY Brunswick Cal Oaks Bowl Carls Jr. Castle Amusement Park Chick -Fil -A - Clear Blue Promotions In -N -Out Burger Left to Right: or Carol Leighty ( Superinendent TVUSD), Vikita Poindexter (SOM Develop - � ment), Jackie Steed (Temecula Valley Chamber of Commerce), Victoria Hmgis (GOHS), Chris Pike (CHS), Meredith Ritter (CHS), Adam Lee(Rancho Vista), Rachel Iversen (Susan H. Nelson), Ked Pmhsmeier (TVHS), Valerie Pistons (TVHS), Mitchell Combs (Linfield), Krisry Ness (Lin - field), Karen Raftery ( Superintendent Linfield Christian School) and Sally Myers (Founder SOM Preen an) OF STUDENT OF THE MONTH PROGRAMS INC., A California Public Benefit Non -Profit Corporation ARTICLE I GENERAL INFORMATION 1.1 Name The name of this Corporation is STUDENT OF THE MONTH PROGRAM, INC. 1.2 Corporate Offices (A) The principal office for the transaction of the activities and affairs of this Corporation is located at 43172 Business Park Drive, Suite 101, Temecula, CA 92590. The Board of Directors (refereed to as `Board" or "Directors ") may change the location of the principal office. Any such change of location must be noted by the secretary in the corporate Minutes; alternatively, this Section of the bylaws may be amended to state the new location. (B) The Board may at any time establish branch or subordinate offices at any place or places where this Corporation is qualified to conduct its activities. 1.3 Pumose_ — 0'j sc$1 o n The purpose of this Corporation is to provide a local high school recognition program which will acknowledge and honor students for their character, their love of learning, commitment to academics; in addition to, their participation in athletics, school activities, or community service; or the ability to persevere and overcome difficult life circumstances in a setting that honors God, Countty, Family, Community and Free Enterprise. Also in the context of these purposes, notwithstanding any other provision of these articles, the Corporation shall not carry on any other activities not permitted to be carried on (1) by a Corporation exempt from federal income tax under Section 501(c)(3) of the Internal Revenue Code or (2) by a Corporation contributions to which are deductible under Section 170(c)(2) of the Internal Revenue Code. Additionally, no substantial part of the activities of this Corporation shall consist of carrying on propaganda, or otherwise attempting to influence legislation, and the Corporation shall notparticipate orintervene in any political campaign (includingthe publishing or disttibudon of statements) on behalf of, or in opposition to, any candidate for public office. 1.4 Context Unless the context requires otherwise, the general provisions, rules of construction, and definitions in the California Nonprofit Corporation Law shall govern the construction of these bvlaws. Page 1 of 18 S1UUENTzUF THE MONTH PROGRAM INC } SALLY A MYERS 43172 BUSINESS PARK DR STE 101 TEMECULA CA 92590 -5626- Purpose Code Section Form of Organization Accounting Period Ending: Organization Number ?EXEMPT CHARITABLE 23701d Corporation December 31 3165952 ACKNOWLEDGEMENT LETTER This letter acknowledges that the Franchise Tax Board (FTB) has received Your federal determination letter that shows exemption under Internal Revenue Code (IRC) Section 501(c)(3). Under California law, Revenue and Taxation Code (R &TC) Section 23701d(c)(1) provides that an organization is exempt from taxes imposed under Part 11 upon submission of the federal determination letter approving the organization's tax - exempt status Pursuant to Section 501(c)(3) of the IRC. The effective date of your organization's California tax- exempt status is 10/21/2008. R &TC Section 23701d(c)(1) further provides that the effective date of an organization's California tax - exempt status is the same date as the federal tax - exempt status under IRC Section 501(c)(3). Under R &TC Section 23701d(c), any change to your organization's operation, character, or purpose that has occurred since the federal exemption was originally granted must be reported immediately to this office. Additionally, organizations are required to be organized and operating for BMW MANA.GEMEN Dear Applicant: _ We are pleased to inform you that upon review of your application for tax exempt status we have determined that you are exempt from Federal income tax under section 501(c)(3) of the Internal Revenue Code. Contributions to you are deductible under section 170 of the Code. You are also qualified to receive tax deductible bequests, devises, transfers or gifts under section 2055, 2106 or 2522 of the Code. Because this letter could help resolve any questions regarding your exempt status, you should keep it in your permanent records. Organizations exempt under section 501(c)(3) of the Code are further classified as either public charities or private foundations. We determined that you are a public charity under the Code sections) listed in the heading of this letter -. - - Please see enclosed Publication 4221 -PC, Compliance Guide for 501(c).(3) Public Charities, for some helpful information about your responsibilities as an exempt organization. Letter 947 (DO /CG) .'� INTERNAL REVENUE SERVICE__, DEPARTMENT ,OF THE �.TREASURY. _.. P -. -O. -BOX 2508 CINCINNATI, OH ...45201.. - - _. .. MAY.. c�:_2 ®� ®.. .. _ Employer. Identification _Number: - Date._ _. 94- 3448962. -_ _.... _. .. _- _.. _. .._.. 17053104032019.. - STUDENT OF THE MONTH PROGRAM INC ..Contact Person: .. - C /O- SALLY A MYERS• -- - -- JOAN -C KISER - ID #.31217. - -43172 BUSINESS PARK DR 'STE 101 Contact Telephone - Number: -. - TEMECULA, CA J92590 : (877) 829 -5500 `- Accounting Period Ending: - - - December 31 _Public Charity Status: - - - --- --- - - 170(b) (1) (A) (vi) F - - -- - - Form 990 Required: -- : Yes - Effective Date of Exemption: .October 21, 2008 _ - Contribution Deductibility: RECEIVED Yes Addendum Applies: MAY 101 .NO BMW MANA.GEMEN Dear Applicant: _ We are pleased to inform you that upon review of your application for tax exempt status we have determined that you are exempt from Federal income tax under section 501(c)(3) of the Internal Revenue Code. Contributions to you are deductible under section 170 of the Code. You are also qualified to receive tax deductible bequests, devises, transfers or gifts under section 2055, 2106 or 2522 of the Code. Because this letter could help resolve any questions regarding your exempt status, you should keep it in your permanent records. Organizations exempt under section 501(c)(3) of the Code are further classified as either public charities or private foundations. We determined that you are a public charity under the Code sections) listed in the heading of this letter -. - - Please see enclosed Publication 4221 -PC, Compliance Guide for 501(c).(3) Public Charities, for some helpful information about your responsibilities as an exempt organization. Letter 947 (DO /CG) Amount Requested: Project Name: Project Start Name Contact PROJECT INFORMATION allowable $5,000) End Date: ORGANIZATION INFORMATION Mailing Address:' ��J i�z� .'o / �T� /G�ryJ� ✓! zy l� Telephoner.LX-- /74 — f�j Year Organization Founded: Number of Paid Staff: / Number of Volunteers:_ c? Geographic Area(s)Served: fror t/Z4 Ao Is this organization incorporated in California as a non -profit organization? Yes _ No Effective Date: If °yes" (Must provide a copy of your statement of non- profit status from the State of California): Date of incorporation as a non - profit: Federal identification number._ 7 3 — cO State identification number. If "no": Name of sponsoring organization: Federal identification number. State identification number. This application has been authorized by the organization's: Executive Committee Board of Directors Members -at -Large Application — Page 1 Temecula Valley. We are open Monday, Wednesday and Friday for the distribution of donated food from food drives, surplus foods from local markets, donated clothing and household goods and furniture. Our goal is to help our clients with their immediate needs in all areas. We refer to community and medical services, as well as state agencies. When funds are available, we assist with temporary housing, bus passes, gas cards, etc. The Pantry welcomes all who come to our door, regardless of race, sex, marital status, disability, religion or political affiliation. Clients are asked for contact information and need requirements only. The Pantry is operated by dedicated volunteers and all expenses are kept to a minimum. The day -to -day management is provided by Margie Hammersley who had been the Director since the Pantrys inception.. She is the only person who receives a salary. A Board of Directors, many long acquainted with the pantry, meet Quarterly to evaluate the needs of the Pantry. A member of the Board is on the premises, or on call, every day the Pantry is open. 10:54 AM -- TEAM EVANGELICAL ASSISTANCE MINISTRY - 07107110 Balance Sheet - Accrual Basis As of June 30, 2010 Pagel -Jun 30, 10 ASSETS i r Current Assets - CheckingfSavings - Bank of America - - 21,501.61 - -. - - Total Checking/Savings - 21,501.61 - - - Total Current Assets - - 21,501.61 - TOTAL ASSETS - 21,601.61 - LIABILITIES & EQUITY - Liabilities Current Liabilities Other Current Liabilities 2112 - Accrued Payroll-State 80.53 2130 - Accrued payroll taxes 749.35. 2132 - Accrued FIT 427.48 Total Other Current Liabilities 1,257.36 - Total Current Liabilities 1,257.36 Total Liabilities 1,257.36 Equity 3001 - Opening Sal Equity 6.701.28 3010 - Unrestdct (retained earnings) 8,499.81 Net Income 5,043.16 Total Equity 20,244.25 TOTAL LIABILITIES & EQUITY 21,501.61 ADMINISTRATION: SALARY PAYROLL TAXES INSURANCE FACILITY: INSURANCE RENT @ $1100.00 MO. TELEPHONE & UTILITY MAINTENANCE OFFICE EXPENSES SPECIAL PURCHASE (FREEZER/REFRIG) MINISTRY: FOOD PURCHASES LODGING TRANSPORTATION SPECIAL NEEDS TOTAL ALL EXPENSES i 20,500.00 1,500.00 4,500.00 2,000.00 13,200.00 6,000.00 1,500.00 2,500.00 20,000.00 20,000.00 2,000.00 3,300.00 1,000.00 $ 26,500.00 $ 45,200.00 $ 26,300.00 $ 98,000.00 ummary mcomPer- xpense _ _. _. _...... __._ _._income.. -. - - 4- Contributed support - - 4010 - Indivlbusiness contribution 12,299.94 - -. - - - -4210 - Corpmatelbusiness grants 28,890.00 4230 - Foundatioritrust grams._ .... _.. 6,820.15... _.. 4420 - Donation from Churches 18,210.51 - - Total 4 - Contributed support 66,220.60 5 - Earned revenues ..5310 - Intwest- savingsishortAimn Inv 2.12 Total 5 • Earned revenues _.. 2.12 5800 - Special events 5820 - Special events - gift revenue - 350.00 5800 - Special events - Other 0.00 Total 5800 - Special events . - 350.00 Total Income 65,872.72 Expense 7000 - Grant & contract expense 7050 - Specific assistance - ind 291.00 Total 7000 - Grant & contract expense 291.00 7200 - Salaries & related expenses 7210.Officers & directors salaries 20,350.00 7250 - Payroll taxes 1,548.74 Total 7200 - Salaries & related expenses 21,898.74 7500.Other personnel expenses 7530 -legal fees 75.00 7540 - Professional fees - other 21.30 7580 - Insurance - Workman's Comp 437.00 Total 7500.Other personnel expenses 533.30 7582 - Insurance- Medical 1,110.00 7584 - Insurance -Auto 400.00 8100 - Non - personnel expenses 8110.Office Supplies 539.07 8120 - Groceries 8,989.59 8130 - Telephone & telecommunication 3,224.30 8140 - Postage, shipping, delivery 72.00 8150 - Supplies 1,531.53 8160 - Equip rental & maintenance 170.00 8170 - Backpack Ministry 250.00 8100 - Non - personnel expenses - Other 1.09 Total 8100 - Non - personnel expenses 14,777.58 8200.Occupancy expenses 8210 - Rent, parking, other occupancy 13,200.00 8220 - utilities 2,923.21 8230 - Real estate taxes 189.22 Total 8200.Occupancy expenses 16,312.43 8300 - Travel & meetings expenses - 8310 • Gasoline 2,400.00 - 8320 - Conferenae,convention,meeting - 95.00 Total 8300 - Travel & meetings expenses 2,495.00 - 8330 - Auto Repairs 361.00 Pagel - - TEAM EVANGELICAL ASSISTANCE MINISTRY 10:06 AM 07123N0 _ .. - Profit & Loss Accrual Basis July 2009 through June 2010 8600. -.Misc expenses__. - - - 8510 - Interest expense - general - - - ..14.50 8520 - Insurance 5,32924 ..... .. ..... 8530 - Auto Repairs _ - .... 26.00.. _ -..... 8500 - Mise expenses- Other _ :_ _._ - __. 0.00. _. _..... .. Total 8500 - Misc expenses 5,369.74 - _ 8600 - Business expenses - 8650 - Taxes - other 521.16 Total 8600 - Business. expenses : - . - 521.16 - - Total Expense 64,069.95 - - - Net Ordinary Income 1,802.77 Net Income 1,802.77 - Page PROJECT DESCRIPTION Howwillyourorganizafion use thefundingawarded? Describe the project, project objectives,lhose.served, area serviced, and numberof volunteers involved. Bespecifrc. Include equipment or, services that would be purchased and why. - Include a detailed budget and a schedule of significant - activilies-related to this project You may attach a maximum of one double- spaced typewritten page of information. (Please type or print legibly.) ,_mil Annlir Finn — Pnna i when we make this move as we will need to purchase a walk -in freezer and refrigeration. Some other expenses will be new shelving and packing tables. When we make this move we will be able to serve more clients. We currently service 50 plus families a month with food boxes. These boxes contain enough complete meals to feed a family for 7 days. In the first 6 months of 2010 we have distributed 15,435 meals. We also distributed 149 Easter Boxes that fed 273 individuals a full meal and left- overs! These clients are referred by the Department of Social Services, other Government agencies, churches and other organizations who work with the poor and needy. Three days a week we distribute bakery goods, surplus food, fresh fruit and vegetables from local markets and growers. We average 50 families each day, and estimate that we distributed over 100,000 partial meals to 3,186 families in the first 6 months of this year. Some of these families are return clients, and over 90% live in Temecula. The average size of each family is 4 persons. We have 25 volunteers each day that service these clients. According to the City of Temecula website, in the Pujol neighborhood there are over 300 very-low and low- income apartment units. These are the families we help daily. PAST PROJECT BENEFITS We used the funding_ from 2009 toward rent on the City owned property on Pujol St. _ We served, in the last year, over 1,400 families and individuals, with food boxes containing groceries sufficient to feed their family for 7 days. We distributed over $400,000.00 worth of food and non - perishable items. We receive the food we distribute from food drives but we need to purchase some items. We also need to purchase items such as ...canned meat, peanut butter, jelly, soup, crackers, pasta, rice, beans and water. We are committed to providing nutritious and balanced meals. With our new walk -in freezer and refrigerator we will be able to add fresh meat, milk, eggs, butter, etc. to our clients. We provide 50/60 families each day with surplus food and bakery goods from local markets and local growers. Anyone in need can get in line for these items. For the homeless we provided bus tickets for them to rejoin their families. We provide them with food boxes, personal items, referrals for dental and medical care. Some of the homeless choose to go into rehab for their drug and alcohol addictions. We are working with Victory Outreach in Aguanga. We can refer those desiring help to their facilities where they can stay a year, and then, hopefully, be ready to rejoin society. We are providing Food Boxes to Victory Outreach to help feed these men. They have an average of 30 men there at any one time. At Thanksgiving and Christmas and Easter we distribute food boxes to local families and last Christmas we distributed 6,000 toys to our neighborhood children., - - We keep track of our clients by computer. Food boxes are limited - - -- - to three times a year, however no one is turned away hungry. Our purpose is to help them through a time of need until they are able to -- become self - sufficient. The food boxes are allocated based on family E size and range in value from $55.00 to $135.00. We are the recipient of food drives by many local businesses, organizations, churches, schools and individuals. We receive funds from Grants, churches, businesses and individuals. I PRESIDENT or n AUTHORIZED OFFICER: A°W `cai° vuu c E and Ti rLE (Please Pc or Tv ORGANIZATION MAILING TELEPHONE: , 4: — 'Op,`O � 7 DATED THIS l of , 2010. (Date) (Month) C �6 Yz, BE SURE TO INCLUDE THE ORIGINAL. PLUS ONE COPY AND SUBMIT TO: Mail Completed Applications to: Or Deliver in Person to: City of Temecula Community Service Funding Program Attn: Judy McNabb Post Office Box 9033 Temecula, CA 92589 -9033 City of Temecula Community Service Funding Program Attn: Judy McNabb 43200 Business Park Drive Temecula, CA 92590 Application — Page 5 Foy,. 8379 -EO Department of the Treasury Internal Revenue - Service Name of exempt organization TEAM EVANGELI RS e4ile Signature AUt110rlZatif for an Exempt Organization Ohio No. 1W -1878 i For catendar year 2009 orfiscal yearDegiming.. ... .and ending ► Do not send to the IRS. Keep for your records. 2009 _ r _. :1 See instructions. - ryaiderddca5onruMrer - i — 0210700 MR and title of officer - - ,,.,. -. �, ..a- ......,, -.n-r r..v ravranr.mr�vc nrncr•mn� _ Check the box for the return for which you are using this Form 8879 -EO and enter the applicable amount, if any, from the return. If you check the box on line Ia. 2a, 3a, 4a, or Sa, below, and the amount on that line for the return for which you - - - - - - - - - are filing this form was blank, then leave line tb, 2b, 3b, 4b, or 6b, whichever is applicable, blank (do not enter -0-). But. If you entered -0- on the return, then enter -0- on the applicable line below. Do not complete more than 1 line in Part 1. - 1a Form 990 check here ►IX. b Total revenue, if any (Form 990, Part Vlll, column (A), line 12) - - - - - - - - - - tb - 530,722 2a Form 990 -EZ check here ► _j b Total revenue, if any (Form 990 -FZ, line 9) - - - - - -- . - - • - - - . - • 2b 32 Form 1120 -POL check here ►; It Total tax (Form 1120 -POL, line 22) - - - -- - - - - - - - - • - - - 3b -- 4a Form 990-PF check here jl b Tax based on investment income (Form 990 -PF, Part VI, line 5) . . - - - - - 4b - Be Form 8868 check here ►. : b Balance Due (Form 8868, line 3c) - - - - - - - - - • - - • - -- - - - • - - - - - 6b " Under penalties of perjury, I declare that I am an officer of the above organization and that I have examined a copy of the organization's 2009 electronic return and accompanying schedules and statements and to the best of my knowledge and belief, they are true. - correct, and complete. I further declare that the amount in Part I above is the amount shown on the copy of the organization's electronic return. I consent to allow my intermediate service provider, transmitter, or electronic return originator (ERO) to send the organization's return to the IRS and to receive from the IRS (a) an acknowledgement of receipt or reason for rejection of the transmission, (b) an indication of any refund offset, (c) the reason for any delay in processing the return or refund, and (d) the date of any refund. If applicable. I authorize the U.S. Treasury and its designated Financial Agent to initiate an electronic funds withdrawal (direct debit) entry to the financial institution account indicated in the tax preparation software for payment of the organization's federal taxes owed on this return, and the financial institution to debit the entry to this account. To revoke a payment, I must contact the U.S. Treasury Financial Agent at 1- 888 - 353 -4537 no later than 2 business days prior to the payment (settlement) date- I also authorize the financial institutions involved in the processing of the electronic payment of taxes to receive confidential information necessary to answer inquiries and resolve issues related to the payment I have selected a personal identification number (PIN) as - my signature for the organizations electronic return and, if applicable, the organization's consent to electronic funds withdrawal Officer's PIN: check one box only X Iauthorize EASY TAX SERVICE on the organization's tax year 2009 electronically filed return. is being filed with a state agency(ies) regulating charfi jm -ps I stommenticned FRO to enter my PIN on the mfu rnrdiscfbst As an officer of the organization. I will enter my I filed return. If I have indicated within this return t charities as part of the IRS Fed /State program. I as my signature 4—, ' ca(g within this return that a copy of the return the 1* 1`6 ate program. I also authorize the ire on the organization's tax year 2009 electronically return is being filed with a state agency(ies) reguinnng I on the return's disclosure consent screen. M ERO•a EFINIPIN. Enter your six -dig it EF& followed by your five -digit self - selected PIN. 335823 58651 I certify that the above numericentry Is my PIN, which is my signature on the 2009 ele1-ironically filed return for the Organization indicated above' `I- confirm ttiai1 arRubmiding this return in accordance with the requirementS of Pub. 4163, Modernized a -File (MeF) information for Authurized:IRS e-file Providers for Business Returns- EUCZ.��nawre B MACDONALD onto ► 04 -28 -2010 ERO Must Retain This Form - See Instructions Do Not Submit This Form To the IRS Unless Requested To Do So For Paperwork Reduction Act Notice, see instructions. LLA Form 8879 -E0 ( %009) K h - of p T Y �C tperano^ ^T t - 'AS don '�Olhe ►- !L Yearoffomrahrm 1987 I M slate of legal e0"ahas CA Pill -- Returt 2f Organization Exempt From Inc- ne-Tax _ Form �..' t a i .990 Under section 501(c), 527, or4947(a)(1) of the Internal Revenue Code (except black lung - - -.. 2009 - - 7 7 benefit trust or private foundation) - - - -. 12 - 0 Departmentof de, Treasury - - have to use copy of this return to satisfy state reporting requirements- `. .. _ aspeetion, ..: - totemat Revenue service - ► The organization may a 530, 716 A For the 2009 calendar year, or tax year beginning- - , 2009, and ending- - ; PO - - - - - B Check d applicants: -- Planets . C Name of oimmitmtion TEAM EVANGELICAL - ASSIST- MINISTRIES _..... -.. _. D_Erpbyefd¢nMw4pirra. _ -_ � going ausness As OF RANCHO TEMECIILA MORRIETA VA.. - . 33- 0210704 Address change or. _ Name change -- - pmdor -- - Number and samet (or P.O. tick K mall is cat delivered to sheet address)- - -. - -- - RoomhWhi __.. .. E- Teiephpnetnmber, Inifial rewm M°- 2887D PUJOL ST - - - �- See - (951)676-8022 Tmeinmed usbuo_ CdYwfavn, slate or cormiry.aM 21P +4 - G -Gross recepts - Amended remm - ..§anus... .Temecula, CA 92590 -..... _�.. _.. _ _... g. ..530,722 -- Application pending F Name and address of principal effraec MARGE HAMMERSLEY - ri(a) H ads - - return fa mgroup 3185 DANIEL DR; HEMET, CA 92545 - afifiates? _,Yes ,X No.. I Taxcxemut status: X mu.)( 3 ) A (insedna) .. 4947(a)(1) of :527 H(b) Are aN affiliates mtluded>- .Yes _,., No '. K h - of p T Y �C tperano^ ^T t - 'AS don '�Olhe ►- !L Yearoffomrahrm 1987 I M slate of legal e0"ahas CA Pill I Summary — - -- 1 Briefly describe the organizations mission or most significant activities: PROVIDE ASSISTANCE TO NEEDY IN THE AREAS OF - FOOD, CLOTHING, TEMPORARY SHELTER, ETC A d G t a i y v a t r t n t r a s c x e 2 Check this box ►: if the organization discontinued its operations or disposed of more than 25% of its net assets. 3 Number of voting members of the governing body (Part VI, line ta) - - - - - - - - • - - - - - - • - - 4 Number of independent voting members of the governing body (Part VI, line 1 b) - - - - - - - - - - - - - - - - 5 Total number of employees (Part V, line 2a) - - - - - - • - - - - - - - - • • - - • • • • - - - - - • " 5 Total number of volunteers (estimate if necessary) - - - - - - - - • • - - • • • • - • • • • • • • • - - - - • - 7a Total gross unrelated business revenue from Part Vlll. column (C). line 12 - - - - - - - - - - - • - • • - • - • It Net unrelated business taxable income from Form 990-1, line 34 - - - - - - - - - • • • • • . 3 7 7 4 5 1 5 12 - 0 7b v e n it X P n e Atr. h pr Fund BaI - _— - -_ 8 Conhibutions and grants (Part vul, line ih) - • • .. - ... • - - • - - - - - - - 9 Program service revenue (Part VIII, line 29) • • • • • • • • • • - • • - • • - - 10 investment income (Part VIII, column (A), lines 3, 4, and 7d) - - .. • - • • -- • _• • �_� • 11 Other revenue Part VIII, column (A), lines 5, 6d. 8c, 9c. 10c. and 1 fie) G�' - - - 12 Total revenue - add lines 8 through 11 (must equal Part VIII, column (A) Lne 12} ... - • 13 Grants and similar amounts paid (Pad V, column (A), lines 1 -3) . _ - 14 Benefits paid to or for members (Part 1X, column (A) line 4) - 15 Salaries.. other compensation. employee benefits (Pan IX Him (A) lines 5 1D) - - - t8a PrnfessinnaI fundraising fees (Part IX, column (A). l(pe -T1e) " - - - - - - It Total fundraising expenses (Part IX, column (D) line 25) ► - 3,181 17 Other expenses (Part IX. column (A), lines 1la 11.pf11f -24f) - - • - - - - - • - - - - - 18 Total expenses. Add lines 13 -17 (must equal Part iX. cpiumn W, line 25) • • • • • • • • 110 Revenue less expenses. Subtract line ,-M from line 17 - - - • • • - • • • • • • - • -- 12b Total assets (Pad X. line 16) - - - - • - - • • • • • • • • • • • • ' 21 Total liabilities (Part X- line 26) T • - '•. • • - • • • - • - - • • ' • • • • • • - 121 Net assets or Fund balances Subtract tine 21- #corn line 20 - - - - - - - - - - - - PrnrYrnr - -272, 422 C.mnad Yana 530, 716 0 a _ o _ _ _ 272,426 202,925 _ - 530,722 465, -595 0 26,635 21, 315 _ 0 _ 32,076 -- 43,166 531, 076 (354 End (A Year 261,636 10,790 Beginning us ona ar yrva 16, 907. 16, 460 1,.239 - 11330 - 15,577 15,222 ParY:Il I Sianature Block ° sign Here llnder rallms of porjury -1 dedarei6a[ I Have examined this rehun- inuludmg aceampanyvn9 scneaams acv etanxirouu. auv m .,.,�.......y •........,..;r nud tmba(. it i i Wa. rArfO°f. enC-CVmPtere:t7atlaraaon orProParer (ether vrnn omx�d k based an all inicrmation of Which Ixaparof Was ortY xOtlWleg98. Slpnat M nfi .. Dec, \'- MARGE HAMMERS'LEY, EXECUTIVE DIRECTOR - ';Type or print name and life -- - unit Check if Prepamt a mwnlgang nwnuer PrePamrs. yeti -'. (sec.i,ulrudrtnni - .,innalure ' 1. erlllllPy9a ► X- _ Paid MICHAEL B MACDONALD Prrparcen EASY TAX SERVICE Use Only FimrS name (nrymus if =_ett- unyroyed). 39844 MOUNT BLANC AVE address. and Zm +n Murrieta, CA 92562 I May the IRS discuss this return with the preparer shown above? (see instmcl For Privacy Act and Paperwork Reduction Act Notice, see the separate (ns1 LIN Phoncno_ ►951 -970 -9935 - - • - • - .... .. • . - __yes _X No s. tr-,A Form 990 (20091 Form g90 (2 09) - -: - -TEAM EVANGE , )AL ASSIST MINISTRIES `� - 33-0210704 Page P rt IV Checklist of Required Schedules ..... - __ _ -.___ Yes No - X: I Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)?. If "Yes," _._.__..._ `..._-_- _.._._...- ._._- ".::..._ __ -. .: -1 - 2 X complete Schedule A'•. 2 - Is the organization required to complete Schedule B. Schedule of Contributors ?_. - - • -.'_ • ' ' ' ' - - ' '.' ' ' ' " ' 3 Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to ______ _ _________._.__._. -- -candidates for public ogee ? If " Yes; " complete - Schedule C,. Part l. _ -_rr _ .. _ -_.. -4 - Section 501(c)(3) organizations. Did the organization engage in lobbying activities? If "Yes, complete Schedule C. Part 11 ..... _... _ _ ... _ ..... _ _ .. _ _ _ . _. _ ' - 5 � Section 501(c)(4), 501(c)(5), and 501(c)(6) organizations. Is the organization subject to the section 6033(e) - -- _ notice and reporting requirement and proxy tax? If "Yes," complete Schedule C, Part 111 - _ - - _- - _ - 6 Did the organization maintain any donor advised funds or any similar funds or accounts where donors have - the right to provide advice on the distribution or investment of amounts in such funds or accounts? If "Yes:- complete Schedule D, Part 1 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ • - - ' - - ..... - . -X j -- - X 3 j s -. - 7 - Did the organization receive or hold aconservation easement, - including easements to preserve open space, _ _ - - the environment, historic land areas, or historic structures? if "Yes," complete Schedule D. Part 11 . _ • - • • • _ _ • . • . ' ' - 8 Did the organization maintain collections of works of art, historical treasures, or other similar assets? If'Yes-" complete Schedule D. Part ill - - - - - - - - - • • - - - .. • ' " ' _ " " • • • _ • . _ • • . .. • - • - - - • • . • 9 Did the organization report an amount in Part X, line 21; serve as a custodian for amounts not listed in Part - X: or provide credit counseling, debt management, credit repair, or debt negotiation services? If "Yes," - complete Schedule D. Part IV ........ • • • • • • • . ' ... ' ... • " " " 10 Did the organization, directly or through a related organization, hold assets in term, permanent, or _ quasi- endowments? if "Yes," complete Schedule D, Part V - - • - • - - - - - - - - " " - _ " " _ " " - " - - _ " - - - - • 11 Is the organizations answer to any of the following questions "Yes'? If so, complete Schedule D; Parts VI, - - VII, VIII. IX, or X as applicable ' . _ _ _ • • • • _ • • • • ' • ' ' . _ ' ' ' ' _ " • " " . • .. • • .... _ . - _ _ . + Did the organization report an amount for land buildings. and equipment in Part X, line 109 If "Yes;' complete 7 X X X X_ _ X l 8 - 9 10 tt Schedule D, Part V1. - • Did the organization report an amount for investments - other securities in Part X, line 12 that is 5% or more of its total assets reported in Part X, line 161 if Yes," complete Schedule D, Part VII. Did the organization report an amount for investments- program related in Part X, line 13 that is 5% or more of its total assets reported in Pad X, line 16? if ,yes," complete Schedule D, Part VIII. Did the organization report an amount for other assets in Part X, line 15 that is 59' oc more'gf its total assets reported in Part X. line 16? If "Yes," complete Schedule D, Part IX. s Did the organization report an amount for other liabilities in Part X, line 257 Ei''Yes fmmplete`chedule D, Part X. separate or consolidated financial statements f u the f year include a1ootnote- that addresses Did the organizations the organization's liability for uncertain tax positions under FIN 48? If Ales Xcorr plefe Schedule D. part X. 12 Did the organization obtain separate. independent audited financia)statements for-the tax year? If "(as,- complete Schedule D. Parts XL XII. and XIII - - - - - - - - .._ . .. _ . _ ... ' . ' ' ' _ " • " - ' - - 12A Was the organization included in consolidated, Indepepdent audited fiflaneal statements for the tax year. If Yes." completing Schedule D. Parts XI, Xn, and Xii(rs optional :. -:.. • ' • • • _ • _ • • . • _ • • _ . 13 Is the organization a school described in section 170(b)($, f'Yes," complete Schedule E - - --- -- -_- ..._ -_ _.o 14a Oki the organization maintain an office. employees. or agen(s-outside of the United States? •. - .... _ . b Did the organization have aggregate revenues,pexpenses of more than 510.000 from gi antmaking, fundraising, business, and program service activilles:Dutsidelhe United States? If "Yes," complete Schedule F, Part I _ . .. • - . _ _ 18 Did the organization report on Pad IX, c.UlumKj-�-),. IIW1 more than 55.000 of grants or assistance to any organization or entity located outside lfie- United Slates? If "Yes," complete Schedule F. Part II - - - - - - - - - - - - - - 1s Did the organization repod on f?d'rt'IX w -himn (A); line 3, more than $5,000 of aggregate grants_ or assistance to Individuals located- tOutside.the UndedStams? If "Yes," complete Schedule F. Part III _ - - - - - - - - - - - • - - - - - - • 17 Did the organization repart.,a total of more than $15.000 of expenses for professional fundraising services -- _ =- . _ _ on Part IX. column (Aj. Iine5 *and fie? If "Yes "complete Schedule G, Part 1 • . _ • • .... • ' 18 Did the organization repaq motelhan 515.000 total of fundraising event gross Income and contributions on Part VIII lines is and 0 tf"Yes," complete Schedule G. Part II • _ • • • . • • • • • • ' ' ' . ' • ' ' ' • ' ' ' ' • • _ 19 Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, lino 9a? II "Yes." complete Sc ti dule G. Part III ... • . • . • • • • • _ • • .. ' 20 Did the organrzat:on operate one or more hospitals? If "Yes;' complete Schedule H - • ... • . -... ' • ` - ' >- • ' ' ' • ' . X . X X X X X X X ,. X [20001 1z ' 13 14a ._ idb _ 16 17 18 2a For 990 - FEA - - Suhedule S tForm 990,990-E7, or 99"F) (2009) Page 1 of 1 of Part I Name of organization _ Employer identlflcation number -TEAM- EVANGELICAL ASSIST - TIINISTRIES - - - - - - -. __ _ 33- 0210704. Part t Contributors (see instructions) No. Name address and ZIP +4 AggMate contributions Type of contribution 1- CITY OF TEMECULA - - _ - Person _ . X Payroll _ 43200 BUSINESS PARD DRIVE.. - _ $.... - 5,000. Noncash _— - . (Complete Part 11 if there is Temecula, CA 92589 - a noncash contribution.) - (a) No. (b) Name, _address and ZIP +4 (c) Aggregate contributions (d)_ Tyne of contribution 2 GRACE PRESBYTERIAN CHURCH Person - - -_X. Payroll _ 31143 NICHOLAS ROAD $ 6,563 Noncash (Complete Part II if there is Temecula, CA 92591 a noncash Contribution.) (a) No. (b) Name address and ZIP + 4 (c) Aggregate contributions (d) Type of contribution 3 PECHANGA RESORT AND CASION Person X -- Payroll PECHANGA PARKWAY $ 8,750 Noncash (Complete Part It if there is -a noncash contribution.) Temecula, CA 92592 l s (a) No_ (b) Name address and ZIP + 4 (c) Awgrectiate contributions (d) e ontri ution T of c r - Person _ _ $ Payroll Noncash I - - -- _, - - (Complete Part It if there is a noncash contribution.) (a) No_ (= Name addres" d ZIP +4 (cj Aggregate co tri utions (d) Type of contribution Person Payroll _ $ Noncash (Complete P2111 it there is -' - - (c) Aggregate contribution a noncash contribution.) (d) T e ntrlbutian- (a) No. (b) Name address and ZIP + 4 Person Payroll $ Noncash (Complete roan n it mere Is a noncash contribution.) rrA < N _ a a CL (no y m � � ID m H o a y tl � m o � Y r m — a7 N m H r N D m T fn' tll m u 0 aCD � ¢C x N z m a r o R ' 9 � m j. n D e] S o I Q1 r N b 4 y n =s c n s � b e x - c� d m e; ro sl o , t i �I < N _ a a CL (no y m � is ID m H a y < N _ a CL (no y m � is ID C . N b M. N � m o � Y r m — a7 N m H N N D m T fn' tll m u N 3 aCD � ¢C w b 0 s schedie A (FOrm990 oraso- EZ)2ooa - -- -. TEA4' .- �ANGBLICAL ASSIST MINISTRIES. •;_ 33- 0210704 - -Page M;tt Support Schedule for Organ zations Described in Sections 170(b)(.,( )(iv) and 170(b)(1)(A)(vi) x - - - (Complete only if you checked the box on line 5, 7, or 8 of Part L) _ Section A. Public Support Calendar year (or fiscal year beginning in) ll� (a) 2005 (b) 20(16 ' (y 2007 (d) Section B. Total Support Calen 7 8 9 10 11 12 13 dar year (or fiscal year beginning in) ► (a) 2005 (b) 2006 (c) 2007 (d) 2008 (e) 2009 (f) Total Amounts from line - • • • • - • • - 238,936 238,986 248,582 272,422 530,716 1,529,642 Gross income from interest, dividends, - payments received on securities loans, - - - - - rents. royalties and income from similar sources • •- • -• - -• ••••• 11 11 28 Net income from unrelated business activities. whether or not the business is regularly carried on • • • • • • • • • • - Other income. Do not include gain or loss from the sale of capital assets`' (Explain in Part IV.) .. - . - Total support Add lines 7 through 10 _ - 777777 670 Gross receipts from related activities, etc. (see Instructions) - - - - - - - - _ - • • • - • - • • First five years. If the Form 990 is for the organization's first, second third fourth, or filth tax year as a section 501(x)(3) organization, check this box and stop here - - - - - - - - - - - - - - - - - - - • • • • • • • - • • - • • • • • • • • • • i 14 Public support percentage for 2009 (line 6, column (f) diyid6dby line } wiumn (f}) - - - - - • • - - - - . - - 1141 100.00 16 15 Public support percentage from 2008 Schedule A, Part; -I line 14 = - - - - - 15 16a 33 1/3% support test - 2009. If the organization did not e$eck the fmZdn line 13, and line 14 is 33 113% or more. check this box and stop hare. The organization qualifies as a publicly sup ported oigan'vation - - - • - - - - - - - - - - - - - - - - - - - - - �" $ Is 33 1131% support test - 2009. If the organization-Aid not check a °tiba on line 13 or 16a, and line 15 is 33 1t3% or more, check this box and -strip here. The organization qualifies "ublicly supported organization - - - - - - - - - - - - - - - - • • - • • - - • ` ... 17a 10 / - sects- and- clrcumstenees test - 2009.9(,;1te or`ganiya[ion did not check a box on line 13, 16a, or 16b, and line 14 is 10% or more, and if the organization meets tha "!acts- ank;,circamslances '* test, check this box and stop here. Explain in Part IV how Ilia organization meets the "tadsand- circumslances'test. The organization qualifies as a publicly supported organization • • • • • • • • • • • - F, b 10 %•facts- and - circumstances tv}-z 20p8. ffihe organization did not check a box on line 13,16a. 1 6b; or 17a, and line 15 is 10% or more. and if the organization meets ttre'Y;tcts- endcircumstances" test. check this box and stop here. Explain in Part IV how the k organization meets the °faefrand- circuitgaiances" test. The organization qualifies as a publicly suppottetl organization - - - - - - - - - - - - � 19 Private foundation If thborgahizahon did not check a box on line. 13, 16a, 16b, 172, or 17b, check this box and see Instructions - - - - - - - ► - -� EEa. sum�m.ntPnsnamo<smrTsms 2008 - (e) 2009 - - (f) Total - " - 1 - Gifts. grants, contributions, and - -- membership fees received. (Do not - -- - -- -- - - - - -- - - - - - -- -: include any "unusual grants:') - - - - - -- 238;936 238,986 -- 248,582 272.,422 530,716 1,529,642 - _ -- - - - - - - - - - - - -- - - -- - 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 - - - - - - 238,936 238,986 - 248,582 272,4221 530,716 1,529,642. 4 Total- Add -lines l through • - - - • 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 In . +w ' i<s ,,:_- 1,529,692 Section B. Total Support Calen 7 8 9 10 11 12 13 dar year (or fiscal year beginning in) ► (a) 2005 (b) 2006 (c) 2007 (d) 2008 (e) 2009 (f) Total Amounts from line - • • • • - • • - 238,936 238,986 248,582 272,422 530,716 1,529,642 Gross income from interest, dividends, - payments received on securities loans, - - - - - rents. royalties and income from similar sources • •- • -• - -• ••••• 11 11 28 Net income from unrelated business activities. whether or not the business is regularly carried on • • • • • • • • • • - Other income. Do not include gain or loss from the sale of capital assets`' (Explain in Part IV.) .. - . - Total support Add lines 7 through 10 _ - 777777 670 Gross receipts from related activities, etc. (see Instructions) - - - - - - - - _ - • • • - • - • • First five years. If the Form 990 is for the organization's first, second third fourth, or filth tax year as a section 501(x)(3) organization, check this box and stop here - - - - - - - - - - - - - - - - - - - • • • • • • • - • • - • • • • • • • • • • i 14 Public support percentage for 2009 (line 6, column (f) diyid6dby line } wiumn (f}) - - - - - • • - - - - . - - 1141 100.00 16 15 Public support percentage from 2008 Schedule A, Part; -I line 14 = - - - - - 15 16a 33 1/3% support test - 2009. If the organization did not e$eck the fmZdn line 13, and line 14 is 33 113% or more. check this box and stop hare. The organization qualifies as a publicly sup ported oigan'vation - - - • - - - - - - - - - - - - - - - - - - - - - �" $ Is 33 1131% support test - 2009. If the organization-Aid not check a °tiba on line 13 or 16a, and line 15 is 33 1t3% or more, check this box and -strip here. The organization qualifies "ublicly supported organization - - - - - - - - - - - - - - - - • • - • • - - • ` ... 17a 10 / - sects- and- clrcumstenees test - 2009.9(,;1te or`ganiya[ion did not check a box on line 13, 16a, or 16b, and line 14 is 10% or more, and if the organization meets tha "!acts- ank;,circamslances '* test, check this box and stop here. Explain in Part IV how Ilia organization meets the "tadsand- circumslances'test. The organization qualifies as a publicly supported organization • • • • • • • • • • • - F, b 10 %•facts- and - circumstances tv}-z 20p8. ffihe organization did not check a box on line 13,16a. 1 6b; or 17a, and line 15 is 10% or more. and if the organization meets ttre'Y;tcts- endcircumstances" test. check this box and stop here. Explain in Part IV how the k organization meets the °faefrand- circuitgaiances" test. The organization qualifies as a publicly suppottetl organization - - - - - - - - - - - - � 19 Private foundation If thborgahizahon did not check a box on line. 13, 16a, 16b, 172, or 17b, check this box and see Instructions - - - - - - - ► - -� EEa. sum�m.ntPnsnamo<smrTsms Gross receipts from related activities, etc. (see Instructions) - - - - - - - - _ - • • • - • - • • First five years. If the Form 990 is for the organization's first, second third fourth, or filth tax year as a section 501(x)(3) organization, check this box and stop here - - - - - - - - - - - - - - - - - - - • • • • • • • - • • - • • • • • • • • • • i 14 Public support percentage for 2009 (line 6, column (f) diyid6dby line } wiumn (f}) - - - - - • • - - - - . - - 1141 100.00 16 15 Public support percentage from 2008 Schedule A, Part; -I line 14 = - - - - - 15 16a 33 1/3% support test - 2009. If the organization did not e$eck the fmZdn line 13, and line 14 is 33 113% or more. check this box and stop hare. The organization qualifies as a publicly sup ported oigan'vation - - - • - - - - - - - - - - - - - - - - - - - - - �" $ Is 33 1131% support test - 2009. If the organization-Aid not check a °tiba on line 13 or 16a, and line 15 is 33 1t3% or more, check this box and -strip here. The organization qualifies "ublicly supported organization - - - - - - - - - - - - - - - - • • - • • - - • ` ... 17a 10 / - sects- and- clrcumstenees test - 2009.9(,;1te or`ganiya[ion did not check a box on line 13, 16a, or 16b, and line 14 is 10% or more, and if the organization meets tha "!acts- ank;,circamslances '* test, check this box and stop here. Explain in Part IV how Ilia organization meets the "tadsand- circumslances'test. The organization qualifies as a publicly supported organization • • • • • • • • • • • - F, b 10 %•facts- and - circumstances tv}-z 20p8. ffihe organization did not check a box on line 13,16a. 1 6b; or 17a, and line 15 is 10% or more. and if the organization meets ttre'Y;tcts- endcircumstances" test. check this box and stop here. Explain in Part IV how the k organization meets the °faefrand- circuitgaiances" test. The organization qualifies as a publicly suppottetl organization - - - - - - - - - - - - � 19 Private foundation If thborgahizahon did not check a box on line. 13, 16a, 16b, 172, or 17b, check this box and see Instructions - - - - - - - ► - -� EEa. sum�m.ntPnsnamo<smrTsms =orm 990 (2009) - - TEAM EVANC(--:?AL ASSIST MINISTRIES - _- - - 33- 0210704 _.✓ P46 IV i Checklist of Required Schedules (continued) Page -- .No,. _ Yes 21 Did the organization report more than $5,000 of grants and other assistance to governments and- 0rgan¢ations -- • . in the United. States on Part IX, column (A), line 12 If "Yes," complete Schedule I, Parts 1 and II - 22 Did the organization report more than $5,000 of grants and other assistance to individuals in the - - United States on Part IX, column (A), line 2? If "Yes," complete Schedule 1, Parts 1 and III • . • .. _ • • _ _ .. • • .. • ' ... 21 - t X:: _ 22 X -23 - Did the organization answer "Yes' -to Part VII, Section Aline 3,4, or 5 about compensation of the organization's current and former officers, directors, trustees, key employees, and highest compensated - If "Yes, "complete Schedule J- ---•"-••-•- -"--- --- •------- •-------- - - - -•- X 24a - employees? 24a -Did the organization have a. tax -ex empt 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 25 .. • • ...... _ • .. ' ... ' _ _ . ' _ _ ' ' • . " • • b Did the organization invest any proceeds of tax - exempt bonds beyond a temporary period exception? - - - - - _ • _ c Did the organization maintain an escrow account other than a refunding escrow at any time during 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 during the year? . • • .. • .. • • . • . 25a Section 501(c)(3) and 501(c)(4) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? if "Yes." complete Schedule L, Part I • - • - - - . - - • -- - - ` • - - - . - - - • - - - -- X �. X - 24b 24c 24d 252 - It Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization's prior Forms 990 or 990-EZ? If "Yes," complete Schedule L, Part I . • . • _ . • • • . • • • ... ' _ ... ' _ _ .. • . . ... . .... . ... 25b X 26 Was a loan to or by a current or former officer, director, trustee, key employee; highly compensated employee, or disqualified person outstanding as of the end of the organization's tax year? If "Yes," complete Schedule L. Part II .. • .. - 27 Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantial contributor, or a grant selection committee member, or to a person related to such an individual? If "Yes." complete Schedule L, Part 111 - . • . _ . •••. • •.. • • • •.. - • - - - - - - - - - - - - - - - - - - - "' 26 X X 27 28 Was the organization a party to a business transaction with one of the following parties (see Schedule L. Part IV instructions for applicable filing thresholds. conditions. and exceptions): a A current or former officer, director, trustee, or key employee7 if "Yes," complete Schedule L. Part IV - - - - - - - - - - - - - • b A family member of a current or former officer, director, trustee, or key employee? if "Yes." complete Schedule L, Part IV - - . • - • • • - - - - - • • - - •-`..__ _ _ _ ___ _ _ _ _ _ _ _ _ __ _ _ c Ar. entity of which a current or former officer, director, bustee, or key employee of theorgat jzation (or a family member) was an officer, director. trustee, or direct or indirect owner? If Yes,_ eciffj ele Schedule L. ,_ ............. ... ' . Pats IV - - - - - - - - - - - - - - - - - - - - - - --- - -- - - . .. .. 29 Did the organization receive more than $25,000 in non -cash contributions" - VA Yes," complete = Schedule M • • • . • . . 3n Did the organization receive contributions of art, historical treasure" T'difler Slmilar-assets, or qualified conservation contributions? If "Yes," complete Schedule M _ _ • -'= - - - ' ' - - ' - ' ' ' ' ' ' ' • ' • • 31 Did the organization liquidate.. terminate. or dissolve and-Tea ope€ati, = (f"Yes, complete Schedule N, . _ . _ _ _ _ _ _ Part s- - - - - - ' -------'.' :.:.- .................. 32 Did the organization sell, exchange, dispose of or transfer more than 25% of its net assets? If "Yes," complete _.. .. Schedule N. Pad If ............ :: s- ............. ' . . . _ . . _ .. 33 Did the organizator. ❑wn 100% of an entity{1"amed as separate from the organization under Regulations sections 301.7701.2 and 301.7701 -37 If `Yes.ftomplete Schedule R, Part I - • • .. • • • • . • • • ..... • .. _ ..... - -.- 28a - X X X X ' X X -, —. X 28b 28c 2S X 30 31 32 33 34 Was the organization related to any tax - exempt O6`taxagle entity9 if'Yes," complete Schedule R. Parts II, .._ .. ........... ... . . .. . . . . . In. IV. and V. line 1 . • • • • _ -° -'- - - - - - ..... _ ' 35 Is any related Organization a controlled•;Cfrtlly within the meaning of Section 512(bl(13)? If "Yes," complete Schedule R. Pan V. Tine 2 - ..... . .... . . . . .. . . . . . . . . . . . . .. .. ... . ... 36 Section 501(c)(3) otgahizattuos G3id the organization make any transfers to an exempt non - charitable related �. .. . -: ___ If "Yes," ulmplete Schedule R. Part V, line 2 • . • • • • • " . • • • ' ' _ ____ _ _____ ' ' ' ' ' 34 X - 24 X 35 36 organization? 37 Did the otguNZation eo0duoUttore'lban 5% of its activities through an entity that is not a related organization and that is treated as a patlnership for federal income tax purposes? if 'Yes." complete Schedule R, _. Pan Vl.:.._ .`°---------------• ............................... 38 Did the organization complete Schedule O and provide explanations in Schedule O for Part VI. lines 11 and 19? Note. A11 form WO titers are required to complete Schedule O • .... • ... • ` • • ..... ' .... - - - - - - 37 X j{ -- - 38 - EEA Form 980 (2n0`J)- -.. Forn 99D (2009) TEAM EVANGI' \AL ASSIST MINISTRIES 33- 0210704 Page7 - Parf Vfl Compensation of Officers; Directors, Trustees,- Key Employees, Highest Compensated- - - Employees, and Independent Contractors Section A. Officers, Directors, Trustees,. Key _Employees, and Highest Compensated Employees - -- - - -'- 1a Complete this table for all persons required to be listed. Report compensation. for the calendar. year ending with or within the organizations tax year. Use Schedule J -2 if atlditionai space . is needed_. List all of the organinflon`s current officers, directors, trustees (whether individuals or organization), regardless of amount of compensation. Enter- in columns (D); (E); and (F) if no compensation was paid • List all of the organization's current key employees. See 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 andfor Box 7 of Form 1099 -MISC) of more than 5100,000 from the organization and any related .organizations. __ _- List all of the organization's former officers, key employees, and highest compensated employees who received more than - - 3100.000 of reportable compensation from the organization and any related organizations. List all of the organization's former directors or trustees that received, in the capacity as a- former director or trustee of - - - the organization, more than $10,000 of reportable compensation from the organization and any related organizations_ List persons in the following order: individual: trustees or directors; institutional trustees; officers; key employees; highest- - -- - -. -. compensated employees; and former such persons. Check this box if the organization did not compensate any current officer, director, or trustee. - - (A) Name and Title (a) Average hours per (C) Pam n(dreck an that ap*) (D) Reportable compensation - (E) Reportable - compensation (F) tsumated amount of T —td I t o K H c e F week n r i n r f e i am a from from related Other u r s u f y g m r g� orgen¢ations compensobon i s e. v t C s i l r o e p I e e p m a organization (W- 21IM"ISC) hvm Ere ' at l e a m p s n y r {W.2:ID99 -MISCj nrger,i�efnn d e o u e r I t s e and,.L M a e a o i t orynnV:nlatis o y a I n a d a MARGE HA)MdERSLEY - - ADidINISTRATOR 40.00 VICE CHAIRMAN DOUG BLOIS BOARD MEMBER X { -- JENNY LOVELL •' _,- SECRETARY TREASURER RANDY TAYLOR CHAIRMAN BOARDOMEMBER =. ,SPX I' I I ( 1 I -- EFA - Fmm 990 (200 §). Forrri990 ) - TEAM.EVANC \CAL. ASSIST MINISTRIES i __ 33- 0210704 Page10 Part IX (2009 Statement of Functional Expenses ':" - -- _ - - -- -- Section 501(c)(3) and 501(c)(4) organizations Must complete all columns. All other organizations must complete column (A) but are not required to complete columns (a), (C), and (p).- _. Do not include amounts reported on lines 6b, -, - 7b, 8b, 9b, and 10b of Part Vlll, -- - - - — - -- -- - Pq - Total expenses � - - - -- -- - -- .. - n s Pmgram service .. expenses --. rie Mana9emmt grid _ g. r ial expenses N) FUntlraisug expenses 1 ' Grants and other assistance to governments and - - organizations in the "U.S. See Pan IV, line 21 - -..• • - 2 - Grants and other assistance to individuals in - - the U.S" See Part IV, line 22 -. - - . - . - . • - - • • • -- - - - - -... - , z f� '' 466,595 466,595 A k - - 3 -- Grants and other assistance to governments,._ -�.. - - organizations, and individuals outside the - U.S. See Part IV, lines 15 and 16 - - - - - - - • • - 4 Benefits paid to or for members • .... _ • -• -• -• • - - -- -" -- '- 5 Compensation of current officers, directors, - -- trustees, and key employees ...... • . •. • • • - - - -... _.. 6 Compensation not included above, to disqualified - persons (as defined under section 4958(f)(1)) and - - .persons described in section 4958(c)(3)(9) , .. • _ .. 7 Other salaries and wages - - - . - .. - - - - - • • _. 19,800 19,800 - 8 Pension plan contributions (include section 401(k) and section 403(b) employer contributions) - - - _ - - 9 Other employee benefits - - - - - - - - - - - - - - - 1,515 1,515 io Payroll taxes _ - _ - - - - - • - - - - - - - - - - . - - 11 Fees for services (non-employees): a Management - - - - - - - - • • - • - • • • • - - - - b Legal .................. .. ..... c Accounting - - - - - - - - - - - - - - - - - - - - - - 75 75 61 fit it Lobbying - - - - - - - - - - - - - - - - - - - - - - - '" e Professional fundraising services. See Part IV, line 17 - - f Investment management fees - - - - - - - . , - • • - gOther ......................... 3 ,181 .,.,. 5,825 12 Advertising and promotion • • .... • . • • • • • . 13 Office expenses - - _ - - - - - - - - • - - - • - • - 14 Information technology - . - • - - • . - - - - • - - . 15 Royalties 16 Occupancy .. ... .... . . . ....... . .. 17 Travel .......... • • ........... • ,..7.5 ?,.- 15,481 __... _. 3,357 ,- 3,31,57• 1 18 Payments of travel or entertainment expenses for any federal. state, or local public officials 19 Conferences. conventions" and meetings _ .. • .�i, 20 Interest - - - - - - - - - - - - - - - - - - - - - - -- ...- =' 15 15....� - 21 Payments to affiliates - + -• - ^ -- - 22 Depreciation, depletion, and amortization - - - - 6,279 6,279 23 Insurance - - - - - - - - - - - - - - - +:° -- • 14 Other expenses. Itemize expenses rWV- covered above. (Expenses grouped together and labeled miscellaneous magno`tesceed;_.._ _ 5% Of total expenses shown oil llne25 below.) 8,637 8,637 a FOOD PORCHAS$S -- -.:;, .. . -. 255 255 it _ e f All other expenses - f • . • • .. . 25 Total functional expenses. Add lines 1 through 24f - - 61, 300 531, 076 466,595 -F 3', 1 ill 26. Joint costs. check here ),. - it following - SOP 98 -2. Complete this line only if the - organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation • - - - - - EEA Fofm 990.12009)_ EVAN. IICAL ASSIST MINISTRIES -- - - 33- 0210704 - -.Page 11. [RArtXj Balance Sheet (A) _ _ (B) Beginning of year End of year 1 Cash - non - interest - bearing:. -:- " - - - -. - - . • - -. - • • ' • • - -' • _._ 1 - 16,907 2 16,460 - 2 Savings . and temporary investments . • • • • • • " ' • " . • ' - 3 - 3- Pledges and grants receivable, net - _ - - - • - • - - " - •_ '. - - - • " ', - _. _ 4 - - 4 Accounts receivable, net ... " . • • • . - • - • ' ' ' ' • - •.' - - _ - s Receivables from current and former officers, directors. trustees, key. and highest compensated employees. Complete Part 11 of - employees, , - - • - -. - - - - - - - • - _ . - ......._.. " . • .... 5 _ r a �..:- s a. -� •- ' Schedule - - 6 Receivables from other disqualified persons (as defined under section - : - - 4958(f)(1)} and persons described in section 4958(c)(3)(B). Complete �._�. _ v -' - >i • - -- - A - Part II of Schedule L • " • • • • • • • ' ' ' ' " ' ' ' ` ` • .. • . 6 7 s s 7 Notes and loans receivable, net - - - - - - • • • • - • - - - ' ' ' - ' ' ' ' ' ' 8 a 8 Inventories for sale or use . " . • • • • ' • . ' ' ' " " ' - " - ` • - ` - s 9 Prepaid expenses and deferred charges . " . • . • .. • • • • • • • • " ' " - 10a land, buildings, and equipment cc or r other basis. Complete Part VI of Schedule 0 • - • - - 10a - -. - b Less: accumulated depreciation - • ....... 10b 1Qc 11 11 Investments - publicly traded securities - . • .. • ... - . • " • " . " ' ' " • ' 12 12 Investments - other securities. See Part IV, line 11 . • . • • • • • ' • ' " ' - - 13 13 Investments - program- related. See Part IV, line 11 - - - • • • - • • - - - - " - - 14 14 Intangible assets - - - - • • - • • • • • • • • ' • ' ' ' ' • ' ` ` ` ` ` • . 15 _ 15 Other assets. See Part IV, line 11 - - -- - - -- - - • - • • • - - - - - - • - • - ' - 16,460 ' 16 Total assets. Add lines 1 through 15 (must equal line 34) - - - - • - - • • • - - - 16,907 16 ' - ' - • - ` - 1,330 17 1,238 17 Accounts payable and accrued expenses .... • . • • • • " • ' 18 Grants payable • .. " ........ • • .............. ........ 18 t9 - - - - L 19 Deferred revenue - - • • - • - - • • - - - - - - - - - - - - • - - - ` _ 20 i 20 Tax - exempt bond liabilities • - - - • - - - • - • • - - - - - - " - - - - ' -' —. a Escrow or custodial account liability, Complete Part IV of Schedule D b i 121 22 Payables to current and former officers. directors, trustees, key _ - 1 employees, highest compensated employees, and disqualified _ i t persons. Complete Part II of Schedule L . " • ... • • • . 22 -. 23 r 23 Secured mortgages and notes payable to unrelated third panes - - - 24 e S 24 Unsecured notes and loans payable to unrelated third parties - - - 25 -- 25 Other liabilities. Complete Part X of Schedule D - " " - ••-' ' ' ' ' _ 1,330 26 - • ' ' 1, 238 26 Total liabilities. Add lines 17 through 25 - - - - " - • •. - *. organizations that follow SFAS 117, check h&bff - N F Complete lines 27 through 29, and lines 33 40 34_ a u 27 Unrestricted net assets - - - - - - - - _ . • • • • 3 - - - - - - - - • - 28 - - -.- t n . Temporarily restricted net assets - " " ' ' ' ' • ' IF_ . A 29 Permanently restricted net assets ,., - - -- G B i Organizations that do net follow SFAS' 17, check here i -XI - e t .and complete lines 30 through LL t a _ 30 Capital stock or trust prinCIPal or current funds - • • . • • • . • . • • .... ' ' 30 sd- 31 Paid -in or capital surplus or tanit building. or equipment fund - .. • • • • - 39 15, 577 32 c a e 32 Retained earnings- endowrnent, act_ emulated income, or other funds . . 15, 712 15, 577 33 r s 33 Total net assets or fund bdfan(Ts -- - - - - - - - • ' • ' ' ' ' - - - - 76, 860 -� Total liabilities net- 8ssets1fund balances - - ' - - - ` - ' ' ' 16,907 34 34 aid Form 980 i2Q091 1, 1. _ f E .G A 1 GG Oita 4 a P.O. Box 2 �pn' -. A- A. 830. E CJ(]_R?_I_T - SaMMOR o. CA 95812.. �cIIUAW.� _ �r,��y� Phone:(916)445 -2020 - -•--� ° tC'fOVacL'r._. ziTATEMENT BY DOMESTIC NONPROFIT CORPORATION _ TWS STATEMENT MUST BE FILED WITH _. CALIFORNIA SECRETARY OF STATE (SECTIONS 6210. 8210, 9660 CORPORATIONS. CODE) DUE DATE: 2 -19 -87 TEAM EVANGELICAL ASSISTANCE MINISTRIES OF RANCHO - TEMECULA- MURRIETA VALLEYS Dd._NOT AL'[ER PREPRINTED NAME iF. 1'TEM 113. 131 K, pi.EASE EN'[IM GpRPORATE NAME DO NOT WHITE W TNIS _SPACE THE CORPORATION NAMED HEREIN;. ORGANIZED UNDER THE LAWS OF THE STATE OF CALIFORNIA. MAKES THE FOLLOWING STATEMENT: x. STREET A000E33 OR PRINCURAL OPM9 Sum oR Roou 2A. 2s. RP MONE, COMM.Eia 3-30 5A 5e. - 5C. 41945 Fifth St. - Temecula, CA 92390 NOT Ilea PA I'm 140.1 3- WINESS OR RESIDENCE ADDRESS 00 NOT USE P.O. DOx) CRY AND STATE L CODE MNA/DO DRESS- (OKAU "URE OR ROOG13A BO 3e4 41945 Fifth St. - Temecula, CA 92390 CHIEF PwANCNL OFFICER I OUsRIEss OR RESIDENCE ADDRESS (DO NOT USE P.O. IDX) CRY AND STATE 21P CODE NAMES OF THE FOLLOWING OFFICERS ARE - John H. Stanley C 119E ExECURVE OFF:ee 27895 -L Diaz Rd. BUSINESS OR RESIDENCE ADDREss 100 NOT USE FA. OOx) 4e Temecula, CA CTrc AND STATE 4C- 9239C ZIP CODE L 5A 5e. - 5C. T.J. Mercer 28030 Del Rio Rd. Temecula, CA 9239C SECRETARY �. WINESS OR RESIDENCE ADDRESS 00 NOT USE P.O. DOx) CRY Y AND STATE I P COOS BA BO BC. - Roger Brewer 29141 Vallejo Ave. Temecula, CA 9239C CHIEF PwANCNL OFFICER I OUsRIEss OR RESIDENCE ADDRESS (DO NOT USE P.O. IDX) CRT AND STATE ZIP CODE AGENT FDA SERVICE OF PROCESS. John H. Stanley 27895 -L Diaz Rd. Temecula, CA 92390 .FORMA SDSWEHS OR RESIDENCE ADDRESS IF AN INONIDUAL 100 NOT USE P.O. DODO ONLY ONE AGENT CAN eE NAMED. DO NOT INCLUDE ADDRESS IF AGENT .v A CORPORATION. EKAMWED THIS STATEMENT AND TO THE REST OF MY KNOWLEDGE AND BELIEF. R IS TRUE. CORRECT nANy COMPIXIS. ` PROJECT INFORMATION Amount Requested: $5,000 (Maximum allowable $5,000) Project Name: SAFETY TOWN Project Start Date: Mid -to -late July, 2011 Project End Date: Late July to early August ORGANIZATION INFORMATION Name of Organization: Temecula Sunrise Rotary C``)b Foundation Contact Name: Marti Treclanan Title: Club Secretary Mailing Address: P.O. Box 2203, Temecula, CA 92593 Telephone: 951- 698 -6116 Year Organization Founded: Club 1987; Foundation 1991 Number of Paid Staff: None Number of Volunteers: More than 40 in 2010, including Rotary members, JROTC, Interact, and other volunteers) Geographic Areas Served: Temecula, Murrieta, and surrounding areas Is this organization incorporated in California as a non -profit organization? Yes Date of incorporation as a non - profit: September 16, 1991 Fed ID: 33- 0484340, CA ID: C1694701 This application has been authorized by the organization's Board of Directors. MISSION STATEMENT The mission of Rotary International is to provide service to others, promote integrity, and advance world understanding, goodwill, and peace through its fellowship of business, professional, and community leaders. Temecula Sunrise Rotary follows all these edicts, and its special interest is providing opportunities and encouragement to the youth in our community. The club foundation is a lion -profit which is free from discrimination and makes its services available to all. We believe that we provide a strong benefit to the City of Temecula in bringing visitors to Temecula to participate in its projects, and especially giving recognition and help to the children of Temecula. In addition to the Safety Town project for which this application is made, Temecula Sunrise Rotary, primarily through its foundation, gives the following opportunities to Temecula youth: Literacy Program - We team up each year with third grade teachers at Temecula Elementary School, a Title 1 school, to create an incentive program for third graders to get excited about reading and to improve their reading comprehension skills. We created a contest where children compete to accumulate the most points on their reading comprehension quizzes. Top point earners are recognized at an end -of -the -year party, and each child receives a beautiful trophy and certificates from our Rotary club and the school. Scholarships - Over the years, our club has given between $5,000 and $15,000 every year to graduating seniors in Temecula. During the club's relatively short existence, over $200,000 in scholarships has been presented to worthy students. Interact - This high school service club sponsored by local Rotary clubs is a very important way to develop youth leaders in the community. Our club sponsors and supports the Interact club at Chaparral High School. RYLA - Rotary Youth Leadership camp in our District 5330 is the biggest in the world! Our club has been sending five students each year to participate in this wonderful opportunity to develop leadership skills. The young people always come to visit our club and report on their experiences. The program makes leaders of our young people, and they return to tell us the great difference it has made in their lives. Four Way Test Speech Contest - Each speech is crafted by the high school student on various subjects, but the speech must include the Rotary Four Way Test. Every week the Temecula Sunrise Rotary club members recite the Four Way Test, of the things we think, say or do: V - Is it the truth? 2nd - Is it fair to all concerned? 3rd - Will it build goodwill and better friendships? 0' - Will it be beneficial to all concerned? Rotarian believe these are goals that all good citizens should strive to attain. The winners of the club contest go on to compete in the Rotary District 5330, then speak at the District Conference. Music Competition - In 2011, Rotary District 5330 will hold its 12th year of high school music competitions. Our club has sent a number of outstanding musicians to the finals, and several have been the grand prize winners of $1,000. Competitors are local serious high school musicians who must play or sing classical music, or as an option for vocalists, Broadway music. Temecula Sunrise Rotary rewards_ its winners with $400, $250, and $100 prizes. Teacher of the Month - Each month the club invites a teacher and his or her principal to share breakfast with us, and we recognize the teacher with a plaque, a gift, and our thanks for all they do for our children. Rotary Park - In 1992, the Temecula Sunrise Rotary Club began plans for a Rotary Park to be built in a particularly needy area of Temecula, on Pujol Street. It was a huge project which was not completed for several years. After a period of time, the Rotary Club of Temecula joined with our club, and the City of Temecula also came on board to accomplish the building of the park. When it was completed, then- District Governor Fred Ford made his visitation, and as our gift to him, we planted a tree at the park in his honor. This park is near the Boys and Girls Club and serves many poor children in Temecula. lOK Run through the Vineyards - This is our main fund- raiser, held each May for 23 years, and now run at Maurice Car'rie Vineyards. Runners come from all over southern California to compete. PROJECT DESCRIPTION Temecula Sunrise Rotary plans to use the funding awarded to enhance its annual Safety Town project, which was begun by the club in Temecula in 2003, but was originally founded in 1937 in Mansfield, Ohio by a traffic commissioner and a kindergarten 'teacher. It was designed to teach various areas of traffic safety to pre- kindergarten children in a -free community program, and -the- program has -been carried to communities all over the country. Designed for 5 -8 -year -olds, the program teaches life - saving lessons on stranger danger, 9 -1 -1, fire, water, gun; poison, drug and bicycle safety, and much more, _ Our club members built a child- sized to which includes working traffic lights, miniature street signs, railroad crossing signs, crosswalks, and colorful little houses. Students not only walk around the Safety Town, they also use miniature pedal cars (with seat belts, of course) to learn pedestrian crossing and other safety lessons. The 8th annual Temecula Sunrise Safety Town was held from July 19 -30, 2010 at Helen Hunt Jackson Elementary School in Temecula. It was supported by the Temecula Unified School District, and had one major sponsor this year, State Farm Insurance Company. Two -hour classes were held for one week, ending with a graduation ceremony and cake and lemonade. Highly - qualified and credentialed teachers are paid to be in charge of carrying out the curriculum at Safety Town, and experts in many fields visit and volunteer their time to share their knowledge with the children. Included this year were the Temecula Fire Department and its beautiful trailer, Temecula paramedics, Officer John Thomas, Crime Prevention and Plans Officer for the City of Temecula, as well as experts in swimming and water safety, self - protection, dog safety, and others. The lead teacher is also a music teacher, who taught the children safety songs, which they performed at the graduation. Many handouts were provided to the children and to the parents for their education and follow -up. Some of these were free, while others had to be duplicated. Parents were admonished at the graduation to listen to their children when they say, "Mom, you shouldn't do that. We learned in Safety Town that it isn't safe!" The Temecula Police Department was especially impressed with the results of this year's Safety Town, when in exit interviews it was discovered that one child had already saved the life of her friend in a pool in French Valley, using what she learned at Safety Town about water safety. The story was published in several area newspapers. We were privileged to have many teen volunteers from Temecula Valley High School's Interact and JROTC. These teens served as mentors to the children and were available to help the Rotary volunteers and teachers where necessary. They are wonderful young people who don't really need the extra service hours, but love to volunteer. Because our little town is eight years old, we need funds to upgrade the traffic lights, repaint the houses, and do some repairs. We would also like to consider building our own house with the equipment like that in the fire department trailer, so the children can spend more time learning about fire safety. As we critiqued this year's program, the lead teacher said that she would recommend adding a half hour to the classes, expanding to 2 -1/2 hours a day. This would give the teachers and presenters more time to do what they would like to accomplish. It is also anticipated that we will add some parent classes to be held during the children's Safety Town sessions. Subjects might include bullying, gangs, drugs and alcohol, Internet safety, and many subjects that Officer Thomas is willing to present. The lead teacher last year presented a nutrition class for parents, and we would like to bring her back. These additional features would require more funding. We need to have more publicity about the program, perhaps providing more advertising and signage, and we would like to be featured in Temecula Today and other lists of programs available in Temecula. PRESIDENT or SIGNATURE: :ER. ,T,4r�k SC H ij tl"E NAME and TITLE (Please Print or Type) ORGANIZATION NAME I t✓M C- JLA J )(.121 C� le0 TRR� ©1nJJ7f� I /� N MAILING ADDRESS: P -box DATED THIS/ L4 A of 52,E +gym Y , 2010. (Date) f (Month) BE SURE TO INCLUDE THE ORIGINAL PLUS ONE COPY AND SUBMIT TO: Mail Completed Applications to: City of Temecula Community Service Funding Program Attn: Judy McNabb Post Office Box 9033 Temecula, CA 92589 -9033 Or Deliver in Person to: City of Temecula Community Service Funding Program Attn: Judy McNabb 43200 Business Park Drive Temecula, CA 92590 Anolination — Paoe 5 ORGANIZATION NAME: IE:MeauLA JUfJlzlS� 1�(J�N�� �'�Un/l7i+ % /fi/v MAILINGADDRESS: P D, ! oX DATED THIS IqA of Ee- A+-emt P, , 2010. (Date) (Month) BE SURE TO INCLUDE THE ORIGINAL PLUS ONE COPY AND SUBMIT TO: Mail Completed Applications to: City of Temecula Community Service Funding Program Attn: Judy McNabb Post Office Box 9033 Temecula, CA 92589 -9033 Or Deliver in Person to: City of Temecula Community Service Funding Program Attn: Judy McNabb 43200 Business Park Drive Temecula, CA 92590 ADDlication — Paoe 5 Y _ F I persion. DATED: September %1.6,, emecula Sunrise tay Foundation - 1 Bu 2010 — Estimated - Item Budget Actual x 8/1012010 Rent S ace $0 School Distr 0 Maintain S pace 50 0 Head Teacher 3,000 2,004 nd Teacher 1,000 800 hird Teacher 1,000 800 Shirts 800 156 Books and su lies 600 94 Be v erages and Ice 50 66 Lunch for Volunteers 100 375 Saloons for Graduation 20 0 raduation Certificates 30 0 raduation Snacks 100 68 Fliers, Printin 15on 1 000 1,082 i ns and Banners 200 429 E ui ment Car and Belts 0 100 ifts 50 440 Misc Total 8,500 6,410 RRYMM Registrations Primary Students 4,75095050 3,450 70@$50 1check bounce Primary Students -late registr. 325.5@$65 -105 Adiustrnts 1 Regis. refund Siblings 17 @ 45 2M 20@45 900 20@$45 Total Paid 5,975 4,245 Sponsors- State Farm 0 25-0-0- Total Revenue 5,975 6,745 Total Program Gain! Loss $2,525 335 91512010 DHS /12/2010 Net Ordinary Income 294.32. Net Income 294.32 Pagel . .,.. 10:17 AM .:- _ Temecula Sunrise Rotary - 07i+5110 Profit & Loss - : Cash Basis July 2009 through June 2010 Jul'09 -Jun 10 Ordinary Income/Expense -,... _ . -. .. _.. Income Dues 3,426.50 - - Fines 2,006.35 - s0 -so _ - _ — 867.10 Interest Inc 4.35 — - - Meals - 8,276.35 Socials 205.00 - - Total Income : 14,785.65 - - Expense. - - . Club Expenses - Accounting Support and Tax _ 570.00 Bereavement 139.14 - - - - Board Meetings - 65.68 - - Bus Bench Supplies 76.73 - Gift Expense - 50.00 - Meals Expense - 10,040.25 - Misc expense - 30.00 Postage & Supplies 125.13 Supplies 8.69 - - - Total Club Expenses -.. 11,105.62 - - Club Socials - Demotion Party 289.65 - - Foundation Gala 52.91 Total Club Socials 342.56 Club Training District Seminars 72.00 GSE Dinner 125.00 - - PETS 695.00 Total Club Training 892.00 Membership Dues District 800.00 International 1,085.75 Total Membership Dues 1,885.75 Secretary of State 25.00 Tax Filing - 25.00 Website -- - -- 215.40 Total Expense 14,491.33 - Net Ordinary Income 294.32. Net Income 294.32 Pagel Page t ` 10:21 AM Temecula Sunrise Rotary 107115110 Balance. Sheet Cash Basis As of June 30, 2070 _Jun 3Q 10 ..__ ASSETS Current Assets.. - - Checking/Savings_ General 4,635 19 Total Checking /Savings... ._.4,635.19 ' - Accounts Receivable - - Accounts Receivable - - 237.50 -- - - - - Total Accounts Receivable - -- — 237.50 - - - - - - - - Total Current Assets - 4,397.69 - - - - - TOTAL ASSETS 4,397.69 ... ; LIABILITIES .& EQUITY Equity Retained Earnings.. _ 4,103.37 - - - Net Income 294.32 - Total Equity 4,397.69 TOTAL LIABILITIES & EQUITY 4,397.69 Page t - - -- Temecula Sunrise Foundation -11:03 PM ...... _. _ ._..... _. ......... __ __. Profit & Loss _. .._ _.._ . __. 06110110 Cash Basis -- = July 2009 through March 2010 - Jul'09 -Mar 10:._ _ Ordinary Income/Expense- Income - .. Guard A Wit .. .. ..46.00. - - - Polio Plus 555.00 Bus Bench _.. .. _ _. 6.000.00 Interest Inc Safety Town Tuition (Net) 6,407.00 - _ 10 RaRegistration- 3,580.00 _Sponsor 250.00 Total 10K (Net) _ 3,830.00 - Otherincome— TWO6TrceJ 5,000.00 Total income 21,852.49 - Expense ... 1 -. -. Foundation -Polio Plus Giving 100.00 Total Foundation 100.00 Foundation Expenses - Bank Service Charge 12.00 Corp Tax - 10.00 - - - - ? - Total Foundation Expenses _ - - 22.00. _. 1OK expenses Design 175.00 - Highway Patrol -7.00 Management 1,800.00 Supplies - 316.34 Total tOK expenses 2.284.34 Community Service Choir 200.00 Guard A Kid. 1,186.00. Literacy project 600.00 Safety Town 6,934.30 Spring Fling Silver Sponsor 250.00 Teacher Of The Month 108.67 _ Weight Program 365.00 Total Community Service 9,663.97 International Service Eye Doctor - Van 200.00 E Village - 2.300.00 Total international Service 2,500.00 " Youth Service Interact Club 86.57 - - PRYDE -. 860.00 RYLA 1,060.00 Total Youth Service 2,006.57 Vocational Service Music Competition Church Gratuity 200.00 - District Semi-Finals Regist 300.00, Local Competition - Prizes 750.00 Total Music Competition 1,250.00 Scholarships 10.000.00 _ Speech Contest - Prizes 400.00 Total Vocational Service 11,650.00 Page 2 11:03 PM Tentecula. Sunrise Foundation Profit & Loss 05110no .cash Basis July 2009: through, March 2010- - - _ _. _.._ _.. ...... .. - _... .. .._ Jul. T9- Mar .10: - .- Admin ...__. _.. _. Printing for. Grant Application_._ .._.. __.. ..,10.44_ Acc2uatina _. 250,00 Taxes - 25.00 Total Admin _ _.. _ 285.44 - Total Expense 28,512.32 - Net Ordinary income - 6,659.83 - Net Income - 6,659.83 Page 2 LIABILITIES & EQUITY Liabilities Current Liabilities Foundation Pass - through Total Current Liabilities Total Liabilities Equity Retained Earnings Net Income Total Equity TOTAL LIABILITIES & EQUITY 69.25 69.25 69.25 18,426.44 9,008.74 27,435.18 27,504.43 (Please Pfint or Type) AI MEM, m i .S".`"+ t'"xk rr�s. �i -�h"i Amount Requested: $_5, 000 Project Name: 'Art in PROJECT INFORMATION all - Art -:9 Art Events m allowable $5,000) Project Start Date. December 2010 Project End Date: June 30, 2011 ORGANIZATION INFORMATION Name of Organization: _Temecula Valley Art League Contact Name: Sandra Williams Title /Position: President Mailing Address: Box 631 Temecula.,CA 92593 web page. temeculavalleyartleague.org Telephone: 951-662-3973 Year Organization Founded: 1977 Number of Paid Staff: 0 Number of Volunteers: 100 Geographic Area(s) Served: Temecula Valley and the surrounding areas Is this organization incorporated in California as a non -profit organization Yes x No Effective Date: 1977 if "yes° (Must provide a copy of your statement of non- profit status from the State of California): Date of incorporation as a non - profit 1977 Federal identification number. 33-0603418 State identification number cT123824 Tem Non - profit C1881942 If "no "' Name of sponsoring organization: Federal identification number: State identification number: This application has been authorized by the organization's: Executive Committee x Board of Directors X Application — Page I Members -at -Large FINANCIAL STATEMENTS PLEASE ATTACH COPIES OF THE CURRENT BUDGET OF THE ORGANIZATION AND FINANCIAL STATEMENTS (BALANCE. STATEMENT AND INCOME STATEMENT). It does not require a CPA's audit, but please submit if. available. MSSION STATEMENT Briefly describe the goals and objectives of your organization and community services it provides. Describe the ways your organization meets the criteria listed on page 2 of the GS Funding Policy. Our purpose is to create interest and encouragement for the artist through * Instruction by demonstration * Furnishing exhibit locations * Giving sources of information * Providing a meeting place fnr artist We are well regarded non - profit organization that provides a service in the visual arts to the community of Temecula. We are growing and aggressively working to expand our reach by staging art events to promote the city of Temecula along with our artist and gallery. We have people with extensive experience in marketing and advertising, a gallery, and contacts with multiple art groups in S. California that share their knowledge and experience to help us develop community events. We have been a part of the community for the past 23 years and expect to endure and flourish in the future. TVAL is fiscally responsible. Our growt in the last few years has provided us with more manpower, money and experience all which will enable us to put on major art events. We want to promote Temecula as a destination for artist and art lovers around S_ California and to expose our town by creating energy in the art industry. The results we aspire to is more awareness of the arts, exposure for the community and a solid venue for artist and art lovers alike. Application - Page 2 PROJECT DESCRIPTION How will your olganimafion use the funding awarded? Describe the project, project objectives, those served, area serviced, and number of volunteers involved_ Be specific. Include equipment or services that would be purchased and why. Include a detailed budget and a schedule of significantactivities related to this project" You may attach a maximum of one double- spaced typewritten page of information. (Please type or print legibly.) We would like,to do three events. 1. "Paint Temecula" - $1650 - -- - This is a event that highlights the city of Temecula. we.arne basing this on a successful event that the city of San Clemente has been hosting for 13 years. They have people come trom as tar as Germany and England to Pain 3-n this event and they attract lots of tourist" We feel that Temecula has many paintable venues wineries, horse farms, Duck Pond, Old Town and the new City Ball- This is an area - - Jurors -$300 Prizes /ribbons $600 - xecept±on *2!50 Advertising /promotion /posters /marketing -$500 - 2" "Art by the Inch Challenge" - $1650 - - the imeh rove -_ - cliff-event gremps werkimg- to ere- ee3:9!efta _ mural- This involves two 30 feet lengths of heavy weight Art Paper. Groups like the Boys and Girls Club, Rose Society, the Garden Club, school groups, company groups are 231 nvitad -te sempleUe -.a SaRtion 09 the muW-a1 Your. end Fxedu -is _�_es1arL7Al, interesting mural" At the reception each visitor is given their choice of different sizes of mats. They check out all of the unique painting that make up the mural" When ' th z finA � conhi,n Phar l,i l "lro t h^ "t lA f A 'll •_. - inch -- -5x7 would by $35 and 8x10 would by $80- This is a fun inclusive event! - 1. Supplies - $850 7 Larger Reception to include -a that Minted S400 3. Advertising /promotion /posters /marketing - $400 3" 02 Annual Western and Wildlife ow" - $19slY This is run in conjunction with Western Days in Old Town Temecula Last year was the first year of this event_ We are interested in attracting a, stronger showing of western anct WL.La-LIte Painters all oug ouE So i ornla s a ing our mai i g and promotions earlier, we think this is possible" Last year, we took a loss on the event but we will be able to use this as a learning experience to put on a much I- Juror - $300 - 2 Prizes /Ribbons - $600 4" Advertising /promotion /posters /marketing- $550 Application — Page 3 PRESIDENT or AUTHORIZED OFFICER: Sandy Williams President. NAME and TIT[ F rPlaaaw Print nr Tvnnl ORGANIZATION NAME: Temecula Valley Art League MAILING ADDRESS: PO Box 631 Temecula, California 92593 TELEPHONE: (951) 695 -0698 Cell (951) 662 -3973 1 DATED THIS / of , 2009. (Date) onth) BE SURE TO INCLUDE THE ORIGINAL PLUS ONE COPY AND SUBMIT TO: Mail Completed Applications to: Or Deliver in Person to: City of Temecula Community Service Funding Program Attn: Judy McNabb Post Office Box 9033 Temecula, CA 92589 -9033 City of Temecula Community Service Funding Program Attn: Judy McNabb 43200 Business Park Drive Temecula, CA 92590 Application — Page 5 State of California ; Secretary of State - STATEMENT OF INFORMATION (Domestic Nonprofit; Credit Union and Consumer -- - - Cooperative Corporations) Filing .Fee: $20.00...If amendment, see instructions.,,_ -- - IMPnRTAMT -- RFAn INSTRUCTIONS BEFORE COMPLETING THIS FORM t This Space For Filing Use Only - 1. CORPORATE NAME (Please do not alter if name is pmprinted.) - - N Temecula Valley Art League DUE DATE: COMPLETE PRINCIPAL OFFICE ADDRESS (Do not abbreviate the name of the city. Item 2 cannot be a P.O. Box) 2 STREET ADDRESS OF. PRINCIPAL OFFICE IN CALIFORNIA, IF ANY CITY STATE ZIP CODE CA 3.. MAILING ADDRESS OF THE CORPORATION, IF REQUIRED CITY STATE ZIP CODE P9. Box 631 Temecula CA 92593 NAMES AND COMPLETE ADDRESSES OF THE FOLLOWING OFFICERS (The corporaton must have there three officers. A comparable title for the specific officer may be added: however, the preprinted titles on this form must not be altemd.) 4. CHIEF EXECUTIVE OFFICER/ - ADDRESS. CITY STATE ZIP CODE Carol Landry 31495 Cale Camasco - Temecula CA 92592 5. SECRETARY / ADDRESS CITY STATE ZIP CODE Mary K Stradley 30198 Via Norte Temecula CA 92591 6. CHIEF FINANCIAL OFFICER/ ADDRESS - CITY STATE ZIP CODE Melody Brunsting 21705 Como Street Wildomar CA 92595 AGENT FOR SERVICE OF PROCESS (If the agent Is an individual, the agent must reside in California and Item 8 must be completed with a California street address (a P.O. Box address Is not acceptable). If the agent is another corporation, the agent must have on file with the California Secretary of state a certificate pursuant to Corporations Code section 1505 and Item 8 must be left blank.) 7. NAME OF AGENT FOR SERVICE OF PROCESS Carol Landry 8. STREET ADDRESS OF AGENT FOR SERVICE OF PROCESS IN CALIFORNIA; IF AN INDIVIDUAL CITY STATE ZIP CODE 31495 Gala Carrasco Temecula CA. 92592 DAVIS-STIRLING COMMON INTEREST DEVELOPMENT ACT (California Civil Code section 1350, et seq.) 9. ❑Check here N the corporation is any association formed to manage a common interest development under the Davis-Stirling Common Interest Development Act and proceed to Items 10,11 and 12. NOTE: Corporations formed to manage a common interest development must also file a Statement by Common Interest Development Association (Farm SI -CID) as required by California Civil Code section 1363.6. Please sea Instructions on the reverse side of this form. 10. ADDRESS OF BUSINESS OR CORPORATE OFFICE OF THE ASSOCIATION, IF ANY CITY STATE ZIP CODE 11. FRONT STREET AND NEAREST CROSS STREET FOR THE PHYSICAL LOCATION OF THE COMMON INTEREST DEVELOPMENT 9-DIGIT ZIP CODE (Complete a the business or corporate office is nor an the site of the common interest development.) 12. NAME AND ADDRESS OF ASSOCIATION'S MANAGING AGENT, IF ANY CITY STATE ZIP CODE 13. THE INFORMATION CONTAINED HEREIN IS TRUE AND CORRECT. 8-19 -2009 Mary K Stradley Secretary DATE TYPE/PRINT NAME OF PERSON COMPLETING FORM .TITLE SIGNATURE SI -100 (REV 01/2008) vAPPRovED BY SECRETARY OF 5 Electric Trash/Water Insurance Chamber of Commerce Gallery Supplies Advertising/Signs /Cards Constant Contact Mailings Entertainment Juried Show -4 Community Art Projects Emergency Fund $88.00 monthly $43.00 monthly Yearly 3 payments of $86 posters /postcards email mailing eprogram Members Xmas Party/Installment Juror /Prize Money /Ribbon /Reception Art by the Inch, Gift to City Hall Total This fund is money set aside to cover the cost associated with rectifying any unexpected situations that may arise that impacts the organization and its programs 1,056 516 750 258 340 480 80 80 400 6,000 2,000 14,020 $6,000 Working Capital $3,600 This fund is money kept in the Leagues general account to carry on the general day to day financial activities of the League Budget 2010- 2011 Income Membership 100 members @ $30 ea 3,000 Wall Space Rental $20/$10 members special show 2,000 s Monthly Drawings tickets for chance drawing 400 Donations ex- members - - 350 Book Sales members donate book/fordonation 480 Class Room Rental $10 Hr /2 teachers /6 hrs week 2,400 Juried Show Entry Fee $25.00 each x 40 5 shows at $1,000 ea 5,000 Total 14,350 Expenses Electric Trash/Water Insurance Chamber of Commerce Gallery Supplies Advertising/Signs /Cards Constant Contact Mailings Entertainment Juried Show -4 Community Art Projects Emergency Fund $88.00 monthly $43.00 monthly Yearly 3 payments of $86 posters /postcards email mailing eprogram Members Xmas Party/Installment Juror /Prize Money /Ribbon /Reception Art by the Inch, Gift to City Hall Total This fund is money set aside to cover the cost associated with rectifying any unexpected situations that may arise that impacts the organization and its programs 1,056 516 750 258 340 480 80 80 400 6,000 2,000 14,020 $6,000 Working Capital $3,600 This fund is money kept in the Leagues general account to carry on the general day to day financial activities of the League Total 14,350 Expenses Budget 2010 -2011 $88.00 monthly 1,056 Income $43.00 monthly 516 Membership 100 members @ $30 ea 3,000 Wall Space Rental $20/$10 members special show 258 Monthly Drawings tickets for chance drawing 400 Donations ex- members 350 Book Sales members donate book/for donation 480 Class Room Rental $10 Hr /2 teachers /6 hrs week 2,400 Juried Show Entry Fee $25.00 each x 40 5 shows at $1,000 ea 5`000 Total 14,350 Expenses Electric $88.00 monthly 1,056 Trash/Water $43.00 monthly 516 Insurance Yearly 750 Chamber of Commerce 3 payments of $86 258 Gallery Supplies papers to log in/ signs in /pic labels 180 Advertising/Signs /Cards 480 Constant Contact email mailing eprogram 80 Mailings 80 Entertainment Members Xmas Party/Installment 400 Juried Show -5 Juror /Prize Money /Ribbon /Reception , 6,000 Community Art Projects Art by the Inch, Gift to City Hall 2,000 Total 14,020 Long Term Savings $6,000 Total 14,350 Expenses Electric $88.00 monthly 1,056 Trash/Water $43.00 monthly 516 Budget 2010 -2011 Yearly 750 Income 3 payments of $86 258 Membership 100 members @ $30 ea 3,000 Wall Space Rental $20/$10 members special show 2,000 Monthly Drawings tickets for chance drawing 400 Donations ex- members 350 Book Sales members donate book/for donation 480 Class Room Rental $10 Hr /2 teachers /6 hrs week 2,400 Juried Show Entry Fee $25.00 each x 40 S shows at $1,000 ea 2,_0 Total 14,350 Expenses Electric $88.00 monthly 1,056 Trash/Water $43.00 monthly 516 Insurance Yearly 750 Chamber of Commerce 3 payments of $86 258 Gallery Supplies papers to log in/ signs in /pic labels 180 Advertising/Signs /Cards 480 Constant Contact email mailing eprogram 80 Mailings 80 Entertainment Members Xmas Party/installment 400 Juried Show -5 Juror /Prize Money /Ribbon /Reception 6,000 Community Art Projects Art by the Inch, Gift to City Hall 2,_0 Total : 14,020 Page 1 Temecula Valley Art League Trial Balance ^ As of May 31, 2010 Accrual Basis May 31, 10 Debit Credit First Citizens Bank Checking 3,614.90 First Citizens Bank COD 3,564.49 First Citizens Bank Unactive 2,271.66 Gallery Cash Box 103.50 Petty Cash - Undeposited Funds 1,083.93 _ Security Deposits 635.00 Accounts Payable 531.64 Sales Tax Payable 13.93 Opening Bal Equity 6,736.11 Retained Earnings 211.23 Advertising (TVAL)" 60.00 Gallery Class Room 1,710A0 Gallery Commission on Sales 12720 Gallery Sales 270.23 Gallery Wall Space 2,725.00 Interest Earned 18.48 Membership Dues 1,870.00 Miscellaneous Income 619.18 Raffles 457.75 Shows 975.00 Advertising 338.40 ^ Awards 900.00 Bank Expense Checks 19.25 Gallery Expenses 467.57 Guest Speakers 900.00 Holiday Party 365.98 Licenses and Permits 50.00 Newsletter 94.47 Office Supplies 218.11 Postage and Delivery 45.75 Printing and Reproduction 20.21 Special Events 445.12 Supplies:Marketing 120.00 Supplies:Office 12.50 Trash Utilities:Electric 626.59 Utilities:Trash 392.94 Other Expenses 7.52 TOTAL 16,311.82 16,311.82 Page 1 Temecula Valley Art League Balance Sheet As of May 31; 2010 Accrual Basis - _ _. May 31, 10 _..- .. ASSETS - Current Assets CheckinglSaWngs First CKb*ns Bank Checking .: 3,614.90 - - .First Citlzens Bank COD 3.564.49 -...: - ....... - . First Cit ams Bank Uneattve 2,271.66 Gallery Cash Box 103.50 - .. Total CheckinglSavings i 9,554.55. - - - Other Current Assets - - Undeposited Funds 1,083.93. Total Other Current Assets - 11083.93 - - total Current Assets - 10,638.48. - - Other Assets Security Deposits 635.00 Total Other Assets 835.00 TOTALASSETS - 11,273A8 - LIABILITIES & EQUITY - - - - Liabilities - Current Liabilities _ Accounts Payable Accounts Payable 531.64 Total Accounts Payable 531.64 Other Current Liabilities �— Sales Tax Payable -13.93 - Total Other Current Liabilities - -13.93 Total Current Liabilities 517.71 Total Liabilities 517.71 Equity Opening Bal Equity 6,736.11 Retained Earnings 211.23 - Net Income 3,808.43 Total Equity 10,755.77 - TOTAL LIABILITIES & EQUITY 11,273.48 PROJECT INFORMATION L \ .fOle Amount Requested: $ ��, ooy - � DC 1�� �(`(�QA �b5s (Maximurn allowable $5,000) Project Name: k U Project Start Date: /U o �..J Project End Date:_ c a L3A ORGANIZATION INFORMATION Name of Organization. Contact Name::� Title /Position: Mailing Address .O . �J Telephone: Year Organization Founded: Z 5 �c2s /So Number of Paid Staff: d — Number of Volunteers: Geographic Area (s) Served c� J\P, Is this organization incorporated in California as a non - profit organization? Yes ✓ No Effective Date: If "yes" (Must provide a copy of your statement of non - profit status from the State of California): Date of incorporation as a non - profit: tCZ'��o2 Federal identification number: -0 _t to 'Ji2 -9­1 State identification number: ;_7'4(o9-ioc) If "no ": Name of sponsoring organization: Federal identification number: State identification number: This application has been authorized by the organization's: Executive Committee Board of Directors Members -at -Large Application - Page 1 FINANCIAL STATEMENTS PLEASE ATTACH COPIES OF THE CURRENT BUDGET OF THE ORGANIZATION AND FINANCIAL STATEMENTS (BALANCE STATEMENT AND INCOME STATEMENT). It does not require a CPA's audit, but please submit if available.. MISSION STATEMENT Briefly describe the goals and objectives of your organization and community services it provides. Describe the ways your organization meets the criteria listed on page 2 of the CS Funding Policy. Application — Page 2 PROJECT. DESCRIPTION: How will your organization use the funding awarded? Describe the project, project objectives, those served, area servlced , and number of volunteers involved. Bespecific. Include equipment or services :that would be purchased and why. Include a detailed budget and a schedule of significant activities related to this project. You may attach a maximum of one double - spaced typewritten page of information. (Please type or print legibly.) Application — Page 3 SIGNATURE PAGE SIGNATURE: ORGANIZATION MAILING ®� . TELEPHONE: qn ` -5-1 4lYz� DATED THIS �P (` of , 2010. (Date) (Month) - BE SURE TO INCLUDE THE ORIGINAL PLUS ONE COPY AND SUBMIT TO: Mail Completed Applications to: City of Temecula Community Service Funding Program Attn: Judy McNabb Post Office Box 9033 Temecula, CA 92589 -9033 Or Deliver in Person to: City of Temecula Community Service Funding Program Attn: Judy McNabb 43200 Business Park Drive Temecula, CA 92590 Application - Page 5 i Financial Statements : We don't, per se, have a budget. I have attached our profit and loss statement from our last fiscal year. We- have -a profit of - "x° amount which in part is going towards some new instruments this year that we desperately have to replace and part to our Uniform-Drive. "N' We are the Temecula Valley High School Band & Color Guard. We - - - represent our school and City at Tournaments, parades, football games, and other organizations throughout the City of Temecula. Our goal is to continue to grow and progress with our current Program. Our members are exemplary students and their commitment to the Program is unconditional in that they practice six days out of the week, travel to Competitions (we have made it to finals the last two years), and work hard to keep this Program running by being actively involved in the many fundraisers that we must do to keep running. We must raise, on our own, approximately $100,000 a year to maintain our current level, that is to travel to competitions, repair and replace equipment, pay for coaches (we need 6 to 8 per season); music, etc. $40,000 of that amount is needed strictly through fundraising. This is a huge task for us to do on a yearly basis. Rising above that amount is overwhelming and we cannot do it alone. "B" We will use the funds to replace our fourteen year old uniforms. The estimated cost is $55,000.00. It has become very difficult to fit the many students we have with our current inventory. Our students perform in a variety of situations, grass, mud, heat, etc. As a result, we have unremovable stains and smell, even after cleaning. We have taken extreme care with our current uniforms, but like most things that are used over and over again they have worn out and need to be replaced. The students have studies, twenty+ hours a week in practices, competitions and we have fundraising functions at least two times a month for the first four months of school. Our most challenging time comes in the fall as that is when we need the most funds. Music, coaches, travel, etc. is very expensive. We believe that as the oldest high school and oldest band of our District we are ambassadors of our community. At all times, our students are stellar examples of our City when we travel to competitions, City and other school functions, football games, etc. We think our appearance is our first impression and when we have worn out, soiled and "smelly" uniforms, that may not always be portrayed. Thank you so much for your consideration. Income /Expense by Category TVHS Band Boosters - 2010' 7/1/2009 through 6/30/2010 (Cash .Basis) 9/15/2010 Page 1 _ 7/1/2009 Category Description 6130/2010 Fundraising 24,097.13 Tournament Income GVC 17,796.08 Tournament Income SCPA 12,383.87 _ - Uniform Cost Reimbursment 290.00 TOTAL INCOME 54,567.08 Uncategorized 0.00_ Fundraising Expense 11,967.70 GVR 1,587.88 Overhead 2,053.66 Spring Programs 0.00 Tournament Host GVC 12,215.67 Tournament Host SCPA 6,759.99 Winter Programs 2,365.00 - - - -TOTAL EXPENSES - 36,949.90 OVERALL TOTAL 17,617.18 TOTAL LIABILITIES 0.00 EQUITY 24,591.71 TOTAL LIABILITIES & EQUITY 24,591.71 Balance Sheet NHS Band Boosters -As of 6730/2010 - - _. As of 6/3012010 (Cash Basis) 9115/2010 Page 1 6/30/2010 Account Balance Cash and Bank Accounts NHS Band Booster- Checking 24,591.71 TOTAL Cash and Bank Accounts- -- - — 24,591.71 - TOTAL ASSETS 24,591.71 LIABILITIES Other Liabilities _ *Sales Tax* 0.00 TOTAL Other Liabilities 0.00 TOTAL LIABILITIES 0.00 EQUITY 24,591.71 TOTAL LIABILITIES & EQUITY 24,591.71 Net Worth = As of 6/30/2010 As of .6 /30/2010 9115/2010. Page 1 _ 6/3 012 01 0 Account Balance . Cash and Bank Accounts _ NHS Band Booster - Checking 24,591.71 - TOTAL Cash and Bank Accounts 24,591.71 TOTAL ASSETS - 24,591.71 LfA_- e Other Liabilities *Sales Tax* 0.00 TOTAL Other Liabilities 0.00 TOTAL LIABILITIES 0.00 OVERALL TOTAL 24,591.71 EXEMPT AETERh1IMAT'ION LETTER ermined you are eXempt 3iforni -a Revenue and T; section. An 9 This decision present nPerz 'application." .. - or4anizatia.n -- mu I n ca: ou fr "TEIVIECULA VA=Y HIGH SCHOOL BAND - Contact Person.: - - BOOSTERS - -- JOHN J KOESTER - _ -- ID# 313.64 - -C /O SHERI RYAN - Contact Telephone Number: . _ _. - , '1 PO. 80 %:892381 - (817).'829. -5500 - TEMECULA, -CA- 92592 -3516 - - Accountings Period Ending: -- :: June 30: - ` ..'• ,_ ., _ Puhl:Lc,_ iEy Statusq 170 -rn) (1) (A). (V1) Form - -936 Required: Yes< ruxm�urinr. REVENIIE: SERQICE D DEPARTMENT OE .THE TREASURY P:S O Box: 2508 "CINCINNA'TI,. OA 45201 - E Employer Identification Number_ Data: 2 1.637297 - -1705309631600D I MEMBER CERTIFICATE OF INSURANCE 8127/10 Thank you for purchasing your insurance from AIM. This is your Member Certificate and should be kept with your permanent records. .. .. - - Insured #: CA254313:. NAMED INSURED MEMBER: Named Insured & Mailing Address PRODUCER NAME Temecula Valley HS Band BC - - Education Support Purchasing Group EI91n B Allen l "_ - - . Attn: Jeff Gardner - c/o AIM PO Box 742946 - 31555 Rancho Vista Road - - P.O. Box 742946. - Dallas T3(,75374-2946 : Temecula, CA 92592 - - - - - - Dallas TX, 75374 -2946 - - Company / Coverage Policy # Effective Dates Deductible Limits of Insurance Homeland Ins Co of New York / BWO9359 1118/10 - 1/18/11 NONE Each Occurrence $1,000,000 -. Commercial General Liability _ General Aggregate $2,000,000 Products - COMP /OPS Aggregate $2,000,000 - - Personal & Advertising Injury $1,000,000 Fire Damage (any one fire) _ $50,000 Homeland Ins Co of New York I BWO9359 1/18/10 - 1/18/11 NONE Any One Person $50,000 Medical (Accident Medical)* Aggregate $50,000 Homeland Ins Co of New York / BV07556 - 1/18/10 - 1/18/11 $ 250 Each Occurrence $10,000 Property (Bus. Personal - - Prop /Comp Sys) - Homeland Ins Co of New York / 6X07379 1/18/10 - 1/18111 $ 1,500 Aggregate - $1,000,000 - Non -profit Prof Liability (Officers Liability) - Annual Aggregate applies to all $20,000,000 member certificate holders combined. Retroactive Effective Date: 1/18/08 - Certificate Holder: I This member certificate, together with the common policy conditions, coverage part(s), coverage- form(s), and endorsements, if any, complete the above numbered - policy. Copies of the Master Policies are available upon request or may be printed at www.aim- companies.mm AUTHORIZED REPRESENTATIVE /' d.that it State V d.that it State Of FOUR (nRhis cotpo of within fhe meaning for 1 Wlon shall con=sist of ce Y 'ag, ^ice ko'lxaranon are: - - -r� - pPulrrreuso aci es the initial Ve the above n'enfoned initial directo s ofthis co persons who executed the fore Ing Art Iles of fnco poration, i ereby declare that deed. - we are fhe rporarion, which execution is our act and Lynn Ra all, Director' �f �r� �� r✓ �-���/it1y� D,4 f/,� Val Gallaher, Director ' Isabel S611 Director t Ann e Waso�ner, Drr or �..t nn Da Directo Awk ns, r PROJECT INFORMATION Amount Requested: $ 5,000.00 (Maximum allowable $5,000) Project Name: 2010 Care to Share Holiday Programs Project Start Date: Oct. 1st, 2010 Project End Date: Jan 30, 2011 ORGANIZATION INFORMATION Name of Organization:_TVPHP Group - Temecula Valley People Helping People Contact Name Denny Mighell —Title/Position:-Pre s ident /CEO Mailing Address: 37887 Spur Drive, Murrieta, CA 92563 Telephone: 951- 757 -5212 Year Organization Founded: 1992 Number of Paid Staff: None Number of Volunteers: 100 plus Geographic Area(s) Served: Temecula & Southwest Riverside County Is this organization incorporated in California as a non -profit organization? Yes X No Effective Date: 1997 If "yes" (Must provide a copy of your statement of non - profit status from the State of California): Date of incorporation as a non - profit: 9 -6 -1996 Federal identification number: 33-0754195 State identification number: 1978608 If "no ": Name of sponsoring organization: Federal identification number: State identification number: This application has been authorized by the organization's: Executive Committee X Board of Directors X Members -at -Large Application - Page 1 NHSSION STATEMENT Briefly describe the goals and objectives of your organization and community services it provides. Describe the ways your organization meets the criteria listed on page 2 of the CS Funding Policy. Our mission, as a nonprofit charity and information service, is to actively serve the people of our local community and Riverside County by building permanent charitable capital, and providing services that contribute to the health and vitality of the community. Through collaboration with other service organizations, city and government officials, and caring individuals, TVPHP will continue to unite resources, experience, and other effort to work towards a mutual goal in assisting those in need in our community. vision TVPHP will be Riverside County's premier knowledge resource; and a recognized leader in assisting individuals, families, children and seniors in need. Application - Page 2 PROJECT DESCRIPTION How will your organization use the funding awarded? Describe the project; project pbjeetives, those served, areaserviced , and number of volunteers involved Be speck. Include equipment or services that would : be purchased and why. include a detailed budget and a- schedule of significant activities related to this - - project. You may attach a maximum of one double - spaced typewritten page of information. (Please type or print legibly) TVPHP - 2010 Care to Share Holiday Program if awarded the grant would use the funds to help those in need in City of Temecula. We provide Thanksgiving and Christmas Diners and food. - - -- -- We provide for Christmas gifts and other needs for theneeded - children, - seniors and families in the community. In 2009 we handle around 10,000 plus needed children, seniors and families in our communities (Temecula and Southwest Riverside County). TVPHP works and partner up with approximately 40 organizations and groups to provide food , gifts and information to those in need. TVPHP volunteers base is well 100 plus. TVPHP works with The City of Temecula Fire Department program "Spark of Love Toy Drive and all the donations go to TVPHP and we handle all the families that come through the City's programs. TVPHP will not finish or closed its door until Christmas Eve around 5pm and still will handle last minute calls for those in need. There is never enough money, we could always use more, do to the over amount of people needed help each year and it keeps growing each year. Application - Page 3 PAST PROJECT BENEFITS If your organization received City of Temecula funding in the previous year, please explain and show how - - -_ Temecula residents benefited. _ - 2009 and other years as well, TVPHP received a grant from City of Temecula in the amount of $5,000.00 these fund were used to help those in need -. To - purchase turkeys, food and gifts. We have provide receipts to the City for 3 2009 grant fund We all provided holiday happiness to those who were not going to have it. Thousand's of children, seniors and families were given an opportunity to have save and a beautiful holiday season. This can only happen when people, E organizations, businesses and groups partner together to help those in need. Application - Page 4 SIGNATURE PAGE We hereby certify the information contained in this application is true to the best of our knowledge and belief. PREPAREDBY: Denny Mighell - President /CEO NAME and TITLE (Please Print or Type) SIGNATURE: PRESIDENT or AUTHORIZED OFFICER: Denny Mighell - President /CEO NAME and TITLE (Please Print or Type) ORGANIZATION NAME: TVPHP Group - Temecula Valley People Helping People MAILINGADDRESS: 37887 Spur Drive, Murrieta, CA 92563 DATED THIS 25 Of Augst , 2010. (Date) - (Month) BE SURE TO INCLUDE THE ORIGINAL PLUS ONE COPY AND SUBMIT TO: Mail Completed Applications to: Or Deliver in Person to: City of Temecula Community Service Funding Program Attn: Judy McNabb Post Office Box 9033 Temecula, CA 92589 -9033 City of Temecula Community Service Funding Program Attn: Judy McNabb 43200 Business Park Drive Temecula, CA 92590 Application - Page 5: Inflows_ 15,976 Cash donations 70,000 In kind contributions (clothing, toys, etc.) 1,000,000 Note' below - information Office /Warehouse:donation/sponsor 135,000 Note' below- information Riverside County - grant 5,000 City of Temecula - grant 5,000 - - Total Inflows 1,188,000 Outflows In kind contributions (gifts for children & elderly) Gifts (not received through inkind contributions) 1,000,000 135,000 Office/Warehouse donation /sponsership Riverside County - grant- Food, turkeys & gif 5,000 City of Temecula - grant - Food, turkeys & gif 5,000 Gifts (not received through inkind contributior 10,000 Insurance: auto, medical, building & Etc 15,976 Telephone 3,000 Supplies 4,024 Bank fees 250 Licenses & permits 500 Travel: Fuel & Etc 750 Professional services 4,000 Miscellaneous bills & fees 3,500 Postage & Etc 1,000 Total Outflows 1,188,000 Note` the businesses below are sponsorship of TVPHP Group - for Inkind Goods for all year round programs Zumiea Foundation / Head to Toe / All new Clothing, Hats, Gloves, Shirts, Blankets & Etc Note* inkind donations/sponsorships of Office/Warehouse space for TVPHP Group / price value $.90 cent per sq ft x 50,000 sq ft @ Estimated of $135,000.00 - inkind Prepared by Denny Mighell C IRS Depa h I R w= Treasu y internal Revenue Service P.O. Box 2508 - -° -- - -fn reply refer to: 0248667585 Cincinnati OH 45201 Sep. 15, 2009 -LTR 4168C EO 33- 0754295 000000 OD _ -- - -- 00014400 BODC: TE . TEMECULA VALLEY PEOPLE HELPING PEOPLE z PEOPLE HELPING PEOPLE 26201 YNEZ RD STE 102 TEMECULA CA 92591 -6048 012340 Employer Identification. Number: 33- 0754195.... Person to Contact: Mrs.Pam Skiles- Toll Free Telephone Number: 1- 877 - 829 -5500 Dear Taxpayer: This is in response to your request of Sep. 03,2009, regarding your tax- exempt status - - Our records indicate that a determination letter was issued in May 1997, that recognized you as exempt from Federal income tax, and discloses that you are currently exempt under section 501(c)(3) of the Internal Revenue Code. Our records also indicate you are not a private foundation within the meaning of section 509(a) of the Code because you are described in section(s) 509(a)(1) and 170(b)(1)(A)(vi). Donors may deduct contributions to you as provided in section 170 of the Code. Bequests, legacies, devises, transfers, or gifts to you or for your use are deductible for Federal estate and gift tax purposes if they meet the applicable provisions of sections 2055, 2106, and 2522 of the Code. If you have any questions, please call us at the telephone number shown in the heading of this letter. Sincerely yours, Michele M. Sullivan, Oper. Mgr. Accounts Management Operations I . - 1 1715 SD of the Trewwy 1 Infemnt Revenue Service P.O. Box-2506. ._.. .. _ - _ ...... -. Cincinnati.. ON _. 45201 012340.605154.0051.002 1 AT 0.357 -532 - ir�,lii,i.i irnlhn,►+ iIIlpI„yy1111,., Jim III TEMECULA VALLEY PEOPLE HELPING PEOPLE PEOPLE HELPING PEOPLE - - 26201 YNEZ RD.STE 102 TEMECULA CA. 92591-.6048 012340 - CUT OUT AND RETURN THE VOUCHER AT THE BOTTOM OF- THIS -PAGE IF- YOU -ARE MAKING A PAYMENT, - EVEN IF YOU ALSO HAVE AN INQUIRY. IRS address must appear in the window. - Use for payments 0248667585. Letter Number: BODCD -TE Letter Date Tax Period *330754195* _ TEMECULA. VALLEY PEOPLE HELPING INTERNAL REVENUE SERVICE... -. - PEOPLE... P.O. Box 2508 PEOPLE HELPING PEOPLE Cincinnati ON 45201 26201 YNEZ RD STE 102 - 11111 TEMECULA CA 92591-6048 330754195 RL TEME 00 2 000000 670 00000000000 LTR4168C 2009 -09 -15 000000 Please review this information to determine if you have located the correct corporation. Statements of Information amendment filings are not eligible for electronic filing at this time. The corporation is not yet due to file the required statement; therefore, this filing is considered tamendment and must be filed either by mail or at our public counter in Sacramento. Forms and instructions can be downloaded from our bsite at htto.//www sos ca aov /business /corn /corn soinfo htm •.. �� �-,- __ ._ ___.,.-_.._,-,.._ n_ _._n..___...— m„nnrnoa_— ._.�__ -,R mim,nn�ima__�- _�t__. oiocnnm Corporation TVPHP GROUP Number: 01978608 Incorporation Date :9 /6/1996 "' Status:Active Jurisdiction: CA Type: Domestic Nonprofit _ Address _ 37887 SPUR DRIVE, MURRIETA, CA 92563 Agent For Service Of Process DENNY JETT MIGHELL 37887 SPUR DRIVE, MURRIETA, CA 92563 Please review this information to determine if you have located the correct corporation. Statements of Information amendment filings are not eligible for electronic filing at this time. The corporation is not yet due to file the required statement; therefore, this filing is considered tamendment and must be filed either by mail or at our public counter in Sacramento. Forms and instructions can be downloaded from our bsite at htto.//www sos ca aov /business /corn /corn soinfo htm •.. �� �-,- __ ._ ___.,.-_.._,-,.._ n_ _._n..___...— m„nnrnoa_— ._.�__ -,R mim,nn�ima__�- _�t__. oiocnnm Entity Name : TVPHP GROUP Entity Number : 1978608 1. The above entity is in good standing with this agency. 2. The above entity is currently exempt from tax under Revenue and Taxation Code. Section 23701 d. ❑ 3. Our records indicate the above entity is not incorporated, qualified, organized, or registered through the Secretary of State to transact business in California. 4. The above entity was incorporated, qualified, organized, or registered through the Secretary of State on 09!06/1 996 . ❑ 5. The above entity has an unpaid liability of $_ for account period(s) ending T ❑ 6. Our records do not show that the above entity filed returns for account period(s) ending _ ® 7. The above entity was revived effective 09103/2008 [] 8. The above entity's current address on record with this agency is: ❑ 9. We do not have current information about the above entity. Comments: ASSISTANCE Telephone assistance is available year-round from 7 a.m. until 8 p-m. Monday through Friday. From January through June, assistance is also available from 8 a.m. until 5 p.m. on Saturdays. We may modify these hours without notice to meet operational needs From within the United States. can .. ............................... (801) 852 -5711 From outside the United States, can (not toll-free) ............. (916) 845 -6500 Website at www.ftb.ca.gov Assistance for person with disabilities: We comply with the Americans with D'isabili ies Act. Persons with hearing or speech impairments please call TTY/TDD (800) 822 -6268. I State of California Bill �+ F1 LED B - ill Jones Saaaawift CA 9424, -2309 IR 1ha DlHCe of ihe- .Seerntary D- 04tIFOPNIT Secretary Of State Planw-1916) 857 -3537 of the State of CaUfOmfa STATEMENT BY DOMESTIC NONPROFIT CORPORATION cif 17 997 THIS STATEMENT MUST BE FUM W" CAIIF01114A SECRETARY OF STATE (SEMM S 6279. 8210. 9660 CORPORATIONS CODE) THE $10 FILING FEE MUST ACCOMPANY THIS STATEMENT. DUE DATE: DECEMBER 6, 1996 BILL ,S5 of 81$ TEMEOULA VALLEY PEOPLE HELPING PEOPLE 1978608 DO Np1` ALTER PREpRINIF•p NAME ff ITEM 7 IS BLANK, PLEASE E[ITHi COtiPORAiE NAME _ _ DO NOT WRITE iN THIS SP/ THE CALIFORNIA CORPORATION NAMED HEREIN, MAKES THE FOLLOWING STATEMENT 2. STREET ADDRESS OF PRINCIPAL OFFICE - SLRE OR ROOM 2A. 2 (IF NONE. COMPLETE }31) 40L47 HOLDEN CIRCLE TF.MF.(_ULA F CA F, J 400 NOT use P.O. BOX NO.) CRY AND STATE _ F 3. MAILING ADDRESS BYRE OR ROON 9A. SAME AS ABOVE CITY AND STATE THE NAMES OF THE FOLLOWING OFFICERS ARE: 4. CHIEF EXECUTIVE OFFICER 4A. STREET ADDRESS (SEE REVERSE SIDE) 4B. C{TY. AND ST/(TE ' DENNY MIGHELI. 40147 HOLDEN CIRCLE TEMECULA SA. STREET ADDRESS (SEE REVERSE .. SIDE) 56. CITY AND STATE t R 8. SECRETARY JANNETTE HALE 40147 HOLDEN CIRCLE TEMECULA CFI 6. CHIEF FINANCIAL OFFICER SA. STREET ADDRESS (SEE REVERSE SIDE) 60. CITY AND STATE DENNY MIGHELL• SAME AS ABOVE DESIGNATED AGENT FOR SERVICE OF PROCESS P., READ ITEMS 7 AN- B OX �ENSe SIDE BFRFpgRO'IS)ON. T. NAME ... _ DENN_Y MIGHELL'• STREET ADDRESS W AGENT 19 AN INDIVIDUAL (DO NOT USE P.O. BOX) DO NOT INCLUDE ADDRESS OF AGENT IS A CORPI B. CALIFORNIA SAME AS ABOVE COMMON INTEREST DEVELOPMENT ASSOCIATION SEGRON 1350. ET SEO GIVIL CODE S• CORPORATION IS NOT AN ASSOCIATION FORMED TO MANAGE A COMMON INTEREST DEVELOPMENT OF THIS BOX IS C14ECKM ❑THIS PROCEm TO NUMBER /1.) 10. CORPORATION IS AN ASSOCIATION FORMED TO MANAGE A COMMON INTEREST DEVELOPMENT UNDER THE DAVIS- STIRLIN ©THIS COMMON INTEREST DEVELOPMENT AGE. (IF THIS BOX IS CHECKED. COMPLETE 10A AND tOB.) IOA. BUSINESS OR CORPORATE OFFICE SAME AS ABOVE E JOB. NAME AND ADDRESS OF mn mnv.u+m.+ •.nom ^• - DENNY MIG14F.Iff ADDRESS SAME. AS ABOVE FISCAL YEAR 2010-2011 COMMUNITY SERVICE FUNDING PROGRAM POLICY The City of Temecula, in its fiscal year 2010 -11 budget, has allocated funds for community service programs within the City of Temecula. PURPOSE The purpose of this policy is to establish processing and evaluation criteria for funding requests received from community -based organizations that provide community service programs to Temecula residents throughout this fiscal year. GENERAL POLICY The City receives requests throughout the year for financial assistance from various organizations that provide a variety of services within the community. It is the City's policy to channel all requests through an annual review, thereby ensuring that all requests are evaluated equitably and consistently to enter into agreements for spec measurable services and to ensure that recipients are held accountable for providing the agreed upon services within the specified time frame. FUNDING PHILOSOPHY Requests for funding received from organizations will be considered during a speed period. Due to limited resources, not all requests can be funded. It is not the City's intention to fund each request received but rather to evaluate each proposal and provide funding to those organizations which most effectively serve the needs and improves the well -being of the residents of Temecula. The City will give special consideration to proposals that replace or enhance services the City is responsible for providing. The City also puts a higher priority on projects that have a broad community appeal. The City Council encourages a goal of self - sufficiency for all local organizations. The City Council supports providing grants to organizations that have demonstrated their effectiveness in raising funds and volunteer services for their programs within the community. The Council discourages an over- reliance on City financial assistance to maintain such programs on an ongoing basis. Therefore, all organizations requesting funds from the City should continue efforts to develop stable ELIGIBILITY To be eligible for funding, organizations: • Must be tax exempt; • Must be non- profit; • Cannot include salaries as part of their funding request; ■ Cannot include scholarships to high school students as part of theirfunding request; - • Cannot include debts as part of their funding request; - • Eligible individuals must be Temecula residents. GUIDELINES The program or service should benefit the general community of Temecula residents. The maximum allowable funding award is $5,000. COMPLIANCE Funds received from the City should be expended prior to June 30, 2011. Proper documentation to substantiate the funds received and expended should be provided to the City by September 1, 2011. If the funds are not expended in accordance with the approved purpose, the organization will be required to refund the amount of funds. Failure to provide proper documentation may jeopardize any future funding. TIMELINES • Thursday. July 16. 2010 Applications are available at City Hall and on the City s website at: http: /hvww.cityoftemecula.org/ Temecula /Government/Finance /Comm unityFunding • Wednesday. September 15, 2010 - Deadline for submitting applications. • November 2010 - Award recipients will be announced. CRITERIA In making funding determinations, the City's Community Service Funding Ad Hoc Committee will consider the following criteria: A. Is the organization currently non - profit? B. Does the organization provide a service to the overall community? C. Is the size and make -up of the organization equipped to provide the program/service to the overall community? D. What is the public reaction to the group? E. Does the organization have a high quality level of fiscal management? F. Is the group well organized to ensure longevity in the City of Temecula? G. Is there evidence of satisfactory service provided to the City's citizens? 2 H. [s the organization free from discrimination based on race, color, creed, nationality, sex, marital status, disability, religion, or political affiliation? 1. Does the organization require attendance or participation in any political, religious or social activity? J. Can the. organization providefiinancial statements (prepared using an appropriate method of accounting) to demonstrate sound financial management? K. Can the organization provide a budget for the fiscal year of request demonstrating cost- effectiveness? L. Does the organization make its services available to ail? M. Does the organization possess ongoing program evaluation tools? DIRECTIOti1S . A. Detach the Application from the Policy. B. Complete the application, filling in all of the blanks. Secure any attachments with staples. C. Do not attach more than is requested. D. Submit the original, plus one copy of the Application to: Mail to: Deliver to: City of Temecula City of Temecula Community Service Funding Community Service Funding Attn: Judy McNabb Attn: Judy McNabb P.O. Box 9033 43200 Business Park Drive Temecula, CA 92589 -9033 Temecula, CA 92590 Due to the large volume of applications submitted for this funding program, the City is unable to accept applications via fax or e-mail. If you have any questions please contact Judy McNabb at (951) 694 -6432. 3 ..........a . wyucJlCU• �- 3.�LLl% (Maximum allowable $5,000) Project Name: j 7��sp� A- �/AJ, Project Start Date: —f� r Project End Date:. -,? n / / ORGANIZATION INFORMATION Name of Oraani7afl.,r,• Contact Mailing Address: SIC 7s ¢iN' 49 D!G' -C !/ Telephone: Q.'/ ( -7! / — Year Organization Founded:__ Number of Paid Staff.--­6/,E ri Number of Volunteers:_ Geographic Area(s) Served: 7-,L--m , o ,., , , I /„ , . __ Is this organization incorporated in California as a non -profit organization? Yes 1 No Effective Date: 7L,49,e4 If "yes" (Must provide a cupy of your statement of non - profit status from the State of California): Date of incorporation as a non - profit: t7-,t-e z_ l Federal identification number: — C`c d'G State identification number: / f 2w e g If "no ": - ---- -- Name of sponsoring organization: Federal identification number. State identification number. This application has been authorized by the organization's: Executive Committee Board of Directors Members -at -Large Application - Page 1 Bniernal rtevenue Sent Department of Treasury - P.O. Box 2350 Los Angeles, Calif, 90053 District _...:. Director Person toContact: :E. Knight ° Veterans' -of Foreign Wars Post Telephone Number. (213) 688 4553 4089 Temecula 42820 Tierra Robles _ Refer Reply to: EP /EO:EOG -2 Temecula,. CA 92390" - Date: JUL 2 -5 1984 Dear Applicant: Your application for exemption from Federal income tax as an organization described in section 501(c)(3) of the Internal Revenue Code has been considered. Information submitted discloses that you are affiliated with the Veterans of Foreign Wars Department of California. Our- records indicate that in June s issued to that organization, holding it and its of 1958, a group exemption wa subordinates to be exempt. You should contact the above organization to establish your exemption from Federal income tax under their group exemption. Very truly Yours, District Director �— a' tE:: ➢I•xt•ttaaiYlle� �iY n71f3:7n3� F /,iixas�Y: ilia: r•]TnAq�3: \'L-L \a:i•��®. • � i�ta�na report has been Maned & found correct F'rira7rIFY.91Rc�37a�i71PTFYi� -- •Y Trustee 1 fEWi�SrrSlv�vZ�E���j'014 iYa'.YL•�]3QirllTla���Ftr�.7 Trustee 2 IGtd�7.iT;F-P.1177.1�?\a:�� �'� "dam ^:?_AIR.y3!1.7:in:f3lrl t =a.E:sp' ia�l Y�F�TI.O Tii_-P.li-��— Rx�lss• i31F?iT• t��!• ®t�� AI BRpn1YJL�13rrd 14113 ;7 n�i ®t =.S,3L� Disbursemenh Cash e � J: ri7: IiAIACIAIn�L�CVT3 :r!Ta1371.fJRa:�� for the Balance Period This Period 327.70 �Ir�a:�sF�Ca.1,�rry,Rncnn���.� - 327.70 90.50 - — tarkYif�C7:1, r d3117]rf��M� 289.23 48.02 286.80 �t�aa<Yib�[a:A.173d:69n77a1d.�� 1,953.53 MRSa•M - 1,953.53 9 8.76 15.02 21.50 92.28 194.00 28.00 - MUMM 1,912.45 2,723.25 2,716.17 .1,919.53 1,695.11 - 252.00 .1,443.11 t =c5M 2,812.29: 3,278.47. 6,087.10 t taa<ys c� p 3 si na rx� MW —t�:ll i7•f?YST bI TN mteim - t =aa:nt• � iT�:ytrxyrrrrr- .nira:nsa� Statement of Funds Distribution of Rec4phd, Disbursements & Cash Bal. National & Department Dues Application Fees Past General Fund Post Relief Fund Post Dues Reserve National Home Fund Post Canteen or Club Fund - Building Account- RolipaugtdCey Grant TOTALS Check Book Balance Bank Statement Balance VARIANCE..- This IS m cerldy that this report has been Maned & found correct Trustee 1 Trustee 2 Trustee 3 Cash Balance Receipts For Disbursemenh Cash Last Report This Pedal for the Balance Period This Period 327.70 - - 327.70 90.50 - 90.50 289.23 48.02 286.80 48.45 1,953.53 - - 1,953.53 9 8.76 15.02 21.50 92.28 194.00 28.00 - 222.W 1,912.45 2,723.25 2,716.17 .1,919.53 1,695.11 - 252.00 .1,443.11 6,581.28 2,812.29: 3,278.47. 6,087.10 _ 6,097.10 6,097.10 v f s QKI M. �� >i p _(�_� o 3� CD W CL `/D� :3 CD VJ w a cr O =~ /D CX CD 0 CD :V ' C cn 0 �� \' CD CD Cn/w ^' -U ll( `V!/ CD CD C: VIe v f s QKI M. �� >i p _(�_� qty T 0 0) a cr CD W � CD 0 o CD o C Vcn Cn/w -U ll( 3 CD C: 0 CD O CD D 0 :3 Q 0 0 CD �\ �e //���� iY V/ CD CD CD 3 =: CD v M CD CD .;. CD V! CD V/ v f s QKI M. �� >i l s 1 •2 '1"7 _ T _L! O O_ O O _._. _.. • < < /� CD CD -� 0 =r CD o CD 0 (7 w 3. 0 CD . CD 0 _ 0 ` W V ll TF \V ®, ry ^V Vo, / VI s S to ®� CD CD ca^ ® —z Q S L /CAD cn W � M mac\ CD 3 cx e. CD 0 V! ® M T 3 O 11 0- FD' CD 3 W ' V/ T ® Cn PSq %�� < ® /1 L0 VJ CD /�:- }� a ) fT"`P. = ® °_ 0 �1f cn ° -69 (D /= CD //� /On ITAJ CD cn CD 70 pyC� C/) v® T \ 6 L �CD CD CD ,- A //; 1 •2 t g - PRESIDENT or AUTHORIZED OFFICER: ���1rv' l<z[��°kcN�cG/�� C�Odi�yYJrI✓1�/L�00�— af7rZg NAME and TITLE (Please Print orTyp) ORGANIZATION NAME: T loo VE7LA h Als 1) /= F,'A-E/ C=2 MAILINGADDRESS: --)/AZ 7yCM EC' Lf GAS e /`� TELEPHONIE: G Z DATED THIS of �a EvrE� i2. 2010. (Date) (Month) BE SURE TO INCLUDE THE ORIGINAL PLUS ONE COPY AND SUBMIT TO: Mail Completed Applications to: Or Deliver in Person to: City of Temecula Community Service Funding Program Attn: Judy McNabb Post Office Box 9033 Temecula, CA 92589 -9033 City of Temecula Community Service Funding Program Attn: Judy McNabb 43200 Business Park Drive Temecula, CA 92590 Annliratinn - Pnna 5 C'TV Of TFMF ('u A September 10, 2010 SEP 1 0 2010 NANCE DEPT. City of Temecula Finance Department 43200 Business Park Drive Temecula, CA 92590 Attention: Judy McNabb Dear Ms. McNabb: Enclosed please find our 2010 -2011 Community Service Funding Program Applications which have been properly executed by the VFW Post Commander, Dean L. Klockenteger. Please do not hesitate to call if you need additional information or have questions. 7Sincerely, Dean L. Klockenteger 0— Commander 2007 -2010 DLK/ik Encl - - PROJECT INFORMATION Amount Requested: $ I o?Sp • d - (Maximum allowable $5,000) Project Project Start Date: /d '/- End Date: 6 - 3° * R-,P// ORGANIZATION INFORMATION I Name of Organization: V,,W ova -vt �4bP9 Contact Name: / L/11dr0A/ Title /Position: IIA10(�5 . Y.G'did� Mailing Address: / d S� .D% L /ZA Telephone: Call -//,?'D.2W? Year Organization Founded: Number of Paid Staff: 0 Number of Volunteers: GeographicArea(s) Served: Is this organization incorporated in California as a non - profit organization? Yes (/ in No Effective Date: if -yes" (Must provide a copy of your statement of non - profit status from the State of California): Date of incorporation as a non - profit: Federal identification number: —,00CdL pDo? !f State identification number: 5K 0// "" 795/ ` F'F Ac If "no ": Name of sponsoring organization: Federal identification number: State identification number: This application has been authorized by the organization's: Executive Committee Board of Directors Application - Page 1 Members -at -Large _ Employer Sdentification- Humber: 33- 0028024 Dee= Taxpayer+ Your employer . i.dentifioation number is 33- 0028024_ Please keep this number in your permanent records_ You should enter your. name and your identification number, exactly as shown, on all Federal tax forr that require its use, and on any related correspondence or documents. Si you have any questions about this letter, please write to us at the address shown on this letter. It you prefer, you may call the SI telephone number listed in your local directory_ Pn MRS employee there may be able to help you. but the office at the address shown on this letter is most famii:ar with your case. =f you write to us with questions about this letter, please provide your telephone number and the most convenient time for us to call so we can contact you it we need additional information_ Please attach this letter to any correspondence to help us identify your case_ Kee the copy for your records- Thank -you for your cooperation_ Enclosure(s)c Copy of this letter Sincerely yours, G_ L_ Joly Chief, Inquiry and Support Section r2fillaomX Your application for exemption from Federal. income tax asap organization described in section 501(c)(3) of the Internal Revenue Code has been considered Information submitted discloses that you are affiliated with the Veterans of Foreign Wars Department of California_ Our-records indicate that in June of 2958, a group exemption Gras issued to that organization, holding it and its subordinates to be exempt_ You should contact the above organization, to establish your exemption from Federal income tax under their group exemption_ Very /truly yours, District Director - - Gyod -i coi 000�2 00 C qp m X 3 -- z + _.. .00 mp jN FymOm OtJ 1Y�Uj �NpO�.. OIJW OSm 00 y V �0 pp POO O s�gxg $o7E pup q�q�o iM;88 , G _NN d Sm s i [m f Sr S Ito - �=R - a 1s. OPERATIONS Not Cash Balances. -._ .. @rperrtlibras_ Net Cash Batarncee FIRIM atBegiroft of 10. Qumta.. _.. Dating Qum* 11 -. Durm or,mrbm�, 12. at Em orb 1. National ad0eparbnmrt Dues oerCeplaTa0 -- - 2. Admit tonorAppGce5onFees(Depmenma) s. PostGendral Fund 4. =ReNdFund ProftDOnauons.ete) 5. Po Dues Reserve Fund (See Sm218,MmamlofProoedue) B..Pbat Horne a.BtnWBrg Fnrnd (kmkK a Savhgs but Not Real Estate T. PoattmnaCYAt _... _ - 8. National Norse g.Accnmis -S _.- - 1.327.70 S 90.50 $ 3.157.47 $ 367365 S 490.70 S - .444.40 S _ -. 1- ,459:55 t 24126 s 406.00 $ _.0.00 $ 0.00 $ 91%0.02 S 606.82 $ 145.00 S MOD $ 6,299.50 S 62.00 f 0.00 __ -0.003 0.00 6295.90 1.08&41 150.50 0.00 _ ..5.520.60 32325 406.OD $ S 6,421.58 $ 319205 S - 48520 S - 444:40 $ 2,238.46 S 0.00 S MOD S $ Bat $ 14,198.90 s 9. Bonds and bnmsmmft NotCrerRled to Fends s It s i SavbgsAcoount Balance s i X Cash on Hand AmonmtofCubfenCftbEs 14. TOTALS. $ 16,893.34 13.784.67$ 14.199.8D S 11.29123 $ 1s. OPERATIONS 17. RECONMMTMMC# 0 DBAtAM= - NavererpmmlParoldeducdmb WA Umdmg AcaotAdBalmnoe S 14.189.90 Nave Payments bear male hire props Less Oufttwxrtg chaff - Bat $ 14,198.90 Have sales bursa been collected ar : )S SavbgsAcoount Balance Are dub mrployM bmdal X Cash on Hand AmonmtofCubfenCftbEs S KIN TOM $ 14,199.9D Value of Reel Estate - $ N/A Bursts and hweshnefft (costvahm) Amoadotfnabdlyirmnarce S 1,000.0DD.00 _ Total $ 14,199.90 Owed on narigages and loam $ WA Vakm 0fPmsorurt property S 20.000.00 M TRUSTEM AND CDWAAMDEFrS - t:rdsiwtcArE� atJ� Osle /�i0 %3 . 20 %Iq sting Si DEC O9 rn arco.d.me alMNraael9Y-taxeatltlrtaic ebrs -- - - -rle otID Dm lomvled9emld he seFMm cmrsmWdmdmhmebemmmdrmdaWftLmdiu dYaPP Post Quarteynlastey MWE HEMOSER _- of Tnmtm . 28rr5DWReed Siprmd `' ' �/�} Thatee le Tama: CA MM SLe�od• /_X �i._ J„- j _ • TtU89@8 PWdass) This ism cm VISt One OMM Of MO Oummmmster is bon0edwhh Tm-efaftcmwOSwwCo.ofAfnsrica In iheanr tofS 19,ODD. u99 August 12010 and By adbthebvstofmylmoMedge and begat. • Goal: The goal of the VFW Post 4089 for the purposes of this grant is to support our Veterans Service Officer, John Daub, by purchasing equipment needed so that he can carry out his job effectively. John Daub works out of the Temecula Vet Center on a weekly basis. The computers at the Temecula Vet Center are open to the public and not appropriate for working with veterans (information must remain confidential). He has to leave the room inhere he interviews the veterans and go to a separate room, where the computers are placed close together and enter the information. It is difficult to keep the veteran's information confidential when sitting so close to other service officers and computers. John Daub works with over (30) thirty veterans a month, preparing and filing claims on their behalf. Objectives: At this time we are requesting the funds to purchase a laptop and related equipment so that Service Officer John Daub may (1) meet and greet veterans at any convenient location for both John Daub and veteran (some are disabled and/or in hospital and unable to make it to Temecula Vet Center; (2) interview the veteran; (3) look up records of the History. He has helped and assisted many returning troops and veterans in claiming benefits for their medical and physical ailments and/or disabilities. He has proven to be a valuable resource, both to the veterans and Temecula. I Brother- MFC -J630W Wireless All -in -One Printer (SP 149.99) 1 Microsoft Office Home &Business 2010 (SP $199.00) 2 Brother -Ink Cartridge- Black 2 Brother -Ink Cartridge -Color 2 Multipurpose Paper- Case 1 NETGEAR- RangeMax Wirelss -N 150 Router (SP $49.99) 1 Cables, etc Taxes Total request of funds= $1,250.00 w3c, ; Application — Page 4 NAME and TITLE (Pleasff Print or Type) PRESIDENT o AUTHORIZED ORGANI2 MAILING I) &76- DATED THIS ��f� of _ , 2010. (Date) (Month) BE SURE TO INCLUDE THE ORIGINAL PLUS ONE COPY AND SUBMIT TO: Mail Completed Applications to: Or Deliver in Person to: City of Temecula Community Service Funding Program Attn: Judy McNabb Post Office Box 9033 Temecula, CA 92589 -9033 City of Temecula Community Service Funding Program Attn: Judy McNabb 43200 Business Park Drive Temecula, CA 92590 Application — Page 5 PROJECT INFORMATION Amount Requested: $ 5 , 0 0 0 (Ma)imum allowable $5,000) Project Name: Mourning Star Center - Murrieta (MSC) Project Start Date: January 1, 2011 Project End Date: June 3 0 , 2 011 _ i ORGANiZATION INFORMATION Name of Organization: VNA of the Inland Counties (VNAIC) Contact Name: Doug Morin Title/Position: Director of Develognelt Mailing Address: 39815 Alta Murrieta Dr Ste C -4 Murrieta Ca 92g6'3 Telephone: (760) 773 -6261 Year Organization Founded: 1931 sa l Number of PaidStaff:l Part time Number of Volunteers: 4 plus 3 awaiting training GeographicArea(s) Served: South Riverside County including the City of mamacula Is this organization incorporated in California as a non -profit organization? Yes X No Effective Date: 09/1960 if^yee (Must provide a copy of your statement of non- profit status from the State of California): Date of incorporation as a non -profd: September 1960 Federal identification number. 95 - 1641973 State identification number. 910-2503-1 If "no ": Name of sponsoring organization: Federal identification number. State identification number This application has been authorized by the organization's: Executive Committee Board of Directors x Members -at -Large Application — Page 1 — MISSION STATEMENT - Briefly describe the goals and objectives of yourorganization and communityservices it provides. Describe the ways your organization meets the criteria listed on page 2 of the CS Funding Policy. The mission of the VNAIC is to provide home health and hospice care to everyone in need, regardless of their ability to pay. From July 1, 2009 through June 30, 2010 we provided these services to 389 home health patients and an additional 113 hospice patients who resided in the. City of Temecula. Additionally, the VNAIC provides a multitude of health related community service programs, such as community education, bereavement care and the Mourning Star Center, a free program that provides grief support to children and teens, aged 3 to 18 years who are grieving the death of a parent or sibling. Now in our 79th year of continuous service, (7 years in the Temecula/ Murrieta area) the Mourning Star Center is available to anyone in the community regardless of any prior affiliation with the VNAIC. We provide Mourning Star services in other areas of our Agency's service area including Palm Desert Victorville, Riverside and Banning and have recently recognized the need for these special and unique services in the southern Riverside County area. As has occur- red in these other areas, our Agency's Development Department works to develop relationships with current and potential donors in the area, as well as businesses and foundations to ensure sustainability of the program. Special events are also planned for, and the Agency commits to long term, sustaining funds while donor relations develop. ADDllcation - Pace 2 PROJECT DESCRRY17ON HowwiAyourorganization use the funding awarded? Describetheproject ,projectobjectims,.thoseserved, - area serviced, and number of volunteers involved. Be specific. Include equipment or servicesthafwould be purchased and why. Include a detailed budget and a schedule of significant acfivitles related to this project You may attach a maximum of one double- spaced typewritten page of information. (Please type or print legibly.) Funds awarded from the City of Temecula would provide the ;n;t; =1 funding to start one new support group for between a to in rhiid,ea/ teens Initial costs include costs related to volunraar fran nr - and support and program materials and supplies The -yNATr acc „mca unfunded costs for administrative expenses such as occupanny, nhnna_e and the majority of salary related expenses Funding from th;G request would create a new group to begin in January of 2011 anLj_1,n through the remainder of the program year, or May /June of 2011 Children participating in this group will be identif ;ed th;� fall through outreach conducted to Temecula schools and comman;ry nrtan- izations All of the children will be grieving the death of n „ rent, sibling or other close loved one such as a grandparent wh J-e ;n Lhe group, children will be encouraged to share their emo tify appropriate and healthy coping skills to deal wi occurs through play and art projects and guided discussions__ Recaarch clearly demonstrates the need for such services and we incLuda — one attachment - "Why Centers For Grievinq Children Matter” - for your information and consideration In the 2009/2010 DroQram year the Temecula /Murrieta Mourning Star Center served a total of 15 children and has interest from as many children again for the c,om;na program year. The Development office of the VNAIC is actively soliciting individual and community donations requesting grant fund- ing and planning fund raising activities to benefit this program. Application - Page 3 Application — Page 4 PRESIDENT or AUTHORIZED OFFICER: Lynn M. Campbell President and CPO NAME and TITLE (Please Print or Type) SIGNATURE ORGANIZATION NAME: Visiting Nurse Association of the Tnland rn„nt;P� MAILINGADDRESS: Attn: Development Department 6235 River Crest Dr Ste T Riverside ['a a ?rp7 TELEPHONE: (760) 773 -6261 DATED THIS 13th of September , 2010. (Date) (Month) BE SURE TO INCLUDE THE ORIGINAL PLUS ONE COPY AND SUBMIT TO: Mal Completed Applications to: City of Temecula Community Service Funding Program Attn: Judy McNabb Post Office Box 9033 Temecula, CA 92589 -9033 Or Deliver In Person to: City of Temecula Community Service Funding Program Attn: Judy McNabb 43200 Business Park Drive Temecula, CA 92590 Application - Page 5 Why Centers for Grieving Children Matter Families can encounter physical, emotional, psychological, spiritual, financial and geographic upheaval after a loved one's death. Children -need nurturing, attention, love- and stability during the grieving process, but unfortunately, often their parents and other family members are dealing with their own grief and cannot always be emotionally present for their young ones. When support services for the bereaved are present in the community, families can gain strength by learning to grieve well together. But some children, who do not have the language skills to express their anger and frustration, may become introverted, depressed, act out, start fights, refuse to leave the presence of a surviving parent, or struggle to attend classes and complete schoolwork. For teens and young adults, unresolved grief can lead to addictions to alcohol and drugs, criminal behavior such as gang violence, self - mutilation, dropping out of school, and sexual activity that may result in untimely and sometimes unwanted pregnancies. Frequently, these young survivors run households, pay bills, comfort one or both parents, and often put their own grief on hold while the parent or parents are grieving. Then, some time later, when the parents are feeling stronger, the roles reverse and the teen will begin to experience their own personal grief. But peers, teachers and even their own family are now asking "shouldn't you be over this by now ?" If you speak with an adult who experienced the death of a parent, sibling or someone with whom they had a significant connection to as a child, they will tell you how devastated they were and how it changed their life. Studies have shown that when grief is unaddressed or intentionally suppressed because of cultural or religious reasons, these hurts are carried into adulthood only to arise in depression, poor relationships, self - esteem problems, or some form of unconstructive behavior. We cannot change the death individuals have experienced, but we can make a difference by providing an opportunity to be with other bereaved children and teens, as well as trained adults who truly understand their pain. source. Foundation for Grieving children. The Mourning Star Center of the VNAIC For more information, contact: Doug J. Morin, Director of Development (760) 773 -6261 doug.morin @vna- ic.org Financial Information 2010 Agency Summary Budget Balance Sheet ending 6/30/10 Statement of Financial Activity ending 6/30/10 2010 Estimated Program Budget 501 (c)3 Tax Determination Letter 2009 Audited Financial Statement } ....... _ - Visiting Nurse Association of the Inland Counties - _.VNASummary For the Twelve Months Ending December 31, 2010 I ND_ Revenue Medicare $46,438,909 _ ..__..__Medical..___ 1.837.696 ..12,078,483_. _ Managed Care Facility &Selpa 773,706 _ Less Doubtful Accounts - (330,735) - ... _ _. .... Total Revenue ... _ _.. 60,798,059. Other Income Charily Care Funding -. - 120,000. Grants 56,850 - Moumirg Star Donations - 61,050 237,900 Net Revenue from Operations. .. _ ...61,035,959. Direct Expenses: Salaries 23,235,426 Benefits 1,883,119 - Payroll Taxes 1,795,567 Workers Comp - 1,994,466 - Contractors 80.004 - Total Direct Salaries & Benefits 28,988,582 - Other Direct Cost Transportation 2,120,191 Medical Supplies 2,433,150 - - Hospice Contracts. 2,256,392 Physician Visits Net 18 Room and Board Net 151.132 Total Other Direct . Cost 6,960,883 _ Total Direct Expense 35,949,466 Net Income before Indirect Fbrpenses 25,086,494 Indirect Expenses Salaries 14,009,290 Serrefts 1,584,614 Payroll Taxes 1,149,413 Workers Comp 206,352 Total Indirect Salaries & Benefits 16,949,669 Other Indirect Cost Transportation 232,737 Recruitment 84,500 Occupancy Cost 2,341,034 Dues and Membership 117,100 Equipment Maintenance 313,918 Insurance. 396,000 ConsuftingtPurchase Services 120,100 Legal 46.000 Accounting 74,000 Office Supplies, 263,010 Postage 93:150 Printing 162,400 Software Support 1,078,831 Telephone 984,285 Depreciation 375,000 Education; Cont, Trips 135,900 - Comm Ed & NonAllow /Allow B/D 84,000 .Equip Rental & Minor 458,370 Interest Expense 137,850 Organizational Meeting 69,630 Other Admin & General Expense 203,710 Total Other Indirect Cost 7,773,475 Total Indirect Expenses 24,723,144 Total Expenses 60,672,609 Net Income From Operations 363,350 Other Income United Way - _ - 36,000 Interest 12,000 - Donations - General - - - 270,000 Misc Income 12,000 Charity Care (120,000) Total Other Income 210,000 - - BR_TrentlTree Statement of Activity Income Statement ttD only 01/14/10 Liabilities Current Liabilities 5,868,360 5,868,360 5,868,39 ' Visiting Nurse Association of the Inland Counties- 1,001,822 963,33 Payroll and Benefits Payable Balance Sheet 4,542,425 4,562,00 _. _... _... _.. _ .As of June 30,2010:.: 1,277,484 1,325,23. - - - - 06130110 06131110- 04130110 Workers Compensation - Current Assets - 563,701 549,84 Current Assets 196,784 - 221;33• Cash and Cash Equivalents ... -- _ . _ _ _ .. $4,750,780 _ $4,233,538 _ $3,900,39, _ - - Accounts Receivablesfrom Operations -- - -- - - 7467,863 - 8,280;221 - - 8,262,01 - Allowance for Doubtful Accounts -- (591,336) (537,040) (494,74 Net Accounts Receivables from Operations 6,876,527 7,743;181 - - 7,767,27- F - Other Receivables - Current 4,097 2,106 - 2,25 - Total Current Receivables - - -- - - 6,880,624 - 7,745,287 - - 7,769,53 Inventory 29,816. 29,816 -.... ..29,81, Prepaid Expenses. 649,071 542,645 474,85_ Deposits - 217,758 220,758 186,00 Total Current Assets 12,528,048 12,772,044 12,360,60 Long Term Asset and Investments _ _ Restricted Cash -Wells Fargo 1,700,950 1,700,811 1,700,66 - 457 Retirement Plan 68,357 74,373 73,52: River Springs LP Investments 357,209 357,209 357,20 Total Investments and Long Term Assets 2,126,516 2,132,392 2,131,39 Property and Equipment 6,217,302 6,217,302 6,217,30 Less Accumulated Depreciation (5,524,288) (5,496,054). (5,467,48 Total Property and Equipment 693,014 721,248 749,82 Total Assets 15,347,578 15,625,684 15,241,82 Liabilities Current Liabilities 5,868,360 5,868,360 5,868,39 Accounts Payable. 1,024,574 1,001,822 963,33 Payroll and Benefits Payable 4,140,162 4,542,425 4,562,00 Deferred Revenue - Medicare 1,283,669 1,277,484 1,325,23. Accrued Liabilities 474,718 452,786 491,38 Workers Compensation - Current 666,283 563,701 549,84 Equipment Loans &Leases - Current 196,784 210,107 221;33• Total Current Liabilities 7,788,190 8,048,324 8,113,14 Long Tenn Liabilities 6,384,239 6,386,588 5,929,23 .. Workers Compensation - Non - current 970,473 970,473 970,47 Equipment Loans & Leases - Non -current 136,319 145,925 155,44 457 Retirement Plan 68,357 74,373 73,52: Total long Term Liabilities. 1,175,149 1,190,771 11199,44 Total Liabilities - 8,963,339 9,239,095 9,312,59. Fund Balance Gomm] Fund Beginning Balance 5,868,360 5,868,360 5,868,39 Current Surplus \(Deficit) 201,608 206,965 (242,39 Total General Fund Balance 6,069,968 6,075,325 5,625,99: Temporarily Restricted Funds 116,167 123,282 126,76 Endowment Fund 25,ODO 25,000 25,00 Board Designated Funds 145,770 136,038 125,09 Nightingale Society Funds. 27,334 26,943 26,39: Total Other Fund Balances 314,271 311,263 303,24 Total Fund Balances _ 6,384,239 6,386,588 5,929,23 .. Total Liabilities and Fund Balance 15,347,578 15,625,684 15,241,82 B.LSht_YID 00k B.W. She0 1 0225P ` Murrieta Mourning Star Center Monthly Rent for unit 6 2,142.00 Estimated Budget 50.000/0 Monthly Cost 1,071.00 For 2010 6.00 6,426.00 Phones Calculation Avg 4,985.45 usage YTD as of June Monthly Annualized 30, 2010 Cost Cost Salary (only) 24,402. 4,067 48,805 Employee benefits 2,732 455 5,464 Payroll Taxes 353 59 706 Mileage 1,042 174 2,084 Office Supplies 511 85 1,022 - Phones 249 42 499 Postage (PD cost) 186 31 372 Rent 6,426 1,071 12,852 Training /Education (RIVMSC Budget) 750 Total 72,554 35,902 5,984 Labor Cost and Mileage is base on Murrieta Hospice Bereavement Coordinator as of 6/30/10 Office Supplies is based on actual sent for Murrieta MSC as of 6/30/10 Phones is based on Murrieta Hospice cost (See calculation below) Postage is based on PD Cost as of 6 /30/10 Rent based on per contract, Per Mark N. MSC uses about 50% of unit 6 (See Below) training /Education used Riv MSC Budget amount for 2010. Rent Calculation Monthly Rent for unit 6 2,142.00 %of Use 50.000/0 Monthly Cost 1,071.00 Months 6.00 6,426.00 Phones Calculation Total Phone as of June 30,10 4,985.45 usage 5% Total Telephone cost 249.27 VISITING NURSE ASSOCIATION OF THE INLAND COUNTIES 6235 RIVER CREST DR STE L :L RIVERSIDE CA 92507 -0758 012935 Employer Identification Number: 95- 1641973 Person to Contact: Mrs Lutes Toll Free Telephone Number: 1- 877-829 -5500 Dear Taxpayer: This is in response to your Jan. 06, 2010, request for information regarding your tax- exempt status. Our records indicate that your organization was recognized as exempt under section 501(c)(3) of the Internal Revenue. Code in a determination letter issued in September 1960. our records also indicate that you are not a private foundation within the meaning of section 509(a) of the Code because you are described in section(s) 509(a)(1) and 170(b)(1)(A)(vi). Donors may deduct contributions to you as provided in section 170 of the Code. Bequests, legacies, devises, transfers, or gifts to you or for your use are deductible for Federal estate and gift tax purposes if they meet the applicable provisions of sections 2055, 2106, and 2522 of the Code. Beginning with the organization's sixth taxable year and all succeeding years, it must meet one of the public support tests under section 170(b)(1)(A)(vi) or section 509(a)(2) as reported on Schedule A of the Form 990. If your organization does not meet the public support test for two consecutive years, it is required to file.Form 990 -PF, Return of Private Foundation, fot the second tax year that the organization failed to meet the support test and will be reclassified as a private foundation. If you have any questions, please call us at the telephone number shown in the heading of this letter. For the Years Ended December 31, 2009 and 2008 Independent Auditors' Report Consolidated Balance Sheets Consolidated Statements of Operations and Changes in Net Assets Consolidated Statements of Cash Flows Notes to Consolidated Financial Statements Page 1 2 4 5 6 , - .Gary L. Christenson, CPA4 Soren McAdam Ch istenson LLP �. Kenneth N. Goddard, Douglas - Douglas R. McAdam, c.rA Lucia A Powell, CPA • • Certified Public Accountants and Business Advisors James L. Soren, cm -. - Kirk G. Stitt, cPA David P.'Nit ttle, CJA Roger E. Wadell, CPA _. Cindy R Watts, cxP _ Independent Auditors' Report To the Board of Directors Visiting Nurse Association of the Inland Counties We have audited the accompanying consolidated balance sheets ofthe Visiting Nurse Association ofthe Inland Counties and subsidiary (the Organization) as of December 31, 2009 and 2008, and the related consolidated statements of operations and changes in net assets and cash flows for the yews then ended. These consolidated financial statements are the responsibility of- the Organization's management. Our responsibility is to express an opinion on these consolidated financial statements based on our audits. We conducted our audits in accordance with auditing standards generally accepted in the United States of America. Those standards require that we plan and perform the audit to obtain reasonable assurance about whether the consolidated financial statements are free of material misstatement. An audit includes examining, on a test basis, evidence supporting the amounts and disclosures in the consolidated financial statements. An audit also includes assessing the accounting principles used and significant estimates made by management, as well as evaluating the overall consolidated financial statement presentation. We believe our audits provide a reasonable basis for our opinion. In our opinion, the consolidated financial statements referred to above present fairly, in all material respects, the consolidated financial position of the Visiting Nurse Association of the Inland Counties and subsidiary as of December 31, 2009 and 2008, and the consolidated results of its operations and its cash flows for the years then ended, in conformity with accounting principles generally accepted in the United States of America. A.. �Vl`G "c dam Ci�ixao� —�� June 7, 2010 1 2068 Orange Tree Lane, Suite 100 HO. Box 8010 Redlands, CA 92375 -1210 (909) 798 -2222 (909) 798 -9772 fax sme@sme-cpas.com Members of PKF North American Network and of PKF International, an association of legally independent firms and American Institute of Certified Public Accountants This page intentionally left blank ASSETS... _... _. Current assets Cash and cash equivalents (Note 1) Trade accounts receivable, net of allowance for uncollectible accounts of $325,349 and $354,729, respectively (Notes 1, 2) Other receivables Prepaid expenses and other assets Total current assets Property and equipment, net (Notes 1, 3) - December 31, 2009 2008 $ 4,167,737 $ 2,793,242 7,568,871 8,974,889 16,057 - 8,473 820,481 609,269 12,573,146 12,385,873 Other assets Restricted cash (Note 8) Investment in unconsolidated affiliate (Note 4) Funds designated to pay deferred executive compensation (Note 6) Total other assets Total assets 864,971 946,429 1,725,000 25,000 357,209 372,425 65,998 39,400 2,148,207 - 436,825 $ 15,586,324 $ 13,769,127 See accompanying notes to financial statements. i) LIABILITIES AND NET ASSETS - Current liabilities.. Accounts payable Accrued salaries and benefits Notes payable Current portion of capital lease. obligations (Note 5) Overpayments from third parties on patient accounts Accrued worker's compensation claims Deferred revenue (Note 1) Total current liabilities $ 1,679,822 $- 1,641,863 4,174,410 3,907,556: — 32,172 252,334 290,513. 189,415 264,840 564,044 646,410 1,330,623 1,046,731 8,190,648 - 7,830,085 Noncurrent liabilities Capital lease obligations, long -term (Note 5) Long -term portion of accrued worker's compensation claims Deferred executive compensation (Note 6) Total liabilities Net assets (Note 1) Unrestricted Board- designated Undesignated Total unrestricted net assets Temporarily restricted Permanently restricted Total net assets Total liabilities and net assets 3 205,718 332,902 970,473 1,003,405 65,998 39,400 9,432,837 9,205,792 93,706 426,844 5,868,365 3,905,955 5,962,071 4,332,799 166,416 205,536 25,000 25,000 6,153,487 4,563,335 $ 15,586,324 $ 13,769,127 Visiting Nurse Association of the Inland Counties and Subsidiary - Consolidated Statements of Operations and Changes in Net Assets Years Ended December 31, 2009 2008 Revenue and support - - - -- Net patient service revenue (Note 1) - $ 62,473,535 -$- 61,077,959 - Contributions _ _ _ 485,059 528,237 Otherrevenue (65,936) 64;301 Income from investment in unconsolidated affiliate (Note 4) 97,779 88,658- Net assets released from restrictions Total revenue and support .Expenses Program Home health Hospice services Caregivers Supporting services General and administrative Fundraising Total expenses - Income from operations Other income (Note 6) Increase in unrestricted net assets Changes in temporarily restricted net assets Contributions Investment earnings Net assets released from restrictions (Decrease) increase in temporarily restricted net assets Changes in permanently restricted net assets Funds released from restrictions Decrease in permanently restricted net assets Change in net assets Net Assets Balance, beginning of year Balance, end of year 62,990,437 89,836 63,080,273 25,712,203 25,047,000 23,794 10,309,020 358,984 61,451,001 1,629,272 1,629,272 61,759,155 300,244 62,059,399 25,443,201 25,847,472 (4,189) 10,121,209 282,341 61,690,034 369,365 614,579 983,944 50,689 224,564 27 1,060 (89,836) (198,723) (39,120) 26,901 (101,521) .(101,521) 1,590,152 909,324 4,563,335 3,654,011 $ 6,153,487 $ 4,563,335 See accompanying notes to financial statements. n See accompanying notes to financial statements 5 A CMC3 GUUCU LCCCulyer 01, 2009 2008 - Cash flows from operating activities _.. _.. _ Change in net assets _. _ $ .1,590,152 $. 909_,3.24 _ -- Adjustments to reconcile changes in net assets to net cash provided - _ by operating activities - - Depreciation and amortization 391,989 650,564 - .> Decrease in restricted assets - - — 101,521 Provision for uncollectible accounts 578,973 766,534 Loss on disposal of equipment 108,744 —. Decrease (increase) in Accounts receivable 827,045 647,818 Other receivables (7,584) 337,929 Other assets (308,991) 245,847 Increase (decrease) in Accounts payable 37,959 (815,443) Accrued salaries and benefits 266,854 275,501 Overpayments from third parties on patient accounts (75,425) (275,163) Deferred revenue 283,892 (93,728) Accrued worker's compensation claims (115,298) - :27,272 Net cash provided by operating activities 3,578,310 2,777,976 Cash flows from investing activities Purchases of property and equipment (432,889) — Distributions from investment 112,995 98,415 Net cash (used in) provided by investing activities (319,894) 98,415 Cash flows from financing activities Principal payments on long -term debt (32,172) (31,133) Borrowings under capital lease obligations 169,985 — Principal payments on capital leases (321,734) (441,068) Restricted cash to secure letter of credit (1,700,000) — Net cash used in financing activities (1,883,921) (472,201) Net increase in cash and cash equivalents 1,374,495 2,404,190 Cash and cash equivalents (Note 1) Balance, beginning of year 2,793,242 389,052 Balance, end of year - - $ 4,167,737 $ .2,793,242 Cash paid during the year for interest $ , 300,162. $ 222,100 Non -cash investing and financing transactions Equipment financed with capital lease obligations $ 13,614 $ - 16,605 See accompanying notes to financial statements 5 _ 1. Summary of Operations and Significant Accounting Policies - The Visiting Nurse Association of the Inland Counties and subsidiary (the Organization) is licensed by the State ofCalifomia _ - - to provide home health and hospice services to patients, under the direction of licensed physicians in San Bernardino and - Riverside Counties. Revenues are derived predominantly from home health and hospice . services. - VNA Caregivers, Inc., a wholly owned subsidiary, ceased operations during July 2004. The Organization dissolved VNA Caregivers, Inc. effective March 1, 2010 after all worker's compensation claims against it were settled. _ The preparation of these financial statements requires management to make estimates and assumptions. Those estimates and assumptions affect the reported amounts of assets, liabilities, revenues, and expenses, as well as the disclosure ofoomingent assets and liabilities. Actual results could differ from those estimates. Management has considered events occurring through - June 7;- 2010 -in its evaluation of the conditions on which estimates were based or for changes in conditions subsequent to the balance sheet date which should be disclosed. The financial statements were available to be issued at this date. Management also determines the accounting principles to be used in the preparation of financial statements. A description of the significant accounting policies employed in the preparation of these financial statements follows: Consolidation The accompanying consolidated financial statements include the accounts of Visiting Nurse Association of the Inland Counties and its wholly owned subsidiary, VNA Caregivers, Inc. Intercompany transactions and balances have been eliminated in consolidation. - Use of Estimates The preparation of financial statements in conformity with accounting principles generally accepted in the United States requires management to make estimates and assumptions that affect the amounts reported in the consolidated financial statements and disclosures made in the accompany notes to the consolidated financial statements. While management believes these estimates are adequate, actual results could differ from these estimates. Concentration of Credit Risk The cash which the Organization has in financial institutions is insured by the Federal Deposit Insurance Corporation (FDIC): up to $250,000 at each institution. At various times throughout the year, the Organization may have cash balances at financial institutions which exceed the FDIC insurance limit. Management reviews the financial condition ofthese financial institutions on a periodic basis and believes this concentration of cash does not result in a high level of risk for the Organization. Financial Statement Presentation The Organization reports information regarding its financial position and activities according to three classes of net assets. Temporarily restricted net assets include those resources whose use is restricted by donor - imposed criteria that either expire due to the passage of time or because of actions of the Organization. Permanently restricted net assets include resources whose use is permanently restricted by donor - imposed criteria that neither expire by the passage oftime nor can be fulfilled or otherwise removed by actions of the Organization.. Unrestricted net assets include resources that are not temporarily or permanently restricted by donor and are available for operations of the Organization without limitation. 3 Visiting Nurse Association of the Inland Counties and Subsidiary Notes to Consolidated Financial Statements 1. Summary of Operations and Significant Accounting Policies (Continued) Cash and Cash Equivalents The Company considers all highly liquid investments with a maturity of three months or less when purchased to be cash - - equivalents, Cash and equivalents limited for long -term purposes by donor - imposed restrictions are presented as restricted .cash. Trade Accounts Receivable Trade accounts receivable are presented net of the allowance for uncollectible accounts. The Organization provides an allowance for doubtful collections based upon a review of outstanding receivables, historical collection information, and existing economic conditions. Collection efforts are pursued on all valid receivables until appeals are exhausted or the account is deemed uncollectible. At that point, the account is written off and sent to a collection agency, if appropriate. Property and Equipment Purchased property, equipment, and leasehold improvements are recoded at cost and depreciated over theirestimated useful lives using the straight -line method of depreciation in compliance with Medicare guidelines. Estimated useful lives are as follows: - Furniture and fixtures 3 -10 years Office equipment 3 -10 years Software 3 years Medical and therapeutic equipment 3 -5 years Leasehold improvements Lesser of asset life or remaining life Equipment under capital lease obligations are amortized over their useful lives. The Organization adheres to Medicare guidelines by making it a policy to capitalize any asset with a useful life of more than two years that is purchased at a cost of $5,000 or more. Federal and State Income Taxes Visiting Nurse Association of the Inland Counties and VNA Caregivers, Inc. are exempt from federal and California income taxes under Internal Revenue Code Section .501(c)(3) and Cal ifornia Revenue and Taxation Code Section 23701(d).. 7 - Notes to Consolidated Financial Statements - - - - - 1. Summary of Operations and Significant Accounting Policies (Continued) Board - Designated Funds .. The Organization's board of directors has designated $93,706 and $426,844 of unrestricted net assets to be retained for special projects to be determined at a later time as of December 31, 2009 and 2008, respectively. Temporarily Restricted Net Assets The Organization reports gifts of cash and other assets as restricted support if they are received with donor stipulations that limit the use of the donated assets. When a donor restriction expires, that is, when a stipulated time restriction ends or a - purpose restriction is accomplished, net assets classified as 'temporarily restricted" are reclassified to "het assets released from restriction" in the statement of operations and changes in net assets. Support that is restricted bythe donor is reported as an increase in unrestricted net assets if the restriction expires in the reporting: period in which the support is recognized Temporarily restricted net assets at December 31, 2009 and 2008 are restricted for the following purposes: December 31, 2009 2008 Patients with nonmedical needs $ 26,377 $ 27,127 Medical equipment — 1,781 Community education and services 140,039 176,628 $ 166,416 $ 205,536 Permanently Restricted Net Assets Permanently restricted net assets consist of endowment funds to be held indefinitely, the income from which is restricted to the Camp Erin grief counseling program for children. During 2008, a donor of permanently restricted funds in the amount of $100,000 changed the conditions for the use of the funds such that they are to be used in specified annual increments for the support of Camp Erin. Net Patient Service Revenue Net patient service revenues from patients and third -party payors are reported at the estimated net realizable amounts, including estimated retroactive adjustments under reimbursement agreements with third -party payors. Retroactive adjustments are accrued on an estimated basis in the period the related services are rendered, and adjusted in future periods as final settlements are determined. For the years ended December 31, 2009 and 2008, approximately 75 percent of the Organization's revenue was derived from patient charges under the federal Medicare program. As a result of the Balanced Budget Act of 1997, the Medicare Prospective Program Payment System (PPS) for home health agencies became effective October 1, 2000. Consequently, the Organization is reimbursed for home health services provided to Medicare patients on a per- episode, rather than a per - visit, basis, and there is no settlement process as a result of submitting cost reports. The Organization continues to receive a daily rate for hospice services provided to Medicare. patients. The Organization also derived approximately 3 percent of its revenue from patient charges under the California Medi -Cal program for the years ended December 31, 2009 and 2008. Reimbursement is based on a standard fee schedule established by Medi -Cal for each type of service. Contracts have been signed with health maintenance organizations and insurance companies to provide services for less - than - standard rates. 8 4. Investment in Unconsolidated Affiliate. In August 1993, the Organization entered into a limited partnership agreement with The Betty L. Hutton Company to form River Springs, L.P. The partnership was formed to acquire, develop, improve, and invest in certain real property in Riverside, California. Currently, the Organization leases administrative space from this partnership in a 15 -year lease that expires in the year 2014. Rental expense for December 31, 2009 and 2008 was $434,061 and $413,660, respectively. The Organization accounts for its investment in River Springs, L.P. using the equity method. Investment income of$97,779 and $88,658 was recognized for the years ended December 31, 2009 and 2008, respectively. The Organization has a 24.3 percent limited partnership . interest in River Springs, L.P. 10 Visiting Nurse .Association of the Inland Counties and Subsidiary _ Notes to Consolidated Financial Statements 2. - Trade Accounts Receivable - Trade accounts receivable, net of associated contractual allowances, are due from third -party payers as follows: December 31, 2009 December 31, 2008 _ - Amount Percentage Amount Percentage Medicare $ 2,926,696 38.7% $ 3,962,025 44.2% Medi -Cal 1,201,840 15.9% 1,327,378 14.8% Private insurance 3,765,684 49.7% 4,040,215 45.0% 7,894,220 104.3% 9,329,618 104.0% Less allowance for.uncollectible accounts 325,349 4.3% 354,729 4.0 %. $ 7,568,871 100.0% $ 8,974,889 100.0% 3. Property and Equipment December 3l, 2009 2008 Leasehold improvements $ 448,668 $ 408,865 Furniture and fixtures 289,233 289,233 Office equipment 2,803,922 2,821,917 Software 2,184,940 2,062,553 Medical and therapeutic equipment 490,539 490,539 Construction in progress — 34,351 6,217,302 6,107,458 Less accumulated deprecation 5,352,331 5,161,029 $ , 864,971 $ 946,429 4. Investment in Unconsolidated Affiliate. In August 1993, the Organization entered into a limited partnership agreement with The Betty L. Hutton Company to form River Springs, L.P. The partnership was formed to acquire, develop, improve, and invest in certain real property in Riverside, California. Currently, the Organization leases administrative space from this partnership in a 15 -year lease that expires in the year 2014. Rental expense for December 31, 2009 and 2008 was $434,061 and $413,660, respectively. The Organization accounts for its investment in River Springs, L.P. using the equity method. Investment income of$97,779 and $88,658 was recognized for the years ended December 31, 2009 and 2008, respectively. The Organization has a 24.3 percent limited partnership . interest in River Springs, L.P. 10 Visiting Nurse Association of the Inland Counties and Subsidiary - Notes to Consolidated Financial Statements -- 7. Professional Liability Insurance - - - - The Organization is insured for professional liability claims under an occurrence -based policy. The insurance provides -- $1, 000,000 maximum coverage per incident, with a $3,000,000 aggregate limit. Premium expense _was .$342,753..and $298,956 in 2009 and 2008, respectively. 8. Letter of Credit _..... _ The Organization has an unused letter of credit in the amount of$2,750,000 for the benefit of Zurich American Insurance - Company w fmance the Organization's worker's compensation insurance plan. The letter of credit matures on December 1, 2010 and is secured by all accounts receivable, inventory, equipment, and a restricted bank account in the amount of $1,700,000. 9. Contingencies Amounts received or receivable from third-party payors are subject to review by the third -party payors. Any disallowed claims, including amounts already collected, may constitute a liability oflhe Organization. The amount, ifany, which may be disallowed by third -party payors is not determinable. Various claims and litigation involving the Organization are currently outstanding. The outcome of these matters is not determinable at this time. 12 xame Heatch,& IosRi�e: City of Temecula .(76Q)z551,6 Community Service Funding Program Attn: Judy McNabb Murneta Home.HeaI (9�T7,89+5400 Post Office Box 9033 Hospice :(951}8,. 5336 Temecula, Ca 92589 -9033 D - 1966': 64' Dear Ms. McNabb: Please extend our appreciation to the Council Members of The City of Temecula for the opportunity to request funding from the City for a community service program provided by our organization, specifically, the Mourning Star Center. As you will see from the enclosed application, the Mourning Star Center provides grief support to children and teens who are grieving the death of a parent, sibling or other close loved one. Please contact me directly if you have any questions or need any additional information. Thank you in advance for your consideration of this request. Sincerely, Doug J. Morin Director of Development The Mourning Star Center Direct: (760) 773 -6261 Email: doug.morin @vna- ic.org FISCAL, YEAR 20'10 -'I 1 SEP 1 5 2010 COMMUNITY SERVICE FUNDING PROGRAM A0 (Please Print or Typed / 07 H PROJECT INFORMATION Amount Requested: $ 5. oo0 (Maximum allowable $5,000) Project Name: 211 Riverside Project Start Date: Ongoing Project End Date: Ongoing I ORGANIZATION INFORMATION I Name of Organization: Volunteer Center of Riverside County Contact Name: Bobbie Neff Title /Position: CEO Mailing Address: 2060 University Avenue, Suite 212 Riverside, Ca. 92507 Telephone: 951 329 -4706 Year Organization Founded: 1966 Number of Paid Staff: 50 Number of Volunteers: 100 Geographic Area(s) Served: All of Riverside Co n y Is this organization incorporated in California as a non- profit organization? Yes X No . Effective Date: December 1966 if -yes° (Must provide a copy of your statement of non - profit status from the State of California): Date of incorporation as a non - profit: December 14, 1966 Federal identification number: 95- 2287250 State identification number: 519207 If "no ": Name of sponsoring organization: Federal identification number: State identification number: This application has been authorized by the organization's: Executive Committee Board of Directors X Members -at -Large Application — Page 1 FINANCIAL STATEMENTS - - PLEASE ATTACH COPIES.OF.THE_CURRENT BUDGET OF THE.ORGANIZATION AND. FINANCIAL STATEMENTS (BALANCE STATEMENT AND INCOME STATEMENT). It does not require a CPA's audit, but please submit if available. Please see attached audit,. financial statements, and bud et NIISSION STATEMENT Briefly describe the goals and objectives of your organization and community services it provides. Describe the ways your organization meets the criteria listed on page 2 of the CS Funding Policy: Since 1966, The Volunteer Center of Riverside County (VCRC) has been serving the residents of Riverside County through it's mission, "linking people in need with those who can help ". A sound management system and team administers over a $2 million budget annually, comprised of diverse funding including foundations,Federal,State,and local funding sources including 3 United Ways. With 50 employees and hundreds of volunteers, VCRC services residents through 8 unique social service programs ranging from housing to suicide prevention. One of the programs is 211 Riverside which is the program these funds will benefit. All residents may use 211 to locate health and human services. There are no eligibility requirements. 211 has over 898 agencies and 2700 programs listed in the data base that provide help to Temecula residents for a broad range of services including such things as housing, food stamps, legal assistance, utility assistance, employment, counseling. VCRC and 211 does not discriminate against any person and does not require attendance in any political, religious, or social activity. Application - Page 2 PROJECT DESCRIPTION How will your organization use the funding awarded? Describe the project, project objectives, those served, area serviced, and number of volunteers involved. Be specific. Include equipment or services that would be purchased and why. Include a detailed budget and a schedule of significant activities related to this project. You may attach a maximum of one double - spaced typewritten page of information. (Please type or print legibly.) Funding from the City of Temecula would be used for the 211 Riverside g Program. 211 is _a 3 digit phone number that any Temecula resident can call 24 hours a day, 7 days a week to find help for any health and human services needs. 211 serves all of Riverside County. Last year, calls increased to 211 by 20% to a total of 76,911 calls. Temecula residents made 2026 of those calls for help. The 211 data base has over 898 agencies with over 2700 programs in it. The information about each agency, including eligibility criteria is included. When a person calls 211, they are asked their zip code and other demographic information. They are referred to an agency closest to their home and one that most fits their needs. A caller can get help for a wide variety of needs including mortgage and rental assistance, utility assistance, emergency food, food stamps, counseling, legal assistance, employment, and many other things. 211 Riverside operators are crisis trained so they are sensitive and capable to handle calls from people in crisis. Over 850 of the staff are bilingual in English and Spanish and 211 has access to a language bank for other languages 211 is ADA complaint and can be accessed by the deaf and hard of hearing. 211 also serves as a critical tool for City staff and other professionals in Temecula who need resources for citizens and clients. In addition to paid staff, 211 regularly uses volunteer student interns from local colleges. Currently, there are 5 fully trained student interns volunteering at 211. 211 is an ongoing program that has been serving the families of Temecula for the past 4 years. No implementation time is required for this project as it is ongoing. A detailed budget is attached. Funding from the City of Temecula would be used for contracted services, telecommunications, and misc. Based on the 2026 calls to 211 by Temecula residents last year, the cost .per call to the City of Temecula would only be $2.47 to help each family greatly improve their quality of life. Application - Page 3 Public Support Contributions / Donations Total Public Support Miscellaneous Income Misc. Income - Other Total Misc. Income Total Income Expenses Contracted services Payroll Processing Accounting & audit Supplies Telecommunications Postage Office lease Equipment maint/lease Insurance volunteers Insurance general Staff business /meeting expense Staff mileage /travel Dues and fees Salary Sick Vacation Holiday Hourly Rate Taxes payroll Taxes unemployment Insurance work comp EE benefit Delta Dental ins EE benefit Health Net ins Total Expense 2400 2400 50 50 407150 79,000 950 2700 1700 10200 1000 3900 1800 200 2600 150 800 400 73,000 8000 10000 6000 160900 19000 5000 4800 50 15000 407150 VOLUNTEER CENTER OF RIVERSIDE COUNTY 211 Riverside Program Budget Fiscal 2010 -2011: FY2011 Budget Income _ _ Grants _ County General -211 12,500 _ City of Riverside- 26,500 - Foundation Awards _ _ 54,000 _ State 211 37,350 First 5 1,500 Food Bank 42,000 Housing Authority 16,200 United Way Inland Valley 34,150 United Way Desert 17,500 United Way Corona /Norco 8,000 Support from other cities 85,000 DPSS 70,000 Total Grants 404,700 Public Support Contributions / Donations Total Public Support Miscellaneous Income Misc. Income - Other Total Misc. Income Total Income Expenses Contracted services Payroll Processing Accounting & audit Supplies Telecommunications Postage Office lease Equipment maint/lease Insurance volunteers Insurance general Staff business /meeting expense Staff mileage /travel Dues and fees Salary Sick Vacation Holiday Hourly Rate Taxes payroll Taxes unemployment Insurance work comp EE benefit Delta Dental ins EE benefit Health Net ins Total Expense 2400 2400 50 50 407150 79,000 950 2700 1700 10200 1000 3900 1800 200 2600 150 800 400 73,000 8000 10000 6000 160900 19000 5000 4800 50 15000 407150 Application — Page 4 SIGNATURE:rrl//rw PRESIDENT or AUTHORIZED OFFICER: Bobbie Neff, CEO NAME and TITLE (Please Print or Type) ORGANIZATION NAME: Volunteer Center of Riverside County MAILINGADDRESS: 2060 University Avenue, Suite 212 Riverside, Ca. 92507 TELEPHONE: 951 329 -4706 1 DATED THIS J 3 M of ✓G�!% , 2010. (Date) (Month) BE SURE TO INCLUDE THE ORIGINAL PLUS ONE COPY AND SUBMIT TO: Mail Completed Applications to: City of Temecula Community Service Funding Program Attn: Judy McNabb Post Office Box 9033 Temecula, CA 92589 -9033 Or Deliver in Person to: City of Temecula Community Service Funding Program Attn: Judy McNabb 43200 Business Park Drive Temecula, CA 92590 Application — Page 5 i Rr ncome Alternative Sentencing Program eNP �a - -4000 -Communi Sery ice- Riverside County -ASP - - 267897.00 2''. 00 ....,3$j10, ..;��pq`yfFJ „�; r� _ -� r 0.: y'. 6v.6§ '"', - 428000.00. ,_.. 4005.. Community ervice - Outside County - -. 4010 - Juvenile Community Service ._ASP - -ASP _.._. _..45,566,00- 23,574.00 62,00D.00 ;4; 33 000.00 .144,000.00 :, :. ...1100.00 qb 1000.0 500.00 ;q'g 60 000.00 4015- Dom. Violence -Anger Management ASP 189,067.48 4021 - Interlock - 4020 - VIP - Victim Impact Panel 4025 - Parole 4030 TEMPA -Teen Dmnk Drivin 4035 Probation Formal ASP - - -ASP - ASP ASP ASP. - 3080:00 1,120.00 76,038.00 54,875.00 `f.=' .ems - tea, ° 4q ° -B�fYD F gQ e 50;600 ",5`71832'5i87t`U' 3�zifq h>7T72'00 - 46 000.00 .; ;j". t6 300.00 a> r-> ` bMon .. 400.00' 4AD� 400.00 4050 HAM- Hospital Morgue Mentoring ASP 8,005.00 4055 -AWARE -TEMPO ASP 96, 661.41 - 4070 Victim Awareness" -- 4060 Boating DUI -- -ASP ASP 200.00 - :b r _�4 . ' 70bbQ� p( 4150 - ASP Agency Fees - Total Alternative Sentencing Pro rem ASP - 766,123.89 .rants 4200 - County General- Info /Referral 4210 - Mental Health - HELPIine - 211 Hel line 12,000.00 50000.00 a 'F28f; f0"p �,a1 -93?6A " 10,000.00 ?" 50'pOQU ';50 Op090 Sp�:Q88' 50000.00 8,000.00 11'yx3j 1f00 yy2F,,,0'p� - "` =,a'0"r"g' 61.000.00 ?'s' bit: e3 51,000.00 s'- 52;5`0 q0r ":'3 {{7'q"' "K -',,.q 53,600.00 `00fq ,.5`'pU"`' .88;' B 87,600.00 f i _tfi00 4 00 ry i({-0 - 16,000.00 ; 'S5'01i090 �30,0�-p040 80,000.00 [ 74t;OB0AP �' ".2;➢d'O..,pgy' 4215 - Probation - Alt Sentencing ASP 8,021.00 4225-A in - Fadlity Visits Ombudsman 270,799.00 4226-Aging- Ombudsman Initiative Ombudsman 4231 Aging - Volunteer Recruitment 4240. Aging -One Time Only Gran[ 4246 CDBG - Corona- Shared Housing 4248. Corona Rent Guarantee Program 4250CDBG -Hemet Ombudsman Ombudsman Shared Housing Shared Housin q Ombudsman 5200500 15,000 00 54,147 00 25,00000 4251 CDBG -City of Riverside/211 4252 - CDBG - County of Riverside 211 Ombudsman 9,000.00 4261.Mon Valley Initiative Shared Housing 28,24817 20,000 06:220.,0`tf 00;,,. 26 ;�S' 28,000.00 X85890 1 1it$ 20,495.00 140 000.00 z-` = 00x,- ^�:""_ 30,000.00 „ 0g9'` „ °q3 84 736.00 A bO Off :u 42 60,000.00 4276 - EFSP - Emergency Food 8 Shelter 4320 TAP - Transportation Access Shared Housing TAP /Atlmin 43,401 13 183,607.00 r "4' ' 4ZT1 gw 4330Foundatlon Awards Various 6840002 4372 . First Five of Riverside- Resource Ctr 4374 California Wellness Resource Center Resource Center 164,815.78 4375 First Five of Riverside -211 - 4377 - DPSS - 211 Grant 211 211 70,000.00 - =' 700fY00 ' -,' 00000 -�` 70 p'6800= 7,500.00 70,000.00 4376- DPSS- Hel line Hel line bA 00 71 99706_'- 10 000.00 4391 - California Volunteers Volunteer Connection 3,50000 ,4,0QIf00 ,-. %4`98Q -06^ b`x1= 4392- Amedcorps Volunteer Connection ` :;- 89" '7= F'�,9;: .. TUO ' ".t 9734'c2,9a -a 72.000.06' 41,10 0.00 4393- City of Moreno Valley Shared Housin6`dpb g 4394- Food Bank (stamps) 4395 -State 211 211 211 .� 'r 28,675.00 4396 -HPRP 211 - 211 a 14400.00 Total Grants 1,048,944.10 1,023347:00, # 238 428,00 1 -:p8 732.40`: 1,013 505.00 rbllc Support 4400 Contributions/ Donations Various 23588.13 1 0,00 ,3,4$743` 3,500.00 4410 - Desi nated Donations - P ram Various 2 290.00 ` 1,50A9b ., 3 30000:. - _2pb55:fY21 1,000.00 4417AnnualA al: Admin. 3,78500 40,OOA0 „2900'OA .. 2595"0(1` 4,000.00 4420 United Way Inland Valleys Various 702,00651 10:1,Q�$9R :738,40a '1 $1LW6:. = 7Z8ilFi . ' 3T6'98'= 72445.00 350.00 4427 - United Way ontribution Admin. 650.66 ': 4422 DnHed Wa G N/A 73,63600 -. 7436300 4423 - Unitetl Wa sert 211 17 SgOpb 1750090 17 500.00 4425 CdronalNo Wa 4435 Gaelic GalN/A Various 4,186.80 35,050.014440 T,- 500;00. 8000 p0, ': $,�55 OOt 8 000.00 Gmnd sceowers Atlmin. 5,575.50 't 75400" ti"35q,00 : " `µ 1350;fl9z 1 500.00 4450 -5 ecial EvVarious 4467 - Coverlet IncAdmin. 206560 2;00b.'00 QpDAb: 1747,000.00 8;363;00= 8,5p 8,500.00 4480 Ci 7COUn 2 -1 -1 Services 211 11785613 425000:00 71,600.00 Total Public Su ort source Center 310 690.34 296 6 00 204389.06' .,227 477,75' 189,395.00 4500 Resource Center Resource Center 350.00 - 4505 Workshops _ Resource Center 17,810.96 17 H00"r00 t00© 0a snhhn� .o cnn nn IL E e - -- - - -- -� VOLUNTEER CENTER OF RIVERSIDE COUNTY - -- _ Budget 4510 -Consultants _ . - .Resource Center - 22 579.35 ._ :_ a '.: -ice - - 1,400.00 I. _ z,'', -a • 10 500.00 , - : °.'wff - 5,500.00 nr�8 „,,. 3,500.00 <<nr {j •4�. 1,000.00 - 34 400.00 - 4515 Non -Profit Day 4520. Membership Dues Resource Center. Resource Center 14,970.00,x., _ 4525 . S nsorshi s - - Resource Center 2.500.00 4530. Miscellaneous- Resource Center 5276.58 > .fix - 4500 -Other Income - -Total Resource Center Income Resource Center liscellaneous Inwme - - - 4115 - Directory Sales Admin. 2,570.68 ,,`'�`' , ,: q '�,�`'sh�.m`i;; 1 300.00 5100 - Interest Income Admin. - - 1 383.63 5205 - Volunteer R ntion Event Volunteer Connection 4,718.00 z";?:'4 @ q ,3°�%"'""' `38` 4,700.00 200.00 6,200.00 5200Misc. Inwme - Other Total Misc. Income Various 420.77 9,093.08 Total Income 2198 337.30 '; 2 ( 6-00- , - 3Sq`3�'4;pA :2i8i+"7 2,070,200.00 x enses Payroll Expenses - 6305 -.Salaries and Wa es 1,369,981.14 " % s`1�34 tSflit `1 'Op 2st10.� ..,s(r= Wg 773@ 1,181 298.00 6330 - Payroll Taxes 102 248.03 f'r 03i0db00- r`� `... V ,,� "' �. QOA .,': A6` 87,810.00 0 s 25 000.00 19000.00 6332 - Insurance - Unemployment 23 424.15 _ 6335 Workers Compensation 20,496.38 6340..Employee Insurance Benefits - 84,689.27 6400 ;33 56500.00 Total Payroll Expenses 1600 836.97 ? ; i i596r8:0ii:. " :h;50.1`4io0 - "ir49x 1,369,608.00 perating Expenses Cn tracted Services 11092373 309;.6gQRf1's. Y20- 0,00 ;731 tF9631: 129,100.00 6011. Consultant Fee - Resource Center 4760747 46"3111; 6D 845¢S¢ 8` &466 €' r ...2Dfl9'f0- ,„ ..�?.dijpd;4Uz .,., a-I#Y, gig, - ;w - ,2OOQQQ p O 2b$2g95< -�� 9 40_ , `57A o6 7W-- - - - 16,500.00 6,100.00 20 000.00 30,000.00 6019. Payroll Processing 8.697.99 6020 - Accounting/Audit 17,992.40 6025 - SU lies 28,97526 6035 - Telecommunications - 5486647 70,000.0D 6036 Fingerprinting 75200 ,�d69, r `" 800 3G', Dx 500.00 6037 - MADD meetings/TEMPO 990.00> 1,500.00 6038 Debrieiin -Tem ASP 1,850.00 r` ,, ,1,y't3 ss"%Oq .- 6"'' '':,, , ,1,3j A0 DD , ;;r4A,ffop „. ,i 9;12aa3 2,700.00 6045 - Postage 13.608.32 9,500.00 6050 Office Lease -VCRC 3275748 ' .,48600 4IlO:oq, = '` �U2:? 32,788.00 5,400.00 8051 OtRce Lease -Other - 4,488.00 6053 Office Maintenanw & Repairs - Y 10,000.00 6960 E ui ment Maint/Lease 7,58779 ,. „, cs;29 EQQ j"50600 - ;. tZ745.3 -%+- 18,000.00 6075 Insurance-Volunteers 6080 -Insumnce- General 96000 1391103`_ = ,- 9,Ei ©:oQ (,0¢1}0 - 966_<01° ,14-Oi Q'00`, id oD600 14:68172 960.00 14,900.00 6090. Prinfin - Other 2,935.80' 30011;00 _500A6 . _ 1,919zB$ 4,000.00 6091. Prinfin - RedBooks 6095Ativertisin /Classifietls 5,60859 ,: 1500 Op .,-3 d0U.0D;: - 369;85: 3,000.00 6100 Staff Business/Meeting Expense 8,981.47 -_ , ' 2:OY1 00 _,"Olt .AO- -; 6^6,4- 098 N;. 36;000,00 x20000#00.- ,- 19,4$606;: 3 000.00 6105 Stag Mileage & Tmvel - 33M2,341.84 576.42 20000.00 6116 Volunteer Travel /Miles a Q,900000 6130 Staff Tminin 25; a(X00 - _'50000 r '�! 2283A 2,300.00 6132- Referenoe/Tminin Materials 6135 Dues Fees, Subscri tions 22110:00 sDAOO - 697030:` 7,000 00 6136 Bank Char es 3,050.00 6138 -Taxes and Fees - 94,43,! 100.00 6140 - interest nse - 3,285 35 2,50DA00= , 2,SOUDO.. < 2,633'i�0 2,550M 6146 - Miscellaneous 556.60 -.� ,, 050 %00 ��p0 -,{30. ;_' '. ��t,•{83 500.00 6161 .Volunteer Reco -Vol Connection 6,540.07 *'.� - 20,'0,00 4,200.00 6162. Volunteer Rew - Ombudsman 3,000.00 - 6163. Volunteer R - Other 4, 'C#b2Yj 6175 Fundraising-Other 10,886.93 - 11"I)00Q ` ,.q'36'3:�0r 5;390.54;:. 5;40000 6176. Fundraisin - Non Profit Day 0.00 10 922{I0: 3;86p o0- ; -° 4'71`7,77 -; 4,800.00 6177 . Fundraisin - Grandparents Day 1,047:00 7880.00 '883,53= 900.00 6185 - Bus Tickets 118,500.50 124,420:00 130;fA 0_ 185284 Obi M000.00 6400. Rental Assistance - EFSP 28,75850 36,000!00 51;801,00_ :28;79385: 20,093.00 6405. Rental Assistance - Comm Rent Guarantee 39,893.82 4o,0oo:04" 70OQ0.00 $9999.54: 70,000.00 6407 - Rental Assistance Oy or Moreno valley 37. 63 ,66 6�866,r}Z 6 000.00 7000 Capital Expenditures 970044 21 761.00 Total Operating Expenses 623,582.90 600987;00 .6931102.00 673X9.46 =, 700592.00 - - � - VOLUNTEER CENTER OF RIVERSIDE COUNTY l - - - -- - - .....,.Budget... _. _ -.. _.... TotalExpenses - -- - -- - - -- 2224,419.87 -' 6:0 '.} -- 2070200.00 Net Surplus (DeficR). ... 26082.57.. fv. 81F ' 0.00 6138 Depreciation Expense. 53.403.81 - _. - .30000.00 - Net Surplus Deficit After Depreciation - 79 466.36 130 403.81 83 234.26 39 651.31 30 000.00 For the First Month Ending July 31, 2010 Unaudited Financial Statements prepared by: Volunteer Center of Riverside County - 4005 - C=mu nitY Service - Outside County - - 39.8. _. 4070 -Dom. 7e COmmuni Service 4015 Dam. Violence -Anger Management 4020- VIP - Victim Im act Panel 4027- Intetlock 4025 -E 4030- TEMPO -Teen Omnk Driving"" 4035 - HAM - Hn Formal 4050- HAM -HOS itaI Morgue Mentodn 4055AWARE -TEMPO '- 3'xifii�OOS 9,i5D.{f'. �9tI;Y1� "Al _ 59YrQtl :� - 4000 BoaW DUI ? 3a 3✓$3 ° 3333: 33E3 4070. Victim Amreness +" 339'3' 35 3333, ` (3 4150 ASP en Feea- _ Total Alternative Semencin Pro mm'-'" «.53r18.9>. ,6,g=8g.."` -� y'T �$0,e Grams I..n TI otal Public Support �- 19 Zkt d3 �`�• 15`�9191k 3S585U' 19741C? 767829T i9Kx °h" i VOLUNTEER CENTER OF RIVERSIDE COUNTY - - _ -.�.. _ _...Income Statement _ _.. _.. . _ ... . -. _.. _..:. June30,2010 -. - - -- ..Income_ ... .. _ _ _. ._ - _ _ . - A AltemaRve Sentencing Program - 4000 Caminuni Service- Rivemide County - I..n TI otal Public Support �- 19 Zkt d3 �`�• 15`�9191k 3S585U' 19741C? 767829T i9Kx °h" i -' VOLUNTEER CENTER OF RIVERSIDE COUNTY - - - -. Ineome Statement - June30,2010 . . . .' f ^,..o + .. .. t a ME eY+ a $y Net Surplus(Dencit) 5139 - Depredaeon Expense, Mr - Nat SU lus Deficit After Depredation - - 25,080.22 2500.00 27580.22 � - 25,080.22 - 2,500.00 27,550.22 30000.00 FINANCIAL STATEMENTS AND AUDr RS'REPORT FOR THE YEAR ENDED NNE 30.2009 SMITH MARION & CO. CERTIFIEO W BLIC d COUNTWS Schedule of Finding and Questioned Costs 13 Summary of Prior Finding. and Questioned Costs 14 VOLUNTEER CENTER OF RIVERSIDE COUNTY FINANCIAL STATEMENTS AND AUDITORS' REPORT FOR THE YEAR ENDED DONE 30; 2009 TABLE OF CONTENTS Page 5 FINANCIAL INFORMATION Independent Auditors' Report 1 Statement of Financial Position - - - -- - - 2 <. Statement of Activities 3 Statement of Cash Flows 4 Statement of Functional Expenses 5 -6 Notes to Financial Statements 7-10 REPORT ON INTERNAL CONTROLS Report on Internal Control Over Financial Reporting and on Compliance and Other - Matters Based on an Audit of Financial Statements Performed in Accordance with Govern mentAuditingStandards 11 -12 Schedule of Finding and Questioned Costs 13 Summary of Prior Finding. and Questioned Costs 14 INDEPENDENTAUDITORS' REPORT We have audited the accompanying statement of financial position of Volunteer Center of Riverside County as of June 30, 2009, and the related statements of activities, cash flows, and functional expenses for the year then ended. These financial statements are the responsibility of the Agency's management. Our responsibility is to express an opinion on these financial statements based on our audit. We conducted our audit in accordance with auditing standards generally accepted in the United States of America and the standards applicable to financial audits contained in GovernmentAudifingStandards, issued by the Comptroller General of the United States. Those standards require that we plan and perform the audit to obtain reasonable assurance about whetherthe financial statements are free of material misstatement. An audit includes examining, on a test basis, evidence supporting the amounts and disclosures in the financial statements. An audit also includes assessing the accounting principles used and significant estimates made by management, as well as evaluating the overall financial statement presentation. We believe that our audit provides a reasonable basis for our opinion. In our opinion, the financial statements referred to above present fairly, in all material respects, the financial position of Volunteer Center of Riverside County as of June 30, 2009, in conformity with accounting principles generally accepted in the United States of America.. In accordance with GovernmentAuditing Standards, we have also issued our report dated December 03, 2009, on our consideration of the Volunteer Center of Riverside County's internal control over financial reporting and our tests of its compliance with certain provisions of laws, regulations, contracts, and grant agreements and other matters. The purpose of this report is to describe the scope of our testing of internal control over financial reporting and compliance and the results of that testing, and not to provide an opinion on the internal control over financial reporting or on compliance.. That report is an integral part of an audit performed in accordance with GovernmentAuditing Standards and should be read in conjunction with this report in considering the result of our audit. S be 6 -Decemr 0009 - www.smcocpa.com Murrieta Office 38605 Calistoga Drive, Suite 120 Munieta, CA 92563 Telephone (951) 461 -2045 Facsimile (951) 461 -2095 Lebanon Office 303 Antietam Court Lebanon, TN 37087 Telephone (615) 453 -7855 Facsimile (615) 453 -7855 Subtotal - Cash 119,163 Grants and contributions receivable 155,675 United Way pledge receivable 71,581 .Prepaid expenses and deposits - - 4,691 Total Current Assets 351,110 Noncurrent Assets Fixed assets (net) 94,661 Total Noncurrent Assets 94,661 Total Assets $ 445,771 LIABII.ITIES AND NET ASSETS Current Liabilities Accounts payable Accrued expenses Line of credit Accrued payroll costs Lease payable - current Deferred revenue Accrued compensated absences Total Current Liabilities Noncurrent Liabilities Leasepayable . Total Noncurrent Liabilities Total Liabilities Net Assets Temporarily restricted Unrestricted Total Net Assets TOTAL LIABILITIES AND NET ASSETS See notes to the financial statements 2 $ 91,286 12,588 9,200 28,953 79,813 38,286 260,126 260,126 165,888 19,757 185,645 $ 445,771 SUPPORT AND REVENUES Government grants Private foundations and indirect support Contributions Program fees Special events (net) Investment income Other income Gain (Loss) on disposal of equipment Net assets released from restrictions TOTAL SUPPORT AND REVENUES EXPENSES Program Services: ASP HELPIine Resource center Ombudsman Shared Housing TAP Volunteer Tempo Information and Referral Total Program Services 538,189 82,441 252,538 297,570 208,012 190,046 82,284 105,014 412,305 2,168,399 538,189 82,441 252,538 297,570 208,012 190,046 82,284 105,014 412,305 2,168,399 Supporting Services - Management and general 150,722 150,722 .. ...Fundraising.._ ..__ ..... .... ... .. ..... .. .. .......... ...... _. ..__:.. ..... _..... Total Supporting Services 150,722 150,722 TOTALEXPENSES 2,319,121 - 2,319,121 Change in Net Assets (104,807) 14,606 (901201) Beginning Net Assets 124,564 151,282 275,846 Ending Net Assets $ 19,757 $ 165,888 $ 185,645 See notes to the financial statements 3 Temporarily_ Unrestricted Restricted Total $ 1,064,070 $ 65,101 $ 1,129,171 168,880 168,880 114,662 - 114,662 496,010 254,811 750,821 23,814 - 23,814 911 583 1,494 71,866 - 71,866 (31,788) (31,788) 474,769 (474,769) - 2,214,314 14,606 2,228,920 538,189 82,441 252,538 297,570 208,012 190,046 82,284 105,014 412,305 2,168,399 538,189 82,441 252,538 297,570 208,012 190,046 82,284 105,014 412,305 2,168,399 Supporting Services - Management and general 150,722 150,722 .. ...Fundraising.._ ..__ ..... .... ... .. ..... .. .. .......... ...... _. ..__:.. ..... _..... Total Supporting Services 150,722 150,722 TOTALEXPENSES 2,319,121 - 2,319,121 Change in Net Assets (104,807) 14,606 (901201) Beginning Net Assets 124,564 151,282 275,846 Ending Net Assets $ 19,757 $ 165,888 $ 185,645 See notes to the financial statements 3 Cash Flows from Operating Activities Change in Net Assets $ (90,201) Adjustments to reconcile change in net assets to net cash used for operating activities: Non -cash item: Depreciation Loss of disposal (Increase) Decrease in: Grants and contributions receivable Increase (Decrease) in: Accounts payable and accrued expenses Deferred Revenue Accrued payroll Accrued compensated absences Net Cash Provided (Used) from Operating Activities Cash Flows from Investing Activities Purchases of equipment Net Cash Provided (Used) from Investing Activities Cash Flows from Financing Activities Net increase (decrease) in line of credit Principal payments on leases payable Net Cash Provided (Used) from Financing Activities Net Increase (Decrease) in Cash 46,244 51,115 (42,984) 58,739 71,067 (3,456) 774 91,298 (50,426) (50,426) (14,464) (22,313) (36,777) 4,095 Begining Cash 115,068 Ending Cash $ 119,163 _.. Supplemental Data: Interest expense paid during the year $ 2,378 See notes to the financial statements 4 UN W W@z z� o�e 4 W � F U O c Pty F -1 tri N -' b r H y y n • �Y r 1 O N N b V O N � " t� O• V1 Vl 'M1 o7 m W N M t•1 UN W W@z z� o�e 4 W � F U O c Pty F tNry o n •+Nf � N• 'rO]t m m ti 'rOi � N O • h' i e � eV t.' H W ti N c•1 � Vt tf O lV � N N mn ry N ' O • l•1 sf O p] M1 V) n NI ' •O a N � V Cf N a 'II c•) m N ' man n �n aia �rnnv � a Ct [d m V N N W N b �Vy d' �-' • b • a O O W H O ••1 yOy�� • u> n b n 1•t O V b n W V � O M I. Ib c0 O ' CO ' n O H A O � N N • � • 3 0 d c h e .3 0 y qW g O N• r 1 O N N b V b N G' C N � " t� O• V1 Vl 'M1 o7 m W N M t•1 tNry o n •+Nf � N• 'rO]t m m ti 'rOi � N O • h' i e � eV t.' H W ti N c•1 � Vt tf O lV � N N mn ry N ' O • l•1 sf O p] M1 V) n NI ' •O a N � V Cf N a 'II c•) m N ' man n �n aia �rnnv � a Ct [d m V N N W N b �Vy d' �-' • b • a O O W H O ••1 yOy�� • u> n b n 1•t O V b n W V � O M I. Ib c0 O ' CO ' n O H A O � N N • � • 3 0 d c h e .3 0 y r i��s'e -a '•� a }� h�TV m}n N.M Df � v� rn 'i� �'i .y �v0 �ilN ��e�j •N-1 m ? d�•�'! .M b �.f•1 � h m (N � i'� V � fM•1 •00 O • n ? H < b •4 r b V 1�I1. • b • � N - �.• C n b b t`i O• N CCt011 v b � 1+ ~ N er N N 'ti O �i �I 0 i O b m=•!itN •.4 V gNNPe "W.b , y o N r CO O\ Cl n• l� ' O W m O VI U V VI O N v1 N F r0 0< O - R k trt r !` •� N O• N t` M O M O O n N N n ••1 N m vl Ci N1 'r r N tS m � � ab rnmtiH � � � m°n 000.N.•"c�i a •^ ° a •D a ao ti e m m e e vl m o D rm' •o' a r m �J' m v o ei y� p trt `y er M W O• � N 1 M V V V M N •ry N• N 1 N �q] O 7 U U C _ 0 � E .O C U C C� D y F C U m y W. .�. O' � U ••U.: W_ m V U � v O. U LUO pC O Y 7 G1 W u W ^. G W w• C.L �. U L C U e� 'D CDi rnww`U W x q .°. Oa °w�HC7ow'S F" M History of the Organization and Nature of Activities The Volunteer Center of Riverside County (the Center) is a public benefit corporation incorporated in 1966 under the laws of the State of California. The Center Coordinates the services of. all agencies in Riverside County,_ maintaining information and referral services, 24 -hour crisis help -line and other volunteer programs. in 2005, the Volunteer Center was approved by the California Public Utilities Commission (CPUC) to build, and be the -- - " designated service provider for, the 2-1-1 call system in Riverside County. The 2 -1 -1 call system instantly connects callers to a comprehensive database of social service providers through professionally trained call center staff, including bilingual staff. The Center is a member of a network of volunteer centers in the state and is supported primarily from government grants, private foundations, program fees and indirect contributions through United Way. Basis of Presentation The financial statements of Volunteer. Center of Riverside County have been prepared in accordance. with the AICPA Audit and Accounting Guide for Not for- Profet Organizations, issued June 1, 1999. The Center reports information regarding its financial position and activities in three classes of net assets: Unrestricted net assets, temporarily restricted net assets, and permanently restricted net assets. The Center has never received permanently restricted contributions. Unrestricted net assets include resources that are not temporarily or permanently restricted by the donor and are available for operations of the Center without limitation. Temporarily restricted net assets include those resources restricted by donor imposed criteria and which either expire with the passage of time or by actions of the Center. Cash and Cash Equivalents Forpurposes of the statements of cash flows, the Center considers all highly liquid investments available for current use with an initial maturity of three months or less to be cash. Equipment and Leasehold Improvements Equipment and leasehold improvements are stated at cost or fair market value at date of contribution. Depreciation is being recorded using the straight -line method over the estimated useful lives ranging from three to ten years. Expenditures in excess of $2,500, which materially increase the life or enhance the usefulness of equipment or leasehold improvements are capitalized. The cost of maintenance and repair is expensed as incurred. Upon sale or retirement of any equipment, the cost and the related accumulated depreciation are removed from their respective accounts iin8 the resulting gain or loss is included in revenue Equipment purchased with federal grant funds reverts back to the federal agency upon retirement, if required by the granting agency. The Center also receives grant funds to purchase assets for the program. Those assets are fully expensed at the time of purchase to comply with grantor reporting requirements. These assets are also recorded as fixed assets and off set against Government Owned Assets to comply with general accepted accounting principles. 7 NOTES TO FINANCIAL STATEMENTS (CONTINUED) . Contributions All contributions including promises to give are considered to be available for unrestricted use unless specifically - _restricted by the donor. Contributions: received that are designated for future periods or restricted by the donor for.- - specific purposes are reported as temporarily restricted or permanently restricted support. When a donor restriction expires, that is, when a stipulated time restriction ends or purpose restriction is accomplished, temporarily restricted net assets are reclassified to unrestricted net assets and reported in the statement of activities as net assets released _ from restrictions. During the year ended June 30, 2009, the value of contributed services meeting the requirements for recognition in the financial statements was not material and has not been recorded. However, many individuals volunteer their time - - - and perform a variety of tasks that assist the Center. This contributed time is not reflected in the accompanying -- - - financial statements since the services do not meet the requirement of specialized skills. Accounts Receivable and Allowance for Uncollectible Accounts Accounts receivable consist primarily of grants receivable at the end of the fiscal year. The Center uses the allowance method of accounting for receivables determined to be potentially uncollectible. In management's opinion, all receivables were collectible at year end; therefore no allowance has been established. Expense Allocation The costs of providing various programs and other activities have been summarized on a functional basis in the statement of activities and the statement of functional, expenses. Accordingly, certain costs have been allocated among the programs and supporting services benefited. Method of Accounting The financial statements have been prepared utilizing the accrual basis of accounting in accordance with generally accepted accounting principles. Revenues The majority of revenues consist of government and private grants (59 %) and fees for service from the alternative sentencing program (34 %), while direct public support make up approximately (6 %). Income Taxes The Center is exempt from federal and state income tax under provisions of Section 501(c)(3) of the Internal Revenue Code, and Section 23701(d) of the California Revenue and Taxation Code. The Center has been determined by the Internal Revenue Service not to be a "private foundation" within the meaning of Section 509 (a) of the internal Revenue Code. Estiloates The preparation of financial statements in conformity with generally accepted accounting principles requires . management to make estimates and assumptions that affect certain reported amounts and disclosures. Accordingly, actual results could differ from those estimates. Compensated Absences The Center accrues compensated absences (vacation and sick leave). and classifies them as a current liability. Accrued compensated absences totaled $38,286 on June 30, 2009. 0 Private Foundation and Other Contributions United Way of Inland Valleys 71,581 Ending balance - $ 227,256 Management believes all receivables are fully collectible, and has not set an allowance for doubtful accounts. - 3. EQUIPMENT AND LEASEHOLD IMPROVEMENTS _ NOTES TO FINANCIAI. STATEMENTS (CONTINUED) 2. GRANTS AND CONTRIBUTIONS RECEIVABLE At June 30, 2009, grants and contributions receivable, due within one year, consisted of the following: - Government Grants .. Dept of Public Social Services $ 75,446 First 5 Riverside. - - .._ 49,990. - County of Mental Health 4,167 Mon Valley Initiative 20,803 Probation -. Alternative Sentencing 667. - Community Development Block Grant -946 - - - - Rent Guarantee Program 206 Miscellaneous 3,450 - - Total Assets 339,273 50,426 155,675 Private Foundation and Other Contributions United Way of Inland Valleys 71,581 Ending balance - $ 227,256 Management believes all receivables are fully collectible, and has not set an allowance for doubtful accounts. - 3. EQUIPMENT AND LEASEHOLD IMPROVEMENTS As of year end, the costs, depreciation, and lives of these assets were: Balance Balance at at Assets 6/30/2008 Additions Deletions 6/30/2009 Office Furniture, computers and Equipment $ 327,952 $ 50,426 $ (187,475) $ 190,903 Leasehold Improvements 11,321 11,321 Total Assets 339,273 50,426 (187,475) 202,224 Accumulated Depreciation (197,679) (46,244) 136,360 (107,563) Net Book Value $ 141,594 $ 4,182 $ (51,115) $ 94,661 Depreciation expense for the period ended amounted to $ 46,244 4. LINES OF CREDIT The Center had a line of credit with Provident Bank in the amount of $50,000, which expired on June 21, 2008. The line had interest at 2.00% over prime and was secured by the assets of the Center. There was no outstanding balance as of June 30, 2009. The Center also has a line of credit with Altura Credit Union in the amount of $100,000, which expires on February 14, 2011. The line has an interest rate of 3.00% over prime and is secured by the assets of the Center. The balance as of June 30, 2009was $9,200. 5. TEMPORARILY RESTRICTED NET ASSETS 9 _NOTES TO FINANCIAL STATEMENTS - (CONTINUED)_ - Net assets released from restrictions, due to time restrictions expiring, amounted to $474,769 for the year ended June 30, 2008. Prior year ending balance - $ 151,282 Add: Revenue 489,375 Less: Satisfaction of program restrictions (474;769) . Temporarily restricted net assets as of year end $ 165,888 Temporarily restricted net assets in the amount of $489,375 to be expended during the year ending June 30, 2009, consisted of the following: United Way of Inland Valleys $ 71,581 Emergency Food And Shelter Program 62,459 TAP Program 192,935 City of La Quinta - 211 Program 1,700 City of Banning - 211 Program 5,500 City of Corona - Rent Guarantee - 55,000 - City of Indian Wells - 211 Program 200 California Wellness 100,000 $ 489,375 6. FUNDRAISINGACTIVrff Gaelic Grandparent's Other Gala Day Flowers Events Total Revenue $ 35,624 $ 1,750 $ 844 $ 38,218 Expenses (12,781) (1,047) (576) (14404) Net $ 22;843 $ 703 $ 268 $ 23,814 7. CONTINGENCIES AND CONCENTRATIONS OF CREDIT RISK The Center has participated in various federal and state assisted grant programs, which are subject to financial and compliance audits by the grantor or their representatives the purpose of which is to ensure compliance with conditions precedent to the granting of funds. Management believes that any liability for reimbursement which may arise as a result of these audits is not material. The Center's financial instruments that are exposed to concentrations of credit risk consist primarily of cash and cash equivalents. The Center places its cash and temporary cash investments with highly creditworthy institutions. At times, such investments may be in excess of the FDIC insurance limit. The amount of cash subject to risk was $0 at June 30, 2009. 8. SUBSEQUENT EVENTS Accounting standards require that Volunteer Center of Riverside County assess and disclose the date and the basis - for that date through which potential subsequent events have been evaluated. The date represents the date the financial statements were issued or were available to be issued. The Organization evaluated all potential subsequent events as of December 03, 2009 when the financial statements were authorized and available to be issued. No subsequent events or transactions were identified after the balance sheet date or as of December 03, 2009 that _ require disclosure in the financial statements. _ IIQ Board of Directors Volunteer Center of Riverside County Riverside, CA REPORT ON INTERNAL CONTROL OVER FINANCIAL REPORTING AND ON COMPLIANCE AND OTHER MATTERS BASED ON AN AUDIT OF FINANCIAL STATEMENTS PERFORMED IN ACCORDANCE WITH GOVERNMENT AUDITING STANDARDS We have audited the financial statements of Volunteer Center of Riverside County as of and for the year ended June 30, 2009, and have issued our report thereon dated December 03, 2009.. We were engaged to and conducted our audit in accordance with generally accepted auditing standards and the standards applicable to financial audits contained in GovernMenrAudiring Standards, issued by the Comptroller General of the United States. Internal Controls Over Financial Reporting In planning and performing our audit, we considered Volunteer Center of Riverside County's internal control over financial reporting to determine our auditing procedures for the purpose of expressing our opinion on the financial statements and not to provide assurance on the internal control over financial reporting. Accordingly, we do not express an opinion on the effectiveness of the Organization's internal control over financial reporting. Our consideration of the internal control over financial reporting was for the limited purpose described in the preceding paragraph and would not necessarily identify all deficiencies in internal control over financial reporting that might be significant deficiencies or material weaknesses. However, as discussed below, we identified certain deficiencies in internal controls over financial reporting that we consider to be significant deficiencies. A control deficiency exists when the design or operation of a control does not allow management or employees, in the normal course of performing the assigned functions, to prevent or detect misstatements on a timely basis. A significant deficiency is a control deficiency, or combination of control deficiencies, that adversely affects the organization's ability to initiate, authorize, record, process, or report financial data reliably in accordance with generally accepted accounting principles, such that there is more than a remote likelihood that a misstatement of the organization's financial statements that is more than inconsequential will not be prevented or detected by the organization's internal control. We consider the deficiencies described in the accompanying schedule of findings and questioned costs to be significant deficiencies is internal control over financial reporting 09 -1. A material weakness is a significant deficiency, or combination of significant deficiencies, that result in more than a remote likelihood that a material misstatement of the financial statements will not be prevented or detected the - - organization's internal control. Our consideration of the internal control over financial reporting was for the limited purpose described in the first paragraph of this section and would not necessarily identify all deficiencies in the internal control that might be considered to be material weaknesses. However, we believe that none of the significant deficiencies described above is a material weakness. - Murdeta Office 38605 Calistogo Drive, Suite 120 Moulds, CA 92563 Telephone (951) 461 -2045 Facsimile (951) 461 -2095 www.smcocpa.com 11 Lebanon Office 303 Antietam Court Lebanon, TN 37087 Telephone (615) 453 -7855 Facsimile (615) 453 -7855 .REPORT ON INTERNAL CONTROL (Continued) - - - Compliance and Other Matters As part of obtaining reasonable assurance about whether Volunteer Center of Riverside County's financial statements are free of material misstatement we performed tests of its compliance with certain provisions of laws, regulations, contracts and grants, noncompliance with which could have a direct and material effect on the determination of financial statements amounts. However, providing an opinion on compliance with those provisions was not an objective of our audit and, accordingly, we do not express such an opinion. The results of our test disclosed no instances of noncompliance or other matters that are required to be reported under Government Auditing Standards. Volunteer Center of Riverside County's response to the findings identified in our audit is described in the accompanying - - schedule of findings and questioned costs. We did not audit Volunteer Center of Riverside County's response and, accordingly, we express no opinion on it: This report is intended solely for the information of management, The Board of Directors, and federal awarding agencies and pass- through entities and is not intended to be used and should not be used by anyone other than these specified parties. S tU December 03, 2 09 12 VOLUNTEER CENTER OF RIVERSIDE COUNTY SCHEDULE OF FINDINGS AND QUESTIONED COSTS JUNE 30, 2009 09 -1 Allocation of Payroll Costs. Finding: Payroll costs are not allocated to grants based on actual time spent, in instances where employees are charged to mom than one grant, but are based on the annual budget for the grantor other allocation method.. Although the Center uses time sheets, the allocation of time among multiple grants is based upon estimates in most cases. OMB Circular A -122 requires that payroll costs charged to a grant be based on actual time or periodic sampling of actual time spent. Context. Reviewed system to determine allocation of payroll costs to grants was appropriate. Effect Certain payroll and benefits charged to grants could be subject to disallowance by granting agency. - - Cause: System design did not allow for actual posting of time. Recommendation: We recommend that the Center perform periodic time studies to support charges to multiple grants. Center's Response: We have conducted a time study that will be completed by April 2010. 13 VOLUNTEER CENTER OF RIVERSIDE COUNTY _ SUMMARY OF PRIOR YEAR FINDINGS AND QUESTIONED COSTS JUNE 30, 2009 08-1 Allocation of Payroll Costs Fuid ng: Payroll costs are not allocated to grants based on actual time spent, in instances where employees are charged to more than one grant, but are based on the annual budget for the grant or other allocation method. Although the Center uses time sheets, the allocation of time among multiple grants is based upon estimates in most cases. OMB Circular A -1 22 requires that payroll costs charged to a grant be based on actual time or periodic sampling of actual time spent. Context. Reviewed system to determine allocation of payroll costs to grants was appropriate. Effect. Certain payroll and benefits charged to grants could be subject to disallowance by granting agency. Cause: System design did not allow for actual posting of time. Recommendation: We recommend that the Center perform periodic time studies to support charges to multiple grants. Center's Response: The Center plans to conduct a time study to determine if an adjustment to the current estimated time allocations is necessary. Current Stanrs.: Still present as of June 30, 2009. - SECRETARY OF STATE CERTIFICATE OF STATUS DOMESTIC CORPORATION 1, KEVIN SHELLEY, Secretary of State of the State of California, hereby certify: That on the 14th day of December, 1966, VOLUNTEER CENTER OF RIVERSIDE COUNTY became incorporated under the laws of the State of California by filing its Articles of Incorporation in this office; and That no record exists in this office of a certificate of dissolution of said corporation nor of a court order declaring dissolution thereof, nor of a merger or consolidation which terminated its existence; and That said corporation's corporate powers, rights and privileges are not suspended on the records of this office; and That according to the records of this office, the said corporation is authorized to exercise all its corporate powers, rights and privileges and is in good legal standing in the State of California; and That no information is available in this office on the financial condition, business activity or practices of this corporation. NP -26 A IREV. 1 -03) IN WITNESS WHEREOF, I execute this certificate and affix the Great Seal of the State of California this day of February 2, 2005. KEVIN SHELLEY Secretary of State_ RECEIVED FEB 0 720 ap OSP 03 74700 PROJECT INFORMATION Amount Requested: $ 4,920 (Maximum allowable $5,000) Project Name: Breast Health Assistance Program 12/1/10 7/1/11 Project Start Date: Project End Date: I ORGANIZATION INFORMATION I Name of Organization: Michelle's Place, Breast Cancer Resource Center Contact Name: Kim Goodnough Title /Position: Executive Director Mailing Address: 41785 Elm St. #405, Murrieta, CA 92562 Telephone: 951-304-1280 Number of Paid Staff: 3 Geographic Area(s) Served:_ Is this organization incorporated Yes x Year Organization Founded: 2001 Number of Volunteers: 65 Riverside County, CA in California as a non - profit organization? No Effective Date: 2001 If "yes" (Must provide a copy of your statement of non- profit status from the State of California): Date of incorporation as a non- profit: 08/3/2001 Federal identification number: 33- 0951216 State identification number: 2267780 If "no ": Name of sponsoring organization: Federal identification number: State identification number. This application has been authorized by the organization's: Executive Committee Board of Directors x Members -at -Large Application - Page f - FINANCIAL STATEMENTS PLEASE ATTACH - COPIES OF THE CURRENT BUDGET OF. THE ORGANIZATION -AND FINANCIAL STATEMENTS (BALANCE STATEMENT AND INCOME STATEMENT). It does not require a CPA's audit, but please submit if available. - - - MISSION STATEMENT Briefly describe the goals and objectives of your organization and community services it provides. Describe _ the ways your organization meets the criteria listed on page 2 of the CS Funding Policy. Mission Statement: To provide emotional and educational support to those living with breast cancer and facilitates services for breast health. Michelle's Place is a local resource center for women and their families dealing with breast cancer. Michelle's Place was created as a dying wish of Michelle Watson. Michelle was a 26 year old victim of breast cancer. As a Temecula resident, Michelle was frustrated with the lack of resources available to her while facing the challenges of cancer treatment. She wanted a place to go where she would find comfort, resources and information. Through the Breast Health Assistance Program, Michelle's Place is providing uninsured women in Riverside County with free and low cost mammograms and other diagnostic breast health services. Because of recent State funding cuts to the "Every Woman Counts" program, there is currently no State or local funding to provide uninsured women with breast health care. Michelle's Place is filling that need. Michelle's Place offers all of our services free to the community. We provide free wigs, prosthesis, and support groups. We also have a lending library and a survivor telephone support system. The survivor network provides newly diagnosed women and their families with a source to answer their questions, find comfort and provide insight into their new diagnosis. We offer free educational seminars and weekly exercise programs that are open to the public. These seminars offer information on nutrition, breast health, breast cancer prevention, exercise, stress relief and methods to help in the healing process. The Pink Ribbon Assistance program offers basic needs assistance to women going through treatment. Since it's inception in 2001, Michelle's Place has provided over 26,900 services to women and their families dealing with breast cancer. There are currently no other resources in the City of Temecula providing free resources to women and their families dealing with breast cancer. Michelle's Place is the only resource in Riverside County. Application - Page 2 i PROJECT DESCRIPTION How will your organization use the funding awarded? Describe the project, project objectives, those served, _ area serviced, and number of volunteers involved. Be specific._ Include equipment or services that would be purchased and why. Include a detailed budget and a schedule of significant activities related to this project. You may attach a maximum of one double - spaced typewritten page of information. (Please type or print legibly) Please see attached - Application - Page 3 j Breast Health Assistance Program The Breast Health Assistance program.began.in April of 2004, when Michelle's Place, The Breast Cancer Resource Center received grant funding from the Inland Empire. Affiliate of the Susan G. Komen Foundation. Almost six years later, more than 2,800 women have been accepted into the Breast Health Assistance program. We have facilitated in the diagnosis of 32 cases of breast cancer. 19 of these women were less than 40 years old. More than 26,900 free services have been provided to women in the Inland Empire. And in 2009, Michelle's Place provided 265 Temecula residents with free resources. The Breast Health Assistance program provides breast health resources, navigation, financial assistance and. support to women and their families in Riverside County, One component of the Breast Health Assistance program is free and low -cost mammograms; ultrasounds and other diagnostic breast health services. The process begins with a referral from a clinic or a call into the Resource Center requesting a breast health service. An intake form is immediately completed by the volunteer operator to determine the best resource for the woman. After determining her needs, she is either sent a Michelle's Place application for services or directed to a resource that would better meet her needs. Once a woman is accepted into the program through a Michelle's Place application she is referred to an imaging facility. Our Patient Navigator ensures she receives timely appointments. Upon receiving the results of the imaging, she will be referred for additional tests, referred to a surgeon for further tests or be released from the program and prescribed follow -up treatment. Since breast cancer is generally treated on an outpatient basis, clients are often in need of direction during the treatment process and benefit greatly from outpatient care coordinating. The Breast Health Assistance program provides a patient navigator to each client enrolled in the program. The Breast Health Assistance program services include: • Complete initial clinical and needs assessment at time of enrollment. • Individualized plan of care. • Education regarding disease process, treatment modalities and psycho - social issues. Materials are mailed as needed. • Provider liaison to ensure timeliness of appointments and care. • Referrals to community resources, • Facilitates free diagnostic services. • Insurance /claims assistance. • Basic needs resources including transportation, financial assistance, in home services, meals and other support services upon diagnosis. • Lymphedema support services including free fittings, gloves, sleeves and resources. As Michelle's Place continues to be one of the Inland Empire's sole providers for diagnostic services to uninsured women less than 40 years old, it is important for Michelle's Place to continue in administering this program. The American Cancer Society estimates that at least 1,055 women will be diagnosed with breast cancer in 2009 in Riverside County and at least 230 residents will die. Now, with the recent funding cuts in the "Every Women Counts" breast cancer screening program, the need for services will increase dramatically. No longer is the gap in service limited to uninsured women less than 40 years old. The need now includes all uninsured women who have a symptom of breast cancer. - - -- - - A primary objective of the Breast Health Assistance program is to be available to all clients = of any age who need breast health services. The diagnostic program targets women who would otherwise fall through the cracks. These women include uninsured, underinsured women who are less than 40 years old and have a symptom of breast cancer. Although breast cancer is a disease affecting women primarily over the age 40, a significant number of women under age 40 are affected in this region. This has been well documented by the success of the `Every Women Counts" program. Unfortunately, effective January 1, 2010 the "Every Women Counts" program lost its funding. There are currently no resources for breast health services in the State of California for any women of any age. This poses a huge problem for uninsured women who have a symptom of breast cancer. At least 60 women will receive diagnostic services directly related to breast health. An additional 3,000 women will receive support resources by directly visiting the Center or calling the 800# for resources: The Breast Health Assistance program goal is to provide outpatient navigating and breast health care services to any qualified individual seeking assistance. Budget: 60 women x screening mammogram ($82) = $4,920.00. Funding from the City of Temecula will directly benefit the residents of Temecula. A minimum of 60 women will receive free screening mammograms and all navigation and support of the Breast Health Assistance program through our Patient Navigator. There is currently no resource available to uninsured, low- income women of Temecula Valley to receive breast health services. Michelle's Place is meeting that need. Through the generous support of our local practitioners and imaging facilities, Michelle's Place receives a significant discount on all services provided to the participants of the Breast Health Assistance Program. All fees are reimbursable at Medi -Cal rates or a 40% discount, whichever is lower. If any of the participants who receive a screening are in need of additional tests, surgeon consult or biopsy, they will receive these services free through the Breast Health Assistance program. PRESIDENT or Marilyn Watson, President AUTHORIZED OFFICER: NAME and TITLE (Please Print or Type) SIGNATURE: ORGANIZATION NAME: Michelle's Place, Breast Cancer Resource Center MAILING ADDRESS: 41785 Elm St. #405, Murrieta, CA 92562 951- 304 -1280 DATED THIS 14 of September , 2010. (Date) (Month) BE SURE TO INCLUDE THE ORIGINAL PLUS ONE COPY AND SUBMIT TO: Mail Completed Applications to: City of Temecula Community Service Funding Program Attn: Judy McNabb Post Office Box 9033 Temecula, CA 92589 -9033 Or Deliver in Person to: City of Temecula Community Service Funding Program Attn: Judy McNabb 43200 Business Park Drive Temecula, CA 92590 Application - Page 5 Internal Revenue service i - Department of the Treasu Date: November 8.2005 P- 0. Box 2508 ry Cincinnati, OH 45201 WOMENS BREAST CANCER RESOURCE Person to Contact- CENTER CENTER Steve Brown 31 -p7422 % MARILYN R WATSON 41538 EASTMAN DR - Customer Service Specialist Toll Free Telephone Number. MURRIETA CA 92562 877- 829 -5500 Federal Identification Numlwr: 33- 0951216 Dear Sir or Madam: This is in response to your request of November 8, 20051 regarding your organization's tax- exempt status. In December 2001 we Issued a determination letter that recognized your exempt from federal income tax. Our records indicate that your organizat�s currently exempt under section 501(c)(3) of the Internal Revenue Code. Our records indicate that your organization is also classified as a public section 509(a)(2) of the internal Revenue Code. charity under Our records indicate that contributions to your organization are deductible under section .170 of the Code, and that you are qualified to receive tax deductible bequests, devises, transfers or.gifts under section 2055, 2106 or 2522 of the Intemal Revenue Code. If you have any questions, please call us at the telephone number shown in the heading of this letter. Sincerely, Janna K. Skufca, Director, TF✓GE Customer Account Services W N O T (D m O w Fa T O N N C � - a ro m n A m � .� 1n n_ to m 3 m o o m m m m' - 00 W d d m � u 3 , m 9 � n S W m 0 m ,t N e n °o- oW o 0 0 0 o e 0 o a oW Wo 0 0 o o p W 0 O m 8s000S ooS o' o00o SooS m J Y Y0 � Ow Q O O � O O O p G N 0 'J pla °o m FFF p O m _ m C O O o S c s 0 _ m o O O O d 0910 O 80 3 c e It 0 �r c o 0 � 3 m $ o 0 41 o z 0 0 nq °o °o 0 O w O O 0 N + O 0 T A C O O O O O O'O O O O O O O O 00 G O O O O O O'W S S O O O S O p O S S A N+ N O O C O O O G O 0 0 0 O O y a o O O O O o O o 0 0 o a o O O 0 0 0 0 0 0 O O O 0 0 0 0 0 0 O 0 0 0 0 0 0 O S O S O O S O Fa T O N N C � - a ro m n A N O S T O A to m - � b A 0 0 0 3- O 0 l.. 3 y x v - m v.: m 'w 3 ° ° x o c 3 c V 9 . °e n m o' m of _. O 6 m. - 3 m o ° o p m o m' o ° o w n,. 3 O O O O P 9 O O S p O O O O O O S N O O O O m - °p °p °p S °p °O °O °p ° T C O b O O O O _ O S O O O O O � fp 0 0 0 O O b 3 O S S O O O O O O C x � O sr S N N O O O O W m J O O O O O O O O O O N A = Q m O a o° Op pp $ mm O O C 0 m A A 'm w in 0 0 bN O O WO p w G, o e O S S w X00 a 3 � +m3 � c +o� � D m � n o � o � c m' A O O O O 00 O V O S O 0 O O 0 0 O N O O O O O O O S O O p O p O O O O O O O O O O O O S O O O O O S O O S O O N O S T O A to m - � b A N o n T eA_ � A _ G y OQ 'O n n m m m � 3H 9� d d n H m m 3 o. g mum +o Am u° Nom rA.1m T r C + O 1p 1�� O O O S S O O fO O S S O S S O O S O F � o AA W 3 J N VNi j O O O S O co O n 0 6 n 0 0 0 _ mm o S o 0 o i o c o m 0 0o c o 0 m 4l o o O 0 3 o ° c � Dm a mx o e s 'om o 0 ° m a g � ; F - o c am g o O 0 S p L M A o 3 A 00000 N00 -O Q + S A toOOO m O O O O O C O O O N m O J O O tJ O O OO O O O O 10 O IS, N o n T eA_ � A _ G y OQ 'O n n m Short Form .__ -.. - -.. OMB NO 1545 -1150 990 -EL Return of Organization Exempt From Income Tax Unde«aan501(e) 52i .ar49a7(axi)dmaktmnai Revenue Code 2009 (except lizard[ lung benefit bust private foundation) ► Sponsoring organizations of donor advised funds and controlling organizations as defined In section - 512(b)(13) must file Farm 990. All other organizations with gross receipts less than $5 shoed In total ,Open t0 PUI$ilC nmeMOfNe treasury assets less than $1, 250,000 at entl o /the year may use this form 1111, , a avenue Service or the 2009 calendar _ - year, or The organization may have to use a copy of this return to sidl fy state repo tax year beginning - - - - , 2009, a - heck d applicable. -_.. -_.. - a Name of organizaton - ddresschange omens Breast Cancer Resource Cents eR ame Mange - Nat relum - label Prntw IYpe. Number and street (or P.O. box, d mail is not delivered to street address) __.. - . _. .... imJnated tie 7877 Glen Oaks Road mantled return opliralion pending Irwrr, tons. City a town, state or country, and ZIP i 4 " - reariecula, CA 92592 - "- - - - ■ Section 5111(4131 oraanizafinr.c - a completed Schedule A 9requirements 1n$p @Ctlbb ending. _. _ 20 - D Employer identification. number 33- 0951216 Roornisude E.. Telephone number Group Exemption Number ► mg Method: UCash UAccrual H Check► ® ifthe orgamzation is not lebsite: ► michellesplace -org required to attach Schedule B (Form 990, ax-exempt status (check only one) - p 501(c) ( 3 ) (insert no) �4947(a)(1) or E] 527 - 99 "d-EZ or 990 PF)- heck ► d the organlzahon Is not a section 509 a 3 supporting pporting organization and its gross receipts are normally not more than $25,000. A )in 990 -EZ or Form 990 return is not required, but if the organization chooses to file a return. be sure in filo rmm�inre .,mots uu, on, ana 10, to One 9 to determine gross receipts; if $500,000 or more, file Form 990 instead of Form 990 -EZ qt` Revenue Ex enses and Changes in Net Assets or Fund Balances (See the instructions 1 Contributions, gifts, grants, and similaramounts received • • • ............... • • 1 1 government f 2 ........... • • • • • • • 3 3 . ............ 4 4 • • • ......... L L5a c Gain or (loss) from sale of assets other than inventory (Subtract line 5b from line 5a) • 5b • • . ' ...... 5 6 Special events and activities (complete applicable parts of Schedule G. If any amount is from I amm check here ► El 5c a Gross revenue (not including $ o of contributions reported on line l) .....................,,,. 80 1 130,349 b Less: direct expenses other than fundraising expenses • • • • h6f; 3 33,261 c Net income or (loss) from special events and activities (Subtract line � • • • ...... 6 �6ti�from'r t - 6c ' 7a.' - cost of goods sold ... - ........ , _ ' • 7 7b c Gross profit or (loss) from sales of inventory (Subtract line 7b from brie 3a) §4' • • ........... . . 7c 9 Total revenue. Add lines 1, 2, 3, 4, 5c, 6c, 7c, . 8 ) 9 schecIA) .. • • _ • • , • • • • 11 Benefits paid to or for members .. - 12 Salaries, other compensation, and e 11 employee benefits „ 12 381,675 Part l.) 246,764 4,562 t 97,088 117 .... .. ..... 14 Occupancy, rent, utilities, and maintp0, ancer ..: .. ....................... .... 13 42,868 . 15 Printing, publications, postage,aind shipping m`� 14 20, 917 ............................... 15 16 Other expenses (describe ► At 4130 �" =.'t 7,474 17 Total expenses. Add hoes 10 throw h.16 ) 16 184,188 9 . .............................. ► 17 18 Excess or (dehcit) for the year (Subtract line 17 from line 9) ... , ........ 414,564 11 19 Net assets or fmcl'l)alan' as at )7ygimmng of year (from line 27, column • A 18 (66,150) ( )) (must agree with end of -ygar figure repoi;ed on "prior years return) • • .... ......... . • • .•••• 19 274,503 20 011- trehanges in rfet assets or fund balances (attach explanation) • • ........ .. 8�p4 20 21 Net assets or fund bardnces at end of year. Combine lines 18 through 20 - (16, 492) .............. ► 21 191,861 1 B ante $ bets. If Total assets on line 25, column (B) are $1,250,000 or more; file Form 990 instead of Form990 -EZ. - -. (See the instructions for Part Ih) - ash savings, and investments • • • • • . . . . . . . .. . . . . (A) Beginning oryear (B) End of year ' ...... • • • • • 212,741 22 140,778 and and buildings . . . . . . . . . . .. . . ... . . . . . . . . _ dher assets (describe ► STM131 23 otal assets •...... ) 61,76224 51,083 ........................ Dal liabilities (describe ► 274,50325 191,861 ) at assets or fund balances (line 27 of column (B) must agree with line 21) • • • • ' ... 274,503 26 Icy Act and Paperwork 27 191, 861 Reduction Act Notice, see the separate instructions. FFL C.._� non �-• ..- - EZ(2rA9)- Womens Breast Cancel .esourca Cente - 33- 0951216 Paget ` Statement of Pro fain Service ACCOOI lishments (See the instructions for Part lif) _ ,Expenses - eprganizalioWs primary exempt purpose? . support for victims of breast.. cancer - - vhat was achieved in carrying out the - organization's exempt purposes.. In -a: clear and concise -- escribe the services provided, the number of persons benefited, or other relevant information for _. _ _. ram title __ _ __.. _... __. _.. _. __ __._ (Required for section . 501(c)(3) and 501(c)(4) organizations and section 4947(a)(1) trusts; optional for others.) ided facility for support meetings and counseling for -- - - - - n with breast cancer available for the entire community - plans deferred compensation - account and -other allowances - -R Watson President s $ - , . ). If this amount includes foreign grants; check here -• • • • • •... _. -28a - ._. -156,599 Lding, medical examinations for women with -or -at risk for - - -- -- - -- 29a 83,818 at cancer s -.$ ) If this amount includes foreign grants, check here • • • . • • .. 0 :ding information relating to breast cancer to patients - -- - 30a 24,851 .0 the community -at- -large ice President If this amount includes foreign grants, check here • • • • ... grogram services (attach schedule) . • • • • • .... .. ..... . . . . . . .. ... . .. .. . ;$ ) If this amount includes foreign grants, check here • .. • • ... - 31a See SERVICES 16,983 rogram service expenses (add lines 28a through 31 a) • • • • • .............. ....... 32 282 , 251 (a) Name and address (b) TAIe and average hours per week (c) Compensation (Knot paid. (d) Contributions to employee benefit 8 (e) Expense - tlevmetl to position enter �.) plans deferred compensation - account and -other allowances - -R Watson President .en Oaks Road Temecula CA, 92592 8 0 Watson ice President en Oaks Road Temecula CA, 92592 8 0 er irector dical Center Dr 103 Murrieta, 9256 5 0 tson irector erdale Dr Yorba Linda CA, 92886 6 0 oontz irector lie Azucar Murrieta CA, 92562 C 0 onrad irector erra de Ronda Murrieta CA, 92562 10, 0 lmacio irecto„w'+'f at St., Ste 305 Murrieta, 92562 -" 3 0 Goodnough xecut; Direc n St. Ste 305 Murrieta CA, 92562 55,606 x'50 0 1) s, �i EEA Form 990- EZ(2009) Short Form OMBNo, 1545.1450 Foam• 9WEZ Return of Organization Exempt From Income Tax 2009 tkxWiseWm5B1 (e).=."4947(a$1)a#MU48 WReraxc de Ca - .(except black lung benefit trust erAefcuxlaean) - - - - ► Sponsoring organizations of donor advised funds and controlling organizations as defined in section 512(b)(13) must file Form 990 All other organizations with gross receipts less than $500,000 and total Q[]en'fp Public - Department of the Treasury assets less than $1,250,000 at the end of the year my use this form - ' - lnspectlao: . Internal Revenue Service �� _ - ►Theorgamzalidn may have fo use acopy of this return to satisfy state reporting requirements. _ - - -" - - _A: For the 2009: calendar year, or tax year beginning : - - - - 2009, and ending - - , 20 - B Checkifapplidable: -- - -- -C- Nameoforganization- - - - -- -. - -- - - - - -- - -D Employer identification number - ❑Addresschang� omens Breast - Cancer Resource Conte 33- 0951216 - - use ❑ Name Mange, P �a Number and street (or P.O. box, if mail is not delivered to street address). - RooMsuxe - E Telephone number ❑Initial return .... -. type.. See F] Terminated 7877 Glen Oaks Road - ❑Amendedreturn 1 City ortovm, state "country, and ZIP +4 F Group Exemption El Application pending emecula, CA 92592 - -- - Number ► - - �. Section 501(c)(3) organizations and 4947(a)(1) nonexempt charitable trusts must attach _ G _ Accounting Method: F] Cash. ❑Accrual. - - - -- -- -- a completed Schedule A(Form 990 or 990- F2). - - -- - - -- - - Other (specify) -► - _ H Check ► ® if the organization is not 1 Website: - ► michellesplace.org required to attach. Schedule B.(Form 990, J Tax - exempt status (check only one) M 501(c) ( 3 ) / (insert no.) ❑ 4947(a)(1) or M 527 990 -EZ, or 990 -PF). -K Check ► ❑ if the organization is not a section 509(a)(3) supporting organization and its gross receipts are normally not more than $25,000. A Form 990 -EZ or Form 990 return is not required, but if the organization chooses to file a return, be sure to file a complete return. L Add lines 5b, 6b, and 7b, to line 9 to determine gross receipts; if $500,000 or more, file Form 990 instead. of Form 990 -EZ ► $ T81,675 Revenue Expenses, and Changes in Net Assets or Fund Balances (Seethe instructions for Part].) 1 Contributions, gifts, . grants, and similar amounts. received • •. • • r. • • •. • • . • • • • • • • • • ....... 1 246,764 2 Program service revenue including government fees and contracts • • • • • • • • • • • • • • ...... 2 3 Membership dues and assessments • • • • • • • • - - - • - • • • ............ .. 3 4 Investment income • • • • • • - • - - • • - • • • • • • • • • • • • • • • • . ... . .. .. . . .. . 4 4,562 5a Gross amount from sale of assets other than inventory • • • • • • • - - - 5a b Less: cost or other basis and sales expenses - 5b R c Gain or (loss) from sale of assets other than inventory (Subtract line 5b from line 5a) • • • • • • • • .... Sc e 6 Special events and activities (complete applicable arts of If an amount is from ► ❑ v ( P PP P ) Y gamg, checkhere e a Gross revenue not including " n ( g $ of contributions U u reported on line 1) • • • - • • - - • • • • • • . - • • ....... ¢`` 'ga 130,349 e to Less: direct expenses other than fundraising expenses • • • • • • `° � -�- $)fta• 33,261' c Net income or (loss) from special events and activities (Subtract line % from-�r1p 6a) iit - - - - • .. - .. 6c 97,088 7a Gross sales of inventory, less returns and allowances ,. 7a» - b Less: cost of goods sold - .... x' �. 7b c Gross profit or (loss) from sales of inventory (Subtract line 7b from line a) -%Its • • • . • - ........ 7c 8 Other revenue (describe ►"''" k ) g 9 Total revenue. Add lines 1, 2, 3, 4, 5c, 6c, 7c, "did 8 ::� •' - .. .................. ► g 1 348,414 10 Grants and similar amounts paid (attach schedu e] .. #), ... . ........... . ...... 10 11 Benefits paid to or for members 11 E.. .. .. -... . P12 Salaries, other compensation, and enjplto, ee benefits . - • • • • • • - • ......... - . 12 159,117 . a 13 Professional fees and other payments < {v `dependent contractors - ....... - 13 42,868 s14 Occupancy, rent, utilities, and matglgRxanco • • • • - • • ............. . ....... 14 20,917 s15 Printing, Publications, postage,{and srippl4i9 . • • • • • • • • • • • • • • • • • • • • • - • • • • • - - 15 7,474 16 Otherexpenses (describe ►_ 3',y$;L30 IV- 16 169,188 : 17 Total expenses. Add hnes"f ; rough.l6 • • • • • • - • • • • • • .................. ► 17 414,564 !. 18 Excess or (deficit:) for ttte ygar (Sg"¢tract line 17 from line 9) • • • • • - • • • • • • • .......... 18 (66.,150) A 5.2 Ns 19 Net assets or fundglanr�e$ am�t ,))..eginning of year (from line 27, column (A)) (must agree with as end -of year figu[,g re' q orTpnor year's return) • • • • • • • • • • ..... . ............ 19 274,503 t s 20 Other changes in not assets or fund balances (attach explanation) • • • - • • • • • ....... STM104 20 (16,492) 21 Ne `assets or fund balances at end of year. Combine lines 18 through 20 • • • • • • • • • • ... -.. lll� 21 191,861 B ante S Bets. If Total assets online 25, column (B) are $1,250,000 or more, file Form 990 instead of Form 990 -EZ. i2 - (See the lnslructions for Part II.) (A) Beginning of year - (B) End of year 22 Cash, savings anti investments • • • • - • • • • • • .................... 212,741 22 140,778 23 Land and buildings • • • • - • • { - • • • • .. . . .......... . .... . ... - 23 24 Other assets (describe ► STM131 ) 61, 762 24 11,113 25 Total assets • • • . . .................. . ............ .... 274, 503 25 191, 861 26 Total liabilities (describe ► ) 26 27 Net assets or fund balances (line 27 of column (B) must agree with line 21) • • • • .... 274,503 27 191, 861 For Privacy Act and Paperwork Reduction Act Notice, see the separate instructions. EEA Form 990 -EZ 00091 Form 990- EZ(2009) art l Womens Breast Cancer Resource Conte - .337 0951216 _..Page Statement of Program Service Accomplishments (Seethe instructions for Pad III.) - Expenses What is the organization's primary exempt purpose? Support for victims of "breast cancer - Describe what was achieved in carrying out the organization's exempt purposes: In a- clearand concise - - - - - manner, describe the services provided,. the number of persons benefited,.or other relevant. information for .. _ - each program title. (Required for section 501(c)(3) and 501(c)(4) organizations and section - 4949(a)(1) trusts; optional for others.) - - 28 Provided_ facility, for support and counseling for_._ devoted to position women with breast cancer available for the - entire - community- - - deferred compensation - -- Marilyn R Watson resident (Grants $ - -- - - ) - -if this amounftitcluders foreign grants, check here • _ -.... • . � � _28a 156,599 29 Providing medical examinations for women with or at risk for breast cancer _ William Watson ice President (Grants $ ) If this amount includes foreign grants, check here • • • ..... �,. 29a 83,818 30 Providing information relating.to breast cancer to- patients. _ and to the community at large 0 Jan Geller irector (Grants $ - ) If this amount includes foreign grants, check here • • • • .... � E 30a 24,851 31 Other program services (attach schedule) . • . • • .... .. .. .. .. .... ................ . . (Grants $ ) If this amount includes foreign grants, check here . • • • .... 31a See SERVICES 16,983 32 Total program service expenses (add lines 28a through 31a) • • ........ ................ .. 32 282,251 .3 i�/? List of . ••.� . •wy onl,rvyGOJ. LRl CGG11 une even Ir nor comoensarea 1111 nle Nco-ncnrN,e 1, fond Iv r - (a) Name and address (b) Title and average - hours per week (e) Compensation (orml paid, (d) Contributions to employee benefit plans & (e) Expense account and devoted to position enter -o.j deferred compensation other allovences Marilyn R Watson resident 37877 Glen Oaks Road Temecula CA, 92592 8 0 William Watson ice President 37877 Glen Oaks Road Temecula CA, 92592 8 0 Jan Geller irector 25460 Medical Center Dr 103 Murrieta, 9256 5 0 Wayne Watson Director 6082 Amberdale Or Yorba Linda CA, 92886 - 6 0 Ginger Koontz irector 4, 39577 Calls Azucar Murrieta CA, 92562 5r=a4,,. ..`;a t 0 Carole Conrad Director 40199 Sierra de Ronda Murrieta CA, 92562 A ' o Maria Dalmacio 41765 irecte Elm St., Ste 305 Murrieta, 92562 0 Kimberly Goodnough xebut>.�cg Di ec �0 41785 Elm St. Ste 305 Murrieta CA, 92562 � ''6- 55, 606 0 zy Y 4E. yy "RF _EEA Form .990 -EZ (2009) 2 FOrm.990 -EZ 2009) Womens- Breast Cancer Resource Cents - -- - 33 -0953 Page - -- X X _ f X ompee c e us . Part I ... ............................... 40b X c Section 501(c)(3) and 501(c)(4) organizations. Enter amount of tax imposed on organization managers or disqualified persons during the year under sections 4912 ,. 4955. and 4958 .............................. .;,.... ► _ .. d Section 501(c)(3) and 501(c)(4) organizations. Enter amount of tax on line 40c reimbursed by the organization • • • • ............ da1,;, • ► e All organizations. At any time during the tax year, was the organization a part' a prohibited shelter transaction? If "Yes," complete Form 8886 -T • • ....... .:.,, a _ �,.. .y rt'.. . . . . 40e X 41 List the states with which a copy of this return is filed. ► CA- ° ., -._ 42 a The or anization's book g oo s are m care of ► Marilyn R Watsorjr Telephone no. ► 951- 302 -0739 ...... va..cr nuvnuouvrr v--•-• ..-- •••.�...•..,.,�yw,,....,�„w ,,, ago „muwumw wr ran v. /.. Located at ► J;a' 37877 Glen Oaks Road Temecy,"' -C:A a ZIP +4 ► 92592 - 33. Did the organization engage in any activity not previously reported to the IRS? If "Yes," 7attach over a financial account in aforei n count g country (such as account, securities account, or other financial de scription of each- activity ..,- .- .- .....,. -. -.... , -.... , ,- .- ..... .... - account)? . .. . . . . .. .. . . .. k . . . . . .. .... . .. . .. .. . . . .. . . . "Yes," = 34 7detailed Were any changes made to the organizing or governing documents? If "Yes," attach a - - No X. If enter the name of the foreign coun ► - the changes - .__..._.... _...- ... -... - ....- ... .:.. _, - .- .. _.. ........ . • 3a 35 If the organization hadincome from business activities, such as those reported on lines 2, 6a. aners), but not reported on Form 990 -T, attach a statement explaining why the organization did not report th_ m 990 -T. - and Financial Accounts. - e a Dad the organization have unrelated business gross income of $1,000 or more or was it subject to section c At any time during the calendar year the organzation maintain an office outside of the U.S'? 6033(e) notice, reporting, and proxy tax requirements? • • • • • • • • • :. ................. ........ • 35a b If "Yes," has it filed a tax return on Form 990 -T for this year? • • • • • • • ............... ........ 35b 36- -Did the organization undergo a liquidation, dissolution, termination, or significant disposition of net assets - - - during the year? If "Yes," complete applicable parts of Schedule :N • • • • ............. 36 37 aEnter amount of political expenditures, direct or indirect as described in the instructions • • . . lo- I 37a b Did the organization file Form 1120 -POL for this year? • • • • • • • • . . .......................... 37b 38 a Did the organization borrow from, or makeany loans to, any officer, director, trustee, or key employee orwere - No any such. loans made in a prior year and still outstanding at the end of the period covered by this return? • .... .. 38a b If "Yes," complete Schedule L, Part 1I and enter the total amount involved • • • • • • • • ..... 38b 45 Is any related 39 Section 501(c)(7) organizations. Enter. meaning of section 512(b)(13)? If - Yes,' Form;990 muss' a completed instead. of Form -EZ • • • • • • ........ a Initiation fees and capital contributions included on line 9 • • • • • • • .............. 39a 45 b Gross receipts, included on line 9, for public use of club facilities • • • • • • • • • ........ 39b -FZ (2009) 40 a Section 501(c)(3) organizations. Enter amount of tax imposed on the organization during the year under: section 4911 ► ; section 4912 ►. ; section 4955 lo- b Section 501(c)(3) and 501(c)(4) organizations. Did the organization engage in any section 4958 excess benefit transaction during the year or is it aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization's prior Forms 990 or 990 -EZ? If "Yes " c I t S h d l L Page - -- X X _ f X ompee c e us . Part I ... ............................... 40b X c Section 501(c)(3) and 501(c)(4) organizations. Enter amount of tax imposed on organization managers or disqualified persons during the year under sections 4912 ,. 4955. and 4958 .............................. .;,.... ► _ .. d Section 501(c)(3) and 501(c)(4) organizations. Enter amount of tax on line 40c reimbursed by the organization • • • • ............ da1,;, • ► e All organizations. At any time during the tax year, was the organization a part' a prohibited shelter transaction? If "Yes," complete Form 8886 -T • • ....... .:.,, a _ �,.. .y rt'.. . . . . 40e X 41 List the states with which a copy of this return is filed. ► CA- ° ., -._ 42 a The or anization's book g oo s are m care of ► Marilyn R Watsorjr Telephone no. ► 951- 302 -0739 Located at ► J;a' 37877 Glen Oaks Road Temecy,"' -C:A a ZIP +4 ► 92592 b At anytime during the calendar year, did the organizafi"on have anotere5[ m or a signature or other authority it t-1 over a financial account in aforei n count g country (such as account, securities account, or other financial account)? . .. . . . . .. .. . . .. k . . . . . .. .... . .. . .. .. . . . .. . . . "Yes," = 42b Yes No X. If enter the name of the foreign coun ► - See the instructions for exceptions and filing wrements for Form TD F 90 -22.1, Report of Foreign Bank and Financial Accounts. - e c At any time during the calendar year the organzation maintain an office outside of the U.S'? �dYd • ........ ...... If "Yes." enter the name of the foreign °cGUntry:..� ' ►. 42c X 43 Section 4947(a)(1) nonexempkcharl(yple fry §ts filing Form 990 -EZ in lieu of Form 1041 -Check here . • ..... ............ ► and enter the amount of tax exempt intgrtest received or accrued during the tax year . • • • • , .... ► I LI , 43 - - 44 Did the organization maintain any donor advised funds? If "Yes," Form 990 must be completed instead of Yes No Form 99(4EZ .: arx .... .. -- ........ 45 Is any related ... ........... . . - ....... orgamz (Ion a controlled entity of the organization within the 44X meaning of section 512(b)(13)? If - Yes,' Form;990 muss' a completed instead. of Form -EZ • • • • • • ........ 990 -_ ..................... 45 X EEA Form 990 -FZ (2009) (a) N_ ame and address of each employee paid more than $100.000 (b) Title and average hours per week devoted to position (c) Campensalion Form 990- EZ,(2009) . -. Worsens Breast Resource.Cente .. - __. ___ 33- 0951216 .. Page 4 -r - - -- (e)Expense account and other allowances Section 501(c)(3) organizations and section 4947(a)(1) nonexempt charitable trusts only. All section Here 501(c)(3) organizations and section 4947(a)(1) nonexempt charitable trusts must answer questions 46-49ti -- - - - - -. - -- - - and complete the tables for lines 50 and 51. - - - - 46- Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to -. - Paid Yes ' No - candidates for public office? If "Yes," complete Schedule C, Part I • . • • • -• • • .. - .: .............. 46 x X -47 _ Did the organization engage in lobbying activities? If "Yes," complete. Schedule C, _Part II • • • • _..................... 47. "Winifred A Sansta CPA Firm's nhma (or yoyrs 4 X _ - 48 Is the organization a school as described. in section 170(b)(1)(A)(ii)? If "Yes." complete. Schedule E • . • •, .......... q8 X -- 49 a -Did the organization make any transfers to an exempt non-charitable related organization? .. •- • • • • • • . • • .. -....- 49a - X - - b If 'Yes," was the related organization a section 527 organization? .. • • • • • . • .................. 49b X 50 Complete this table for the organization's five highest compensated employees (other than officers, directors, trustees and key . _ employees) who each received more than $100,000 of compensation from the organization. If there is none, enter "None." (a) N_ ame and address of each employee paid more than $100.000 (b) Title and average hours per week devoted to position (c) Campensalion (d) Contributions to employee benefit plans 8 defamed compensation (e)Expense account and other allowances NONE _ Here Signature of officer Date NONE Type or print name and iHfi '. Paid Preparers' ' ¢ signature Dale Ceheck A Preparers Identifying No. (See inst.) x 05 -11 -2010 employed x - Preparer's "Winifred A Sansta CPA Firm's nhma (or yoyrs 4 EIN use Only d¢Olfemployed) ::-t 26204 Ridgemoor Road ....... ............ o,,,., ...... a pwc vvc, Y mgwu 51 Complete this table for the organization's five highest compensated independent contractors who each received more than $100,000 of compensation from the organization. If there is none, enter "None." (a) Name antl address of each independent conlraMOr paid mwre than $100,000 Under penalties of perjury . I declare tha'V ayg exammetl Nis reium, including accompanying schedules and statements, and to the best knowledge (b) Type of service (c) Compensation Here Signature of officer Date NONE Type or print name and iHfi '. Paid Preparers' ' ¢ signature Dale Ceheck A Preparers Identifying No. (See inst.) x 05 -11 -2010 employed x - Preparer's "Winifred A Sansta CPA Firm's nhma (or yoyrs 4 EIN use Only d¢Olfemployed) ::-t 26204 Ridgemoor Road j� Phone no. ► 951- 679 -4500 Maven lac a. "a. ��b NSA - . ........... . ... ... ....��...,r•c"cc.,, ...,naaew,a taco reyelwny uver:p mu,uuu .. .. _ _r _ ons . . ... . ...... .. . .. . ..11i, LN Yes J No w .�`, EEA Form 990- EZ(2009) Under penalties of perjury . I declare tha'V ayg exammetl Nis reium, including accompanying schedules and statements, and to the best knowledge of my and belief, it is Me, comets, and complex Elgolarabon of preparer (other than officer) is based on all information of which preparer has any knowledge. Sign Here Signature of officer Date Type or print name and iHfi '. Paid Preparers' ' ¢ signature Dale Ceheck A Preparers Identifying No. (See inst.) x 05 -11 -2010 employed x - Preparer's "Winifred A Sansta CPA Firm's nhma (or yoyrs 4 EIN use Only d¢Olfemployed) ::-t 26204 Ridgemoor Road address and ZIP .4 i -; Sun City, CA 92586 Phone no. ► 951- 679 -4500 Maven lac a. "a. .. _ _r _ ons . . ... . ...... .. . .. . ..11i, LN Yes J No w .�`, EEA Form 990- EZ(2009) $CHEDULE A Jh`L ) OMB No. 1545-00,17 (FPHED oLE A... _ Yublic Charity Status and Public support - - - Complete if the organization is asection 501(0)(3) organization ore section - - 2009 - - 4947(a)(1) nonexempt charitable trust : p Department of the Treasury - Open ta- Rubllc'. -. 1 - Internal Revenue Sefvioe ► Attach to Form 990 or Form 990 -EZ. - ► See separate instructions. - Inspection = ..Nameoftheorgamuaewl _.._ _._ BooloyerxknWk*m number... Womens_Breast Cancer Resource Cente.. _. 33- 0951216 The organizationds-not at private foundatiortbecause it is (For lines 1 through 91, check only one box.' - i. n A church, convention of churches, or association of churches described in section 170(b)(1)(A)(i). - 2 n -A school described in section 170(b)(1)(A)(ti). (Attach Schedule E.) - - - - - - - - - - 3 u 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 section 170(b)(1)(A)(iii). Enter the hospital's name, city, and state: 5 r] An organization operated for the benefit of a college or university owned of operated by a governmental unit described in section 170(b)(1)(A)(Iv). (Complete Part ll.) - - 6 A federal, stale, or local government or governmental unit described in section 170(b)(1)(A)(v). 7 An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in section 170(b)(1)(A)(vi). (Complete Part 11.) - 8 �_ A community trust described in section 170(b)(1)(A)(vi). (Complete Part 11.) 9 An organization that normally receives: (1) more than 33 1/3% of its support from contributions, membership fees, and gross receipts from activities related to its exempt functions - subject to certain exceptions, and (2) no more than 33 1/3% of its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.) 10 L] An organization organized and operated exclusively to test for public safety. See section 509(a)(4). - - 11 An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box that describes the type of supporting organization and complete lines 1 to through 11h. a 0 Type I b [] Type It c ❑ Type III - Functionally integrated d ❑ Type III -Other e By checking this box, I certify that the organization is not controlled directly or indirectly by one or more disqualified persons other than foundation managers and other than one or more publicly suppo %ed organizations described in section 509(a)(1) or section 509(a)(2). If If the organization received a written determination from the IRS that it is a T YR T ` YRfi81, or Type A, 1Z YP III supporting organization, check this box • • • • • • • • ..........., ;', . ...... .... .............. '� , g Since August 17, 2006, has the organization accepted any gift or conirj w pGbon froin any oP3he following persons ?w..,' (i) A person who directly or indirectly controls, either alone orJdJii1ber m416 per'Sons described in (ii) and (iii) below, the governing body of the supportedM lon orga'- ato :. • • • • - • • . - - . .... y� tt 1 �) (ii) A family member of a person described in (I) apove'A` • • • • • • • ................ . . (iii) A 35% controlled entity of a person describgd Yin (i) or (ii).�po0� ?' .............. h Provide the following information about the supported organize n(s). O Name of supported ll EIN - (w) Type of &g° ''zatlon - `(w) Is the organization (v) Ditl you notify (v) Js the (a) Amount of organize[ >.; (descdbed on liAlik.i- 9 in col. O listed in your the organization in organization in col. support %L*'ove o IRC section governing document? col, O of your O organized in the (W iubrlmorsi if support? U.S.? " Yes No Yes No Yes No °aGy? ,z Total` F or Privacy Act and Paperwork Reduction Act Notice, see the Instructions for EEA SrhsduleA (FarmMor 99aE) 2009 Form 990 or 990 -EZ.- t schedule A(Foun 990 or990-EZ)2009 W. I's Breast Cancer Resource cente � 33- 0951216- Page 2` Part I' Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and - 170(b)(1)(A)(v)) - - . (Complete only if you checked the box on line 5, 7, or 8 of Part I.) .. _ Section A. Public Support :alendar year (or fiscal year beginning in) 0- ( (a) 2005 ( (b) 2006 - - (c) 2007 ( (d) 2008 ( (e) 2009 - ( (f) Total 1. Gifts, grants, contributions, and membership fees received. (Do not - - - - - _ - -- include any "unusual - - - - - - - - - - _.- - 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 u u ' ''+ a y y 3 person (other than a governmental unit orj publicly supported organization) included I I "' "' -, c c s fit• _ shown on line 11, column (f) . • • - _ 6 Public support. Subtract line 5 from In :ur£nn Q .. T..F1 . ___...... NN Calendar year (or fiscal year beginning in) 7 Amounts from line --- ......... 8 Gross income from interest, dividends, Payments received on securities loans, rents, royalties and income from similar sources .............. . 9 10 11 12 13 Net income from unrelated business activities, whether or not the business is regularly carried on • . • • ..... . Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.) • • • • • ... . Total support. Add lines 7 through 10 Gross recei is from related (a) 2005 (b) 2006 (c) 2007 (d) 2008 (e) 2009 (f) Total p aWvdles, etc. (see instructions) • ....... , q2 First five years. If the Form 990 is for the organization's first, second thrzd loo •�t' organization, check this box and stop here ....... _ f rtht or tax year as a section 501(c)(3) Public support percentage for 2009 (line 6, column (f) divided byline 13 column (f)) .............. 14 15 Public support percentage from 2008 Schedule A, Part(lt" line 14 ti,:"'"a............. tg tsa 33 1/3 % support test - 2009. If the organization did not e�leck the boe n line 13, and line 14 is 33 1/3 %•or more, check this box /o and stop here. The organization qualifies as a publicly suISPorted organization . . . . .......... t b 331/3 %su ►�,_,. pport test - 2008. If the organizatidn,diQ, not check vb x on line 13 or 16a, and line 15 is 33 1/3% or more, check this box and stop here. The organization qualifies ,,� ublicly supported organization . • • ... _ 17a 10%- facts - and - circumstances test -2009 Ifthe o g pibajion did not check a box on line 13, 16a, or 16b, and line 14 is 10% or ► - tws;. more, and if the organization meets the,( acts andzcircrY Stances" test, check this box and stop here. Explain in Part IV how the organization meets the "facts and circumstances" fe'st. The organization qualifies as a publicly supported organization ..... ....... ►-I b 10%- facts- and - circumstances test - 2008- 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 meetthe "facts -and- circumstances" test, check this box and stop here. Explain in Part IV how the organization meets tirg "facts and circumstances" test. The organization qualifies as a publicly supported. organization 78 Private foundation If ttle.orgamzati n lid not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see instructions ►I SdierkOeA (Farm 99aar990E2) 2099 p aWvdles, etc. (see instructions) • ....... , q2 First five years. If the Form 990 is for the organization's first, second thrzd loo •�t' organization, check this box and stop here ....... _ f rtht or tax year as a section 501(c)(3) Public support percentage for 2009 (line 6, column (f) divided byline 13 column (f)) .............. 14 15 Public support percentage from 2008 Schedule A, Part(lt" line 14 ti,:"'"a............. tg tsa 33 1/3 % support test - 2009. If the organization did not e�leck the boe n line 13, and line 14 is 33 1/3 %•or more, check this box /o and stop here. The organization qualifies as a publicly suISPorted organization . . . . .......... t b 331/3 %su ►�,_,. pport test - 2008. If the organizatidn,diQ, not check vb x on line 13 or 16a, and line 15 is 33 1/3% or more, check this box and stop here. The organization qualifies ,,� ublicly supported organization . • • ... _ 17a 10%- facts - and - circumstances test -2009 Ifthe o g pibajion did not check a box on line 13, 16a, or 16b, and line 14 is 10% or ► - tws;. more, and if the organization meets the,( acts andzcircrY Stances" test, check this box and stop here. Explain in Part IV how the organization meets the "facts and circumstances" fe'st. The organization qualifies as a publicly supported organization ..... ....... ►-I b 10%- facts- and - circumstances test - 2008- 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 meetthe "facts -and- circumstances" test, check this box and stop here. Explain in Part IV how the organization meets tirg "facts and circumstances" test. The organization qualifies as a publicly supported. organization 78 Private foundation If ttle.orgamzati n lid not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see instructions ►I SdierkOeA (Farm 99aar990E2) 2099 Sthedute A(Fo" 990 or 990- E2)2009 - Wov.ens I3reast Cancer Resource Cents � '- -- 33- 0951216- -- - Page - P " - It' Support Schedule for Organizations Described in Section509(a)(2) (Complete only if you checked the box on line 9 of Pan l) - Section A. Public Support Calendar year (or fiscal year beginning in) ► (a) 2005 (b) 2006 - (c) 2002 (d) 2008 (e) 2009 - (f) Total - 1 Gifts, grants, contributions, and membership fees received. (Do not include - - - any "unusual grants. ") - -• • • - . • . • -• • -- - -- 263-,940 - - 398 -,32 -7 - 415,437 ° - -- 240- ,137- -- 246,764 - -1- ,564,605- 2 Gross receipts from admissions, merchan- dise sold or services . performed, or fac- -. lities furnished in any activity that is related to -the- organization's tax- exempt purpose - - 3 Gross receipts from activities that are not anunrelatedtradeorbus. under sec 513 125,547 107,311 127,012 165,759 130,349 655,978 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 l through • ... • • • 389,487 505,638 542,449 405,896 377,113 2,220,583 7a Amounts included on lines 1, 2, and 3 received from disqualified persons - b Amounts included on lines 2 and 3 receiv- ed 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.) . . . . . .... "-- s to � �4 ,ev„ :_ 2,220,583 Jection B. Iota[ Support Calendar 9 Ann 10a Gros pay rent sou b Unr sect acq c Add 11 Net i acliv whet earn 12 Oth loss (Exp 13 Tots and year (or fiscal year beginning in) 0, ( (a) 2005 ( (b) 2006 ( (c) 20.7 ( (d) 2008 ( (e) 2009 ( (f) Total 14 First five years. If the Form 990 organization, check this box anc 15 Publicsupport 16 Public support illzation's first, second, third, fourth, or fifth tax year as a section 501(c)(3) .................. ............................... ne 8, column (f) divided by line 13, column (f)) • • • .. • • ..... . Schedule A, Part III, line 15 • • • • • . • • . • ............. . 98.96 % 17 Investment income percentage for 2009 (line 10c, column. (f) divided by line 13, column (f)) • -. • - • .... 17 1.09 18 Investment mcome. percentage from 2008 Schedule A, Part 111, line 17 • • • • • • •......._............ 18 % 19a 33113% support tests - 2009. If the organization did not check the box on line 14, and line 15 is more than 33 113 %, and line 17 is not more than 33 113 %, check this box and stop here. The organization qualifies as a publicly supported organization • • • • • • .... P. [YI b 33113% support tests - 2008. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1!3 %, and line 18 is not more than 33 113 %, check this box and stop here. The organization qualifies as a publicly supported organization • • • • • . • • ► 20 Private Foundation: If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions • • • ........ 10 EEA _ SdeeuleA(Form990a990-Q)2009 atATMENTID Federal Supporting Statements 2009 Name(s) as shown on return - - - - _ _ FEIN Form 990EZ, Part I, Line 16 Other Expenses Schedule 2 Description _ _ Amount - Administrative - expenses - - -- - 26,508" - - Depreciation 10,679 Insurance 3,102 Other Program expenses 143,899 Total - - 184,188 Form 990EZ, Part II, Line 24 Other Assets Schedule 3 Beginning Description of Year End of Year Furniture & equipment net 61,762 51,083 Total 61,762 51,083 Form 990FZ Part I �axie 20 Other Chang�#i `in Net P�sets Schedule Description t Amount Unrealized investment loss9 (16,492) Total (16,492) P Yr- b x'. atATMENTID 990 - - Overflow Statement - 2009: Pa e 1 .. Narne(s) as shown on return _ .. - _ - -. . FEIN.. -. Womens Breast Cancer Resource Cente - Program Service Accomplishments Description Amount Utility bill assistance - - - $ 16,983 Total: $ 16,983 s ze= ws .T� 4 YVijly OVERFLOW.LD - TAXA134E YEAR California Exempt Organization -- - - - - -FORM -- 2009 Annual Information Return 199 _- Calendar Year 2009 or fiscal . year beginning month. _. year _,: and ending month day._ _... year _. _.. A First Return Filed? ❑ Yes B Type of organization - -- - CORP p - - - _ Fx1 . No - Exempt under Section 23701 - -D _ . (nsertletterF IRC Section 4947(a)(1) trust ❑ - 2267780 CorporationlOrganizalion Name - - FEIN Womens Breast Cancer Resource Cente 33= 0951216 Address 37877 Glen Oaks Road CITY .. .. State Zip Code _ C Amended Realm? • • • • • •_ • • • • • • • • • • _•_ • y U Yes IxI No D Are you a subordinate/affiliate in a group exemption? • . • • • ❑ Yes ® No (a) Is this a group filing for affiliates? See General Inst L •• ❑ Yes ❑ No (b) If "Yes," enlerthe number of affiliates • • • • • • • - (c) Are all affiliates included? • • • • • • • • • • • • • ❑ Yes ❑ No (IF'No, "attach a list. See instructions.) No - (d) Is this a separate return filed by an organization covered by a 2 4 6 7 6 4 group piing? • • • • • • • • • • • • • • • • • • • . ❑Yes ®No (e) Federal Group Exemption Number • • . • • . . • • • • No -(0 Is a roster of subordinates attached? • • . . • • • • • • ❑ Yes ® No E Final return? • Q Dissolved • ❑ Surrendered(Withdravm) • ❑ Merged/Reorganized (attach explanation) 21 If a box is checked, enter date 0 r�;No No F Check the box if the organization fled the following federal forms a schedule: (1) • ❑990T (2) • LI990PF (3) • ❑(Schedule H) 990 �r`,', [kl No G If organizationis exempt under RSTC Section 237014 and is exclusively religious, 8 Total gross income. Subbact line 7 from line 4'��. •t� • contributions, check box. See General Instruction F. No filing fee is required _ .0 ,J H Accounting method used (1) lg Cash (2) ❑ Accrual (3) ❑ Other • 11 1 If exempt under R &TC Section 23701Q has the organization during the year: (1) participated in any political campaign or (2) attempted to influence legislation or any ballot measure, or - (3) made an election under R &TC Section 23704.5 (relating to lobbying by public - charities)? 1f "Yes." complete and attach from FTB 3509, Political or Legislative 00 Activities by Section 23701d Organizations • • • • • • • • • .0 ❑ Yes No J Did the organization have any changes in its activities, governing instrument, articles of 2 4 6 7 6 4 incorporation, a bylaws that have not been reported to the Franchise Tax Board? If "Yes," Revenues, complete an explanation and attach copies of revised documents y El Yes No K Is the organization exempt under R&TC Section 23701g? .• ❑ Yes L,11 No If Yes, "enter amount of gross receipts from nonmember sources $ L Is the organization under audtt by the IRS or has the IRS audited in a pnoryear? ............. . ...... ...•I — h IYes 21 M Is the organization a Limited Liability Company? • • • • • • • . • 11 Yes Yes r�;No No N Did the organization file Form 100 or Form 109 to report taxable income? . ..,s . .. . . . . . .. . . .. .. . . ...•UYes �r`,', [kl No Pant Cmo4'•e Parlrnlxx Mmnmrel rn fRn rbie R,m, Cmr �r r...i..�.r:..,.w�..nr ".1 i May the Y I B discuss this realm with the preparer shown�above See 'nslruct onus • • • • • • • • • • • . • U Yes ❑ N For Privacy Notice, get form FTB 1131, 0 4 3 � 3 6510 9 4 Form 199 C7 2009 Side 7 1 Gross sales or receipts from other sources. From Side 2, Pont II, line 8 • • • • • • • • • . • • • 11 134, 911 00 2 Gross dues and assessments from members and affiliates • '� g?r. • - • p 00 Rea•loes 3 Gross contributions, gifts, grants, and similar amounts received • • • • . • • • • • • R • 3 2 4 6 7 6 4 00 Revenues, 4 Total gross receipts for filing requirement test. Add line 1 through line 3 -- This lie must be completed. If the result is less than $25 OQQ see Gefieml Instruction C `. • • • • • • • • • • • • • . • • • 4 381, 675 00 r- a b.. 5 Cost of gootls sold . . . . . • 5 00 {.. 6 Cost or other basis, and sales expenses of assets sold • 6 00 - - 7 Total costs. Add line 5 and line 6 . • • • • • ax.? • . r ' • • • • • • . . . . . . . . . . . . . . . . . . - 8 Total gross income. Subbact line 7 from line 4'��. •t� • • e 381, 675 Do Exposes 9 Total expenses and disbursements. From Sutle j,_.pad II lone 18 • • • • • • • • • • • • • • . • • • • • . • • . . .. • 9 447,825 00 10 Excess of receipts over expenses and i isbwile;Wts. Subtract line 9 from line 8 • • • • • • • • • • • • • • • • • • • • 10 (66, 150 Do 11 Filing fee $10 or $25. See General) nF"'.,. +' -• • • • . • • • . • • • • • • • • .. .. . . . . . . . . .. 11 10 00 r 12 Total payments • • . . . .,.4 .` 12 00 F13 Penalties and Interest See Gene ml ImtJuction f; €•. • • • • • • • • • • • • • • • . • • • • • • • • • . ... . . . . 13 00 14 Use lax. See General In a - . 15 Balance due -,Add Ilne {t IInB 13 aiw line 14. Then subtract line 12 from the result • • • • ` • • • • • • . • '• • • • • 15 1 O 00 it is penalties of perfury. I dgolare thaLt:have examined Nis return, including accompanying schedules and statements, and to me best or my knowledge and belief, it is True, correq, antl conei I Oocleration Sign of preparer (otherthan taxpayer) is based on all information of which preparer has any knowledge, Here Signature a' Title Date • Telephone ofo icer ► Fw - - Fir Pparefs Date Check if seR- •Preparer's SSN /PTIN Signature ► 05 -.11 -201 ilemployed ► X P00547393 Paid �s Only Finns namo,loryours, if self-employed) ► Winifred A Samstag CPA •FEIN 33- 0320167 and address 26204 Ridgemoor Road • TeleP hone Sun City CA 92586 951- 679 -4500 i May the Y I B discuss this realm with the preparer shown�above See 'nslruct onus • • • • • • • • • • • . • U Yes ❑ N For Privacy Notice, get form FTB 1131, 0 4 3 � 3 6510 9 4 Form 199 C7 2009 Side 7 Do not completLi"jhis s "dule if the amount on Schedule L, line 13, column (d), is less than $25,000 1 Net income per books r. - - 2 Federal income tax • • • • • • • • 3 Excess of capital losses ove €'capital gains 4 Income npt recorded on books this year. Attach schedule • .. • • . • .. • • • . • • • • 5 Expenses recorded on books this year not deducted in this return. Attach schedule • • • • 6 Total. Add line 1 through line 5 • • • • • • • • • • 7 Income recorded on books this year not included in this return. Attach schedule • • • • ......... 8 Deductions in this return not charged against book income this year. Attach schedule - - 9 Total. Add line 7 and line 8 • • • • • • 10 Net income per return. Subtract line 9 from line 6 • • • • • • • • ~ _ 33- 0951216 . - Part If Organizations with gross receipts of more than $25,000 and private foundations - regardless of amount of gross receipts - • - -- - complete Part 11 or furnish substitute information. See Specific Line Instructions. - - -- -- . - 7 Gross sales or receipts from all business activities. See instructions • -• .. • • • • • • • . • • • • • • • 1 - 13 0 34900 - - 2 Interest ........ ............................... .. . • 2 4 56 00 _ 3Dividends_ ... ... _........... • • . • ....................... • 3 00 mm-prs tram 4 Gross rents . -. _ .:....... - _......... • .......- ....................... • . . • 4. 00. ,_.On" 5- Gross royalties -._.._. ... ................._. .._..... ... ...,..... .... ......... • •• 5 - 00 _ $910 6 - Gross amount received from sale of assets (See Instructions) - • • • • • • • • • • • -• • • • • • • • y 6 - 00 - 7 Other income. Attach schedule • • • • • ... • • - • • • • • • • • • • • • • • • • • • • • • • • • • 7 00 ..- - 8 Total gross sales or receipts from other sources. Add line 1 through line 7. Enter here and on Side 1, Part I, line 1 • • •' • • • • • • • • • • • • • • • • • • • • • • • . • • • • • • • 8 :. 134, 91 00 i i 9 Contributions, gifts, grants, and similar amounts paid. Attach schedule • • • • • • • • • • • . • • • • • • 9 - 00 j - 10 Disbursements to or for members • • • • • • • • • • • • • • • • • • • • • • • • • • .. • -• . 0 10 00 11 Compensation of officers, directors, and trustees. Attach schedule • • • • • • • _ • • • • • • • • • • 11 55, 6 0 600 -.. _EVnses_ 12 Other salaries and wages.. ....._..... ..- .................• ...... ................• 12 74 7 7 00 am 13 Interest .................. ............................... • 13 - 00 mr.nrse ments 14 Taxes . .... ............................... ......... • 14 00 15 Rents .................. ............................... 15 20 91 00 16 Depreciation and depletion (See instructions) • • . • . • • • • • • • • • • • • • • • • • • • • • • • • • 15 10 67 00 17 Other. Attach schedule • • • • • • • • • • • • • • • • • • • • • • • • • • • • • . • • • • • • • • • • • 17 285, 84 00 '. 18 Total expenses and disbursements: Add line 9 through line 17. Enter here and on Side 1, Part I, line 9 18 447, 82 00 Schedule L Balance Sheets Beginning of taxable year End of taxable year Assets (a) (b) (c) (d) 1 Cash ..................... • 140,778 212 74 - -�:... -', .-; :•'_ s ) 2 Net accounts receivable • • • • • • • • • ,,, %i'. �.?r`�,r, i -. 3 Net notes receivable. Attach schedule • • • • 4 Inventories • • • • • • • • • • • • • • • • • • •:,, ,s'``,,'�J 5 Federal and state government obligations • • • • ,, 6 Investments in other bonds. Attach schedule • a,A =rte '�:` y 7 Investments in stock. Attach schedule • • • ; ',y^';,n • 8 Mortgage loans (number of loans ) ;74 'M- 9 Other investments. Attach schedule • • • • r , „,_. & ,yr ,:, -�. • 83, 9 8 4 83, 981 10 a Depreciable assets • • • • • • • • • • • • • ( 22 22& 6476, ( 32 901 b Less accumulated depreciation • • • • • • • 51,083 ,:v.;F 'r':-- E,..,' _ rz;_ 11 Land . . . . . . . . . . . . .. . ... . .. • 12 Other assets. Attach schedule • • • • • • • 'a:! ';.,. "' • "'' ',y" y r ; mss, =•.274 50 13 Total assets - 191,86 `- ."`_�, _yx• }},;:.. n. Liabilities and net worth 14 Accounts payable • • • • • • • • • • • • • • 15 Contributions, gifts, or grants payable • • • 16 Bonds and notes payable. Attach schedule 17 Mortgages payable • • • • • • • 18 Other liabilities. Attach schedule t 19 Capital stock or principle fund • •r y ti 20 Paid -in or capital surplus. Attach recenlolliahon 21 Retained earnings or income fund � �' 22 Total liabilities and net worth '•, t *� • • • • - i 191,861 I. 191 861 =., ,.,,.1n,. ; -; ',: „„,;` `r� {. '- = ' i 2 7 4 50T - :' ;4 ' ' '_. � ,,�.?„ $ ;;;' ';', .,;_ ";..• 274,561 - Schedule m -1 Reconcivatiortgf ii)_c`omq„per books with income per return Do not completLi"jhis s "dule if the amount on Schedule L, line 13, column (d), is less than $25,000 1 Net income per books r. - - 2 Federal income tax • • • • • • • • 3 Excess of capital losses ove €'capital gains 4 Income npt recorded on books this year. Attach schedule • .. • • . • .. • • • . • • • • 5 Expenses recorded on books this year not deducted in this return. Attach schedule • • • • 6 Total. Add line 1 through line 5 • • • • • • • • • • 7 Income recorded on books this year not included in this return. Attach schedule • • • • ......... 8 Deductions in this return not charged against book income this year. Attach schedule - - 9 Total. Add line 7 and line 8 • • • • • • 10 Net income per return. Subtract line 9 from line 6 • • • • • • • • y •. • • '- Side 2 Form 199 C1 2009 —043 3652094 r- FOVFLOW.LD State Supporting Statements - 2009 Pacre 1 Name(s)as shw on return - - - - - - -- - - Your Soda[ Security Number- - - Womens Breast - Cancer - Resource Cente _33- 0951216 Other Expenses Description Amount Special events $ 33,261 Professional fees 42,868 Insurance 3,102 Administrative expenses 26,508 Program expenses 143,899 Independent contractors 28,736 Printing and publications 7,474_ Total: $ 285,848 x x� r Ni 5. `so r A4 ,w t N_, FOVFLOW.LD Item No. 6 Approvals City Attorney Director of Finance City Manager CITY OF TEMECULA AGENDA REPORT TO: City Manager /City Council FROM: Genie Roberts, Director of Finance DATE: November 23, 2010 SUBJECT: General Liability Insurance Renewal PREPARED BY: Roberto Cardenas, Fiscal Services Manager RECOMMENDATION: That the City Council approve the insurance policy renewal for general and excess liability insurance with St Paul Fire and Marine Insurance Company and Ironshore Specialty Insurance Company, in the amount $204,284, for the period of December 1, 2010 through December 1, 2011. BACKGROUND: In preparation for the expiration of the liability insurance policy with St Paul Fire and Marine Insurance Company and Princeton Excess & Surplus Lines Insurance Company on December 1, 2010, staff requested that the City's insurance broker, Brown & Brown, Inc., market the City's application for general liability insurance. In response, Brown & Brown, Inc. obtained proposals from the companies listed below (in the order of responsiveness as determined by the insurance broker). These premiums were quoted with a minimum self- insured retention (SIR) of $150,000 and range up to $250,000 All Other Liability /500,000 Employment Practices Liability. In addition, each quote had an Occurrence Limit of $5,000,000 and an Aggregate Limit of $5,000,000. GENERAL LIABILITY Company Premium Self- Insured Retention St Paul Fire and Marine Insurance Company $160,961 $150,000 Lexington Insurance Company $187,000 $150,000 Illinois Union Insurance Company $215,000 $150,000 Markel Insurance Company $225,000 $150,000 Genesis Insurance Company $200,000 $200,000 Everest National Insurance Company $200,000 $250,000 Munich American Insurance $250,000 $250,000 Ironshore Specialty Insurance Company No Bid No Bid EXCESS LIABILITY Company Premium Ironshore Specialty Insurance Company $41,300 Princeton Excess & Surplus Lines Ins. Co. $48,631 Markel /Evanston Insurance Company $51,625 St Paul Fire and Marine Insurance Company has an "A +" rating with a financial size category of "W" Ironshore Specialty Insurance Company has an "A -" rating, with a financial size category of "XIII." The proposal by St Paul Fire and Marine Insurance Company and Ironshore Specialty Insurance Company provides coverage of $10 million per Occurrence and $10 million Aggregate, for a premium of $202,261 (general liability of $160,961 and excess liability of $41,300) with a self- insured retention of $150,000. In previous years, the City purchased terrorism insurance with the general liability policy only. This year the City will purchase terrorism insurance with the general liability policy (for an additional $1,610), as well as with the excess liability policy (for an additional $413), bringing the total policy amount to $204,284. The excess terrorism coverage will allow both the primary policy and the excess policy to cover third party bodily injury and property damage should a certified act of terrorism occur. Considering the City's increasing exposure associated with growth and increased activities, staff recommends the City accept the proposals of St Paul Fire and Marine Insurance Company and Ironshore Specialty Insurance Company, in the amounts noted, for coverage from December 1, 2010 through December 1, 2011. The schedule below reflects general and excess liability insurance premiums for the past eight years (with $10 million coverage). The liability premium for this year represents a premium small increase over the previous year: Year 2003 2004 2005 2006 2007 2008 2009 2010 Quote Premium $279984 $274,063 $278,901 $252,779 $221,445 $207,403 $200,498 $204,284 Limits As reflected above, although the City has continued to grow, the premiums have remained steady. FISCAL IMPACT: Sufficient funds have been budgeted in the fiscal year 2010 -2011 insurance fund. ATTACHMENTS: Proposal from St Paul Fire and Marine Insurance Company and Ironshore Specialty Insurance Company. Brown & Brown, Inc. INSURANCE PROPOSAL For CITY OF TEMECULA PUBLIC ENTITY GENERAL, AUTOMOBILE, MANAGEMENT, EMPLOYMENT PRACTICES, LAW ENFORCEMENT, EMPLOYEE BENEFIT PLANS ADMINISTRATION & UMBRELLA LIABILITY Coverages Incepting: 12 -01 -10 Presented by: Michael G. Bush Senior Vice President November 3, 2010 California Insurance License OB02587 500 N. State College Blvd., Suite 400 Orange, CA 92868 P.O. Box 6989 Orange, CA 92863 714/ 221 -1800 800/ 228 -7975 714/ 221 -4196 Fax IMPORTANT NOTICE DISCLAIMER Disclaimer: This proposal /policy presented is based upon the exposures to loss made known to the agency. Any changes in these exposures (i.e. new operations, new products, additional state of hire, etc.) need to be promptly reported to our agency in order that proper coverage(s) may be put in place. The proposal contains only a general description of the coverage(s) and does not constitute a policy / contract. For complete policy information, including exclusions, limitations and conditions, refer to the policy document. Specimen policy forms and endorsements are available upon request. St. Paul Fire & Marine Insurance Company ❑ Non - Admitted Carrier Taxes & Fees: $ N/A Minimum Earned Premium: N/A % Princeton See Excess Coverage ® Non - Admitted Carrier Taxes & Fees: Premium Section Minimum Earned Premium: 25 % Higher Limits may be available upon request T Automobile Premium is subject to audit based on a rate of $188.00 per vehicle unit Premiums include Terrorism Coverage Options CARRIERS St. Paul Fire & Marine Insurance Company 1. (Travelers Insurance Companies) 2. Princeton Excess & Surplus Lines Ins. Co. 3. Ironshore Specialty Insurance Company Please read your policy for specific details. A.M. BEST RATING A +: XV; Admitted A +: XV; Non - Admitted A -: XIII; Non - Admitted The information obtained from Best's Rating is not in any way a warranty or guaranty by Brown & Brown, Inc. of the financial stability of the insurer and this information is current only as of the date of publication. THIS FORM IS FOR ILLUSTRATION ONLY. READ YOUR POLICY FOR SPECIFIC DETAILS 2010 -City of Temecula Proposal vl doc 2 ) NAMED INSURED City of Temecula Temecula Community Services District Redevelopment Agency of the City of Temecula Temecula Public Financing Authority THIS FORM IS FOR ILLUSTRATION ONLY. READ YOUR POLICY FOR SPECIFIC DETAILS 2010 -City of Temecula Proposal vl doc 3 ) PUBLIC ENTITY GENERAL, AUTOMOBILE, MANAGEMENT, EMPLOYMENT PRACTICES, LAW ENFORCEMENT, EMPLOYEE BENEFIT PLANS ADMINISTRATION & UMBRELLA LIABILITY I. Discuss Markets Available A. Major Carriers Providing Municipal Coverage 1. Travelers Insurance Company 2. Lexington Insurance Company 3. Genesis Insurance Company 4. Markel Insurance Company 5. Ironshore Insurance Company 6. Everest National Insurance Company 7. Munich American Insurance Company 8. ACE Public Entity Insurance (Illinois Union Insurance Company) 9. Zurich Insurance Company (Note — No longer writing Municipal Coverage in California) 10. Clarendon America Insurance Company (Note — No Longer Writing Municipal Coverage) II. Travelers Insurance Company A. Policy Review (Per Expiring) 1. Occurrence Form (except Employee Benefit Plans Administration Liability — Claims Made) 2. Exclusions - Review Individual Coverage Parts Also Attached: Coverage Part Public Entity General Liability: $1,000,000 Occurrence and Aggregate a. Back -up Sewers & Drains k. Lead Exclusion Included: $1,000,000 Limit I. Unsolicited Communication b. Failure to Supply Utility Services Exclusion Included: $1,000,000 Sublimit m. Terrorism Exclusion unless C. Mold, Fungi, or Bacteria Exclusion purchased d. Injury to Voluntary Firefighters n. Healthcare Professional Exclusion Liability:EMT's, Nurses & e. Injury to Fellow Employees Social Services Professionals Exclusion Included f. Medical Expense(Without Liability) o. Sexual Abuse Coverage Exclusion Included $1,000,000 OCC/ g. Eminent Domain and Inverse $2,000,000 AGG Condemnation Exclusion p. Premises Damage 300,000 h. Asbestos Exclusion Limit i. War Exclusion q. Property Damage j. Employment Practices Liability Change /Intellectual Property Exclusion Exclusion r. Discrimination Exclusion THIS FORM IS FOR ILLUSTRATION ONLY. READ YOUR POLICY FOR SPECIFIC DETAILS 2010 -City of Temecula Proposal vl doc 4 ) Also Attached: Coverage Part Public Entity Law Enforcement Liability: $1,000,000 Occurrence and Aggregate a. Injury to Employees and Volunteers Exclusion b. Mold, Fungi, or Bacteria Exclusion C. Employment Related Practices Exclusion Also Attached Coverage Part Management Liability: $5,000,000 Occurrence and Aggregate a. Healthcare Professional Services Exclusion b. No Exclusion for Architects, Engineers or Lawyers C. Eminent Domain Exclusion d. Board Exclusions for Airports, Healthcare Facilities, Port Authorities, Transit Authorities, Gas, Electric and Housing Authorities, Schools, School Districts and JPA's Also Attached Coverage Part Public Entity Employee Benefit Plan Administration Liability: $1,000,000 Occurrence and $3,000,000 Aggregate Also Attached Coverage Part Public Entity Employment Practices Liability: $5,000,000 Occurrence and Aggregate a. Declaratory, Injunctive or Other Non - Monetary Relief Costs Exclusion b. Defense Expenses Included Within Limit of Liability C. Damages include Attorneys' Fees of Person making claim if the Protected Person is legally required to pay under the law which was violated Also Attached Coverage Part Public Entity Automobile Liability: $1,000,000 Occurrence and No Aggregate a. Injury to Volunteer Workers, including Volunteer Firefighters Exclusion b. Injury to a Fellow Employee Exclusion C. Professional Services Exclusion d. Rate: 188.00 Per Power Unit (Auditable) Also Attached Coverage Part Public Entity Umbrella /Excess Liability: $4,000,000 Occurrence and Aggregate over Public Entity General (including Sexual Abuse and Molestation), Law Enforcement, Employee Benefit Plan Administration, Automobile Liability (only) (Aggregate does not apply to Automobile Liability), and Employers Liability a. Healthcare Professional Services Exclusion — EMT's Exclusion b. Asbestos Exclusion C. Mold, Fungi, or Bacteria Exclusion d. Public Use of Property Exclusion (Eminent Domain) e. Uninsured and Underinsured Auto Exclusion f. Lead Exclusion Unsolicited Communication Exclusion Injuryto Volunteer Firefighters Exclusion Failure to Supply Utility Services Exclusion THIS FORM IS FOR ILLUSTRATION ONLY. READ YOUR POLICY FOR SPECIFIC DETAILS 2010 -City of Temecula Proposal vl doc 5 ) j. Terrorism Exclusion (unless purchased) k. Employment Related Practices Exclusion I. Property Damage Change /Intellectual Property Exclusion m. War Exclusion n. Discrimination Exclusion B. Limit of Liability — Per Coverage Parts above C. The Limits of Liability are excess over the Self- Insured Retention D. Defense Costs — Are within the Self- Insured Retention and within the Limits of Liability. THIS FORM IS FOR ILLUSTRATION ONLY. READ YOUR POLICY FOR SPECIFIC DETAILS 2010 -City of Temecula Proposal vl doc 6 ) III. Quotation #I - Primary A. St. Paul Fire & Marine Insurance Company (Travelers Insurance Companies) (A +: XV; Approved, Admitted) B. Term: 12 -01 -10/11 C. Form: Occurrence (Form enclosed) D. Limit /Coverage Primary Coverage Premium" $5,000,000 Per Event or Wrongful Act or Combination $160,961 of Event and Wrongful Act Excess Over Self- Insured Retention (S.I.R.) Public Entity General (Including Bodily Injury, Property Damage, Personal Injury, Advertising Injury, Products & Completed Work Liability), Law Enforcement, Employment Practices, Management, Automobile, and Umbrella Liability $1,000,000 Per Wrongful Act Public Entity Employee Benefit Plans Administration Liability $1,000,000 Per Occurrence Health Care Professional (EMT's, Nurses, Social Services Professionals) $5,000,000 Total Limit (Aggregate) Management Liability $5,000,000 Total Limit (Aggregate) Employment Practices Liability $3,000,000 Total Limit (Aggregate) Employee Benefit Plan Administration Liability $5,000,000 Total Limit (Aggregate) General and Law Enforcement (Optional) Terrorism Risk Insurance Act Coverage: $1,610 E. Self- Insured Retention: $150,000 Each Event or Wrongful Act Including Loss & Loss Expense F. Previous Years' Premium Comparisons (not including taxes & fees) (P2000 M2001 c( 12002 c( 12003 c( 12004 c( 12005 c( 12006 M2007 M2008 M2009 M2010 Total Premium $102,999 $140,291 $199,000 $208,000 $202,000 $206,687 $195,000 $169,882 $157,684 $152,379 $160,961 TPrimary Limits Retention (a) Limit -20 mil Occ /24 mil Agg GL; 20 mil occ /20 mil Agg E &O; 20 mil Auto Occ $ 50,000 (b) Limit -15 mil Occ /19 mil Agg GL; 15 mil occ /15 mil Agg E &O 15 mil Auto Occ $100,000 (c) Limit - 5 mil Occ /5 mil Agg Pers Inj Liab, Prod -Comp Ops, E &O /5 mil Auto Occ$150,000 (d) Limit — 5 mil Occ /5 mil Agg GL & Law Enforcement /5 mil Agg Management Liability 5 mil Agg EPL /5 mil Auto Occ $150,000 TE &O — Includes Employment Practices Liability Also See Excess Coverage Quotation IV. Other Marketing Results THIS FORM IS FOR ILLUSTRATION ONLY. READ YOUR POLICY FOR SPECIFIC DETAILS 2010 -City of Temecula Proposal vl doc 7 ) Primary A. Genesis Insurance Company (A ++ XV; Admitted) $5,000,000 Occ / $5,000,000 Agg Excess Over: 1) $200,000 Self Insured Retention = $200,000 Minimum Premium + TRIA B. Lexington Insurance Company (A: XV: Non - Admitted) (Did not approach — Discuss. Negative Outlookl $5,000,000 Occ / $5,000,000 Agg Excess Over: (Historically) 1) $150,000 Self Insured Retention = $187,000 Premium + 3.25% Taxes & Fees; TRIA $5,610 plus 3.25% Taxes & Fees C. Munich American Insurance (A+ XV: Admitted) $5,000,000 Occ /$5,000,000 Agg Excess Over: 1) $250,000 Self Insured Retention = $250,000 Minimum Premium D. Everest National Insurance Company (A+ XV: Admitted) $5,000,000 Occ /$5,000,000 Agg Excess Over: 1) Lowest Available Retention: $250,000 Self Insured Retention/ $500,000 Self Insured Retention for Employment Practices Liability= $200,000 to $225,000 Premium E. Illinois Union Insurance Insurance Company (A+ XV; Non - Admitted) $5,000,000 Occ /$5,000,000 Agg Excess Over: 1) $150,000 Self Insured Retention (Not competitive at this Self Insured Retention) = Premium over $215,000 last year Markel Insurance Company (A XIII; Admitted) 1) $150,000 Self Insured Retention = $225,000 Premium (Indication) G. Ironshore Specialty Insurance Company (A- XIII; Non - Admitted) 1) Not competitive with Travelers Primary V. Excess Coverage Premium A. Princeton Excess & Surplus Lines Ins. Co. $47,100 + 3.25% (taxes (A +: XV Approved, Non - Admitted) & fees) = $48,630.75 (Optional Terrorism = 1. $5,000,000 Occ /Agg xs over $5,000,000 Occ /Agg $4,485 + *taxes /fees) 2. $10,000,000 Occ /Agg xs over $5,000,000 Occ /Agg $70,650 (Indication) + 3.25% (taxes (Both include EPL coverage) & fees) = $72,946.13 (Optional Terrorism = $7,065 + *taxes /fees) B. Markel /Evanston Insurance Company $50,000 + 3.25% (taxes (A: XIII, Non - Admitted) & fees) = $51,625.00 (Optional Terrorism = 1. $5,000,000 Occ /Agg xs over $5,000,000 Occ /Agg $2,453 + *taxes /fees) (Includes EPL Coverage) THIS FORM IS FOR ILLUSTRATION ONLY. READ YOUR POLICY FOR SPECIFIC DETAILS 2010 -City of Temecula Proposal vl doc 8 ) C. Ironshore Specialty Insurance Company (A -: XIII; Non - Admitted) 1. $5,000,000 Occ /Agg xs over $5,000,000 Occ /Agg (Includes EPL Coverage) Terms & Conditions (Princeton Excess & Surplus Lines Ins. Co) Following Form Excess Liability: Form Per Expiring $40,000 + 3.25% (taxes & fees) = $41,300 (Optional Terrorism = $400 + *taxes /fees) ( *Taxes /Fees = 3.25 %) Exclusions: Terrorism (unless purchased), Nuclear, Pollution - Absolute, Asbestos, ERISA, Silica, Care Custody & Control Real & Personal Property, Fungi or Bacteria, Blast Faxing, Landfill and Disposal Site Liability, Failure to Supply, Riot Civil Commotion, Eminent Domain, Buildings Acquired by Housing Authority (Unless Reported & Added), Trampolines or Rebounding Equipment, Abuse, Molestation or Failure to Report, Dam Rupture or Accidental Discharge, Penal Facilities (Except Temporary Holding Facilities), Hospitals or Clinics,Transit Authorities or Systems, Punitive Damages Terms & Conditions (Ironshore Specialty Insurance Company) Following Form Excess Liability: Exclusions: Terrorism (unless purchased), Nuclear, Asbestos, War, ERISA, Uninsured Motorists, Trade - Sanctions, Sub limited Coverage THIS FORM IS FOR ILLUSTRATION ONLY. READ YOUR POLICY FOR SPECIFIC DETAILS 2010 -City of Temecula Proposal vl doc 9 ) Insured: City of Temecula — Public Entity General, Automobile, Management, Employment Practices, Law Enforcement, Employee Benefit Plans Administration & Umbrella Liability 12/01/2010 to 12/01/2011 Compensation In addition to the commissions or fees received by us for assistance with the placement, servicing, claims handling, or renewal of your insurance coverages, other parties, such as excess and surplus lines brokers, wholesale brokers, reinsurance intermediaries, underwriting managers and similar parties, some of which may be owned in whole or in part by Brown & Brown, Inc., may also receive compensation for their role in providing insurance products or services to you pursuant to their separate contracts with insurance or reinsurance carriers. That compensation is derived from your premium payments. Additionally, it is possible that we, or our corporate parents or affiliates, may receive contingent payments or allowances from insurers based on factors which are not chent-specific, such as the performance and /or size of an overall book of business produced with an insurer. We generally do not know if such a contingent payment will be made by a particular insurer, or the amount of any such contingent payments, until the underwriting year is closed. That compensation is partially derived from your premium dollars, after being combined (or "pooled ") with the premium dollars of other insureds that have purchased similar types of coverage. We may also receive invitations to programs sponsored and paid for by insurance carriers to inform brokers regarding their products and services, including possible participation in company-sponsored events such as trips, seminars, and advisory council meetings, based upon the total volume of business placed with the carrier you select. We may, on occasion, receive loans or credit from insurance companies. Additionally, in the ordinary course of our business, we may receive and retain interest on premiums you pay from the date we receive them until the date the premiums are remitted to the insurance company or intermediary. In the event that we assist with placement and other details of arranging for the financing of your insurance premium, we may also receive a fee from the premium finance company. Questions and Information Requests' Should you have any questions, or require additional information, please contact this office at 1-800-228-7975 or, if you prefer, submit your question or request online at httn:// www. bbinsurance .com /customerinauiry.shtml Wholesale Broker /Managing General Schinnerer Insurance Services Agent: This intermediary ❑ is ® is not owned in whole or part by Brown & Brown, Inc., the parent company of Brown & Brown of California, Inc. Brown & Brown entities operate independently and are not required to utilize other companies owned by Brown & Brown, Inc.. but routinely do so. In addition to providing access to the insurance company, the Wholesale Insurance Broker /Managing General Agent may provide additional services including, but not limited to: underwriting, loss control, risk placement, coverage review, claims coordination with insurance company; and policy issuance. Compensation paid for those services may be up to 15% of the premium you pay for coverage, and any compensation paid for those services is derived from your premium payment. The Fee, if any, for the Wholesale Insurance Broker's /Managing General Agent's services above is $0.00. THIS FORM IS FOR ILLUSTRATION ONLY. READ YOUR POLICY FOR SPECIFIC DETAILS 2010 -City ofTemecula Proposal vl doc 10 ) TRAVELERS INS. CO. Selected Forms I MAP TG VOLUNTEER FIRDIGNiERS EXCLUSION EN 118111 BVT — UMBRELLA EXCESS LIABRItV fm This endorsement changes your Umbrella Excess Liability Protection. m. :a Now Conga Is Cha lied Voluralaer firefighter Includes a first aid, rescue squad or ambulance corps volunteer. The following is added to the Exclusions - " What This Agreement Won't Cover section. Other Tam change excludes coverage. moy to volutber firefighters. We won't terms of your policy remain the F" cover bodily injury or personal Injury to any cover same. volunteer firefighter that results from their duties as volunteer firefighters for you or anyone else. But we won't app N this exclusion to bodily Injury Injury by or personal covered your Basic Insurance and otherwise covered by this agreement. ma v,v m r+, aw mt fm 47287 Ed. 4-91 4 Endorsement (° 9 1991 The St. Paul Travelers Companies. Inc. All Rights Reserved Page 1 of 1 r r r P" rn P" i i rn F+1 rq I P Pn M PROPERTY DAMAGE CHARGE AND INTELLECTUAL PROPERTY EXCLUSION ENDORSEMENT — UMBRELLA EXCESS LIABILITY This endorsement changes your Umbrella Excess Liability Protection. Now Coverage Is Changed There are two changes which are explained below. 1. The following Is added to the Bodily InJury and property damage liability section of the What This Agreement Covers sectiotl. This change limits or excludes coverage anywhere our coverage Intent would be Interpreted more broadly then where intended by the revised wording under the law that applies. Elsewhere, this change doesn t change coverage. Tangible property doesn't include data. 2. The following to added to the Intellectual property exclusion as the second paragraph of that exclusion. This change excludes coverage. Nor will we cover any other In ury or damage that's alleged in any claim or suit which also alleges any such Infringement or violatlom aim? Tetras All other terms of your policy remain the same. E0197 Ed. 7 -01 Endorsement e 2001 The St. Paul Travelers Companies, Inc. All flights Reserved Page 1 of t VEHICLE SCHEDULE CITY OF TEMECULA Liability Vehicle Schedule (12 -01 -10/11 Renewal) VEHICLE VIN PHYSICAL DAMAGE HAULS OTHERS 1 1990 Dodge Maxi Van 265WB35Z8LK769631 2 1992 GMC Top Kick Breathing Support(F) 1GDP7H1J502955 Yes 3 1995 Sentry Pumper 4ENRAAA86S1004369 Yes 4 1996 Ford Utility Truck 1FTHX25HIVEA52787 5 1997 GMC Savana Van 1 GTHG35R3V1034278 6 1997 GMC Sierra Pick-up 1GTHK34R7VF012996 7 1998 Patch Truck 1HTSCAAN8WH550494 8 1998 Ford Windstar Van 1 -8 Passj 2FMZA5145WBD50410 Yes 9 1999 Dodge Ram Truck (TCCI 3B7HC12YXXG187157 10 1999 Chevy Pick-Up Truck 1GBGC24R3XR709218 11 1999 Chew Pick-up 1GCGK29R7XF033865 12 1999 Dodge Ram Pick-up FP 3B7HC12YBXG187156 13 2000 Dodge Pick-up 3B7HF12YXYG117182 14 2000 Ford Ran erPick -u FP 1FTYR14X9YPA63039 15 2000 Ford F150 Pick-up 1 FTRX18L3YKA37177 16 2000 Ford Ran er Pick-up 1FTYR14X7YPA63038 17 2001 Jee2 Cherokee 1J4FF48S711-542306 18 2001 Ford Pick-up 1FTYR14UBlPA35261 19 2001 Ford Pick-up iFTYR14U81PA39245 20 2001 Ford Ranger Pick-u FP 1FTYR14UXlPA35259 21 2001 Ford 550 (Utility Truck Med. iFDAF56F71EA81705 22 2001 GEM Vehicle P 5ASAG474XIF012456 23 2001 Ford 550 Boom Truck Med. 1FDAF56FBlEA24722 Yes 24 2001 Chevy Pick-up 16CEK19V21E238554 25 2001 Ford Utility Truck Med. 1FDAF56F91EB60874 Yes 26 2001 Dodge Durango FP 1B4HS28NX1F578823 27 2002 Ford Ran er Pick-up Truck FP 1 FTYR14UX2PA21184 28 2002 Elec. GEM Vehicle F 5ASAK27452FO31405 29 2002 Elec. GEM Vehicle F 5ASAG47472FO23190 30 2002 Chevy Pick-up Truck 1GCGK13U32F142274 31 2002 Ford F150 Truck 1FTRX18W72NA62633 32 2002 Ford F150 Truck 1FTRX18W52NA62954 331 2002 Ford F550 Med. Rescue E2 1FDAX56F92EB25749 Yes n140t012" 1 of 5 CITY OF TEMECULA Liability Vehicle Schedule (12 -01 -10/11 Renewal) VEHICLE VIN PHYSIGAL DAMAGE HAULS OTHERS 34 2002 Ford F150 Truck 1FTRWO8662KB68781 35 2003 Ford Ranger Truck FP 1FTZR15E53PA56244 36 2003 Ford F150 Truck 1FTZR15E73PA56245 37 2003 Ford F1 50 Truck 2FTRX18W-- - ----$2 38 2003 Ford F150 Truck 2FTRX18W93CA32041 39 2003 Ford F550 T uck Med. 1FDAF56F23EA94199 Yes 40 41 2003 Ford F350 Van 9.20 Pass. 2003 Ford F250 Truck FP 1FBSS31LX3HA48533 3FTNX21L03MB16676 Yes 42 2003 Che CG33803 1GBJG31UB31209119 43 2003 GMC Savanna Caro Van lGTHG35UX51183677 44 2003 Ford 550 Med. Rescue F 1FDAX56FO3EB25804 Yes 45 2004 Ford Ranger 1FTZR15EX4PA26822 46 2004 Ford Ranger FP 1FTZR15E14PA26823 47 2004 Ford F150 Truck 1FTRX14WX4NA82402 48 2004 Ford F150 Truck 1FTRX14W84NA82401 49 2004 Toyota Prius (Hybrid) JTDK820U--- ---- -8 50 2004 KME Fire Aerial FT ffl. K9AF42884NO58774 Yes 51 2004 Intl Multipurpose UtilLty,Truck Med, Dump) 1 HTMAOT64J093129 Yes 52 2005 GMC Sierra 2500 (FE). 1GTHK29U35E223576 53 2005HDMotorccle P 1HD1FHW185Y684112 54 2005 HD Motorcycle P iHDiFHW125Y684641 GMC Pick-up 1GTEC19VO5Z230349 GMC Sierra 1500 1GTEC19V35Z226666 Smeal Fire En ine F 4S7CT20956CO54456 m t572GO5 Che Im ala 1GIM52E559203793 Che Trailblazer iGNET16S456108449 HDMotorc de P 1HD1FHW196Y677168 HD Motorcycle P 1HD1FHW106Y611074 ��� 2 of 5 CITY OF TEMECULA Liability Vehicle Schedule (12 -01 -10!11 Renewal) VEHICLE VIN PHYSICAL DAMAGE HAULS OTHERS 62 2006 HD Motorcycle P 1HDlFHW116Y613464 63 2006 HD Motorcycle P 1HD1FHW106Y675944 64 2006 Frei hther Towing Truck F 1FVACWCS86HW91952 Yes 65 2006 Ford F -150 Truck 1FTPX12506KC01905 66 2006 Ford F -550 Pick-up Med. 1 FDAF56P56ED20121 671 2006 Ford F -350 Pick-up 1 FDWX30536EB79936 68 2006 Ford Ex edition 1 FMPU16576LA25220 69 2006 El Dorado 26 Passenger Bus 21 -60 Pass, 1GBG5V1 E75F513455 Yes Yes 70 2006 Ford Ecoline Van 1 -8 Pass. 1 FTRE14W06DB36806 Yes 71 2007 Ford F -150 Truck 1 FTRX12W77FA29769 72 2007 Ford F -150 Truck 1FTRX12W37FA32393 73 2007 Ford F150 Truck Park Ranger) 1 FTRX14W67NA26641 741 2007 Ford F250 Truck FP 1 FTSW21547EB16523 75 2007 Ford F150 Truck FP 1FTRX12W27NA26638 76 2007 Dodge Ram Truck Land Dev 1D7HU18N97J544861 77 2007 Dodge Ram Truck Land Dev 1D7HU18N07J544862 78 2007 Dodge Ram Truck Land Dev 1D7HU18N27J544863 79 2007 Dodge Ram Truck 1D7HU18N47J544864 80 2007 Harley Davidson Motorcycle P 1HDlFHM137YB62394 81 2007 Harley Davidson Motorcycle P 1HD1FHM177Y663838 82 2007 Harlev Davidson Motorcycle P 1HD1FHM1X7Y662764 83 2007 Ford Escape Hybrids P 1FMYU49H57KB87852 84 2007 Ford Escape Hybrids P 1 FMYU49H77KB87853 85 2007 Ford Escape Hybrids P 1FMYU49HX7KB96546 86 2007 Ford F -150 Truck 1 FTRX12W07NA26640 87 2007 Ford F350 Truck iFDWX36P57EB16525 88 2007 Altec Aerial Boom Truck Traffic Med. 1GDG5C1G97F405242 Yes 89 2007 Ford F -150 Truck 1 FTRX12W47NA26639 90 2008 Ford Ranger 1FTZR45E25PA43864 91 2008 Ford F150 Truck 1 FTPX14W88FA65176 92 2008 Ford F350 Utility Truck 1FDWX345X8ED09174 93 2008 Ford F350 UU01 Truck 1FDWX3458BED13286 94 2008 Ford F350 Utility Truck IFDWX30528EE41755 951 2008 Ford Expedition FP 1 FMFK6548LA81345 961 2008 Hadev Davidson Motorcycle P 1HDFHM188Y673859 97 2008 Honda Motorcycle P JH2SC51717M500039 98 2008 BMW Motor cle P WB103880782112332 99 2009 Ford F250 Pick-Up P 1FTSX20Y59EA01537 Yes 100 2009 Honda Motor cie P JH2SC51769K600409 ,azo2o�ayo 3 of 5 CITY OF TEMECULA Liability Vehicle Schedule (12 -01 -10/11 Renewal) VEHICLE VIN I PHYSICAL DAMAGE HAULS OTHERS 101 2009 Ford F -150 1FTRXA13240 8309 102 2009 Hot Patch Truck iHTWCAAR29AAR29J196473 Yes TRAILERS 103 1991 Big TX Trailer 16VAX1020MIC14047 104 1991 Light Tower Trailer 8309 106 1991 Li ht Tower SPMBL Trailer P 8311 106 1992 Arrow Board Trailer 9891 107 1993 H dro utility Trailer 1H9BCP167P1120905 108 1993 Flatbed Trailer (City Float 13AH13203PC768415 109 1994Kustom Signals RadarTrailer P IK98SO811RK118177 110 1997 Eagle Command Post Trailer P 1U9T10P20V1016022 Yes 110 1997 Texas Bragg Utility Trailer 17XFP1223V1970250 112 1997 Texas Bragg Utility Trailer P 17XFP1822V1973883 113 1997 Pace American Cargo Trailer P 4P2FB0819W006254 1141 1997 Big TX Trailer 16VPX162SVIE9300 115 1998 Essick Walk Behind Roller Trailer 1D631029 Yes 116 1998Kendon Motorcycle Trailer P 4G44S0811WA000711 117 1998 Wells Cargo Shelter Trailer EOC 1WC20GE17W1002027 118 1999 Wanco Arrow Board Trailer 1 W91S1019X1249336 119 1999 Wanco Arrow Board Trailer 1W91S1011X1249332 120 2000 H dro Trailer /Sandblaster 1H9CSC251Yi120390 121 2001 Zieman Trailer & Vibratory Roller 1ZCT20E201ZP23612 122 2003 SMART Trailer P 1 K9BS08133K118043 123 2004 Interstate ATV Trailer P 4RACS16214KO04152 124 2004 Victor Trailer F iV9EN22444C084086 125 2004 Charmac Caro Trailer F 4RYC322094T110951 Yes 126 2004 Interstate ATV Trailer P 4RACS18214KO04410 127 2005 Zieman Carrier Backhoe Trailer 1ZCE34E2X5ZP26052 1281 2005 Radar Trailer P 1K9BM11124G118033 1291 2005 Carson Trailer 4HXRC16225CO97897 1301 2006 Magnum Light Tower Trailer 5AJLS16186B004887 1311 2006 Ma gun Li ht Trailer P 5AJLS161X6B004888 132 2006 PACE Trailer Posse P 4P2FB10156U075137 133 2006 Pacific Boat Trailer 40RIAlBB36AO24706 1341 2007 Solar Tech Message Board Trailer 4GMIM091371453371 135 2007 PACE Trailer 4P2FB12107U485413 136 2007 Interstate Trailer F 4RAGS12297KO16799 137 2008 Carson Thermoplastic Trailer 4HXSU12168GI34420 138 2008 Zieman Trailer 1ZCE19E2XSZP28102 139 2009 Hauimark Trailer 1GH1961268A028471 "mm+ 4 of 5 CITY OF TEMECULA Liability Vehicle Schedule (12 -01 -10!11 Renewal) VEHICLE VIN PHYSICAL DAMAGE I HAULS OTHERS L1401 2010 Haulmark Trailer 16HPB1425AA035534 478TE1400VA807742 5-41F2010 Haulmark Trailer 16HPB1422AA038043 ICUNH2227PL000708 Yes Miscellaneous Rollin Stock 1421 1997 Honda ATV P 478TE1406VA807745 1431 1997 Honda ATV P 478TE1400VA807742 1441 Cushman 4 Wheel Truckster ICUNH2227PL000708 Yes 145 2001 Kawasaki Wity Vehicle Mule JK1AFCG1516501159 146 2004 Kawasaki ATV P JKSVFJC1X4B501587 147 2004 Kawasaki ATV P JKSVFJC124BS03124 148 2006 Se wa P 2211021446 149 2006 Se wa P 2211021439 150 2006 Se wa P 2211021445 1511 2006 Se wa P 2211021437 152 2006 Se wa P 52231014433 153 2006 Se P 52451017629 154 2006 Se a P 62241021797 155 2007 Bobcat Utility Vehicle A59Z160329032007 156 2007 Kawasaki Utility Vehicle Mule P JKIAFCJ127BS10676 Yes 157 2007 Kawasaki Utility Vehicle Mule P 1JKIAFCJ137B510945 Yes m w,012, 5 of 5 TERRORISM Acceptance /Rejection Forms (To Follow) Item No. 7 Approvals City Attorney Director of Finance City Manager CITY OF TEMECULA AGENDA REPORT TO: City Manager /City Council FROM: Aaron Adams, Assistant City Manager DATE: November 23, 2010 SUBJECT: Agreement establishing the Twin Cities of Southern California Marketing Partnership between the cities of Murrieta and Temecula (at the request of the Temecula /Murrieta Subcommittee, Naggar/Washington). PREPARED BY: Christine Damko, Economic Development Analyst RECOMMENDATION: That the City Council Adopt a resolution entitled: RESOLUTION NO. 10 - A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF TEMECULA APPROVING THE "AGREEMENT ESTABLISHING THE TWIN CITIES OF SOUTHERN CALIFORNIA MARKETING PARTNERSHIP BETWEEN THE CITIES OF MURRIETA AND TEMECULA" BACKGROUND: The Cities of Murrieta and Temecula wish to establish a joint economic development marketing partnership designed to attract and expand business in the two cities. The Cities of Temecula and Murrieta understand that job creation and retention have economic effects that cross city boundaries. This strategic partnership allows both municipalities to come together and leverage its resources to the market area. The Twin Cities Partnership will work together to attract companies in the high technology, life sciences, biotechnology, medical, aerospace, telecommunications, greentech and manufacturing industries. Attracting these types of new business and investments to the area will create opportunities for higher paying jobs. The Twin Cities will also work on creating a general awareness of the area and its many benefits such as a business friendly atmosphere, high quality of life, well educated workforce, competitive housing prices and close proximity to San Diego, Orange and Los Angeles counties. With this in mind, the Twin Cities marketing campaign will create greater recognition of the area outside the county limits and generate leads that will ultimately result in business start- ups and /or relocation or expansions to the area. The joint marketing plan shall include activities such as marketing outreach, trade show attendance, print advertising and business special events. All retail leads will be kept separate and are not a part of this Agreement. The purpose of this Agreement is to provide the funding mechanism for the Twin Cities of Southern California Partnership and to provide for the implementation of the marketing program being developed by the two parties. It is important to note that both cities have budgeted for the various marketing programs but this Agreement will specifically designate them for the Twin Cities Partnership. There is no anticipated fiscal impact to the City of Temecula, as existing marketing resources will be utilized. The City of Murrieta is scheduled to take this Agreement forward for City Council approval at a November 16`h meeting. FISCAL IMPACT: Existing marketing budget will be utilized to implement the Twin Cities Agreement and promotion efforts. ATTACHMENTS: Resolution 10- Marketing Partnership Agreement RESOLUTION NO. 10- A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF TEMECULA APPROVING THE "AGREEMENT ESTABLISHING THE TWIN CITIES OF SOUTHERN CALIFORNIA MARKETING PARTNERSHIP BETWEEN THE CITIES OF MURRIETA AND TEMECULA" THE CITY COUNCIL OF THE CITY OF TEMECULA DOES HEREBY RESOLVE AS FOLLOWS: Section 1. The City Council does find, determine and declare as follows: A. Murrieta and Temecula desire to establish a joint economic development marketing partnership designed to attract and expand business in the two cities that shall be called the "Twin Cities of Southern California Marketing Partnership ". B. The motivating factor for the Twin Cities of Southern California Marketing Partnership is the recognition that job creation and retention have economic effects that spill over boundaries. This strategic partnership allows both municipalities to come together and leverage its resources to market the area. C. The objective of the Twin Cities of Southern California Marketing Partnership is to: 1. Attract new business and investment to the area with the beneficial result of new job creation providing additional higher paying jobs. 2. Promote business development, economic opportunities, a skilled and educated workforce as well as our quality of life to business decision makers both in and out of the city boundaries. 3. Create a general awareness of the Twin Cities area and its many benefits. 4. Develop additional higher education facilities including universities, vocational and technical schools. 5. Improve and expand hospitals and health care options. 6. Implement new infrastructure needed for business development. D. The Twin Cities of Southern California Partnership will set its sights on attracting companies in the high technology, life sciences, biotechnology, medical, aerospace, telecommunications, greentech and manufacturing industries. The many strengths of the region that lend to supporting these industries and have contributed to the development of the cluster of these industries in the Twin Cities area. E. Some of the more favorable attributes of the Twin Cities area are: a business friendly atmosphere, high quality of life, well educated workforce, competitive housing process, access to the major ports of Southern California, convenient freeway access and close proximity to San Diego, Orange and Los Angeles counties. With this in mind, the business marketing campaign will create greater recognition of the area outside the county limits and generate leads that will ultimately result in business start - ups,and/or relocations or expansions to the area. F. The purpose of this Agreement is to provide the funding mechanism for the Twin Cities of Southern California Partnership and to provide for the implementation of the marketing program being developed by the parties. Section 2. The City Council hereby approves that certain agreement entitled: "AGREEMENT ESTABLISHING THE TWIN CITIES OF SOUTHERN CALIFORNIA MARKETING PARTNERSHIP BETWEEN THE CITIES OF MURRIETA AND TEMECULA" and authorizes the Mayor to sign the Agreement in substantially the form presented to the City Council. PASSED, APPROVED, AND ADOPTED by the City Council of the City of Temecula this 23rd day of November, 2010. Jeff Comerchero, Mayor ATTEST: Susan W. Jones, MMC City Clerk [SEAL] STATE OF CALIFORNIA ) COUNTY OF RIVERSIDE ) ss CITY OF TEMECULA ) I, Susan W. Jones, MMC, City Clerk of the City of Temecula, do hereby certify that the foregoing Resolution No. 10- was duly and regularly adopted by the City Council of the City of Temecula at a meeting thereof held on the 23rd day of November, 2010, by the following vote: F- Ayd:.Ko1l1► [MIN diIAdil:l:4:63 NOES: COUNCIL MEMBERS: ABSENT: COUNCIL MEMBERS: ABSTAIN: COUNCIL MEMBERS: Susan W. Jones, MMC City Clerk AGREEMENT ESTABLISHING THE TWIN CITIES OF SOUTHERN CALIFORNIA MARKETING PARTNERSHIP BETWEEN THE CITIES OF MURRIETA AND TEMECULA THIS AGREEMENT is made and effective as of November 23, 2010 by and between the City of Murrieta, a municipal corporation ( "Murrieta ") and the City of Temecula, a municipal corporation ( "Temecula ") In consideration of the mutual covenants and conditions set forth herein, the parties agree as follows: 1. Recitals. This Agreement is made with respect to the following purposes and facts that each party acknowledges as true and correct: A. Through this Agreement, Murrieta and Temecula desire to establish a joint economic development marketing partnership designed to attract and expand business in the two cities that shall be called the "Twin Cities of Southern California Marketing Partnership." B. The motivating factor for the Twin Cities of Southern California Marketing Partnership is the recognition that job creation and retention have economic effects that spill over city boundaries. This strategic partnership allows both municipalities to come together and leverage its resources to market the area. C. The objective of the Twin Cities of Southern California Marketing Partnership is to: 1) Attract new business and investment to the area with the beneficial result of new job creation providing additional higher paying jobs. 2) Promote business development, economic opportunities, a skilled and educated workforce as well as our quality of life to business decision makers both in and out of the city boundaries. 3) Create a general awareness of the Twin Cities area and its many benefits. 4) Develop additional higher education facilities including universities, vocational and technical schools. 5) Improve and expand hospitals and health care options. 6) Implement new infrastructure needed for business development. D. The Twin Cities of Southern California Partnership will set its sights on attracting companies in the high technology, life sciences, biotechnology, medical, aerospace, telecommunications, greentech and manufacturing industries. The many strengths of the region that lend to supporting these industries and have contributed to the development of the cluster of these industries in the Twin Cities area. E. Some of the more favorable attributes of the Twin Cities area are: a business friendly atmosphere, high quality of life, well educated workforce, competitive housing prices, access to the major ports of Southern California, convenient freeway access, and close proximity to San Diego, Orange and Los Angeles counties. With this in mind, the business marketing campaign will create greater recognition of the area outside the county limits and generate leads that will ultimately result in business start-ups, and/ or relocations or expansions to the area. F. The purpose of this Agreement is to provide the funding mechanism for the Twin Cities of Southern California Partnership and to provide for the implementation of the marketing program being developed by the parties. 2. Joint Marketing Plan. Murrieta and Temecula shall develop a Joint Marketing Plan that shall include the following elements: A. Marketing Outreach. Develop joint branding/marketing logo, design a joint Twin Cities exhibit booth and table linen, create joint demographic profile report and marketing literature. B. Trade Show Attendance. Attend and exhibit together at industry specific trade shows in California including: MDM, Solar International, NAIOP events, BIO events and other selected marketing events. C. Print Advertising. Conduct a joint advertising campaign to Twin Cities' targeted industries such as medical device, solar, biosciences, etc. Develop targeted print media ads using publications that are industry specific. Publications include, but are not limited to The Daily Transcript including Soaring Dimensions, Expansion Management, Site Selection Magazine, Business Journals, and other publications yet to be determined. D. Business Special Events. Organize joint commercial broker /developer breakfasts, meetings /site tours /business events inviting site selectors, developers, qualified company leads and venture capitalists to the Twin Cities area. Jointly sponsor San Diego Venture Group, CONNECT, NAIOP and other events in San Diego to get Twin Cities name out to targeted segment of the San Diego business community. E. Other Marketing Activities. Develop such other marketing actions and activities as are similar to those described in this paragraph and consistent with the objectives and purposes of the Twin Cities of Southern California Marketing Partnership described in Paragraph 1 of this Agreement. 3. Responsibilities of the Parties for Implementation of the Joint Marketing Plan A. The city council of each city shall appropriate funds for the Twin Cities of Southern California Marketing Partnership that will be used to pay for the marketing activities described in this Agreement. Funds may be appropriated by the respective city councils at any time and each city shall notify the other of appropriation of such funds. B. Murrieta and Temecula shall each pay fifty percent (50 %) of the costs and expenses necessary to implement the marketing activities as provided in this Agreement; provided, however, that each city shall bear the costs of its staff time to implement this Agreement. -2- Error! Unknown document property name. C. The city manager of each city, or his or her designee, shall be the representatives of the respective cities to perform the staff functions necessary to implement the marketing activities described in this Agreement. These representatives shall meet regularly to discuss and approve the marketing activities described in this Agreement. D. Each of the cities' representatives shall approve in writing the proposed activity, project and /or program and the costs to be incurred for the proposed activity, project and /or program. E. Murrieta shall be responsible for paying the expenses for the approved activity, project and /or program including, but not limited to, vendors and organizations providing services or products for that are utilized for the approved activity, project and /or program. 1) Murrieta shall pay each of the vendors /organizations in full. 2) Murrieta shall then invoice the City of Temecula fifty percent (50 %) of the vendor's invoice. Temecula shall pay its portion of those costs within 30 days of receipt of invoice. F. Representatives from Murrieta and Temecula shall respond jointly to contacts and leads generated as a result of the marketing activities provided for in this Agreement, except for leads and contacts for generating sales taxes businesses. Leads and contacts for businesses generating sales taxes are not subject to this Agreement. Each party shall be free to pursue leads and contacts for business generating sales taxes whether those leads or contacts were generated by marketing activities pursuant to this Agreement or otherwise generated. 1) Contacts are defined as individuals who involved in the real estate and development profession who have made general inquiries into the Southwest Riverside County region. 2) Leads are defined as either real estate professionals or employees of a company that have expressed an interest in expanding or relocating into Southern California or specifically Murrieta/Temecula area that require immediate and thorough follow -up. It is the responsibility of the cities to send out joint identity packages, conduct follow -up phone calls, and schedule meetings with leads and assist them with the information needed in the decision making process for expansion or relocation process. 3) The appointments shall be attended by representatives of both cities. 4. General Provisions. A. Term. This Agreement shall terminate on June 30, 2013; provided however, that either party may terminate it for any reason or no reason on thirty (30) days prior written notice to the other. The provisions Paragraph 3 of this Agreement shall survive termination as to any obligations to third party vendors or organizations outstanding at the time of termination and the parties shall fulfill their responsibilities for such obligations. B. Indemnification. -3- Error! Unknown document property name. 1) Murrieta agrees to defend, indemnify, protect and hold harmless the City of Temecula, Temecula Community Services District, Redevelopment Agency of the City of Temecula, their officers, officials, employees and volunteers from and against any and all claims, demands, losses, defense costs or expenses, including attorney fees and expert witness fees, or liability of any kind or nature which Indemnified Parties may sustain or incur or which may be imposed upon them for injury to or death of persons, or damage to property arising out of Murrieta's negligent or wrongful acts or omissions arising out of or in any way related to the performance or non - performance of this Agreement, excepting only liability arising out of the negligence or wrongful acts or omissions of the City of Temecula, Temecula Community Services District, Redevelopment Agency of the City of Temecula, their officers, officials, employees and volunteers. 2) Temecula agrees to defend, indemnify, protect and hold harmless the City of Murrieta, Redevelopment Agency of the City of, their officers, officials, employees and volunteers from and against any and all claims, demands, losses, defense costs or expenses, including attorney fees and expert witness fees, or liability of any kind or nature which Indemnified Parties may sustain or incur or which may be imposed upon them for injury to or death of persons, or damage to property arising out of Murrieta's negligent or wrongful acts or omissions arising out of or in any way related to the performance or non - performance of this Agreement, excepting only liability arising out of the negligence or wrongful acts or omissions of the City of Murrieta, Redevelopment Agency of the City of Murrieta, their officers, officials, employees and volunteers. 3) In the event of concurrent intentional or unintentional misconduct, negligent acts or omissions by Temecula or Murrieta or each of their respective their officers, officials, employees and volunteers, then the liability for any and all claims for injuries or damage to persons and/or property which arise out of terms and conditions of this Agreement shall be apportioned according to the California law of comparative negligence. C. Notice. Any notices which either party may desire to give to the other party under this Agreement must be in writing and may be given either by (i) personal service, (ii) delivery by a reputable document delivery service, such as but not limited to, Federal Express, that provides a receipt showing date and time of delivery, or (iii) mailing in the United States Mail, certified mail, postage prepaid, return receipt requested, addressed to the address of the party as set forth below or at any other address as that party may later designate by Notice. Notice shall be effective upon delivery to the addresses specified below or on the third business day following deposit with the United States Mail as provided above. To Murrieta: 1 Town Square 24601 Jefferson Ave. Murrieta CA 92562 Attention: City Manager To Temecula prior to January 1, 2011: City of Temecula -4- Error! Unknown document property name. 43200 Business Park Drive Post Office Box 9033 Temecula, Ca. 92589 -9033 Attention: City Manager To Temecula on or after January 1, 2011: City of Temecula 41000 Main Street Post Office Box 9033 Temecula, Ca. 92589 -9033 Attention: City Manager D. Severance. If any part of this Agreement is held to be illegal or unenforceable by a court of competent jurisdiction, the remainder of this Agreement shall be given effect to the fullest extent reasonably possible. E. Validity of Agreement. Each party acknowledges that this Agreement is